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PubMed1994

[The use of pacifiers in children: fecal contamination and association with diarrhea].

A cross-sectional study of 354 children under two years of age was carried out in two periurban slums, with poor sanitary and socioeconomic conditions, located in Pelotas, southern Brazil. Most (79%) of the children studied were current users of pacifiers, 15% had never used one and the remaining 6% were ex-users. Among current users, 38% sucked a pacifier most of the time ("constant users"). Of the pacifiers in constant use, 93% were cultured for evidence of fecal contamination. Fecal coliforms were present in 49% of these. Diarrhoea was reported in 35% of all the children in the two weeks preceding the survey. Among constant pacifiers users, 40% had had diarrhoea in the preceding fortnight; this proportion was 32% for occasional users and 37% for non-users. These differences were not statistically significant.

Brazil↗
PubMedDate not supplied

Vibrios among patients of good socioeconomic conditions during the cholera epidemic in Recife, Brazil.

Between March and July, 1992, we screened for Vibrio all fecal samples submitted for bacteriologic diagnosis at a private clinical laboratory in Recife. Of 1435 cultures examined only 1 (0.07%) was positive for V. cholerae 01, biovar Eltor, serovar Inaba, but 17 (1.2%) yielded non-cholera Vibrio (V. cholerae non-01; V. fluvialis; V. furnissii, V. parahaemolyticus and Vibrio spp). Thus, V. cholerae 01, differently of other enteropathogenic vibrios, spared individuals of good socioeconomic conditions even during the cholera epidemic, which made hundreds of victims in the neighboring slums.

Brazil↗
PubMedDate not supplied

[Human leptospirosis in Belo Horizonte City, Minas Gerais, Brazil: a geographic approach].

A retrospective study on human leptospirosis, was done in Belo Horizonte in 1995, using geographic processing resources. Thirty suspected and 19 confirmed cases of leptospirosis were mapped in the area. The majority of confirmed cases (68.4 +/- 13%) were located in North, Northeast and West of the city. The main foci of disease were found in slums and other poor areas: 73.7 +/- 12% of the confirmed cases and 26.7 +/- 12% of suspected cases. Ninety-five percent +/- 6% of the confirmed cases were found in the outskirts of the city where there was a population increase and inadequate infrastructure. It was observed that 50 +/- 14% of the suspected cases and 42 +/- 14% of the confirmed cases were found in areas of high concentration of water resources. Suspected (83.3 +/- 10%) and confirmed cases (79 +/- 11%) occurred in lower altitude areas of the city (750 to 1,000m) and 78 +/- 12% of the individuals had been in contact with contaminated water and/or animals.

Adolescent↗
PubMed2006

High exposure to Tunga penetrans (Linnaeus, 1758) correlates with intensity of infestation.

Tungiasis is a parasitic skin disease widespread in resource-poor urban and rural communities in Brazil. Inhabitants of an urban slum in Northeast Brazil were examined for the presence of tungiasis lesions and followed-up twice a week for a period of three weeks. Each time the number, stages, and topographic localization of lesions were recorded on a documentation sheet. The infestation rate (number of newly embedded sand fleas per individual and day) remained stable during the observation period. The infestation rate was significantly related to the intensity of infestation (total number of lesions present) (rho = 0.70, p < 0.0001) and the proportion of viable lesions (rho = 0.28, p < 0.0001). The results indicate that in an endemic area the infestation intensity and the proportion of viable lesions can be used as a proxy to assess the exposure of individuals at risk for tungiasis. Persistently high infestation rates during the transmission season favour the use of prevention measures against invading sand fleas (such as a repellent) rather than a drug to kill already embedded parasites.

Adolescent↗
PubMed2003

Headache complaints associated with psychiatric comorbidity in a population-based sample.

The objective of the present study was to determine the frequency at which people complain of any type of headache, and its relationship with sociodemographic characteristics and psychiatric comorbidity in S o Paulo, Brazil. A three-step cluster sampling method was used to select 1,464 subjects aged 18 years or older. They were mainly from families of middle and upper socioeconomic levels living in the catchment area of Instituto de Psiquiatria. However, this area also contains some slums and shantytowns. The subjects were interviewed using the Brazilian version of the Composite International Diagnostic Interview version 1.1. (CIDI 1.1) by a lay trained interviewer. Answers to CIDI 1.1 questions allowed us to classify people according to their psychiatric condition and their headaches based on their own ideas about the nature of their illness. The lifetime prevalence of "a lot of problems with" headache was 37.4% (76.2% of which were attributed to use of medicines, drugs/alcohol, physical illness or trauma, and 23.8% attributed to nervousness, tension or mental illness). The odds ratio (OR) for headache among participants with "nervousness, tension or mental illness" was elevated for depressive episodes (OR, 2.1; 95%CI, 1.4-3.4), dysthymia (OR, 3.4; 95%CI, 1.6-7.4) and generalized anxiety disorder (OR, 4.3; 95%CI, 2.1-8.6), when compared with patients without headache. For "a lot of problems with" headaches attributed to medicines, drugs/alcohol, physical illness or trauma, the risk was also increased for dysthymia but not for generalized anxiety disorder. These data show a high association between headache and chronic psychiatric disorders in this Brazilian population sample.

