Dental caries in the primary dentition in public nursery school children in Juiz de Fora, Minas Gerais, Brazil

The aim of this study was to assess the prevalence of dental caries in the primary dentition and associated variables in low socioeconomic preschool children enrolled in public nursery schools in Juiz de Fora, Minas Gerais, Brazil. Four public institutions were selected by geographic criteria (two in the central region and two in the peripheral region). The study population comprised 338 children (181 boys; 157 girls) aged 2-6 years old. Dental caries was recorded using the decayed, missing, and filled teeth (dmf-t) index. Among the examined children, 50.6% were caries-free. The mean dmf-t index was 2.03. It was higher in the peripheral nursery schools (p<0.01). A trend towards a difference between sexes (p = 0.06) was observed. Logistic regression analysis selected a previous child's visit to dentist (p<0.001), geographic location of the public nursery school (p<0.01), and age (p<0.01) as predictive variables for the dmf-t index. The study showed the need for an oral health program for this population, including both curative and preventive measures in order to achieve the WHO/FDI goals for the year 2000, namely 50% of children free of caries at age 5-6 years.     

Validation of a health survey questionnaire focusing on risk factors for coronary artery disease in a group of public employees in Juiz de Fora, Minas Gerais State, Brazil

The validity of a health survey questionnaire used in a family health promotion program to identify individuals at risk of developing coronary artery disease (CAD) was studied in a random sample of 297 State public employees in Juiz de Fora, Minas Gerais State, Brazil. The sample was stratified by sex, and subjects were 40 years of age or older. Results obtained in interviews were compared to laboratory and clinical data. We assessed the questionnaire's sensitivity, specificity, and positive and negative predictive values in relation to questions about current or previous history of diabetes, hypertension, smoking, and high cholesterol. Among individuals with at least one altered clinical or laboratory test, 81% (total sensitivity) were identified by the referred risk inquiry when reporting at least one risk factor. Sheffield and New Zealand tables were used to determine the individuals with increased risk of developing CAD and to assess if they would also be identified by the health survey questionnaire. The sensitivity for identifying this subgroup was 100%.     

Missed opportunities for tetanus vaccination in pregnant women, and factors associated with seropositivity

The aim of this study was to identify the seroprevalance rate of tetanus and to determine missed opportunities for tetanus vaccination. Two hundred and twenty-seven female volunteers who were hospitalized following delivery participated in the study. Blood samples were analyzed using enzyme-linked immunoassay to measure tetanus antibody levels. In addition, a questionnaire was used to investigate the factors associated with vaccination status. Sixty-five percent of the study participants had safe protective levels of antibodies. Factors associated with antibody level were age, level of education and number of doses. Only 25.7% of women who received antenatal care (ANC) had received tetanus vaccinations. Women who received ANC from primary healthcare facilities were more likely to have been vaccinated than those who received ANC from hospitals or private practice (P < 0.05). Factors associated with both tetanus vaccination and immunizations in pregnant women should be further investigated by qualitative and quantitative studies. Knowledge, attitude and practice surveys of mothers and healthcare providers on provision of the tetanus vaccine to pregnant women need to be undertaken urgently.     

The impact of multidrug therapy on the epidemiological pattern of leprosy in Juiz de Fora, Brazil

We investigated the impact of multidrug therapy (MDT) on the epidemiological pattern of leprosy in Juiz de Fora, Brazil, from 1978 to 1995. Evaluation of 1,283 medical charts was performed according to the treatment regimen used in two different periods. Following the introduction of MDT in 1987, prevalence of leprosy decreased from 22 patients/10,000 inhabitants to 5.2 patients/10,000 inhabitants in 1995. Incidence rate of leprosy was lower in period II (1987-1995) than in period I (1978-1986). Decreasing prevalence and incidence appear to be related to drug efficacy rather than decreased case identification, since both self-referred and professionally referred treatment increased markedly from period I to period II. For both periods, multibacillary leprosy was the most frequent clinical form of the disease (+/-68%), and the main infection risk factor identified was household contact. Leprosy is predominantly manifested in adults, but an increase in the number of very old and very young patients was observed in period II. The MDT program has been effective both in combating leprosy and in promoting awareness of the disease.     

