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PubMedDate not supplied

[The various meanings of Brazil's certification as free of Chagas disease].

The article discusses Brazil's recent certification as free of Chagas disease transmission by Triatoma infestans, analyzing the various meanings ascribed to this position. Resulting mainly from measures by both the Chagas Disease Control Program (PCDCh) established in Brazil in 1975 and the Southern Cone Initiative launched in 1991, this certification has been interpreted in ways that lead to confusion between the elimination of Chagas disease transmission by T. infestans and eradication of the disease. The present status of vector transmission control in Brazil is discussed, with emphasis on the Northeast, in most States of which T. infestans is not the main species involved in transmission. The article highlights the need to broaden the discussion of the readings and consequences involved in the present control achievements in light of possible harm from misinterpretations that might jeopardize further efforts to control the disease.

Animals↗
PubMedDate not supplied

Paracoccidioidomycosis mortality in Brazil (1980-1995).

This study analyzes 3,181 deaths from paracoccidioidomycosis in Brazil, based on 16 years of sequential data (from 1980 to 1995). During this period paracoccidioidomycosis showed considerable magnitude and low visibility, representing the eighth most common cause of death from predominantly chronic or recurrent types of infectious and parasitic diseases. It also had the highest mortality rate among the systemic mycoses. The mean annual mortality rate was 1.45 per million inhabitants, indicating a downward long-term trend (reduction of 31.28%), while spatial distribution among the different regions and States of Brazil was non-homogenous. The South (with the highest regional rate) and the Southeast showed a downward trend, while the Central West had the second highest rate in the country. At least one-fifth of Brazilian municipalities (or 22.71% of the country's total area) reported deaths from paracoccidioidomycosis. Overall nationwide mortality per area was 3.73/10,000km2. The disease was endemic in non-metropolitan areas. The majority of deaths occurred in males (84.75%), and there was a sex ratio of 562 men/100 women. The 30-59-year and over-60-year age groups were the most affected. The study showed that the mortality rate justifies classifying this disease as a major health problem in Brazil.

Adolescent↗
PubMed2003

[Maternal age and Down syndrome in Northeast Brazil].

This study analyzes the association between advanced maternal age and increased incidence of Down syndrome in neonates, based on a population sample from the State of Bahia in Northeast Brazil. Age of the mothers of 220 Down syndrome subjects was investigated, and age distribution was compared to that of the population control group, 220 mothers of subjects without Down syndrome. The proportion of Down syndrome infants dependent on advanced maternal age was estimated at 43.6%, thus showing a high correlation (r = 0.95) between advanced maternal age and Down syndrome incidence. However, this component was significantly lower than the 75% reported in the literature. The component independent of maternal age was estimated at 56.4%, indicating the action of other factors on meiotic non-disjunction associated with 21 trisomy. The results also indicate that despite the regional characteristics of Northeast Brazil, factors both dependent and independent of maternal age show the same distribution observed in Southeast Brazil, where extensive studies have been performed.

Adolescent↗
PubMed2003

[The resurgence of pertussis in developed countries: a problem for Brazil as well?].

Pertussis is currently considered an important public health problem in developed countries. In most of these countries, mass immunization for pertussis was initiated in the 1950s and was followed by a marked decrease in disease incidence. In the 1970s, pertussis was apparently under control in countries were vaccine coverage was maintained high. However, in the last two decades of the 20th century, the number of reported cases increased in all age groups, including adolescents and adults, indicating resurgence of the disease. This brief note aims to present the possible reasons for resurgence of this disease and to discuss the prospects of its future dynamics in Brazil. There has been no evidence to date for the resurgence of pertussis in Brazil. However, since mass immunization in Brazil began only in the 1980s, one cannot rule out the possibility that pertussis will resurge in the near future. Therefore, it is important that public health services closely monitor the epidemiological situation of pertussis in order, if necessary, to rapidly update the current immunization strategy.

Adolescent↗
PubMed2004

[Knowledge and opinions concerning legal and ethical issues with abortion among physicians working in emergency wards in Ribeirão Preto, São Paulo, Brazil].

This study focused on the knowledge and opinions of physicians regarding legal and ethical aspects of abortion. A self-administered questionnaire was filled out by 57 physicians working in the emergency rooms of two hospitals in Ribeirão Preto, São Paulo State, Brazil in 2001. The questionnaire had 38 questions on general knowledge, legislation, and attitudes towards abortion. Interviewees' mean age was 28.3, most were females, 52.6% were single, 42.1% were married, 54.4% were Catholic, and 21% were Spiritists. Although most of the physicians had a good level of overall knowledge on abortion (70%), one in five was not aware that abortion is the main cause of maternal mortality in Brazil. Most accepted the prevailing legal conditions for performing an abortion in Brazil but would also include fetal malformation incompatible with life, while opposing decriminalization of abortion on other grounds. Limited knowledge is revealed by misconceptions concerning enforcement of the prevailing legislation in practice. The study strongly suggests that many physicians lack knowledge or face difficulties in conforming to the Brazilian legislation on abortion.

