Spatial distribution of leptospirosis in the city of Rio de Janeiro, Brazil, 1996-1999

Leptospirosis, one of the most widely disseminated zoonoses in the world, is endemic in Brazil and is characterized by outbreaks during seasons with the greatest rainfall. In 1996 the city of Rio de Janeiro experienced one of the largest urban epidemics in the country, shortly after heavy rainstorms in the month of February, with 1,732 reported cases and 51 deaths. The objective of this work was to describe the spatial distribution of leptospirosis in the city of Rio de Janeiro during the period 1996-1999. Data were from the National Information System for Reportable Diseases. The kernel ratio for cases and population generated a smoothed surface, which estimates the intensity of the leptospirosis incidence rate. In the resulting maps over the course of the study period, the sites with the highest leptospirosis intensity were not repeated, and the sites normally considered as having the highest risk -- slum areas and flooded areas -- were not always the most heavily affected. The techniques used can represent an important methodological acquisition for establishing territory-based surveillance.     

Climate variables, living conditions and the health of the population: leptospirosis in the city of Rio de Janeiro from 1996 to 2009

Extreme climate events have major repercussions on the health of the population, especially when they cause disease or even result in victims due to accidents. The population of Rio de Janeiro is vulnerable to climate variations, mainly due to the socio-economic factors, as the city has a topography and climate that enhance this vulnerability. This article discusses the evolution of leptospirosis in the thirty-two administrative regions of the city of Rio de Janeiro from 1996 through 2009, testing the hypothesis that climate variations lead to an increase in the number of cases of the disease. The meteorological data examined were provided by the National Meteorology Institute and the Brazilian Airport Infrastructure Company. Data on the morbidity and mortality of leptospirosis was collected from Rio de Janeiro's Municipal Health and Civil Defense Department. In this work, it was concluded that there is a direct correlation between the incidence of leptospirosis and rainfall. However, in the final analysis, it must be emphasized that the oscillation of the number of cases is not only determined by rainfall, since other factors influence this dynamic, such as sanitation, in addition to environmental and social factors.     

Maternal mortality in the city of Rio de Janeiro, 1993-1996]

The maternal mortality rate is considered an important indicator of quality of care during the gravid-puerperal cycle. To shed light on the maternal mortality pattern in the city of Rio de Janeiro, maternal deaths from 1993 to 1996 among residents of the city were analyzed, based on data from death certificates. The maternal mortality rate was calculated according to cause, age, and schooling. High annual mortality rates were detected throughout the period analyzed (74.3, 47.9, 51.5, and 55.3 per 100,000 live births, respectively). Main causes of death were hypertension, hemorrhage, and puerperal complications. Greatest risk of death was among the youngest and oldest women and those with less schooling. The study discusses strategies to decrease under-recording of deaths and increase quality and results of care.     

Particulate suspended matters and cases of respiratory disease in Rio de Janeiro city (Brazil)

This paper investigates the existence of a possible relationship between suspended particulate matters levels and cases of respiratory diseases from a random and systematic sample of medical and air pollution records in the metropolitan area of Rio de Janeiro. Records of emergency cases of the year 1991 (months of January, June and July) were collected at Miguel Couto Hospitals and suspended particulate matter (1980-1995) at FEEMA (Rio de Janeiro Environmental Agency). The results revealed that the diseases of the respiratory system of those patients who seek the hospital's emergency care are more frequent during the wintertime. Their number increases markedly during winter months of June and July when compared with the summer's (January) number of cases. The analysis of the historical series (1980-1995) of atmospheric pollution measured at Bonsucesso monitoring station showed that the monthly figures (measured by the number of times that the value exceed the national standard, maximum daily concentration of 240 micro g (-3), are higher in wintertime (June, July and August). During this same period the level of pollution by atmospheric particulate matter in Rio de Janeiro metropolitan area measured by the annual geometric averages showed results well above the national standard (80 micro g(-3). This unfavorable situation, together with the fast growing number of new cars circulating in the city and the absence of a clear air pollution control and management plan, may contribute to an increase of the incidence and seriousness of respiratory diseases during subsequent winter months.     

