Basic sanitary systems and social inequalities in the Rio de Janeiro metropolitan area

This article deals with the distribution of financial resources allocated to the basic sanitary systems in the Rio de Janeiro metropolitan area during the 1975-1991 period. The study analyzes the investments allocated by the local utility company, known as Cedae, using a spatial model produced especially for this research. The model was produced using information from the national demographic census of 1980, the only one developed within the study period. The recent changes as observed are explained on the basis of their relationship to the spatial and political contexts in the metropolis and the country, as well as from the organization of the services themselves. The paper adds important arguments to the discussion over the restructuring of metropolitan areas and urban public policies. The spatial and social distribution of resources observed during the period differed from the preexisting pattern, yet although there was a substantial democratization in the allocation of public resources, the pattern was not subverted.     

AIDS mortality in the State of Rio de Janeiro, 1991-1995

This article focuses on the AIDS mortality profile as related to socioeconomic and geographic variables, as well as evaluating the impact of deaths from AIDS in the State of Rio de Janeiro. The analysis included all death certificates for residents of the State from 1991-1995, 10,024 of which had AIDS recorded as the primary cause of death. In the 20-49-year age bracket, among individuals who had died of AIDS, the proportion of those with university schooling (14%) and the proportion of single individuals (75%) were greater than the respective proportions for all other causes of death (5.4% and 56.3%). For the population as a whole, the AIDS mortality rate increased from 1991 to 1995, from 20.6/100,000 to 30.2/100,000 for males and from 3.7/100,000 to 7.9/100,000 for females. For the year 1995 in the 20-49-year bracket, considering the 17 groups of causes from the ICD-9, AIDS was the third most common cause of death among men and the fifth most common among women. The proportion of Potential Loss of Life Years up to 65 years as a function of AIDS increased from 1991 to 1995, from 3.4% to 4.7% for men and from 1.4% to 2.9% for women. During this same period there was also an increase in the number of counties in the State of Rio de Janeiro with reported deaths from AIDS.     

Regional differentials in cancer mortality in the state of Rio de Janeiro, Brazil, 1979-1981]

In 1980, malignant neoplasms ranked 3rd as a cause of death in the State of Rio de Janeiro, Brazil, with a crude mortality rate of 89.8 per 100,000. Cancer mortality data for 1979-1981 are presented for the State, with the objective of analyzing regional differentials. For the purpose of comparing mortality from the most important cancers, the State was divided into three regions: Capital, Metropolitan Belt and Interior, on the basis of the geographical structure of the State--which gave rise to the present urbanization patterns. Average annual age and sex-specific mortality rates per 100,000 were calculated for the period 1979-1981 for each cancer site and for 5-year age groups up to 79 years and for 80 years and above. Age standardized rates (ASR) were calculated by direct standardization to the world population and standardized mortality ratios (SMR) were also calculated with the objective of comparing different geographical areas. It was found that the most important malignant neoplasms among males were those of the lung (ASR 27.9), stomach (ASR 24.0), prostate, oesophagus and liver. The breast was the most important site for females (ASR 16.0), followed by the stomach (ASR 10.8), lung, cervix uteri and uterus (unspecified). The highest ASR were in the Capital (164.4 in males, 106.2 in females) and the lowest in the Interior (126.5 in males, and 91.3 in females). The highest SMR were found for breast (1.28), colon (1.71) and lung (1.70) cancers, the mortality rates for which were almost two-times higher in the Capital than in the Interior.(ABSTRACT TRUNCATED AT 250 WORDS)     

Dengue study in a slum area in Rio de Janeiro: preliminary analysis

This study is part of a program to control and prevent dengue in a slum bordering on the grounds of the Oswaldo Cruz Foundation in Rio de Janeiro, Brazil. The results obtained from a questionnaire and entomological survey called attention to problems pertaining to the information transmitted by public health campaigns and its interpretation, since many practices result from misunderstanding or forgetting preventive messages. Dengue-related data include most frequent vector breeding sites, people's knowledge, and dengue-related habits. The study's conclusions in terms of dengue prevention point to the need for drafting messages not only about ideal preventive practices but also teaching possible solutions: disseminating frequent messages throughout the year and not only seasonally and planning health education to join health professionals and the population in the search for sustainable dengue control alternatives.     

