The paradoxes of humanized childbirth care in a public maternity ward in Brazil

The maternity ward of the University Hospital in Florianópolis, Santa Catarina, Brazil, attempts to follow World Health Organization guidelines for humanized childbirth care, including the encouragement of non-surgical delivery, breastfeeding, rooming-in, extended family visitation, and reduction of excessive technological intervention in the delivery process. The study focuses specifically on the choice of delivery procedure and on family presence during labor/childbirth, as well as women's experience with labor and breastfeeding.     

The experience of communitary health agents with sexually transmitted diseases

It is an experience report in the training of Communitary Health Agents, Sexually Transmitted Diseases, developed in health centers in Florianópolis, Santa Catarina. The challenge of this experience is related to difficulties in transmitting information in face of limitations of the Communitary Health Agents in this area. It was used problem-solving methodology, developing workshops, performing, modellings, seminars, educational tapes, experience reports, among other, using as subsidies the didactic materials of the Health Ministry. It was presented the developed activities of the municipal district, in the promotion/ prevention/treatment/recovery of Sexually Transmitted Diseases, evidencing the family planning and the Project of Damages Reduction.     

Relationship between the contamination of gulls (Larus dominicanus) and oysters (Crassostrea gigas) with Salmonella serovar Typhimurium by PCR-RFLP

Shellfish can bioaccumulate in their tissues pathogenic contaminants present in water and they have been related with several outbreaks of food-borne diseases worldwide. With their increased population in urban areas, gulls have been reported as an important source of water environment contamination. During a 10-month period, water, gulls feces and oyster samples were collected in a shellfish harvesting site and analyzed for total and fecal coliform counts (water) and Salmonella presence (gull feces and oyster meat). Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to differentiate Salmonella species detected in gulls and oysters. Salmonella presence was detected in 3/10 of oyster samples and in 6/10 of gull feces samples by PCR. There was a relationship between Salmonella presence in oysters and fecal contamination in water. Restriction profiles of both gulls and oyster samples were similar to Salmonella Typhimurium profile by RFLP. These findings indicate strong evidence that gulls can contribute to Salmonella contamination of harvested oysters.     

Breastfeeding in two Brazilian State capitals: a comparative analysis

This paper describes rapid assessment of infant feeding practices based on surveys conducted on National Immunization Day in the cities of Florianópolis and Jo?o Pessoa, Brazil. Two different infant feeding patterns emerge clearly in the data analysis. Most infants begin breastfeeding, but exclusive breastfeeding (EBF) from 0-4 months (46.3% in Florianópolis and 23.9% in Jo?o Pessoa) and timely complementary feeding rates (32.2% in Florianópolis and 24.8% in Jo?o Pessoa) are below recommended standards. EBF and breastfeeding duration medians were 53 and 238 days, respectively, in Florianópolis and 16.5 and 195 days, respectively, in Jo?o Pessoa. The results pointed to increasing breastfeeding rates and duration medians in Florianópolis as compared to Jo?o Pessoa. Use of these data could improve planning and monitoring of breastfeeding activities and infant nutrition policies.     

Waist-hip ratio and waist circumference associated with body mass index in a study with schoolchildren

The objectives of this study were to determine the percentile levels of the anthropometric indices body mass index (BMI), waist-hip ratio (WHR), and waist circumference (WC) and to verify possible correlations among theses indices in schoolchildren registered at the State Institute of Education, Florianópolis, Santa Catarina State, Brazil. A total of 419 children ages 7 to 9 years were investigated: 215 (51.3%) boys and 204 (48.7%) girls. BMI, WHR, and WC were higher for boys than for girls. However, the differences were only statistically significant for WHR and WC. Prevalence rates were 17.9% for overweight and 6.7% for obesity. The anthropometric indices with the highest correlation were BMI and WC (r = 0.87 and p < 0.01). For overweight, BMI and WC also presented the strongest correlation (r = 0.74). For obesity, WHR and WC showed the best correlation (r = 0.54).     

The public-private mix and health service utilization: a study of the therapeutic itineraries of Brazilian supplementary care beneficiaries

This study analyzes the health-disease-care experience reported by users of the Brazilian supplementary system in cardiovascular, oncological, mental health and obstetric care in Florianópolis, capital of the state of Santa Catarina. It discusses the selection of indicators in these areas such as myocardial infarction, breast cancer, alcoholism and childbirth besides exploring socio-anthropological contributions to the management field. The results show a search for solutions in three interconnected sub-sectors of the system - the professional sector, the popular sector and the folk sector, the two latter being of greatest importance in mental and oncological care. Combined use of public and private services appears in cardiovascular and oncological field. Seeking to overcome the gaps with respect to access and integrality by using their own choices with respect to accessibility and comprehensiveness of care by using paths or strategies the users establish a variety of arrangements in their everyday life. The socio-anthropological approach is therefore useful for deepening the understanding of the meaning of public and private in health systems as well as of the care models undertaken by the patients.     