Dietary and reproductive determinants of plasma organochlorine levels in pregnant women in Rio de Janeiro

Organochlorine (OC) plasma levels and their dietary and reproductive determinants were investigated in 64 pregnant women from Rio de Janeiro, Brazil. Prenatal exposure of newborns was evaluated in a subset of these women in which umbilical cord blood was analyzed. To assess the influence of dietary factors on OC levels, a semiquantitative food frequency questionnaire was completed by participants. Nondietary determinants were investigated through a general questionnaire that addressed reproductive history, lifestyle, and social-demographic characteristics. Both women and their newborns had detectable but low levels of OCs. The most frequently detected compound was p,p'-DDE, the main metabolite of p,p'-DDT. This compound was found in 97% of the women who participated in the study and in 67% of the umbilical cord blood samples, with levels ranging from 0.161 to 8.03ppb and from 0.320 to 1.06ppb, respectively. Among the OCs detected, only p,p'-DDE showed any correlation with dietary and nondietary factors. There was a positive correlation between maternal p,p'-DDE and the consumption of fish (Pearson r=0.38,P=0.002) and chicken (Pearson r=0.26, P=0.042). The correlation between pork consumption and p,p'-DDE exhibited an inverse relationship (Pearson r=-0.25,P=0.052). Parity was the only nondietary factor that showed a significant correlation (Pearson r=-0.36,P=0.004). The main determinants of p,p'-DDE levels in this group of women were fish consumption and parity, together explaining 28% of the variance (P<001), in a multivariate model.     

Characteristics of children hospitalized with dengue fever in an outbreak in Rio de Janeiro, Brazil

During a dengue epidemic in Rio de Janeiro in 2007–2008 the Instituto de Puericultura e Pediatria Martagão Gesteira Hospital was a reference for admitted children. The World Health Organization (WHO) considered several manifestations as warning signs of severe dengue This is a retrospective cohort study of all children admitted with dengue fever. Clinical variables considered warning signs by WHO were evaluated in the multivariate analysis, to investigate if they were independently associated with severe dengue.One hundred and eighty one children were admitted, aged from 4 months to 15 years; 30 were classified as severe dengue. Abdominal pain (OR = 2.63, 95% CI1.06–6.53) and lethargy (OR = 3.40, 95% CI 1.45–7.99) were independently associated with severe dengue.     

Socio-demographic determinants of suicide in the State of Rio de Janeiro, Brazil, 1998-2002

Epidemiology has identified violence as a major worldwide public health concern. Suicide is classified as violence. This study analyzes the association between suicide and socio-demographic factors. The methodological design was ecological, using correlation techniques and backward multiple linear regression. Normality of the residuals in the final model was analyzed. Proportional mortality in relation to total deaths was identified as the best outcome for modeling (R(2) = 0.41). The resulting variables were: % Pentecostal religion, % single marital status in the population over 10 years of age, mean years of schooling, altitude of the municipality, % homes without latrines, % population over 10 years of age working in the educational sector, and % population over 10 years with per capita earnings up to one minimum wage. All these variables were statistically significant at 5%. The results support the idea of the influence of extrinsic causal factors in determination of suicide.     

An outbreak of gastroenteritis caused by both rotavirus and Shigella sonnei in a private school in Rio de Janeiro

In May 1980 an extensive outbreak of gastroenteritis occurred in a private school in the city of Rio de Janeiro. Examination of faeces and paired sera showed that this outbreak was caused by both rotavirus and a virulent strain of Shigella sonnei. In the first 19 stool samples collected seven (37%) had rotavirus only, six (32%) had Sh. sonnei only, while four (21%) had both agents. Examination of the second and third stool collections revealed only the presence of Sh. sonnei. The 18 paired sera showed seroconversion for rotavirus in four cases (22%) and in seven cases (39%) for Sh. sonnei. The overall attack rate of the disease was approximately 75%, the nursery and kindergarten having higher attack rates. Students in all grades became sick at the same time, and the unimodal curve of the onset dates of symptoms indicates a common source outbreak. Evidence suggested a contaminated water supply.     

Spatial analysis of early neonatal mortality in the municipality of Rio de Janeiro, 1995-1996]

The objective of this study was to establish the spatial distribution of the early neonatal mortality rate (0-3 days) in the municipality of Rio de Janeiro for 1995-1996, identifying the best explanatory factors for spatial variations. By considering Rio de Janeiro's 153 neighborhoods as ecological units of analysis, socioeconomic and maternal indicators were analyzed according to place of residence. Spatial statistical analysis was performed using the Cliff & Ord methodology, appropriate for lattice data. From the 0-3 day mortality thematic map, we clearly identified two clusters of high early neonatal mortality rates. Spatial dependence was also confirmed by the statistical results of the spatial analysis. The variables that explain the clusters are the proportions of "adolescent mothers", "slum-dwellers", and "heads of households below the poverty level". Spatial statistics provided a better understanding of the geographic distribution of early neonatal mortality and suggested potential hypotheses for further investigation, which could support preventive programs and contribute to a decrease in infant mortality.     

