Municipalization of vaccination in Ribeirão Preto, São Paulo, Brazil

The object of this study is the organization of activities in the vaccination program in Ribeir?o Preto, S?o Paulo, during the process of municipalization of health services, analyzing changes and estimating results. The methodology included a survey performed during supervisory visits and questionnaires with 20 nurses and 39 vaccination workers in all the vaccination rooms at the municipal primary health care unit in this city, a survey of storage conditions for immunobiological products at the municipal level and a questionnaire for the section head, and interviews with five health professionals responsible for vaccination at the State, regional, and municipal levels. It followed that since implementation of the so-called Integrated Health Actions proposal there has been an expansion of primary health care services, including vaccination services; there has also been a technical and administrative centralization of decisions involving vaccination activities, including training of human resources by the Municipal Epidemiological Surveillance division. The study points out that although this activity is dealt with carefully by those responsible for the State, municipal, and district levels, the same is not true at the local level.     

Periodontal conditions in a 7-19-year-old student population in Araraquara, São Paulo, Brazil, 1995

The Purpose of this study was to assess the periodontal conditions and treatment needs in 7-19-year-old Brazilian school children and adolescents enrolled in the urban public schools in Araraquara, S?o Paulo, Brazil, in 1995, to provide baseline data for monitoring changes in their periodontal status. A sample of 1,956 school children and adolescents aged 7 to 19 years was examined by two examiners previously calibrated using the CPITN (Community Pe riodontal Index of Treatment Needs). The results showed that bleeding was the most frequently observed periodontal condition in all age groups, with a mean of 3.0 sextants affected at age 15. The presence of calculus increased with age. In the 15-19-year age group, calculus and shallow pockets (3.5-5.5 mm) were observed in 39.8 per cent and 1.6 per cent of the adolescents, respectively. In order to achieve the WHO oral health goal of no more than one sextant scoring GPITN 1 (bleeding) or 2 (presence of dental calculus) at age 15, priority should be focused on primary prevention programs to benefit the periodontal health of the majority.     

Sperm characteristics in a sample of healthy adolescents in São Paulo, Brazil

The article presents preliminary data from a prospective investigation in a sample of healthy 14-17-year-old students from a technical school in Sao Paulo, Brazil. Ninety-six Tanner stage 5 and thirty-one Tanner stage 4 adolescents were evaluated: testicular volume was measured using a Prader orchidometer, and semen analysis was performed according to standard procedures. Median testicular volume was 20.0 ml among Tanner 5 students and 15.0 ml in Tanner 4 students in both the right and left testes. No significant differences were found in sperm volume or motility. Median concentration was 66.0 million/ml for Tanner 5 and 47.0 million/ml for Tanner 4 subjects. Morphological patterns showed abnormal forms in 81.9% of Tanner 5 and 93.6% of Tanner 4 adolescents. Oligospermia (sperm concentration < 5 million/ml) was observed in 7.3% of Tanner stage 5 and 12.9% of Tanner stage 4 individuals. Azoospermia was observed in 3 students (1.8%), with counts less than 1.0 in 8 students (4.8%). The authors discuss the observed results, analyzing the potential implications arising from biological development and potential environmental exposures.     

Asthma mortality in the city of São Paulo,Brazil

OBJECTIVE: To quantify and compare asthma mortality rates as the main cause of death, taking into consideration the following variables: sex, age and seasonality. METHODS: Data was collected from all death certificates coded 493 of people aged 5 to 34 years in the periods of 1983-5 and 1993-5 in the city of S?o Paulo, SP, Brazil. Data analysis was performed by directly comparing death rates and identifying the odds ratio trend and directly comparing the numbers of asthma deaths. RESULTS: There was no increase in asthma mortality rates for the study periods. There was no difference between men and women. A greater number of deaths in the age group 20 to 34 years were observed. Seasonality was more evident in the first period studied. CONCLUSIONS: Differing from reports in other countries, the results did not show any increase in asthma mortality rates, The variable sex didn't seem to interfere with mortality. Deaths are more frequent among young adults, and their risk may be 9 times greater than that of young children. Deterioration of social and economic issues and health care services and even climatic changes may have been implicated in the absence of seasonality as a risk factor for asthma mortality. The disease by itself is not considered by many health professionals as critical in order to explain the chain of events that lead to death.     

