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PubMed2003

Expanding access to emergency contraception: the case of Brazil and Colombia.

Emergency contraception was proven effective nearly 30 years ago yet remains greatly under-utilised. In the Latin American and Caribbean region, it would serve the goals of reducing unwanted pregnancy, unsafe abortion and related morbidity, and as a back-up to condom use and a bridge to longer-term contraceptive methods if made more widely known and available. The International Planned Parenthood Federation Western Hemisphere Region has developed a model for the integration of emergency contraception into sexual and reproductive health care services. This model is being tested in a two-year project with national affiliates in Brazil, Chile, Colombia, the Dominican Republic and Venezuela, and will contribute to the work of the Latin American Consortium for Emergency Contraception. Case studies of Brazil and Colombia describe how health sector reforms, e.g. decentralisation and managed competition among health insurers and service providers, have influenced promotion strategies. The experience of Profamilia Colombia with registration of a dedicated product and providing emergency contraception within its national network of clinics, with a focus on staff training and work with young people, is described. In Brazil, BEMFAM's study of different modalities for offering emergency contraception, e.g. through contractual agreements with municipalities and its own clinics, is highlighted.

Brazil↗
PubMed2005

The population and reproductive health programme in Brazil 1990-2002: lessons learned.

The story of Brazil's evolution in sexual and reproductive health and rights during the 1990s documents not only a decade of change in the population field, but the powerful role of social movements in a democracy. Between October and December 2002, 23 people were interviewed about where they believe progress has been made in Brazil and where there are still needs in relation to population trends, sexual and reproductive rights, and health policies. This paper contains excerpts from the full report and covers the economic and political background of Brazil; the role of non-governmental and women's organisations in influencing the national agenda; the intersection of national and international agendas on population and development, HIV/AIDS, human rights, racism and other issues; changes in sexual and reproductive health policies; HIV/AIDS policy progress, perhaps most importantly mandatory free treatment for people with HIV/AIDS; recent progress in women's health, especially in relation to antenatal and obstetric services, and services addressing violence against women. Finally it describes the role of policy accountability mechanisms that aim to ensure that the many excellent policies that have been passed since 1990 are implemented in a decentralised health system of national, state and local management and services.

Brazil↗
PubMed1999

Trends in asthma mortality in young people in southern Brazil.

BACKGROUND: Mortality from asthma increased and is now declining in some countries, but little is known about these trends in South America. OBJECTIVE: We aimed to assess trends in mortality from asthma in southern Brazil in children and young adults. METHODS: Death certificates of 425 people in the state of Rio Grande do Sul aged between 5 and 39 years in whom asthma was reported to be the underlying cause of death during the period 1970 to 1992 were reviewed. Population data were available in 10-year age groups. Testing for trends in mortality rates was conducted using linear and log-linear regression procedures. RESULTS: Asthma mortality rates in the age groups 5 to 19 and 20 to 39 years ranged between 0.04 and 0.39/100,000 and 0.28 to 0.75/100,000, respectively, and were nonuniformly distributed over the study period. The mean annual increase in rate in 5- to 19-year olds was +0.01 (95% CI 0.003 to 0.016), an average annual percentage increase of +6.8% (95% CI 3% to 11%), with a total increase of 352% between 1970 and 1992. This increase was not due to a shift in labeling from bronchitis to asthma. In the 20 to 39-year age group, asthma and bronchitis mortality rates showed no trend to increase or decrease. CONCLUSIONS: Asthma mortality in southern Brazil is low, but rose significantly between 1970 and 1992 in the 5 to 19-year age group. This trend differs from that found in other states of Brazil and several other Latin American countries. Reasons for this difference remain unclear.

Adolescent↗
PubMed2002

The epidemiology of oral and pharynx cancer in Brazil.

