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[The risk of urban yellow fever outbreaks in Brazil by dengue vectors. Aedes aegypti and Aedes albopictus].

Urban yellow fever (YF) epidemics have disappeared from Brazil since about 50 years, but a selvatic cycle still exist. In many States, cases are more or less numerous each year. Ae. aegypti was eradicated in 1954, re-appeared temporarily in 1967, and then definitively in 1976-1977. Ae. aegypti is a vector of yellow few (YF), but also of dengue, whose first cases were reported in 1982. Today, dengue is endemic in many regions. A second Flavivirus vector, Aedes albopictus is present since about ten years in some States, from which Säo Paulo. The analysis of the YF cases between 1972 and 1994 allowed us to determine the epidemiologic regions. In the first region, the endemic area, the YF virus is circulating "silently" among monkeys, and the emergence of human cases is rare. In the second region, the epidemic area, some epizootics occur in a more or less cyclic way, and human cases can be numerous. Nevertheless, these outbreaks are considered "selvatic" epidemics, as long as Ae. aegypti is not concerned. From the Amazonian region, the virus moves forward along the forest galleries of the Amazone tributaries, from North to South. Actually, dengue epidemics appear in quite all States, and reflect the geographical distribution of Ae. aegypti. Recently, Ae. aegypti was found in the southern part of the Pará State, in the Carajás region considered to be the source of the main YF epidemics. In another hand, Ae. albopictus is now increasing its distribution area, specially in the suburban zones. The ecology of this potential vector, which seems to have a great adaptative capacity, give this vector an intermediate position between the forest galleries, where the YF virus circulates, and the agglomerations infested with Ae. aegypti. Since a few years, the possibility of urban YF is threatening Brazil, it is more and more predictable and we must survey very carefully the epidemiological situation in some regions of the country.

Aedes↗

Besnoitia sp. (Protozoa:Toxoplasmatinae) from Akodon montensis (Rodentia:Cricetidae) in Santa Catarina State, Brazil.

Tissue cysts of Besnoitia sp. were found in muscles and several organs from a naturally infected Akodon montensis captured in the rural area of the municipality of Timbó, Santa Catarina State, in southern Brazil. Indirect fluorescence and enzyme-linked immunosorbent assays carried out with sera from mice chronically infected with Toxoplasma gondii and Besnoitia sp. showed, as expected, a stronger reaction against homologous than heterologous antigens. No cross-protection was observed in mice immunized with T. gondii when challenged with Besnoitia sp. This is the first description of a natural infection of A. montensis by parasites of the genus Besnoitia sp. in Brazil.

Animals↗

LSSP-PCR for characterization of strains of Entamoeba histolytica isolated in Brazil.

Strains of Entamoeba histolytica isolated in Brazil were characterized using the Low-Stringency Single Specific Primer PCR (LSSP-PCR), that detects single or multiple mutations in gene size DNA fragments. Using this technique, a 482-bp genomic DNA fragment from a structural gene in 8 strains and 2 clones of E. histolytica, isolated from symptomatic and asymptomatic patients in Brazil, including pathogenic and non-pathogenic zymodemes were studied. The results obtained indicate that LSSP-PCR is a valuable method for differentiating strains of E. histolytica. Moreover, the results are consistent with the concept that pathogenic and non-pathogenic strains of E. histolytica may represent distinct species or subspecies and are in accord with phenotypically characteristic isoenzyme patterns.

Animals↗

Hepatitis C virus genotypes in Southern Brazil.

The prevalence of hepatitis C virus (HCV) genotypes in Southern Brazil was studied in the plasma of 100 HCV-RNA-positive patients attended in Porto Alegre, South of Brazil. Reverse transcription-polymerase chain reaction (RT-PCR) products from the 5' noncoding region were double digested with RsaI-HaeIII and BstNI-HinfI and analyzed by restriction fragment length polymorphism (RFLP). Three genotypes (1, 2 and 3) were demonstrable, the most prevalent being HCV type 1 (55 of 100 patients, 55%), followed by HCV type 3 (37 of 100 patients, 37%) and HCV type 2 (8 of 100 patients, 8%). There was an unusual high prevalence of genotype 3, in contrast to the majority of published data from the Southeast region.

