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Background: There is evidence that a high proportion of people living with HIV infection are unaware of their serologic status, which indicates unmet prevention needs. The aim of the present study was to estimate the rate of lifetime HIV testing and assess the association between previous HIV testing and sociodemographic, clinical characteristics, and risk behaviors in psychiatric patients., Methods: Cross-sectional national multicenter study including 2380 chronic mentally ill patients randomly selected from 26 Brazilian mental health institutions. Multivariate logistic regression analysis was used to describe the association between patient characteristics and previous HIV testing., Results: The rate of previous lifetime HIV testing was 27%. Most participants were female (52%), 40 years old or younger (52%) with low schooling (59%), and had previous psychiatric hospitalizations (57%) and schizophrenia as a primary condition (48%). Being tested for HIV was independently associated (P < 0.05) in the multivariate analysis with higher schooling, being younger than 40 years old, living alone, having other self-reported medical conditions, higher HIV/AIDS knowledge, substance use as a main psychiatric condition, a history of sexually transmitted diseases, sexual abuse, and inconsistent lifetime condom use. However, those who never had sexual intercourse and did not know their HIV risk were less likely to be tested., Conclusions: The rate of HIV testing among these psychiatric patients was low despite their increased risk for HIV infection. These findings support the need for increasing HIV testing and awareness of HIV status among psychiatric patients. Mental health providers should play an active role in providing HIV testing and counseling to this population.

The availability of increasingly complex and multidimensional datasets is one of the main causes for the increase in studies employing multivariate analyses based on fuzzy sets. Even though the Grade of Membership method has been widely used in Brazil for empirical studies in health and social sciences, issues regarding identifiability and stability of the final parameters estimated by GoM 3.4 software have not been thoroughly examined. Given the relevance of unique and stable parameters, Guedes et al. (2010) proposed an empirical method to locate a global maximum (GM) with stable parameters. However, the GM locator does not incorporate variability. In the present article, this limitation is circumvented by employing a weighted statistic - weight global maximum (WGM) - similar to the variation coefficient. This indicator does not affect disproportionately situations with very low mean deviations. The WGM locator is shown to decrease the distance of the identified model from the real structure, when compared with the GM locator.

Human and nonhuman primates rely almost exclusively on vision for social communication. Therefore, tracking eye movements and examining visual scan paths can provide a wealth of information about many aspects of primate social information processing. Although eye-tracking techniques have been utilized with humans for some time, similar studies in nonhuman primates have been less frequent over recent decades. This has largely been owing to the need for invasive manipulations, such as the surgical implantation of devices to limit head movement, which may not be possible in some laboratories or at some universities, or may not be congruent with some experimental aims (i.e., longitudinal studies). It is important for all nonhuman primate researchers interested in visual information processing or operant behavior to realize that such invasive procedures are no longer necessary. Here, we briefly describe new methods for fully noninvasive video eye-tracking with adult rhesus monkeys (Macaca mulatta). We also describe training protocols that require only ∼30 days to accomplish and quality control measures that promote reliable data collection. It is our hope that this brief overview will reacquaint nonhuman primate researchers with the benefits of eye-tracking and promote expanded use of this powerful methodology., (© 2011 Wiley-Liss, Inc.)

Although the orbitofrontal cortex has been implicated in important aspects of social behavior, few studies have evaluated semi-naturalistic social behavior in nonhuman primates after discrete lesions of this cortical area. In the present report, we evaluated the behavior of adult rhesus monkeys during dyadic social interactions with novel animals following discrete lesions of the orbitofrontal cortex. In a constrained condition, in which animals could engage in only restricted social behaviors, there were no significant differences in social behavior between the lesion group and the sham-operated control group. When the experimental animals could freely interact with partner animals, however, lesioned animals differed from control animals in terms of social interest and fear-related behaviors. These alterations were contingent on the partner with which they interacted. The lesioned animals, when compared to the control animals, had a significantly greater propensity to approach some but not all of their social partners. They also grimaced more towards the partner animal that they did not approach. Behavioral alterations were more apparent during the initial interactions between animals. We discuss these findings in relation to the role of the orbitofrontal cortex in context dependent modulation of social behavior., (Copyright © 2011 IBRO. Published by Elsevier Ltd. All rights reserved.)

The purpose of this article is to describe and analyze the dynamics of cooperative public health research networks, and their utilization as the principal coordination instrument for a technological development program in a public health research institution. It begins with a few methodological considerations in regard to carrying out surveys and systemizing and analyzing data. Next a brief conceptual explanation of cooperative networks is made along with the characteristics of the program. Then the cooperative networks are described and analyzed, observing the relationships between the various actors that dynamize the program, the presence of IT and communications tools, and the sharing of the techno-scientific base among the projects of cooperative networks. The article concludes by interlacing some considerations about the local appropriation of a conceptual techno-scientific organizational model - the cooperative networks. The creation of a data bank of empirical data, and of local concepts and categories for analyses are considered to be decisive factors for increasing the knowledge acquired through sociology and anthropology about research best practices and administration of biomedical research.

To identify food patterns and eating behaviors among adolescents and to describe the prevalence rates, this study applied the Grade of Membership method to data from a survey on health risk factors among adolescent students in Rio de Janeiro, Brazil (N = 1,632). The four profiles generated were: "A" (12.1%) more frequent consumption of all foods labeled as healthy, less frequent consumption of unhealthy foods, and healthy eating behaviors; "B" (45.8%) breakfast and three meals a day as a habit, less frequent consumption of fruits and vegetables and of five markers of unhealthy diet; "C" (22.8%) lack of healthy eating behaviors, less frequent consumption of vegetables, fruit, milk, cold cuts, cookies, and soft drinks; and "D" (19.3%) more frequent consumption of all unhealthy foods and less frequent consumption of fruits and vegetables. The results indicate the need for interventions to promote healthy eating in this age group.

