Peso al nacer de niños brasileños menores de dos años

Low birth weight is associated with increased risk of dying in the first year of life. This study was motivated by recent changes in the determination of birth weight patterns with the advent of the perinatal epidemiological transition. We analyzed data from the Brazilian National Survey of Demographic and Health of Children and Women including only children < 24 months. Prevalence of low birth weight in Brazil was 6.1%. Risk factors included female gender, residence in the South and Southeast geographic regions, low maternal education, and maternal smoking. The low birth weight profile changed, with higher prevalence in more economically developed regions, reflecting the neonatal epidemiological transition determined by changes in patterns of childbirth care and incorporation of perinatal life support technologies, in addition to the previously known biological risks associated with poverty and misinformation.El bajo peso al nacer tiene una gran relación con el riesgo de morir en el primer año de vida. Estudios muestran su asociación con problemas de desarrollo en la infancia y enfermedades en la vida adulta. Dada la importancia de este indicador, el objetivo de este estudio fue investigar los factores sociales, demográficos, biológicos y ambientales involucrados en su determinación. Se analizaron los datos de la Investigación Nacional de Demografía y Salud del Niño y de la Mujer (PNDS-2006), incluyendo solamente niños menores de 24 meses de vida. La prevalencia de bajo peso al nacer en Brasil fue de un 6,1%. Los factores de riesgo identificados fueron sexo femenino, residir en las macrorregiones Sur y Sudeste y ser hijo de madres con baja escolaridad o tabaquistas. Hubo cambios en el perfil de bajo peso al nacer, con mayor prevalencia en regiones más desarrolladas económicamente, reflejando la transición epidemiológica perinatal, caracterizada por cambios en los padrones de asistencia al parto e incorporación de los avances tecnológicos en la asistencia perinatal, además de factores de riesgo biológicos conocidos, asociados a la pobreza y a la desinformación.O baixo peso ao nascer tem grande relação com risco de morrer no primeiro ano de vida. Estudos mostram sua associação com problemas de desenvolvimento na infância e doenças na vida adulta. Dada a importância desse indicador, o objetivo deste estudo foi investigar os fatores sociais, demográficos, biológicos e ambientais envolvidos na sua determinação. Analisaram-se dados da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher (PNDS-2006), incluindo apenas crianças menores de 24 meses de vida. A prevalência de baixo peso ao nascer no Brasil foi de 6,1%. Os fatores de risco identificados foram sexo feminino, residir nas macrorregiões Sul e Sudeste e ser filho de mães com baixa escolaridade ou tabagistas. Houve mudanças no perfil do baixo peso ao nascer, com maior prevalência em regiões mais desenvolvidas economicamente, refletindo a transição epidemiológica perinatal, caracterizada por mudanças nos padrões de assistência ao parto e incorporação dos avanços tecnológicos na assistência perinatal, além de fatores de risco biológicos conhecidos associados à pobreza e à desinformação.Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Characteristic Potentials for Mesoscopic Rings Threaded by an Aharonov-Bohm Flux

Electro-static potentials for samples with the topology of a ring and penetrated by an Aharonov-Bohm flux are discussed. The sensitivity of the electron-density distribution to small variations in the flux generates an effective electro-static potential which is itself a periodic function of flux. We investigate a simple model in which the flux sensitive potential leads to a persistent current which is enhanced compared to that of a loop of non-interacting electrons. For sample geometries with contacts the sensitivity of the electro-static potential to flux leads to a flux-induced capacitance. This capacitance gives the variation in charge due to an increment in flux. The flux-induced capacitance is contrasted with the electro-chemical capacitance which gives the variation in charge due to an increment in an electro-chemical potential. The discussion is formulated in terms of characteristic functions which give the variation of the electro-static potential in the interior of the conductor due to an increment in the external control parameters (flux, electro-chemical potentials). Paper submitted to the 16th Nordic Semiconductor Meeting, Laugarvatan, Iceland, June 12-15, 1994. The proceedings will be published in Physica Scripta.Comment: 23 pages + 4 figures, revtex, IBM-RC1955

Missed opportunities in the diagnosis of pulmonary tuberculosis in children

In 52% of children with confirmed and probable tuberculosis the diagnosis could have been made earlier than it was. The main clinical clues which should have led to suspicion of tuberculosis were close adult contacts and previous recurrent respiratory tract infections

Symptom screening rules to identify active pulmonary tuberculosis: Findings from the Zambian South African Tuberculosis and HIV/AIDS Reduction (ZAMSTAR) trial prevalence surveys.

