Suicidal ideation during pregnancy: prevalence and associated factors among low-income women in São Paulo,Brazil

The aim of this study was to estimate the prevalence and correlates of suicidal ideation among low-income pregnant women living in Brazil. We performed a cross-sectional analysis of 831 women surveyed during 20 to 30 weeks of pregnancy using the Self-Report Questionnaire-20. The prevalence of suicidal ideation was 6.3%. The factors associated with suicidal ideation were common mental disorders, single partner status, past psychiatric history, and smoking tobacco. All cases of suicidal ideation were associated with common mental disorders.     

Common mental disorders during pregnancy: prevalence and associated factors among low-income women in São Paulo, Brazil

To estimate the prevalence of common mental disorders (CMD) and factors associated with these disorders among pregnant women of low socio-economic status (SES) in São Paulo. We performed a cross-sectional study with 831 women in their 20th to 30th weeks of pregnancy, who were attending antenatal clinics in primary care in São Paulo, Brazil. CMD were assessed with the Clinical Interview Schedule-Revised. Crude and adjusted prevalence ratios and 95%CI were calculated to examine the association between CMD and exposure variables. The prevalence of CMD was 20.2% (95%CI 17.5 to 23.0). Age at current pregnancy and at first delivery, current obstetric complications, not having friends in the community, living in a crowded household, lower occupational status and history of previous psychiatric treatment were all independently associated with increased prevalence of CMD. CMD is highly prevalent among pregnant women of low SES seen in primary care settings in São Paulo. A combination of distal and proximal psychosocial factors increase the risk for CMD. Primary health care professionals need to be aware of how common CMD in such settings and properly trained to deal with CMD during pregnancy.     

Is birth weight associated with pregestational maternal BMI? BRISA Cohort,Ribeirão Preto,Brazil

Given the increase of women with excess weight or obesity and its possible effects on birth weight, the present study aimed to investigate the association between pregestational maternal body mass index (BMI) and birth weight in a birth cohort from Ribeirão Preto, SP, Brazil. This was a prospective study conducted on 1362 mother-child pairs involving singleton births. The women were evaluated using standardized questionnaires during the second trimester of pregnancy and at the time of childbirth. Information about the newborns was obtained from their medical records. The dependent variable was birth weight, categorized as low, adequate, or high. The independent variable was pregestational maternal BMI, categorized as malnutrition, adequate weight, overweight, and obesity. A multinomial regression model was used to estimate the crude and adjusted relative risk (RR) of low and high birth weight. A high frequency of pregestational excess weight (39.6%) was detected and found to be independently associated with high birth weight (RR=2.13, 95%CI: 1.19-3.80 for overweight and RR=3.34, 95%CI: 1.80-6.19 for obese pregnant women). There was no association between pregestational malnutrition and low birth weight (RR=1.70; 95%CI: 0.81-3.55). The present data showed a high rate of women with excess pregestational weight, supporting the hypothesis that pregestational BMI may contribute to high birth weight babies and indicating the need for actions aiming to prevent excessive weight in women at reproductive age.     

Drug hypersensitivity in students from São Paulo, Brazil

BACKGROUND:

Drug hypersensitivity is responsible for substantial mortality and morbidity, and increased health costs. However, epidemiological data on drug hypersensitivity in general or specific populations are scarce.

METHODS:

We performed a cross-sectional survey of 1015 university students, using a self-reported questionnaire.

RESULTS:

The prevalence of self-reported drug hypersensitivity was 12,11% (123/1015). The most frequently implicated drugs were non-steroidal anti-inflammatory drugs (45,9%) and beta-lactam and sulfonamide antibiotics (25,40%). The majority of the patients reported dermatological manifestations (99), followed by respiratory (40), digestive (23) and other (19). Forty-five patients had an immediate type reaction, and 76,72% (89) had the drug by oral route.

CONCLUSION:

The results showed that drug hypersensitivity is highly prevalent in university students, and that non-steroidal anti-inflammatory drug and antibiotics (beta-lactams and sulfonamide) are the most frequently concerned drugs.     

High prevalence of chronic pelvic pain in women in Ribeirão Preto, Brazil and direct association with abdominal surgery

INTRODUCTION:

Chronic pelvic pain is a disease that directly affects the social and professional lives of women.

OBJECTIVE:

To estimate the prevalence of this clinical condition and to identify independent factors associated with it in women living in Ribeirão Preto, Brazil.

