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.     

Pap smear screening for the control of cervical cancer in Minas Gerais State, Brazil, 2002

This article analyzes the implementation of Pap smears by the Cervical Cancer Control Program in 2002 in women 25-59 years of age residing in 850 municipalities (counties) in Minas Gerais State, Brazil. Cluster analysis was performed to classify municipalities by: number of Pap smears performed; test findings; and adequacy of slides. The variable "satisfactory slide, but limited by" was the principal factor for classifying municipalities into 5 clusters. Spatial representation of clusters indicated a more critical situation in the North, Jequitinhonha, Vale do Mucuri, and Vale do Rio Doce "meso-regions" of Minas Gerais and identified operational problems resulting from inadequate collection of material, with more "desiccated" slides observed in the North of the State and more slides with "absent endocervical cells" in the Center and South. The methodology allowed identifying clusters of municipalities with problems in the screening process, related to quality of sampling and fixing and reading of slides.     

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.     

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.     

Epidemiological surveillance in the Chagas disease control program in Minas Gerais State, Brazil (1984-1998)

This paper describes the surveillance phase of the Chagas Disease Control Program in Minas Gerais State. Surveillance was conducted by the County Health Services with community participation in the planning, decision-making, and maintenance processes and is intended to be sustainable in the context of Brazil's Unified National Health System (SUS).     

Emerging and reemerging rickettsiosis in an endemic area of Minas Gerais State,Brazil

This article describes a serological survey for rickettsiosis in the county of Novo Cruzeiro, Minas Gerais State, Brazil, in 1998, testing schoolchildren and dogs. Sera included 331 samples from schoolchildren from an endemic area and 142 samples from schoolchildren from a non-endemic area in the county. All children examined were healthy and had not reported clinical symptoms of Brazilian spotted fever prior to the serological survey. Some 35 children in the endemic area were reactive to Rickettsia rickettsiiby indirect fluorescent antibody (IFA) with a titer of 1:64, corresponding to 10.6%. Sera from 73 dogs were tested, showing seroreactivity (IFA 1:64) to Rickettsia rickettsi, Ehrlichia chaffeensis, and Ehrlichia canisin 3 (4.11%), 11 (15.07%), and 13 (17.81%), respectively. The results in schoolchildren and the presence of canine seroreactivity to Ehrlichiaspecies that are potentially pathogenic to humans suggests the risk of transmission of other Rickettsiaein the study area.     

Yellow fever in children and adolescents previously immunized in Minas Gerais State,Brazil

Background - Yellow fever (YF) is a viral hemorrhagic fever that is transmitted by arthropods. It can occur with little symptomatic manifestations to the most fulminant forms. The most effective way to avoid YF is through vaccination. There is a lack of information about the immune response of the vaccine in childhood. Methods - We described children and adolescents with YF who had been previously immunized in Minas Gerais State from July 2017 to June 2018. Results − 527 cases of YF were observed representing an incidence of 7.6/100,000 inhabitants. Only 26 patients (4.9%) were ≤ 20 years and 501 (95.1%) were > 20 years. Only 9 vaccinated patients were ≤ 20 years and 15 were > 20 years. 34.6% (9/26) of YF patients ≤ 20 years were previously vaccinated and 3% (15/501) of those > 20 years (p < 0.001). The median age at vaccination was 1 year between those ≤ 20 years and 31 years between those > 20 years (p = 0.002). Among 9 vaccinated children and adolescents ≤ 20 years, age ranged from 7 to 18 years, the most described symptoms were fever (88%), headache (77%), myalgia (77%), and abdominal pain (66%). All patients recovered from the disease and none died. Conclusion - Prior YF vaccination may be associated with mild forms of the disease in children and adolescents. YF vaccination in the first years of life may be associated with poor vaccine response and high infection rates in this group as it fail to seroconvert a significant proportion of infants.     

Decentralization of the HIV/AIDS epidemic and inter-municipal flow of hospital admissions in the Zona da Mata, Minas Gerais State, Brazil: a spatial analysis

The aim of this article was to analyze the decentralization of the HIV/AIDS epidemic (a shift towards rural areas or away from the coast) and to investigate access to HIV/AIDS services from 1988 to 2002 in the Zona da Mata, Minas Gerais State, Brazil. An ecological study was performed using temporal and spatial approaches. A hospital admissions flow between municipalities developed, and the reference group was AIDS patients over 15 years of age admitted in 1996 and 2004, residing in municipalities in the Zona da Mata. There were 2,469 reported AIDS cases in individuals over 15 during the period. Mean incidence and mortality rates were calculated and recalculated by a local empirical Bayesian method in order to more clearly represent the municipalities with the highest concentration of cases and deaths. Decentralization of the epidemic was observed. Juiz de Fora was the municipality with the most cases and may have acted as a hub for spread of HIV in the region. Hospital care for AIDS cases in the Zona da Mata was concentrated in that municipality. There is a strong need to further investigate why referral hospitals in other municipalities in the region have not participated in providing management and care for HIV/AIDS patients.     

