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PubMedDate not supplied

[Recent trends in fertility in the state of Sao Paulo].

Fertility trends in the Brazilian state of Sao Paulo are analyzed for the period 1960-1980 using census and vital statistics data. The total fertility rate declined from 4.69 in 1960 to 3.40 in 1980; however, fertility has remained constant since 1975 following a rapid decline in the early 1970s. "The stability of the 1975-80 period is explained by an increase in the order of 10% of the native population of the State, an increase of the proportion of migrants, and an improvement of mortality levels, favoring women in the reproductive ages. Taking the socio-economic conjuncture of the State and the birth registration data of the first years of the 1980 decade as a reference, it is expected that the fertility decline will continue." (summary in ENG)

Americas↗
PubMedDate not supplied

[An increase in differential mortality by sex in the state of Sao Paulo].

"Historical data series from the vital registration system of the State of Sao Paulo are used to identify the age-groups where the increase of male surplus mortality has been most intense. In these age-groups, the evolution of the principal causes of death which account for this increase of the sex differential of mortality are analyzed over the past 40 years." The results show that despite a general decline in mortality, there has been an increase in mortality differentials by sex, particularly between ages 15 and 39. This is primarily due to a decrease in female deaths related to pregnancy and an increase in accidents and homicides among males. (summary in ENG)

Age Factors↗
PubMedDate not supplied

[The post menopausal climacteric woman with coronary artery disease: implications to quality of life].

PURPOSE: To analyse the quality of life of post menopausal women with coronary artery disease. METHODS: The population consisted of 100 women, divided into 2 groups. The first group made up of 50 women whose average age was 58 +/- 4,2 years with > stable coronary artery disease (CAD) proved by angiography undergoing treatment at The Heart Institute (InCor) - University of São Paulo Medical School, Brazil (CAD group). This group was compared with 50 women (55.1 +/- 5.4 years old) without clinical evidence of coronary artery disease (control group) from a primary health care center, Centro de Saúde Escola Geraldo de Paula Souza, São Paulo - FSP- USP. The quality of life was assessed by a structured interview and by Medical outcomes study 36-item short-form health survey (SF-36) validated to the Brazilian population. RESULTS: They were homogenous regarding age of the last menstruation period: 49 +/- 3.9 years old in CAD and 49.2 +/- 3 years old in controls. The groups were also similar in education level, marital status (64% of CAD and 45% of controls were married; and 18% of CAD and 24% of controls were widowhood). The active working status was more frequent in controls than in CAD (52% vs. 14%; p= 0.0001). Both groups showed similar perceptions in their sexual experience. The evaluation of quality of life by SF-36 showed better scores for the control group in: physical functioning (84 vs. 50.5), role physical (84 vs. 45,5), general health (87.2 vs. 59.1), vitality (69.7 vs. 51,4), p<0.0001; and total score of mental components (70.4 vs. 58.6), p = 0.028. CONCLUSION: Coronary artery disease alters the quality of life of climacteric women by limiting the physical capacity to perform ordinary daily activities and by intensifying emotional conflicts usually present in this phase of life.

Case-Control Studies↗
PubMed2006

Quality of life of family caregivers of elderly patients on hemodialysis and peritoneal dialysis.

BACKGROUND: Despite the growing number of elderly patients with end-stage renal disease who need support, there are few studies about their caregivers. The objective of this study is to describe caregivers' characteristics and evaluate their burden and quality of life. METHODS: We studied caregivers of elderly patients (>or=65 years) on hemodialysis (HD) therapy (n = 84), on peritoneal dialysis (PD) therapy (n = 40), and a group of caregivers (n = 77) of nonelderly HD patients. Their quality of life was evaluated by using the Medical Outcomes Study 36-Item Short-Form Health Survey questionnaire, Caregiver Burden scale, and Cognitive Index of Depression. RESULTS: Most caregivers of the elderly were women (78%) aged 55 +/- 15 years and sons or daughters (41%) or wives or husbands (50%) of patients. Caregivers' Emotional Aspect, Vitality, and Mental Health were the most affected dimensions. The Mental Component Summary mean score, adjusted for patient race, educational level, primary diagnosis, hematocrit, comorbidities, and physical functional status, was worse for caregivers of PD than HD elderly patients (36.3 +/- 1.9 versus 44.8 +/- 1.5; P < 0.01). The most affected Caregiver Burden scale dimensions were General Strain and Environment. Thirty-two percent of caregivers showed signs of depression. CONCLUSION: Caregivers of elderly dialysis patients, especially of those on PD therapy, experience a significant burden and adverse effects on their quality of life. Educational, social, and psychological support interventions should be considered to improve the quality of life of caregivers.

