Cow's milk consumption and childhood anemia in the city of São Paulo, southern Brazil

OBJECTIVE: To evaluate the influence of the consumption of cow's milk on the risk of anemia during childhood in the city of S?o Paulo. METHODS: We have studied a probabilistic sample (n=584) of underfive children living in the city of S?o Paulo, southeastern Brazil, between 1995 and 1996. Anemia (hemoglobin <11 g/dl) was diagnosed using capillary blood obtained by fingertip puncture. The cow's milk content and the density of heme and nonheme iron in the child's diet were obtained using 24-hour recall questionnaires. Multiple linear and logistic regression models were used to study the association between cow's milk content in the diet and hemoglobin concentration or risk of anemia, and included statistical control for potential confounders (age, sex, birthweight, presence of intestinal parasites, family income, and mother's schooling). RESULTS: The prevalence of anemia was 45.2% and the mean contribution of milk to the total caloric content of the children's diets was 22.0%. The association between milk consumption and risk of anemia remained significant, even after considering the dilutive effect of milk consumption on the density of iron in the diet, thus indicating a possible inhibitor effect of milk on the absorption of the iron present in the other foods ingested by the child. CONCLUSIONS: The relative participation of cow's milk in the child's diet showed a significant positive association with risk of anemia in children between ages six and 60 months, regardless of the density of iron in the diet.     

Asthma mortality in the city of São Paulo,Brazil

OBJECTIVE: To quantify and compare asthma mortality rates as the main cause of death, taking into consideration the following variables: sex, age and seasonality. METHODS: Data was collected from all death certificates coded 493 of people aged 5 to 34 years in the periods of 1983-5 and 1993-5 in the city of S?o Paulo, SP, Brazil. Data analysis was performed by directly comparing death rates and identifying the odds ratio trend and directly comparing the numbers of asthma deaths. RESULTS: There was no increase in asthma mortality rates for the study periods. There was no difference between men and women. A greater number of deaths in the age group 20 to 34 years were observed. Seasonality was more evident in the first period studied. CONCLUSIONS: Differing from reports in other countries, the results did not show any increase in asthma mortality rates, The variable sex didn't seem to interfere with mortality. Deaths are more frequent among young adults, and their risk may be 9 times greater than that of young children. Deterioration of social and economic issues and health care services and even climatic changes may have been implicated in the absence of seasonality as a risk factor for asthma mortality. The disease by itself is not considered by many health professionals as critical in order to explain the chain of events that lead to death.     

Association of children's consumption of processed foods and family income in the city of São Paulo,Brazil

OBJECTIVE: To describe children's consumption of processed foods and its relationship with per capita family income based on a household survey. METHODS: Food consumption was studied in a statistical sample of 718 children living in the city of S?o Paulo in the period 1995-1996. A 24-hour dietary recall was used. Data regarding the association of children's consumption of 24 processed foods and per capita family income (arranged in quartiles) was analyzed. RESULTS: Consumption of sugar was higher among children of low income families whereas the consumption of chocolate powder, chocolate, yogurt, infant formula and soft drinks was higher among children of high income families (p< 0.05). CONCLUSIONS: It seems that per capita family income affects the consumption of some processed foods.     

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.     

Estimation of the dog and cat population in the State of São Paulo

OBJECTIVE: To estimate the total dog and cat population with owners in order to enable better planning of the control actions against diseases involving these animals. METHODS: The study was carried out in the non-metropolitan regions of the State of S?o Paulo, Brazil, from May to December 2002. Forty-one municipalities and 100 census tracts were surveyed. These were selected by probabilistic stratified cluster sampling in two stages. The strata were formed by grouping the municipalities according to their populations and living conditions. The Pasteur S?o Paulo Technique was used to obtain data on the canine population. This technique was developed to estimate and classify dogs according to their degree of dependence and restriction. RESULTS: Almost 53% of the 20,958 households visited owned a dog, and the average was 1.6 dogs per household. A total of 4,624 cats were found, concentrated in 12.6% of the households. The results indicate a dog/inhabitant ratio of 1:4.0 and a cat/inhabitant ratio of 1:16.4. CONCLUSIONS: The animal/inhabitant ratios were much higher than expected. Incorporation of these ratios into evaluations of the vaccination campaign against rabies has revealed more realistic coverage patterns, thus leading to renewed discussion of the vaccination targets for municipalities. An association was observed between the size of the municipality or its inhabitant's living conditions and the level of restrictions on dogs.     

