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[Factors associated with drug use among adolescent students in southern Brazil].

OBJECTIVE: To assess factors associated with drug use among adolescent students from schools providing secondary education. METHODS: A cross-sectional study was carried out in Pelotas, Southern Brazil, in 1998. An anonymous, self-administered questionnaire was answered by a proportional sample of 10-19-year-old students, enrolled in primary (5th grade and further) and secondary classes in all public and private schools of the urban area which providing secondary education. Schools were visited up to three times in order to reach absent students. Results were expressed as prevalence ratios (PR). RESULTS: 2,410 students were interviewed, losses amounting to 8%. The prevalence of drug use (except alcohol and tobacco) in the last year was 17.1%. After confounder control, associations remained between drug use and parents' divorce (PR=1.46; 95% CI: 1.18-1.80), poor relationship with father (PR=1.67; 95% CI: 1.17-2.38), poor relationship with mother (PR=2.71; 95% CI: 1.64-4.48), open-minded father (PR=1.36; 95% CI: 1.08-1.72), drug user in household (PR=1.61; 95% CI: 1.17-2.18), abuse (PR=1.62; 95% CI: 1.27-2.07), having been mugged or robbed in the previous year (PR=1.38; 95% CI: 1.09-1.76) and absence of religious practice (PR=1.31; 95% CI: 1.07-1.59). CONCLUSIONS: The study suggests associations between several family characteristics and drug use by adolescents, providing useful information for a complete understanding of this problem in Brazil.

Adolescent↗

[Epidemiological aspects of suicide in Rio Grande do Sul, Brazil].

OBJECTIVE: To describe epidemiological aspects of suicide mortality in a 10-year time series. METHODS: Suicide deaths reported in the state of Rio Grande do Sul (RS), Brazil, were put together as historical time series based on data from the Ministry of Health Mortality Reporting System for the period 1980 to 1999. Suicides were grouped according to the WHO criteria and analyzed using standard demographic variables. RESULTS: Suicide rates (proportional mortality and mortality rates) in RS during the study period were the highest in Brazil. The standardized rates grew from around 9 per 100,000 in the 1980s to 11 per 100,000 in 1999. This increase in mortality was attributed mainly to male mortality rates that grew from 14 per 100,000 to the current 20 per 100,000. The male:female ratio increased from 3 to 5. The highest ratios were seen among the elderly although this ratio has been increasing in young adults as well. Widows, widowers and farmers/fishers had the highest mortality rates. CONCLUSIONS: The study highlights suicide as a collective health problem in RS and shows aspects that could contribute to preventive action.

Adolescent↗

[Trends of homicide death in Brazil in the 90s: the role of firearms].

OBJECTIVE: To describe the growth of homicide death in Brazil and to investigate the contribution of firearms to homicide death growth in the 90s. METHODS: An ecological descriptive time series was carried out for the period 1991 to 2000. External cause mortality data were obtained according to place of residence for the overall population and by gender from the Ministry of Health Mortality Information System. Homicides were classified as firearm, non-firearm and unknown (weapon) deaths. Proportional mortality and mortality rates (by 100,000) were calculated. RESULTS: Homicides accounted for 33% of all external cause deaths in the 90s. Firearms were used in more than 50% of deaths in 1991 and in almost 70% in 2000. This growth was seen for both genders and in all state capitals. Homicide mortality rate grew 27.5% in the whole country, and firearm homicide mortality rate grew 72.5%. During the same period there was a drop in deaths classified as unknown weapon homicide, which could partially explain the growth seen in firearm homicide rates. CONCLUSIONS: Data suggest the magnitude of firearm contribution for the growing tendency of homicide deaths in Brazil in the 90s. Data quality regarding intentionality and type of weapon used has hindered data analysis.

Brazil↗

[Breast cancer mortality in women of Southern Brazil, 1980-1999].