METHODS:

A one-year cross-sectional study was conducted in a population sample of 1,278 women over the age of 14 years. The target population was predominantly composed of women who are treated by the public health system. The questionnaire was administered by interviewers who were not linked to the city health care programs. The prevalence of the morbidity was estimated. First, we identified the significant variables associated with pelvic pain (p<0.10) and then we attributed values of 0 or 1 to the absence or presence of these variables. Logistic regression analysis was used to identify and estimate the simultaneous impact of the independent variables. The results were expressed by odds ratio and their 95% confidence interval with p<0.05.

RESULTS:

The disease was found in 11.5% (147/1,278) of the sample. The independent predictors were dyspareunia, previous abdominal surgery, depression, dysmenorrhea, anxiety, current sexual activity, low back pain, constipation, urinary symptoms, and low educational level.

CONCLUSION:

The prevalence of chronic pelvic pain in Ribeirão Preto is high and is associated with conditions that can usually be prevented, controlled, or resolved by improvement of public health policies and public education.     

Detection of a new mumps virus genotype during parotitis epidemic of 2006-2007 in the state of São Paulo, Brazil

Nucleotide sequence analyses of the SH gene of 18 mumps virus isolates collected in the 2006–2007 parotitis epidemic in the state of São Paulo identified a new genotype, designated genotype M. This new designation fulfills all the parameters required to define a new mumps virus genotype. The parameters were established by an expert panel in collaboration with the World Health Organization (WHO) in 2005. This information will enhance the mumps virus surveillance program both at the national and global levels. J. Med. Virol. 80:323–329, 2008. © 2007 Wiley‐Liss, Inc.     

Prevalence,associated factors,outcomes and transmission of extensively drug-resistant tuberculosis among multidrug-resistant tuberculosis patients in São Paulo,Brazil: a cross-sectional study

ObjectivesTo describe the prevalence, associated factors, treatment outcomes and transmission of extensively drug-resistant (XDR) tuberculosis (TB) in the state of São Paulo, Brazil, for 2011 to 2013.MethodsDrug susceptibility testing to first- and second-line drugs was performed by BACTEC MGIT 960 and molecular typing, by IS6110 restriction fragment length polymorphism. Clinical, epidemiologic and demographic data were obtained from surveillance information systems for TB. Patients were divided into three groups: multidrug resistant (MDR) TB (resistance to at least isoniazid and rifampicin), pre–XDR-TB (MDR-TB resistant to a fluoroquinolone or to at least one of the second-line injectable drugs) and XDR-TB (MDR-TB resistant to a fluoroquinolone and to at least one of the second-line injectables).ResultsAmong the 313 MDR-TB patients identified, the prevalence of XDR-TB and pre–XDR-TB was 10.2% (n = 32) and 19.2% (n = 60), respectively. Compared to MDR-TB patients, XDR-TB patients were more likely to be female (odds ratio (OR) = 2.74, 95% confidence interval (CI), 1.29–5.83), have a history of TB (OR = 5.16; 95% CI, 1.52–17.51) and present higher death rates (OR= 3.74; 95% CI 1.70–8.25). XDR-TB transmission was observed in households, between neighbours and between a patient and a healthcare worker in a hospital.ConclusionsThe prevalence of XDR-TB in the state of São Paulo is close to that estimated globally. Most of the XDR-TB patients were treated previously for TB and presented the lowest successful outcome rates. Because transmission of XDR-TB occurred, it is important that timely diagnosis of drug resistance is performed.     

Population variation of HLA genes in rural communities in Brazil,the Quilombos from the Vale do Ribeira,São Paulo – Brazil

In the present study, we characterized the allelic and haplotypic profile of the genes HLA-A, -B, -C and -DRB1 (PCR-SBT) in a population sample of 144 highly admixed individuals, coming from rural communities in Brazil (Quilombos from Vale do Ribeira, in the State of São Paulo). Furthermore, we identified three individuals with a new null allele in the HLA-C gene (HLA-C¹02:105N), associated with the haplotype HLA-A¹80: 01∼B¹18: 01:01G∼DRB1¹ 07:01.     