Early Infant Morbidity in the City of São Paulo, Brazil

Background

Early infant morbidities may produce adverse outcomes in subsequent life. A low Apgar score is a convenient measure of early infant morbidity. We study determinants of early infant morbidity (sex, plurality, mode of delivery, prior losses, gestational age, prenatal care and birth weight, parity and maternal age, race, maternal education and community development) for the 1998-birth cohort, City of São Paulo, Brazil.

Methods

This study identified all deliveries that took place in the City of São Paulo during 1998. Information was extracted from 209,628 birth records. We used multivariate logistic regression to assess the effect of each independent variable on Apgar score less than seven at one minute and Apgar score less than seven at five minutes.

Results

Low birth weight, prematurity and community development were found to be strong predictors of morbidity. Maternal education showed strong negative correlation with both Apgar scores. The negative correlations between maternal schooling and Apgar scores were observed after prenatal care, parity and maternal age were included in the model. Unmeasured proximate factors may thus be the true source of disparity between educational groups. Children of very young adolescent mothers had lower Apgar scores at one minute (but not at five minutes) than those born to mothers 15 to 19. Parity one or higher was associated with decreased odds of low Apgar scores. Cesarean section and operative delivery were associated with higher odds of early infant morbidity.

Conclusion

Education may allow mothers to have better care in the peripartum period. More educated mothers may be more likely to recognize certain morbidities through the pregnancy period and the monitoring of such morbidities yields better infant outcomes. Also, having less than seven prenatal care visits was found to predict early infant morbidity and one way to increase the use of such services is to focus on aspects of care that may lead to easier accessibility and continuity of prenatal care. Physicians should inform mothers about the risks associated with high number of children for a next infant and also about the risks for the infant associated with unnecessary cesarean sections. Special attention should be paid to adolescent mothers, since much of their increased risk is likely to be minimized by counseling.     

Anthropometry of elderly residents in the city of São Paulo, Brazil

The article presents gender and age-specific selected anthropometric data for a representative sample of elderly Brazilians in the city of S?o Paulo. This was a cross-sectional, population-based household survey. A total of 1,894 older adults (men and women, > 60 years) were examined from January to March 2001. Data were presented as means and percentiles for body mass (BM); height or stature (ST); body mass index (BMI); waist (WC), hip (HC), arm (AC), and calf (CC) circumferences; triceps skinfold thickness (TST); and arm muscle circumference (AMC), and differences were described according to age (all variables) and gender (BMI). Except for HC (men), all anthropometric variables were lower in the oldest than in the youngest individuals (p < 0.01) in both genders. BMI was significantly higher (p < 0.01) in women than men (all age groups). The observations suggest that there is loss of muscle mass and redistribution and reduction of fat mass with age (both genders). The data can be used in clinical practice and epidemiological studies based on interpretation of anthropometric measurements in the elderly in S?o Paulo.     

Serum lipids levels and some risk factors of cardiovascular diseases in a population of the municipality of S?o Paulo, SP (Brazil)

An attempt was made to characterize lipemic levels according to sex, age and presence or absence of cardiovascular disease risk factors, in a population of 3,792 people between the ages of 20 and 59, in terms of smoking habits, obesity, family history of diabetes and use of oral contraceptives. Those individuals who did not present any of the risk factors mentioned were classified as "exempt". After submitting the data to variance analysis it was found that: for men between 20 and 49 years of age there were high significant differences in the averages obtained for the seric levels of total lipids, triglycerides and total cholesterol between "exempt" and obese and "exempt" and obese with a family history of diabetes; for the 50 to 59 age group there were significant differences in the average of the values corresponding to the seric levels of total lipids between "exempt" and those individuals in whom obesity appeared associated with smoking habits or associated with a family history of diabetes. The averages obtained for seric triglycerides were significantly different between "exempt" and non-obese with a family history of diabetes, obese, obese smokers and obese with a family history of diabetes. On the other hand, the averages relating to seric levels of total cholesterol were different, at significant levels, between "exempt" and obese smokers; the risk represented by the smoking habit showed no relevance with regard to the lipemic levels in any group except for that of men between 30 and 39 years of age. In their case, there were significant differences between the averages obtained for the seric levels of total lipids, triglycerides and total cholesterol, between "exempt" and smokers and between "exempt" and obese smokers. It is to be noted that the differences obtained with regard to the averages relating to lipemic levels as between "exempt" and obese were less those obtained between "exempt" and obese smokers, thus showing the possible relevance of the risk presented by the smoking habit; -- among the women there were less accentuated differences in the averages corresponding to the lipemic levels as between "exempt" and those who presented one or more risk factors. Thus, for the age group from 20 to 29 there were significant differences in the averages obtained for total lipids as between "exempt" and obese.(ABSTRACT TRUNCATED AT 400 WORDS)     