Brazil has an exceptionally dynamic research sector in Latin America in health, biotechnology, and pharmacology, backed by defined government policies on science and technology and a health research agenda focusing on important neglected diseases: malaria, leishmaniasis, Chagas disease, turberculosis, leprosy, and dengue. The Brazilian health research policy promotes partnerships and networks among scientists in academic institutions in both wealthy industrialized and disease-endemic countries, and in these efforts the government's guidelines for animal use in biomedical research are considered fundamental to guarantee both animal welfare and the quality of research. Given international discussions of animal experimentation regulations and guidelines, in this article we describe current Brazilian legislation governing the use of animals in scientific investigations. We conclude that, despite advances in the implementation of the 3Rs (reduction, refinement, replacement), the new regulatory framework does not sufficiently incorporate ethical considerations, lacking explicit reference to the 3Rs as well as measures for their full application. The more humane use of animals in research will depend on the approach adopted by Brazil's National Council for the Control of Animal Experimentation to promote the 3Rs and to improve internal regulations as well as data collection and analysis in research institutions. In Brazil as elsewhere, one of the greatest challenges to policymakers is to harmonize the myriad and intertwined legal provisions without hindering biomedical research.

The sophisticated analysis of gestures and vocalizations, including assessment of their emotional valence, helps group-living primates efficiently navigate their social environment. Deficits in social information processing and emotion regulation are important components of many human psychiatric illnesses, such as autism, schizophrenia and social anxiety disorder. Analyzing the neurobiology of social information processing and emotion regulation requires a multidisciplinary approach that benefits from comparative studies of humans and animal models. However, many questions remain regarding the relationship between visual attention and arousal while processing social stimuli. Using noninvasive infrared eye-tracking methods, we measured the visual social attention and physiological arousal (pupil diameter) of adult male rhesus monkeys (Macaca mulatta) as they watched social and nonsocial videos. We found that social videos, as compared to nonsocial videos, captured more visual attention, especially if the social signals depicted in the videos were directed towards the subject. Subject-directed social cues and nonsocial nature documentary footage, compared to videos showing conspecifics engaging in naturalistic social interactions, generated larger pupil diameters (indicating heightened sympathetic arousal). These findings indicate that rhesus monkeys will actively engage in watching videos of various kinds. Moreover, infrared eye tracking technology provides a mechanism for sensitively gauging the social interest of presented stimuli. Adult male rhesus monkeys' visual attention and physiological arousal do not always trend in the same direction, and are likely influenced by the content and novelty of a particular visual stimulus. This experiment creates a strong foundation for future experiments that will examine the neural network responsible for social information processing in nonhuman primates. Such studies may provide valuable information relevant to interpreting the neural deficits underlying human psychiatric illnesses such as autism, schizophrenia and social anxiety disorder.

The aim of this study was to describe the effect of non-adherence on the main laboratory outcomes, TCD4+ lymphocyte count and viral load, routinely used to monitor patients initiating treatment according to three different approaches to measure adherence to antiretroviral therapy. Among 288 participants, 22.9%, 31.9% and 74.3% were considered non-adherent, according to medical charts, self-report and pharmacy records, respectively. Depending on the adherence measures used, the average gain in TCD4+ lymphocyte count ranged from 142.4 to 195.4 cells/mm3 among adherent patients, and from 58.5 to 99.8 lymphocytes TCD4+/mm3 among those non-adherent. The average reduction on viral load ranged from 4.25 to 4.62 log copies/mL among the adherent patients, and from 1.99 to 4.07 log among those non-adherent. Monitoring antiretroviral adherence should be considered a priority in these public AIDS referral centers in order to identify patients at high risk of developing virologic failure. Early interventions are necessary in order to maintain the initial therapeutic regimens for longer periods.

Across a variety of species, the amygdala appears to play a key role in the detection and avoidance of potential dangers (e.g., unfamiliar social partners, novel objects or contexts, potential predators, etc.). For many species, seeking out appropriate food sources and avoiding novel, distasteful or potentially tainted food is also a daily concern. Amygdala damage in nonhuman primates has been linked to increased willingness to select unfamiliar or unpalatable foods, as well as inedible items that intact animals typically reject. However, such findings have not always been consistent and have typically been observed in relatively restrictive, laboratory-based testing contexts. We evaluated the food choices of six adult male rhesus monkeys (Macaca mulatta) with bilateral, neurotoxic amygdala lesions and six age- and experienced-matched unoperated control animals. Each animal was able to forage freely in a large enclosure stocked with five preferred and five nonpreferred foods that changed locations each day. While both groups quickly selected palatable foods, monkeys with amygdala lesions consistently selected unpalatable foods that the unoperated control animals generally avoided. Even after repeated presentations of the unpalatable foods, the amygdala-lesioned monkeys failed to change their initial pattern of diminished avoidance. These results are consistent with a general role for the amygdala in danger detection and prevention of harm in the presence of novel or noxious stimuli, regardless of whether such stimuli are conspecifics, predators, objects or foods., (© 2010 APA, all rights reserved.)

Malformations of the hippocampal formation and amygdala have been implicated in several neurodevelopmental disorders; yet relatively little is known about their normal structural development. The purpose of this study was to characterize the early developmental trajectories of the hippocampus and amygdala in the rhesus macaques (Macaca mulatta) using noninvasive MRI techniques. T1-weighted structural scans of 22 infant and juvenile monkeys (11 male, 11 female) were obtained between 1 week and approximately 2 yrs of age. Ten animals (five males, five females) were scanned multiple times and 12 monkeys (six males, six females) were scanned once between 1 and 4 weeks of age. Both structures exhibited significant age-related changes throughout the first 2 yrs of life that were not explained by overall brain development. The hippocampal formation increased 117.05% in males and 110.86% in females. No sex differences were evident, but the left hemisphere was significantly larger than the right. The amygdala increased 86.49% in males and 72.94% in females with males exhibiting a larger right than left amygdala. For both structures, the most substantial volumetric increases were seen within the first month, but the hippocampal formation appeared to develop more slowly than the amygdala with the rate of hippocampal maturation stabilizing around 11 months and that of amygdala maturation stabilizing around 8 months. Differences in volumetric developmental trajectories of the hippocampal formation and amygdala largely mirror differences in the timing of the functional development of these structures. The current results emphasize the importance of including early postnatal ages when assessing developmental trajectories of neuroanatomical structures and reinforces the utility of nonhuman primates in the assessment of normal developmental patterns., (Copyright 2009 Wiley-Liss, Inc.)

