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PubMed2005

Epidemiology of hepatitis A and E virus infection in Brazil.

This review has the objective to discuss the epidemiological aspects of the enterically transmitted hepatitis A and E in Brazil. The prevalence of hepatitis A varies greatly in different Brazilian regions, from 56% in South and Southeast to 93% in North region (Manaus, Amazon). Such differences are also found in different socioeconomic levels among age groups. A significantly higher prevalence was seen in the low socioeconomic group between 1-30 years. This difference is most striking in the first 10 years of age (23.5% vs 60.0%, high/middle vs low, respectively). Despite the improvements in sanitary conditions, hepatitis A is still endemic and outbreaks may occur. As an increasing proportion of the population is becoming susceptible to hepatitis A virus infection and as adult individuals may present more severe forms of the disease, the authors conclude that the implement of hepatitis A vaccination should be considered. Some Brazilian data have shown that the genotype found in our country were IA and IB. Isolates from this study were closely related genetically (or even identical) to isolates originating in other South American countries and overseas, providing firm evidence for epidemiological links between persons who travel to endemic areas. In spite of favorable environmental conditions, outbreaks of hepatitis E have never been reported in Brazil. Nevertheless, reports have demonstrated the evidence of anti-hepatitis E virus antibodies in some Brazilian regions. The seroprevalence of IgG anti-hepatitis E virus among normal populations shows positivities of 6.1% in gold-miners, 3.3% in general population, 2.0-7.5% in blood donors, 1.0% in pregnant women, and 4.5% in children, with no differences among regions. In populations at risk the prevalence of anti-hepatits E virus varies greatly. Among patients with acute non-A, non-B, non-C hepatitis 2.1% was detected in the Southeast to 29% in the Northeast, in 10.6% of acute non-A, non-B, non-C hepatitis relatives in the Amazon basin, in 12% of acute sporadic non-A non-B hepatitis patients in the Northeast, a co-infection with acute hepatitis A in 25 to 38% in the Northeast, in 14 to 18% among prostitutes and women considered at risk for human immunodeficiency virus in the Southeast, and in 12% of the intravenous drug users in the Southeast.

Adolescent↗
PubMed2001

Risk factors for breast cancer among pre- or post-menopausal women in Belo Horizonte, Brazil.

BACKGROUND: Much controversy has been generated about pre- and post-menopausal breast cancer patients and investigators have sought to identify whether risk factors differ between these two groups. In Brazil, breast cancer is an important cause of death among women and there are few analytical studies concerning pre- or post-menopausal comparisons. METHODS: A case-control study was carried out at the Federal University Hospital, Belo Horizonte, Brazil, to determine if selected socio-economic and reproductive risk factors for breast cancer differed between pre-menopausal and post-menopausal women. Cases were 300 women with breast carcinoma and controls were 600 women with other benign diseases matched for age and date of diagnosis, admitted to the same hospital during the same period (1978-1987). Univariate and multivariate conditional logistic regression analyses were performed. RESULTS: Multivariate analysis showed no differences in breast cancer risk in pre- and post-menopausal women (risk factors were similar in direction and magnitude). Occupation, irregular menstrual cycles, parity, history of breast cancer in at least one first-degree female relative, and oral contraceptive use had similar associations in both groups. CONCLUSIONS: The present study indicates that breast cancer diagnosed before and after menopause has a similar risk profile.

Adult↗
PubMed2002

Outcome of treatment in adult acute lymphoblastic leukemia in southern Brazil using a modified german multicenter acute lymphoblastic leukemia protocol.

Reports on treatment outcomes in adults with acute lymphoblastic leukemia (ALL) in Brazil are sparse. To evaluate the outcome of patients with ALL managed by the public healthcare system, we studied 42 adults treated from 1990 to 1997 in the Division of Hematology at Hospital de Clínicas, Porto Alegre, Brazil. Of these patients, 14/42 were females and their median age at diagnosis was 26 (17-64) years. The diagnosis of ALL was based on cytological examination of marrow smears, and immunophenotypic and cytogenetic studies, when available. Fifty percent of the patients expressed CD10, 30% were CD10 negative and CD19 positive and 20% expressed T markers. Philadelphia chromosome was found in 4 (7.14%). The chemotherapy protocol was adapted from the German Multicenter ALL (GMALL) 02-84 protocol. The complete remission rate was 93% and the overall survival at 5 years was 41%. No particular risk factor was identified in our series. These results are comparable to the findings of other international studies.

