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PubMed2006

Characteristics of known leprosy contact in a high endemic area in Brazil.

BACKGROUND AND PURPOSE: The annual number of new cases of leprosy has not declined in Brazil over the last 15 years, indicating that transmission continues at the same level. To study transmission, we interviewed leprosy patients about their known leprosy contact (KLC). METHODS: Clinical and demographic data were collected from 506 leprosy patients in four health units in the Metropolitan Region of Vitŕia, State of Espírito Santo, Brazil. SPSS 9.0 was used as a database and analysis. RESULTS: Two hundred and twenty-six (44.7%) of 506 leprosy patients reported KLC, 136 (60.2%) of 226 were parents. Among 226, the mean of KLC was 1.89 (SD +/- 1.65), and 61.3% had one KLC. KLC as a household contact was reported by 92 (40.7%) out of 226, and 121 (53.5%) had no household contact. KLC were most frequently sisters and brothers in the PB cases, and sons/daughters in MB cases. Mothers occurred more frequently as a KLC than fathers. From the leprosy patients that had reported household contacts, 73% said that at the onset of their skin lesions, the KLCs were either undergoing were not yet released from treatment (RFT), and 23.45% had not begun the treatment yet. Altogether, 62.3% of 226 cases had daily contact with the KLC. CONCLUSION: In Brazil, household contacts, including the family members (mothers, sisters and brothers), as well as the social contact need to be investigated by the control programs.

Adolescent↗
PubMedDate not supplied

[Abuse of caesarean delivery in Brazil: geographic dimensions of a medical aberration].

"Brazil is the world champion of caesareans." This prowess points out a serious public health problem. While the increase in the percentage of caesareans among all deliveries is an international phenomenon, it is highest by far in Brazil, where caesareans account for nearly 40% of births, that is, three times the maximum recommended by WHO. This abusive practice appears pandemic and has spread in recent years throughout the entire country, although at divergent rates. It weighs heavily on Brazil's national health insurance fund. After a critical examination of the information sources related to births, we analyze successively the principal factors likely to explain this abuse: level of development, emergence of family planning and the association of caesarean delivery with tubal ligation for sterilization purposes, and tension within the healthcare system, especially the role of private physicians in urban areas. By studying these aspects of the problem in their geographic dimensions, we find important regional differences that must be considered in defining policies to limit this excess.

Birth Rate↗
PubMed2006

Risk of tuberculous infection in an indigenous population from Amazonia, Brazil.

SETTING: Suruí Indians, Amazonia, Brazil. OBJECTIVE: To estimate the prevalence and the annual risk of infection (ARI) of tuberculosis (TB) in an indigenous population in Brazil. METHODS: We applied a method to estimate the prevalence of TB infection in populations with high bacille Calmette-Guérin (BCG) vaccine coverage. The method consisted of comparing levels of skin test reactivity in individuals tested with purified protein derivative (PPD) before and after stimulation with intradermal BCG. Fieldwork was carried out among the Suruí Indians (n = 993) in two phases, 3 months apart. RESULTS: A total of 645 subjects were tested. In pre-BCG revaccination, tuberculin skin test (TST) indurations averaged 5.9 mm (33.5% > or =10 mm). In post-BCG revaccination TST, indurations averaged 9.4 mm (48.7% > or =10 mm). Conversion from non-reactor to reactor was 54.4%. The ARI ranged from 1.2% to 2.2%. In the logistic regression, age and history of TB were the strongest independent predictors of TB infection. BCG scar and the number of individuals per house were also associated with infection. CONCLUSION: Tuberculous transmission is very high in the Suruí, surpassing the ARI reported for Brazil (0.6%). The epidemiology of TB in this indigenous population is related to unfavourable social and economic conditions, as well as to deficient health care services.

Adolescent↗
PubMed1991

Lack of evidence for HIV-2 infection among at-risk individuals in Brazil.