BACKGROUND: High tuberculosis (TB) burden countries should consider systematic screening among adults in the general population. We identified symptom screening rules to be used in addition to cough ≥2 weeks, in a context where X-ray screening is not feasible, aiming to increase the sensitivity of screening while achieving a specificity of ≥85%. METHODS: We used 2010 Zambia South Africa Tuberculosis and HIV/AIDS Reduction (ZAMSTAR) survey data: a South African (SA) training dataset, a SA testing dataset for internal validation and a Zambian dataset for external validation. Regression analyses investigated relationships between symptoms or combinations of symptoms and active disease. Sensitivity and specificity were calculated for candidate rules. RESULTS: Among all participants, the sensitivity of using only cough ≥2 weeks as a screening rule was less than 25% in both SA and Zambia. The addition of any three of six TB symptoms (cough <2 weeks, night sweats, weight loss, fever, chest pain, shortness of breath), or 2 or more of cough <2 weeks, night sweats, and weight loss, increased the sensitivity to ~38%, while reducing specificity from ~95% to ~85% in SA and ~97% to ~92% in Zambia. Among HIV-negative adults, findings were similar in SA, whereas in Zambia the increase in sensitivity was relatively small (15% to 22%). CONCLUSION: High TB burden countries should investigate cost-effective strategies for systematic screening: one such strategy could be to use our rule in addition to cough ≥2 weeks

Bridges over troubled waters: an interdisciplinary framework for evaluating the interconnectedness within fragmented domestic flood risk management systems

Diversification of strategies in Flood Risk Management (FRM) is widely regarded as a necessary step forward in terms of lessening the likelihood and magnitude of flooding, as well as minimizing the exposure of people and property, and in turn the disruption, economic damage, health impacts and other adverse consequences that ensue when floods occur. Thus, diversification is often heralded as an essential condition for enhancing societal resilience to flooding. However, an inevitable consequence of diversifying strategies and practices in FRM is that it can lead to fragmentation within FRM systems, in terms of the distribution of responsibilities between actors and governing rules enacted within different policy domains. This can prove detrimental to the effectiveness of FRM. Building upon the notion of fragmentation developed in legal and governance literature, this paper introduces the concept of ‘bridging mechanisms’, i.e. instruments that remedy fragmentation by enhancing interconnectedness between relevant actors through information transfer, coordination and cooperation. This paper develops a typology of both fragmentation and bridging mechanisms and analyzes their relations, partly drawing upon empirical research conducted within the EU ‘STAR-FLOOD’ project. In turn, this paper outlines a novel interdisciplinary methodological framework for evaluating the degree and quality of the interconnectedness within fragmented domestic FRM systems. A pragmatic, flexible and broadly applicable tool, this framework is both suited for academic purposes, as well as for practically oriented analysis and (re)development of fragmented FRM systems, and potentially other fragmented systems, within the EU and abroad

Transport Properties of a One-Dimensional Two-Component Quantum Liquid with Hyperbolic Interactions

We present an investigation of the sinh-cosh (SC) interaction model with twisted boundary conditions. We argue that, when unlike particles repel, the SC model may be usefully viewed as a Heisenberg-Ising fluid with moving Heisenberg-Ising spins. We derive the Luttinger liquid relation for the stiffness and the susceptibility, both from conformal arguments, and directly from the integral equations. Finally, we investigate the opening and closing of the ground state gaps for both SC and Heisenberg-Ising models, as the interaction strength is varied.Comment: 10 REVTeX pages + 4 uuencoded figures, UoU-002029

The use of a geographical information system (GIS) to evaluate the distribution of tuberculosis in a high-incidence community

CITATION: Beyers, N. et al. 1996. The use of a geographical information system (GIS) to evaluate the distribution of tuberculosis in a high-incidence community. South African Medical Journal, 86(1):40-44.The original publication is available at http://www.samj.org.zaObjective. To determine the geographical distribution of tuberculosis in the two Western Cape suburbs with the highest reported incidence of tuberculosis. Design. Descriptive illustrative study. Setting. Two adjacent Western Cape suburbs covering 2.42 km2 with a population of 34 294 and a reported tuberculosis incidence of > 1 000/100 000. Subjects. All patients notified as having tuberculosis over a 10-year period (1985-1994). Interventions. None. Outcome measure. The geographical distribution of the cases was determined using a geographical information system (GIS) and the National Population Census (1991). Results. One thousand eight hundred and thirty-five of the 5 345 dwelling units (34.3%) housed at least 1 case of tuberculosis during the past decade and in 483 houses 3 or more cases occurred. These cases were distributed unevenly through the community, with the tuberculosis incidence per enumerator subdistrict (ESD) varying from 78 to 3 150/100 000 population. Conclusion. In a small area with a high incidence of tuberculosis, the cases are spread unevenly through the community and there are certain houses where tuberculosis occurs repeatedly. This information should be used to direct health services to concentrate on certain high-risk areas.Publisher’s versio

