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.     

Epidemiology of tegumentary leishmaniasis in São João, Manaus, Amazonas, Brazil

In Manaus, Amazonas State, Brazil, the degree of individual exposure to leishmaniasis is related to disorganized land occupation. In order to evaluate predisposing factors for an outbreak, confirm the parasitological diagnosis, treat patients, and assess etiological agents, reservoirs, and vectors, a 12-month study was conducted in Manaus in a community located along the BR-174 federal highway. Some 451 individuals were studied, among whom 17 cases of American tegumentary leishmaniasis (ATL) were diagnosed (six women and 11 men). Age varied from one to 64 years. Eleven patients had from one to three lesions. As for reservoirs, three opossums were captured. No hemoflagellates were found in the blood tests. Lutzomyia umbratilis was the predominant vector species captured. Many ATL patients were engaged in activities that exposed them to Leishmania vectors. Some patients may have been infected in the household and peridomiciliary environments. The epidemiological profile of ATL in this community is similar that of other foci in the region. This case series characterizes ATL as an endemic local public health problem.     

Characteristics of adolescent pregnancy in São Luís, Maranhão, Brazil

OBJECTIVE: To identify the main socioeconomic, demographic, anthropometric and behavioral characteristics, and pregnancy outcomes of adolescent pregnancy and to assess health services used by pregnant adolescents. METHODS: Data were collected from a cross-section of 2,429 deliveries by women residing in the municipality of S?o Luís, Brazil, of which 94% were hospital births. Women were categorized into six age groups. The two groups of teenagers (under 18 and 18-19 years) were compared to four groups of older women. Comparison was also made between the two teenage groups. The chi-square test was used to compare proportions and prevalence ratio was used as an effect measure. RESULTS: Of 2,429 women, 714 (29.4%) were adolescents. Their specific fertility coefficient was higher than in other regions of the country. Adolescents showed lower socioeconomic and reproductive conditions than older women and a higher proportion of inadequate prenatal care. The majority had no partner. They had the lowest percentages of caesarean section and smokers. CONCLUSIONS: Despite their equally unfavorable socioeconomic situation, 18-19 year-old adolescents had pregnancy outcomes comparable to the age group 25-29, whereas those under 18 had the highest proportions of low birth weight, preterm birth, and infant mortality rate. This suggests that biologic immaturity may be associated with adverse pregnancy outcomes.     

Risk factors for preterm births in São Luís, Maranhão, Brazil

Preterm birth continues to be one of the main causes of neonatal morbidity and mortality. The objective of the present study was to identify risk factors for preterm birth in S?o Luís, Maranh?o, Brazil. The sample consisted of hospital births at 10 public and private hospitals from March 1, 1997 to February 28, 1998. A total of 2,443 live births were randomly selected, excluding multiple deliveries and stillbirths. Preterm birth rate in S?o Luís was 12.7%. Risk factors for preterm delivery were maternal age below 18 years, family income equal to or less than one minimum wage/ month, primiparity, vaginal delivery at a public hospital, single mothers (or living without a partner), and absence of prenatal care. The following factors remained associated with preterm birth after multivariate analysis to control for confounding: maternal age below 18 years (OR=1.9), primiparity (OR=1.5), and failure to appear for scheduled prenatal care visits (OR=1.5).     

Spatial distribution of endemic diseases in Ribeirão Preto, São Paulo State

The perception that some diseases happen in certain places is old. The concern in studying the relation between the human being and the environment resulted in several studies of medical geography, directed to the analysis of diseases spatial distribution. This sectional study was carried out in Ribeir?o Preto, S?o Paulo State, and aimed to illustrate, through health problems (dengue, leprosy and tuberculosis), how a Geographic Information System tool allows the identification of heterogeneous areas, providing support for the choice of strategies and specific interventions according to the need of residents, as well as, priority of resources to more vulnerable groups. The population comprised cases of dengue, leprosy and tuberculosis notified in Ribeir?o Preto in 2000. Data were collected in the Health Secretary Epidemiological Surveillance of the city. In order to obtain the thematic maps, data were geo-codified with the software MapInfo 7.8 e Spring 4.3. The thematic maps showed the density distribution of dengue, leprosy and tuberculosis cases in the city as a way to complement the analysis of health information, pointing priority areas for the control of these diseases.     