Association of parents' nutritional status, and sociodemographic and dietary factors with overweight/obesity in schoolchildren 7 to 14 years old

To assess the association of parents' nutritional status, and dietary and sociodemographic factors with overweight/obesity in schoolchildren in Florianópolis Island, Santa Catarina State, Brazil, this cross-sectional epidemiological study examined 2,826 schoolchildren 7 to 14 years old, classified according to body mass index curves for age and sex recommended by the International Obesity Task Force. Data were analyzed using Poisson regression. The final model showed overweight/obesity in boys associated directly with father's educational level, mother's age, and parents' nutritional status, and inversely with mother's educational level, and number of daily meals. Among girls, it associated directly with parents' nutritional status and the schoolchildren's age, and inversely with consumption of risk foods. The variables that associated with overweight/obesity differed between the sexes, except parents' nutritional status. Boys and girls with both parents overweight or obese were, respectively, 80% and 150% more likely to exhibit the same diagnosis, indicating the need for interventions that include the family environment.     

First report of Cryptosporidium spp. oocysts in oysters (Crassostrea rhizophorae) and cockles (Tivela mactroides) in Brazil

The consumption of oysters and cockles, which are usually eaten raw or lightly-cooked, can cause outbreaks of human diseases, especially if these shellfish are harvested from polluted areas. In Brazil data about the occurrence of pathogens, like hepatitis A virus, in shellfish have been reported but research on natural contamination for pathogenic protozoa is still non-existent. Cryptosporidium oocyst contamination of oysters (Crassostrea rhizophorae) and cockles (Tivela mactroides) was evaluated during two different periods in a coastal area from S?o Paulo, Brazil. From June to November 2005, and from July to December 2006, 180 mollusks were harvested for tissue examination. The gills and gastrointestinal tract (n = 36 pools) were carefully extracted from the animals and homogenized in a tissue homogenizer by adding surfactant Tween 80 (0.1%). Immunofluorescence assays were performed and Cryptosporidium oocysts were detected in 50.0% of gill pools of cockles and 10.0% of gill pools of oysters. In order to evaluate seawater quality in shellfish growing areas, total levels of thermotolerant coliforms, Escherichia coli and enterococci were determined. This is the first time that Cryptosporidium oocysts were found in shellfish from the coastal region of Brazil, and to the best of our knowledge it is also the first report in Latin America and the case might be of public health importance, reflecting the extension of the contamination on seafood, requiring a need for quality control standards.     

Cervical cancer screening coverage and associated factors in a city in southern Brazil: a population-based study

This study focused on coverage of screening for cervical cancer and associated factors in women 20 to 59 years of age in Florianópolis, Santa Catarina State, Brazil, in 2009. This was a cross-sectional study using cluster random sampling. Two outcomes were examined: a history of at least one Papanicolaou test and delaying the test (never performed or performed more than three years previously). Among 952 women, 93% (95%CI: 91.5-94.7) had ever had a Pap smear, whereas 14% (95%CI: 11.8-16.2) had delayed the test. According to Poisson regression, both outcomes were associated with marital status, schooling, presence of chronic disease, and consulting a physician for other reasons. Age, income, and hospitalization in the previous year were only associated with ever having a Pap smear. Although test coverage was high, much of the screening was opportunistic. In addition, various social, economic, and demographic disparities influenced the odds of being screened.     

First report of Cryptosporidium spp. oocysts in oysters (Crassostrea rhizophorae) and cockles (Tivela mactroides) in Brazil