Brazil↗

Psychiatric morbidity among the elderly in a primary care setting--report from a survey in São Paulo, Brazil.

Brazil has been experiencing a steady increase in the elderly population during the past few years, and as a result old age health-related problems are increasing continuously in number. Psychiatric symptoms are among the most prevalent health problems of the elderly and are an important source of distress for patients and carers, being also associated with significant growth in the costs and demand for the provision of health care services. This study aimed to investigate the prevalence of mental health problems among the elderly attending a regional primary care unit in the city of São Paulo, Brazil. A total of 351 patients older than 60 were assessed during a 6-month period with the SRQ-20 (a scale for the detection of minor psychiatric problems), four questions on psychotic symptoms. AMTS (a scale for the assessment of cognitive functioning) and CAGE (a scale for the assessment of alcoholism); demographic variables were also recorded. Subjects' mean age was 71.22 (CI = 70.51-71.92) and 83.5% were female. Thirty-two per cent of subjects were considered 'cases' as they scored more than 7 on the SRQ-20 (26.8% of total), or more than 1 on the CAGE (1.4% of total), or at least 1 on the questions assessing psychotic symptoms (12.2% of total). There was a significant excess of women among those found to suffer from psychiatric problems (90.1% vs 80.4%). Cases were also more likely to be illiterate (23.4% vs 12.1%) and to have a lower income (2.21 vs 4.01 minimum wages). Depressive symptoms and tension were highly prevalent (72.9% of subjects). Somatic complaints and signs of inefficient functioning were also common (50.4% and 45.9% respectively). Only five patients answered affirmatively two or more CAGE questions and 12.2% scored at least 1 on the questions assessing psychotic symptoms. Cognitive deficit, as determined by the AMTS, was observed in 13.4% of the sample and was associated with ageing, being illiterate and having higher total SRQ-20 scores. We suggest, that the organization of health care services should take into account the needs of this population, and should also emphasize professional training for the correct assessment and treatment of the most frequent mental health problems in old age.

Age Factors↗

The importance of operational factors for the interpretation of indicators in the Hansen's disease endemic in Brazil.

In Brazil, an increase has been recorded in recent years in the magnitude of detection coefficients for new cases of Hansen's disease, which is frequently interpreted as evidence of the endemic's expansion. The objective of this work is the determine the role of operational factors for interpreting the trend displayed by the morbidity coefficients for Hansen's disease from 1982 to 1995 in the country. We observed a strong correlation between the adjusted detection coefficients and the number of technicians trained (r = 0.80), a decrease in the proportion of new cases with disabilities at the time of diagnosis (r = 0.86), and a downward trend in tuberculoid forms (r = -0.70). Patient time on the active register is correlated negatively with MDT-WHO coverage (r = -0.95) and the percentage of patients discharged from treatment due to cure (r = -0.91). These results suggest that the increase in the potential for detection of new cases of Hansen's disease resulting from new strategies adopted by the program, i.e., mainly extensive training of health personnel, could be a coherent explanation for the increase in detection coefficients for new cases observed in Brazil in the last ten years.

Adolescent↗

Studies on a primaquine-tolerant strain of Plasmodium vivax from Brazil in Aotus and Saimiri monkeys.

A nonimmune American acquired an infection of Plasmodium vivax Type 1 malaria in Brazil in 1994. After returning to the U.S.A., he had a primary attack followed by 3 relapses. The primary attack and first 2 relapses were treated with a standard regimen of chloroquine, followed by 14 days of primaquine (15 mg/day). Following the third relapse, the primaquine treatment was extended to 28 days. No further relapses occurred. The lack of response to primaquine by this strain may recommend it as a suitable candidate for chemotherapeutic study if it can be adapted to an animal model. Anopheles quadrimaculatus mosquitoes infected by feeding on the patient during the first relapse were used to establish the strain in Aotus and Saimiri monkeys. Monkeys supported well the development of long-lasting parasitemia. Anopheles freeborni, Anopheles stephensi, and Anopheles gambiae mosquitoes were readily infected by feeding on the monkeys and by membrane feeding on diluted blood. Monkey-to-monkey transmission was obtained via the bites of infected mosquitoes and the intravenous injection of sporozoites dissected from salivary glands. This parasite is designated as the Brazil I/CDC strain of P. vivax.