Integrated assessment of multilevel biomarker responses and chemical analysis in mussels from São Sebastião, São Paulo, Brazil

The aim of the present study was to investigate the presence of contaminants in the mussel Perna perna from S?o Sebasti?o Channel, S?o Paulo, Brazil, and to evaluate the effects of these contaminants on these organisms at biochemical (catalase [CAT], glutathione-S-transferase [GST], and cholinesterase [ChE]), cellular (neutral red retention time [NRRT] assay), and physiological (cardiac monitoring) levels. Two sampling surveys were performed (winter of 2001 and summer of 2002) at six stations along the channel: Cigarras, station 1; Iate Clube de Ilhabela, station 2; Oil Terminal, station 3; Toque Toque, station 4; Ponta da Sela, station 5 (reference station); and Taubaté, station 6. Differences in CAT activity were observed between mussels from stations 3 and 5 during the winter, but no differences were detected in the summer. No differences in GST activity were found among stations during the winter, although animals from station 3 showed higher activity during the summer. The ChE activity was significantly higher in the mussels from stations 1 and 2 during the winter and from stations 1 and 3 during the summer. Organisms from stations 1 through 4 showed statistically lower NRRT in both seasons. Similar heart rates were observed in the mussels from all stations. Hydrocarbons were detected in organisms from all the stations in both seasons. During the winter, higher polycyclic aromatic hydrocarbon (PAH) levels were observed in organisms from station 3, whereas during the summer, higher levels of metals were found in organisms from stations 1, 3, and 4. The multivariate analyses showed a strong influence of PAHs on the winter biological results, but metals showed higher influence on these responses in the summer, indicating multiple contaminant sources.     

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).     

Neonatal mortality trends in São Luís, Maranhão, Brazil, from 1979 to 1996

This study examined neonatal mortality trends in S?o Luís in the last 18 years. The early and late components were assessed and causes were classified according to SEADE Foundation criteria based on reducibility of deaths and timing of prevention (during prenatal care, childbirth, or neonatal care). Data were derived from official live birth and death records. We detected an unexpected increase in the neonatal mortality rate, due primarily to a steep rise in early neonatal deaths. Causes reducible by early diagnosis and treatment (other specific infections and other neonatal respiratory causes) and those partially reducible by adequate monitoring of pregnancy (preterm births, low birth weight, and respiratory distress syndrome) showed the largest increase. Conversely, the post-neonatal mortality rate fell. The infant mortality rate remained the same, reflecting these antagonistic trends. The important rise in the neonatal mortality rate from 1995 onwards suggests a deterioration in the quality of obstetric and neonatal services. The high cesarean rate and overcrowded neonatal services (i.e., unable to cope with increasing demands foe specialized neonatal care) indicate the urgent need for restructuring the mother and child health care system.     

Metals in landfill leachate in Ribeirão Preto, São Paulo State, Brazil, and its relevance for public health

This study analyzed the levels of cadmium, lead, copper, chromium, manganese, mercury, and zinc in leachate from the Ribeir?o Preto landfill site in S?o Paulo State, Brazil. Samples were taken from runoff tanks in Module I (operating from 1989 to 2000) and Module II (operating since November 2000). Metal levels were measured by atomic absorption spectrophotometry at the University of S?o Paulo in Ribeir?o Preto (University Hospital). Results were compared to the maximum limits for metal concentration in liquid effluents set by Ruling 357/2005 of the National Environmental Council (CONAMA). The study also investigated whether there was any attenuation in metal concentrations in the leachate, considering differences in the life spans of the various Ribeir?o Preto landfill site modules. Metal levels in the samples were within the maximum limits for cadmium, chromium, copper, mercury, and manganese, but lead and zinc were above the limits set by the above-mentioned ruling.     