A study was carried out on the occurrence of oral and pharynx cancer among populations living in five Brazilian geographic regions, by using incidence and mortality rates and trends. Information on survival was also analyzed. Complementary information regarding prevalence of the disease risk factors has been supplied in the attempt to establish some etiological connections with the incidence and mortality observed. Two clear patterns for the occurrence of oral and pharyngeal cancer have been detected: a pattern for the north (including the northern, northeastern and midwestern regions, which are the poorest ones) and a pattern for the south (including the southern and southeastern regions). The southern pattern revealed incidence rates higher than 15 per 100,000 among males, and the northern pattern displayed lower rate levels. Similarly, mortality rates in the south were higher than three per 100,000 and the northern pattern was characterized by lower rates. Other cancers linked to tobacco smoking, such as esophagus, larynx, lung and bladder cancer kept the same pattern of incidence and mortality rates related to oral and pharyngeal cancer in males per region. Information on survival of patients with oral and pharyngeal cancer was very restricted in Brazil, thus hindering the survival analysis per region, but the studies conducted allowed to conclude that the majority of diagnoses were conducted in advanced stages of the disease and implied the low 5-year survival rate observed in Brazil. Tongue tumors displayed the worst survival rates. The southern region shares specific risk factors involved in the oral and pharyngeal cancer present in the Argentinean and Uruguayan populations, namely heavy tobacco smoking and alcohol consumption, as well as high intake of charcoal-grilled red meat and mate. In addition to these risks, part of the oral and pharyngeal cancer registered in Brazil might be linked to a few factors present among people with low life standards, including poor oral hygiene and nutrition.

Alcohol Drinking↗
PubMed2003

Following in Soper's footsteps: northeast Brazil 63 years after eradication of Anopheles gambiae.

Sub-Saharan Africa has long suffered under the yoke of the Anopheles gambiae mosquito, but for northeast Brazil (figure 1) its arrival over 60 years ago was a new and horrifying experience. This African mosquito is an exceptionally effective malaria vector because it is well adapted to feeding upon people and to exploiting aquatic habitats associated with our daily activities. Anopheles gambiae sensu lato probably accounts for most of the world's malaria deaths and socioeconomic burden. Fortunately, the Brazilian experience had a happy ending. The prospect of A gambiae spreading across much of the Americas motivated a ruthlessly effective response that deserves a special and heroic place in the annals of public health. Building on the successes and infrastructure of the Yellow Fever Service for Aedes aegypti elimination, the Rockefeller Foundation and Brazilian government collaborated to form a new Malaria Service of the Northeast. This new entity rolled the invader back into oblivion with an aggressive eradication campaign, focusing primarily upon larviciding of all potential habitats. The driving force of this endeavour was an enigmatic man called Fred Soper whose sheer will and determination was a key element in this success, and a source of inspiration today (see Killeen GF, et al. Eradication of Anopheles gambiae from Brazil: lessons for malaria control in Africa? Lancet Infect Dis 2002; 2: 618-27). I recently took an opportunity to fulfil a long-held dream and follow in some of Soper's footsteps. Tired of gazing at yellowing maps like figure 1, I went to see the northeast of Brazil for myself.

Animals↗
PubMedDate not supplied

Smoking, smoking cessation and otorhinolaryngologists in the state of Sao Paulo, Brazil.

UNLABELLED: Otorhinolaryngologists are directly involved in the diagnosis and management of smoking related diseases, including upper airway malignancy. It is important that the specialists have skills to treat smoking and nicotine dependence. It is also known that there are smokers amongst doctors. AIM: To assess the opinions and practices of the otorhinolaryngologists of the state of Sao Paulo, Brazil, concerning smoking and nicotine dependence, and evaluation of smoking habits of the specialists. STUDY DESIGN: Cross-sectional. MATERIAL AND METHODS: We randomly selected 600 otorhinolaryngologists of Sao Paulo State, Brazil. A survey was mailed to the specialists in March 2005. We gathered data received from March to May 2005. RESULTS: There were 209 respondents. Forty-seven specialists (46.4%) rated themselves as moderately familiar with the methods for treatment of nicotine dependence, and 60 (28.7%) as unsatisfactorily familiar. One hundred and forty-four respondents (68.9%) have never smoked, 50 (23.9%) were former-smokers, nine (4.3%) were occasional smokers and six (2.9%) were regular smokers. CONCLUSION: The prevalence of smoking in the sample of 209 otorhinolaryngologists of Sao Paulo State, Brazil, was 7.1%.

Adult↗
PubMed2005

Changing epidemiology of melioidosis? A case of acute pulmonary melioidosis with fatal outcome imported from Brazil.

