Search

The centrifugation of bovine sperm in the 45-90% Percoll gradient is a technique used in in vitro fertilization. The objectives of the study were: to determine the percentages of sperm with positive endosmosis (PE) and negative (NE), individual motility (IM), viability (alive and dead) and normal head and tail morphology at different centrifugation times. The HOST test was used for cell endosmosis, the eosinnigrosin staining for viability and the Minitube Spermac staining for the morphology. Four treatments were evaluated with six repetitions: thawed and centrifuged semen in 45-90% Percoll gradient for 5, 10 and 15 minutes and thawed semen only (control). For the HOST test, the percentages of PE for the 15, 10 and 5 minute centrifugation times were similar with values of 73.92%, 75.19% and 73.63% respectively, however, these differ from the control with 65.11% (P=0.05); the IM percentages for the 15, 10 and 5 minute centrifugation times were 92.00%, 93.00% and 91.50%, being similar to each other, but these differ from the control with 69.5% (P=0.05). The viability was 71.32%, 71.42% and 73.56% for the times of 15, 10 and 5 minutes respectively and they differed from the control with 56.63% (P=0.05). In normal head and tail morphology, there were no significant differences (P>0.05) with values higher than 92% and 82% respectively. It is concluded that centrifugation during 5, 10 or 15 minutes when performing the 45-90% Percoll gradient, does not affect the integrity of the plasma membrane of bovine sperm. [ABSTRACT FROM AUTHOR]

This article aims to show how incorrect ideas about COVID-19 were promoted by physicians in Brazil, contributing to a catastrophic response at the cost of hundreds of thousands of lives, and to examine the implications of this episode for the social studies of science, technology and medicine. The literature on the relationship between science and society takes two broad approaches, which are sometimes at odds with each other: (i) there is a traditional critique of science that points to unsupported claims of certainty and thus undue interference in general human affairs; (ii) there are many examples of attempts to undermine reasonable scientific claims, when they clash with economic and/or political interests of certain groups. Navigating those extremes is particularly critical in situations in which accurate knowledge is necessary for intervening in people's lives, as is the case in health-related issues. Determining who has actual epistemic expertise is a key factor in solving this conundrum. This became painfully clear during the unfolding of the COVID-19 pandemic, which highlighted the uncertainties of science in guiding decisions being made in real time, and provided opportunities for many forms of disinformation and conspiracy theories that hampered public health measures and promoted useless or even dangerous "treatments". This article discusses an instructive example of such developments in the chaotic response to the pandemic challenge in Brazil, which saw, among other unfortunate situations, physicians aligned with the denialist federal government advocating for unproven - or proven as ineffective - treatments and disseminating unfounded doubts about vaccines. Presumed expertise on the basis of professional training clearly did not translate into actual expertise in the necessary domains to ascertain the validity of such claims and scientific advice was overridden by ideology., Competing Interests: Declaration of conflicting interestsThe author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Given