Knowledge on sexually transmitted diseases among low-income adolescents in Ribeirão Preto, São Paulo State, Brazil

This study examined female adolescents' knowledge concerning STDs and transmission, condom use, and health care. It was a cross-sectional study of 90 adolescents living in an area covered by the Family Health Program in Ribeir?o Preto, S?o Paulo, Brazil. Data were collected through household interviews using a structured questionnaire, followed by preliminary analysis of simple frequency of variables. Most adolescents were single, sexually active, and with limited knowledge concerning STDs. Condoms were known as the main means of prevention, but only 35.2% of the sample reported always using them. There was a large drop in condom use (from 71.1% to 37.1%) when comparing the first versus the most recent sexual intercourse. Teenagers did not consider themselves at risk of STDs (65.5%), although 57.8% reported related symptoms and 36.7% had never undergone gynecological examination. The results point to the need for special attention to adolescent health care. The lack of effective protection makes them vulnerable to STDs, including HIV/AIDS, even though they do not consider themselves at risk.     

Survival in gastric cancer patients in Campinas, São Paulo, Brazil

This study analyzes the survival of gastric cancer patients in the city of Campinas, S?o Paulo State, Brazil. Data from the Campinas Population-Based Cancer Registry (RCBP) related to gastric cancer cases diagnosed from 1991 to 1994 were analyzed. Observed and relative survival rates were calculated, and to compare rates between different groups and international populations, the relative mortality risk was used. One-year relative survival rate for patients with gastric cancer was 33%, and five-year relative survival was 9%, confirming the poor prognosis of gastric cancer. Gender had no influence on survival, while the prognosis was better for young people. There was a gradient of severity from the localized to the metastatic state, not statistically significant. The group with undifferentiated adenocarcinomas had longer survival, with 47% of patients alive after the first year, whereas only 7% of those without a histological classification survived the first year after diagnosis. Compared with international results like the pool of European registries, the risk was greater, especially considering the five-year survival rates.     

Dietary patterns and correlates in adults living in Ribeirão Preto, São Paulo State, Brazil: the OBEDIARP Project

This study aimed to identify and analyze correlates of dietary patterns in residents of Ribeir?o Preto, S?o Paulo State, Brazil. This was a cross-sectional study including both men and women aged > 30 years (n = 930, weighted sample = 2,197). Factor analysis was applied to identify food consumption patterns, using a semi-quantitative questionnaire. Four patterns were identified: (a) obesogenic: associated with more physical activity, more schooling, and age < 40 years; (b) healthy: associated with female gender, individuals without overweight, older adults, central obesity, more physical activity, and higher socioeconomic status; (c) mixed: without overweight, female gender, and younger adults; and (d) popular: associated with absence of hypercholesterolemia and lower family income. The results highlight the need to encourage eating healthy foods in order to prevent chronic non-communicable diseases.     

Alcohol addiction and associated factors in adults in Ribeirão Preto, São Paulo State, Brazil, 2006: the OBEDIARP project

This study aims to estimate the prevalence and severity of alcohol addiction and to identify associated factors. A cross-sectional population-based study was conducted in Ribeir?o Preto, S?o Paulo State, Brazil, in 2006. Prevalence estimates were based on AUDIT (Alcohol Use Disorders Identification Test). Crude and adjusted prevalence ratios (PR) were calculated, and the outcome variable was classified in two levels: (1) scores = 0-7; and (2) scores = 8-40. Overall prevalence of alcohol addiction was 20.18% (43.47% in men and 10.18% in women). In the final model, the following variables were associated with alcohol addiction: gender, age, schooling, marital and work status, smoking, religion, and self-rated health. Prevalence of alcohol addiction was high, especially among men. The results should contribute to the adoption of health promotion and prevention strategies, considering the consequences of alcohol addiction.     

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.