Recent reports have indicated the possibility that HIV-2 has been introduced into groups at risk for AIDS in Brazil. We studied sera collected in 1987 and 1988 from 1,821 at-risk individuals from diverse regions in Brazil. Of the 1,821 sera, 367 (20%) were confirmed as being positive for HIV-1 antibodies by enzyme-linked immunosorbent assay (ELISA), immunofluorescence (IF), and Western blot. An additional 33 (2%) sera displayed some reactivity to HIV-2-infected cells by IF. All 33 sera were subsequently tested in HIV-1 and HIV-2 Western blots as well as an ELISA using HIV-1- or HIV-2-specific peptides. All sera were confirmed as positive for HIV-1 and negative for HIV-2 antibodies in both assays. We conclude that caution should be used in the interpretation of serologic cross-reactivity between HIV-1 and HIV-2 and that there is no evidence that HIV-2 has entered groups at risk for HIV infection in Brazil.

Blotting, Western↗
PubMedDate not supplied

[Identification of wild rodents as hosts of Angiostrongylus costaricencis in southern Brazil].

Increasing number of human cases of abdominal angiostrongyliasis has been diagnosed in the south of Brazil. The main definitive host of Angiostrongylus costaricensis in Central America is the cotton rat (Sigmodon hispidus) that does not occur in South America, except in the north of Colombia, Peru and Venezuela. Rodents were captured in the endemic area in Rio Grande do Sul (RS) and definitive hosts were identified for the first time in Brazil: Oryzomys nigripes and Oryzomys ratticeps. O. nigripes is a small wild rodent and it appears to be the main definitive host of A. costaricensis in the highlands of RS, Brazil's southernmost State.

Angiostrongylus↗
PubMed1990

[Antigenic variants of rabies virus isolated in the northeast and southeast of Brazil. Preliminary study].

To help identify the different strains of rabies virus existing in Brazil, the antigenic profile of 13 virus isolates from humans and animals was determined. The indirect immunofluorescence technique was used, with monoclonal antibodies targeted at the viral nucleocapsid. In the northeast of the country five different viral strains were identified, and in the southeast, two. A rhabdovirus isolated from a fox could not be characterized as a rabies virus. Previously, only two antigenic variants had been identified in Brazil. It would appear that distribution of the strains is not related to the species from which they are isolated or to their geographical origin, a finding that differs from previous observations. These preliminary results underscore the need for further research in order to identify the existence and distribution of different strains of rabies virus in Brazil, which would help to prevent rabies vaccination failures.

Animals↗
PubMed1986

Chemical analysis of compounds extracted from the tergal "spots" of Lutzomyia longipalpis from Brazil.

The chemical composition of the compounds contained in the tergal spots of Lutzomyia longipalpis was investigated. Four populations of L. longipalpis were examined, originating from: Sobral, Ceará, Brazil (one spot and two spot populations), Santarém, Pará, Brazil (one spot) and Marajó Island, Pará, Brazil (one spot). The tergal spots were dissected out, extracted in hexane and analysed on a gas chromatograph/mass spectrometer. Two compounds were found, identical to compounds found in earlier studies, but there was no correlation between number of tergal spots and type of compound present. It was suggested that the number of tergal spots could not be used as a marker for reproductively isolated populations, and that analysis of the compound present within the spots might be necessary to characterize potentially good vector populations.

Animals↗
PubMed1985

[Family medicine in Brazil].

A need for general physicians, chiefly to deal with health problems in the interior, has made itself felt since 1948. The first two medical residency programs for the training of general physicians were begun in 1976, and today there are 13 such programs. Ten of those programs have been studied in this report, which is based on visits to the establishments where the resident physicians receive training and to some areas served by the programs, and on interviews with education and health officials, alumni of the programs, resident physicians, and coordinators and supervisors of residency programs. "Community general medicine" is the term most widely used in the profession to designate medical practice addressed to the individual, the family and the community and providing total, ongoing and personalized care of the patient. Community general medicine must take account of psychological and socioeconomic factors and interact with the community to collaborate in the solution of its problems. The residency programs in community general medicine are essential for the training of teachers and researchers who will be models to the graduating students and change the undergraduate courses by removing them from the now prevalent overspecialization so as to arrive at a more humane medicine that is more responsive to the health needs of less developed regions. For lack of information on the practice and teaching of community general medicine, attitudes in the medical profession vary from apathetic to sceptical to approving. As a new movement in Brazil, it has great difficulties to overcome, including shortcomings in the training for it and a lack of job openings for graduates. Up to 1982, 174 physicians had completed residencies in community general medicine in Brazil, and about 154 of them are known to have been employed. There are at present 138 physicians attending the 10 programs considered. The regular teaching staff are joined by many professionals in different capacities, who vary in number and working hours with the requirements of the program. In addition to the 13 residency programs in community general medicine, others have sprung up under the agreement between FEPAFEM, PAHO and the K. W. Kellogg Foundation; they are already operating under different names in Brazil and include the training of general physicians. The residency programs in community general medicine are still new and need to become better known to the public and members of the profession before it can be confirmed that they are of use.