Common sources and composition of phytosterols and their estimated intake by the population in the city of São Paulo,Brazil

ObjectivePhytosterols have been used alone, or combined with lipid-altering drugs, to reduce cholesterol levels and the burden of cardiovascular disease. Considerable variation in the composition of phytosterols exists and its consumption, in a regular diet, by the Brazilian population is still unknown. Thus, the aim of the present study was to determine the phytosterols content of the most consumed plant foods and to estimate the phytosterols intake by this population.MethodsIntake of plant foods of a representative population of the city of São Paulo (n = 1609), randomly selected on the basis of the Brazilian Institute for Geography and Statistics census data (2010), was obtained by a food frequency questionnaire (FFQ). Foods were chosen on the basis of the Consume Expenditure Survey (2002–2003) and from answers to the FFQ. Phytosterols composition of most consumed greens, legumes, cereals, and seeds, fruits, and vegetable oils was determined by gas chromatography (flame ionization detection). Daily phytosterols intake was estimated in terms of mg per 100 g (mg/100 g^?1) of edible portion. Underreporters and overreporters were excluded.ResultsMean (SE) daily phytosterols intake in the diet of the study population was 100.6 (1.2) mg, with β-sitosterol as the largest sterol component (65.4%), followed by campesterol (23.2%), and stigmasterol (10%). No significant changes in daily phytosterols intake were observed after exclusion of underreporters and overreporters. Considerable variation was observed in phytosterols content among the most consumed plant foods.ConclusionsAnalysis of phytosterols composition in most consumed plant foods has shown that phytosterols content varied among food groups. Dietary intake of phytosterols in a large population of the city of São Paulo is in the same range of some countries.     

Food insecurity perception in families with elderly in Campinas, São Paulo, Brazil

The aim of this study was to determine the prevalence of food insecurity (FI) in families with elderly members and to describe their socio-demographic profile. The study focused on families with members aged 65 years or more (n = 195) participating in a household survey in Campinas, S?o Paulo, Brazil, in 2003. The Brazilian Food Insecurity Scale, an adaptation of the USDA FI module, was used to diagnose food security/insecurity (FS/FI). Mild FI was present in 33.0% of families, moderate in 11.8%, and severe in 7.2%. The elderly had no income in < 5.0% of the families. Families with FI, as in the United States, had a greater proportion of elderly with low income and low level of education (no schooling or incomplete primary schooling). A significantly higher proportion of daily qualitative food intake was observed in FS families (vegetables 92.3 vs. 61.8%; OR = 7.4; 95%CI: 2.9-19.6; meat 74.2 vs. 43.1%; OR = 3.8; 95%CI: 1.9-7.3; fruit 77.4 vs. 49.0%; OR = 3.6; 95%CI: 1.8-6.9). The elderly contribute to family income and thus do not pose a burden to their families.     

Asthma prevalence and risk factors in schoolchildren of the city of São Paulo, Brazil