The European Union approach to flood risk management and improving societal resilience: lessons from the implementation of the Floods Directive in six European countries

Diversity in flood risk management approaches is often considered to be a strength. However in some national settings, and especially for transboundary rivers, variability and the incompatibility of approaches can reduce the effectiveness of flood risk management. Placed in the context of increasing flood risks, as well as the potential for flooding to undermine the European Union's sustainable development goals, a desire to increase societal resilience to flooding has prompted the introduction of a common European Framework. This paper provides a legal and policy analysis of the implementation of the Floods Directive (2007/60/EC) in six countries; Belgium (Flemish Region), England, France, the Netherlands, Poland and Sweden. Evaluation criteria from existing legal and policy literature frame the study of the Directive and its impact on enhancing or constraining societal resilience by using an adaptive governance approach. These criteria are initially used to analyze the key components of the EU approach, before providing insight of the implementation of the Directive at a national level. Similarities and differences in the legal translation of European goals into existing flood risk management are analyzed alongside their relative influence on policy and practice. The research highlights that the impact of the Floods Directive on increasing societal resilience has been nationally variable, in part due to its focus on procedural obligations, rather than on more substantive requirements. Analysis shows that despite a focus on transboundary river basin management, in some cases existing traditions of flood risk management, have overridden objectives to harmonize flood risk management. This could be strengthened by requiring more stringent cooperation and providing the competent authorities in International River Basins Districts with more power. Despite some shortcomings in directly impacting flood risk outcomes, the Directive has positively stimulated discussion and flood risk management planning in countries that were perhaps lagging behind

Five-year follow-up of participants diagnosed with chronic airflow obstruction in a South African Burden of Obstructive Lung Disease (BOLD) survey

Background. A community-based prevalence survey performed in two suburbs in Cape Town, South Africa (SA), in 2005, using the international Burden of Obstructive Lung Disease (BOLD) method, confirmed a prevalence of chronic airflow obstruction (CAO) in 23.1% of adults aged &gt;40 years.Objectives. To study the clinical course and prognosis over 5 years of patients with CAO identified in the 2005 survey.Methods. Patients with CAO in 2005 were invited to participate. Standard BOLD and modified questionnaires were completed. Spirometry was performed using spirometers of the same make as in 2005.Results. Of 196 eligible participants from BOLD 2005, 45 (23.0%) had died, 8 from respiratory causes, 10 from cardiovascular causes and 6 from other known causes, while in 21 cases the cause of death was not known. On multivariate analysis, only age and Global initiative for Obstructive Lung Disease (GOLD) stage 4 disease at baseline were significantly associated with death. Of the 151 survivors, 11 (5.6% of the original cohort) were unavailable and 33 (16.8%) declined or had medical exclusions. One hundred and seven survivors were enrolled in the follow-up study (54.6%, median age 63.1 years, 45.8% males). Post-bronchodilator spirometry performed in 106 participants failed to confirm CAO, defined as a forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ratio of &lt;0.7, in 16 participants (15.1%), but CAO was present in 90. The median decline in FEV1 was 28.9 mL/year (interquartile range –54.8 - 0.0) and was similar between GOLD stages. The median total decline in FVC was 75 mL, and was significantly greater in GOLD stage 1 (–350 mL) than in stages 2 or 3 (–80 mL and +140 mL, respectively; p&lt;0.01). Fifty-eight participants with CAO in 2005 (64.4%) remained in the same GOLD stage, while 21 (23.3%) deteriorated and 11 (12.2%) improved by ≥1 stage. Only one-third were receiving any treatment for chronic obstructive pulmonary disease (COPD).Conclusions. The prevalence, morbidity and mortality of CAO and COPD in SA are high and the level of appropriate treatment is very low, pointing to underdiagnosis and inadequate provision of and access to effective treatments and preventive strategies for this priority chronic non-communicable disease