Availability of essential drugs in two regions of Minas Gerais, Brazil]

OBJECTIVE: To investigate the availability of essential drugs in municipalities with a human development index < 0.699. METHODS: We surveyed 69 institutions, including municipal pharmacies, public clinics, private and philanthropic health units, and commercial pharmacies, in 19 municipalities of the state of Minas Gerais, Brazil. The municipalities were chosen according to the following selection criteria: (1) a human development index (HDI) < 0.699 (the HDI for the entire state of Minas Gerais in 1991) in the microregion where the municipality was located; (2) the municipality had to be the seat of government for the microregion where it was located; (3) there had to be at least two eligible institutions (belonging to the public, private, or philanthropic sectors) in full functioning in the municipality during the survey period. Health professionals who were directly responsible for stock control and drug dispensation at the institutions surveyed were interviewed. Institutional documents and records were also reviewed. A list of 21 tracer essential drugs, which were selected among the drugs most widely employed in the State of Minas Gerais' Basic Pharmacy Program, was used to measure availability. The availability of each tracer drug was calculated at the time of the site visit and for the 12-month period immediately before the survey. In addition, the availability of tracer drugs was calculated for each type of institution surveyed. RESULTS: The availability of essential drugs in municipal pharmacies was 52.0%; in public health clinics, 46.9%; and in philanthropic and private health units, 41.0% and 38.1%, respectively. In commercial pharmacies, the availability of essential drugs reached 81.2%. CONCLUSION: The availability of essential drugs in public facilities is low and varies widely, with the result that persons who need such drugs the most are often those who lack access to them. Private pharmacies are the main source of essential drugs. The results of this study point to the need to seek increased awareness and implementation of the concept of essential drugs throughout the country.     

The use of psychotropics by dental patients in Minas Gerais, Brazil]

In Brazil, psychotropics and other drugs are often indiscriminately overused. Nevertheless, there are few studies regarding the use of psychotropics, especially among dental patients. The purpose of this study was to assess the prevalence of psychotropic consumption among patients of the general primary care clinic of the Dentistry School at the Minas Gerais Federal University, in Brazil. To collect data, students working in the clinic interviewed all patients over 12 years of age seen at the clinic during June 1997 and asked them about their use of psychotropics during the preceding 2-week and 12-month periods. The results showed that 4% of the patients had used psychotropic drugs in the 2 weeks before the study and that 10% of them had used psychotropics in the preceding 12 months. The drugs used most frequently in the 12-month period were anxiolytics (around 40% of total use). The median age of the patients was 23 years old. Persons under the median had used psychotropics less in comparison with older persons (P < 0.01). A significant association (P < 0.05) was found between using drugs and being female, and also between the use of drugs and being a housekeeper or a housewife (P < 0.03). Patients with a regular relationship (married or living together) used more psychotropics than patients who were single, widowed, or divorced (P < 0.03). There was no association between the use of drugs and the level of education. Even though information on the use of psychotropics is important for dental diagnosis and planning, only 40% of the students said they noted this information in their patients' charts. That fact suggests that dental student education may be lacking in this regard and that dentistry training should take into consideration the issue of patients' use of drugs.     

Drinking-and-driving prevalence in Belo Horizonte, Minas Gerais State, Brazil

Problems resulting from alcohol consumption by drivers have been studied worldwide, and epidemiological research points to high injury and death rates related to drinking-and-driving. However, equivalent data are limited in Brazil. In this study, 913 drivers were stopped on public roads with heavy traffic and high concentrations of bars, restaurants, and nightclubs in Belo Horizonte, Minas Gerais State, and asked to answer a questionnaire and submit to an active breathalyzer test. The study was done in December 2005 and December 2006. The study adopted the internationally accepted sobriety checkpoint method. In the sample, 38.0% of drivers showed some trace of alcohol in their exhaled air, and 19.6% were at or above the legal limit (0.6 g/l). These figures were five times those found in similar surveys in other countries. The findings suggest a critical drinking-and-driving problem in Belo Horizonte (and probably elsewhere in Brazil) and the need for on-going research, the development of specific public policies to deal with the problem, and effective enforcement of the existing law.     