Objective: To analyze the influence of demographic, socioeconomic, health, and contextual factors of the Brazilian federation units on the functional disability of the elderly., Methods: Cross-sectional study based on data from the 2003 PNAD (Brazilian National Household Survey), of IBGE (Brazilian Institute of Geography and Statistics) and Ipea (Institute of Applied Economic Research). The sample was composed of 33,515 individuals aged 60 years and older. The dependent variable was functional disability, measured by difficulty in climbing slopes or stairs. The independent variables were divided into two levels: individual (demographic, socioeconomic and health-related characteristics) and contextual (Gini Index and Gross Domestic Product per capita by Brazilian state in 2000). A multinomial and multilevel logistic regression model was utilized in order to estimate the effect of the independent variables on the functional disability of the elderly., Results: Functional disability was associated with demographic, socioeconomic and health factors. At the individual level, sex, level of schooling, income, occupation, self-perception of health and chronic diseases were the factors that were most strongly related to functional disability. At the contextual level, income inequality proved to exert an important influence., Conclusions: Self-perception of health is the factor that is most strongly related to the functional disability of the elderly in Brazil, followed by chronic diseases. Sex, occupation, level of schooling and income are also highly associated with it. Actions that approach the main factors associated with functional disability can contribute significantly to the well-being and quality of life of the elderly.

The gastric bypass is a good option in the therapy of morbid obesity. Nevertheless, it must be considered the rare condition as occurred in a patient with previous abdominal surgery with Situs Inversus Totalis. A 24 year-old male patient with body mass index of 40 Kg/ m(2), multiple dietary failures, and arterial hypertension as co-morbidities, with a anterior paramedial right incision due to a previous appendicectomy (8 years ago).With a indication for bariatric surgery, was performed Roux-en-Y gastric bypass by laparoscopic procedure, with previous planning of Situs Inversus Totalis.

The article analyzes Brazilian public policy and legislation concerning the use of animals in teaching and biomedical research. It examines the institutional and judicial framework and legal status of animal protection in Brazil, including the legislative debate that preceded enactment of Law 11.794/2008, which defined procedures to be employed in the scientific use of animals. It underscores certain features of current regulatory practice and also explores considerations of a theoretical and methodological nature, with a view to broadening our understanding of the question.

O método Grade of Membership (GoM) tem sido cada vez mais utilizado por demógrafos brasileiros e tem a vantagem de possuir um parâmetro que mensura a heterogeneidade individual, com base nas correlações não-observáveis entre as categorias de resposta das variáveis de interesse, gerando um medida do grau de pertencimento de cada indivíduo a perfis extremos. Alguns autores, contudo, chamam atenção para questões importantes na calibragem dos modelos finais que utilizam o programa GoM versão 3.4, como o problema de identificabilidade - soluções múltiplas para parâmetros estimados. Neste artigo, é sugerido um procedimento capaz de identificar um modelo final com solução única que descreva os tipos puros mais fidedignos à base de dados, em uma tentativa de otimização. Para ilustrar esse processo, utilizou-se uma base de dados correspondente a um levantamento econômico e sociodemográfico de uma população de pequenos agricultores residentes ao longo da Rodovia Transamazônica, no Estado do Pará. Também identificou-se a existência de instabilidade nos parâmetros estimados pelo programa GoM 3.4, sendo proposto um método de estabilização de seus valores. Com esses procedimentos combinados, os usuários do programa GoM 3.4 poderão descrever sua base de dados de forma mais adequada e responder às críticas sobre questões de identificabilidade e estabilidade dos modelos resultantes. Essas soluções empíricas são relevantes por afetarem cálculos de prevalência e de incidência de eventos de interesse, além de trazerem consequências importantes sobre o ponto e o momento corretos para intervenções de políticas públicas ou de planejamento prospectivo em análises de projeção.

The increase of the percentage of elderly population in Brazil and the increase in longevity incite a demand for information on the quantity of years spent in good health. The aim of the present study is to measure the life expectancy for the elderly of 60 years and above, by sex and age, in the year of 2003. The Sullivan method was used, which combined the life-table with the current experience of mortality and the self-perceived health. The mortality information was obtained from the life tables published by the IBGE (Brazilian Institute of Geography and Statistics), 2003. The self-perceived health was used and it was dichotomized in good and bad. This information came from the National Research of Household Sample (PNAD), 2003. The results indicate that women live longer, but spend a higher number of years perceiving their health as bad, as compared to men. The results also highlights to the need of considering the differences between sexes in relation to the demand for health care. It is also important to consider the need to have policies designed to allow the increase in the number of years that the elderly can live in good health conditions.

In the present study, changes in the population mortality structure in the State of São Paulo, Brazil, were analyzed from 1980 to 2005, aimed at identifying the effects of these changes on the variability of age at death. Evidence of a change in the distribution of deaths toward more advanced ages was found, and the mean lifespan for the overall population increased by seven years during the period. Two different scenarios were observed. The first (1980-1995) showed an increase in the variability of age at death. The second (1995-2005) showed a downward trend in variability. Estimates beyond a given quartile of the death distribution by age indicated that compression of mortality took place throughout the entire period. However, variability of age at death was lower for males as compared to females.