Adult↗
PubMed1999

Comparison of spiramycin and clarithromycin for community-acquired lower respiratory tract infections.

This open multicentre study compared the efficacy and tolerability of clarithromycin and spiramycin in the treatment of lower respiratory tract infections in Brazil and Colombia. A total of 125 patients with a clinical and radiological diagnosis of pneumonia, acute bronchitis or exacerbation of chronic bronchitis were randomised to receive oral doses of either clarithromycin (500 mg) or spiramycin (3 MIU) every 12 hours for courses of 5-10 days. Patients were assessed before the start of treatment, and at days 3-4 and days 9-17. Twenty-six (26) patients (16 in the spiramycin group and 10 in the clarithromycin group) reported adverse events, seven of whom withdrew from the trial. Statistical analysis detected no significant differences between efficacy (p = 0.768) or tolerability (p = 0.236) for the two treatment groups. Spiramycin therefore has similar efficacy to clarithromycin in the treatment of community-acquired lower respiratory tract infections.

Adolescent↗
PubMed2000

[The historicity of the interpretative theories about health and disease].

The interpretative theories of the health-illness process that can be identified through History have as consequence intervention projects upon the reality, in response to social needs. Until the 19 century, they could be synthesized in two main streams: ontologic and dynamic. In the ontologic conception, illness assumes the character of a natural or supernatural entity, external to the human body, that shows itself when invading it. The dynamic conception sees illness as a product of the disharmony among vital forces, and the re-establishment of the health comes of the restoration of this balance. At the end of the 18 century, the social-environmental paradigms prevailed in Europe as forms of explanation for human illness, linked to the dynamic conception, and the first evidences of the social determination of the health-illness process were formulated. The onset of the Bacteriologic Era made the ontologic conception victorious and its conquests led to the abandon of the social approaches to face the populations health problems. At the present time, one can identify the prevalence of the multicausal theory, with emphasis in the individual conditionings. This paper proposes the articulation of the individual and collective dimensions of the health-illness process, in consonance with the Theory of Nursing Praxical Intervention in Collective Health.

Brazil↗
PubMed2003

Long-term population isolation in the endangered tropical tree species Caesalpinia echinata Lam. revealed by chloroplast microsatellites.

Habitat fragmentation represents the single most serious threat to the survival of tropical ecosystems. In formulating strategies to counteract the detrimental effects of fragmentation, knowledge of the levels and patterns of genetic diversity within and between natural populations is vital to the establishment of any conservation programme. We utilized polymorphic chloroplast microsatellite markers to analyse genetic diversity in populations of the endangered tropical tree Caesalpinia echinata Lam. representing the entire extant range of the species. Levels of within-population diversity were low, with only two of seven populations studied displaying any variation. The vast majority of the genetic variation was partitioned between geographical regions (36%) and between populations within regions (55%). These levels of genetic structuring, coupled with a calculated pollen-to-seed flow ratio of approximately 6.7:1, suggest that there has been little gene flow between the three major geographical regions over an extended period. Thus, the current tripartite distribution of the species is more consistent with the existence of separate glacial refugia, rather than reflecting any anthropogenic effects.

Brazil↗
PubMedDate not supplied

[Epidemiology and clinical picture of accidents by adult and young snakes Bothrops jararaca].

Four hundred and fifteen cases of bites by adult Bothrops jararaca (group A) were admitted to the Hospital Vital Brasil between 1981 and 1987. These cases were compared to 562 cases of bites by young snakes of the same species (group B) during the same period and at the same hospital. In group B blood incoagulability was more frequent when compared to group A. However in group A bites in the leg, use of tourniquet, tecidual damage (blister, necroses and abscess), were more frequent when compared to group B. The doses of sero given for the group A was greater when compared to group B. Accidents month distribution, dates available were for the patients admitted between 1975 and 1988. The accidents were more frequent in the first and at the end of the year. In the first months of the year for the young snakes and mainly at the end of the year for the adult snakes.

Adolescent↗
PubMed2005

[Proposal of a method for collective analysis of work-related accidents in the hospital setting].

The article presents a method for the analysis of work-related accidents in hospitals, with the double aim of analyzing accidents in light of actual work activity and enhancing the vitality of the various professions that comprise hospital work. This process involves both research and intervention, combining knowledge output with training of health professionals, fostering expanded participation by workers in managing their daily work. The method consists of stimulating workers to recreate the situation in which a given accident occurred, shifting themselves to the position of observers of their own work. In the first stage of analysis, workers are asked to show the work analyst how the accident occurred; in the second stage, the work accident victim and analyst jointly record the described series of events in a diagram; in the third, the resulting record is re-discussed and further elaborated; in the fourth, the work accident victim and analyst evaluate and implement measures aimed to prevent the accident from recurring. The article concludes by discussing the method's possibilities and limitations in the hospital setting.