Neurological adverse events temporally associated to mass vaccination against yellow fever in Juiz de Fora, Brazil, 1999-2005

The identification of adverse events following immunization (AEFI) and their prompt investigation are important to allow a timely and scientifically based response to the users of immunization services. This article presents an analysis of notified AEFI cases between 1999 and 2005 and their temporal association with 2001 yellow fever vaccination campaign, AEFI notification attributed to yellow fever vaccination rose from 0.06 to 1.32 per 100,000 vaccinees in Brazil, between 1998 and 2000. During the 2001 yellow fever mass vaccination campaign held in Juiz de Fora, Brazil, 12 cases of aseptic meningitis were temporally associated to yellow fever vaccination, but clinical and laboratory data were not available to confirm nor deny causality. Epidemiological studies associated to enhanced surveillance and standardized protocols should take advantage of public health interventions like mass vaccination campaigns and implementation of new vaccination strategies in order to assess and investigate vaccine safety.     

Schistosomiasis in an ecotourism area in Minas Gerais State, Brazil

This paper discusses schistosomiasis transmission in S?o José da Serra, a village with a population of 500 in the county of Jaboticatubas, Minas Gerais State, Brazil. The area receives thousands of visitors a year for ecotourism. The study was motivated by a case of acute schistosomiasis involving a couple that spent the 2007 Carnival (Mardi Gras) holiday in the area. Stool tests from 268 local residents (53.6% of the population) showed that 35 (13%) were positive for the infection. A comparison with a previous survey (2005) in the same location showed an increase in the schistosomiasis-positive rate from 9.6% to 12.5%, among the 56 individuals who participated in both surveys. A malacological survey of 65 Biomphalaria glabrata snails showed one specimen (1.5%) eliminating cercariae. In a similar survey in 2005, no positive snail specimens were found. The study indicates that active schistosomiasis transmission is occurring in the area, and that integrated educational programs are needed for both the local community and tourists.     

Epidemiology and evolution of Zika virus in Minas Gerais,Southeast Brazil

Autochthonous Zika virus (ZIKV) transmission in Brazil was first identified in April 2015 in Brazil, with the first ZIKV-associated microcephaly cases detected in October 2015. Despite efforts on understanding ZIKV transmission in Brazil, little is known about the virus epidemiology and genetic diversity in Minas Gerais (MG), the second most populous state in the country. We report molecular and genomic findings from the main public health laboratory in MG. Until January 2020, 26,817 ZIKV suspected infections and 86 congenital syndrome cases were reported in MG state. We tested 8552 ZIKV and microcephaly suspected cases. Ten genomes were generated on-site directly from clinical samples. A total of 1723 confirmed cases were detected in Minas Gerais, with two main epidemic waves; the first and larger epidemic wave peaked in March 2016, with the second smaller wave that peaked in March 2017. Dated molecular clock analysis revealed that multiple introductions occurred in Minas Gerais between 2014 and 2015, suggesting that the virus was circulating unnoticed for at least 16 months before the first confirmed laboratory case that we retrospectively identified in December 2015. Our findings highlight the importance of continued genomic surveillance strategies combined with traditional epidemiology to assist public health laboratories in monitoring and understanding the diversity of circulating arboviruses, which might help attenuate the public health impact of infectious diseases.     

Avoidable perinatal deaths in Belo Horizonte,Minas Gerais,Brazil, 1999

The perinatal mortality rate is still high in Belo Horizonte. This study investigated all 826 perinatal deaths taking place in 1999, focusing on the possibility of their prevention, using the Wigglesworth classification. The perinatal mortality rate was 20.2 per one thousand births, and the risk of perinatal death was 20 times higher in children with low birthweight. Some 24.6% of the children weighed more than 2,500g, and the main cause of death in this group was asphyxia during labor. The antepartum cause of death contributed to 30% of all deaths, and 25% of these children weighed more than 2,500g. Some deaths occurred out of hospital, and in some cases the mother arrived at hospital in end-stage labor. About 40% of all perinatal deaths or 60% of all early neonatal deaths could have been prevented, suggesting flaws in prenatal, intrapartum, and neonatal care at both the clinical and health-care organizational levels. To intervene in this situation, progress is needed in improving quality of care and ensuring accountability in the specific health services and the health care system as a whole.     