Abortion, Induced↗
PubMed2005

Hemoglobinopathies in newborns from Salvador, Bahia, Northeast Brazil.

Hemoglobinopathies are hereditary disorders of the hemoglobin molecule with a high prevalence worldwide. Brazil has a prevalence of 0.1 to 0.3% of newborns with sickle cell anemia and 20.0 to 25.0% of heterozygous alpha2 thalassemia among African Brazilians. In the present study, we investigated the presence of variant hemoglobins and alpha2(3.7 Kb) and alpha2 (4.2 Kb) thalassemia in newborns from Salvador, Bahia, Brazil. Samples of umbilical cord blood from a total of 590 newborns were analyzed, of which 57 (9.8%) were FAS; 36 (6.5%) FAC; one (0.2%) SF; and five (0.9%) FSC. One hundred fourteen (22.2%) newborns had alpha2(3.7 Kb) thalassemia, of whom 101 (19.7%) were heterozygous and 13 (2.5%) homozygous, showing statistical significance for hematological data between newborns with normal alpha genes and alpha2(3.7 Kb) thalassemia carriers. The alpha2(4.2 Kb) thalassemia was not found. Frequencies found in the present study confirm that hemoglobinopathies are a public health problem in Brazil, emphasizing the need for neonatal screening and genetic counseling programs.

Anemia, Sickle Cell↗
PubMed2005

Heterogeneous geographic distribution of human T-cell lymphotropic viruses I and II (HTLV-I/II): serological screening prevalence rates in blood donors from large urban areas in Brazil.

Brazil may have the highest absolute number of HTLV-I/II seropositive individuals in the world. Screening potential blood donors for HTLV-I/II is mandatory in Brazil. The public blood center network accounts for about 80.0% of all blood collected. We conducted a cross-sectional study to assess the geographic distribution of HTLV-I/II serological screening prevalence rates in blood donors from 27 large urban areas in the various States of Brazil, from 1995 to 2000. Enzyme immunoassay (EIA) was used to test for HTLV-I/II. The mean prevalence rates ranged from 0.4/1,000 in Florianopolis, capital of Santa Catarina State, in the South, to 10.0/1,000 in São Luiz, Maranhão State, in the Northeast. EIA prevalence rates are lower in the South and higher in the North and Northeast. The reasons for such heterogeneity may be multiple and need further studies.

Blood Donors↗
PubMed2005

[Birth defects and health strategies in Brazil: an overview].

Birth defects have increased progressively in Brazil, shifting from the fifth to the second cause of infant mortality from 1980 to 2000, thus highlighting the need for specific health policy strategies. Some governmental and nongovernmental actions related to birth defects in Brazil include information services on teratogenic agents and inborn errors of metabolism, monitoring of birth defects, neonatal screening and treatment of some genetic diseases, and rubella immunization. In addition, flour fortification with folic acid for prevention of certain birth defects has begun recently. Despite the importance of such initiatives, it is still difficult to view birth defects from a comprehensive perspective. A specific national policy on birth defects must be formulated. Active participation is needed by the Ministry of Health, using existing genetic services as the backbone, in order to develop a regionalized, hierarchical, and functional network related to birth defects in Brazil.

Brazil↗
PubMed2006

Human T-cell lymphotropic virus type II in Guaraní Indians, Southern Brazil.

Human T-cell lymphotropic virus type II (HTLV-II) is found in many New World Indian groups on the American continent. In Brazil, HTLV-II has been found among urban residents and Indians in the Amazon region, in the North. Guaraní Indians in the South of Brazil were studied for HTLV-I/II infection. Among 52 individuals, three (5.76%) showed positive anti-HTLV-II antibodies (enzyme-linked immunosorbent assay and Western blot). This preliminary report is the first seroepidemiological study showing HTLV-II infection among Indians in the South of Brazil.

Blotting, Western↗
PubMed2006

[Asthma-related mortality, Brazil, 2000: a study using multiple causes of death].

