Paracoccidioidomycosis mortality in the State of Paraná, Brazil, 1980/1998

The paracoccidioidomycosis mortality rate in the State of Paraná, Brazil (1980/1998) was analyzed using the death registry data from the Brazilian Mortality Information System and the estimated population from the Brazilian Institute of Geography and Statistics. To qualify the deaths, we deployed ICD-9 for 1980/1995 and ICD-10 for the more recent years. During this period there were 551 deaths from paracoccidioidomycosis in the State of Paraná. Most of the deaths were in male in the 30-59-year age group. The average annual mortality rate was 3.48 per million inhabitants, showing a tendency to stabilize during the study period. Paracoccidioidomycosis was the fifth cause of mortality among the predominantly chronic infectious diseases and had the highest mortality rate among the systemic mycoses. Paracoccidioidomycosis was observed in 184 counties in the State of Paraná. Most deaths were recorded in the North-Central meso-region, and the highest mortality rate occurred in the West meso-region.     

Dental caries and socioeconomic conditions in the State of Paraná, Brazil, 1996

The aim of this research was to determine the correlation between dental caries and socioeconomic conditions in the State of Paraná, Brazil. Caries prevalence was estimated for each city in the State by gathering data on the DMFT index (in 12-year-old schoolchildren) supplied by the State Health Department. Official socioeconomic data for the municipalities were also presented. Ordinary least squares regression analysis was performed, and significant correlation coefficients were observed between the dental caries index and various social development indicators. Maps highlighting the overlapping areas with poor outcomes for most of these variables were presented. The results showed a significantly lower DMFT index in cities with fluoridated water supply and a negative correlation between the caries index and the proportion of households with running water in cities with fluoridated water supply. This observation highlights the importance of fluoridated drinking water for the prevention of dental caries and as a measure to reduce the impact of socioeconomic inequalities on the prevalence of tooth decay.     

Preliminary information on sandflies in the north of Paraná State, Brazil

The results from sandfly collections in 10 municipalities in Paraná State, Brazil are reported. The captures were done using Falc?o traps in homes, domestic animal shelters and forested areas, from 1999 to 2002. A total of 13,653 sandflies were collected from 10 species of the genera Brumptomyia, Expapillata, Evandromyia, Migonemyia, Pintomyia, Nyssomyia and Psathyromyia. The species Nyssomyia neivai was predominant in five municipalities. N. whitmani predominated in the other five, in greater numbers than for N. neivai in the first five municipalities. High frequencies of sand flies were found in forests, homes, pigpens and henhouses. Investigations on the participation of domestic animals and phlebotomine fauna in the epidemiology of tegumentary leishmaniasis should be routine in health surveillance, especially where this disease is endemic.     

Inclusion of oral health services in the Family Health Program in the State of Paraná, Brazil

The aim of this study was to analyze the implementation of dental care in the Family Health Program (FHP) in the State of Paraná, Brazil, one year after Ministry of Health (MoH) Ruling 1,444 went into effect. A qualitative and quantitative study was designed, focusing on the 136 municipalities which had included oral health services in the program by early 2002. The dental care teams received previously tested questionnaires on administrative and operational issues. The mean population covered by each team is close to the minimum stipulated by the MoH in 2000. However, some teams experienced difficulties in developing all the activities under their responsibility. Referral of more complex cases was also reported as a critical point. Favorable reception by the population and participation by dentists in the training courses were identified as positive points. Finally, a large proportion of dentists were under temporary work contracts (37.7%); there were also reports of the need to train general dental practitioners with an adequate profile for the FHP.     

Sustainable development and child health in the Curitiba metropolitan mesoregion,State of Paraná, Brazil

The purpose of this study was to analyze social determinants of health through the relationship between Sustainable Development and child health outcomes. The population studied lives in 37 municipalities of the Curitiba mesoregion, in the State of Paraná, Brazil. It is a cross-cutting ecological study. In the 1st phase of the study, 16 contextual indicators were obtained from the 2010 demographic census performed by the Brazilian Institute of Geography and Statistics. Principal Components Factor Analysis was undertaken to demonstrate possible correlations between social determinants of health, resulting in Sustainable Development indices for the places where the children live. In the 2nd phase the mortality rate in children aged under 5 was obtained from the Ministry of Health database. Pearson's correlation demonstrated statistically significant, moderate and negative association between the mortality rate in children aged under 5 (2001–2010) and the Sustainable Development Index (r=−0.62, p<0.01); with the Equity component (r=−0.70, p<0.01); and with the clusters (r=−0.68, p<0.01). Contextual indicators of Sustainable Development for the places where the children live showed themselves to be associated with the child health outcome. As such, equitable and sustainable social policies, based on inclusive health promotion strategies, need to be integrated into the children's life context.     