Accidents, Occupational↗
PubMedDate not supplied

Quality of life in Brazilian breast cancer survivors age 45-65 years: associated factors.

The objectives of this study were to evaluate quality of life (QOL) and identify its associated factors in climacteric women with a history of breast cancer. A cross-sectional study was performed including 75 breast cancer survivors age 45-65 years who had undergone complete oncologic treatment and nonusers of hormone therapy or tamoxifen in the last 6 months. Sociodemographic and clinical characteristics in addition to the prevalence of climacteric symptoms were evaluated. QOL was evaluated by the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) questionnaire, including eight components that can be condensed into two summaries: a physical component summary (physical functioning, role-physical, body pain, general health) and a mental component summary (vitality, social functioning, role-emotional, and mental health). Generalized linear models were used to analyze the data, allowing the identification of factors affecting QOL, adjusting for confounding variables. The mean age of the participants was 53.1+/-5.9 years. Breast cancer survivors reported good QOL. The most prevalent symptoms were nervousness (69%) and hot flashes (56%). Factors associated with poorer QOL were dizziness, postmenopausal status, and breast-conserving therapy (physical component), as well as insomnia and being married (mental component). In conclusion, participants demonstrated good QOL. We identified factors that may influence QOL in women with breast cancer, highlighting being married, climacteric symptoms, postmenopausal status, and breast-conserving therapy. Given the impact of these factors, health professionals and patients must discuss choices for alleviating climacteric symptoms and explanations for the potential repercussions of breast cancer treatment.

Aged↗
PubMedDate not supplied

[The epidemiology and clinical picture of an accidental bite by the South American rattlesnake (Crotalus durissus)].

Under study were two hundred and forty-nine cases of accidents caused by South American rattlesnakes (Crotalus durissus) admitted to the Vital Brasil Hospital, São Paulo, Brasil, from 1974 to 1990. The accidents were more common in the afternoon, from January to April and from October to December. Ninety nine out of 100 snakes classified as subspecies were C. d. terrificus. Most of the patients were males (80.7%). The inferior and superior limbs were bitten in 66.4% and 29.2% of the cases, respectively. The more frequent clinical manifestations were pain (61.0%) and edema (55.0%) at site of the bite, palpebral ptosis (75.9%), darkening of the urine due to myoglobinuria (38.6%) and myalgia (36.1%). Nine (3.6%) out of 32 patients with acute renal failure were submitted to dialysis, three presented respiratory failure treated with intubation and/or tracheotomy and one presented an ischemic cerebral stroke. Alteration of the blood coagulation was present in 48.1% of the patients. The blood picture of some patients several hours after the accident showed leucocytosis with a left shift and a tendency to normal values with eosinophilia. Serum creatine kinase activity was increased in 20 of 21 patients, with higher values 24 hours after the bite reaching 2,377 times the reference value. Lethality was 0.8%.

Adolescent↗
PubMed2003

Not telling the truth in the patient-physician relationship.

The presence of truth and honesty is a permanent demand, and becomes vital the more committed and intimate a relationship is. Medical practice is relevant to this discussion when one questions whether or not a physician should always tell their patient the truth in the face of a progressive or potentially fatal disease, regarding their diagnosis, outcome, therapy and evolution of the specific disease. From this discussion we aim, with the present report, to look at the truth applicable to the patient-physician relationship, and its ethical and moral implications; and also to look at where the Brazilian Code of Medical Ethics (BCME) and the medical literature stand regarding this issue. One concludes that there are only two moments not to tell a patient the truth: when the patient does not want to be informed, and when the truth could be iatrogenic. The question now is, when would the truth be iatrogenic? Physicians, in our opinion, would not be able to judge solitarily when the truth might be deleterious to their patient. Alternatively, we proposed the appointment of a multidisciplinary commission to help the doctor with such a decision.

Brazil↗
PubMed2002

Frequencies of GSTM1, GSTT1, and GSTP1 polymorphisms in a Brazilian population.