the time and monetary costs associated with traditional analytical chemistry, there remains a need to rapidly characterize environmental samples for priority analysis, especially within disaster research response (DR2). As PAHs are both ubiquitous and occur as complex mixtures at many National Priority List sites, these compounds are of interest for post-disaster exposures., Objective: This study tests the field application of the KinExA Inline Biosensor in Galveston Bay and the Houston Ship Channel (GB/HSC) and in the Elizabeth River, characterizing the PAH profiles of these region's soils and sediments. To our knowledge, this is the first application of the biosensor to include soils., Methods: The biosensor enables calculation of total free PAHs in porewater (C free), which is confirmed through gas chromatography-mass spectrometry (GC-MS) analysis. To determine potential risk of the collected soils the United States Environmental Protection (USEPA) Agency's Regional Screening Level (RSL) Calculator is used along with the USEPA Region 4 Ecological Screening Values (R4-ESV) and Refined Screening Values (R4-RSV)., Results: Based on GC-MS results, all samples had PAH-related hazard indices below 1, indicating low noncarcinogenic risks, but some samples exceeded screening levels for PAH-associated cancer risks. Combining biosensor-based C free with Total Organic Carbon yields predictions highly correlated (r > 0.5) both with total PAH concentrations as well as with hazard indices and cancer risks. Additionally, several individual parent PAH concentrations in both the GB/HSC and Elizabeth River sediments exceeded the R4- ESV and R4-RSV values, indicating a need for follow-up sediment studies., Conclusions: The resulting data support the utility of the biosensor for future DR2 efforts to characterize PAH contamination, enabling preliminary PAH exposure risk screening to aid in prioritization of environmental sample analysis., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Hurricane Harvey made landfall along the Texas Gulf Coast as a Category 4 hurricane on August 25, 2017, producing unprecedented precipitation that devastated coastal areas. Catastrophic flooding in the City of Houston inundated industrial and residential properties resulting in the displacement and transfer of soil, sediment, and debris and heightening existing environmental justice (EJ) concerns., Objectives: The primary aim of this study was to evaluate the presence, distribution, and potential human health implications of polycyclic aromatic hydrocarbons (PAHs) in a residential neighborhood of Houston, Texas following a major hurricane., Methods: Concentrations of PAHs in 40 soil samples collected from a residential neighborhood in Houston, Texas were measured. Spatial interpolation was applied to determine the distribution of PAHs. Potential human health risks were evaluated by calculating toxicity equivalency quotients (TEQs) and incremental excess lifetime cancer risk (IELCR)., Results: Total priority PAH concentrations varied across samples (range: 9.7 × 10 1 ng/g-1.6 × 10 4 ng/g; mean: 3.0 × 10 3 ng/g ± 3.6 × 10 3 standard deviation). Spatial analysis indicated a variable distribution of PAH constituents and concentrations. The IELCR analysis indicated that nine of the 40 samples were above minimum standards., Conclusions: Findings from this study highlight the need for fine scale soil testing in residential areas as well as the importance of site-specific risk assessment., Competing Interests: The authors declare no competing financial interests., (© Pure Earth 2021.)