Animals↗

Truck drivers in Brazil: prevalence of HIV and other sexually transmitted diseases, risk behavior and potential for spread of infection.

OBJECTIVES: To determine the prevalence of HIV and syphilis and related risk behavior in a sample of truck drivers in Santos, Brazil. SUBJECTS AND METHODS: A cross-sectional study was performed of 300 male truck drivers recruited in the port of Santos, Brazil, including a face-to-face interview and blood sampling for HIV and syphilis serology. RESULTS: Of 300 subjects, 4 (1.3%) were positive for HIV, 25 (8.3%) for syphilis by the Venereal Disease Research Laboratory (VDRL) test and 38 (13%) were positive for syphilis by the fluorescent treponemal antibody (absorbed) test (FTA-Abs). Seventy-one per cent had been employed as truck drivers for more than 10 years and 93% lived outside of Santos. Most participants were married (72%); 40% reported having more than one sex partner; 21% reported sex with commercial sex workers; 14% reported sex with girls that they met on the road; 16% had sex with other men's wives; and 3.3% reported sex with men during the past year. The use of rebite, an oral stimulant, was reported by 43% and was associated with being FTA-Abs-positive (P = 0.04). Being HIV-positive was associated with having sex with friends (P = 0.04), partners usually considered 'safe' by truck drivers. Being syphilis-positive (VDRL) was significantly associated with sex with partners also considered as 'safe', namely primary sex partners, steady partners and other men's wives. DISCUSSION: This is the first study to determine HIV and syphilis seroprevalence among truck drivers in South America. Findings confirm that this group has a high potential risk for HIV infection and other sexually transmitted diseases, and thus currently presents an opportunity for prevention.

Adult↗

[Trends in the teaching of epidemiology in Brazil].

The teaching of epidemiology in Brazil began in the 1920s and has always been connected to public health. The 1970s witnessed an expansion in the number of graduate-level courses in epidemiology. The 1980s were characterized by "social epidemiology," which incorporated the social sciences and their methods into epidemiology; the second half of the decade was marked by the development of biostatistical techniques. Currently, the definition of guidelines for the teaching of epidemiology in Brazil depends on careful reflection regarding a number of issues, among which are the reformulation or elimination of medical residency programs in preventive medicine, social medicine, and collective health; the creation of masters and doctoral programs exclusively in epidemiology; the conflict between a theoretical emphasis and a technical emphasis; and the development of strategies to strengthen new instructional groups that are being created in teaching institutions in less developed regions of the country. A positive trend is that teaching institutions are working more closely with health services, both for training personnel and for providing technical support in planning, organizing, and evaluating health programs. Regarding the teaching of health service professionals, successful training depends on how well teachers can provide in-service training that ties students' learning to real work situations, where the application of theories can be understood in the natural context of real problems.

Brazil↗

Pyogenic liver abscess in children: some observations in the Espírito Santo State, Brazil.

Pyogenic liver abscess in children is uncommon in developed countries and there are few reports about the disease in developing countries including Brazil. As pyogenic liver abscesses in children are frequently diagnosed in Vitória (E. Santo State, Brazil), the records of admissions at the Children's Hospital (Hospital Infantil N.S. da Glória) were surveyed. Sixty-five cases of pyogenic liver abscess were observed over a period of three years, from May 1991 through April 1994 (mean of admissions of 2800 children/year). Fourty-seven cases occurred in boys (mean of ages 8.1 +/- 3.5 yr, median 8 yr) and 18 in girls (mean of ages 6.1 +/- 3.3 yr, median 7 yr) with a 2.7:1 male/female ratio. Predisposing factors were skin infections (23 cases), bile duct ascariasis (six cases), trauma (two cases) but in 30 cases a predisposing factor was not evident. Staphylococcus aureus was the bacteria most frequently isolated (16/29 examined). Entamoeba histolytica trophozoites were never found in the exudate of abscesses and cysts were found once in fecal examination. Clinical manifestations were similar to those observed in other reports about pyogenic liver abscess in children. There was a high frequency of intestinal helminth infection (80.6% of 36 cases in which a fecal examination was recorded) and eosinophilia in the peripheral blood (36.2% of 61 cases). In addition most cases came from the urban periphery of Vitória, where intestinal parasites are frequent. These data showed that the frequency of pyogenic liver abscess is higher in Vitória (one case/138 admissions) than in developed countries (25 cases or less/10,000 admissions in USA). We hypothesyse that the helminth infection (mainly with ascaris and toxocara), whose larvae migrate through the liver inducing granulomas, could enhance the localization of bacteria, increasing the risk for pyogenic liver abscess.