Living conditions and infant mortality in the State of Paraná, Brazil, 1997/2001

This objective of this paper was to verify the relations between the living and infrastructure conditions of municipalities in the State of Paraná, Brazil, and infant mortality rate and its components. An ecological study was carried out having the 399 municipalities of the State being classified into five clusters of living conditions. Infant, neonatal and postneonatal rates were calculated for the period 1997/2001. The mean infant, neonatal and postneonatal mortality rates in the State were, respectively, 19.3, 12.0 and 7.3 per 1,000 live births. Postneonatal mortality rates ranged from 8.7 (cluster of worst living conditions) to 6.3 per 1,000 live births (in the cluster classified as having the best living conditions). Regarding the neonatal component, clusters classified as holding the best and the worst living conditions presented the lowest values: 11.8 and 11.4 per 1,000 live births, respectively. We conclude that the postneonatal component still adequately discriminate living conditions in the State of Paraná. However, there is a need of complementary studies that aim to clarify the causes of similar neonatal mortality rates observed in the richest and in the poorest cluster of municipalities.     

Prevalence of cervical intraepithelial neoplasia and invasive carcinoma based on cytological screening in the region of Campinas, São Paulo, Brazil

This study aimed to estimate and analyze the prevalence of cervical intraepithelial neoplasia (CIN) and invasive cervical carcinoma based on cytological diagnosis. The study included 120,635 women undergoing cytological exams in public health services in the region of Campinas, S?o Paulo State, Brazil, between September 1998 and March 1999. Prevalence rates per 100,000 women were: 354 for CIN I; 255 for CIN II; 141 for CIN III; and 24 for invasive carcinoma. As age increased, prevalence rates and prevalence ratios decreased for CIN grades I and II and increased for CIN III until the 50-54 age group, decreasing thereafter The prevalence rate of invasive carcinoma increased with age. The prevalence pattern of CIN II was distinct from that of CIN III, but similar to that of CIN I. This would not have been observed if the Bethesda System had been used for cytological diagnosis. Mean age at time of CIN II diagnosis was about 10 years less than for CIN III diagnosis. Therefore, a high-grade lesion diagnosed in a young woman according to the Bethesda System would probably be a CIN II, whereas in an older woman it would probably be a CIN III.     

Committees for the prevention of infant mortality in the State of Paraná, Brazil: implementation and operation

This article reports on the implementation and operation of committees for the prevention of infant mortality in the State of Paraná, Brazil, with the operational strategies, formation, and relations at three levels: State, regional, and municipal. To implement the committees it was necessary to train professionals to investigate infant deaths. In two years the committees analyzed 50% of the infant deaths occurring in the State. The goal is to increase the number of cases analyzed and to continue to monitor the committees' work, seeking improved performance, agility, and data quality.     

Prospects for the elimination of leprosy as a public health problem in the State of Paraná, Brazil

Leprosy, an endemic contagious/infectious disease, is still a public health problem in most States of Brazil, despite an important decrease in the prevalence rate in recent years. The current study aims to analyze the prospects for the elimination of leprosy in the State of Paraná, based on detection and prevalence rates for the years 2000 to 2005, in addition to data on gender, age, clinical form, operational classification, and number of skin lesions. Data were obtained from the Reportable Diseases Information System (SINAN) and the Tabnet software. Leprosy detection and prevalence rates in Paraná remained unaltered during the study period. The leprosy detection rates were high or very high in the majority of the health districts in the State. In terms of prevalence, eight health districts had reached the goal of eliminating the disease. In conclusion, the State of Paraná is close to reaching the goal of eliminating leprosy. Based on the study results, actions are recommended to eliminate the disease as a public health problem.     