Introduction: Interstitial lung disease (ILD) is a common comorbidity present in patients with systemic sclerosis (SSc). Employment of high-resolution computed tomography (HRCT) is very limited and lung ultrasound (LUS) can be an alternative tool for the early evaluation of ILD., Objective: To determine the validity of LUS in the early detection of ILD in patients with SSc., Methods: Sixty-eight patients with SSc ≥18 years without respiratory symptoms were included. A rheumatologist rated the subclinical respiratory condition, another rheumatologist blinded to the clinical assessment performed the LUS. To determine validity HRCT was performed as well., Results: Prevalence of ILD in SSc patients was 41.2% in contrast to the 4.8% healthy controls (P=.0001). Variables associated with LUS and HRCT findings were anti-centromere antibodies (P=.005) and the Rodnan skin score (P=.004). A positive correlation was present between the findings of HRCT and LUS (P=.001). Sensitivity and specificity were 91.2% and 88.6% respectively. Good reliability in the LUS findings was found between observers (k=.72)., Conclusions: By proving to be a valid, trustworthy and feasible alternative tool, we consider that LUS can be implemented for the early detection of ILD in SSc., (Copyright © 2019 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.)

Hurricane Harvey led to a broad redistribution of sediment throughout Galveston Bay and the Houston Ship Channel (GB/HSC), but the resulting changes in chemical contaminant distributions have yet to be characterized. To address this question, we collected and analyzed post-Harvey sediment for concentrations of the EPA 16 Priority Pollutant polycyclic aromatic hydrocarbon (PAHs), determining the extent to which the spatial distribution and sourcing of contaminants may have changed in contrast to historical surface sediment data (<5 cm) from the National Oceanic Atmospheric Administration (NOAA) available for the years 1996-2011. We found a small, but detectable increase from pre- to post-Harvey in PAH concentrations, with PAH diagnostic sourcing indicating combustion origins. Of the detected PAHs, none exceeded Sediment Quality Guideline values. Overall, we have added to the understanding of PAH spatial trends within the GB/HSC region, and developed a reference PAH baseline to inform future studies., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: The environmental health community needs transparent, methodologically rigorous, and rapid approaches for updating human health risk assessments. These assessments often contain reference values for cancer and/or noncancer effects. Increasingly, the use of systematic review methods are preferred when developing these assessments. Systematic evidence maps are a type of analysis that has the potential to be very helpful in the update process, especially when combined with machine-learning software advances designed to expedite the process of conducting a review., Objectives: To evaluate the applicability of evidence mapping to determine whether new evidence is likely to result in a change to an existing health reference value, using inhalation exposure to the air pollutant acrolein as a case example., Methods: New literature published since the 2008 California Environmental Protection Agency's Office of Environmental Health Hazard Assessment (OEHHA) Reference Exposure Level (REL) for acrolein was assessed. Systematic review methods were used to search the literature and screening included the use of machine-learning software. The Populations, Exposures, Comparators and Outcomes (PECO) criteria were kept broad to identify studies that characterized acute and chronic exposure and could be informative for hazard characterization. Studies that met the PECO criteria after full-text review were briefly summarized before their suitability for chronic point of departure (POD) derivation and calculation of a reference value was considered. Studies considered potentially suitable underwent a targeted evaluation to determine their suitability for use in dose-response analysis., Results: Over 15,000 studies were identified from scientific databases. Both machine-learning and manual screening processes were used to identify 60 studies considered PECO-relevant after full-text review. Most of these PECO-relevant studies were short-term exposure animal studies (acute or less than 1 month of exposure) and considered less suitable for deriving a chronic reference value when compared to the subchronic study in rats used in the 2008 OEHHA assessment. Thirteen epidemiological studies were identified but had limitations in the exposure assessment that made them less suitable for dose-response compared to the subchronic rat study. Among the 13 studies, there were four controlled trial studies that have the potential to be informative for future acute reference value derivation. Thus, the 2008 subchronic rat study used by OEHHA appears to still be the most appropriate study for chronic reference value derivation. In addition, advances in dosimetric modeling for gases, including new evidence pertinent to acrolein, could be considered when updating existing acrolein toxicity values., Conclusions: Evidence mapping is a very useful tool to assess the need for updating an assessment based on understanding the potential impact of new studies on revising an existing health reference value. In this case example, the focus was to identify studies suitable for chronic exposure dose-response analysis, while also identifying studies that may be important to consider for acute exposure scenarios, hazard identification, or for future research. This allows the evidence map to be a useful resource for a range of decision-making contexts. Specialized systematic review software increased the efficiency of the process in terms of human resources and time to conduct the analysis., (Published by Elsevier Ltd.)

In the 1950s, the psychosomatic medicine movement emerged in Brazil, led by psychiatrist and psychoanalyst Danilo Perestrello. This article analyzes the strategies developed to configure this proposal and establish this field of study. From the beginning, this movement was characterized by a plan to reformulate medicine based on psychoanalytic theory and obtain favorable reception in institutions. During his career, Perestrello published articles and books with the intention of establishing a new way of thinking among physicians and worked at strategic institutions. His withdrawal from professional work due to a serious illness in 1976 was a factor contributing to the fragmentation of the psychosomatic movement in Brazil.

This essay discusses the resurgence of anti-vaccine activism in recent years, based on relevant literature and the author's own experiences. After presenting possible reasons for the reemergence of such movements and their consequences, the author analyses the role of Internet-mediated communication in amplifying this discourse and making it less amenable to criticism, presenting some of the main arguments deployed by the anti-vaccine agents in their discussions. The text concludes with a draft of possible responses to this increasingly worrying phenomenon.