OBJECTIVE: To analyze time and geographical trends of breast cancer mortality. METHODS: Annual mortality rates per 100,000 female inhabitants aged 20 to 59 years for the Baixada Santista metropolitan area, the city and state of São Paulo and Brazil, from 1980 to 1999, were standardized by age groups and analyzed. The analyses included regression models to estimate and compare time trends of each area.? RESULTS: Increasing mortality rate trends were observed for all areas. However, intrametropolitan variations have higher baselines and time trends than the other areas. Santos had standardized mortality rates between 25 and 35 per 100,000 women, which were the highest in the study. Differences between Santos rates and the rates of other cities included in the study were statistically significant (p<0.001). The cities of São Vicente, Cubatão and Peruíbe of the Baixada Santista metropolitan area also showed increased mortality rates trends and higher rates than those for the state of São Paulo and Brazil. CONCLUSIONS: A similar increasing trend in mortality rates was observed in all cities of the study area and higher rates were seen in Santos. There is a need for further studies in order to identify the determinant conditions for this trend.

Adult↗

[Social inequalities in cesarean section rates in primiparae, Southern Brazil].

OBJECTIVE: To investigate the effect of social inequalities in cesarean section rates among primiparae having single pregnancy and delivering in maternity hospitals. METHODS: The study was carried out in Southern Brazil in 1996, 1998 and 2000. Data from the Live Birth National Information System were used to estimate annual rates and crude and adjusted odds ratios (OR) of cesarean sections according to social conditions (maternal age and education, newborn skin color/ethnicity and macro-regions), duration of pregnancy, and number of prenatal visits. RESULTS: The overall cesarean section rate was 45%, and above 37% in all macro-regions. Increased rates were seen among native and black mothers, aged 30 years or more, living in metropolitan, river valley and mountain macro-regions and having attended to more than six prenatal visits. Crude and adjusted OR show that cesarean rates were negatively associated with all categories of skin color/ethnicity when compared to white newborns, particularly those of native Brazilian (ORadj=0.43; 95% CI: 0.31-0.59), and they were positively associated with higher maternal education (ORadj=3.52; 95% CI: 3.11-3.99), older age (ORadj=6.87; 95% CI: 5.90-8.00) and greater number of prenatal visits (ORadj=2.16; 95% CI: 1.99-2.35). The effects of age and education were partly mediated by the greater number of prenatal visits among higher educated older women. The OR varied among macro-regions but were greater for the wealthier mountain region. CONCLUSIONS: High rates of cesarean section rates in Southern Brazil are a public health concern. They are associated with social, economic and cultural factors which can lead to misuse of medical technology during labor and delivery.

Adult↗

[Rickettsial diseases in Brazil and Portugal: occurrence, distribution and diagnosis].

The present study is an update review on the occurrence and diagnosis of rickettsial diseases in Brazil and Portugal, aiming at promoting their epidemiological surveillance in both countries. A literature review was carried out and unpublished data of laboratories and surveillance systems were presented. The results described the occurrence of rickettsial diseases and infections in Brazil and Portugal, including other new and still poorly understood rickettsial infections. Current diagnostic methods were discussed. As in many other countries, rickettsial diseases and infections seem to be an emerging public health problem. Treated as a minor problem for many decades, the interest in these infections has increased in both countries but further studies are needed to establish their role as a public health problem.

Animals↗

[Factors associated with influenza vaccination among elderly persons in Southeastern Brazil].

OBJECTIVE: Even though influenza vaccination is free and widely available in Brazil since 1999, coverage is still inadequate in several of the country's municipalities. The aim of the present study was to estimate vaccine coverage and to identify factors related to vaccination against influenza in the elderly population. METHODS: A household survey was carried out using a systematic random sample (N=365) of the urban population older than 60 years from the city of Botucatu, Southeastern Brazil. A logistic regression model using vaccination in 2002 as the dependent variable was used. The following covariables were tested: sex, age, socioeconomic variables (per capita income, number of persons per dormitory, schooling, marital status, occupation, time living in the city), history of morbidity and hospital admission, smoking, respiratory symptoms in last 15 days, and community activities (voluntary work, neighborhood and church activities). RESULTS: Vaccine coverage was 63.2% (95% CI: 58.3-68.2). We found a lower proportion of vaccination among the 60-64 years age group. Variables associated with vaccination in the final model were age (OR=1.09 per year; 95% CI: 1.06-1.13); arterial hypertension (OR=1.92; 95% CI: 1.18-3.13); and participation in community activities (OR=1.63; 95% CI: 1.01-2.65). With the exception of hypertension, vaccination among subjects with chronic diseases did not reach adequate levels, as expected for this high-risk group. Participation in social and community activities was associated with vaccination status. CONCLUSIONS: Socioeconomic conditions, habits, and age did not restrict access to vaccination campaigns. On the other hand, specific campaigns aimed at the 60-64 years age group may increase vaccination coverage.