Brazil↗
PubMed1984

Corpus Christi strain-induced protection to Trypanosoma cruzi infection in C3H(He) mice: transfer of resistance to Brazil strain challenge with lymphocytes.

Treatment of susceptible C3H(He) mice with 10(7) live Corpus Christi strain culture-derived Trypanosoma cruzi provided protection against a subsequent Brazil strain challenge. This protection was indicated by a greater than 10-fold decrease in parasitemia and an increase in longevity (including survival) in many groups. The Corpus Christi organisms were unable to establish an apparent infection, but viability is an important element in the treatment in that freeze-thawed, non-viable preparations of the Corpus Christi strain were unable to provide protection. Adoptive transfer of resistance was achieved with spleen cells from Corpus Christi-treated, Brazil-infected mice which had recovered from the acute phase of infection. The T cell-depleted population of these spleen cells was able to transfer resistance whereas the T cell-enriched population was not protective. Passive transfer of serum from Corpus Christi-treated and Brazil-infected mice provided a temporary decrease in parasitemia in infected mice. The results presented herein suggest that Corpus Christi-induced protection to virulent T. cruzi challenge is mediated by antibody mechanisms.

Animals↗
PubMed1983

[Comparative studies on properdin factor B (Bf) polymorphism in random samples from Brazil, Germany and Guinea-Bissau].

Three different population samples have been tested for properdin factor B markers: 395 individuals from Schleswig-Holstein (Germany), 343 individuals (Europids) from Southern Brazil, and 309 individuals (Negroids) from Guinea-Bissau (Western Africa). These samples are showing marked differences in the distribution of Bf gene frequencies. As for the sample from Southern Brazil the Bf data are confirming the assumption that the Caucasoid population in Southern Brazil is somewhat mixed with Negroids.

Alleles↗
PubMed1995

The nutrition transition in Brazil.

OBJECTIVE: To describe and analyse changes in child and adult nutritional status in Brazil during the past several decades. DESIGN: Two large nationally representative cross-sectional anthropometric surveys undertaken in 1974 and 1989 are the primary source of information. Child nutritional status was described based on weight-for-age and weight-for-height indices using NCHS/WHO standards. Body mass index was employed to assess adult nutritional status. SUBJECTS: 27,960 children and 94,699 adults in 1974 and 5969 children and 23,544 adults in 1989. SETTING: All regions in Brazil. RESULTS: Undernutrition, although still relevant particularly in children from lower income families, is declining among adults and children of all economic strata. Concurrent increases in adult obesity have been occurring among all groups of men and women with a higher proportion of increase among lower income families. A profound change in the income-obesity relationship determines that in the most recent survey: (1) income and body mass index are inversely related among the 30% richest women; (2) a higher prevalence of female obesity (15.4%) occurs for the 40% middle-income group; and (3) the 30% poorest Brazilian women (9.7% prevalence) can no longer be considered to be protected from obesity. CONCLUSION: Brazil is rapidly shifting from the problem of dietary deficit to one of dietary excess.

Adult↗
PubMed1993

Oral contraceptive use and blood pressure levels among women workers in São Paulo, Brazil.