Physical activity in a probabilistic sample in the city of Rio de Janeiro

This study evaluated physical activity in a probabilistic sample of 4,331 individuals 12 years of age and older residing in the city of Rio de Janeiro, who participated in a household survey in 1996. Occupation and leisure activity were grouped according to categories of energy expenditure. The study also evaluated number of hours watching TV, using the computer, or playing video-games. Only 3.6% of males and 0.3% of females reported heavy occupational work. A full 59.8% of males and 77.8% of females reported never performing recreational physical activity, and there was an increase in this prevalence with age, especially for men. Women's leisure activities involved less energy expenditure and had a lower median duration than those of men. Mean daily TV/video/computer time was greater for women than for men. The greater the level of schooling, the higher the frequency of physical activity for both sexes. Analyzed jointly, these data show the low energy expenditure through physical activity by the population of the city of Rio de Janeiro. Women, the middle-aged, the elderly, and low-income individuals were at greatest risk of not performing recreational physical activity.     

An outbreak of gastroenteritis caused by both rotavirus and Shigella sonnei in a private school in Rio de Janeiro.

In May 1980 an extensive outbreak of gastroenteritis occurred in a private school in the city of Rio de Janeiro. Examination of faeces and paired sera showed that this outbreak was caused by both rotavirus and a virulent strain of Shigella sonnei. In the first 19 stool samples collected seven (37%) had rotavirus only, six (32%) had Sh. sonnei only, while four (21%) had both agents. Examination of the second and third stool collections revealed only the presence of Sh. sonnei. The 18 paired sera showed seroconversion for rotavirus in four cases (22%) and in seven cases (39%) for Sh. sonnei. The overall attack rate of the disease was approximately 75%, the nursery and kindergarten having higher attack rates. Students in all grades became sick at the same time, and the unimodal curve of the onset dates of symptoms indicates a common source outbreak. Evidence suggested a contaminated water supply.     

Air pollution and mortality in the elderly in Rio de Janeiro: a time-series analysis

This study investigates the association between particulate air pollution and mortality from cardiovascular and respiratory diseases among the elderly in the city of Rio de Janeiro. Death counts, levels of total suspended particles (TSP), and meteorological data were obtained from secondary databases. Daily counts of deaths and daily TSP levels from 1990 to 1993 were analyzed in Poisson regression models adjusted for long-term temporal trends, seasonality, weekdays, temperature, and humidity. For an increase in TSP levels from the 10th to the 90th percentile (104.7 microg/m3), the relative risks for mortality in elderly people from cardiovascular and respiratory diseases were 1.04 (95%CI: 0.96-1.13) and 1.10 (95%CI: 0.97-1.26) respectively. Although an upward trend in risk was observed, the associations were not statistically significant, which could be explained partially by the small number of pollution measures available for the period analyzed.     

AIDS epidemic dynamics in the municipality of Rio de Janeiro, Brazil, 1988-1996: Spatial-temporal statistic modeling]

This study uses a spatial-temporal model to analyze the spatial spread of the AIDS epidemic (adult cases) in the municipality of Rio de Janeiro, Brazil, during three periods: 1988-1990, 1991-1993, and 1994-1996. City districts were used as the geographic units of analysis. A spatial analysis was also performed for pediatric AIDS cases due to vertical HIV transmission, according to period of birth, 1985-90 and 1991-96. For total adult AIDS cases, the initial period was characterized by a polygonal cluster located around the harbor area, which expanded from west to east. Among homosexual cases, in situ growth predominated, and a decrease in the intensity of the diffusion process was observed from the second to the final period. Among heterosexual cases, the epidemic displayed a relevant geographic spread, mainly from 1988-1990 to 1991-1993. Among female cases in the final time period, a cluster of high incidence rates was found towards the northwest, including very poor areas. Among pediatric cases in 1991-1996, a significant correlation was found between AIDS incidence rates and poverty levels in the respective municipal districts. The results suggest that a more complete understanding of AIDS spatial-temporal dynamics can make a major contribution to preventive measures.     

