Gestational nightblindness among women attending a public maternity hospital in Rio de Janeiro, Brazil

This study evaluated the prevalence of gestational nightblindness among postpartum women seen at the University Maternal Hospital of the Federal University in Rio de Janeiro, Brazil and the association of this symptom with a biochemical indicator (serum retinol levels) and sociodemographic, anthropometric and antenatal care variables. In total, 262 postpartum women, who did not receive vitamin A supplementation during pregnancy, were interviewed. Gestational nightblindness was diagnosed through the standardized interview as proposed by WHO. Serum retinol levels were evaluated by spectrophotometry. Gestational nightblindness relating to low levels of serum retinol (<1.05 micromol/L, p = 0.000) was diagnosed in 17.9% of subjects interviewed. Less than five antenatal care appointments (odds ratio [OR] = 2.179; confidence interval [CI] 95% = 1.078 - 4.402) and a history of one or more miscarriage(s) (OR = 2.306; CI 95% = 1.185 - 4.491) were predictors for gestational nightblindness. These findings justify the need for nutritional counselling, aimed at improving the vitamin A nutritional status, especially among pregnant women with a history of previous miscarriages and poor antenatal care.     

Quality of hand hygiene in a pediatric hospital in Rio de Janeiro, Brazil.

We assessed the quality of hand hygiene among healthcare workers at a pediatrics hospital in Rio de Janeiro, Brazil. Hand hygiene was performed in 491 (34%) of 1,455 opportunities. Of these hand hygiene events, correct performance was observed in only 173 (35%). Multivariate analysis revealed that correct performance of hand hygiene was associated with the use of an alcohol-based product and a lack of jewelry (for all events) and employment in an infirmary with a comparatively higher ratio of nurses to patients (for events involving nurses).     

Cat-transmitted sporotrichosis, Rio de Janeiro, Brazil

Sporotrichosis is an emerging zoonosis in Rio de Janeiro, Brazil. From 1998 to 2003, 497 humans and 1,056 cats with culture-proven sporotrichosis were studied. A total of 421 patients, 67.4% with a history of a scratch or bite, reported contact with cats that had sporotrichosis.     

Factors associated with cesarean sections in a public hospital in Rio de Janeiro, Brazil

Brazil has one of the world's highest cesarean section rates. Contributing factors include the organization of obstetric practice, physicians' attitudes, and women's preferences and decisions. This study aimed to identify factors associated with cesarean sections in a public maternity hospital in Rio de Janeiro. A case-control study was conducted with 231 cesarean sections (cases) and 230 vaginal deliveries (controls). Hierarchical logistic regression analysis was performed, based on a conceptual model. Factors associated with increased odds of cesarean section were: primiparity; mother's age 20-34; last birth by cesarean; cervical dilatation < 3cm at admission; patient request; daytime birth; male attending obstetrician; obstetrician on duty for more than 24 hours a week; obstetrician with private practice; gestational hypertension; non-cephalic presentation; and gestational age > 41 weeks. Factors associated with lower odds of cesarean were: gestational age < 37 weeks; leaving home with signs of labor, use of oxytocin; and amniotomy. In this hospital, interventions aimed to modify the above-mentioned factors can help lower the cesarean rate.     

Dietary patterns among postpartum women treated at a municipal health center in Rio de Janeiro, Brazil

This study aimed to longitudinally compare nutrient and food intakes by 276 lactating women. Dietary intake was collected using a food frequency questionnaire. Data analysis used the Student-t and ANOVA tests, comparing quantitative and qualitative dietary variation from pregnancy to postpartum. Mean daily energy intake was 2,889 kcal for pregnant and 2,081 kcal for lactating women. Macronutrient dietary distributions were within internationally recommended standards. Compared to pregnancy, there was a decrease in most nutrients and foods ingested during postpartum. Dietary changes increased the density of proteins, fat, iron, rice, beans, chicken, and beef (p < 0.02) and decreased the density of carbohydrate, cereals, fruits, and milk and dairy products (p < 0.001). The results indicate a need for dietary guidelines for women, particularly during the postpartum period.     