Adolescent↗
PubMed2005

[Induced abortion among low income women: dimensions of the problem].

This paper examines the practice of abortion, especially induced abortion among low income women. The discussion is based on survey data collected between 1984 and 1985 in seven slum communities (favelas) situated in the metropolitan area of Rio de Janeiro, Brazil. Despite restrictive law, induced abortion is extremely frequent. Among married women 21.4 per cent reported experience of induced abortion. Most abortions were performed by physicians, however the quality of care of these procedures can be questioned since almost all induced abortions are illegal there is no possible supervision by health authorities. The incidence of post-abortion complication is very high, especially for those performed by traditional midwifes or by the woman herself. More than 60 per cent of the women were not using contraception at the time of pregnancy. About, 21 per cent reported that they were using the pill. Such a high pill failure rate is inacceptable, and probably was related to incorrect use. This points to the need for a better access to family planning care within the health services. The consequences of the restrictive abortion laws in Brazil are also discussed. Restrictions that in practice prove to have little impact on the practice of induced abortion, appear to be very effective in brooding even more the social-economic inequalities.

English Abstract↗
PubMed1997

[Community health centers: an alternative for the health system]

Reflecting on the current reorganization of the relationship between the state and civil society, the health care field is involved in an intense debate over the organization and use of government and private health services. The authors propose an alternative, consisting of the implementation of primary health care clinics, managed by local institutions and funded by the Unified Health System. To support this proposition, they report on the current experience at the Rocinha slum in Rio de Janeiro, where a community health center was built by the neighborhood association 12 years ago and has been managed by the community since then. The hospital referral rate at the clinic, requests for laboratory tests, and use of precriptions have been considerably limited, although these services are available. These low rates are attributed to the possibility of closer social control by the community, as well as to the geographical features of the center, favoring a broader perception of both health problems and treatment. In order to provide more substantial support to the proposed centers, some suggestions are presented, like the implementation of direct agreements between the government and neighborhood associations (not allowed under current legislation) and expanding potential sources of funding for the health centers, currently restricted to government programs.

Journal Article↗
PubMedDate not supplied

[Spatial analysis of Aedes aegypti larval distribution in the Ilha do Governador neighborhood of Rio de Janeiro, Brazil].

This study aims to help expand knowledge on Aedes aegypti in Rio de Janeiro, based on spatial analysis of the mosquito's breeding sites in the neighborhood of Ilha do Governador, Rio de Janeiro, from June 1992 to July 1994. Use of spatial analysis techniques is proposed for vector surveillance and control. Information obtained from the number of dwellings per block that were used for the analysis. A smoothing method, a Gaussian Kernel, was used in the spatial distribution analysis. Breaks in National Health Foundation intervention activities were observed between cycles 4 and 5 and 5 and 6, respectively, followed by increases in vector density and vector-positive areas. Permanently positive areas, like slums and a military compound, display the persistence of favorable environmental conditions for oviposition and larval growth, indicating flaws in the vector control program. Although Kernel is an exploratory analytical method involving subjective interpretation, it provides easy and fast visualization of sites subject to different degrees of risk, unaffected by existing political and administrative territorial apportionment.

Aedes↗
PubMedDate not supplied

[An outbreak of acute schistosomiasis at Porto de Galinhas beach, Pernambuco, Brazil].

We recently confirmed several cases of acute schistosomiasis in Porto de Galinhas beach, Northeast Brazil. A total of 662 patients were diagnosed by parasitological and clinical examinations. The infection likely occurred during the September 7 national holiday, when heavy rainfall flooded the Ipojuca River and people were infected when the water covered their yards. Families were continuously exposed to infection for a period of three weeks until the water had completely dried up. Previous investigation suggests that snail vectors were introduced as a result of landfill in marshy areas. The swamp-flooding of such areas facilitated the emergence of slums surrounded by snail breeding sites. Heavy rainfall caused open-air sewage ditches to overflow, allowing for infection of snails by Schistosoma mansoni. Thus, continuous floods were responsible for the spread of human infection. Clinical and laboratory results identified 62% of acute cases of S. mansoni. Complementary studies are being conducted to define the impact and epidemiological meaning of the acute schistosomiasis outbreak.