Oral contraceptive use has been increasing in Brazil since the late 1970s, and oral contraceptives have been associated with higher incidence of cardiovascular diseases, including hypertension, since their release in the United States and Europe. We examined the association between oral contraceptive use and blood pressure levels in 1457 workers from 10 sectors of the economy, between the ages of 15 and 49 years, in São Paulo, Brazil. Oral contraceptive use was associated with higher age, lower parity, higher income, white ethnic group, and administrative occupations. Using multiple linear regression and logistic regression techniques, we evaluated blood pressure and hypertension differences between users and nonusers. Oral contraceptive users had a mean systolic blood pressure 2.6 mm Hg higher than nonusers after adjustment for multiple potential confounders, including age, income, parity, ethnicity, body mass index, and occupation. There was a statistically significant positive trend between length of time on oral contraceptives and mean systolic blood pressure levels. After adjustment for demographic and social variables, there were no differences between whites and blacks. Oral contraceptive users have an adjusted odds ratio for hypertension of 2.66 (95% CI: 1.51-4.70). The finding of an increasingly positive association between oral contraceptive use and mean systolic blood pressure level suggests cause and effect. This observation has substantial importance because systolic blood pressure is considered the primary predictor of blood pressure-associated morbidity and mortality. This may pose a particular problem in Brazil, since most women on oral contraceptives are not under medical supervision.

Adolescent↗
PubMed1994

Seroprevalence of Helicobacter pylori infection in children of low socioeconomic level in Belo Horizonte, Brazil.

OBJECTIVE: To study the epidemiology of Helicobacter pylori infection in children of low socioeconomic level in Belo Horizonte, Brazil. METHODS: Serum samples were collected from 249 children (134 boys, 115 girls, mean age 6.4 yr, range 1 month to 18 yr) at an outpatient clinic of the University Hospital/UFMG, Belo Horizonte, Brazil. Information obtained included age, gender, nutritional status, family income, domestic crowding, sewage, and water supply. H. pylori infection was identified by means of an indirect immunofluorescence assay (sensitivity, 94.3% and specificity, 100.0% in children) which detects the presence of IgG against H. pylori. RESULTS: Ninety-seven percent of the children had an annual family income of US $5,000.00 or less, 93.7% had city water, and 79.5% had sewage. In 90.2% of the families, the number of persons per room was > 1. Of the 241 children evaluated for nutritional status, 129 (53.5%) were considered to be eutrophic, 62 (25.7%) presented mild malnutrition, 34 (14.1%) moderate malnutrition, and 16 (6.6%) severe malnutrition. The prevalence of H. pylori infection was 34.1% and was similar in boys (35.8%) and girls (32.2%). The prevalence of H. pylori infection increased significantly (p = 0.001) with age as follows: 1 month-2 yr, 16.4% (11/67); 3-5 yr, 36.7% (22/60); 6-8 yr, 29.5% (13/44); 9-11 yr, 48.8% (21/43); 12-14 yr, 42.8% (9/21); and 15-18 yr, 64.3% (9/14). There was no significant difference in H. pylori infection with regard to nutritional status or the presence of sewage. CONCLUSION: The results of present study demonstrate that in Belo Horizonte, Brazil, as also reported in other developing countries, H. pylori infection occurs early and increases with age.

Adolescent↗
PubMed1993

[Sickle cell disease as a public health problem in Brazil].

Sickle cell anemia is the most prevalent hereditary disease in Brazil. However, the Brazilian literature registers no investigations into the public health aspects of the disease. This present study investigates the way of life of 80 adult patients (49 women and 31 men) with a diagnosis of sickle cell anemia, at a blood center in Brazil. The late diagnosis of the disease was one of the most significant aspects observed in this group of patients. It was also observed that the dominant problem faced by adult patients with sickle cell anemia is of an economic nature, mainly due to lack of professional opportunities. However, patients can well undertake economic activities under adequate medical supervision, according to their own limitations and potentialities. The psychotherapeutic orientation was well accepted by patients regardless of sex. It is concluded that there exists need for the establishment of community programs for early diagnosis and medical, social and psychological orientation for sickle cell anemia patients in Brazil.