Polycyclic aromatic hydrocarbons (PAHs) are environmental contaminants associated with adverse human health outcomes. Environmental justice neighborhoods experience disproportionate environmental health risks. Hurricane Harvey made landfall on August 25, 2017, bringing record rainfall and catastrophic flooding to Houston, Texas, redistributing PAHs in residential soil. We aimed to describe PAH distributions in soil in the Manchester neighborhood of Houston, TX, and identify their potential sources. Soil samples were collected from 24 residential addresses and analyzed for 16 priority PAH concentrations using an accelerated solvent extractor. PAH distribution and source determination were conducted using spatial analysis and isomer ratios. All sample sites detected PAHs in soil, with the total mass ranging from 0.75 to 69.9 ng/g, which were predominantly four-ring structured PAHs. Total PAH concentrations were highest on the northeastern border of the neighborhood, whereas lower overall concentrations of PAHs were found on the southwestern border, at the highest elevation in the watershed. The ratio indeno[1,,3-cd]pyrene (IP) to indeno[1,,3-cd]pyrene plus benzo[ghi]perylene indicated vehicular combustion as the primary source in 19 of 23 samples. After heavy rainfall from Hurricane Harvey in the Manchester neighborhood, PAHs in soil were unevenly distributed throughout the neighborhood, with an accumulation of PAHs in the northeastern edges. Using isomer ratios and spatial analysis, the likely source of PAHs is from use of transportation infrastructure., Competing Interests: No competing financial interests exist., (Copyright 2019, Mary Ann Liebert, Inc., publishers.)

Objective: The aim of this study was to evaluate work ability and productivity in women who had undergone different types of surgical treatment for breast cancer, as well as breast reconstruction after mastectomy., Methods: This cross-sectional study assessed 152 women between 30 and 60 years of age, who worked outside the home in formal or informal jobs, or as self-employed. Thirty-eight of them had no history of breast cancer (control group), and 114 had undergone surgical treatment for breast cancer at least 1 year before their enrollment in the study, and were allocated as follows: mastectomy group (n = 38), breast-conserving surgery group (n = 38), or breast reconstruction breast reconstruction group (n = 38). The validated Brazilian versions of the Work Productivity and Activity Impairment-General Health questionnaire and Work Limitations Questionnaire were self-administered., Results: The groups were homogeneous regarding age, education level, and other sociodemographic characteristics. Patients in the mastectomy and breast-conserving surgery groups showed reduced work performance and productivity compared with women in the breast reconstruction and control groups (P = 0.0004 and P = 0.0006, respectively). In addition, women in the mastectomy group had more difficulty in performing activities of daily living compared with those in other groups (P = 0.0121)., Conclusions: Women who had undergone mastectomy or breast-conserving surgery had decreased work ability and productivity compared with women without a history of breast cancer and to those who had undergone breast reconstruction.

Introduction: Polycyclic aromatic hydrocarbons (PAHs) are complex environmental toxicants. Exposure to them has been linked to adverse health outcomes including cancer, as well as diseases of the skin, liver, and immune system. Based on an ongoing community engagement partnership with stakeholder groups and residents, we conducted a small longitudinal study to assess domestic exposure to PAHs among residents of Manchester, an environmental justice neighborhood located in the East End of Houston, TX., Methods: In December, 2016, we used fiber wipes to collect samples of household dust from 25 homes in Manchester. Following Hurricane Harvey, in September 2017, we revisited 24 of the 25 homes to collect soil samples from the front yards of the same homes. Wipes and soil were analyzed for the presence of PAHs using gas chromatography-mass spectrometry (GC-MS) methods. Principal component analysis plots, heatmaps, and PAH ratios were used to compare pre- and post-Hurricane Harvey samples., Results: While direct comparison is not possible, we present three methods for comparing PAHs found in pre-hurricane fiber wipes and post-hurricane soil samples. The methods demonstrate that the PAHs found before and after Hurricane Harvey are likely from similar sources and that those sources are most likely to be associated with combustion. We also found evidence of redistribution of PAHs due to extreme flooding associated with Hurricane Harvey., Discussion: Residents of the Manchester neighborhood of Houston, TX, are exposed to a range of PAHs in household dust and outdoor soil. While it was not possible to compare directly, we were able to use several methods to assess detected concentrations, changes in site-specific PAH allocations, and PAH origination. Additional research is needed to identify specific sources of domestic PAH exposure in these communities and continued work involving community members and policy makers should aim to develop interventions to reduce domestic exposure to and prevent negative health outcomes from PAHs.