Acute Disease↗
PubMedDate not supplied

[Spatial analysis of early neonatal mortality in the municipality of Rio de Janeiro, 1995-1996].

The objective of this study was to establish the spatial distribution of the early neonatal mortality rate (0-3 days) in the municipality of Rio de Janeiro for 1995-1996, identifying the best explanatory factors for spatial variations. By considering Rio de Janeiro's 153 neighborhoods as ecological units of analysis, socioeconomic and maternal indicators were analyzed according to place of residence. Spatial statistical analysis was performed using the Cliff & Ord methodology, appropriate for lattice data. From the 0-3 day mortality thematic map, we clearly identified two clusters of high early neonatal mortality rates. Spatial dependence was also confirmed by the statistical results of the spatial analysis. The variables that explain the clusters are the proportions of "adolescent mothers", "slum-dwellers", and "heads of households below the poverty level". Spatial statistics provided a better understanding of the geographic distribution of early neonatal mortality and suggested potential hypotheses for further investigation, which could support preventive programs and contribute to a decrease in infant mortality.

Adolescent↗
PubMedDate not supplied

Spatial modeling using mixed models: an ecologic study of visceral leishmaniasis in Teresina, Piauí State, Brazil.

Most ecologic studies use geographical areas as units of observation. Because data from areas close to one another tend to be more alike than those from distant areas, estimation of effect size and confidence intervals should consider spatial autocorrelation of measurements. In this report we demonstrate a method for modeling spatial autocorrelation within a mixed model framework, using data on environmental and socioeconomic determinants of the incidence of visceral leishmaniasis (VL) in the city of Teresina, Piauí, Brazil. A model with a spherical covariance structure indicated significant spatial autocorrelation in the data and yielded a better fit than one assuming independent observations. While both models showed a positive association between VL incidence and residence in a favela (slum) or in areas with green vegetation, values for the fixed effects and standard errors differed substantially between the models. Exploration of the data's spatial correlation structure through the semivariogram should precede the use of these models. Our findings support the hypothesis of spatial dependence of VL rates and indicate that it might be useful to model spatial correlation in order to obtain more accurate point and standard error estimates.

Analysis of Variance↗
PubMedDate not supplied

[What is garbage, anyway? The opinions of women from an outlying neighborhood in a large Brazilian city].

Domestic solid waste is cause for current environmental concern in large cities around the world. Little is known about the human health consequences of solid waste disposal in open-air dumps. In addition, there are few studies on people's health practices in relation to solid waste. As the initial step in epidemiological research on the relationship between solid waste and diarrhea, this study describes women's perception of the definition of garbage and the popular understanding of the relationships between garbage and disease, and between garbage and the environment. The study used a qualitative approach in a slum neighborhood in Salvador, Bahia. A total of 13 women were interviewed using a semi-structured questionnaire in 1999. The FileMaker "diaricamp" application was used for data analysis. Interviewees defined garbage as anything useless and considered it a problem whenever it accumulated in the surroundings producing a bad smell or visual pollution, attracted animals, caused disease in children or adults, or was shifted from the individual to the collective/institutional sphere of action to solve the problem.

Adolescent↗
PubMed2003

[Prenatal and childbirth care equity in an area in Greater Metropolitan São Paulo, 1996].

A cross-sectional study was conducted to evaluate prenatal and childbirth care interviewing mothers of infants in the municipality of Embu (Greater Metropolitan São Paulo) in 1996, according to four socioeconomic strata. A door-to-door survey included a probabilistic sample consisting of 483 infants. In all strata more than 90% of the mothers had received prenatal care, but with late access in stratum 4 (residents of favelas, or slums). Breast examination during prenatal care, reported by only 60.8% of the mothers, was the worst single indicator of quality of prenatal care in the municipality. The outcome indicator - first prenatal consultation after the first trimester and total number of consultations less than six - was associated with maternal age (less than 20 years), low per capita family income (less than one minimum wage), and lack of private health plan. As for deliveries, 97.7% occurred in hospital, of which 32.5% by cesarean section, with the latter more frequent in private health care facilities (63.2%). No population segments were identified as being excluded from the health care system, but some indicators suggest greater deficiencies in socioeconomic stratum 4. These results have supported local health system managers in redefining health measures for the municipality.