The consumption of oysters and cockles, which are usually eaten raw or lightly-cooked, can cause outbreaks of human diseases, especially if these shellfish are harvested from polluted areas. In Brazil data about the occurrence of pathogens, like hepatitis A virus, in shellfish have been reported but research on natural contamination for pathogenic protozoa is still non-existent. Cryptosporidium oocyst contamination of oysters (Crassostrea rhizophorae) and cockles (Tivela mactroides) was evaluated during two different periods in a coastal area from São Paulo, Brazil. From June to November 2005, and from July to December 2006, 180 mollusks were harvested for tissue examination. The gills and gastrointestinal tract (n = 36 pools) were carefully extracted from the animals and homogenized in a tissue homogenizer by adding surfactant Tween 80 (0.1%). Immunofluorescence assays were performed and Cryptosporidium oocysts were detected in 50.0% of gill pools of cockles and 10.0% of gill pools of oysters. In order to evaluate seawater quality in shellfish growing areas, total levels of thermotolerant coliforms, Escherichia coli and enterococci were determined. This is the first time that Cryptosporidium oocysts were found in shellfish from the coastal region of Brazil, and to the best of our knowledge it is also the first report in Latin America and the case might be of public health importance, reflecting the extension of the contamination on seafood, requiring a need for quality control standards.     

Sensitivity and specificity of the body mass index for the diagnosis of overweight/obesity in elderly

The aim of this article was to verify the sensitivity and specificity of the body mass index (BMI) cut-off points proposed by the World Health Organization (WHO) and the Nutrition Screening Initiative (NSI) for the diagnosis of obesity in the elderly. A cross-sectional study was made with 180 healthy elderly subjects from Florianópolis, Santa Catarina State, Brazil. Body fat percentage (%BF) was determined using DEXA (dual energy X-ray absorptiometry). The BMI cut-off point of the NSI offers better sensitivity and specificity for men (73.7% and 72.5% respectively). For women, the lower the cut-off point the better the sensitivity, with a BMI of 25kg/m2 (sensitivity of 76.3% and specificity of 100%) being the most accurate for diagnosing obesity in elderly women. The WHO cut-off point offered very low sensitivity (28.9%). The results of this investigation lead to the conclusion that the cut-off points proposed by the WHO and the ones adopted by the NSI and by Lipschitz are not good indicators of obesity for the elderly of either sex, since they offer low sensitivity.     

Health status and physical activity levels among the elderly who are participants and non-participants in social welfare groups in Florianópolis

This study sought to verify the association between health status and physical activity levels among the elderly who are participants and non-participants in social welfare groups in Florianópolis in the State of Santa Catarina, Brazil. The sample included 1,062 elderly people (625 women), mean age 71.9 (±7.6). The variables analyzed were gender, age, schooling, marital status, physical activity levels (International Physical Activity Questionnaire) and physical health status information (Brazil Elderly Schedule Questionnaire). Data were analyzed by Chi-square test. The results revealed that 60.6% were classified as physically active (total physical activity level) and 74% of the elderly reported illness. Illness status was more prevalent among social welfare group participants than non-participants. However, a better positive perception of physical health status was observed among social groups participants. For women, participation in social welfare groups was associated with a positive perception of physical health status (p<0.001) and with illness (p=0.005). The conclusion was that participation in social welfare groups contributes to a better perception of physical health status, as well as for the maintenance of adequate physical activity levels.     

Exposure and response of aquacultured oysters, Crassostrea gigas, to marine contaminants

Comparative growth rates were monitored in the Pacific oyster, Crassostrea gigas, at two sites in Singapore, one uncontaminated and the other contaminated with respect to ambient seawater quality. Growth rates differed significantly at the two sites, revealing that marine water quality can have potentially adverse effects for the oyster aquaculture industry in Singapore. Shell abnormalities (chambering) were observed for juvenile and mature oysters at the contaminated site. Water quality parameters including temperature, salinity, dissolved oxygen, total organic carbon and chlorophyll-a were essentially similar at both sites. Differences in the levels of tributyl tin detected in soft tissues were not observed, but significant differences in the burden of persistent organic pollutants (POPs) existed between the two sites. On a positive note, the effects of pollution on oysters were found to be reversible, where transplantation of individuals to the uncontaminated site resulted in the ability of C. gigas to recover in terms of growth rate and the burden of bioaccumulated POPs.     