Brazil↗

Fish intake and cardiovascular risk among middle-aged Japanese in Japan and Brazil.

BACKGROUND: Studies of immigrant populations are useful for analysis of the effects of environmental factors on cardiovascular disease. We have examined the association between dietary habit of fish intake and cardiovascular risk. METHODS: Population-based samples of 433 middle-aged Japanese men and women in Japan (Shimane (group JS) and Okinawa (group JO)) and 269 Japanese immigrants in Brazil (Sâo Paulo (group BS) and Campo Grande (group BC)), who had originally moved to Brazil mainly from Shimane and Okinawa, were recruited to the study. They underwent blood pressure measurement, 24-h urine collection, blood tests and electrocardiographic examination, and completed a dietary questionnaire. RESULTS: There was a significant gradient through the groups, from JS to JO, BS and BC with respect to the prevalence of obesity, hypertension, increased glycohaemoglobin concentrations and ST-T segment change on the electrocardiogram (prevalences for men and women combined: group JS 2.0%, group JO 3.8%, group BS 3.9% and group BC 9.0%; P < 0.025). The prevalence of hypercholesterolaemia was noted more frequently in groups BS and BC. Twenty-four-hour urinary taurine excretion in both sexes and n-3 polyunsaturated fatty acids (n-3 PUFA) in plasma phospholipids in men were significantly higher in groups JS and JO than in groups BS and BC. A striking negative gradient in the frequency of fish intake per week was found from group JS (men/women, 4.7/4.8) to groups JO (3.8/3.6), BS (1.9/1.6) and BC (0.5/0.5). CONCLUSIONS: This study suggests a possible association between fish intake and reduced cardiovascular risk, through the beneficial effects of taurine and n-3 PUFA and a habitual low intake of calories and fat.

Analysis of Variance↗

[Historical analysis of psychiatric nursing practices in Brazil in the period between 1920 to 1950].

This study focuses on the relation between the psychiatric project that had been established in Brazil from the end of the XIX century and the practices of the nursing staff preparation developed in Brazilian psychiatric institutions, between the 20s and 50s, using oral history as the research method. Through the historical reconstruction of certain aspects that characterized the psychiatric care organization in this country and the ways assumed by the processes of formation of the nursing staff in those institutions, it was verified that nursing constituted a fundamental element for the establishment of the asylum assistance model adopted in Brazil.

Brazil↗

[Profile of medical schools of the State of São Paulo, Brazil, in 1996].

The author examines different aspects of medical schools located in the region of São Paulo State (Brazil). There are 19 schools corresponding to 23% of the total number of medical schools in Brazil. The analysis includes elements about students and teachers, including their number and academic titulation; elements about teaching-learning process are also evaluated. An important contribution is the comparative analysis of the curricular evolution from 1986 to 1996.

Brazil↗

Iron deficiency anemia in children: prevalence and prevention studies in Ribeirão Preto, Brazil.

Iron deficiency and ferropenic anemia are, certainly, the most prevalent and specific nutritional problems in Brazil. The Ribeirão Preto region is no exception to it. A large prevalence of iron deficiency/anemia is found, mainly in the age group 6-24 months. In spite of the fact that several aspects of its physiopathology are known it is a very difficult problem to be solved. Many approaches and alternatives for their prevention have been tried but we are far from controlling the situation. Several studies carried out at the Medical School of Ribeirão Preto, University of São Paulo, Brazil have shown this high incidence of iron deficiency and iron anemia among infants and preschool children. The importance of iron supplementation to preterm, premature and normal infants was pointed out. The possibility of use of iron complexes to prevent iron deficiency, besides the usual ferrous sulfate, was shown. Several community studies proved the feasibility of distribution and intake of iron as supplements or fortification of carriers as alternatives to prevent iron deficiency.