Serological study of vaccinia virus reservoirs in areas with and without official reports of outbreaks in cattle and humans in São Paulo, Brazil

Vaccinia virus (VACV), the etiological agent of an exanthematic disease, has been associated with several bovine outbreaks in Brazil since the end of the global vaccination campaign against smallpox. It was previously believed that the vaccine virus used for the WHO global campaign had adapted to an unknown wild reservoir and was sporadically re-emerging in outbreaks in cattle and milkers. At present, it is known that Brazilian VACV is phylogenetically different from the vaccinia virus vaccinal strain, but its origin remains unknown. This study assessed the seroprevalence of orthopoxviruses in domestic and wild animals and farmers from 47 farms in three cities in the southwest region of the state of São Paulo with or without official reports of outbreaks in cattle or humans. Our data indicate a low seroprevalence of antibodies in wild animals and raise interesting questions about the real potential of wild rodents and marsupials as VACV reservoirs, suggesting other routes through which VACV can be spread.     

Molecular characterization of Hepatozoon sp. in cats from São Luís Island, Maranhão, Northeastern Brazil

Few molecular studies have been done concerning the molecular characterization of Hepatozoon species among domestic and wild felids. The present work aimed to characterize molecularly the presence of Hepatozoon sp. DNA in cat blood samples from S?o Luís Island, Maranh?o state, Northeastern Brazil. EDTA-whole blood samples were collected from 200 domestic cats with outdoor and wood areas access from S?o Luís, Maranh?o, Brazil. Each sample of extracted DNA was used as a template in PCR reactions aiming to amplify a partial sequence of 18S rRNA of Hepatozoon spp. We also performed sequence alignment to establish the identity of the parasite species infecting these animals using DNA sequences based on 18S rRNA. From 200 sampled cats, Hepatozoon DNA was only found in one animal (0.5%). The found Hepatozoon DNA showed 97% of identity with Hemobartonella felis isolates 1 and 2 from Spain. When analyzing the phylogenetic tree, the found Hepatozoon DNA was in the same clade than H. felis isolates. Our findings suggest that more than one species of Hepatozoon could infect felids in Brazil.     

Prevalence and underrecognition of dysthymia among psychiatric outpatients in São Paulo,Brazil

BACKGROUND: Dysthymia is a highly prevalent disorder with rates varying from 3 to 6%. It is estimated that 7% of primary care and up to 36% of the psychiatric outpatients have this disorder. Dysthymia is characterized by a pattern of low intensity and long duration depression, leading to impairment in many aspects of the patient's life (work, family). However, it is a condition which is not frequently diagnosed, thereby remaining untreated and leading to chronification, risk of developing depression and substance abuse. Despite the well-known fact that dysthymia is underdiagnosed, there are no studies in Brazil regarding this problem. This paper presents a study on the prevalence of dysthymia in an outpatient psychiatric population in S?o Paulo, Brazil, identifying factors associated with the underdiagnosis of dysthymia. METHODS: Two raters carried out a study of 81 patients from a university outpatient clinic in S?o Paulo, using the SCID-I/P. The kappa coefficient was used to measure the inter-rater reliability for the dysthymia diagnosis. The SCID-I/P diagnosis was compared to consulting psychiatrist's diagnosis. Factors associated with underdiagnosis were identified. RESULTS AND CONCLUSIONS: 27% of the sample had SCID dysthymia. They presented more comorbidities than non-dysthymics. Only 27% of these SCID dysthymics were considered 'pure' dysthymics. Clinicians had identified only 37% of these SCID diagnosed cases as dysthymic. The main reason for missing diagnosis of dysthymia in this sample was axis I comorbidity. LIMITATION: As we did not investigate the presence of personality disorder, the impact of axis II on misdiagnosis of dysthymia could not be investigated in our sample.     

The 1918 influenza A epidemic in the city of São Paulo, Brazil

The 1918 pandemic H1N1 outbreak in the city of S?o Paulo is revisited. The outbreak lasted for 10 weeks and reached 116,771 officially recorded cases amongst 523,194 inhabitants. The total number of deaths summed up to 5331, with a lethality rate of 4.5% and an overall mortality rate of around 1%. We propose a mathematical model that tallies available data with good accuracy and allows the estimation of the basic reproductive number, R(0). The model showed a remarkably good accuracy in retrieving the real data from S?o Paulo city outbreak considering the total number of recorded cases and deaths and the timing of the outbreak. The basic reproduction number calculated of 2.68 can be compared to estimates carried out for other flu strains, like the estimates for H3N2, whose values ranged from 1.5 to 2.5. We hypothesize that the Southern parts of the world in which there was relatively little impact of the Great War, like South America, suffered a much lower H1N1 influenza mortality as compared with that reported for the Northern hemisphere heavily affected by the I World War.