Prevalence of tobacco use and associated factors among women in Paraná State, Brazil

This study aimed to estimate the prevalence of tobacco use and to describe the demographic profile of female smokers in Paraná State, Brazil. The study used a cross-sectional population-based design with cluster sampling (n = 2,153) of women 18 years or older in seven cities. Prevalence of smoking was 13.4%, ranging from 10% in Cascavel to 19% in Irati. According to multivariate analysis, city of residence, marital status, and schooling were significantly associated with tobacco use. Women in Irati (OR = 2.08; 95%CI: 1.22-3.54) were more likely to smoke than those in Cambé. Married women and widows were less likely to smoke (OR = 0.47; 95%CI: 0.30-0.73 and OR = 0.43; 95%CI: 0.22-0.87) than single women. Women living with a partner (but not married) were more likely to smoke than single women (OR = 2.49; 95%CI: 1.12-5.53), and women with university degrees were less likely to smoke than those with eight years of school or less (OR = 0.41; 95%CI: 0.22-0.87). The results confirm the need for tobacco control programs that take gender and regional differences into account.     

Evaluation of noise pollution in the Botanical Garden in Curitiba,Paraná, Brazil

This study focuses on noise pollution in the Botanical Garden in Curitiba, Paraná, Brazil. Equivalent noise levels (Leq) were measured at 21 points throughout the park, and interviews were conducted with park visitors. Some 47.6% of the measurement sites presented Leq levels over 65dB(A), considered by preventive medicine as the maximum tolerable exposure level without risk of health impairment, and 90.5% of the sites failed to comply with Municipal Ordinance 8,583, setting 55dB(A) as the maximum noise emission level for green areas. The results of interviews with visitors showed that 78% visit the park at least twice a week and that 96% come for physical activity. During their activities in the Botanical Garden, 24% of interviewees identified noise pollution as a source of annoyance, as compared to 22% who complained of insufficient park security.     

Prevalence of obesity in a locality of the State of S?o Paulo, Brazil, 1987]

The prevalence of obesity in Araraquara, a county of 150,000 inhabitants situated 250 km from S. Paulo, Brazil was studied. The study population, of 18-74 yrs. of age, resident in the urban area in 1987, was composed of 1,126 inhabitants, 502 males and 624 females, selected through a cluster equiprobabilistic sampling process. The prevalence of overweight (Quetelet 25-29.9 Kg/m2) was 26.9% for males and 27.7% for females. The prevalence of obesity (Quetelet equal or greater than 30.0 kg/m2) was 10.2% for males and 14.7% for females. These percentages are high when compared with those of affluent Anglo-saxon countries. The reasons for this phenomenon are discussed in the light of the fact that the economy of the city is affluent and is dependent on agroindustrial activities. When own cut-off criteria (P85 and P95 for Quetelet for 20-29 yrs of age, for each sex) are calculated, the "lean pattern" for Araraquara County is leaner than that for the a United States population. This raises doubts as to the possibility of applying cut-off criteria of particular regions to regions of different characteristics.     

Prevalence of dental caries in schoolchildren in the rural area of Itapetininga, São Paulo State, Brazil

The present study is an attempt to characterize dental needs of the rural population in Itapetininga, S?o Paulo State, Brazil. One single dentist examined 291 children ages 5 and 12 years in rural schools, adopting WHO criteria for oral health surveys. Parents reported their children's socioeconomic characteristics and habits. Non-primary data gathered by the Brazilian health authority supplied information regarding the schoolchildren in the urban area of the town. Caries indices ranked as follows: dmft = 2.63 (5-year-old children) and DMFT = 2.45 (12-year-old children). The decayed component comprised 85.6% of the dmft and 34.2% of the DMFT, indicating limited utilization of dental treatment by children with decayed deciduous teeth. Caries prevalence was higher in rural schoolchildren than in their urban counterparts. Analysis of the results aims to improve planning of dental care.     

