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.     

Knowledge on sexually transmitted diseases among low-income adolescents in Ribeirão Preto, São Paulo State, Brazil

This study examined female adolescents' knowledge concerning STDs and transmission, condom use, and health care. It was a cross-sectional study of 90 adolescents living in an area covered by the Family Health Program in Ribeir?o Preto, S?o Paulo, Brazil. Data were collected through household interviews using a structured questionnaire, followed by preliminary analysis of simple frequency of variables. Most adolescents were single, sexually active, and with limited knowledge concerning STDs. Condoms were known as the main means of prevention, but only 35.2% of the sample reported always using them. There was a large drop in condom use (from 71.1% to 37.1%) when comparing the first versus the most recent sexual intercourse. Teenagers did not consider themselves at risk of STDs (65.5%), although 57.8% reported related symptoms and 36.7% had never undergone gynecological examination. The results point to the need for special attention to adolescent health care. The lack of effective protection makes them vulnerable to STDs, including HIV/AIDS, even though they do not consider themselves at risk.     

Spatial distribution of endemic diseases in Ribeirão Preto, São Paulo State

The perception that some diseases happen in certain places is old. The concern in studying the relation between the human being and the environment resulted in several studies of medical geography, directed to the analysis of diseases spatial distribution. This sectional study was carried out in Ribeir?o Preto, S?o Paulo State, and aimed to illustrate, through health problems (dengue, leprosy and tuberculosis), how a Geographic Information System tool allows the identification of heterogeneous areas, providing support for the choice of strategies and specific interventions according to the need of residents, as well as, priority of resources to more vulnerable groups. The population comprised cases of dengue, leprosy and tuberculosis notified in Ribeir?o Preto in 2000. Data were collected in the Health Secretary Epidemiological Surveillance of the city. In order to obtain the thematic maps, data were geo-codified with the software MapInfo 7.8 e Spring 4.3. The thematic maps showed the density distribution of dengue, leprosy and tuberculosis cases in the city as a way to complement the analysis of health information, pointing priority areas for the control of these diseases.     

Predicting the number of cases of dengue infection in Ribeirão Preto, São Paulo State, Brazil, using a SARIMA model

This study aimed to develop a forecasting model for the incidence of dengue in Ribeir?o Preto, S?o Paulo State, Brazil, using time series analysis. The model was performed using the Seasonal Autoregressive Integrated Moving Average (SARIMA). Firstly, we fitted a model considering monthly notifications of cases of dengue recorded from 2000 to 2008 in Ribeir?o Preto. We then extracted predicted values for 2009 from the adjusted model and compared them with the number of cases observed for that year. The SARIMA (2,1,3)(1,1,1)12 model offered best fit for the dengue incidence data. The results showed that the seasonal ARIMA model predicts the number of dengue cases very effectively and reliably, and is a useful tool for disease control and prevention.     

Dietary patterns and correlates in adults living in Ribeirão Preto, São Paulo State, Brazil: the OBEDIARP Project

This study aimed to identify and analyze correlates of dietary patterns in residents of Ribeir?o Preto, S?o Paulo State, Brazil. This was a cross-sectional study including both men and women aged > 30 years (n = 930, weighted sample = 2,197). Factor analysis was applied to identify food consumption patterns, using a semi-quantitative questionnaire. Four patterns were identified: (a) obesogenic: associated with more physical activity, more schooling, and age < 40 years; (b) healthy: associated with female gender, individuals without overweight, older adults, central obesity, more physical activity, and higher socioeconomic status; (c) mixed: without overweight, female gender, and younger adults; and (d) popular: associated with absence of hypercholesterolemia and lower family income. The results highlight the need to encourage eating healthy foods in order to prevent chronic non-communicable diseases.     

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).     

Metals in landfill leachate in Ribeirão Preto, São Paulo State, Brazil, and its relevance for public health

This study analyzed the levels of cadmium, lead, copper, chromium, manganese, mercury, and zinc in leachate from the Ribeir?o Preto landfill site in S?o Paulo State, Brazil. Samples were taken from runoff tanks in Module I (operating from 1989 to 2000) and Module II (operating since November 2000). Metal levels were measured by atomic absorption spectrophotometry at the University of S?o Paulo in Ribeir?o Preto (University Hospital). Results were compared to the maximum limits for metal concentration in liquid effluents set by Ruling 357/2005 of the National Environmental Council (CONAMA). The study also investigated whether there was any attenuation in metal concentrations in the leachate, considering differences in the life spans of the various Ribeir?o Preto landfill site modules. Metal levels in the samples were within the maximum limits for cadmium, chromium, copper, mercury, and manganese, but lead and zinc were above the limits set by the above-mentioned ruling.     