We analyzed uncertainties and complexities of the Zika virus outbreak in Brazil, and we discuss risk reduction for future emergencies. We present the public health situation in Brazil and concurrent determinants of the epidemic and the knowledge gaps that persist despite building evidence from research, making public health decisions difficult. Brazil has adopted active measures, but producing desired outcomes may be uncertain because of partial or unavailable information. Reducing population group vulnerabilities and acting on environmental issues are medium- to long-term measures. Simultaneously dealing with information gaps, uncontrolled disease spread, and vulnerabilities is a new risk scenario and must be approached decisively to face emerging biothreats.

Membrane type 1-matrix metalloproteinase (MT1-MMP) is involved in numerous biological processes, including morphogenesis. However, the role of MT1-MMP in the development of the vertebrate intestine is poorly understood. This study aimed to evaluate the expression of MT1-MMP in the intestine of rats and chickens along the embryonic and postnatal periods using immunohistochemistry. Results revealed a remarkable spatiotemporal correlation between MT1-MMP expression and intestinal villi morphogenesis in both vertebrates. However, the villi morphogenesis process was found to be different in chickens to that of rats. Moreover, extensive MT1-MMP labeling was observed in the entire villus epithelium from birth until the complete maturation of the small intestinal mucosa in both vertebrates. From these results, we suggest that MT1-MMP contributes to intestinal development, particularly to villi morphogenesis, in both vertebrates. However, further studies are necessary to confirm the role of MT1-MMP in this cellular process. In addition, we performed validation of the primary antibody against human MT1-MMP for adult chickens., (Copyright © 2016 Elsevier GmbH. All rights reserved.)

Study Objective: An association between rapid repeat pregnancy (RRP; occurring within a birth interval of up to 24 months) and undesirable obstetric and perinatal outcomes has been shown, especially among adolescents and women without adequate schooling. The objective of this study was to evaluate the effect of the interaction between maternal schooling and age on the incidence of RRP. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: A nonconcurrent cohort study was carried out using probabilistic record linkage techniques. The 59,400 linked records of singleton live-born infants delivered in 2002 whose mothers were up to 29 years old and lived in Rio de Janeiro City were evaluated., Results: Compared with young adults with adequate schooling, the adjusted risk ratio for RRP for adolescents with inadequate schooling was 2.1 (95% confidence interval, 1.8-2.4). The attributable proportion was 0.16 (95% confidence interval, 0.02-0.29)., Conclusion: Young maternal age and inadequate schooling interact, increasing RRP., (Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.)

Context: The autosomal recessive form of microcephaly-chorioretinopathy syndrome is a rare genetic condition that is considered to be an important differential diagnosis with congenital toxoplasmosis., Case Report: Our patient was a seven-year-old white boy who was initially diagnosed with congenital toxoplasmosis. However, his serological tests for congenital infections, including toxoplasmosis, were negative. He was the first child of young, healthy and consanguineous parents (fourth-degree relatives). The parents had normal head circumferences and intelligence. The patient presented microcephaly and specific abnormalities of the retina, with multiple diffuse oval areas of pigmentation and patches of chorioretinal atrophy associated with diffuse pigmentation of the fundus. Ophthalmological evaluations on the parents were normal. A computed tomography scan of the child's head showed slight dilation of lateral ventricles and basal cisterns without evidence of calcifications. We did not find any lymphedema in his hands and feet. He had postnatal growth retardation, severe mental retardation and cerebral palsy., Conclusions: The finding of chorioretinal lesions in a child with microcephaly should raise suspicions of the autosomal recessive form of microcephaly-chorioretinopathy syndrome, especially in cases with an atypical pattern of eye fundus and consanguinity. A specific diagnosis is essential for an appropriate clinical evaluation and for genetic counseling for the patients and their families.