Adolescent↗
PubMed2002

Familial aggregation of end-stage kidney disease in Brazil.

BACKGROUND/AIMS: Familial aggregation of end-stage kidney disease (ESKD) has been reported in several studies, most of them carried out in USA. It is uncertain to what extent these findings can be generalized to other populations. The objective of this study was to assess whether familial aggregation of ESKD occurs in Brazil and whether it is influenced by race. METHODS: Case-control study including 555 ESKD patients and 595 controls without renal disease. Multivariate logistic regression models were used to assess the association between a history of ESKD in a first-degree relative (Fam-ESKD) and the risk of ESKD. Additionally, the association between Fam-ESKD and race among ESKD cases was analyzed. RESULTS: Twenty-seven cases (4.9%) and 5 controls (0.8%) reported Fam-ESKD (p < 0.001). Fam-ESKD was significantly more frequent among cases in a regression model adjusted for all studied covariates (OR = 5.71, 95% CI = 2.13-15.4; p < 0.001). The frequency of Fam-ESKD among dialysis patients belonging to the white, black and 'mixed' racial subgroups was 6.0, 4.3 and 4.0%, respectively (p = 0.62). There was no association between race and Fam-ESKD (p = 0.54) in adjusted regression analyses. CONCLUSION: Fam-ESKD occurs in Brazil but, as opposed to what has been suggested by American studies, it does not appear to be influenced by race.

Adult↗
PubMed2006

Education of speech-language pathologists and audiologists in Brazil.

The field of speech-language pathology (SLP) in Brazil, named 'fonoaudiologia', comprises both a therapeutic approach to communication disorders and audiology and was officially recognized on December 9, 1981 (law No. 6965). University programs exist since the 1960s. The undergraduate level is a 4-year honors Bachelor of Science program and requires at least a 3,700 h of coursework. Since 1996 four areas of specialization were established: language, audiology, voice and oral myology, requiring a minimum of 500 h of course. Graduate programs in the narrower sense,master's degree and doctorate, exist since the 1970s. Brazil is a 180-million inhabitant country with approximately 25,000 speech-language pathologists, of which 2,700 are specialists, 800 masters and 210 doctors. There are almost 100 undergraduate programs and 70 specialization courses; however, for master's degree and doctorate purposes there are only 8.

Audiology↗
PubMed2006

Assessment of a pioneer metabolic information service in Brazil.

The Information Service on Inborn Errors of Metabolism (SIEM), a pioneer toll-free service in both Brazil and South America, is based in Porto Alegre, Southern Brazil. SIEM has been operating since October 2001 providing support to health care professionals involved in the diagnosis and management of suspected metabolic diseases. We analyzed the demographic and clinical characteristics of the 376 consults received and followed in the first two and half years of SIEM. Our results show that the suspicion of a metabolic disease was most often associated with neurological symptoms. Among the consults, 24.4% were eventually confirmed as inborn errors of metabolism (IEM), with organic acidurias and amino acid disorders being the two most frequent diagnostic groups. Our conclusion shows this kind of service to provide helpful support to the diagnosis and acute management of IEM, especially to health professionals working in developing countries who are often far from reference centers.

Brazil↗
PubMed1991

Oligonucleotide probes for the specific detection of the wild poliovirus types 1 and 3 endemic to Brazil.

Synthetic oligodeoxynucleotide probes, 21-23 nucleotides in length, were prepared which specifically hybridize to the genomes of the wild type 1 and 3 polioviruses currently endemic to the northeastern region of Brazil. The probes are complementary to sequences near the 5'-terminus of the VP1 gene that differ substantially among genetically distant polioviruses but are largely conserved among related isolates. The probes have been routinely used in the laboratory surveillance of poliomyelitis cases in Brazil, permitting direct, rapid identification of the indigenous wild polioviruses by dot-blot hybridization.