Canine visceral leishmaniasis in the Krenak indigenous community, Resplendor, Minas Gerais State, Brazil, 2007

The authors conducted a cross-sectional study of the local canine population in the Krenak indigenous community to detect parasites of the genus Leishmania and identify the circulating species and the proportion of asymptomatic dogs, while investigating associations between canine infection and the dogs' sex, age, and hair length. A seroepidemiological survey was performed, including 63 dogs. All the animals underwent clinical examination to verify the presence of characteristic signs, and serum samples were taken for serological tests (ELISA, IIF). Infected dogs culled by the health service were necropsied and the material was analyzed using molecular diagnostic techniques. The cross-sectional study detected a 46% prevalence rate, and the circulating species was Leishmania (L.) chagasi. The statistical analysis showed no association between infection and the independent variables. The study generated data on the epidemiological situation with canine infection in the area, which was previously unknown.     

Epidemiological characteristics of Brazilian spotted fever in Minas Gerais State, Brazil, 2000-2008

Brazilian spotted fever is the most common rickettsiosis in Brazil, most prevalent in the States of S?o Paulo and Minas Gerais. The aim of this study was to describe the epidemiological characteristics of Brazilian spotted fever in Minas Gerais from 2000 to 2008. Of the 132 cases of Brazilian spotted fever, 53 patients died, representing a case-fatality rate of 40.2%. Males predominated, with 78.8% of confirmed cases, and median age was 26.5 years. Absence of rash was associated with increased risk of death (p = 0.005). Greater Metropolitan Belo Horizonte, Rio Doce Valley, and Zona da Mata accounted for 70.6% of the cases, which occurred mainly from May to November. There was an increase in the number of cases, which could suggest an expansion of the disease, but probably resulted from an increase in the health system's diagnostic capacity and sensitivity. Despite this improvement, the case-fatality rate remains high and with no apparent tendency to decrease, thus indicating the need for improved prevention and patient care.     

Schistosomiasis mansoni in the southwest of the State of Minas Gerais (Brazil)

A new focus of schistosomiasis mansoni at Passos, a town in the Southwest of the State of Minas Gerais (Brazil), region until now considered free of the disease is reported. Malacological surveys showed Biophalaria glabrata naturally infected with Schistosoma mansoni in a country club near Passos. All B. straminea captured at the pisciculture station of the Furnas hydroelectric dam were negative. Six out of seven individuals living in the country club were found to be infected with S. mansoni, including four children who had never been out of Passos. The epidemiological importance of these findings is discussed.     

Effectiveness assessment of public clinical laboratories: the case of Belo Horizonte, Minas Gerais State

The organization of public clinical laboratories is experiencing changes without, however, an organizational assessment of its effectiveness. The study aimed to determine a parameter of effectiveness for public clinical laboratories of Belo Horizonte, Minas Gerais State, and set cut-off points for the sections of these laboratories. In order to do so, the total production and number of hours worked during a period of 7 months in the year 2008 were consolidated. Due to the entrance of the workers in the mode of production in the laboratories network, it could be observed a variability regarding the performance of these workers. The effectiveness parameter of the network was established in 29.90 tests per hour. As a consequence of this first analysis, the cut-off points are: 15.50 for the hematology section; 67.29 for chemistry; 6.45 for parasitology; 11.35 for urinalysis; 4.94 for microbiology and 19.03 for immunology. From these results, it was concluded that the working process in laboratories can generate a decrease in effectiveness.     

Population dynamics and the profile of mortality in the municipality of Montes Claros, Minas Gerais State, Brazil

This study is an ecological study of time trend. The objective of this study is to assess the population dynamics as the 1980 Census, 1991 and 2000, and the profile of mortality in the period between 1996 and 2005, in Montes Claros, Minas Gerais State. We used the information systems database of Datasus and IBGE. The main results indicate that the elderly group increased from 4.1% in 1980, 5.0% in 1991 to 6.6% in 2000. On the proportional mortality by cause, diseases of the circulatory system were the first cause of death, and 23.05% in 1996 and 28.26% in 2005, followed by cancer 14.13% in 1996 and 15.69% in 2005, external causes of morbidity and mortality 11.87% in 1996 and 12.74% in 2005 and infectious and parasitic diseases 8.42% in 1996 and 5.43% in 2005. The profile of mortality followed the population dynamics of the city observed a reduction of infectious diseases and an increase in chronic diseases, consistent with the process of population aging.     