Alcohol addiction and associated factors in adults in Ribeirão Preto, São Paulo State, Brazil, 2006: the OBEDIARP project

This study aims to estimate the prevalence and severity of alcohol addiction and to identify associated factors. A cross-sectional population-based study was conducted in Ribeir?o Preto, S?o Paulo State, Brazil, in 2006. Prevalence estimates were based on AUDIT (Alcohol Use Disorders Identification Test). Crude and adjusted prevalence ratios (PR) were calculated, and the outcome variable was classified in two levels: (1) scores = 0-7; and (2) scores = 8-40. Overall prevalence of alcohol addiction was 20.18% (43.47% in men and 10.18% in women). In the final model, the following variables were associated with alcohol addiction: gender, age, schooling, marital and work status, smoking, religion, and self-rated health. Prevalence of alcohol addiction was high, especially among men. The results should contribute to the adoption of health promotion and prevention strategies, considering the consequences of alcohol addiction.     

Hospital mortality and length of stay: comparison between public and private hospitals in Ribeirão Preto, São Paulo State, Brazil

Performance assessment in health services is essential. The comparison of performance indicators requires the use of risk adjustment strategies. The objective of this paper was to assess variations in clinical performance, measured by hospital mortality and length of stay, between private and public hospitals, while taking into account the hospital case mix. This study is located in the Ribeir?o Preto region in S?o Paulo State, Brazil. From 1996 to 1998, 32,906 patients admitted with cardiovascular and respiratory diagnoses were studied. Variables used for risk adjustment of performance indicators were: sex, age, principal diagnosis, and severity measures based on co-morbidity. Clinical performance in public hospitals as measured by adjusted hospital mortality (OR = 0.41) was better than in private hospitals. Public and private hospitals were not statistically different concerning patients' length of stay. Although some conceptual and methodological problems persist, hospital mortality and other adjusted performance indicators should be considered as useful tools to identify health services' performance problems.     

Drug abuse prevalence among secondary school students in São José do Rio Preto, São Paulo State, Brazil

This study investigates the prevalence of drug consumption among secondary school students in S?o José do Rio Preto, S?o Paulo State, Southeast Brazil, and its distribution in relation to gender and grade in school. A cross-sectional survey was carried out in S?o José do Rio Preto. A self-applied questionnaire was answered by a proportional sample of 1,041 teenagers enrolled in 9th, 10th, and 11th grades in public schools. Lifetime consumption of psychoactive substances was: alcohol 77%, tobacco 28.7%, solvents 18.1%, marijuana 12.1%, amphetamines 3.7%, cocaine 3.3%, hallucinogens 3.1%, and crack 1.4%. Weekly use of marijuana was the highest (2.8%), followed by solvents (1.3%). Males consumed more alcohol, marijuana, cocaine, and crack than females. Nighttime use of tobacco, marijuana, cocaine, and hallucinogens was observed. In the present study, prevalence of psychoactive substance use was observed in S?o José do Rio Preto at rates similar to those found in other Brazilian studies.     

Development of a quantitative food frequency questionnaire for pregnant women attending primary care in Ribeirão Preto, São Paulo State, Brazil

The aim of this study was to design a food frequency questionnaire for pregnant women attending primary care under the Unified National Health System in Ribeir?o Preto, S?o Paulo State, Brazil. A 24-hour food recall was obtained from 150 pregnant women, 50 in each trimester of pregnancy (age 18-35 years). A second food recall was obtained from 90 women, 30 in each trimester of pregnancy, from 7 to 15 days after the first dietary assessment. An 85-item questionnaire was developed with stepwise multiple linear regression models, based on the contribution of each food to inter-individual variation of energy and 28 target nutrients, which accounted for 74.2 to 98.8% of the selected nutrients. Portion sizes were determined according to percentiles 25, 50, 75, and 100 for each food item intake. To our knowledge, this is the first food frequency questionnaire designed for Brazilian pregnant women.     