In situ monitoring of dredged material spoil sites using the oyster Crassostrea virginica

In situ and laboratory bioassays using the eastern oyster, Crassostrea virginica, were undertaken in the Wright River Estuary, South Carolina, to determine the toxic potential of effluent and sediment from recently dredged sediments. Current standards (ASTM, USEPA, and USACE) rely solely on laboratory-based bioassays to assess toxicity of dredge spoils prior to disposal. These bioassays do not necessarily replicate the natural physicochemical estuarine processes, limiting the environmental realism of this approach. In this study, oysters were collected from a site on Leadenwah Creek (SC) and deployed in plastic cages anchored above the sediment and within the intertidal zone for 90 days at four dredge spoil disposal areas (18 sites total, one bushel/site). Oysters were also deployed at a reference site (New River Estuary, SC) and the original collection site. Trace metals and polycyclic aromatic hydrocarbons (PAHs) in tissue, sediment, and effluent samples as well as the assessment of oyster health in adults (% mortality and % reduction in potential yield) and larvae (larval development) were measured. Results indicated high arsenic concentrations in surface water samples (<10 to 147 g/L), some of which exceeded the USEPA chronic marine water quality criteria and sediment concentrations (<1.0–82.2 mg/kg), which also exceeded the ERM (70 mg/kg) and the ERL (8.2 mg/kg) for arsenic, and which may have contributed to the toxic response seen in deployed oysters. A positive relationship was also seen between the in situ percent reduction in potential yield and laboratory-derived data from larval oyster development bioassays. The advantage of the combined in situ/laboratory approach used in this study is the ability to resolve probable factors influencing the toxicity of these effluents to oysters.     

New educational strategies: evaluation of the Jury Trial technique for training council members in women's health in Santa Catarina,Brazil

This article describes and evaluates the Jury Trial technique, an innovative educational instrument used in a pilot workshop on Social Control and Gender by health council members in Greater Metropolitan Florian polis, Santa Catarina, Brazil. The reliability and validity were studied based on the participants' opinions, complemented by qualitative observation of the work. There was consensus in acceptance of the technique based on "acquisition of knowledge" and the fact that it was participatory, democratic, and dynamic. The positive evaluation agrees with a previous study that interviewed municipal health secretaries, with a smaller preference of formal cognitive activities that were also part of the workshop. The article concludes by emphasizing the importance of this innovative technique in training programs, since it is accepted by different target publics, allows for designing the program contents, and is useful in relation to new and controversial issues since it favors practical and reflexive experiences.     

Raw oyster consumption and outbreaks of viral gastroenteritis in New Zealand: evidence for risk to the public's health

OBJECTIVE: To investigate the relationship between consumption of raw Pacific half shell oysters and outbreaks of Norwalk-like virus (NLV) gastroenteritis in Auckland in the last third of 1999. METHOD: Ten outbreaks were investigated as retrospective cohorts using standardised questionnaires relating to food and drink exposures. Trace back of oysters and site inspections of implicated commercial growing areas were performed. Virological analyses compared oysters linked to outbreaks and faecal samples from cases. RESULTS: Eighty-six cases were identified, of whom 32 (37.2%) were confirmed NLV positive on faecal analysis. The summary risk estimate for illness among oyster consumers for all outbreaks was RR 8.23 (95% CI 4.55-14.90; p< 0.001) and in five of seven outbreaks permitting statistical analysis, the risk for those consuming raw oysters was greater than five-fold that of non-consumers. NLVs were identified in two batches of oysters from different growing areas, implicated in four outbreaks. In both the strain (Genogroup II/3 'Mexico-like virus') from cases matched that in the oysters from the same harvest batch. CONCLUSION: The epidemiological and virological evidence implicates oysters as the source of a number of outbreaks of NLV gastroenteritis. This is the first time NLVs have been identified in commercially farmed Pacific oysters in New Zealand. Sewage effluent from recreational boats was the likely source of faecal contamination of growing waters in one site. IMPLICATIONS: Combined use of virological and epidemiological methods have proved invaluable in investigating NLV outbreaks. Further research is needed into enteric viral contamination of commercial oyster farms.     

A norovirus outbreak associated with consumption of NSW oysters: implications for quality assurance systems

Norovirus is a common cause of gastroenteritis outbreaks associated with raw shellfish consumption. In Australia there have been several reports of norovirus outbreaks associated with oysters despite the application of regulatory measures recommended by Food Standards Australia New Zealand. This study describes an outbreak of norovirus gastroenteritis following the consumption of New South Wales oysters. In September 2007, OzFoodNet conducted a cohort study of a gastroenteritis outbreak amongst people that had dined at a Port Macquarie restaurant. Illness was strongly associated with oyster consumption, with all cases having eaten oysters from the same lease (RR undefined, p < 0.0001). Norovirus was detected in a faecal specimen. Although no pathogen was identified during the environmental investigation, the source oyster lease had been closed just prior to harvesting due to sewage contamination. Australian quality assurance programs do not routinely test oysters for viral contamination that pose a risk to human health. It is recommended that the feasibility of testing oysters for norovirus, particularly after known faecal contamination of oyster leases, be assessed.