Organochlorine pesticide residues in human milk in the Ribeirão Preto region,state of São Paulo,Brazil

Thirty-seven samples of human milk (colostrum) from donors living in the Ribeirão Preto region were analyzed to determine the levels of organochlorine pesticide residues. Donors were classified into two groups, i.e., occupationally exposed and non-exposed to pesticides. Other factors such as age, previous lactations, race, smoking habit, occupation, family income and educational level were also considered. Analysis was performed by preliminary lipid extraction followed by fractional partition on a column and finally by gas chromatography with an electron capture detector. Lindane was found in 32% of the samples in amounts of less than 0.001 mg/kg; heptachlor was found in 65% of the samples at mean levels of 0.001 mg/kg, i.e., a level five-fold lower than that established by FAO/WHO (1970) for cow's milk. Aldrin and endrin were not detected in any of the samples. Dieldrin was detected in only one sample at a level of 0.038 mg/kg, which is considered high. DDT and DDE amounts are reported as total DDT and at least one of these compounds was present in every sample. Amounts detected in donors occupationally exposed to pesticides ranged from 0.008 to 0.455 mg/kg (mean, 0.149 mg/kg), i.e., three times the limit established by FAO/WHO (1970), while values for donors who had not been exposed ranged from 0.002 to 0.072 mg/kg (mean, 0.025 mg/kg), i.e., half the limit. Considering the level of acceptable daily intake proposed by FAO/WHO (1973), lactents ingested 1% of the acceptable intake of lindane (all donors), 30% of the acceptable intake of heptachlor (all donors), 60% of the acceptable intake of DDT (nonexposed donors), and 3.7 times the acceptable intake of DDT (exposed donors). Comparing the present results with those obtained 10 years ago, the total DDT level in human milk is decreasing in this part of the country. The mean amount of organochlorine residues in non-exposed women's milk was one of the lowest levels among those recorded in the literature. DDT levels of occupationally exposed women's milk were comparable with those reported for developed countries and lower than those detected in Latin American countries. When the results of this survey are considered in relation to the advantages of breast-feeding, the risk-benefit balance is still favorable to breast-feeding. However, given the lack of long-term epidemiological studies, undesirable or harmful long-lasting effects cannot be excluded.Research supported by Fundacão de Amparo à Pesquisa do Estado de São Paulo (FAPESP) and by Conselho Nacional de Desenvolvimento Cientifico e Tecnológico (CNPq).     

Accidental home deliveries in southern São Paulo, Brazil

OBJECTIVE: To identify the frequency, risks of fetal and early neonatal mortality and the determinants of accidental home deliveries. METHODS: A population-based case control study of fetal and early neonatal deaths was carried out in the southern area of S?o Paulo, Brazil. Data were collected through home interviews and hospital record reviews. The reasons reported by the mothers were obtained from interviews and risk factors for home delivery were obtained comparing home to hospital deliveries. Data were analyzed separately for fetal and early neonatal deaths and survivors. Odds ratios, 95% confidence intervals and Fisher's exact test were used in estimating risk factors and mortality risk. RESULTS: The 0.2% frequency of home deliveries was underestimated in the live births information system. After adjustment, it reached 0.4%, comparable to other urban areas in Europe. All home deliveries identified were accidental and were associated to an increased fetal and early neonatal mortality. Mothers' social conditions and pregnancy characteristics were associated to accidental home deliveries and these factors are different outcomes studied (fetal losses, early neonatal deaths and survivors). In 30%, mothers reported lack of available transportation to the hospital as a reason for home delivery. Failure of health services in identifying labor women and non-availability of emergency care contributed to accidental home deliveries. CONCLUSIONS: Though rare events in urban areas, accidental home deliveries should be of special concern to health services because they seem to be avoidable and imply in increased risk of death.     

