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This aim of this study was to compare the characteristics of metabolic syndrome (MetS) in a Brazilian and an Italian population. The subjects were non-diabetic men and women aged 40-74 years from population-based surveys: 1242 from Brazil and 1198 from Italy. Logistic regression models were used to compare adjusted prevalence rates and make a discrimination analysis to distinguish the subjects with a diagnosis of MetS in the two groups. Dyslipidemia [low high-density lipoprotein (HDL)-cholesterol] and impaired fasting glucose were more prevalent among the Brazilians, and increased blood pressure and abdominal obesity (in men) among the Italians. Generally, the Italians showed higher prevalence of overall obesity and high pulse-pressure, and the Brazilians had higher prevalence of metabolic markers of insulin resistance. Among the subjects with the syndrome, HDL-cholesterol was the most discriminant factor, followed by plasma uric acid levels (which were higher in the Brazilians). The Italian men had a larger waist circumference and the Italian women higher body mass index values than the Brazilians. Italians had higher systolic and lower diastolic pressure values. The patterns of the metabolic alterations seemed to be more linked to insulin resistance among Brazilian subjects, whereas obesity seemed to play a more important role among the Italians. Although they are not sufficient to support the hypothesis of differences in the underlying pathophysiological processes between these groups, our results illustrate the difficulty of using a single unifying definition of MetS, and suggest that different benefits may be obtained from treatments targeting obesity, blood pressure or insulin resistance.

Objective: To study the relationship between behavioural factors, body adiposity and muscle mass., Subjects and Methods: A total of 1415 Italian individuals (705 men and 710 women) aged 40-74 years from a population-based survey carried out in the town of Bollate (Milan). Analysis of covariance was used to refine and improve the precision of the comparisons., Results: Men: Smoking and sedentary behaviour were related to larger waist circumference (WC) and smaller hip circumference (HC). Increased WC was also associated with high-fat diet and moderate-to-heavy drinking (compared to light drinkers). Those more educated (completed high school) were leaner and ex-smokers had higher body mass index (BMI) than non-smokers. Women: BMI was inversely related with education, the more educated having also lower muscle mass. The light drinkers were leaner and moderate-to-heavy drinkers had less muscle mass than abstainers. Moderate-to-heavy drinkers had larger WC than light drinkers. A strong negative trend was found in the relationship between dietary fibre and WC. Overall adiposity (BMI) and, more weakly, HC and peripheral subcutaneous fat increased with more TV watching, whereas BMI lowered, together with WC and muscle mass (as measured by the mid-arm circumference), with more walking/cycling., Conclusions: Modifiable habits such as smoking (men) and moderate-to-heavy alcohol drinking are associated with a pattern that is particularly deleterious to health: increased intra-abdominal fat and less muscle mass. Prevention strategies should be simultaneously aimed at promoting physical activities and reducing sedentary behaviours. A low-fat, fibre-rich diet seems to be closely related to a healthy distribution of body fat.

Mouse CD1d-restricted NKT cells, including invariant (i)NKT cells, are innate cells activated by glycolipid Ags and play important roles in the initiation and regulation of immune responses. Through their ability to promptly produce large amounts of Th1 and/or Th2 cytokines upon TCR engagement, iNKT cells exert crucial functions in the immune/inflammatory system during bacterial, protozoan, fungal, and viral infections. However, their roles during metazoan parasite infection, which are generally associated with strong Th2 responses, still remain elusive. In this study, we show that during the course of murine schistosomiasis, iNKT cells exhibit an activated phenotype and that following schistosome egg encounter in the liver, hepatic iNKT cells produce both IFN-gamma and IL-4 in vivo. We also report that schistosome egg-sensitized dendritic cells (DCs) activate, in a CD1d-dependent manner, iNKT cells to secrete IFN-gamma and IL-4 in vitro. Interestingly, transfer of egg-sensitized DCs promotes a strong Th2 response in recipient wild-type mice, but not in mice that lack iNKT cells. Engagement of TLRs in DCs is not necessary for iNKT cell stimulation in response to egg-sensitized DCs, suggesting an alternative pathway of activation. Finally, we propose that self, rather than parasite-derived, CD1d-restricted ligands are implicated in iNKT cell stimulation. Taken together, our data show for the first time that helminths can activate iNKT cells to produce immunoregulatory cytokines in vivo, enabling them to influence the adaptive immune response.