The authors measured the effects of bilateral amygdaloid, orbital frontal, or hippocampal lesions on emotional reactivity and passive avoidance in rhesus monkeys (Macaca mulatta). Animals were presented with 8 neutral or 8 aversive objects, each paired with a highly preferred food reward. Sham-operated control animals displayed heightened defensive behaviors and typically would not approach or retrieve the food when paired with a potential predator (coiled rubber snake), 2 conditioned aversive stimuli for laboratory-housed monkeys (a capture net and leather handling gloves), and 1 object displaying a threatening social signal (direct eye contact from a human-like doll). Animals with amygdala lesions, but not hippocampal or orbital frontal lesions, showed less tension-related behaviors and diminished passive avoidance of the rubber snake and its matched neutral item (a coiled piece of hose) relative to control animals. All operated groups displayed normal patterns of behavior toward conditioned and socially aversive objects. These results expand our understanding of how the primate brain evaluates reward and threat, and indicate a highly specialized role for the amygdala in mediating passive avoidance and emotional reactivity to potentially life-threatening stimuli., ((c) 2009 APA, all rights reserved.)

The objectives of this study were to evaluate anti-retroviral (ARV) prescription pickups during twelve months following the first prescription and to identify factors associated with irregular pickups or permanent dropout in two public HIV/AIDS referral centers in Belo Horizonte, Minas Gerais State, Brazil. Participants (n = 323) were antiretroviral naïve and were recruited from May 2001 to May 2002. A total of 98 (30.3%) patients abandoned treatment, and 187 (57.9%) had at least one irregular pickup. Patients with irregular pickups and dropouts were compared to those with regular pickups. Multinomial multivariate analysis showed that living outside Belo Horizonte, CD4+ T-lymphocyte count greater than 200/mm(3), and antiretroviral regimen without protease inhibitors were associated with irregular pickups. In addition to these variables, not being on other medications, and any non-adherence recorded on patient charts were associated with treatment dropout. Pharmacy records are important potential indicators of non-adherence and should be incorporated as such in clinical practice. Strategies should be prioritized to reach out to dropouts or patients with irregular ARV pickups.

Objective: There is evidence that patients with mental illness have increased prevalence of sexually transmitted infections, but data in Brazil are scarce. The objective of this study was to determine the prevalence of HIV, hepatitis C and B, and syphilis among patients with mental illness in Brazil., Method: A multicenter representative sample of adults with mental illness was randomly selected from 26 mental health institutions throughout Brazil. Sociodemographic, sexual behavior and clinical data were obtained from person-to-person interviews and blood was collected for serology testing. Seroprevalence with 95% confidence limits were obtained correcting for sampling scheme., Results: Of the 2,475 patients interviewed, 2,238 had blood collected. Most participants were sexually active ever (88.8%) or in the last 6 months (61.6%), female (51.9%), and single (66.6%). Half of the sample had less than 5 years of schooling and the mean monthly individual income was low (US$ 210.00). Condom use was very low either during lifetime (8%) or in the last 6 months (16%). Overall seroprevalence were 1.12%, 0.80%, 1.64%, 14.7% and 2.63% for, respectively, syphilis, HIV, HBsAg, anti-HBc and anti-HCV., Conclusions: Seroprevalences found were higher than other populations with representative studies in Brazil, with high rates of sexual risk behavior. This is of public health concern, and prevention and care strategies for sexually transmitted infections among psychiatric patients should urgently be implemented by health authorities.

The aim of the present study was to describe vulnerability profiles and to verify their association with non-adherence to antiretroviral therapy (ART) among 295 HIV-patients receiving their first prescription in two public-referral centers in Minas Gerais States, Brazil. The cumulative incidence of non-adherence was 36.9%. Three pure vulnerability profiles (lower, medium and higher) were identified based on the Grade of Membership method (GoM). Pure type patients of the "higher vulnerability" profile had, when compared to the overall sample, an increased probability of being younger, not understanding the need of ART, having a personal reason to be HIV-tested, not disclosing their HIV status, having more than one (non-regular) sexual partner, reporting use of alcohol, tobacco and illicit drugs, and having sex among men. Non-adherence to ART was statistically associated (p < 0.001) with this profile. Also, the heterogeneity of the sample was found to be high, since over 40% were mixed type. The implications are that health staff should be trained to develop strategies for incorporating risk-reduction interventions, bearing in mind the three dimensions of vulnerability and the diversity of those patients initiating antiretroviral therapy.

We compared the effects of bilateral amygdala, hippocampal or orbital frontal cortex lesions on emotional and hormonal reactivity in rhesus monkeys (Macaca mulatta). Experiment 1 measured behavioral reactivity to an unfamiliar human intruder before and after surgery. Animals with amygdala lesions demonstrated decreases in one passive defensive behavior (freezing), whereas animals with hippocampal lesions showed decreases in a more stimulus-directed defensive behavior (tooth grinding). Orbital frontal cortex lesions also reduced these two defensive behaviors, as well as decreased cage-shaking dominance displays. Animals with amygdala, hippocampal or sham lesions also demonstrated increased tension-related behaviors after surgery, but those with orbital frontal lesions did not. Finally, all three lesions diminished the operated animals' ability to modulate tension-related behaviors depending on the magnitude of threat posed by the human intruder. Experiment 2 measured circulating levels of cortisol and testosterone when a subset of these same animals was at rest and following physical restraint, temporary isolation, exposure to threatening objects and social interactions with an unfamiliar conspecific. None of the lesions impacted on testosterone levels in any condition. Amygdala or orbital frontal lesions blunted cortisol reactivity during isolation from peers, but not during any other condition. Hippocampal lesions did not alter circulating levels of cortisol under any condition. These results indicate that the amygdala, hippocampus and orbital frontal cortex play distinct, yet complimentary roles in coordinating emotional and hormonal reactivity to threat.

This article aims to review the main concepts and measures of functional disability currently used in studies focusing on this subject. According to this review, functional disability can be defined as a difficulty or the need for help for performing basic or more complex daily activities necessary for keeping an independent life in the community. As refers to measurement criteria, the studies do not follow a clear-cut standard, varying substantially in relation to scales, dimensions and classifications besides depending directly or indirectly on the kind of available information. A correct method for rating functional disability does not exist at yet. For this reason it is essential that the researchers clearly indicate the concept of functional disability used in the studies and detail, which measures or tools were applied.