Knowledge about STD/AIDS and sexual behavior among high school students in Rio de Janeiro,Brazil

The incidence of AIDS and other sexually transmitted diseases (STDs) is increasing among adolescents. In order to better understand high-risk sexual behavior among students, a cross-sectional study based on a self-answered anonymous questionnaire was conducted in 10 public and private high schools in Rio de Janeiro, Brazil. Data were obtained on sociodemographics, knowledge of STD/AIDS, and sexual behavior. Among 945 students aged 13-21, 59% were sexually initiated, and the median age at first sexual intercourse was 15 years (range: 7-19). Although 94% reported being aware of the need for condom use for protection, only 34% informed always using condoms during sex. Low family income was associated with unsatisfactory knowledge (OR = 9.40; 95% CI = 6.05-14.60) and inconsistent condom use (OR = 11.60; 95% CI = 5.54-24.30). However, unsatisfactory knowledge was not associated with inconsistent condom use. School-based educational programs should focus on sexual behavior more than on transmission of knowledge, as well as targeting low-income students.     

Determinants of postpartum weight retention according to skin color among women in Rio de Janeiro, Brazil]

OBJECTIVE: To investigate factors associated with postpartum weight retention according to skin color in the city of Rio de Janeiro, Brazil, as part of the effort to help control overweight and obesity. METHODS: We carried out a cohort study with data collection at four points after delivery: 15 days, 2 months, 6 months, and 9 months. The 450 participants (15 to 45 years of age) were recruited from a maternity center and a city health center in Rio de Janeiro. Postpartum weight retention was defined as the dependent variable. The following covariates were investigated: maternal age, marital status, ability to read a letter, smoking, monthly family income, number of children, age at first delivery, a score for physical activity at work, and a score for physical activity during leisure time. The data were analyzed using multivariate linear mixed-effects models for longitudinal data. RESULTS: The factors that remained associated with postpartum weight retention for white women were time after delivery (beta = -0.0061, P = 0.0002), marital status (married/single beta = -0.9279, P = 0.0457), and age at first delivery (beta = -0.1553, P = 0.0364). The factors for brown women were time after delivery (beta = -0.0062, P < 0.0001), marital status (married/single beta = -0.6000, P = 0.0145), and work physical activity score (beta = -0.1068, P = 0.0003). The factors for black women were smoking (beta = -1.4635, P = 0.0535) and score for physical activity during leisure time (beta = -0.2422, P = 0.0145). CONCLUSIONS: The factors associated with postpartum weight retention were different for the three skin-color categories. Nevertheless, the data do not indicate the need for different interventions for the three skin-color groups. That is particularly true because the physical activity scores were among the variables associated with weight retention, and any initiative to control obesity should take physical activity into consideration. On the other hand, given the socioeconomic differences among the three skin-color categories, new studies should be developed to investigate in more detail the pattern of postpartum weight retention according to skin color.     

Hemophilia care in the state of Rio de Janeiro, Brazil.

In the developing countries of the world, few people with hemophilia receive adequate care. Nevertheless, Brazil has made significant advances in the treatment of hemophilia over the last decade. The provision of factor concentrates imported by the Government of Brazil is gradually increasing, and patients receive the concentrates for free. A national register was established as well as a coordinated program for comprehensive care. Of the 6 297 persons with hemophilia in Brazil who were registered as of January 2001, 689 of them (11.1%) were registered in the state of Rio de Janeiro. Of those 689, 664 of them were being monitored at the state's coordinating blood transfusion center, which is located in the city of Rio de Janeiro. Among those 664, factor VIII inhibitors were identified in 81 of them (12.2%). Among 653 of the Rio de Janeiro patients who were tested for transfusion-transmitted diseases, the overall prevalence found was 41.5%, with the specific rates being 13.3% for human immunodeficiency virus (HIV), 2.9% for hepatitis B virus (HBV), and 39.4% for hepatitis C virus (HCV). The state of Rio de Janeiro has adopted a comprehensive hemophilia management approach that includes medical, psychological, and social care. As a result, the quality of life of hemophilia patients has improved noticeably. For example, the rate of hospitalization among patients fell by 30% between 1998 and 2001, and there has also been a decline in the school and work activities that they have missed.     

Income inequality and homicide rates in Rio de Janeiro, Brazil.