Melioidosis is an infectious disease caused by Burkholderia pseudomallei. It is endemic in South East Asia and tropical regions of Northern Australia. Sporadic cases have been described elsewhere. In this article we present a case of acute pulmonary melioidosis with fatal outcome imported from Brazil. The most common pathogen causing severe community-acquired pneumonia in Brazil is Streptococcus pneumoniae. Other possible pathogens include Legionella spp., Mycoplasma pneumonia, Gram-negative rods and viruses. There are few reports of melioidosis in the Americas. This article represents the second known human case of melioidosis from Brazil. Recognition of melioidosis as a possible cause of severe pneumonia, even if a patient has not been travelling in a highly endemic area, is important because of the therapeutic consequences. The epidemiology of melioidosis will be reviewed.

Acute Disease↗
PubMed2001

Comparison of quality characteristics of soybeans from Brazil, China, and the United States.

Both soybean composition and processing conditions impact the nutritional quality of soybean meal. The objective of this experiment was to compare nutrient compositions of soybeans grown under diverse environmental conditions in a variety of locations. Dry matter, organic matter, and ash concentrations differed in soybeans collected within the countries of Brazil, China, and the United States, although these differences were generally small or due to uniqueness of a particular source. Large differences in dry matter were detected among countries. Differences in crude protein, amino acid, and lipid concentrations of soybeans were detected both within and among countries. Soybeans from China had a greater crude protein concentration (42.14%) than those from Brazil (40.86%), whereas soybeans from China had a lower lipid concentration (17.25%) than those from either Brazil or the United States (18.66 and 18.70%, respectively). Environmental conditions under which soybeans are grown have a great impact on chemical composition and nutrient quality.

Brazil↗
PubMed2003

Fumonisin contamination and fusarium incidence in corn from Santa Catarina, Brazil.

In Brazil, the southern region has the highest incidence of esophageal cancer and also the highest production and consumption of corn (Zea mays) products. Corn samples intended for human consumption from the western, northern, and southern regions of the state of Santa Catarina, southern Brazil, had mean total fumonisin B (B(1), B(2), and B(3)) levels of 3.2, 3.4, and 1.7 mg/kg, respectively. Fusarium verticillioides, the predominant fungus in the corn samples, had mean incidences (percent of kernels infected) of 14, 11, and 18% for the three regions, respectively. Additional corn samples intended for animal feed from the southern region had a mean total fumonisin level of 1.5 mg/kg and a mean F. verticillioides incidence of 10%. The fumonisin levels in corn from the state of Santa Catarina, Brazil, were similar to the high levels determined in other high esophageal cancer incidence regions of the world.

Animal Feed↗
PubMed2004

Pulmonary aspergillosis outbreak in Rhea americana in southern Brazil.

Commercial raising of rheas is currently in expansion in the south of Brazil, and many diseases previously restricted to other avian species are currently emerging on rhea farms, especially as a result of careless management of these animals. The objective of the present article is to report a pulmonary aspergillosis outbreak that occurred in great rhea (Rhea americana) in the south of Brazil. About 50 birds aged 30 to 60 days died suddenly and one of them was submitted to autopsy which revealed the presence of white caseous nodules 0.5 mm in diameter occupying 95% of the lung area. One lung was sent to the Federal University of Santa Maria for histopathological and mycological analyses. Histopathological analysis revealed multifocal areas with necrosis and inflammatory infiltrates and the presence of fungal hyphae, giant cells and fibrous tissue proliferation at the periphery. Aspergillus fumigatus was recovered as pure culture from all culture media. This appears to be the first report of aspergillosis among great rhea in Brazil and the second in the world.

Animals↗
PubMed2004

Pseudopregnancy in Saanen goats (Capra hircus) raised in Northeast Brazil.

The prevalence of pseudopregnancy over 44 months was investigated in 23 Saanen goats raised in Northeast Brazil during continuous oestrous cycling (cyclic group) or after synchronization of oestrus (synchronized group). The goats were monitored by ultrasonography and their plasma progesterone profile. The overall prevalence of pseudopregnancy was 30.4% (7/23). In the cyclic group, 28.6% (4/14) of goats showed pseudopregnancy, while in the synchronized group the prevalence was 33.3% (3/9). There was no significant difference between the groups (p>0.05). The mean (+/- SD) length of pseudopregnancy, as shown by the progesterone profile, was 121.6 +/- 33.5 days, ranging from 70 to 155 days. The study defined the prevalence of pseudopregnancy in Saanen goats raised in Northeast Brazil for the first time. This finding identified a major problem for this breed, as without treatment such animals remain unproductive until the spontaneous resolution of the condition. More research seems desirable to ascertain the prevalence of this condition in other breeds in this region of Brazil.