Although the amygdala has been repeatedly implicated in normal primate social behavior, great variability exists in the specific social and nonsocial behavioral changes observed in nonhuman primates with bilateral amygdala lesions. One plausible explanation pertains to differences in social context. This study measured the social behavior of amygdala-lesioned and unoperated rhesus monkeys (Macaca mulatta) in 2 contexts. Monkeys interacted in 4-member social groups over 32 test days. They were previously assessed in pairs (N. J. Emery et al., 2001) and were therefore familiar with each other at the beginning of this study. Across the 2 contexts, amygdala lesions produced a highly consistent pattern of social behavior. Operated monkeys engaged in more affiliative social interactions with control partners than did controls. In the course of their interactions, amygdala-lesioned monkeys also displayed an earlier decrease in nervous and fearful personality qualities than did controls. The increased exploration and sexual behavior recorded for amygdala-lesioned monkeys in pairs was not found in the 4-member groups. The authors concluded that the amygdala contributes to social inhibition and that this function transcends various social contexts.

The aim of the present study was to estimate disability-free life expectancy for the Brazilian elderly in 2003, by gender and age, based on different concepts of functional disability. The Sullivan method is used to combine the period life tables from the Brazilian Institute of Geography and Statistics (IBGE, 2003) and the prevalence of functional disability according to the 2003 National Sample Household Survey (PNAD 2003). The main results of the study indicate that at age 60, Brazilian men can expect to live 19 years, 39% with mild, 21% with moderate, and 14% with severe functional disability, respectively. At the same age, Brazilian women can expect to live 22 years: 56% with mild, 32% with moderate, and 18% with severe functional disability.

Objective: To describe reliability/validity of a semi-structured questionnaire designed to assess risk behavior to sexually transmitted diseases among adults with chronic mental illness., Method: A cross-sectional pilot study was conducted in one psychiatric hospital and one mental health outpatient clinic. Clinical, behavioral and demographic data were collected from semi-structured interviews and medical charts. One-hundred and twenty patients were randomly selected from pre-defined lists in both centers while 89 (74%) were interviewed, indicating 26% nonparticipation rate. Protocol, participation rates, consent form and feasibility issues were assessed. The semi-structured interview was evaluated with regard to reliability (intra- and inter-rater) and construct validity by randomly repeating the interviews in a 1:1 ratio up to one-week interval. Reliability was estimated by percent agreement and Kappa statistics (95% confidence interval). Construct validity was assessed by Grade of Membership model., Results: Kappa statistics ranged from 0.40 to 1.00 for most variables. Grade of Membership analysis generated three profiles. Profile one was represented by mostly women with no condom use in stable relationships; profile two revealed mostly men in stable relationship but with multiple risk behaviors; while profile three indicated a higher proportion of licit or illicit substance use., Conclusions: Reliability and construct validity assessment using Grade of Membership analysis indicated that the semi-structured interview was suitable for capturing risk behavior among patients with chronic mental illness.

The aim of this study was to identify functional disability and health profiles of the elderly in Brazil, as well as their prevalence rates, based on the National Household Sample Survey for 2003. The sample size was 33,786 elderly individuals. Grade of Membership was used to define the profiles: "healthy elderly" (Profile 1), whose pure types had a lower probability of disability and chronic illness; "elderly with mild functional disability" (Profile 2), whose pure types had mainly hypertension and lower back problems and were independent in activities of daily living, although with high difficulty in mobility; and "elderly with severe disability" (Profile 3), with higher probability of chronic illness, high difficulty with activities of daily living, and high dependency in terms of mobility. In conclusion, the profiles indicate that a consistent approach to functional disability is essential for promoting the health of the elderly.

Objective: To assess underreporting of live birth records by health information systems., Methods: Secondary data of the Sistema de Informação Hospitalar (Hospital Information System - SIH) and of the Sistema de Informação de Nascidos Vivos (Information System on Live Birth - SINASC) were used in the state of Minas Gerais, Southeastern Brazil, in 2001. Two procedures were used in the analysis: the comparison between the number of live births per city and the probabilistic record linkage of individual data. For both procedures, indicators of underreporting considered were the proportion of live births presented at SIH system that were not obtained at SINASC. The municipalities were later added into four strips of population size., Results: The probabilistic linkage was able to identify a greater proportion of live births underreported at SINASC, relative to the comparison of live births in the municipalities. The variations of the differences among underreporting percentages per procedures were 9.4% in cities with population lower than 5,000 inhabitants; 9.1% in cities with population ranging from 5,000 and 9,999; and 8.0% in municipalities between 10,000 and 49,999 and over 50,000 inhabitants., Conclusions: The amount of underreporting was sensitive to the procedures adopted. Probabilistic linkage reinforced the certainty of pairings, and also enabled to identify a greater proportion of cases not recorded at SINASC, also in greater cities. SIH was a strong indicator of underreporting of live births.

Longitudinal analysis of animals with neonatal brain lesions enables the evaluation of behavioral changes during multiple stages of development. Interpretation of such changes, however, carries the caveat that permanent neural injury also yields morphological and neurochemical reorganization elsewhere in the brain that may lead either to functional compensation or to exacerbation of behavioral alterations. We have measured the long-term effects of selective neonatal brain damage on resting cerebral glucose metabolism in nonhuman primates. Sixteen rhesus monkeys (Macaca mulatta) received neurotoxic lesions of either the amygdala (n=8) or hippocampus (n=8) when they were two weeks old. Four years later, these animals, along with age- and experience-matched sham-operated control animals (n=8), were studied with high-resolution positron emission tomography (microPET) and 2-deoxy-2[(18)F]fluoro-d-glucose ([(18)F]FDG) to detect areas of altered metabolism. The groups were compared using an anatomically-based region of interest analysis. Relative to controls, amygdala-lesioned animals displayed hypometabolism in three frontal lobe regions, as well as in the neostriatum and hippocampus. Hypermetabolism was also evident in the cerebellum of amygdala-lesioned animals. Hippocampal-lesioned animals only showed hypometabolism in the retrosplenial cortex. These results indicate that neonatal amygdala and hippocampus lesions induce very different patterns of long-lasting metabolic changes in distant brain regions. These observations raise the possibility that behavioral alterations in animals with neonatal lesions may be due to the intended damage, to consequent brain reorganization or to a combination of both factors.