OBJECTIVES: This study determined the effect of income inequality on homicide rates in the state of Rio de Janeiro, Brazil. METHODS: We conducted an ecological study at 2 geographical levels, municipalities in the state of Rio de Janeiro and administrative regions in the municipality of Rio de Janeiro. The association between homicide and income inequality was tested by multiple regression procedures, with adjustment for other socioeconomic indicators. RESULTS: For the municipalities of Rio de Janeiro State, no association between homicide and income concentration was found an outcome that can be explained by the municipalities' different degrees of urbanization. However, for the administrative regions in the city of Rio de Janeiro, the 2 income inequality indicators were strongly correlated with the outcome variable (P < .01). Higher homicide rates were found precisely in the sector of the city that has the greatest concentration of slum residents and the highest degree of income inequality. CONCLUSIONS: The findings suggest that social policies specifically aimed at low-income urban youth, particularly programs to reduce the harmful effects of relative deprivation, may have an important impact on the homicide rate.     

HIV vaccine evaluation center in Rio de Janeiro, Brazil

We conducted an HIV seroincidence study among high-risk men who have sex with men in Rio de Janeiro to determine whether this population would be suitable for vaccine and non-vaccine HIV prevention studies. There were 34 HIV seroconversions during the follow-up period, for a seroincidence of 3.1 per 100 person-years. The incidence among the youngest members of our cohort was over 8%, an extraordinarily high transmission rate for a homosexual male population. We have used the sensitive/less sensitive ELISA assay to identify a high-risk heterosexual population for intervention studies in Brazil. The estimated seroincidence was 1.9 and 2.8 per 100 person-years among heterosexual females and males, respectively. We are presently conducting a study to investigate behavior changes among 202 participants of a post-sexual-exposure chemoprophylaxis (PEP) study. During a median follow-up of 24 months, there were 11 HIV seroconversions, 10 of which were among non-PEP users. Additionally, we are conducting a phase 2 HIV vaccine trial of the ALVAC-HIV vector vCP1452 alone and in combination with a subunit vaccine, MN rgp120, in healthy adult volunteers. The primary goal of this trial is to define the immunogenicity and confirm the safety of the most promising vector-based vaccine alone and in combination with a recombinant envelope protein vaccine with an established safety and immunogenicity profile. A phase 3 HIV vaccine trial is planned to begin in the next 18-24 months.     

Factors associated with psychological distress among military police in Rio de Janeiro, Brazil

This study investigates factors associated with psychological distress among military police (n = 1,120) in Rio de Janeiro, Brazil. The article describes their social, economic, and demographic characteristics, quality of life, mental health, and work conditions. Measurement of psychological distress used the Self-Reported Questionnaire. Analysis of associations used logistic regression, considering factors associated with psychological distress. The results indicate an association between psychological distress and factors such as ability to react to difficult situations, dissatisfaction with life, health problems (especially digestive, nervous, and musculoskeletal symptoms), and adverse work conditions such as excessive workload, constant stress, and victimization. The article concludes by highlighting the need for health promotion interventions for the military police, focusing especially on their mental health.     

Occupational exposures to bloodborne pathogens among healthcare workers in Rio de Janeiro, Brazil

Healthcare workers (HCWs) frequently face the risk of occupational infection from bloodborne pathogens following exposure to blood and body fluids. This study describes the results of a surveillance system of occupational exposure to bloodborne pathogens among HCWs in Rio de Janeiro, Brazil, during an eight-year period. A total of 15 035 exposures reported from 537 health units were reviewed. Six circumstances comprised nearly 70% of the reported exposures: recapping needles (14%), performing surgical procedures or handling surgical equipment (14%), handling trash (13%), during disposal into sharps containers (13%), performing percutaneous venepuncture (10%) and during blood drawing (5%). Easily preventable exposures, such as incidents related to recapping needles, handling trash, and sharps left in an inappropriate place, represented 30% of the exposures reported. Post-exposure prophylaxis (PEP) for human immunodeficiency virus (HIV) was initiated for 46% of exposed HCWs. Although Brazilian guidelines indicate that PEP is usually not recommended for exposures with insignificant or very low risk of HIV infection, PEP was prescribed to a large proportion of exposed HCWs under these circumstances. The prevention of occupational exposure to bloodborne pathogens among HCWs and their safety must be considered as a public health issue. Although infection-preventative measures such as antiretroviral drugs and rapid tests are available, this study shows that there are still a high number of easily preventable exposures. The implementation of more effective prevention strategies is urgently required in this country.     