Meal consumption patterns and anthropometric measurements in adolescents from a low socioeconomic neighborhood in the metropolitan area of Rio de Janeiro, Brazil

We investigated the association between meal consumption and anthropometric measurements in a probabilistic sample of 528 12–18-year-old adolescents assessed in a population-based cross-sectional study developed in the Rio de Janeiro Metropolitan Area, Brazil. A score ranging from zero to nine according to the frequency of meal consumption (breakfast, lunch and dinner) assessed meal patterns which were defined as satisfactory or unsatisfactory. Nutritional status was defined by the sex- and age-specific body mass index cut-offs. Underweight was observed in 5.7% of the adolescents (8.6% boys, 2.5% girls) and overweight in 20.9%. The omission of breakfast was observed in 4.5% of the boys and 12.4% of the girls. Unsatisfactory meal consumption pattern was more frequent among girls (38.7% vs. 29.2%), and among teenagers over 15 years of age (40.0% vs. 25.4%). Boys with unsatisfactory patterns of meal consumption presented higher means of BMI and of waist and hip circumferences than the ones with satisfactory patterns. The higher values of anthropometric measurement observed among adolescents with an unsatisfactory meal pattern indicate that they may be at risk for overweight or obesity.     

Air pollution and mortality in the elderly in Rio de Janeiro: a time-series analysis

This study investigates the association between particulate air pollution and mortality from cardiovascular and respiratory diseases among the elderly in the city of Rio de Janeiro. Death counts, levels of total suspended particles (TSP), and meteorological data were obtained from secondary databases. Daily counts of deaths and daily TSP levels from 1990 to 1993 were analyzed in Poisson regression models adjusted for long-term temporal trends, seasonality, weekdays, temperature, and humidity. For an increase in TSP levels from the 10th to the 90th percentile (104.7 microg/m3), the relative risks for mortality in elderly people from cardiovascular and respiratory diseases were 1.04 (95%CI: 0.96-1.13) and 1.10 (95%CI: 0.97-1.26) respectively. Although an upward trend in risk was observed, the associations were not statistically significant, which could be explained partially by the small number of pollution measures available for the period analyzed.     

Health, environment, and pesticide use in a farming area in Rio de Janeiro State, Brazil

Pesticide use in agriculture is a nationwide phenomenon in Brazil, and the problem is proportional to this vast country. The widespread and growing use of pesticides for crops and cattle-raising, among other applications, has caused a number of environmental changes and problems, both by contaminating the communities of living beings that comprise the environment and by accumulating in the biotic and abiotic segments of ecosystems (biota, water, air, soil, sediments etc.). Pesticides also cause a number of diseases and health problems in human populations. The current article discusses several pesticide-related implications for human health and the environment in the mountainous region of the State of Rio de Janeiro, an important farming center. The article presents the results of research in the area, identifying possible determinants of the current situation and some of the main challenges for dealing with the problem.     

Spatial distribution of mortality from acute myocardial infarction in Rio de Janeiro, Brazil

The study analyzes the spatial distribution of mortality from acute myocardial infarction (AMI) in Rio de Janeiro, Brazil. Data from the Mortality Information System refers to the year 2000. Empirical Bayes smoothing technique was used to minimize random variation in mortality coefficients due to the population size in the geographic analytical units. Spatial distribution of AMI mortality in the city of Rio de Janeiro is heterogeneous and displays a pattern associated with a strong socioeconomic gradient. The decreased AMI risk in the West Side of the city fails to reflect the social inequality and limited access to healthcare services observed there. A more likely hypothesis is that the risk of AMI death was underestimated in the West Side, due to the high proportion of ill-defined causes of death in that region. In the rest of the city, the spatial pattern of AMI mortality showed higher values in poorer areas. The various hospitals treating AMI also show a clear pattern in their areas of influence.     