Neonatal tetanus in the State of Minas Gerais: a contribution to understand the problem

This study aimed at investigating the status of neonatal tetanus in the state of Minas Gerais from 1989 to 1996. Data were collected from the Investigation Forms of the Epidemiological Surveillance Office. Of the 70 confirmed cases, 48 developed to death, which represents a mortality rate of 68.6% for the period under study. The cases occurred in very poor rural and urban areas with a greater deficit in the distribution of local health resources. Of the total number of cases, 59.4% originated in the rural area, 72.1% were children of multiparae, 68.6% used inadequate substances on the umbilical cord stump, among which olive oil and tobacco, whether isolated or not, were distinguished. Most of the deliveries (65.3%) occurred at home and 60.8% were assisted by an unqualified professional. Comparatively, the chances of children from rural areas dying of tetanus were 3.9 times higher than those of children from urban areas.     

Silicosis among semiprecious gem cutters in Joaquim Felício, Minas Gerais State, Brazil

A cross-sectional study was performed to determine the prevalence of silicosis among semiprecious gem cutters (n=70) and describe their clinical, epidemiological, and occupational profiles in Joaquim Felício, Minas Gerais State, Brazil, from April to December 2002. Occupational history was used with a respiratory questionnaire, chest x-ray, and spirometry. Silicosis prevalence was 7.1%. All affected individuals were men, with a mean age of 21.5 and mean exposure to silica of 7.1 years. All belonged to the informal economy and had been working at small and rudimentary workshops, using improvised lathes, with intense exposure to silica dust. According to the ILO Radiological Classification, four of the five cases of silicosis were classified as grade 1 and one as grade 3. Silicosis among gem cutters constitutes a serious public health problem that requires efforts to minimize risk through work by multidisciplinary teams from government agencies and nongovernmental organizations, with active participation by the workers themselves.     

Screening methodology application to evaluate cancer mortality in selected cities in the State of Minas Gerais, Brazil

An epidemiological investigation was launched in several cities in southern Minas Gerais State, Brazil, considering the possibility of increased cancer incidence due to high exposure to natural radiation. First, the cancer mortality patterns were assessed to determine whether there was an increase in cancer deaths and to discuss the possible risk factors related to such an increase. The study proposed the use of a screening methodology based on standardized mortality ratio (SMR) in order to classify priority areas for future studies. Cities considered high priority for further investigation were: Andradas, for lung cancer in men (SMR = 208 (106-310)) and liver cancer in women (SMR = 403 (104-701)); Po?os de Caldas, leukemia in men and women (SMR = 284 (156-412)) and SMR = 211 (111-312), respectively); Pouso Alegre, leukemia in men (SMR = 333 (127-540)) and hematological cancers in women (SMR = 257 (188-396)). Epidemiological studies are necessary to evaluate the role of radiation and other risk factors in these cancers and thus to support future preventive and control measures.     

Fatal spotted fever rickettsiosis, Minas Gerais, Brazil

The emergence and reemergence of a serious infectious disease are often associated with a high case-fatality rate because of misdiagnosis and inappropriate or delayed treatment. The current reemergence of spotted fever rickettsiosis caused by Rickettsia rickettsii in Brazil has resulted in a high proportion of fatal cases. We describe two familial clusters of Brazilian spotted fever in the state of Minas Gerais, involving six children 9 months to 15 years of age; five died. Immunohistochemical investigation of tissues obtained at necropsy of a child in each location, Novo Cruzeiro and Coronel Fabriciano municipalities, established the diagnosis by demonstration of disseminated endothelial infection with spotted fever group rickettsiae. The diagnosis in the two fatal cases from Coronel Fabriciano and the surviving patient from Novo Cruzeiro was further supported by immunofluorescence serologic tests.     

Intra-urban dynamics of dengue epidemics in Belo Horizonte, Minas Gerais State, Brazil, 1996-2002

This study aimed to describe the temporal-spatial patterns of dengue epidemics in Belo Horizonte, Minas Gerais State, Brazil, from 1996 to 2002 and to analyze residential address as a proxy for exposure. Reported dengue cases were analyzed according to week of onset of symptoms and residential census tract. Local Moran's index was used to assess spatial autocorrelation of incidence coefficients, and recurrent census areas over different epidemic waves were also verified. Ripley's K-function was used to compare spatial distribution patterns between the two population groups, assuming that they were distributed differently around the city. A total of 99,559 dengue cases were analyzed, resulting in seven epidemic waves with different durations and intensities, with cases clustering in a small fraction of areas, thinning out both spatially and temporally. Distinct case distribution patterns were observed according to the two exposed groups, suggesting the need to improve the reporting of possible place of infection. The observed endemic pattern of the disease also requires specific strategies and poses a major challenge for health surveillance services.