Age Distribution↗

[Prevalence of Diabetes Mellitus in Southern Brazil: a population-based study].

OBJECTIVE: To compare the prevalence of Diabetes Mellitus among the adult population of an urban area, according to self-reported diabetes and fasting glucose test results. METHODS: We carried out a population-based cross-sectional study of 1,968 subjects aged 20-69 years, living in the urban area of the city of Pelotas, Southern Brazil, in the year 2000. Sample size was calculated at 1,800 subjects. We visited the households of 40 randomly selected census sectors. We administered a standardized questionnaire to all subjects, which included questions on the presence of "blood sugar" and on medical confirmation in case of positive responses. A subsample of 367 participants was selected to donate blood samples for laboratory tests, including fasting blood glucose. We adopted as cutoff points for the detection of diabetes levels of 126 mg/dl and 140 mg/dl. Results are shown as frequencies and their respective 95% confidence intervals. RESULTS: Of the subjects interviewed, 110 (5.6%; 95% CI: 4.6-6.6) referred the presence of Diabetes Mellitus diagnosed by a physician. In the subsample of 367 subjects who underwent blood testing, the prevalence of self-referred, physician-confirmed diabetes mellitus was 7.1% (95% CI: 4.5-9.7). CONCLUSIONS: The prevalence estimates found in the present study are compatible with those obtained in other national surveys. Population-based studies are rare Brazil, and may contribute to the planning of health care policies.

Adult↗

Mental health and psychiatry research in Brazil: scientific production from 1999 to 2003.

OBJECTIVE: To assess the extent of mental health scientific production in Brazil from 1999 to 2003, and to identify the nature of the publications generated, their sources of finance and the ways of publicly disseminating the research findings. METHODS: Searches for publications were conducted in the Medline and PsychInfo databases for the period 1999-2003. A semi-structured questionnaire developed by an international team was applied to 626 mental health researchers, covering each interviewee's educational background, research experience, access to funding sources, public impact and research priorities. The sample was composed by 626 mental health researchers identified from 792 publications indexed on Medline and PsychInfo databases for the period above, and from a list of reviewers of Revista Brasileira de Psiquiatria. RESULTS: In Brazil, 792 publications were produced by 525 authors between 1999 and 2003 (441 indexed in Medline and 398 in the ISI database). The main topics were: depression (29.1%), substance misuse (14.6%), psychoses (10%), childhood disorders (7%) and dementia (6.7%). Among the 626 Brazilian mental health researchers, 329 answered the questionnaire. CONCLUSIONS: There were steadily increasing numbers of Brazilian articles on mental health published in foreign journals from 1999 to 2003: the number of articles in Medline tripled and it doubled in the ISI database. The content of these articles corresponded to the priorities within mental health, but there is a need for better interlinking between researchers and mental health policymakers.

Bibliometrics↗

[Workers' health in Brazil: graduate research].

OBJECTIVE: To study trends of dissertation and thesis production in workers' health in Brazil. METHODS: Observation units were dissertations and theses developed by Brazilian researchers in national and foreign graduate programs. Theses and dissertations were identified in previously compiled works, LILACS and Capes database. Search keywords were workers' health, ergonomics, occupational hygiene, toxicology, and occupational health. RESULTS: There were identified 1,025 documents. Of them, seven were published before 1970, 31 were published in 1970s, 121 in 1980s, 533 in 1990s, and 333 between 2000 and 2004. An exponential growth of studies during the study period was observed with a corresponding factor approximately equal to 4 in each decade. The majority of studies addresses major public health issues like musculoskeletal diseases, mental health, and occupational risks for health workers. It was noticeable the small number of studies on unemployment, occupational cancer, and primary sector and construction industry workers, known as a risk group for fatal work-related injuries. CONCLUSIONS: The growth of public and collective health graduate programs was a major factor for increasing research on workers' health in Brazil in recent years. Despite increasing academic studies in this area of knowledge there are some persisting gaps persist that need to be narrowed in the near future.