Small area estimation of obesity prevalence and dietary patterns: A model applied to Rio de Janeiro city,Brazil

We propose the use of previously developed small area estimation techniques to monitor obesity and dietary habits in developing countries and apply the model to Rio de Janeiro city. We estimate obesity prevalence rates at the Census Tract through a combinatorial optimization spatial microsimulation model that matches body mass index and socio-demographic data in Brazil's 2008–9 family expenditure survey with Census 2010 socio-demographic data. Obesity ranges from 8% to 25% in most areas and affects the poor almost as much as the rich. Male and female obesity rates are uncorrelated at the small area level. The model is an effective tool to understand the complexity of the problem and to aid in policy design.     

Epidemiological aspects of leptospirosis in a slum area in the city of Rio de Janeiro, Brazil. Search for leptospires and specific antibodies in rodents

101 Rattus norvegicus and 3 Mus musculus were captured in an urban slum of Rio de Janeiro city and examined for leptospiral infection. Direct examination of urine, serology (microagglutination) and culture together gave a positivity rate of 39%. Separately direct examination and serology gave positivity rates of 13% and 36% respectively. Serogroup Icterohaemorrhagiae predominated in the serological tests. Leptospires were isolated from 24 of the 104 rodents (23%), but 4 cultures died. The remaining 20 were identified as members of the Icterohaemorrhagiae serogroup, and 5 were further identified as serovar copenhageni. Human leptospiral infection, mainly caused by Icterohaemorrhagiae, is endemic in Rio de Janeiro city, and rodents are a major source of the disease.     

Abortion itineraries in a clandestine context in the city of Rio de Janeiro - Brazil

From a series of in-depth interviews, we gathered a significant amount of ethnographic material on the concrete and symbolic paths taken by young women and their partners in the search for a solution to an unplanned pregnancy. Inequities in Brazilian society are expressed in itineraries/routes of different sinuosity, complexity and duration according to the individuals' social and material conditions of existence. Thus, for middle class youths access to abortion is very swift and secure, whereas for the rest of women the decision to abort consists of efforts on different levels to achieve the undertaking. The narratives may assume dramatic proportions, including abortion even in advanced stages of pregnancy.     

Census of hospitalized patients in a psychiatric institution of Rio de Janeiro State: preliminary data

Rio de Janeiro State has one of the largest networks of psychiatric hospitals in Brazil, one of them the Dr. Eiras Paracambi Hospital (CSDE-P). In late 2000, the current Mental Health Advisory Division of the Rio de Janeiro State Health Department conducted a clinical and psychosocial census of patients hospitalized in the CSDE-P. The hospital population consisted of 1,494 individuals, the majority men (53.4%), single (81.6%), working-age (66.4%), and with limited schooling (only 11.5% with a complete primary education or more). Most had been in hospital for at least two years (77.6%), received visits from relatives (60.5%), but did not have hospital leave (73.8%). The predominant diagnoses were schizophrenia (53.6%) and mental retardation (26.4%). The main therapeutic approach was psychiatric (84.1%). Only 13.3% took part in systematic activities during the day, although 36% were in a condition to do so. CSDE-P is a mega-hospital where most patients have precarious social links, demanding treatment strategies which take this characteristic into account.     

Health conditions and residential concentration of poverty: a study in Rio de Janeiro, Brazil

STUDY OBJECTIVES: To establish the geographical relation of health conditions to socioeconomic status in the city of Rio de Janeiro, Brazil. DESIGN: All reported deaths in the municipality of Rio de Janeiro, from 1987 to 1995, obtained from the Mortality Information System, were considered in the study. The 24 "administrative regions" that compose the city were used as the geographical units. A geographical information system (GIS) was used to link mortality data and population census data, and allowed the authors to establish the geographical pattern of the health indicators considered in this study: "infant mortality rate"; "standardised mortality rate"; "life expectancy" and "homicide rate". Information on location of low income communities (slums) was also provided by the GIS. A varimax rotation principal component analysis combined information on socioeconomic conditions and provided a two dimension basis to assess contextual variation. MAIN RESULTS: The 24 administrative regions were aggregated into three different clusters, identified as relevant to reflect the socioeconomic variation. Almost all health indicator thematic maps showed the same socioeconomic stratification pattern. The worst health situation was found in the cluster composed of the harbour area and northern vicinity, precisely in the sector where the highest concentration of slum residents are present. This sector of the city exhibited an extremely high homicide rate and a seven year lower life expectancy than the remainder of the city. The sector that concentrates affluence, composed of the geographical units located along the coast, showed the best health situation. Intermediate health conditions were found in the west area, which also has poor living standards but low concentration of slums. CONCLUSIONS: The findings suggest that social and organisation characteristics of low income communities may have a relevant role in understanding health variations. Local health and other social programmes specifically targeting these communities are recommended.