Studying the neural mechanisms underlying complex goal-directed behaviors, such as social behavior, reward seeking or punishment avoidance, has become increasingly tractable in humans, nonhuman primates and rodents. In most experiments, however, goal-directed behaviors are measured in a laboratory setting, which is vastly different from the context in which these behaviors naturally occur. This study adapted a reward assessment paradigm, previously conducted with rhesus monkeys (Macaca mulatta) in the controlled environment of a Wisconsin General Testing Apparatus (WGTA) [Machado CJ, Bachevalier J (2007) The effects of selective amygdala, orbital frontal cortex or hippocampal formation lesions on reward assessment in nonhuman primates. Eur J Neurosci 25:2885-2904], to a more naturalistic context. We used this new paradigm to examine the effects of bilateral amygdaloid, hippocampal or orbital frontal cortex lesions on established food and nonfood preferences. Behavioral modification following reinforcer devaluation was also measured. Consistent with our previous study, none of the lesions produced changes in preference for palatable foods relative to pre-surgery, but animals with amygdala lesions displayed heightened preference for unpalatable foods that control or other operated animals typically avoided. In contrast to several previous WGTA-based experiments, nonfood preference was not affected by any of the lesions. Finally, animals with orbital frontal cortex lesions continued to select preferred foods after satiation, but those with amygdala, hippocampal or sham lesions altered their foraging behavior appropriately and selected less of the sated food. These findings parallel food devaluation results obtained with these same animals when tested in the WGTA. Overall, this study stresses the importance of testing context when measuring decision-making abilities in nonhuman primates with selective brain lesions.

We examined the effects of bilateral amygdaloid, hippocampal or orbital frontal cortex lesions on reward assessment in rhesus monkeys (Macaca mulatta). In Experiment 1, basic preferences for foods and inedible nonfoods were measured pre- and postsurgery. None of the lesions produced changes in animals' preferences for palatable foods or raw meat relative to presurgery, although amygdaloid or hippocampal lesions yielded increased preference for inedible nonfoods postsurgery. When the reinforcement value of each animal's highest-preferred food was decreased by selective satiation, only animals with neurotoxic orbital frontal cortex lesions continued to select the sated food. Experiment 2 measured the impact of each lesion on learning 60 concurrent discrimination problems and, then, on flexibly avoiding objects associated with sated foods in favour of objects associated with nonsated foods. None of the lesions affected concurrent discrimination learning, but animals with neurotoxic amygdala or aspiration orbital frontal lesions could not refrain from displacing items covering devalued foods. Only animals with orbital lesions also selected the devalued food beneath the object. The results indicate a functional dissociation for the amygdala and orbital frontal cortex in reward assessment, depending on the type of the reinforcer available (objects vs. food). Finally, this is the first study indicating that the hippocampal formation is involved in the assessment of familiar nonfoods, but not in judging the current value of unconditioned and conditioned reinforcers.

Following the introduction of highly active antiretroviral therapy (HAART), the HIV-related morbidity-mortality profile has changed. Opportunistic infections are not as prevalent as before, and "pre-AIDS" diseases have become more common, related mostly to the side effects of HAART. This study focused on HIV/AIDS-related mortality, based on multiple causes of death among individuals who died of HIV-related causes in the cities of São Paulo and Santos, Brazil, in 2001. Grade of Membership (GoM) analysis was used. Three mortality profiles were detected: (1) causes of death normally observed before the introduction of HAART, marked by opportunistic infections; (2) causes of death with mixed characteristics, both pre- and post-HAART; and (3) a residual profile, which did not contemplate HIV disease, but incorporated causes of death associated with the pre and post-HAART periods. It is hoped that the current study will contribute to the understanding of the HIV/AIDS morbidity-mortality scenario and help improve the treatment and care provided by public health services.

This population-based study aimed to determine the profile of early neonatal deaths in Belo Horizonte, Minas Gerais, Brazil, from 2000 to 2003. Profiles were analyzed from the perspective of avoidability, justified by persistently high early neonatal mortality rates in the city. Three profiles were generated for multiple causes of death from the perspective of fuzzy sets, using the Grade of Membership method. Birth weight and the hospital's corporate status were also related to the three profiles. Private hospitals were characterized by so-called "difficult-to-prevent deaths, with mention of congenital malformations" (profile 2). The Unified National Health System (SUS) generated two distinct profiles. Private maternity facilities contracted out by the SUS showed "preventable deaths" (profile 1), while "premature deaths" (profile 3) occurred in the public Federal and State maternity hospitals. This typology highlights the need to adopt differential policies in the SUS, focusing on evaluation and accreditation for maternity facilities contracted out by the SUS and--for the system as a whole--on the routine adoption of protocols for childbirth care and prophylactic measures that are known to reduce neonatal morbidity and mortality.

Social dominance, personality ratings, and frequency, duration, and timing of social behaviors were measured pre- and postsurgically in 6 groups of rhesus monkeys (Macaca mulatta), each consisting of 1 sham-operated control and 1 monkey each with a selective amygdala, hippocampal, or orbital frontal cortex lesion. Unlike previous reports, none of the operated groups showed changes in social dominance postsurgery, although changes in other measures varied by lesion site. Although sham-operated monkeys displayed heightened avoidant, anxious, and aggressive behaviors, those with hippocampal lesions also showed increased exploration and excitability, along with reduced responses to affiliative signals. Amygdala lesions yielded several personality changes that precluded positive social interactions (increased exploration and excitability, decreased affiliation and popularity) and altered responses to threatening social signals. By contrast, monkeys with orbital frontal lesions were involved in more aggressive interactions and responded differently to both affiliative and threatening signals. Although several findings differ from earlier nonhuman primate studies, they are largely in agreement with human data and emphasize the context-specific nature of social behavior studies. Interpretation of results in relation to cognitive processes mediated by each structure is discussed., (Copyright 2006 APA, all rights reserved.)