Purpose: To estimate dental caries prevalence and severity among all 12- and 13-year-old schoolchildren enrolled in a public school in 2005 and to establish comparisons with the results of studies previously conducted in the same school in 1971, 1997 and 2002., Methods: A cross-sectional study involving 190 children was carried out. A single calibrated examiner collected the clinical data according to the World Health Organization (1997) criteria., Results: The response rate was 90.0%. Between 1971 and 2005, the observed reduction in caries prevalence was 58.2%, whereas the mean DMFT Index declined from 9.2 to 0.8, which corresponds to a reduction of 91.3%. The significant caries index (SiC) reduced from 3.4 (CI 95% 3.0-3.8) in 2002 to 2.2 (CI 95% 1.8-2.5) in 2005., Conclusion: This study indicates an actual decline in dental caries prevalence and severity among the schoolchildren during the studied period, even though different diagnostic criteria were used.

Circadian variation in cell proliferation of the jejunal epithelium of 18-day-old rats was studied using the 2-h arrested metaphase score and crypt isolation method. A continuous decrease in the arrested metaphases occurred from 07.00 h to 13.00 h. From 17.00 h arrested metaphase values increased and were maintained at the higher level during the dark period as showed by Cosinor analyses (P < 0.05). These results indicate that in the young rat there is already a circadian variation in jejunal epithelial cell proliferation as early as 18 days. We can even suggest that the presence of a circadian rhythm at weaning contributes to the steady state of cell proliferation in the intestinal epithelium observed in adult life.

Unlabelled: The two main forms of hereditary colorectal cancer are familial adenomatous polyposis (FAP) and hereditary nonpolyposis colorectal cancer (HNPCC). Some families do not meet all the diagnostic criteria for HNPCC or FAP and are classified as familial colorectal cancer (FCC). Little information is available on the spectrum of tumors related to HNPCC and FCC in South America., Objective: To describe the frequency of malignant tumors in a group of Brazilian families with HNPCC or FCC in an Institutional Hereditary Colorectal Cancer Registry., Material and Methods: The study included 61 families (29 HNPCC and 32 FCC) between January 1998 and June 2001. HNPCC families were clinically classified according to the Amsterdam Criteria I or II. FCC families were characterized by the presence of at least two individuals with CRC or extra-colonic tumors associated with the HNPCC spectrum, at least one of them being under 50 years of age., Results: In the 29 families with HNPCC, 201 patients with cancer were identified among 1241 individuals (589 men and 652 women). Among the 201 patients 223 tumors were observed: 137 CRC (55 in men and 82 in women) and 86 extra-colonic (37 in men and 49 in women). In the 32 families with FCC, 146 patients with cancer were identified among 1053 individuals (505 men and 548 women); 158 tumors were observed in 146 patients, 75 CRC (33 in men and 42 in women) and 83 extra-colonic tumors (47 in men and 36 in women). The most frequent extra-colonic primary sites among the HNPCC families were: endometrium (26.5%) and breast (26.5%) (women), and stomach (35.1%) (men). Among the FCC families, the most common primary sites were: breast (27.8%) (women), and stomach (44.4%) (men)., Conclusion: The high frequency of endometrial and gastric cancer found was expected, since these tumors are part of the HNPCC spectrum, but the high frequency of breast cancer requires further molecular investigation to determine a possible hereditary predisposition associated with hereditary CRC.

Objective: To describe the food consumption patterns of Italian elderly subjects and the factors associated with different dietary habits., Design: Cross-sectional study., Setting: Population-based study., Subjects: A total of 847 men and 1465 women aged 65 y or older, living in rural areas in the province of Pavia (Northern Italy) and near Cosenza (Southern Italy) in 1992-1993., Interventions: The dietary information was collected by means of a quantitative food-frequency questionnaire, with cluster analysis being used to segregate the subjects on the basis of similarities in their food consumption. A generalised logistic regression model including residence, age, living status, education, physical activity and degree of disability was fitted to assess the factors associated with different food consumption habits., Results: Six dietary clusters were selected for men and seven for women. The largest cluster for both genders was "small eaters" (46% of men and 51% of women); "big eaters", "light diet" and "alcohol" clusters were also identified for both genders. The men were also grouped into "balanced diet" and "cheese" clusters, and the women into "sweet", "greens" and "butter" clusters., Conclusions: In addition to the influence of the area of residence--residents in Northern Italy consume greater amounts of animal fats, sugar and alcoholic beverages, and those living in Southern Italy have a greater intake of fruit, vegetables, fish and olive oil--all of the other studied variables predicted the probabilities of falling into a specific dietary cluster., Sponsorship: National Research Council (Italy)--Invecchiamento Project No. 95.01048. PF40.