Academic Dissertations as Topic↗

Bat rabies in the north-northwestern regions of the state of São Paulo, Brazil: 1997-2002.

OBJECTIVE: Reports on bat rabies in Brazil are sporadic and isolated. This study aimed at describing the detection of rabies virus in bats in the state of São Paulo. METHODS: A total of 7,393 bats from 235 municipalities of the north and northwestern areas of the state of São Paulo, Southeastern Brazil, were assessed according to their morphological and morphometric characteristics from 1997 to 2002. Fluorescent antibody test and mice inoculation were used for viral identification. RESULTS: Of all samples examined, 1.3% was rabies virus positive, ranging from 0.2% in 1997 to 1.6% in 2001. There were found 98 bats infected, 87 in the urban area. Fluorescent antibody test was detected in 77 positive samples, whereas 92 produced rabies signs in mice; incubation period ranging from 4 to 23 days. In 43 cities at least one rabid bat was observed. The highest proportion (33.7%) of rabies virus was found in Artibeus lituratus. Eptesicus and Myotis were the most frequent positive species (24.5%) of the Vespertilionidae family. The species Molossus molossus and Molossus rufus showed 14.3% positive bats. There were no differences in the distribution of positive rabies between females (33; 48.5%) and males (35; 51.5%). CONCLUSIONS: Rabies-infected bats were found in environments that pose a risk to both human and domestic animal population and there is a need for actions aiming at the control of these species and public education.

Animals↗

[Orphans and vulnerable children affected by HIV/AIDS in Brazil: where do we stand and where are we heading?].

This study aimed at identifying human rights' status and situation, as expressed in the United Nations General Assembly Special Session on HIV/AIDS, of children and adolescents living with HIV/AIDS, non-orphans and orphans affected by AIDS, based on local and international literature review. The main study findings did not allow to accurately estimating those children and adolescents living with HIV and non-orphans affected by HIV/AIDS but data was available on those living with AIDS and orphans. The limitations and possibilities of these estimates obtained from surveillance systems, mathematical models and surveys are discussed. Though studies in literature are still quite scarce, there is indication of compromise of several rights such as health, education, housing, nutrition, nondiscrimination, and physical and mental integrity. Brazil still needs to advance to meet further needs of those orphaned and vulnerable children. Its response so far has been limited to providing health care to those children and adolescents living with HIV/AIDS, preventing mother-to-child HIV transmission and financing the implementation and maintenance of support homes (shelters according to Child and Adolescent Bill of Rights) for those infected and affected by HIV/AIDS, either orphans or not. These actions are not enough to ensure a supportive environment for children and adolescents orphaned, infected or affected by HIV/AIDS. It is proposed ways for Brazil to develop and improve databases to respond to these challenges.

Acquired Immunodeficiency Syndrome↗

[Health care to HIV/AIDS patients in Brazil].

This study was intended to assess care provided to those living with HIV/AIDS in Brazil and the Brazilian Unified Health System (SUS) capacity of delivering interventions to cope with the epidemic as well as to discuss the sustainability of the Brazilian initiative of providing universal free access to antiretrovirals (ARVs). Original data from a study comprising 119 respondents on the potential capacity of delivering a prospective HIV vaccine in Brazil was used. Inpatient and pharmaceutical care was based on data from the SUS Hospital Information System and Drug Logistics Management Systems of the National Program for STD/AIDS. The study results indicate good performance of the Brazilian ARV Access Program but access to treatment of opportunistic infections was, however, unsatisfactory. The rates covered by SUS for AIDS hospital admissions remained very low, on average around R$700 in 2004. Health care to HIV/AIDS patients has been considered a citizen's right strongly supported by an effective joint action of the Brazilian government and civil society. The current challenges are fine monitoring of processes and program results and ensuring sustainability of universal free ARV access.

Acquired Immunodeficiency Syndrome↗

[Monitoring and evaluating actions implemented to confront AIDS in Brazil: civil society's participation].