Malaria in the state of Minas Gerais,Brazil, 1980-1992

Epidemiological analysis of malaria in the State of Minas Gerais, Brazil, shows the need for permanent reporting of the endemic-related data in order to maintain clinical suspicion of the infection in any febrile patient. Moreover, it increases the possibility of early aetiological diagnosis. Such reporting aims at improving performance of the local health system. It is important to maintain a well-organized malaria epidemiological surveillance system even in non-endemic areas.     

Hospitalizations for ambulatory care-sensitive conditions,Minas Gerais,Southeastern Brazil, 2000 and 2010

OBJECTIVE

To analyze hospitalization rates and the proportion of deaths due to ambulatory care-sensitive hospitalizations and to characterize them according to coverage by the Family Health Strategy, a primary health care guidance program.

METHODS

An ecological study comprising 853 municipalities in the state of Minas Gerais, under the purview of 28 regional health care units, was conducted. We used data from the Hospital Information System of the Brazilian Unified Health System. Ambulatory care-sensitive hospitalizations in 2000 and 2010 were compared. Population data were obtained from the demographic censuses.

RESULTS

The number of ambulatory care-sensitive hospitalizations declined from 20.75/1,000 inhabitants [standard deviation (SD) = 10.42) in 2000 to 14.92/thousand inhabitants (SD = 10.04) in 2010 Heart failure was the most frequent cause in both years. Hospitalizations rates for hypertension, asthma, and diabetes mellitus, decreased, whereas those for angina pectoris, prenatal and birth disorders, kidney and urinary tract infections, and other acute infections increased. Hospitalization durations and the proportion of deaths due to ambulatory care-sensitive hospitalizations increased significantly.

CONCLUSIONS

Mean hospitalization rates for sensitive conditions were significantly lower in 2010 than in 2000, but no correlation was found with regard to the expansion of the population coverage of the Family Health Strategy. Hospitalization rates and proportion of deaths were different between the various health care regions in the years evaluated, indicating a need to prioritize the primary health care with high efficiency and quality.     

Labor process and workers' health in charcoal production in Minas Gerais, Brazil

This study is a tentative approach to the relationship between environmental and occupational health and development in a specific situation: charcoal production in the Jequitinhonha Valley, the poorest region in the State of Minas Gerais, Brazil. The study focuses on the labor process, involving heavy exploitation, hazardous working conditions, and extremely precarious living conditions. Working conditions and activities are described and related to the workers' health situation. Social policies and decisive participation by the various social stakeholders are necessary to change this reality.     

Periodontal disease in the Arturo's black community in Contagem, Minas Gerais, Brazil

This was a cross-sectional study on periodontal disease in a black community in Brazil. The sample consisted of 104 individuals over 13 years of age (63 females and 41 males). All teeth were examined except the third molars. Six sites per tooth were analyzed in order to measure pocket depth and clinical loss of attachment. Four sites per tooth were used to measure bleeding on probing and presence of calculus. It was observed that bleeding on probing occurred in 97.9% of the total of individuals with teeth, with probing depth >or= 4mm in 43.3% and clinical attachment loss in 63.5%. Calculus was detected in 81.2% of the sample. In the study, individuals 46 to 60 years of age showed the highest mean clinical attachment loss, 8.3mm (+/- 4.27), and a probing depth of 4.6mm (+/- 3.5). Prevalence rate for periodontal disease in this community was similar to rates elsewhere in Brazil and the world, i.e., 9.6% for the severe form. Age, schooling, and tobacco use were identified as risk indicators statistically associated with periodontal disease.     

