Socioeconomic inequalities in the use of outpatient services in Brazil according to health care need: evidence from the World Health Survey

<p>Abstract</p> <p>Background</p> <p>The Brazilian health system is founded on the principle of equity, meaning provision of equal care for equal needs. However, little is known about the impact of health policies in narrowing socioeconomic health inequalities. Using data from the Brazilian World Health Survey, this paper addresses socioeconomic inequalities in the use of outpatient services according to intensity of need.</p> <p>Methods</p> <p>A three-stage cluster sampling was used to select 5000 adults (18 years and over). The non-response rate was 24.7% and calibration of the natural expansion factors was necessary to obtain the demographic structure of the Brazilian population. Utilization was established by use of outpatient services in the 12 months prior to the interview. Socioeconomic inequalities were analyzed by logistic regression models using years of schooling and private health insurance as independent variables, and controlling by age and sex. Effects of the socioeconomic variables on health services utilization were further analyzed according to self-rated health (good, fair and poor), considered as an indicator of intensity of health care need.</p> <p>Results</p> <p>Among the 5000 respondents, 63.4% used an outpatient service in the year preceding the survey. The association of health services utilization and self-rated health was significant (p < 0.001). Regarding socioeconomic inequalities, the less educated used health services less frequently, despite presenting worse health conditions. Highly significant effects were found for both socioeconomic variables, years of schooling (p < 0.001) and private health insurance (p < 0.00), after controlling for age and sex. Stratifying by self-rated health, the effects of both socioeconomic variables were significant among those with good health status, but not statistically significant among those with poor self-rated health.</p> <p>Conclusions</p> <p>The analysis showed that the social gradient in outpatient services utilization decreases as the need is more intense. Among individuals with good self-rated health, possible explanations for the inequality are the lower use of preventive services and unequal supply of health services among the socially disadvantaged groups, or excessive use of health services by the wealthy. On the other hand, our results indicate an adequate performance of the Brazilian health system in narrowing socioeconomic inequalities in health in the most serious situations of need.</p

Polymorphisms in regulatory regions of Cyclooxygenase-2 gene and breast cancer risk in Brazilians: a case-control study

<p>Abstract</p> <p>Background</p> <p>Cyclooxygenase-2 (COX-2) is up-regulated in several types of cancer, and it is hypothesized that COX-2 expression may be genetically influenced. Here, we evaluate the association between single-nucleotide polymorphisms (SNPs) in the COX-2 gene (<it>PTGS2</it>) and the occurrence of breast cancer among Brazilian women.</p> <p>Methods</p> <p>The study was conducted prospectively in two steps: First, we screened the promoter region and three fragments of the 3'-untranslated region of <it>PTGS2 </it>from 67 healthy Brazilians to identify SNPs and to select those with a minor allele frequency (MAF) of at least 0.10. The MAF of these selected SNPs was further characterized in 402 healthy volunteers to evaluate potential differences related to heterogeneous racial admixture and to estimate the existence of linkage disequilibrium among the SNPs. The second step was a case-control study with 318 patients and 273 controls designed to evaluate <it>PTGS2 </it>genotype- or haplotype-associated risk of breast cancer.</p> <p>Results</p> <p>The screening analysis indicated nine SNPs with the following MAFs: rs689465 (0.22), rs689466 (0.15), rs20415 (0.007), rs20417 (0.32), rs20419 (0.015), rs5270 (0.02), rs20424 (0.007), rs5275 (0.22) and rs4648298 (0.01). The SNPs rs689465, rs689466, rs20417 and rs5275 were further studied: Their genotypic distributions followed Hardy-Weinberg equilibrium and the MAFs were not affected by gender or skin color. Strong linkage disequilibrium was detected for rs689465, rs20417 and rs5275 in the three possible pairwise combinations. In the case-control study, there was a significant increase of rs5275TC heterozygotes in cases compared to controls (OR = 1.44, 95% CI = 1.01-2.06; P = 0.043), and the haplotype formed by rs689465G, rs689466A, rs20417G and rs5275C was only detected in cases. The apparent association with breast cancer was not confirmed for rs5275CC homozygotes or for the most frequent rs5275C-containing haplotypes.</p> <p>Conclusions</p> <p>Our results indicate no strong association between the four most frequent <it>PTGS2 </it>SNPs and the risk of breast cancer.</p