Food consumption scores and serum lipids levels in the population of São Paulo, Brazil

OBJECTIVE: To study food patterns assessed using scores of consumption and their relationship with serum total cholesterol (TOTAL-C), low density lipoprotein-cholesterol (LDL-C) and high density lipoproteins (HDL-C) concentration in the population of the metropolitan area of S?o Paulo, Brazil. METHODS: Data on food frequency consumption (FFC), serum lipids, and other covariates were available for a representative sample of 1,045 adults. A 12-month retrospective food frequency questionnaire was used. FFC was assessed using scores of consumption, which was obtained by grouping food according to their composition into two large groups: score I (known as risk food for cardiovascular diseases) and score II (known as healthy food). The association between the scores and serum blood lipoprotein levels among the study population was analyzed through multiple linear regression analyses. Modeling step-wise techniques were used to enter the covariates into the linear models. RESULTS: Increasing mean levels of TOTAL-C and LDL-C were seen from the lowest through the highest quintile of score I when compared to the score II, where decreasing mean levels of TOTAL-C and LDL-C were observed from the lowest to the highest quintile. The results of the linear regression analyses between serum TOTAL-C and LDL-C levels for both FFC score I and score II, after multivariate adjusting, showed a significant positive relationship with score I and a significant and inverse relationship with score II. CONCLUSIONS: In population studies, FFC analyses through scores can be the choice method to evaluate the quality of diet and its potential effect on serum levels of TOTAL-C and LDL-C.     

Seroprevalence of rubella antibodies in the State of São Paulo,Brazil, 8 years after the introduction of vaccine

Rubella vaccine was introduced in the official immunization calendar of the State of S?o Paulo, in 1992, at 15 months of age, following a mass vaccination targeting all children between 1 and 10 years of age. This mixed strategy was designed taking into account serological data and mathematical models to estimate the optimal ages for vaccination. To evaluate the efficacy of routine vaccination on rubella infection in S?o José do Rio Preto, State of S?o Paulo, 8 years after the introduction of vaccine, a seroprevalence survey was carried out in December 2000, comprising 1,536 subjects aging from 6 months to 25 years. Rubella specific IgG was detected in blood samples by enzyme-linked immunosorbent assay (ELISA). From 18 months to 5 years of age (covered by a mass vaccination campaign 6 months before the study) the seroprevalence was above 90%. From 6 to 8 years of age (vaccinated by routine schedule at 15 months), the seroprevalence was 76%. From 9 to 18 years of age (vaccinated at the mass campaign that introduced the vaccine 8 years before) the seroprevalence was about 85%. After 20 years of age, protection was acquired by previous infection, as they were not covered by any vaccine program. From 20 to 25 years of age, the seroprevalence was 70%. As the seroprevalence remains low at ages not vaccinated, it should be expected low infection rates at this age window. Despite this, the present situation deserves care, as routine vaccination is given a protection below the minimum level necessary (80%). The efficacy of the proposed strategy depends on better routine vaccination coverage. A second dose of vaccine should also be considered.     

Prevalence of hypovitaminosis a in children of peripheral districts of Campinas São Paulo, Brazil

The prevalence of hypovitaminosis A among children of the peripheral districts of the city of Campinas, S o Paulo, Brazil, was estimated by determining serum retinol levels by High Performance Liquid Chromatography (HPLC) in a sample of 131 children aged between three and ten years, between April 1991 and February 1992. A prevalence of 17.6% and retinol concentrations in the range of 0.35 to 0.70 micromol/L were found (CI=11.1-24.1; 95%), indicating the existence of public health risk Ophthalmological examinations, however, failed to detect any cases of xerophthalmy. Additional characterization of the sample was obtained from 341 children. The per capita income of the average household was surprisingly high for low-income areas. According to FAO-WHO standards, food consumption was adequate only for protein (133.96%). Adequacy levels were low for energy (87.76%) and particularly for vitamin A (66.13%) and iron (42.14%). Height for-age and weight-for-height anthropometric indices revealed that many children were located below -1 standard deviation.     