Amino Acid Sequence↗
PubMed1976

Activity of glucose-6-phosphate dehydrogenase among Indians living in a malarial region of Mato Grosso and its implication to the Indian-mixed populations in Brazil.

Erythrocyte glucose-6-phosphate dehydrogenase (G-6-PD) activity and electrophoresis were investigated among 154 Indians living in a region hyperendemic for malaria at Alto Xingu, Mato Grosso, Brazil. No enzyme-deficient individual was found, and all subjects belonged to enzyme type B. No statistical difference in G-6-PD levels was found between tribes and sexes. The average of G-6-PD activity of the Indians was significantly higher than the normal mean values found by the same technique in Caucasians, Negroes and Japanese of Säo Paulo, Brazil. The high rates of G-6-PD activity of the Indians are not correlated to an increased reticulocytosis by hypochromic anaemia and appear to be typical of Indian or Indian-mixed populations. Resistance to malaria in those populations should not involve erythrocyte G-6-PD deficiency. It is suggested that the apparent association between G-6-PD deficiency and resistance to malaria found in other populations could be a statistical accident determined by the racial correlation between the incidence of G-6-PD deficiency and sickle-cell or thalassaemic haemoglobins among Negro and Mediterranean populations.

ABO Blood-Group System↗
PubMed1987

Occurrence of a rare variant of superoxide dismutase in Brazil.

During a paternity test performed in Porto Alegre, Brazil, a rare variant of superoxide dismutase, probably SOD A2, was found in a Caucasian child and the putative father. Studies of 1,700 unrelated white individuals from the same and nearby cities had never disclosed such a variant, which was also absent in 2,480 persons of other ethnic groups living in different regions of Brazil. The presence of this rare phenotype in the child and putative father led to the assignment of a very high probability of paternity to the latter.

Brazil↗
PubMedDate not supplied

Molecular characterization of glucose-6-phosphate dehydrogenase deficiency in Brazil.

Molecular characterization of glucose-6-phosphate dehydrogenase (G6PD) variants was carried out in 150 unrelated G6PD deficient blood donors from the region of Campinas, Brazil. By allele specific oligomer hybridization or digestion of exon 4 of the G6PD gene with the restriction endonuclease NlaII, we detected the 202 G-->A mutation in 146 individuals. This mutation was associated with the 376 G-->A substitution and only one haplotype was observed in these individuals. Digestion of exon 6 with the restriction enzyme MboII showed the presence of the Mediterranean variant in three individuals. Haplotype analysis showed, in all three samples, a T at nt 1311 and the C at nt 13 in intron 11, suggesting a European origin of this variant. By SSCP analysis and direct sequencing we detected the mutation nt 1003 G-->A (335 Ala-->Thr) in one blood donor. This mutation was previously described in a boy of Indian ancestry and the variant was denominated G6PD Chatam. The case described here has no Indian ancestry; thus, we presume that the mutations have arisen independently, although we do not know the haplotype of the Indian patient. The haplotype of our case was the most common observed in our population (PvuII, BspHI+, PstI+, 1311C, NlaIII-). Thus, our data indicate that G6PD A- with the 202 G-->A mutation is the most frequent G6PD deficiency in the population of southeastern Brazil. The remaining variants had a Mediterranean origin. These results are in agreement with the origin of the Brazilian population.

Brazil↗
PubMed1990

Immune response to Blomia kulagini and Dermatophagoides pteronyssinus in Sweden and Brazil.

The immune responses to the non-pyroglyphid mite Blomia kulagini and the pyroglyphid mite Dermatophagoides pteronyssinus were compared in 440 Swedish farmers and 34 allergic subjects from Brazil using the radioallergosorbent test (RAST). Both B. kulagini and D. pteronyssinus were shown to be a common cause of sensitization, particularly in Brazil. The highest RAST scores were found against D. pteronyssinus in sera from both countries. Allergenic cross-reactivity between the two mites was studied by the RAST inhibition technique. Both B. kulagini and D. pteronyssinus possess their own unique allergens as well as allergens in common. Thus, besides mites belonging to the Dermatophagoides genus, other pyroglyphid and non-pyroglyphid mites in different countries should be taken into consideration before starting hyposensitization treatments.