Objective: To describe the nutritional profiles of the food consumption patterns identified in an elderly Italian rural population., Design: Cross-sectional study., Setting: : Population-based study., Subjects: A total of 847 men and 1465 women aged 65 y or older, resident in rural areas in the province of Pavia (Northern Italy) and near Cosenza (Southern Italy) in 1992-1993., Interventions: A cluster analysis segregated the subjects into six groups for men and seven for women on the basis of similarities in their food intake (see companion paper). The mean daily energy, macronutrient, mineral and vitamin intakes were calculated for the sample as a whole and for each cluster, and then compared with the age- and gender-specific recommended daily allowances for the Italian population., Results: The largest cluster ("small eaters", which included about half of the population) had an insufficient intake of essential fatty acids, calcium, potassium, zinc (men), iron (women), thiamin, riboflavin, niacin, beta-carotene, and vitamins A, D and E. The most noticeable characteristics of some of the other clusters were a high intake of fats, a high proportion of total energy provided by sugars, a high intake of vitamin C, folic acid and beta-carotene, and a high alcohol consumption. Furthermore, sodium intake was too high in all of the clusters and vitamin D intake was generally inadequate., Conclusions: The dietary habits of elderly Italians living in rural areas combine elements of the Mediterranean and "wealthy" diets., Sponsorship: National Research Council (Italy) - Invecchiamento Project no. 95.01048.PF40.

Objective: To monitor and describe the time trends of the HIV epidemic among intravenous drug users (IDU) attending drug dependence treatment centres (DDTC) in Northern Italy., Design: A cohort of all seronegative IDU attending DDTC in Lombardy between 1993 and 1999; all had been tested for HIV at least twice. Periodic sample interview surveys were done to assess risk behaviours., Methods: The incidence rates of HIV infection were calculated using the person-year (PY) method and expressed as the number of cases per 1000 PY at risk. Background HIV prevalence was calculated by dividing the number of positive cases by the total number of IDU tested at all DDTC in Lombardy., Results: Between 1993 and 1999, 135 seroconversions occurred in 7945 subjects followed for 19 671 PY, yielding an incidence rate of 6.9/1000 PY. Ninety seroconversions occurred among the 6563 males and 45 seroconversions among 1382 females (incidence rates 5.5 and 14.0, respectively). Among the males, the incidence of HIV was 4.5 in those aged less than 25 years and 5.8 in those aged 25 years or more. Among the females, the corresponding figures were 21.1 and 10.3. HIV prevalence decreased over time, and it was higher among females. Sexual behaviours at risk were more common among females., Conclusions: The incidence of HIV infection among IDU in Northern Italy was stable between 1993 and 1999. The higher incidence and prevalence among females and the different prevalence of risk behaviours between genders suggest an increasing role of heterosexual transmission.

A population study to estimate the prevalence of dementia was carried out amongst the residents of four rural towns near Pavia in northern Italy. The population included a 40% sample of the residents between 65 and 69 years old and all residents of 70 years old or older. A door-to-door neuropsychological screening was followed by neurological examination on individuals scoring low at the screening. Of the 1670 subjects who completed the screening, 42.3% scored under the cut-off point. The prevalence of cognitive deficit was higher in women, even accounting for age. Of those who scored under the cut-off point, 336 underwent neurological examination, yielding a prevalence of dementia of 15% (from 1.6% between the ages of 65 and 69; 35% at the age of 85) in women and 5% (from 7% between the ages of 75 and 79; 27% at the age of 85 or more) in men.

Ophthalmological studies often deal with correlated binary outcome variables. We propose a weighted logistic regression method to account for the intraclass correlations between eyes. Using simulation studies, we compared this method with two standard logistic regression approaches: a) based on eyes as the unit of analysis and b) treating individuals classified as cases if at least one eye is affected. The considered approaches were evaluated in terms of type I error, power and estimation properties. The simulation results reveal that the subject-based approach can lead to substantial bias in regression coefficient estimates when the correlation between eyes is heterogeneous across groups or when it is low, and that power is directly affected by this bias. Furthermore, the standard eye-based approach, which ignores intrasubject correlations, leads to inflated type I error rates. The proposed weighted approach performed well in all of the situations considered. This is a simple method which can be implemented using any current statistical or epidemiological package that includes logistic regression analysis.

This is an exploratory descriptive study about Nurse Supervision Pattern (NSP) performed in Feira de Santana-Bahia-Brazil, in 1994, which aims at describing supervision pattern and identifying interference factors. A questionnaire and descriptive statistics have been used. Supervision pattern proved that the kind of hospital is a factor that interferes on NSP. Based on literature, percentual exam of results and author's professional experience, it asserted that sex, academic graduation, earnings, health politics, planning and technical administrative structure are conditional factors for NSP, as well as lack of professional autonomy, interference of political parties, deficiency of material and human resources, low salaries, unsuitable environment and unsatisfactory interpersonal relationships mentioned by the subjects.