The aim of this study is to analyse the impact of maternal age at first birth on low birth weight, preterm birth and low Apgar scores at one minute and at five minutes among live births delivered to primiparous Brazilian women in the city of São Paulo. Analyses were based on 73,820 birth records from the 1998 birth cohort. Logistic regression was used to assess the association between maternal age and each outcome variable, controlling for the following risk factors: delivery mode, plurality, sex, maternal education, number of prior losses, prenatal care, race, parity and community development. Maternal ages below 20 and above 30 years were significantly associated with the risks of low birth weight and preterm birth, but no association was found between maternal ages and Apgar score, with the exception that ages 15-19 reduced the odds of a low one-minute score. Even though this result seems to be inconsistent, low birth weight, preterm birth and low Apgar scores measure different dimensions of newborn well-being, and the association of each measure with maternal age is expected to diverge.

This study aimed to analyze the impact of changes in age-related and cause-related mortality on life expectancy at birth in the State of Santa Catarina, Brazil, in the 1990s. Data were obtained from the Mortality Information System (SIM) for the three-year periods 1989/1990/1991 and 1998/1999/2000. Infant mortality rates and specific mortality rates for individuals > or = 1 year of age were calculated by gender and cause of death. The Pollard method was used to disaggregate the contributions by mortality from different causes and in different ages to life expectancy at birth. The age groups that contributed the most to the increase in life expectancy at birth were 0-1 year and > or = 70 years. The causes of death that most contributed to this increase were chronic non-communicable diseases, such as cardiovascular diseases, in the age brackets above 35 years, and neonatal diseases in the < 1-year bracket. Finally, there were a high proportion of deaths from ill-defined causes, indicating that the true cause-related mortality structure in the State is still unknown.

Rhesus monkeys (Macaca mulatta) with bilateral ibotenic acid-produced lesions of the amygdala were compared with controls in several novel situations, including exposures to metal objects, toy animals, and a person. Early in testing, the monkeys with lesions showed reduced inhibitions on responsiveness compared with controls. With continuing exposures, differences between groups diminished sharply as inhibitions waned in the controls. This outcome is consistent with the hypothesis that the amygdala mediates caution in initial reactions to ambiguous or threatening novel situations, which, in the absence of adverse consequences, diminishes with repetition. Consistency of individual responsiveness across different situations, including pairing with other monkeys, was substantial in lesioned and normal monkeys, suggesting that stable qualities of temperament influenced the results in both groups.

Objective: For persons 60 years of age or older living in the city of São Paulo, Brazil, in the year 2000 to estimate four characteristics: (1) life expectancy free of functional disability, (2) life expectancy with functional disability, (3) life expectancy with functional disability but without dependence, and (4) life expectancy with functional disability and dependence., Methods: The estimates of the four characteristics were calculated by means of a life table constructed based on the method proposed by Sullivan. The basic data used for the calculations were the elderly population estimated for the city of São Paulo as of mid-2000, obtained from the demographic censuses of 1991 and 2000, and deaths in the elderly population, obtained from the State Data Analysis System Foundation (Fundação Sistema Estadual de Análise de Dados, or SEADE) of the state of São Paulo. The prevalences of functional disability and of functional dependence were calculated based on data concerning activities of daily living collected in the city of São Paulo as part of a project called Health, Well-being, and Aging in Latin America and the Caribbean (the "SABE project"). The activities of daily living considered were: dressing, eating, bathing, using the bathroom, lying down on the bed and getting up from it, and walking across a room. Functional disability was defined as difficulty in performing one or more of the activities of daily living. Dependence was defined as the need for help in performing at least one of the activities of daily living., Results: In 2000, 60-year-old men from the city of São Paulo could expect to live, on average, 17.6 years, of which 14.6 years (83%) would be free of functional disability. Women of the same age could expect to live 22.2 years, of which 16.4 years (74%) would be free of functional disability. Men would have a functional disability and be dependent on others for 1.6 years (9%), while the comparable period for women would be 2.5 years (11%)., Conclusions: Despite their longer life expectancy, the women faced more years with functional disability. The number of years with functional disability and dependence was also higher for the women. Public policies should take into account the differing needs of elderly women and of elderly men as well as other specific characteristics of this older population.

Child mortality (the mortality of children less than five years old) declined considerably in the developing world in the 1990s, but infant mortality declined less. The reductions in neonatal mortality were not impressive and, as a consequence, there is an increasing percentage of infant deaths in the neonatal period. Any further reduction in child mortality, therefore, requires an understanding of the determinants of neonatal mortality. 209,628 birth and 2581 neonatal death records for the 1998 birth cohort from the city of São Paulo, Brazil, were probabilistically matched. Data were from SINASC and SIM, Information Systems on Live Births and Deaths of Brazil. Logistic regression was used to find the association between neonatal mortality and the following risk factors: birth weight, gestational age, Apgar scores at 1 and 5 minutes, delivery mode, plurality, sex, maternal education, maternal age, number of prior losses, prenatal care, race, parity and community development. Infants of older mothers were less likely to die in the neonatal period. Caesarean delivery was not found to be associated with neonatal mortality. Low birth weight, pre-term birth and low Apgar scores were associated with neonatal death. Having a mother who lives in the highest developed community decreased the odds of neonatal death, suggesting that factors not measured in this study are behind such association. This result may also indicate that other factors over and above biological and more proximate factors could affect neonatal death.

Probabilistic record linkage allows the assembling of information from different data sources. We present a procedure when a one-to-one relationship between records in different files is expected but not found. Data were births and infant deaths, 1998-birth cohort, city of São Paulo, Brazil. Pairs for which a one-to-one relationship was obtained and a best-link was found with the highest weight were taken as unequivocally matched pairs and provided information to decide on the remaining pairs. For these, an expected relationship between differences in dates of death and birth registration was found; and places of birth and death registration for neonatal deaths were likely to be the same. Such evidence was used to solve for the remaining pairs. We reduced the number of non-uniquely matched records and of uncertain matches, and increased the number of uniquely matched pairs from 2,249 to 2,827. Future research using record linkage should use strategies from first record linkage runs before a full clerical review (the standard procedure under uncertainty) to efficiently retrieve matches.