Adolescent↗
PubMed2006

Progressive decline in stroke mortality in Brazil from 1980 to 1982, 1990 to 1992, and 2000 to 2002.

BACKGROUND AND PURPOSE: We describe the trends in stroke mortality in Brazil during 3 decades and investigate their differences according to regional disparities, sex, and age distributions. METHODS: Official data on mortality and population estimates were retrieved to calculate standardized mortality rates (with the 1980 Brazilian population as a reference) in 6 age strata and in the 5 political regions for the initial period (3 first years) of the 1980, 1990, and 2000 decades. Data were corrected for undefined causes of death. The Poisson model was used to estimate risk reduction during the 3 decades and to study the interaction between those rates and sex, age strata, and regions. RESULTS: The stroke standardized mortality rate decreased consistently in the last 20 years, from 68.2 to 40.9 per 100,000 habitants. This reduction paralleled a decrease in total cardiovascular mortality rates in the same period, from 208.2 to 126.1 per 100,000 habitants. The reduction in stroke standardized mortality rate was detected in men and women and in all age strata. The reduction was evident in all geopolitical regions of the country, with the wealthiest regions' exhibiting higher initial rates and more marked standardized mortality rate reductions. The risk of dying of stroke in the period 2000 to 2002 was 0.45 (95% CI, 0.44 to 0.45) of that found in the period 1980 to 1982. CONCLUSIONS: The risk of dying of stroke in Brazil declined dramatically between the initial period in the early 1980s and the early 2000s. The decline was especially marked in the most developed regions and may reflect an improvement in general health conditions during the study period.

Adolescent↗
PubMed2003

[Research in occupational therapy: postgraduate training program in Brazil].

BACKGROUND: This paper presents an analysis of the postgraduate training process of occupational therapists in Brazil. It also describes a study of the training process' impact on the areas of research, teaching, clinical work and on the professional profile of these occupational therapists. METHOD: In order to obtain information regarding the choices made by the occupational therapists enrolled in a postgraduate program, a questionnaire was mailed to all occupational therapy educators in Brazil. RESULTS: From the data, it was possible to identify the reasons for their choices, the expectations of the professionals towards the training, the perspectives of the profession and the impact of the training on the profiles of the occupational therapy students and future professionals in this field. PRACTICE IMPLICATIONS: The results of the analysis should lead to the implementation of a national postgraduate program designed for occupational therapists.

Brazil↗
PubMedDate not supplied

Changing patterns of HIV-1 transmission in southern Brazil 1985-1991.

In order to describe the changing patterns of risk factors for HIV-1 transmission of patients using hospital services at an AIDS referral centre in Porto Alegre, southern Brazil, data on demographic characteristics, referral patterns and risk factors at time of first presentation were collected prospectively on 405 patients between October 1985 and September 1991. Overall HIV-related patient workload increased during the study period, as did the proportion of infected female patients seen (P < 0.05). Of all patients, 147 (36%) presented with symptomatic HIV disease and 77 (19%) presented with an AIDS defining condition; men were more likely to present with symptomatic disease than women. Approximately 156 (44%) of men were self-referred compared with 4 (8%) of the women (P < 0.0001). Of the 357 infected men, 82 (23%) were bisexuals; of the 26 heterosexually infected women, 7 (24%) had bisexual male partners. These data suggest the increasing importance of heterosexual HIV transmission in this hitherto 'low' prevalence area, with male bisexuals constituting an important route through which heterosexual females are being infected in this area. The data also suggest that heterosexual women in Southern Brazil do not perceive themselves to be at risk for HIV-1 infection.

Adult↗
PubMed1994

Cross-sectional analysis of the differences between patients with systemic lupus erythematosus in England, Brazil and Sweden.