Animals↗
PubMed2001

Socio-economic correlates of traumatic injuries to the permanent incisors in schoolchildren aged 12 years in Blumenau, Brazil.

This study aimed to assess the prevalence of injuries to the permanent incisors in Blumenau, Brazil. In addition, the relationship between dental injuries and socio-economic indicators was examined. A cross-sectional survey was carried out. It included a random sample of 652 children aged 12 years, from both sexes, attending public and private primary schools in Blumenau, Brazil. Multi-stage sampling technique and proportional representation were adopted. A trained and calibrated dentist collected the data through clinical examinations and interviews. Clinical examination included type of damage, treatment provided and needed, size of incisal overjet and type of lip coverage. The response rate was 82.5%. The prevalence of dental injuries was 58.6%. Boys experienced more injuries than girls, 67.2% and 50.2% (P=0.001), respectively. Children from mothers with higher schooling experienced more dental injuries than those from of mothers with lower schooling, 68.2% and 56.6% (P=0.03). Father's level of education, parents' employment status and family income were not statistically significantly associated with dental injuries (P>0.05). There was a tendency for children with incisal overjet greater than 5 mm (P=0.2) and inadequate lip coverage (P=0.1) to have more dental injuries, but differences were not statistically significant. Nearly all (97.3%) children who had dental injuries needed treatment. In conclusion, the prevalence of dental injuries in Blumenau, Brazil, was very high, treatment of dental injuries was severely neglected, and boys and children from mothers with high schooling were more likely to have experienced dental injuries.

Brazil↗
PubMed1997

Predominance and characteristics of Burkitt lymphoma among children with non-Hodgkin lymphoma in northeastern Brazil.

The purpose of this paper was to define the histologic distribution, clinical features, and treatment response of childhood non-Hodgkin lymphoma (NHL) in northeastern Brazil. We reviewed medical records and histopathologic studies of 98 children treated for NHL from 1980 to 1987 at a major pediatric cancer center in Recife, Brazil. Treatment outcome was evaluated in relation to tumor burden (stage and serum LDH) and type of therapy (LSA2L2 vs other multiagent chemotherapy). There was a striking predominance of the small noncleaved cell (Burkitt) subtype, which occurred in 92 of the 98 children and adolescents diagnosed with NHL. Subsequent analyses focused on these patients. The majority (n = 84) had advanced (stage III/IV) disease at diagnosis. The abdomen was the most common site of disease (84 cases); jaw involvement was rare (three cases). Five-year event-free survival (excluding treatment refusals) was significantly better for patients with limited vs advanced stage disease (75 +/- 14% vs 42 +/- 6%; P < 0.04). Elevated serum LDH (>500 U/l) was associated with a poorer outcome (P = 0.008). The type of chemotherapy did not affect EFS (P = 0.95). Only 39% of patients are long-term survivors, reflecting the high rate of septic deaths (25% of patients) and parental refusal/abandonment of therapy (10%). Epstein-Barr virus (EBV) was detected in tumor cells from eight of the 11 cases studied. In clinical presentation, these cases resemble sporadic Burkitt lymphoma, yet in their apparent responsiveness to LSA2L2 therapy and association with EBV, they do not. Childhood NHL in northeastern Brazil is predominantly of the Burkitt subtype, and is associated with clinical features that appear to distinguish it from the endemic and sporadic forms of this tumor. These cases may represent a third or intermediate subtype of Burkitt lymphoma.

Adolescent↗
PubMed1999

Co-infection with malaria and HIV in injecting drug users in Brazil: a new challenge to public health?