Asthma is underestimated in mortality statistics that only look at the underlying cause of death. We studied deaths of residents in the Brazilian states of Ceará, Pernambuco, Bahia, Minas Gerais, Rio de Janeiro, São Paulo, and Rio Grande do Sul, as well as total deaths in Brazil, where asthma was recorded in any line or part of the death certificate. Causes of death were processed using the Multiple Cause Tabulator. In Brazil, the death rate increased about 50% when all mentions of asthma in death certificates were considered. This increase differed between 36% in Ceará and 76% in Rio Grande do Sul. The highest rates occurred among women and the elderly. The majority of deaths occurred in hospitals, except in Ceará, where the majority occurred at home. Diseases of the circulatory and respiratory systems, emphasizing chronic obstructive pulmonary diseases, were found to be underlying and associated (nonunderlying) causes in deaths related to asthma. Mortality with asthma as the underlying cause was greater in Brazil than in Australia, England and Wales, Scotland, Sweden, and the United States.

Adolescent↗
PubMedDate not supplied

[Brazil 500 years. A Jesuit anatomical nomenclature at the time of discovery].

The purpose of rendering easier for priests to hear confessions from Brazilian indians, in the beginning of the colonization of Brazil by the Portuguese, and in order to serve indians for better communication led Pero de Castilho, a jesuit born in Vila do Esp¿rito Santo, to prepare a list of names of parts of the human body. Such a list of tupi (language of the native indians) and portuguese terms of anatomical structures, in alphabetical order, seems to be the first Nomina Anatomica published in Brazil. Such a bilingual vocabulary constitutes a subsidy for the study of both languages spoken soon after the discovery of Brazil and represents a religious related document that contributes to the history of anatomy and medicine.

Anatomy↗
PubMed2006

[The National Health Surveillance Agency, ANVISA, and clinical research in Brazil].

Conduction of clinical trials with drugs in Brazil requires prior approval by Committees for Ethics in Research (CEPs) and, in certain cases, by the National Commission for Ethics in Research (CONEP). Approval by the National Health Surveillance Agency (ANVISA), through its Office for New Drugs, Research and Clinical Trials (GEPEC), is currently required only for drugs and medical devices manufactured in other countries and therefore need permission to be imported. This article briefly reviews the history of clinical research regulation in Brazil, then presents an overview of the current regulatory role of ANVISA and its future prospective. Major points discussed are the new forthcoming ANVISA regulations, with emphasis on adverse event notifications and inspections/audits on clinical trials and their impact on clinical research in Brazil, from the standpoint of the industry, university, contract research organizations, physicians and other health professionals. It should be stressed that to decide upon the licensing of new drugs ANVISA must obtain information from clinical trials.

Biomedical Research↗
PubMed1998

[Brazil within the concert of nations: the struggle against racism in the early days of Unesco].

This article has the objective of approaching the political and scientific context that led Brazil to the position of Unesco paradigm for racial matters. I set out from the hypothesis that soon after the Holocaust, the positive image of race relations in Brazil was in greater evidence, becoming sort of anti-Nazi Germany. At this time, a number of unforeseen efforts took place in the sense of striving for an association between the search for understanding the German totalitarian phenomenon, the radical critique of the scientific standing of the concept of race, the evidencing of socio-economic demands of underdeveloped countries, and the choice of Brazil as a socio-anthropological laboratory. This combination of aims only became viable from the onset of a transnational political-academic alliance universalistic in nature.

Brazil↗
PubMedDate not supplied

[The small pox vaccine: its first century in Brazil (from the Jennerian to the animal vaccine)].

Covering a period of roughly hundred years, the article looks at some of the more meaningful events during the period in which the small pox vaccine was institutionalized in Brazil. Discoveries and discussions then taking place in other countries are also examined, particularly as they influenced Brazil. The process is followed from introduction of the human vaccine to the arrival of the animal vaccine and creation of the Municipal Vaccine Institute--a private initative by physician Pedro Affonso Franco, also known as the barao de Pedro Affonso. Adoption of the animal vaccine not only represented progress in controlling the disease but also spurred discussions that saw medical and political groups in Brazil taking sides with either Oswaldo Cruz or the barao de Pedro Affonso. The debate continued within the academic and political arenas until the Vaccine Institute was made part of the Manguinhos laboratories.

Academies and Institutes↗
PubMed1999

[Infectious and parasitic diseases in Brazil: a decade of transition].