Adolescent↗
PubMed1993

Women's labour force participation and socioeconomic development: influences of local context and individual characteristics in Brazil.

We address several key hypotheses about the effects of socioeconomic development on women's labour force participation during the transition from agriculture to industrialism. To this end, we explore differences in women's labour force participation in Brazil by education, marital status, age, and urban or rural residence. We also show how socioeconomic development affects the overall level of women's participation and the differentials by education, etc. Our data are drawn from a large 1973 PNAD (Pequisa Nacional por Amostra de Domicilos) survey conducted by the Brazilian census bureau. Socioeconomic development in different parts of Brazil ranges from pre-industrial agriculture to heavy industry. Using logistic regression, we show that the general level of women's labour force participation does not change with the level of development. Highly educated women are much more likely than the less educated to be in the labour force (net of other influences); this difference is substantially greater than in post-industrial societies. Somewhat surprisingly, the influence of education is the same across the range of development levels in Brazil. Single women are more likely to be in the labour force than married women, and the difference grows during development. Age has a curvilinear relationship to labour force participation, and the old are much less likely to participate in more developed places. Rural women are slightly more likely to be in the labour force at all levels of development.

Adolescent↗
PubMed1996

[Dengue and its vectors in Brazil].

History of dengue in Brazil is covered from the first citations in the XIXth century to the great outbreaks of the last ten years. DEN-1 and DEN-4 viruses have been isolated for the first time in 1982 during an epidemic in Boa Vista, Roraima State. In 1986-1987, epidemics of dengue type 1 covered an extended area from Rio de Janeiro/Sào Paulo States to the North East States of Brazil. During 1990-1991, dengue type 2 epidemics have been notified in the South East (Rio de Janeiro/São Paulo) and in some States of the interior of the country (Mato Grosso do Sul, Tocantins). DEN-1 virus was also circulating the same year in São Paulo and Minas Gerais States. Recently (1994), an important outbreak has been studied in Ceará State, where DEN-2 and DEN-1 viruses have been isolated. In Rio de Janeiro and Ceara (1990 and 1994, respectively), it is probably the succession of infections by DEN-1 and DEN-2 viruses which has caused many DHF/DSS cases. The urban vector has always been the mosquito Aedes aegypti, from which 4, 7 and 16 strains of DEN-4, DEN-1 and DEN-2 have been isolated, respectively. In Brazil, transovarial transmission of dengue viruses by this species has not yet been shown to occur in nature.

Aedes↗
PubMed1997

[Notes about the historical evolution of health policies in Brazil].

This paper is an historical review of the health policy in Brazil. Ranged since the arrival of the real portuguese family to Brazil until nowadays. The review intent to contextualize present facts based on historical, social and political facts for the needed foundation to give best comprehension of the ways in which is organizing the health policy in Brazil.

Brazil↗
PubMed1999

Geographic heterogeneity of 4 common worldwide cystic fibrosis non-DF508 mutations in Brazil.

Cystic fibrosis (CF) is an autosomal recessive disease caused by at least 750 different mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. The frequency of the most common mutation (DF508) in Brazilian patients of European origin is 47%. To determine the frequency of 4 other common CF mutations (G542X, G551D, R553X, and N1303K) in Brazilian patients of European origin, we used direct polymerase chain reaction (PCR) amplification of DNA obtained from dried blood spots on Guthrie cards. The DNA came from 247 non-DF508 chromosomes from 172 Brazilian CF patients ascertained from 5 different states of Brazil. The results show that the 4 mutations account for 17% of the non-DF508 alleles and only 9% of the total number of Brazilian CF alleles. Overall, the frequency of each mutation is different from northern European and North American populations but similar to southern European populations, mainly the Italian and Spanish populations. When Brazilian patients of European origin are grouped according to state of birth, the frequencies of the mutations are significantly different between southern and southeastern states of Brazil. Therefore there are serious implication for risk assessment of DNA-based tests in heterogeneous populations such as Brazilians. Further studies are needed to identify the remaining 44% of CF mutations for the different populations and regions of Brazil.

Adolescent↗