AIMS: To describe AIDS and malaria geography in Brazil, highlighting the role of injecting drug users (IDUs) in malaria outbreaks occurring in malaria-free regions, and the potential clinical and public health implications of malaria/HIV co-infection. DESIGN: Review of the available literature and original analyses using geoprocessing and spatial analysis techniques. FINDINGS: Both HIV/AIDS and malaria distribution are currently undergoing profound changes in Brazil, with mutual expansion to intersecting geographical regions and social networks. Very recent reports describe the first clinical case of AIDS in a remote Amazonian ethnic group, as well as malaria cases in Rio de Janeiro state (hitherto a malaria-free area for 20 years); in addition, two outbreaks of both infections occurred at the beginning of the 1990s in the most industrialized Brazilian state (São Paulo), due to the sharing of needles and syringes by drug users. Spatial data point to: (a) the expansion of HIV/AIDS towards malarigenic areas located in the centre-west and north of Brazil, along the main cocaine trafficking routes, with IDU networks apparently playing a core role; and (b) the possibility of new outbreaks of secondary malaria in urban settings where HIV/AIDS is still expanding, through the sharing of needles and syringes. CONCLUSIONS: New outbreaks of cases of HIV and malaria are likely to occur among Brazilian IDUs, and might conceivably contribute to the development of treatment-resistant strains of malaria in this population. Health professionals should be alert to this possibility, which could also eventually occur in IDU networks in developed countries.

AIDS-Related Opportunistic Infections↗
PubMed2001

Overdoses among cocaine users in Brazil.

AIMS: A survey of cocaine users was undertaken to study (i) the frequency of reported drug overdoses among cocaine users; and (ii) the frequency of witnessing drug overdoses in the same population. DESIGN AND SETTING: A cross-sectional study as part of the World Health Organization (WHO) Multi-city Study among injecting drug users (IDUs), phase II, was conducted in Santos Metropolitan Region, State of São Paulo, Brazil, in 1999. PARTICIPANTS: Three hundred and ninety-six exclusive users of cocaine in the Santos Metropolitan Region, São Paulo State, Brazil were surveyed concerning their past experience with drug overdoses. FINDINGS: Eighty (20%) of the cocaine users reported having experienced one or more overdoses, and 50% reported that they knew one or more other cocaine users who had died of an overdose. On multivariate analysis, being female and having spent time in jail were associated with an increased likelihood of having had one or more overdoses. CONCLUSION: Cocaine overdoses are an important and under-recognized health problem in the Santos Metropolitan Region, and possibly in other areas of Brazil.

Adolescent↗
PubMed2003

Sexually transmitted infections in a female population in rural north-east Brazil: prevalence, morbidity and risk factors.

OBJECTIVES: To determine the prevalence of major sexually transmitted infections (STIs) and gynaecological morbidity in women of reproductive age living in rural communities in north-east Brazil and to assess risk factors associated with the presence of STIs. METHODS: A total of 341 women (84%) were examined gynaecologically and colposcopically. The gynaecological history was taken by means of a standardized, pre-tested questionnaire. Cervical smears were obtained and vaginal fluid was collected. Vulvovaginal candidiasis (VC), bacterial vaginosis (BV), trichomoniasis (TV) and syphilis seroreactivity were determined by standard laboratory techniques. Infections with Neisseria gonorrhoeae, Chlamydia trachomatis and human papilloma virus (HPV) were diagnosed by hybrid capture assays using vaginal lavage fluid. Odds ratios (OR) were calculated to assess risk factors associated with STIs. RESULTS: The prevalence of HPV, BV and TV was 26%, 15% and 10%, respectively. VC as well as infections with N. gonorrhoeae and C. trachomatis were detected in 6%; syphilis seroreactivity, in 3%. Multiple infections were very common, and 51% of women had at least one STI. Vaginal discharge, the predominant morbidity (56%), was significantly associated with BV (OR = 6.3; P < 0.001), vulvovaginal itching with VC (OR = 3.5; P < 0.05) and lower abdominal pain with C. trachomatis infection (OR = 2.6; P < 0.04). Colpitis was diagnosed in 27% of women and significantly associated with TV (OR = 3.5%; P < 0.001) and VC (OR = 2.9; P < 0.05). Being unmarried was a significant risk factor for having an STI (OR = 2.4; P < 0.05). Among unmarried women, age (<20 years) was a significant risk factor (OR = 3.3; P = 0.01). CONCLUSIONS: The STIs are highly prevalent in this female population in the rural hinterland of north-east Brazil and associated with considerable morbidity. In view of the expected spread of HIV from the urban centres at the coast to the interior there is an urgent need for providing STI-related health care and health education for adolescents and women in rural Brazil.