Public health is usually enacted through public policies, necessitating that the public engage in debates that, ideally, are grounded in solid scientific findings. Mistrust in science, however, has compromised the possibility of deriving sound policy from such debates, partially owing to justified concerns regarding undue interference and even outright manipulation by commercial interests. This situation has generated problematic impasses, one of which is the emergence of an anti-vaccination movement that is already affecting public health, with a resurgence in the United States of preventable diseases thought to have been eradicated. Drawing on British sociologist Harry Collins' work on expertise, we propose a theoretical framework in which the paralyzing, undue public distrust of science can be analyzed and, it is hoped, overcome.

Objectives: The objectives were to investigate the prevalence of adverse birth outcomes according to maternal age range in the city of Rio de Janeiro, Brazil, in 2002, and to evaluate the association between maternal age range and adverse birth outcomes using additive interaction to determine whether adequate prenatal care can attenuate the harmful effect of young age on pregnancy outcomes., Methods: A cross-sectional analysis was performed in women up to 24 years of age who gave birth to live children in 2002 in the city of Rio de Janeiro. To evaluate adverse outcomes, the exposure variable was maternal age range, and the outcome variables were very preterm birth, low birth weight, prematurity, and low 5-minute Apgar score. The presence of interaction was investigated with the composite variable maternal age plus prenatal care. The proportions and respective 95% confidence intervals were calculated for adequate schooling, delivery in a public maternity hospital, and adequate prenatal care, and the outcomes according to maternal age range. The chi-square test was used. The association between age range and birth outcomes was evaluated with logistic models adjusted for schooling and type of hospital for each prenatal stratum and outcome. Attributable proportion was calculated in order to measure additive interaction., Results: Of the 40,111 live births in the sample, 1.9% corresponded to children of mothers from 10-14 years of age, 38% from 15-19 years, and 59.9% from 20-24 years. An association between maternal age and adverse outcomes was observed only in adolescent mothers with inadequate prenatal care, and significant additive interaction was observed between prenatal care and maternal age for all the outcomes., Conclusion: Adolescent mothers and their newborns are exposed to greater risk of adverse outcomes when prenatal care fails to comply with current guidelines., (Copyright © 2012 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.)

Objectives: We investigated involvement and cooperation patterns of local Brazilian AIDS program actors and the consequences of these patterns for program implementation and sustainability., Methods: We performed a public policy analysis (documentary analysis, direct observation, semistructured interviews of health service and nongovernmental organization [NGO] actors) in 5 towns in 2 states, São Paulo and Pará., Results: Patterns suggested 3 models. In model 1, local government, NGOs, and primary health care services were involved in AIDS programs with satisfactory response to new epidemiological trends but a risk that HIV/AIDS would become low priority. In model 2, mainly because of NGO activism, HIV/AIDS remained an exceptional issue, with limited responses to new epidemiological trends and program sustainability undermined by political instability. In model 3, involvement of public agencies and NGOs was limited, with inadequate response to epidemiological trends and poor mobilization threatening program sustainability., Conclusions: Within a common national AIDS policy framework, the degree of involvement and cooperation between public and NGO actors deeply impacts population coverage and program sustainability. Specific processes are required to maintain actor mobilization without isolating AIDS programs.

The term "scientific medicine", ubiquitous in medical literature although poorly defined, can be traced to a number of assumptions, three of which are examined in this paper: that medicine is a form of knowledge-driven practice, where the established body of proven medical knowledge determines what doctors do; if what doctors do is either inadequate or ineffective, the chief reason is the absolute or relative lack of adequate knowledge for providing care for patients; evaluating medical practice boils down to comparing it to a set of standards which should be univocally applied to concrete situations. This paper intends to provide at least a tentative assessment of how does this set of assumptions fare in the real world of clinical care. The methodology was based on direct observation of medical consultations and independent evaluation by referees of data from of medical records. The review of the data shows a far more contingent relationship between handbook prescribed procedures and actual medical practice, even though the referees evaluated the reported data mostly with favorable scores. Furthermore, a few problems were observed relating to the inadequacy of the so-called biomedical model in dealing with some of the more prevalent health problems. The authors conclude that, more than any "technical inadequacies", it would seem that this study has underlined the limitations of the biomedical model in responding to the tasks it attributes to itself, an issue that has to be addressed more effectively by medical education, be it in terms of undergraduate or graduate schooling.