Census of hospitalized patients in a psychiatric institution of Rio de Janeiro State: preliminary data

Rio de Janeiro State has one of the largest networks of psychiatric hospitals in Brazil, one of them the Dr. Eiras Paracambi Hospital (CSDE-P). In late 2000, the current Mental Health Advisory Division of the Rio de Janeiro State Health Department conducted a clinical and psychosocial census of patients hospitalized in the CSDE-P. The hospital population consisted of 1,494 individuals, the majority men (53.4%), single (81.6%), working-age (66.4%), and with limited schooling (only 11.5% with a complete primary education or more). Most had been in hospital for at least two years (77.6%), received visits from relatives (60.5%), but did not have hospital leave (73.8%). The predominant diagnoses were schizophrenia (53.6%) and mental retardation (26.4%). The main therapeutic approach was psychiatric (84.1%). Only 13.3% took part in systematic activities during the day, although 36% were in a condition to do so. CSDE-P is a mega-hospital where most patients have precarious social links, demanding treatment strategies which take this characteristic into account.     

Concealed and revealed violence: an epidemiological study of mortality from external causes in Duque de Caxias, Rio de Janeiro

This paper is part of an interdisciplinary study dealing with violence and the health process in the city of Duque de Caxias, State of Rio de Janeiro. This process expresses structural violence in addition to that related to resistance and deliquency, the outcomes of which are present in the area's overall mortality. This is an analysis of recorded data on mortality form external causes in the period 1979-1987, as well as a critical analysis of information gathered from death certificates for the year 1987. Mortality from external causes in the area studied is shown according to its magnitude and importance in relation to the major causes of death in the city, using absolute numbers, ratios, crude and standardized coefficients, rates, and years of life potentially lost, which are classified by groups of specific external causes, sex, and age. The analysis gives a socio-economic and demographic profile of the victims. The findings are discussed in the light of the sociological and historical knowledge on the social dynamics of Duque de Caxias. As a conclusion, this paper suggests a few actions that are badly needed for providing support to the victims of violence.     

Income inequality,residential poverty clustering and infant mortality: a study in Rio de Janeiro,Brazil

In this paper, we propose an approach to investigate the hypothesis that the residential concentration of poverty affects health status more deeply than when poverty is randomly scattered in a given geographical area. To characterize the geographic pattern of poverty in the city of Rio de Janeiro, Brazil, an index that measures the heterogeneity of poverty concentration among sub-areas was proposed. We used census data and defined poverty by means of the household head monthly income. The 153 neighborhoods that compose the city were used as the geographic units, and the census tracts as the sub-areas. The proposed index measures differences of poverty concentration across census tracts within a neighborhood. The effects of geographic poverty clustering on infant mortality related variables (early neonatal mortality rate; post-neonatal mortality rate; proportion of adolescent mothers; and fertility rate among adolescents) were estimated by partial correlation coefficients, controlling for the neighborhood poverty rate. Our study revealed that intra-city variations of the post-neonatal mortality rate are associated with geographic patterns of poverty, and that pregnancy in adolescence is strongly and contextually correlated with intra-neighborhood poverty clustering, even after adjustment for the poverty rate. The evidence of relevant health differences associated with the spatial concentration of poverty supports the hypothesis that properties of the environment of residence contextually influence health. Our findings suggest that prevention of some infant mortality related problems has to be focused directly on features of communities, considering their physical, cultural and psychosocial characteristics, being of particular concern the health of communities segregated from the society at large by extreme poverty.     

Obstetric care during childbirth in Rio de Janeiro: hospital practices and user access

The purpose of this paper is to identify and describe Rio de Janeiro maternity hospital profiles and the route between the mother's place of residence and the hospital. Data sources were: the State Live Birth Information System (1995) and the National Survey on Medical Care (1992). Two groups of maternity hospitals were identified using multivariate cluster analysis. Group A had an extremely high cesarean rate (81%), with mothers and neonates presenting good health conditions. Cesarean rates were lower in Group B, although still high (32%), and other variables reflected worse neonatal conditions. Cesarean rate was the indicator which best discriminated between the groups, followed by proportion of adolescent mothers and mothers with a high school education. The uneven spatial distribution of maternity hospitals, which were concentrated in the richest area of the city, was a factor in the long routes used by women to reach medical care for childbirth.     