OBJECTIVE: To assess asthma prevalence and potential risk factors associated. METHODS: Cross-sectional study part of the International Study of Asthma and Allergies in Childhood. A total of 561 schoolchildren aged 6-7 years from 35 public schools in the city of S?o Paulo (Southeastern Brazil) were drawn to participate in the study, in 2002. The sample consisted of 168 asthmatic and 393 non-asthmatic children who answered a questionnaire comprising 33 questions on personal, family and environmental information. The association between asthma and the risk factors studied was assessed by logistic regression analysis at a 5% statistical significance. RESULTS: Among the schoolchildren studied, 31.2% reported wheezing in the 12 months preceding the interview. The following risk factors were significantly associated with asthma: male gender (OR=2.4; 95% CI: 1.4;4.2), maternal smoking in the child's first year of life (OR=2.0; 95% CI: 1.1;3.8), eczema on characteristic body areas (OR=3.0; 95% CI: 1.2;7.6) and rhinoconjunctivitis (OR=2.4; 95% CI: 1.2;4.8). CONCLUSIONS: Asthma prevalence in the study area was high and the risk factors identified were male gender, rhinoconjunctivitis in last year, maternal smoking in the child's first year of life and eczema on characteristic body areas.     

Air pollution and respiratory illness of children in São Paulo, Brazil

This investigation reports the association between air pollution and paediatric respiratory emergency visits in São Paulo, Brazil, the largest city in South America. Daily records of emergency visits were obtained from the Children's Institute of the University of São Paulo for the period from May 1991 to April 1993. Visits were classified as respiratory and non-respiratory causes. Respiratory visits were further divided into three categories: upper respiratory illness, lower respiratory illness and wheezing. Daily records of SO₂, CO, particulate matter (PM₁₀), O₃ and NO₂ concentrations were obtained from the State Air Pollution Controlling Agency of São Paulo. Associations between respiratory emergency visits and air pollution were assessed by simple comparative statistics, simple correlation analysis and by estimating a variety of regression models. Significant associations between the increase of respiratory emergency visits and air pollution were observed. The most robust associations were observed with PM₁₀, and to a lesser extent with O₃. These associations were stable across different model specifications and several controlling variables. A significant increase in the counts of respiratory emergency visits – more than 20%– was observed on the most polluted days, indicating that air pollution is a substantial paediatric health concern in São Paulo.     

Socioeconomic differentials in the temperature-mortality relationship in São Paulo,Brazil

BACKGROUND: We investigated the impact of environmental temperature on mortality in S?o Paulo, Brazil, and examined differences in the temperature-mortality relationship with respect to cause, age group, and socioeconomic position (SEP). METHODS: Generalized additive Poisson regression models adjusted for non-temperature related seasonal factors (including air pollution) were used to analyse daily mortality counts for selected causes from 1991 to 1994. Individuals were classified by the aggregate SEP of their area of residency. These were analysed as potential modifiers of the temperature-mortality relationship. RESULTS: Among the elderly we observed a 2.6% increase in all-cause mortality per degree increase in temperature above 20 degrees C, and a 5.5% increase per degree drop in temperature below 20 degrees C, after adjustment for confounding. Relationships were similar in children, but somewhat weaker in adults. Cold effects were present for deaths due to cardiovascular disease (CVD), respiratory, and other causes, with effects being greatest in the respiratory group. Heat effects were not found for CVD deaths in adults, but otherwise varied little by cause of mortality. There was little evidence for a modification of the mortality effects of cold or heat by SEP. CONCLUSIONS: These findings show that the U-shaped pattern of the temperature-mortality relationship found in cooler northern countries occurs also in a sub-tropical city. In addition, the relative effects of temperature were similar in each socioeconomic grouping.     

Seroprevalence of human parvovirus B19 in a suburban population in São Paulo, Brazil

OBJECTIVE: To analyze the prevalence of IgG antibodies to human parvovirus B19. METHODS: Cross-sectional study in a suburban community in S?o Paulo, Southeastern Brazil, between November 1990 and January 1991. Randomly selected (N=435) representative samples of sera were collected from healthy children older than 15 days old and adults up to 40 years old. IgG antibodies were detected using ELISA. RESULTS: High prevalence of IgG antibodies to B19 parvovirus was found in 87% of newborns. The prevalence of maternally derived IgG antibodies exponentially plunged up to the 19th month of age. Low prevalence of antibodies was found in the first 4 years of life, increasing up to 72% in those aged 31-40 years. It was estimated that the average age of first infection in this population is 21 +/- 7 years old and the optimal age for vaccination with a hypothetical vaccine would be 1 year of age. CONCLUSIONS: Parvovirus B19 IgG antibody prevalence was high in newborns and those aged 31-40 years. The analysis by age groups showed a pattern similar to that found in previous studies, i.e., low prevalence of infection in children that increases with age.