Organization of cervical cancer screening in Campinas and surrounding region, São Paulo State, Brazil

Cervical cancer screening remains a challenge in developing countries due to a complex array of problems. This paper aimed to describe the experience with organization of cervical cancer screening in three districts of Campinas and the surrounding region in S?o Paulo State, Brazil, and to report the resulting data. The program was organized in a pyramid format, and the health care hierarchy was defined according to the complexity and total number of medical procedures. Screening has been extended currently to 88 municipalities, of which 51 are equipped with colposcopy and eight have facilities for treating advanced cervical cancer. The standardized incidence rate for cervical cancer in Campinas was 14.2/100,000 women per year in 1993-1995, and the standardized mortality rate per district ranged from 2.7 to 3.0 per 100,000 women in 1997-1998. This project has clearly shown that hierarchical and decentralized organization of health procedures is a necessary condition for achieving the goals of an effective cervical cancer screening program.     

Human resources for the intensive care unit at the municipal district of São Paulo

The study had the purpose to investigate aspects of the ICUs from the Municipal district of S?o Paulo, regarding the composition of the clinical staff; characteristics of the nursing personnel and nurses' characterization. Data were collected through 47 questionnaires distributed in 32 hospitals. Results show that: the morning and the afternoon shifts have a larger number of people from all clinical categories, the majority of the nursing personnel work 36 hours per week, nurses' wages varied from 700 to 1,500 "reais" and 66.1% of them were enrolled in Master Programs. Authors concluded that 79.2% of the clinical staff was formed by the nursing personnel.     

Safeguarding of the social right to pharmaceutical assistance in the state of São Paulo, Brazil

OBJECTIVE: To evaluate how the Judicial Power safeguards the social right to pharmaceutical assistance as well as the relationships between the legal and political systems to safeguard this right. METHODS: There were assessed decisions in lawsuits of drug supply in the state of S?o Paulo, Southern Brazil, between 1997 and 2004. Discourse of the Collective Subject of procedural actors was the methodological approach used. RESULTS: In 96.4% of the cases analyzed, judges' discourse sentenced the State. In these cases, the State was obliged to provide drugs exactly as requested by the plaintiff, even when drugs were not registered in the National Health Surveillance Agency (9.6% of cases). Also, 100% of the lawsuits were proposed by individual plaintiffs; in 77.4% of the cases the plaintiff requested an specific drug of a specific pharmaceutical company; and in 93,5%, the drugs were provided to the plaintiff through an urgent preliminary order. CONCLUSIONS: The Judicial Power is not taking into account in its decisions political elements of drug policies, established to enforce the social right to pharmaceutical assistance. The Judicial Power is hindering the collective decision making process by the political system, prioritizing plaintiffs' individual needs over community interests.     

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).     

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.     

Oral health of institutionalized elderly in the eastern zone of São Paulo, Brazil, 1999

The objective was to verify oral health conditions in institutionalized elderly people in the city of S?o Paulo, Brazil, through epidemiological analysis. The sample consisted of 293 subjects and was stratified according to age (65-74 years and over 75) and gender. Epidemiological analysis was conducted according to WHO criteria to determine prevalence of oral disease. Chi-square and Mann-Whitney tests were used to check differences between strata. Of the subjects evaluated, 64.8% were women and 65.2% were over 75 years old. DMFT was 30.8 with tooth loss of 96.3%, and this percentage was statistically greater for women (97.0%); 94.7% showed calculus as a major degree of periodontal condition, and only 1.8% presented healthy periodontal conditions and 33.3% presented loss of attachment ranging from 6 to 8 mm. Some 48.1% used total upper and 22.5% total lower prostheses. Edentulism was 68.3%. The data indicate unsatisfactory clinical conditions, as shown by the high CPO-D index and high percentage of edentulism.     

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.     

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.     

