High temporal, geographic, and income variation in body mass index among adults in Brazil

OBJECTIVES: Population-based data on body mass index for developing countries are scarce. Body mass index data from two Brazilian surveys were examined to determine regional and temporal variations in the prevalences of underweight, overweight, and obesity. METHODS: Nationwide surveys in 1974/75 and 1989 collected anthropometric data in Brazil from 55,000 and 14,455 households, respectively. Trained interviewers used the same methods to measure weight and stature in both surveys, and survey designs were identical. Prevalences of underweight, overweight, and obesity were determined for persons 18 years of age and older. RESULTS: In the 1989 survey, body mass index varied greatly according to region of the country, urbanization, and income. In the wealthier South, the prevalence of overweight/obesity was the highest and the prevalence of underweight was the lowest; in the poorer rural Northeast, these patterns were reversed. For both surveys, overweight/obesity was more common among women than among men and peaked at age 45 to 64 years in both sexes. Over the 15 years between surveys, the prevalence of both overweight and obesity increased strikingly. CONCLUSIONS: In contrast to findings in developed countries, obesity in Brazil was positively associated with income and was much more prevalent among women than among men. For Brazilian women, the overall prevalence of overweight was nearly as high as that among women in the United States.     

Carmustine and streptozocin in refractory melanoma: an attempt at modulation of O-alkylguanine-DNA-alkyltransferase

The activity of the enzyme O6-alkylguanine-DNA-alkytransferase (AGAT) protects cells from the cytotoxic effects of alkylating agents. This Phase II trial was designed to assess the efficacy of a strategy designed to modulate the resistance to carmustine (BCNU) mediated by AGAT using streptozocin (STZ) in patients with advanced refractory melanoma. Seventeen patients who had failed prior chemotherapy were treated with STZ at 500 mg/m2 daily for 4 days with BCNU at 150 mg/m2 on day 3. Peripheral blood lymphocytes for assay of AGAT activity levels were collected prior to therapy and following the third dose of STZ. There were two partial responses in the 15 patients evaluable for response (13%). Most patients received only a single cycle of therapy due to rapidly progressive disease. Two patients developed fatal pulmonary toxicity, and one developed myelodysplasia. Other toxicities included transient rises in liver function tests. AGAT levels decreased by a mean of 53% in 9 patients but actually increased over baseline in 3 patients while on therapy. Based on these data, BCNU and STZ are not an effective combination for the therapy of advanced refractory melanoma, and pulmonary toxicity due to this combination appears to be increased compared with BCNU alone. STZ is not an effective modulator of AGAT activity when given on this schedule. New strategies designed to deplete AGAT activity using O6-benzylguanine or temozolomide should be explored with careful attention to the possibility that this approach may potentiate both the toxicity and efficacy of BCNU.     

Effect of initial breeding weight and management system using a high-producing sow genotype on resulting reproductive performance over three parities

A study was conducted with sows of a high-producing genotype to evaluate their reproductive performance using three breeding weights over a three-parity period in two management systems. A total of 114 F1 gilts (Landrace x Yorkshire) were used in a split-plot, randomized, complete block experiment conducted as a 3 x 2 factorial arrangement of treatments in two replicates. Three gilt breeding weights of 120, 135, and 150 kg were achieved by feeding 1.8, 2.3, or 3.2 kg/d of a .73% lysine corn-soybean meal (C-SBM) diet, respectively, from 5 to 8 mo of age. Two locations, each with different management systems, were considered the main plot and consisted of 1) outside, concrete-floored gestation lots and indoor farrowing pens or 2) indoor gestation pens and farrowing crates. All sows were fed 1.8 (Parity 1) or 2.1 (Parity 2 and 3) kg/d of a .73% lysine C-SBM diet during the breeding and gestation periods, whereas a .82% lysine C-SBM diet with 5% added fat was available ad libitum during lactation. All sows lost weight during the first lactation; larger weight losses occurred as breeding weight increased (P < .01). During the second and third lactations the 135- and 150-kg sow breeding groups had less lactation weight change, whereas the 120-kg group lost more weight, resulting in a breeding weight x parity interaction (P < .01). The 120-kg breeding weight group consumed less feed (P < .05) for the three lactation periods than did the heavier weight groups. Initial breeding weight had no effect on number of pigs born (total, live) or pig and litter weights at birth. Pig mortality increased with increasing breeding weight (P < .01) and parity (P < .05), a response that was exacerbated when sows farrowed in pens vs crates. Postweaning breeding intervals and sow removal from the experiment were not significantly affected by initial breeding weight, but a numerically higher percentage of sows in the 120-kg group were anestrous or failed to conceive than the percentage of such sows in the heavier weight groups. These data suggest that an initial breeding weight of approximately 135 kg at 8 mo of age may be best when sows farrow in crates, whereas when sows farrow in pens a lower breeding weight may be more desirable.     

A method for shape optimization of a hip prosthesis to maximize the fatigue life of the cement

The long term success of total joint replacement can be limited by fatigue failure of the acrylic cement and the resulting disruption of the bone-cement interface. The incidence of such problems may be diminished by reduction of the fatigue notch factor in the cement, so that stress concentrations are avoided and the fatigue crack initiation time maximized. This study describes a method for numerical shape optimization whereby the finite element method is used to determine an optimal shape for the femoral stem of a hip prosthesis in order to minimize the fatigue notch factor in the cement layer and at interfaces with the bone and stem. A two-dimensional model of the proximal end of a femur fitted with a total hip prosthesis was used which was equivalent to a simplified three-dimensional axisymmetric model. Software was developed to calculate the fatigue notch factor in the cement along the cement/stem and cement/bone interfaces and in the proximal bone. The fatigue notch factor in the cement at the cement/stem interface was then minimized using the ANSYS finite element program while constraining the fatigue notch factor at the cement/bone interface at or below its initial level and maintaining levels of stress in the proximal bone to prevent stress shielding. The results were compared with those from other optimization studies.     

Who is driving when unrestrained children and teenagers are hurt?

This paper examines driver characteristics in crashes where child and teenage motor vehicle crash victims were injured, in particular factors that determine whether or not the victim was restrained. Analyzing the data on children and teenagers who are injured revealed that the presence of a second adult in a vehicle increased the likelihood that these passengers were unrestrained. Other findings are more predictable: victim restraint use generally mirrored driver restraint use; a male driver, a young driver, a drinking driver, a speeding or reckless driver, an unlicenced or suspended driver, and a night-time trip each independently raised the odds that child and teenage passengers were not restrained when they were injured.     

Delayed radiation-induced bulbar palsy

We report a man with a slowly progressive bulbar palsy 14 years after radiation therapy for nasopharyngeal carcinoma. Electromyography demonstrated prominent myokymic and neuromyotonic discharges in muscles innervated by the lower cranial nerves. Late effects of radiation therapy can occur in the cranial nerve musculature that are similar to well-recognized syndromes affecting the brachial plexus and spinal cord.