This study is a cross-sectional analysis of the differences between SLE outpatients seen in Rheumatology departments at University centres in England, Brazil and Sweden, using a standard protocol. The demographic characteristics, extent and activity of disease of 209 patients with SLE were studied; 112 patients were seen in England, 33 in Brazil and 64 in Sweden. The median age of disease onset of Brazilian and English patients was 25 years and of Swedish patients 31.5 years. Disease activity was measured by the BILAG index. In most systems Brazilian patients experienced more activity than English patients and English patients more activity than Swedish patients. Non-Caucasians experienced more active disease than Caucasians. No sex or occupational differences were observed in disease activity. English patients were the most likely to have experienced photosensitivity, oral ulcers and haematological disorders, Brazilian patients renal disorders and Swedish patients discoid rashes. Brazilian patients were the most likely to be prescribed only one drug for treatment of SLE and to be taking steroids and the highest dose of steroids, in contrast to the European patients who were often prescribed steroids and an antimalarial agent or azathioprine. The results of this cross-sectional assessment of disease activity using a standardized instrument indicate that there are real differences in the extent and degree of activity of SLE in different national groups. This reflects a combination of genetic, environmental and social influences on disease expression and has implications for treatment and monitoring of SLE patients.

Adolescent↗
PubMed2005

Network of communities in the fight against AIDS: local actions to address health inequities and promote health in Rio de Janeiro, Brazil.

When combined with major social inequities, the AIDS epidemic in Brazil becomes much more complex and requires effective and participatory community-based interventions. This article describes the experience of a civil society organisation, the Centre for Health Promotion (CEDAPS), in the slum communities (favelas) of Rio de Janeiro, Brazil. Using a community-based participatory approach, 55 community organisations were mobilised to develop local actions to address the increasing social vulnerability to HIV/AIDS of people living in squatter communities. This was done through on-going prevention initiatives based on the local culture and developed by a Network of Communities. The community movement has created a sense of "ownership" of social actions. The fight against AIDS has been a mobilising factor in engaging and organising communities and has contributed to raising awareness of health rights. Local actions included targeting the determinants of local vulnerability, as suggested by health promotion workers.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Equine monocytic Ehrlichiosis (Potomac horse fever) in horses in Uruguay and southern Brazil.

A disease named locally as churrío or churrido equino (i.e., equine scours) has occurred for at least 100 years in Uruguay and southern Brazil in farms along both shores of the Merín lake. This report describes cases of churrido equino and provides serologic, pathologic, and DNA-based evidence indicating that the disease is in fact equine monocytic ehrlichiosis (Potomac horse fever). Results of an epidemiological investigation conducted on an endemic farm are also presented. Clinical signs in 12 horses were fever, depression, diarrhea, dehydration, and sometimes colic and distal hind limb edema. Postmortem findings of 3 horses were of acute enterocolitis. Inclusion bodies containing ehrlichial organisms were found in the cytoplasm of macrophages of the large colon of 1 horse. Eleven of the 12 horses were serologically positive to Ehrlichia risticii (indirect fluorescent antibody assay) and, of 3 paired samples, 2 showed seroconversion. Ehrlichia risticii DNA was identified by a nested polymerase chain reaction in peripheral blood of an affected horse. A healthy horse inoculated with peripheral blood from an affected horse developed the disease and antibodies to E. risticii. The disease had a peak incidence in March (summer) and was statistically associated with a marshy ecosystem near the Merín lake, where large numbers of Pomacea spp. (Ampullariidae) snails were found. Incidence density was almost 8 times higher in nonnative horses than in native horses. It was concluded that the previous diarrheic disease of horses known in Uruguay and southern Brazil as churrido equino is equine monocytic ehrlichiosis.

Animals↗
PubMed2005

Spiritist views of mental disorders in Brazil.

The Spiritist perspective on mental disorders exerts a great influence in Brazil. Spiritist theory supports the survival of the spirit after death with an exchange of knowledge between the incarnated and disincarnated spirits. This article reviews the texts on mental disorders and Spiritism written by four leading Spiritist authors: Allan Kardec, Bezerra de Menezes, Inácio Ferreira and Joanna de Angelis. These authors advocated a model of spiritual etiology without rejecting the biological, psychological, and social causes of mental disorders. The Spiritist etiologic model for mental disorders includes the negative influences of discarnated spirits (termed 'obsession') or trauma experienced in previous lives. In addition to conventional medical and psychological therapeutics, spiritist séances for disobsession are recommended, as well as 'passes', prayers and efforts to live according to ethical principles. The importance of Spiritist views in Brazil indicates the need for more academic research on this tradition.

Brazil↗