Teenage contraception and pregnancy from the perspective of young low-income fathers in a slum area in Rio de Janeiro

The study focuses on how teenage fatherhood affects the life histories of young low-income males. Field work included individual interviews of young fathers living in a shantytown in Rio de Janeiro city. The argument is that an approach from the male standpoint affords access to other levels in a web of meanings and relations that refer back to the logic of contraception, the formation of couples, and active fatherhood. The argument also highlights the links between type of relationship and partnership, use and non-use of contraceptive methods, and the meanings of fatherhood for young low-income males. It highlights that entering actively into fatherhood helps boys consolidate their image as "mature", "responsible", "adult" men.     

Socioeconomic inequalities and low birth weight and perinatal mortality in Rio de Janeiro, Brazil

Socioeconomic inequalities in early infant mortality have been evidenced in Brazil, with a greater mortality risk associated with the mother's socioeconomic status (SES). The aim of this paper is to identify socioeconomic inequalities in relation to low birth weight and perinatal mortality in the City of Rio de Janeiro, Brazil, discussing the appropriateness of the main health inequality indexes proposed in the international literature. As the information source, we use data collected in a survey of approximately 10,000 mothers selected for interview within 48 hours after delivery in public and private hospitals in the city. Using educational level and head of household's income as indicators of SES, as well as population attributable risk and slope index of inequality as health inequality measures, the results show a steep socioeconomic gradient in the proportion of low birth weight, and especially in the perinatal mortality rate. The persistent association between socioeconomic indicators and adverse results in pregnancy indicates (at least partially) the health system's inefficacy in diminishing perinatal health inequalities in Rio de Janeiro.     

Psychiatric nursing and modern nursing in Rio de Janeiro: a history lesson

The present study is the result of an essay written for the discipline Research Laboratory of Nursing History. It refers to the interest and struggle of the Brazilian Association of Nursing (ABEN), in the 1940s, in Rio de Janeiro, to make professionals of this area aware of the need of the inclusion of nursing in the psychiatric field in Rio de Janeiro. Our objective is to present the difficulties of this insertion, although the beginnings and the regulation of the nursing profession in Brazil started in a school of nursing, in the Psychiatric Hospital of Rio de Janeiro. In order to present the difficulties for this inclusion, we analyzed the documents that prescribed the regulation of the nursing profession, in the psychiatric area of the hospital mentioned above. Results indicate that standards established by Anna Nery Nursing School were broken, since psychiatric assistance was denied by this school until 1949, while the Nursing School Alfredo Pinto provided this kind of care since 1890. It is important to point out the strategic and historical role of ABEn as the coordinator and motivator of discussions regarding the course of the nursing profession.     

Evolution of uterine cervical cancer mortality from 1979 to 1998 in the State of Rio Grande do Sul, Brazil

A decrease in uterine cervical cancer (CC) mortality has been observed in developed countries. However, mortality data in Brazil suggest that CC is one of the most frequent causes of cancer death in women; it is the fourth cause of death from cancer in women in Rio Grande Sul State. A time-trend ecological study was performed to analyze CC mortality trends in Rio Grande do Sul from 1979 to 1998. Data were collected from the Mortality Information System, Brazilian Ministry of Health (DATASUS). Standardized mortality ratios were calculated and linear regression was used for time-trend analysis. The impact of cervical cancer death on life expectancy was also estimated for the study population using potential years of life lost (PYLL). Standardized mortality ratios during the study period revealed a positive linear trend of 0.17, and the mean annual mortality rate was 7.58/100,000. Cervical cancer accounted for 21.9 +/- 1.33 PYLL during the period. In conclusion, although CC is a preventable and curable disease, an increase is observed in mortality from this cause in Rio Grande do Sul State, which may suggest failure in screening programs for cervical cancer.