Anemia, Iron-Deficiency↗

Clinical sepsis and death in a newborn nursery associated with contaminated parenteral medications--Brazil, 1996.

In October 1996, a total of 35 newborn infants died in a 26-bed nursery of a 200-bed hospital in Roraima, Brazil; these deaths represented a significant increase over the baseline mortality rate in the nursery (6.0 versus 1.7 per 100 live births; p<0.01). Twenty of the deaths were attributed to sepsis. Fatal episodes of sepsis began 24-72 hours after birth. Although an investigation by the Roraima Health Department resulted in an improvement of infection control, increased episodes of fever and clinical sepsis persisted. As a result, in November 1996, the Secretary of Health of Roraima, Brazil Ministry of Health, requested that CDC assist in the investigation. This report summarizes this investigation, which implicated locally produced intravenous (IV) solutions as the source of the outbreak and underscores the need to assure proper quality control of parenteral medications and the importance of nosocomial infection surveillance.

Brazil↗

[Community participation and control of endemic diseases in Brazil: problems and possibilities].

Community participation (CP) is considered one of the most important elements for the control of endemic diseases in poor countries, particularly for prevention and epidemiological surveillance. Mainly affecting the poorest segments of the population, endemic diseases are costly and require specific government action aimed at efficient, egalitarian, universal health system, where CP acts in a guardian, monitoring capacity and entails other specific tasks. Despite its rationality, CP has not been encouraged in countries like Brazil, due to the highly centralized nature of political power and activity. Several examples and situations of CP in Brazilian endemic diseases are described and discussed in the article. CP for endemic disease control should be seen as an ongoing social process, a profound social exercise, and a great challenge for the country as a whole and the new Unified Health System now being implemented in Brazil.

Brazil↗

Status of health and prevalence of hypertension in Brazil.

In the last 40 years Brazil has experienced both a demographic and an epidemiological transition. Life expectancy has increased and fertility rates have declined. Cardiovascular disease (CVD) has become the leading cause of death, as infectious disease incidence declined. Hypertension is the leading reason for disability benefits and a key factor for cardiovascular disease morbidity and mortality. Hypertension prevalence in Brazil ranges from 5% to 40%, depending on the region of the country and the population subgroup. Risk factors for hypertension are older age, higher body mass index, black ethnicity, high salt and alcohol intake, acculturation of native populations, and additionally, for women, oral contraceptive use. Although there are nationally issued guidelines for hypertension treatment, outcome studies evaluating such programs are scarce. Information available from selected populations suggest that hypertension awareness, treatment and control rates are very low. There is a need for development and implementation of primary prevention programs with adequate evaluation mechanisms to reduce the burden of the disease in the years to come.

Adolescent↗

Red blood cell alloimmunization in sickle cell disease: the influence of racial and antigenic pattern differences between donors and recipients in Brazil.

Red blood cell (RBC) transfusions are widely used in the management of patients with sickle cell disease (SCD). However, repeated RBC transfusions are often complicated by RBC alloimmunization. To investigate whether the frequency of RBC alloimmunization could be accounted for by racial and RBC phenotype differences between donors and recipients in Brazil, in this study we compared the RBC phenotype of 100 SCD patients with that observed in 120 randomly selected blood donors. A comparison of the RBC phenotype between the two groups revealed a statistically significant increase in the frequency of the C antigen in the donor population (P < 0.01), but no significant difference was observed for the A,B,D,c,E,e,K,k,Fya,M,N,S,s, and Jka antigens. Using standard techniques (indirect antiglobulin test, enzyme treatment, and low-ionic-strength solution) we observed an RBC alloimmunization rate of 12.9% (11/85) in the SCD patients. Fifteen alloantibodies were detected in 11 patients, and most (80%) involved antigens in the Rhesus and Kell systems. This observed RBC alloimmunization rate in SCD patients in Brazil is lower than that reported by studies from North America, suggesting that the requirement for extended antigen-matched RBC transfusion for SCD patients in the setting of a RBC phenotype concordant donor-recipient population may not be cost-effective in some countries.

Adolescent↗