The glutathione S-transferase (GST) family of enzymes has a vital role in phase II of biotransformation of environmental carcinogens, pollutants, drugs and other xenobiotics. GSTs are polymorphic, with the type and frequency of polymorphism being ethnic dependent. Polymorphisms in GST genes have been shown to be associated with susceptibility to disease and disease outcome. We determined the frequencies of GSTM1, GSTT1 and GSTP1 polymorphisms in 591 volunteers who had been residents of Rio de Janeiro for at least six months. Blood was collected and DNA extracted by proteinase K/SDS digestion. Information about social habits and health problems was also recorded. GSTM1 and GSTT1 polymorphisms were analyzed by a PCR-Multiplex procedure, whereas GSTP1 polymorphism was analyzed by PCR-RFLP. We found that 42.1% (48.9% of whites and 34.2% of non-whites) of the individuals had the GSTM1 null genotype, whereas 25.4% (25.1% of whites and 25.7% of non-whites) had the GSTT1 null genotype. The genotypic distribution of GSTP1 was 49.7% I/I, 38.1% I/V, and 12.2% V/V, whereas the allelic frequencies were 0.69 for the Ile allele, and 0.31 for the Val allele. The frequencies of GST polymorphisms in this Brazilian population were found to be different from those observed in other populations, particularly of other South American countries.

Adolescent↗
PubMed2001

Forced oscillation technique to evaluate tracheostenosis in patients with neurologic injury.

STUDY OBJECTIVES: To determine the utility of forced oscillation technique (FOT) for measuring pulmonary resistance and reactance in patients with central nervous system injuries, for detection and follow-up of posttracheostomy tracheal stenosis. DESIGN: Case series. SETTING: A rehabilitation hospital, Brasilia, Distrito Federal, Brazil. PATIENTS: Ten consecutive neurologically impaired patients, who had previously undergone tracheostomies, with tracheostenosis without current tracheostomy or other tracheal lesion. INTERVENTIONS AND MEASUREMENTS: FOT evaluations were compared to tracheal diameter before and after bronchoscopic tracheostenosis dilatation procedures. Forced spirometry examinations were also obtained and compared. RESULTS: Tracheal stenotic lesions were characterized by marked increase in resistance and reduction in reactance at low frequency and a marked increase in resonance frequency (Rf). Consistent reversal of this pattern with large reductions in total impedance of the respiratory system (Zresp) Rf and resistance at 5 Hz (R 5 Hz) were noted in all patients after each successful dilatation. Diameter of the stenosis was strongly correlated with Rf, Zresp, and R 5 Hz. The change in diameter before and after dilatation was similarly correlated with the changes in FOT values of Rf and Zresp. Spirometry values did not correlate well with the diameter of the tracheal stenosis. CONCLUSION: The strong correlation of Rf, Zresp, and R 5 Hz to diameter of tracheostenosis suggests a previously unappreciated role for FOT in the noninvasive detection and follow-up of airway stenosis. This may be especially useful for patients with concomitant neurologic disabilities who are at risk of airway stenosis.

Adolescent↗
PubMed2005

Pneumoconiosis after sericite inhalation.

BACKGROUND: Between 1997 and 1999 three sericite plant workers in Parana, Brazil, were diagnosed with pneumoconiosis. AIMS: To investigate and describe the radiological, clinical, and pathological changes in miners and millers exposed to sericite dust with mineralogical characteristics of inhaled dust. METHODS: The working premises were visited to examine the sericite processing and to classify the jobs according to make qualitative evaluation. Respirable dust was collected and the amount of crystalline silica and particle size distribution were measured. Forty four workers were examined by a standard questionnaire for respiratory symptoms, spirometry, and chest x ray. Material from an open lung biopsy was reviewed for histopathological and mineralogical analysis, together with sericite samples from the work site to compare the mineral characteristics in lung lesions and work area. RESULTS: Respirable dust contained 4.5-10.0% crystalline silica. Particle size distribution showed a heavy burden of very fine particles (23-55%) with a mean diameter of <0.5 microm. Mean age of sericite miners was 41.0 (11.9) and mean number of years of exposure was 13.5 (10.1). In 52.3% of workers (23/44), chest radiographs presented a median category of 1/0 or above, and 18.2% (8/44) had a reduced FEV1. There was a significant association between exposure indices and x ray category. Histological studies of the lung biopsy showed lesions compatible with mixed dust fibrosis with no silicotic nodules. x Ray diffraction analysis of the lung dust residue and the bulk samples collected from work area showed similar mineralogical characteristics. Muscovite and kaolinite were the major mineral particle inclusions in the lung. CONCLUSION: Exposure to fine sericite particles is associated with the development of functional and radiological changes in workers inducing mixed dust lesions, which are distinct histologically from silicosis.

Adult↗