The analysis concerns data from the Northern Italian Seronegative Drug Addicts Study, a multicenter longitudinal study about the incidence of human immunodeficiency virus infection in intravenous drug users from Milan and other areas of northern Italy between 1987 and 1991. Different measures of parenteral and heterosexual exposure effects were estimated by fitting multiplicative models for rate ratio and additive models for both rate ratio and rate difference into a Poisson regression model for grouped cohort data. In areas of high human immunodeficiency virus prevalence among intravenous drug users, the adjusted rate ratio under a multiplicative structure was 6.2 (95% likelihood-based confidence interval (LCI) 2.9-14.4) for parenteral and 2.9 (95% LCI 1.3-6.1) for sexual transmission. Under the additive model, the rate ratio was 7.8 (95% LCI 3.4-20.2) for parenteral and 9.2 (95% LCI 2.2-29.7) for sexual transmission, and the rate difference per 100 person-years was 9.8 (95% LCI 5.3-15.6) for parenteral and 10.5 (95% LCI 1.8-24.2) for sexual transmission (controlled for each other). Because of the small sample size, a clear discrimination between models could not be reached. However, in spite of the greater risk associated with parenteral transmission under a multiplicative model, the additive model suggests that the relative impact of measures aimed at inducing condom use is similar to that which would be obtained by measures aimed at stopping syringe sharing.

To compare the efficiency of male-to-female and female-to-male sexual transmission of human immunodeficiency virus (HIV), we studied 524 female partners of HIV-infected men and 206 male partners of HIV-infected women in 16 Italian clinical centers. All of the partners had had a sexual relationship with the index case lasting for at least 6 months and presented no other risk factor than sexual exposure to the HIV-infected partner. Among the 730 couples, 24% of the female partners were HIV positive, in comparison with 10% of the male partners. Using logistic regression analysis, including gender and controlling for condom use, frequency of intercourse, anal sex, partner's CD4+ cell count and clinical stage, sexually transmitted diseases, genital infections, and contraceptive use, we found that the efficiency of male-to-female transmission was 2.3 (95% confidence interval = 1.1-4.8) times greater than that of female-to-male transmission. Between-gender differences in the contact surfaces and the intensity of exposure to HIV during sexual intercourse are possible reasons for the difference in efficiency of transmission.

During the XVIIIth and XIXth centuries, travelers that studied natural history were referred to as travel naturalists. Nature included the stars and planets, the atmosphere, flora and fauna, and surface and underground minerals. While in colonial times they were limited to citizens of Portugal who were instructed to discover natural resources and their uses, those who traveled through Brazil after 1808 came from different regions of Europe and were concerned with observing and classifying people and natural specimens found along the way. Sponsored by either noblemen or scientific societies, they traveled around Brazil in a combined endeavor of discovering, collecting, and classifying natural specimens on the American continent.

In clinical trials aimed at assessing the efficacy of drugs after coronary artery grafting, statistical analysis is usually carried out on a per-patient basis and on a per-graft basis. Owing to the independence of responses among patients, the former outcome is analyzed by assuming a binomial model. However, this model cannot be directly adopted in analyzing the latter outcome because multiple vein grafts in the same patient do not act independently. It has been suggested that patients be considered as clusters of distal anastomoses, subsequently comparing the frequencies of occlusion under different treatments after adjusting the variance of each frequency for the size of the cluster. Alternatively, one can measure the intraclass (intrapatient) correlation coefficient and adopt distribution functions that include this quantity as one of the parameters. This approach has been adopted by many authors although the studies differed in the statistical model used to represent this kind of data. Two probability functions, Altham's and beta-binomial, have found wide application in different biomedical fields. Both are able to model the extrabinomial variability since their tails tend to zero more slowly than those of the binomial distribution. An alternative to adopting a specific probabilistic model consists of specifying a mixed model or a Markov-like susceptibility model. These models follow the same rationale since they assume the existence of two processes, one that causes an individual to become susceptible to occlusion, the other that determines the subsequent probability of occlusion in the individual. After presenting these models in a unified framework, this paper compares the estimates obtained by fitting the models to data gathered at coronary angiography 1 year after surgery by the SINBA group on a total of 847 saphenous vein anastomoses in 349 patients. Finally, the issue concerning the contribution of each patient to the effective sample size is discussed.