Adult↗
PubMed2003

[Comparison of nutritional status of low-income children in the second year of life, before and after primary health care program implantation].

The so-called "Slum Project" or Projeto Favela at the São Paulo School of Medicine, Federal University in São Paulo, conducts numerous primary health care activities in low-income communities in the city of S o Paulo to prevent and control nutritional deficiencies. The aim of this study was to compare the nutritional status of children from 12 to 26 months of age before and after preventive intervention. The study was conducted with two groups, before and after intervention, with 57 and 65 children, respectively. Anthropometric measures and hemoglobin values were obtained. In the before-intervention group, the prevalence of malnutrition as measured by weight for age and weight for height was 12.3% and 1.8% respectively, whereas there were no cases of malnutrition in the after-intervention group. There was a reduction in the prevalence of anemia, especially the severe form, from 33% to 7%. Mean hemoglobin increased from 10.1 to 11.0 g/dl, and the duration of breastfeeding was greater (> 180 days) after intervention.

Adolescent↗
PubMed2004

[Primary health care organization in the context of social exclusion/inclusion processes].

This article reports on a primary health care and training center in São Paulo, Brazil, and the organization of its activities based on equity and positive discrimination. Operating in the city center of São Paulo, the policy aims to provide health services access to certain target groups (homeless, sex workers, and slum-dwellers). It also raises discussion on the various forms of social life found in downtown areas, mainly those of vulnerable groups lacking access to public goods and services. The experience demonstrates the feasibility of implementing health policies based on universal access.

Brazil↗
PubMed2004

[Spatial distribution of leptospirosis in the city of Rio de Janeiro, Brazil, 1996-1999].

Leptospirosis, one of the most widely disseminated zoonoses in the world, is endemic in Brazil and is characterized by outbreaks during seasons with the greatest rainfall. In 1996 the city of Rio de Janeiro experienced one of the largest urban epidemics in the country, shortly after heavy rainstorms in the month of February, with 1,732 reported cases and 51 deaths. The objective of this work was to describe the spatial distribution of leptospirosis in the city of Rio de Janeiro during the period 1996-1999. Data were from the National Information System for Reportable Diseases. The kernel ratio for cases and population generated a smoothed surface, which estimates the intensity of the leptospirosis incidence rate. In the resulting maps over the course of the study period, the sites with the highest leptospirosis intensity were not repeated, and the sites normally considered as having the highest risk -- slum areas and flooded areas -- were not always the most heavily affected. The techniques used can represent an important methodological acquisition for establishing territory-based surveillance.

Animals↗
PubMed2005

[The Meninos do Rio Program: lifeworld, adolescence, and health risks].

This study focuses on health risks among teenagers from two towns in the Sao Francisco River Valley (Ibiai and Morada Nova) and slums in Morro das Pedras, Belo Horizonte, Minas Gerais State, Brazil. The study discusses teaching and extracurricular activities by the Federal University in Minas Gerais in these localities, aimed at promoting health in adolescence. The authors use the Habermas communicative action theory as the main theoretical and methodological approach. The research adopted a qualitative and quantitative methodology, including dynamic observation, focus groups, interviews, and questionnaires answered by high school students. Sexuality, work, and violence were the main themes and were associated with numerous health risks. Work in the 10-to-14-year-old group was associated with nearly all types of health risks. The authors analyze the relations between context and adolescent behavior using the Habermasian concept of lifeworld colonization.

Adolescent↗
PubMed2006

[Factors associated with trachoma in a low-endemic area in southeast Brazil].

A case-control study matched by age and school (n=121 pairs) was carried out among pre-elementary and elementary students from low-income families living in Greater Metropolitan São Paulo, Brazil, with the objective of investigating factors associated with trachoma in a low prevalence area. The case definition for trachoma was that proposed by the World Health Organization. The dependent variable was trachoma and the independent variables were social stratum, housing of migrants from endemic areas, facial hygiene habits, head of family's schooling, access to potable water, contact with another case in the family, and slum residence. Unadjusted and adjusted odds ratios (OR), with their respective 95% confidence intervals (95%CI), were estimated by conditional logistic regression. In the multivariate analysis, belonging to the poorest social stratum (OR = 8.21; 95%CI: 1.50-44.81), housing people from endemic areas (OR = 2.44; 95%CI: 1.10-5.46), contact with another case in the family (OR = 2.52; 95%CI: 0.98-6.48), and facial hygiene habits (OR = 0.50; 95%CI: 0.26-0.98) were independently associated with trachoma.

Adolescent↗