Early Infant Morbidity in the City of São Paulo, Brazil

Background

Early infant morbidities may produce adverse outcomes in subsequent life. A low Apgar score is a convenient measure of early infant morbidity. We study determinants of early infant morbidity (sex, plurality, mode of delivery, prior losses, gestational age, prenatal care and birth weight, parity and maternal age, race, maternal education and community development) for the 1998-birth cohort, City of São Paulo, Brazil.

Methods

This study identified all deliveries that took place in the City of São Paulo during 1998. Information was extracted from 209,628 birth records. We used multivariate logistic regression to assess the effect of each independent variable on Apgar score less than seven at one minute and Apgar score less than seven at five minutes.

Results

Low birth weight, prematurity and community development were found to be strong predictors of morbidity. Maternal education showed strong negative correlation with both Apgar scores. The negative correlations between maternal schooling and Apgar scores were observed after prenatal care, parity and maternal age were included in the model. Unmeasured proximate factors may thus be the true source of disparity between educational groups. Children of very young adolescent mothers had lower Apgar scores at one minute (but not at five minutes) than those born to mothers 15 to 19. Parity one or higher was associated with decreased odds of low Apgar scores. Cesarean section and operative delivery were associated with higher odds of early infant morbidity.

Conclusion

Education may allow mothers to have better care in the peripartum period. More educated mothers may be more likely to recognize certain morbidities through the pregnancy period and the monitoring of such morbidities yields better infant outcomes. Also, having less than seven prenatal care visits was found to predict early infant morbidity and one way to increase the use of such services is to focus on aspects of care that may lead to easier accessibility and continuity of prenatal care. Physicians should inform mothers about the risks associated with high number of children for a next infant and also about the risks for the infant associated with unnecessary cesarean sections. Special attention should be paid to adolescent mothers, since much of their increased risk is likely to be minimized by counseling.     

Cytomegalovirus seroepidemiology in an urban community of São Paulo, Brazil

INTRODUCTION: After the era of rubella vaccine, cytomegalovirus (CMV) infection is one of the most frequently causes of mental retardation and congenital deafness. Seroepidemiological studies are necessary to understand the transmission dynamics of the disease. The purpose of the study was to quantify the transmission rate of CMV disease in a community in the state of S?o Paulo, Brazil. METHODS: Using ELISA test (IgG), a retrospective serological survey looking for CMV antibodies was performed in an non-immunized community. Frozen sera from 443 individuals, randomly selected by cluster sampling technique in the town of Caieiras, S?o Paulo, were collected from November 1990 to January 1991. Seroprevalence was stratified by age (0-40 years). Mathematical techniques were applied to determine the age-dependent decay function of maternal antibodies during the first year of life, the age-dependent seroprevalence function and the force of infection for CMV in this community. RESULTS: It was observed a descending phase of seropositivity in the first 9 months, but changes in antibody titration were observed between 8 months old and one year of age. The average age of the first infection was 5.02 months of age and 19.84 years, when the age-dependent seroprevalence and the force of infection were analyzed between 10 months of age and 10 years of age and from 10 to 40 years old, respectively. CONCLUSION: CMV infection is highly prevalent among the population studied and infection occurs in the first year of life. This study shows that most women at reproductive age are vulnerable to the first infection, increasing the risk for congenital infection.     

Spotted fever in Campinas region,State of São Paulo,Brazil

Brazilian spotted fever was detected for the first time in the State of S o Paulo in 1929. However, there is no systematic reporting of the disease in the State. In 1985, three cases of the disease occurred in the municipality of Pedreira, located in the Campinas Region, belonging to the 5th Administrative Region, in the Northeast part of the State, including 88 municipalities. An investigation was conducted at the time, but the lack of case registry limited its scope. The present study was undertaken with the aim of recovering the history of the disease in the Region. Data recovered from several public health services for 1985-2000 were used to analyze incidence patterns. It was observed that the transmission area expanded and the number of suspected cases increased, especially after 1996, when mandatory reporting was established. Deaths due to spotted fever were observed in most of the years under study. The study concluded that spotted fever incidence is increasing in the Campinas Region. Complementary bio-ecological studies are currently under way to better understand the epidemiology of this disease, recognized worldwide as an emerging public health problem.