Environmental and social determinants in schistosomiasis mansoni in Ravena, Minas Gerais, Brazil

This study identified the role of biological and social determinants in the transmission of schistosomiasis mansoni in Ravena, Minas Gerais, Brazil, in 1980. This data was used to characterize the clinical and epidemiological profiles of the endemic desease in the population, allowing for the determination of the efficacy of the potable water supply and the specific treatment of those infected with S. mansoni. The district contains three locations, Ravenopolis, Ravena and Lavapes, where the prevalence of the endemic disease was, 20.1%, 42.6% and 63.9%, respectively. The prevalence in the district was statistically higher in men. The age brackets that displayed differences by gender were 10-14 and 15-19 years. Severity of infection was statistically different among individuals within the 10-14 year bracket in ali three locations, and in the 15-19 year bracket among individuals from Ravenopolis and Ravena. The hepatointestinal form was associated with age, and individuals under 15 years of age presented risk of infection 8.85 times higher than adults. Multivariable analysis of the factors involved in transmission of the disease showed that Lavapes was independently associated with infection. In that area, poor sanitary conditions and the proximity of houses to streams infested with S. marsoni cercariae facilitated infection of neighborhood women while performing domestic activities, as well as men digging sand from the streams for construction. These results show the focal nature of transmission of the endemic requiring specific intervention for effective control of disease.     

Musculoskeletal disorders among healthcare workers in Belo Horizonte, Minas Gerais State, Brazil

This cross-sectional study investigated the prevalence of musculoskeletal disorders and associated factors in a sample of 1,808 workers (from a total of 13,602) in the municipal health system in Belo Horizonte, Minas Gerais State, Brazil. Prevalence was calculated according to self-reported pain in the upper or lower limbs and/or back, and size of associations was estimated by univariate (p < 0.20) and multivariate Poisson regression (p < 0.05). Musculoskeletal disorders showed a prevalence of 49.9% and were statistically associated with female gender, living with a partner, physical activity less than twice a week, self-reported common mental disorder, certain job positions (dentists, dental technicians, and community health workers), high physical demand, and inadequate working conditions. The results confirm the complexity of musculoskeletal disorders and suggest areas for development of health promotion programs in health services.     

Impact of water supply, domiciliary water reservoirs and sewage on faeco-orally transmitted parasitic diseases in children residing in poor areas in Juiz de Fora, Brazil

The objectives of this study were to characterize faeco-orally transmitted parasitic diseases and to identify the factors associated with these diseases, with emphasis on environmental factors, in children ranging from 1 up to 5 years old residing in substandard settlement areas. A population-based cross-sectional epidemiological design was used in a non-random selection of 29 out of the 78 substandard settlement areas in the municipality of Juiz de Fora, Brazil. A sample of 753 children were assessed from the target population consisting of all children of the appropriate age range residing in the selected areas. Data were collected by means of domiciliary interviews with their mothers or with the person responsible for them. The Hoffmann-Pons-Janer method was used in the parasitological examination of faeces. Binary logistic regression models were used to identify the factors associated with the diseases. A total of 319 sample children presented faeco-orally transmitted parasitic diseases. The factors associated with these parasitic diseases included the children's age, family income, number of dwellers in the domicile, consumption of water from shallow wells, consumption of water from natural sources, absence of covered domiciliary water reservoirs, and the presence of sewage flowing in the street.     

Delta-aminolevulinic acid dehydratase activity in the general population of southern Minas Gerais,Brazil

Blood samples were collected from 113 subjects (56 males and 57 females) living in the district of Alfenas, in southern Minas Gerais state, Brazil, to establish reference values for delta-aminolevulinic acid dehydratase activity (ALA-D, EC 4.2.1.24). The state of health of the population was confirmed by hematological and biochemical parameters analyzed in blood and urine samples. ALA-D determination was performed according to the Berlin & Schaller spectrophotometric method. Distribution may be regarded as according to normal distribution and reference values obtained, in micromol x min(-1) x L(-1) erythrocytes, were: mean (+/- SD) = 54.5 (+/- 9.8); 95% confidence interval = 52.7-56.4; lower reference value (mean-2 SD) = 34.9. Mean ALA-D activity was higher than any other published elsewhere and the reference values established are useful as a baseline for evaluating ALA-D activity when monitoring persons exposed to lead. Age, gender, drinking, or smoking did not significantly alter (Student t-test, p < or = 0.05) the reference values for ALA-D.