Record linkage is a powerful tool in assembling information from different data sources and has been used by a number of public health researchers. In this review, we provide an overview of the record linkage methodologies, focusing particularly on probabilistic record linkage. We then stress the purposes and research applications of linking records by focusing on studies of infant health outcomes based on large data sets, and provide a critical review of the studies in Brazil.

BACKGROUND: Early infant morbidities may produce adverse outcomes in subsequent life. A low Apgar score is a convenient measure of early infant morbidity. We study determinants of early infant morbidity (sex, plurality, mode of delivery, prior losses, gestational age, prenatal care and birth weight, parity and maternal age, race, maternal education and community development) for the 1998-birth cohort, City of São Paulo, Brazil. METHODS: This study identified all deliveries that took place in the City of São Paulo during 1998. Information was extracted from 209,628 birth records. We used multivariate logistic regression to assess the effect of each independent variable on Apgar score less than seven at one minute and Apgar score less than seven at five minutes. RESULTS: Low birth weight, prematurity and community development were found to be strong predictors of morbidity. Maternal education showed strong negative correlation with both Apgar scores. The negative correlations between maternal schooling and Apgar scores were observed after prenatal care, parity and maternal age were included in the model. Unmeasured proximate factors may thus be the true source of disparity between educational groups. Children of very young adolescent mothers had lower Apgar scores at one minute (but not at five minutes) than those born to mothers 15 to 19. Parity one or higher was associated with decreased odds of low Apgar scores. Cesarean section and operative delivery were associated with higher odds of early infant morbidity. CONCLUSION: Education may allow mothers to have better care in the peripartum period. More educated mothers may be more likely to recognize certain morbidities through the pregnancy period and the monitoring of such morbidities yields better infant outcomes. Also, having less than seven prenatal care visits was found to predict early infant morbidity and one way to increase the use of such services is to focus on aspects of care that may lead to easier accessibility and continuity of prenatal care. Physicians should inform mothers about the risks associated with high number of children for a next infant and also about the risks for the infant associated with unnecessary cesarean sections. Special attention should be paid to adolescent mothers, since much of their increased risk is likely to be minimized by counseling.

Troponin C (TnC) is the Ca(2+)-binding subunit of the troponin complex of vertebrate skeletal muscle. It consists of two structurally homologous domains, N and C, connected by an exposed alpha-helix. The C-domain has two high-affinity sites for Ca(2+) that also bind Mg(2+), whereas the N-domain has two low-affinity sites for Ca(2+). Previous studies using isolated N- and C-domains showed that the C-domain apo form was less stable than the N-domain. Here we analyzed the stability of isolated N-domain (F29W/N-domain) against urea and pressure denaturation in the absence and in the presence of glycerol using fluorescence spectroscopy. Increasing the glycerol concentration promoted an increase in the stability of the protein to urea (0-8 M) in the absence of Ca(2+). Furthermore, the ability to expose hydrophobic surfaces normally promoted by Ca(2+) binding or low temperature under pressure was partially lost in the presence of 20% (v/v) glycerol. Glycerol also led to a decrease in the Ca(2+) affinity of the N-domain in solution. From the ln K(obs) versus ln a(H)2(O), we obtained the number of water molecules (63.5 +/- 8.7) involved in the transition N <=>N:Ca(2) that corresponds to an increase in the exposed surface area of 571.5 +/- 78.3 A(2). In skinned fibers, the affinity for Ca(2+) was also reduced by glycerol, although the effect was much less pronounced than in solution. Our results demonstrate quantitatively that the stability of this protein and its affinity for Ca(2+) are critically dependent on protein hydration.

Although non-human primate models have been used previously to investigate the neurobiology of several sensory and cognitive developmental pathologies, they have been employed only sparingly to study the etiology of childhood psychopathologies for which deficits in social behavior and emotion regulation are major symptoms. Previous investigations of both adult human and non-human primates have indicated that primate social behavior and emotion are regulated by a complex neural network, in which the amygdala and orbital frontal cortex play major roles. Therefore, this review will provide information generated from the study of macaque monkeys regarding the timing of normal social and emotional behavior development, the normal pattern of anatomical and functional maturation of the amygdala and orbital frontal cortex, as well as information regarding the neural and behavioral effects of early perturbations of these two neural structures. We will also highlight 'critical periods' of macaque development, during which major refinements in the behavioral repertoire appear to coincide with significant neural maturation of the amygdala and/or orbital frontal cortex. The identification of these 'critical periods' may allow one to better predict the specific behavioral impairments likely to appear after neonatal damage to one or both of these neural areas at different time points during development. This experimental approach may provide a new and important way to inform and stimulate research on childhood psychopathologies, such as autism, schizophrenia and Williams syndrome, in which the development of normal social skills and emotional regulation is severely perturbed. Finally, the promise and limitations inherent to the use of non-human primate models of childhood psychopathology will be discussed.

The role of the amygdala in dyadic social interactions of adult rhesus monkeys (Macaca mulatta) was assessed after bilateral ibotenic acid lesions. Social, nonsocial, and spatial behaviors of amygdalectomized and control monkeys were assessed in 3 dyadic experiments: constrained, unconstrained, and round robin. Lesions produced extensive bilateral damage to the amygdala. Across all experiments, the amygdalectomized monkeys demonstrated increased social affiliation, decreased anxiety, and increased confidence compared with control monkeys, particularly during early encounters. Normal subjects also demonstrated increased social affiliation toward the amygdalectomized subjects. These results indicate that amygdala lesions in adult monkeys lead to a decrease in the species-normal reluctance to immediately engage a novel conspecific in social behavior. The altered behavior of the amygdalectomized monkeys may have induced the increased social interactions from their normal companions. This is contrary to the idea that amygdalectomy produces a decrease in social interaction and increased aggression from conspecifics.