Association between particulate matter air pollution and monthly inhalation and nebulization procedures in Ribeirão Preto, São Paulo State, Brazil

The study was designed to investigate the impact of air pollution on monthly inhalation/nebulization procedures in Ribeir?o Preto, S?o Paulo State, Brazil, from 2004 to 2010. To assess the relationship between the procedures and particulate matter (PM10) a Bayesian Poisson regression model was used, including a random factor that captured extra-Poisson variability between counts. Particulate matter was associated with the monthly number of inhalation/nebulization procedures, but the inclusion of covariates (temperature, precipitation, and season of the year) suggests a possible confounding effect. Although other studies have linked particulate matter to an increasing number of visits due to respiratory morbidity, the results of this study suggest that such associations should be interpreted with caution.     

Epidemiology of dengue infection in Ribeirão Preto,SP, Brazil

OBJECTIVE: To assess dengue transmission in a correctional facility for juvenile delinquents in Ribeir?o Preto, state of S?o Paulo, Brazil. METHODS: A serological and virology investigation was carried out among inmates and employees of a correctional facility for juvenile delinquents in Ribeir?o Preto, Brazil. The study population consisted of 105 inmates and 91 employees representing 89% of the exposed. The collected blood was stored and processed using MAC-ELISA and virus isolation. A questionnaire was applied to each subject at the time of blood collection. RESULTS: Of the total of blood samples collected (n=196), 42 (21.4%) were positive for IgM antibodies and 43 (21.9%) for IgG antibodies; of which, 15 were both IgM and IgG positive and 28 (14.3%) were IgG positive only. Serotype 1 dengue virus was isolated in 5 samples. Out of 42 IgM positive samples, 14 (33.0%) subjects did not have any physical complaints. The incidence rate was 23.8% and 18.6% among inmates and employees, respectively. The first cases in the facility were reported in 1997 and the last ones in March 1997 though results are suggestive of an earlier onset of transmission. CONCLUSIONS: The high incidence rate of dengue infection can be explained by the high population density of the facility, high Aedes aegypti infestation, high numbers of asymptomatic subjects, and a higher transmission of disease in a closed setting.     

Health and work in rural areas: sugar cane plantation workers in Ribeirão Preto, São Paulo, Brazil

This study is based on an understanding of health and rural labor as a social process related to the characteristics of the agrarian issue in Brazilian society, focusing on sugar cane cutters in northeastern S?o Paulo State, Brazil, and attempting to identify patterns of attrition and reproduction in such labor. Based on direct observations, interviews with laborers and other agents involved in production, and a related bibliographical review, the analysis points to daily exposure of cane cutters to physical, chemical, and biological hazards resulting in various diseases, traumas, and accidents: dermatitis, conjunctivitis, dehydration, cramps, dyspnea, respiratory infections, high blood pressure, and wounds, besides aggravating the biopsychic burden underlying attrition patterns showing up in the spinal column, chest, head, and lumbar pains, nervous breakdowns, and other kinds of psychosomatic manifestations. This study of the work process pointed up its unhealthy working conditions and helped provide an overview of the conditions and means by which capital asserts itself in Brazil - in its self-reproduction process - especially in the agro-industrial sector.     

Critical evaluation of the Primary Care Information System (SIAB) and its implementation in Ribeirão Preto, São Paulo, Brazil

As the health information system used by the Family Health Program teams, the Primary Care Information System (SIAB) is a potential tool for follow-up of registered families and local planning, thus motivating the present study. Semi-structured interviews were held with key individuals in this health information system chain, among Family Health Teams in the municipality of Ribeir?o Preto and surrounding region, S?o Paulo State, Brazil, with the objective of analyzing certain characteristics in the system, including: knowledge and having received training to handle it and utilization for local planning and social control. The study concluded that the SIAB is an easy system to handle, but that it presents some limitations already found in other health information systems, such as: difficulty in identifying individuals in the program, limited number of diseases reported, and limited utilization to back planning and decision-making at the local level. Therefore, the analysis of the SIAB was highly important for improving this health information system and can contribute to future improvements and adaptations in the program.