Adolescent↗
PubMed2002

Sunburn, sunscreens, and phenotypes: some risk factors for cutaneous melanoma in southern Brazil.

BACKGROUND: The risk factors for cutaneous malignant melanoma have been studied in populations from numerous countries around the world. There are no published studies on the risk factors for this malignancy in Brazil, the largest country in South America. METHODS: A case-control study of all melanoma patients attending a university hospital in Porto Alegre, Brazil, was conducted over a 3-year period from 1995 to 1998. Phototype, hair and eye color, solar habits, history of sunburn, use of sunscreens, and the number of nevi were evaluated through a questionnaire and full body skin examination. Bivariate analysis and a logistic regression model were used to evaluate the data. RESULTS: One hundred and three malignant melanoma patients and 206 matched controls were enrolled in the study. The female to male ratio was 2 : 1. Light phototypes were more prone to the development of cutaneous melanoma. Although stronger in the bivariate analysis, in the logistic regression model, phototypes I or II and ephelides emerged only as moderate risk factors; light eye color and light hair color were not independently significant, with adjusted odds ratios (OR) close to zero. Commonly acquired nevi (CAN) showed a significant and strong effect in the bivariate analysis only when the "30 or more" category was compared to baseline. In the logistic regression model, the presence of a large number of CAN showed an association with increased levels of risk, although these findings did not reach classical significance. Dysplastic or atypical nevi seemed to contribute more strongly, although still with a moderate excess of relative risk. When the use of sunscreens was compared to no use at all, it appeared to show progressive protection as the solar protection factor (SPF) increased. Only SPF15 or greater (SPF15+) showed strong and significant protection when compared to baseline. Physical measures offered a weaker level of protection. Nevertheless, there was a significant increase in the risk of melanoma for those with a large number of sunburn episodes. It was found that 30 or more alleged episodes of sunburn showed a very strong OR of 11.4 (95% confidence interval, 2.6-50.5), the most significant in the study. CONCLUSIONS: Phototypes I and II, freckles, a large number of acquired nevi, dysplastic nevi, and inadequate photoprotection appeared as risk factors with moderate strength for cutaneous malignant melanoma in the studied population. The color of the eyes and hair showed a very weak statistical significance as a risk factor. Sunscreens showed progressive significance corresponding to an increase in SPF, the best scores in statistical protection being achieved in users of sunscreens with SPF15 or greater. Frequent sunburn episodes appeared as the most important risk factor associated with malignant melanoma in this sample of the white population in southern Brazil.

Adult↗
PubMedDate not supplied

Hepatitis C virus genotypes in hemophiliacs in the state of Minas Gerais, Brazil.

BACKGROUND: Hepatitis C virus (HCV) is a positive-strand RNA virus composed of at least 10 genotypes and dozens of subtypes. Six major genotypes can be distinguished by restriction fragment length polymorphism (RFLP) analysis of the amplified 5' noncoding region (NCR) of the genome. The genotypes are unequally distributed throughout the world. Types 1 and 3 are most common in Europe and the United States. Although fewer studies have been performed in Brazil, the pattern seems to mirror that in the other areas. HCV infection is highly prevalent among hemophiliacs and is a major cause of chronic liver disease. STUDY DESIGN AND METHODS: This study investigated a sample of the hemophiliac population in the state of Minas Gerais, Brazil, by RFLP analysis of the 5' NCR. RESULTS: It was observed that 84.1 percent were of genotype 1 and 13.6 percent of genotype 3. Sequence analysis of nine isolates confirmed the RFLP results and determined that all of the type 1 isolates belonged to subtype 1a. Phylogenetic analysis by parsimony and distance revealed that lineages of genotypes 1, 2, and 3, and 4 could be separated. The isolates of type 3 from this study were distinct from published sequences, which possibly indicated their different geographical origin. CONCLUSION: Although the frequency of genotypes observed (types 1 and 3) among hemophiliacs in the state of Minas Gerais was higher than that in the southern part of the country, these frequencies were not different from those in other groups of patients in Brazil and other countries studied. Further investigation is needed of the evidence that the type 3 isolates observed in these studies are significantly different from other isolates previously characterized by sequence analysis.

Base Sequence↗