Drug utilization and polypharmacy among the elderly: a survey in Rio de Janeiro City, Brazil.

OBJECTIVES: To describe drug utilization by Brazilian retirees with an emphasis on inappropriate use. METHODS: Cross-sectional study with a simple random sample of 800 retirees of the Brazilian Institute of Social Security, 60 years of age and older, residing in Rio de Janeiro City, through face-to-face interviews. RESULTS: Medication use in the 15 days before the study was reported by 85% of the sample, with a mean of 3.7 products per person (standard deviation=2.9). About half the sample used one to four medications and a third used five or more. The highest number of drugs used per patient was 24. More women than men used multiple medications. There is a tendency toward positive association (P<0.001) between drug use and variables relating to disease and health care. This trend continues in the analysis by gender. Men who reported five or more diseases were five times more likely to use multiple drugs than men with up to two (zero, one, or two) diseases (prevalence ratio 5.21, 95% confidence interval=2.48-10.90). Women who reported five or more diseases were nearly four times more likely to use multiple drugs than women with up to two diseases (prevalence ratio 3.67, 95% confidence interval=2.24-6.02). Of the active substances used by the sample, 10% were considered inappropriate. CONCLUSIONS: To improve drug therapy for the elderly, health practitioners can take measures to reduce unwarranted use of medication and to optimize the benefits from important drugs. Further studies should be conducted to adjust lists of medications inappropriate for the elderly to the situation in developing countries.     

Food consumption by pregnant adolescents in Rio de Janeiro, Brazil

The increase in teenage pregnancy has been viewed with concern by public health experts. Food consumption to help maintain high nutrient demands has been identified as one of the most relevant components. This study aims to present the habitual consumption of food and energy-specific nutrients by pregnant adolescents. A total of 1,180 adolescent mothers were interviewed in maternity hospitals in the City of Rio de Janeiro, and a simplified questionnaire on semi-quantitative frequency of food consumption was applied. Lower consumption of fruit juice, vegetables, and fruits was observed among adolescent mothers over 15. Adolescent mothers classified in the lowest quartile of consumption lack the minimum recommended consumption of energy and nutrients. An inverse association was found between the number of household members and energy and nutrient consumption. Adolescent mothers who received dietary information and changed their eating habits during pregnancy showed better results concerning the consumption of energy and nutrients. Prenatal care was a key factor for improving the results of pregnancy, emphasizing the importance of providing dietary information.     

Neonatal screening for hemoglobinopathies in Rio de Janeiro, Brazil]

OBJECTIVE: To describe the main results obtained in the first 15 months of neonatal screening for sickle cell disease in the state of Rio de Janeiro, Brazil, from August 2000 to November 2001. METHODS: Starting in August 2000, blood samples began to be collected for sickle cell disease screening from all newborns receiving care in primary health care clinics in the state of Rio de Janeiro. The samples were submitted to high-resolution liquid chromatography. If the resulting chromatogram was compatible with sickle cell disease, the child and the parents were referred for diagnostic confirmation and treatment. RESULTS: Between August 2000 and November 2001, 99 260 newborns were screened. There was one case of homozygous Hb C. On average, one of every 27 newborns who were screened presented sickle cell trait (Hb AS). Sickle cell disease was observed in 83 cases, or one new case in each 1 196 births. The 83 consisted of: 62 Hb S, 18 Hb SC, and 3 Hb SD. One child did not appear for diagnostic confirmation. The 82 children who were followed up by the program presented 15 intercurrent illnesses (upper respiratory infections, fever, splenic sequestration crises, hand-foot syndrome, and vascular occlusion), resulting in seven hospital admissions. Blood transfusions were necessary with 15 children, but none developed alloimmunization. All the other babies were doing well with the use of prophylactic penicillin. CONCLUSIONS: Our data show the importance of early diagnosis for sickle cell disease, so as to prevent the frequent infectious complications faced by these patients.