Non-structural carbohydrates mediate seasonal water stress across Amazon forests

Non-structural carbohydrates (NSC) are major substrates for plant metabolism and have been implicated in mediating drought-induced tree mortality. Despite their significance, NSC dynamics in tropical forests remain little studied. We present leaf and branch NSC data for 82 Amazon canopy tree species in six sites spanning a broad precipitation gradient. During the wet season, total NSC (NSCT) concentrations in both organs were remarkably similar across communities. However, NSCT and its soluble sugar (SS) and starch components varied much more across sites during the dry season. Notably, the proportion of leaf NSCT in the form of SS (SS:NSCT) increased greatly in the dry season in almost all species in the driest sites, implying an important role of SS in mediating water stress in these sites. This adjustment of leaf NSC balance was not observed in tree species less-adapted to water deficit, even under exceptionally dry conditions. Thus, leaf carbon metabolism may help to explain floristic sorting across water availability gradients in Amazonia and enable better prediction of forest responses to future climate change

Production and characterization of chitosan microparticles containing papain for controlled release applications

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)The production and modification of chitosan microparticles using crosslinking agents and papain were evaluated for controlled release applications. Chitosan microparticles were produced and crosslinked with sodium tripolyphosphate (TPP) 10% (w/v) solution or glutaraldehyde (GLU) 0.75% (w/w), with subsequent papain sorption. Microparticles were characterized by Fourier transformed infrared spectroscopy (FTIR) for chemical modifications, scanning electron microscopy (SEM) for morphology and X-ray diffraction (XRD) for crystallographic analysis. Chemical composition and the thermal stability of the material were characterized by thermogravimetric analysis (TGA) and differential scanning calorimetry (DSC). It was observed that the presence of TPP and papain resulted in a decrease of the stability of the chitosan matrix. Papain release rates from the microparticles were also conducted in vitro. The amount of released papain in phosphate buffer (pH = 7.4) was analyzed with UV-spectroscopy, showing release profiles of enzymatic activity ranging from 0.006 to 0.011 mu mol.min(-1). The results indicate that both chitosan-TPP-papain and chitosan-GLU-papain microparticles can successfully be used for systems that aim at a controlled release of papain with potential use in the biomedical area. (C) 2010 Elsevier B.V. All rights reserved.205416996570Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)FAEPEX-UNICAMPCoordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Bioactive Polyelectrolyte Multilayers: Hyaluronic Acid Mediated B Lymphocyte Adhesion

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)A strategy was developed to produce thin, biopolymer-based polyelectrolyte multilayer films, based on hyaluronic acid and chitosan, that are able to effectively bind B lymphocytes. These films explore CD44-hyaluronate interactions and provide a method to make surface-bound B cell arrays without the need for nonselective covalent chemistry. The rational design of these films using solution deposition variables, such as ionic strength and pH, allows one to maximize and fine tune this binding efficiency ex vivo. This work suggests two important conditions for successfully attaching B cells to hyaluronate-containing polyelectrolyte multilayer films: (1) hyaluronic acid is required for the proposed CD44-mediated binding mechanism, and (2) hyaluronic acid deposition conditions that favor loops and tails, such as low pH and with added salt, result in more available CD44 binding ligands and higher cell binding efficiency. Chitosan-terminated films prepared without NaCl in the deposition solutions and hyaluronic acid-terminated films prepared with salt, both under pH 3.0 assembly conditions, presented a similar high lymphocyte binding efficiency. In the former case, however, the binding strength was weaker due to a significant electrostatic contribution to the binding. Bioactive polyelectrolyte multilayers for selective binding of lymphocytes hold great promise in fields ranging from cell-based biosensors to immune system engineering.11924072414National Science Foundation [DMR-0819762]Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)National Science Foundation [DMR-0819762]CAPES [1101-08-0