The United Nations Declaration of Commitment on HIV/AIDS recommends that governments conduct periodic analysis of actions undertaken in confronting the HIV/AIDS epidemic that involve civil society's participation. Specific instruments and mechanisms should be created towards this end. This paper examines some of the responses of the Brazilian government to this recommendation. Analysis contemplates the Declaration's proposals as to civil society's participation in monitoring and evaluating such actions and their adequacy with respect to Brazilian reality. The limitations and potentials of MONITORAIDS, the matrix of indicators created by Brazil's Programa Nacional de DST/Aids [National Program for STD/AIDS] to monitor the epidemic are discussed. Results indicate that MONITORAIDS's complexity hampers its use by the conjunction of actors involved in the struggle against AIDS. The establishment of mechanisms that facilitate the appropriation of this system by all those committed to confronting the epidemic in Brazil is suggested.

Acquired Immunodeficiency Syndrome↗

Serological studies on schistosomiasis mansoni in the northeast Brazil (I).

Sera from the patients (N = 10) with schistosomiasis mansoni of the hospital of Federal University of Pernambuco, the Schistosoma mansoni egg-positive (N = 51) and -negative (N = 452) inhabitants in Cabo City area, out-patients (N = 37) of the IMIP hospital and Japanese immigrants (N = 127) in Petrolina City area of northeast Brazil as well as Japanese healthy subjects (N = 30) were examined by serological tests including an enzyme-linked immunosorbent assay with antigens prepared from eggs (ELISA-egg) and adult worms (ELISA-adult). The ELISA with egg or adult antigen correctly identified 100% of the uninfected individuals lived in non-endemic area of schistosomiasis. Moreover, when examined cross-reactivity of our ELISA with sera isolated from 78 subjects infected with various intestinal parasitic infections, only one of these sera reacted with the egg and adult antigens. On the examination of 51 sera from the egg-positive subjects, the ELISA-egg revealed the highest sensitivity (98.0%), whereas a large number of false negative reactions of ELISA-adult, Ouchterlony method using adult antigen, circumoval precipitation and immediate intradermal skin test were observed. A low sensitivity of these serologic tests except for ELISA-egg appears to be primarily due to their inability to detect antibody in the sera from egg-positive infantiles. There was no positive correlation between the absorbance values of these two types of ELISA among the sera isolated from ELISA-positive subjects. Rather, by the reactivity of these sera to egg or adult antigen, they could be divided into two subgroups; one reacted more positively with egg antigen and the other with adult antigen. Moreover, it was confirmed that the sera from young subjects (under 20 years old) appear to be highly reactive to the egg antigen than did aged ones. These data suggest that the ELISA with egg antigen, but not with the adult antigen, appears to be useful for the serological survey of schistosomiasis mansoni in the endemic area of northeast Brazil.

Adolescent↗

A randomized clinical trial with high dose of chloroquine for treatment of Plasmodium falciparum malaria in Brazil.

This clinical trial compared parasitological efficacy, levels of in vivo resistance and side effects of oral chloroquine 25 mg/Kg and 50 mg/Kg in 3 days treatment in Plasmodium falciparum malaria with an extended followed-up of 30 days. The study enrolled 58 patients in the 25 mg/Kg group and 66 in the 50 mg/Kg group. All eligible subjects were over 14 years of age and came from Amazon Basin and Central Brazil during the period of August 1989 to April 1991. The cure rate in the 50 mg/Kg group was 89.4% on day 7 and 71.2% on day 14 compared to 44.8% and 24.1% in the 25 mg/Kg group. 74.1% of the patients in the 25 mg/Kg group and 48.4% of the patients in the 50 mg/Kg group had detectable parasitaemia at the day 30. However, there was a decrease of the geometric mean parasite density in both groups specially in the 50 mg/Kg group. There was 24.1% of RIII and 13.8% of RII in the 25 mg/Kg group. Side effects were found to be minimum in both groups. The present data support that there was a high level resistance to chloroquine in both groups, and the high dose regimen only delayed the development of resistance and its administration should not be recommended as first choice in malaria P. falciparum therapy in Brazil.

Adult↗

African histoplasmosis. Report of the first case in Brazil and treatment with itraconazole.

We report the first case of African histoplasmosis diagnosed in Brazil. The patient was an immigrant from Angola who had come to Brazil six months after the appearance of the skin lesion. The skin of the right retroauricular area was the only site of involvement. The diagnosis was established by direct mycologic examination, culture and by histopathologic examination of the lesion. The patient was successfully treated with Itraconazole 100mg a day for 52 days. No recurrent skin lesions were observed during the ten month follow-up period.

Adult↗