Brazil has been undergoing a period of epidemiological and demographic transition, which has included an improvement in the quality of death certificate registrations and major changes in the patterns of mortality from infectious and parasitic diseases. This article outlines the changes in the mortality patterns that were observed in the country and in its states during the decade of the 1980s. We used data from the Ministry of Health Mortality Information System, classified according to the International Classification of Diseases, 9th Revision. Our analysis showed important changes in mortality patterns in Brazil. Mortality from infectious diseases decreased by 41% among men and by 44% among women. While these types of changes were especially noticeable in the states of the North and Northeast, these states still have the highest mortality rates in the country. The changes particularly affected the extreme limits of the age continuum, most especially children under 1 year of age. Within the group of infectious and parasitic diseases, we also assessed the mortality due to intestinal infectious diseases, tuberculosis, and septicemia. We found that in the 1980s there was a major decrease in the rates of mortality due to intestinal infectious diseases and to tuberculosis. However, there was an increase in the risk of death from septicemia during the decade. In conclusion, we find that the rate of mortality caused by infectious and parasitic diseases remains high in Brazil. Therefore, Brazilian health authorities still need to give priority attention to this cause of death.

Brazil↗
PubMed2000

[Cervical cancer screening among indigenous women in the Xingu Indian Reservation, central Brazil].

Although the literature presents worrisome data regarding the incidence of cervical cancer among indigenous populations, in Brazil there is very little information regarding the occurrence of this type of cancer among indigenous peoples. Therefore, the objective of the present descriptive study was to assess the prevalence of cervical cancer and of cervical and vaginal infections among 423 indigenous women living in the Xingu Indian Reservation, in the state of Mato Grosso, Brazil. These women were or had been sexually active. Data were collected between 1989 and 1996. Clinical and gynecological examinations were carried out prior to the collection of cervical specimens and to the performance of cytologic analyses. Upon detection of abnormalities, a colposcopy and a biopsy were also performed. Our results show that 1% of the women studied presented invasive carcinoma and that 3% presented premalignant lesions. In addition, 84% presented inflammatory atypia, resulting from sexually transmitted genital infections. The present findings are in accordance with the results of other international reports regarding the high prevalence of cervical conditions among indigenous populations, and they underscore the need to extend to the indigenous peoples of Brazil programs aiming at the control of sexually transmitted diseases and at the early detection and treatment of cervical cancer.

Adolescent↗
PubMed2000

Primary health care lessons from the northeast of Brazil: the Agentes de Saúde Program.

Market-led economic reforms are usually viewed as being in conflict with government-stimulated socioeconomic development for disadvantaged groups. Nevertheless, Ceará, a poor state in the Northeast of Brazil, has since 1987 pursued both of those strategies simultaneously. One part of that approach has been a program of nurse-directed auxiliary health workers serving about 5 million people--almost all the persons outside the capital city and half of those in the capital. The system requires that the auxiliaries, called agentes de saúde, live in the local communities that they serve. The health agents visit each home once a month to carry out a small number of priority health activities. While health agent positions are in high demand, the minimum-wage salary that the agents receive makes up only a small portion of the state budget. A key aspect of the system is timely and comprehensive information, which is based on agent visits and is managed by trained nurses. Since the health agents system was launched, there has been a rapid decline in infant mortality, a rapid rise in immunization, identification of bottlenecks limiting the utilization of other medical resources, and timely interventions in times of crisis. The health agents system has combined administrative decentralization with financial centralization during a period of electoral democratization. The system has strengthened Ceará's commitment to primary care even as market-oriented changes have reduced the overall role of government. The Ceará program is being copied throughout the Northeast and other regions of Brazil. The key role that nurses play in the Ceará program in organizing and leading a system of basic primary care in poor neighborhoods and rural areas may provide useful lessons for other countries. In addition, Ceará does not have many of the favorable characteristics of other countries that have successfully invested in primary health care. Ceará thus represents a more achievable model for other countries, where, like Brazil, income, educational levels, and land tenure equity are limited.

Brazil↗
PubMed2000

[Health care reform and changes in nursing practice in philanthropic hospitals in Ribeirão Preto (SP), Brazil].

This paper describes part of a multicenter study sponsored by the Pan American Health Organization to assess health care reforms and their implications for nursing in several countries. The objective of this research was to learn the views of nurses working in philanthropic hospitals in Ribeirão Preto, in the state of São Paulo, Brazil, regarding the changes in nursing practice coming from Brazil's health care reform and implementation of the Unified Health System (UHS). Data were obtained through structured interviews with seven nurses who met the selection criteria, from the three philanthropic hospitals in Ribeirão Preto. The nurses reported a decline in the quality of care and in the number of beds for UHS patients. The nurses reported that UHS implementation initially led to infrastructure improvements in the philanthropic hospitals. However, the reforms eventually shifted toward improving the care of private and privately insured patients. In addition, the nurses emphasized their heavy work loads and low pay. The nurses' reports indicated that Brazil's UHS is going through a crisis. In general, the nurses linked this crisis to problems in funding and allocation of resources.

Brazil↗