Estimation of the dog and cat population in the State of São Paulo

OBJECTIVE: To estimate the total dog and cat population with owners in order to enable better planning of the control actions against diseases involving these animals. METHODS: The study was carried out in the non-metropolitan regions of the State of S?o Paulo, Brazil, from May to December 2002. Forty-one municipalities and 100 census tracts were surveyed. These were selected by probabilistic stratified cluster sampling in two stages. The strata were formed by grouping the municipalities according to their populations and living conditions. The Pasteur S?o Paulo Technique was used to obtain data on the canine population. This technique was developed to estimate and classify dogs according to their degree of dependence and restriction. RESULTS: Almost 53% of the 20,958 households visited owned a dog, and the average was 1.6 dogs per household. A total of 4,624 cats were found, concentrated in 12.6% of the households. The results indicate a dog/inhabitant ratio of 1:4.0 and a cat/inhabitant ratio of 1:16.4. CONCLUSIONS: The animal/inhabitant ratios were much higher than expected. Incorporation of these ratios into evaluations of the vaccination campaign against rabies has revealed more realistic coverage patterns, thus leading to renewed discussion of the vaccination targets for municipalities. An association was observed between the size of the municipality or its inhabitant's living conditions and the level of restrictions on dogs.     

Prevalence of trachoma in preschool and schoolchildren in the city of São Paulo

OBJECTIVE: To assess the prevalence of trachoma among preschool and school children of public schools to give new focus to control programs. METHODS: An epidemiological survey was carried out in S?o Paulo City in 1999. Children between four and 14 years old were selected by a cluster sampling where school shift was the sampling unit. External eye examination was conducted to detect trachoma. RESULTS: A total of 27,091 children were examined and 597 cases of trachoma were found (2.2%; 95% CI: 1.86-2.55). The prevalence ranged from 0.4% to 4.2% in 10 city areas. The trachoma detection rate in the household contacts examined was 8.7%. Follicular trachoma was found in 99% of the cases and intense trachoma in 1.0%. It was observed that 21.8% of the cases were asymptomatic. CONCLUSIONS: Though the trachoma prevalence was low, the occurrence of severe cases points out to the likelihood of cicatricial trachoma cases in the future if they are not adequately treated and controlled. The great difference in the prevalences in different city areas indicates the need for strengthening epidemiological surveillance activities.     

Anthropometry of elderly residents in the city of São Paulo, Brazil

The article presents gender and age-specific selected anthropometric data for a representative sample of elderly Brazilians in the city of S?o Paulo. This was a cross-sectional, population-based household survey. A total of 1,894 older adults (men and women, > 60 years) were examined from January to March 2001. Data were presented as means and percentiles for body mass (BM); height or stature (ST); body mass index (BMI); waist (WC), hip (HC), arm (AC), and calf (CC) circumferences; triceps skinfold thickness (TST); and arm muscle circumference (AMC), and differences were described according to age (all variables) and gender (BMI). Except for HC (men), all anthropometric variables were lower in the oldest than in the youngest individuals (p < 0.01) in both genders. BMI was significantly higher (p < 0.01) in women than men (all age groups). The observations suggest that there is loss of muscle mass and redistribution and reduction of fat mass with age (both genders). The data can be used in clinical practice and epidemiological studies based on interpretation of anthropometric measurements in the elderly in S?o Paulo.     

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.     

Public perception of depression in the city of São Paulo

OBJECTIVE: To assess how the population identifies symptoms of depression as well as its causes. METHODS: A household survey with a probabilistic sample of 500 individuals, residing in the city of S?o Paulo and aged between 18 and 65 years, was conducted in 2002. A structured questionnaire including sociodemographic data and a vignette presentation describing a person with depression, according to the Diagnostic and Statistical Manual of Mental Disorders-IV and the International Classification of Diseases-10 was used during the in-person interviews carried out by trained, qualified interviewers. Two questions about the vignette's symptom identification were subsequently asked. The results were analyzed by means of logistic regression and variance analysis. RESULTS: Symptoms presented were identified as "depression" by less than half of the sample. About 20% of respondents believed it was a mental illness. Low level of education was the only variable associated with identification as mental illness (OR=2.001, 95% CI: 1.275; 3.141, p=0.003). The most relevant causes were "unemployment" and "isolation". Biological, spiritual and moral causes were considered to be less relevant. Factors that most influenced the responses about causes were level of education, gender, personal experience with mental problems and identification as mental illness. CONCLUSIONS: The population of the city of S?o Paulo in general, especially those with a higher level of education, views depression in terms of a psychosocial model that somewhat differs from the biomedical model.