Background: Strict work timetables, personal and professional duties or an inability to be absent from home or work can all represent major constraints for those wishing to improve their professional skills. Within this context, the World Wide Web can allow people to conveniently follow distance courses from their homes., Objective: To present an experience in the use of the Web in the continuing education of healthcare professionals in Brazil., Methods: A Web-based distance education course in nutrition in public health was developed. The methodology was an adaptation of both problem-based and task-based learning. At the end of the course an evaluation questionnaire which covered the course s contents, the educational methodology and resources, the duration and schedule, and the use of the Web as a tool for distance education was given to the students., Results: There were 83 on line registrations from 13 states, 73 of the applicants were female, 62 had a degree in nutrition and 18 were physicians. From these; eleven students from ten states were chosen: nine female nutritionists, two female physicians, and one male physician. Seven students completed the course, took and passed the final exam. Of the other four students, two failed to follow the schedule, one had health problems, and one did not obtain the minimal score for sitting the final exam. The students had a mean age of 35, and a mean of ten years in practice. They all stated that they were unable to attend a regular course, even though they felt that they needed to improve their professional skills. Most of them studied seven days a week for between two and four hours a day. The students also felt that their professional skills had improved and each reported having made changes in their practice as a result of their participation. The students approved of the course s contents, methodology and resources, however they were divided about its duration. The Web as a tool in distance education was approved by the students. If it was not for the Web they could not have taken part in a continuing education program. All students said they would attend another virtual course, if available. Even though most of them did not have difficulty adapting to the virtual environment, they did feel that an adaptation period would be of value., Conclusions: A Web-based course may be more effective than other distance education methodologies because it is more interactive and dynamic. On-line material can be constantly reviewed and updated, and the students can have the opportunity to submit commentaries or questions directly to the teaching staff. A Web-based course also allows the students to go beyond the course content as they learn how to search and take advantage of the huge resources of information available on the Internet.

This paper presents a system for database linkage based on the probabilistic record linkage technique, developed in the C++ language with the Borland C++ Builder version 3.0 programming environment. The system was tested in the linkage of data sources of different sizes, evaluated both in terms of processing time and sensitivity for identifying true record pairs. Significantly less time was spent in record processing when the program was used, as compared to manual processing, especially in situations where larger databases were used. Manual and automatic processes had equivalent sensitivities in situations where we used databases with fewer records. However, as the number of records grew we noticed a clear reduction in the sensitivity of the manual process, but not in the automatic one. Although in its initial stage of development, the system performed well in terms of both processing speed and sensitivity. Although overall performance of algorithms was satisfactory, we intend to evaluate other routines in the attempt to improve the system's performance.

Focusing on the HIV/AIDS epidemic as a summation of several epidemics coexisting in the same space and drawing on Brazilian epidemiological data, we argue that the epidemic there shows variations already described elsewhere, such as feminization, pauperization, juvenization and interiorization, as a result of the deep inequalities characteristic of Brazilian society. We then examine the contributions of three bodies of sociological and anthropological literature related to HIV/AIDS: 1) sociological research and theory on the impact of recent global economic restructuring and social transformation, and its relationship to public health issues; 2) the cross-cultural and cross-national anthropological and sociological literature on structural factors shaping the course of the epidemic in different settings; and 3) the body of anthropological and sociological research on the synergistic effects of HIV/AIDS, social exclusion, and related social problems in pockets of extreme poverty in the large cities of core countries. We conclude that prevention policies for HIV/AIDS should deal comprehensively with diverse dimensions that determine differential vulnerabilities to the epidemic, thus requiring substantial social transformations.