To evaluate the role of parenteral and sexual transmission of human immunodeficiency virus, we studied seronegative intravenous drug users recruited from 25 drug dependence treatment centers in northern Italy. All attending intravenous drug users were asked for their consent and screened for antibodies to human immunodeficiency virus; those who were seronegative were enrolled, interviewed about their habits, and invited to follow-up visits. Between 1987 and 1989, 1,195 seronegative intravenous drug users were enrolled, 635 were followed up (mean duration, 11.9 months), and 35 seroconversions were observed. The incidence rate ratios were 3.3 (95% confidence interval (CI) 1.4-7.5) for subjects aged less than 20 years, 2.4 (95% CI 1.2-4.7) for less than 2 years of intravenous drug use, 2.2 (95% CI 0.9-5.5) for syringe sharing, and 1.0 for subjects with a sexual partner who had tested positive for human immunodeficiency virus. A case-control approach, using logistic regression and adjusting for sex, age, area, and prevalence, showed odds ratios of 13.2 (95% CI 3.1-56.8) for frequent syringe sharing and 4.0 (95% CI 1.5-10.4) for sexual contacts with seropositive partners; frequent use of condoms was associated with a reduction in risk that did not reach statistical significance. Parenteral transmission is the most important route of infection with the human immunodeficiency virus among intravenous drug users, and sexual transmission plays a relevant, additive role.

To assess the incidence and time trends of human immunodeficiency virus (HIV) infection among intravenous drug users (IVDUs) and to evaluate the opportunities for prevention, we studied IVDUs recruited from 23 drug dependence treatment centers in Milan and Northern Italy. Participants were screened for HIV antibodies, and seronegative subjects were enrolled. A preventive intervention, based on counseling and HIV antibody testing, was done, and participants were invited to the centers for follow-up visits. We enrolled 1,532 subjects between 1 January 1987 and 31 October 1990, and we observed 901 subjects for an average of 15.9 months. Forty-one cases of HIV infection occurred, giving a seroconversion rate of 6.1% in 1987, 4.1% in 1988, 2.2% in 1989, and 1.6% in 1990. HIV prevalence decreased from 54% in 1986 to 49% in 1989. Incidence rates were higher in areas with high prevalence. During follow-up, 35 to 55% of the subjects stopped injecting heroin intravenously altogether, and those who did not stop decreased the frequency of syringe sharing. This is probably the reason for the decline in seroconversion rates, while the apparent decline in prevalence may be due to the entry of new seronegative individuals and/or to differential withdrawal of HIV-positive individuals from the IVDU population to the heterosexual (non-IVDU) population.

Associations between socio-demographic factors, water contact patterns and Schistosoma mansoni infection were investigated in 506 individuals (87% of inhabitants over 1 year of age) in an endemic area in Brazil (Divino), aiming at determining priorities for public health measures to prevent the infection. Those who eliminated S. mansoni eggs (n = 198) were compared to those without eggs in the stools (n = 308). The following explanatory variables were considered: age, sex, color, previous treatment with schistosomicide, place of birth, quality of the houses, water supply for the household, distance from houses to stream, and frequency and reasons for water contact. Factors found to be independently associated with the infection were age (10-19 and > or = 20 yrs old), and water contact for agricultural activities, fishing, and swimming or bathing (Adjusted relative odds = 5.0, 2.4, 3.2, 2.1 and 2.0, respectively). This suggests the need for public health measures to prevent the infection, emphasizing water contact for leisure and agricultural activities in this endemic area.

A cross-sectional study of anthropometric measures and their association with socioeconomic variables, infection by Schistosoma mansoni, intensity of infection and splenomegaly was carried out in an endemic area for schistosomiasis in Brazil (Comercinho), using multiple logistic regression methods. Eighty-seven per cent of all 1.5-14.4 year-old children in the area participated in the study. Children below the 5th percentile (USA Ten State Survey) for height-for-age, weight-for-age and arm muscle area-for-age were compared to those greater than the 5th percentile. There was no association between low anthropometric measures and schistosomiasis or socioeconomic variables in children under five years of age. For the 4.4-14.4 year-old children, poor condition of the heads of family and poorer housing were independently associated with low height and arm muscle area. Heavy excretion of S. mansoni eggs (greater than or equal to 500 epg) was related to low height, and splenomegaly was the variable which showed the strongest association with low height, weight and arm muscle area (odds ratios adjusted for socioeconomic variables were 6.4, 3.5 and 3.7 respectively). This indicates that there is a biological component for low anthropometric measures in the severe form of schistosomiasis and this reinforces the need for public health measures to prevent the development of splenomegalies in endemic areas.