Inter-municipal health consortia: the case of Paraná State, Brazil

Inter-municipal health consortia emerged in Brazil's Unified National Health System (SUS) policy in the late 1980s. Municipal health administrators adhered to this strategy with the aim of upgrading health services supplied to the population. This research analyzes the profile of such consortia in Paraná State, focusing on specialized medical care. Data were obtained from reports by the State Health Council and questionnaires sent to all 20 existing municipal health consortia. Governmental Decree no. 1,101 and data published in 2000 on the profile of the health system in Paraná were used as references. Of the 399 municipalities in Paraná State, 81.5% have joined municipal consortia. Specialists are allocated by municipalities (4.4%), the State government (13.6%), or Federal Government (12.8%); another 69.2% are hired by the consortia themselves. The supply of consultations with specialists is either insufficient or inadequately distributed, and there are flaws in the referral and counter-referral system. Municipal health consortia serve as viable instrument for expanding and increasing the capacity of municipalities to supply specialized care, although there is a need for well-defined criteria, planning, and improving of the referral and counter-referral system.     

PCR in the investigation of canine American tegumentary leishmaniasis in northwestern Paraná State, Brazil

American tegumentary leishmaniasis (ATL) was studied in 143 dogs in a rural area in the county of Mariluz, northwestern Paraná State, Brazil, using direct parasite search, indirect immunofluorescence (IIF), and polymerase chain reaction (PCR). Thirty-nine dogs (27.3%) presented lesions suggestive of the disease, 5 (12.8%) of which were positive in direct parasite search and PCR (lesion), and of these 5, 4 were also positive by IIF. Of the 34 dogs with negative direct parasite search, 12 (35.3%) had PCR-positive lesions, and of these, 5 were also IIF-positive. One hundred and four dogs had no lesions, but 17/101 (16.8%) were IIF-positive. PCR in blood was positive in 10/38 (26.3%) of the dogs with lesions and in 16/104 (15.4%) of dogs without lesions. The association between PCR (lesion or blood), direct parasite search, and IIF detected 24/39 (61.5%) positive results among symptomatic dogs and 31/104 (29.8%) among asymptomatic animals. PCR was useful for diagnosing ATL, but there was no correlation between lesions, serology, and plasma PCR. Furthermore, detection of parasite DNA in the blood may indicate hematogenous parasite dissemination.     

Evaluation of sandfly control measures in northern Paraná State, Brazil

Sandfly captures from April 2001-September 2002 were compared to those from October 1996-September 1997 and October 1998-April 2000 in order to evaluate control procedures conducted in Recanto Marista in the county of Doutor Camargo, Paraná State, Brazil. Sandflies were captured with Falc?o traps twice a month, both in the domiciles and henhouses, from 10 PM to 2 AM. In 2001-2002, 199,821 sandflies were captured, with an hourly average of 1,625.5 insects; average captures in 1996-1997 and 1997-1998 were 1,641.9 and 806.7, respectively. Nyssomyia neivai was the most abundant species (90.4%) in all habitats. This species, together N. whitmani, Migonemyia migonei, and Pintomyia fischeri, accounted for 99.9% of all the specimens captured. The total hourly average sandfly captures increased, but 85% of these insects were captured in henhouses built with the purpose of attracting sandfly specimens, while the density decreased in other environments, especially intradomiciliary.     

Sandflies in rural localities in northwest Paraná State, Brazil

This study reports the results from sandfly captures at six sites in a rural area of Japurá, Paraná State, Brazil, showing the vector's presence indoors, outdoors, and in residual forest. Sandfly captures were performed with Falc?o traps from 8:00 AM to 3:00 PM. At sites 195, 223, 236, and 527, three captures were performed at different times from December 2007 to January 2009. At sites 175 and 218, captures were performed from January to December 2008. 8,453 sandflies were captured, with an average of 155.40 specimens per hour. Nyssomyia neivai was the predominant species. Most sandflies were captured in domestic animal shelters (75.91 per hour) and in ciliary forest (38.45 per hour) during the hottest and rainiest months, in the outdoor environment with accumulation of organic matter and inadequate disposal of household wastewater. The study emphasizes the need for regular outdoor cleaning around households and building domestic animal shelters far from residences.     

Acquired immunodeficiency syndrome in Brazil and the State of Ceará

Since February 1998, a total of 129,000 cases of acquired immune deficiency syndrome have been reported in Brazil. The cumulative frequency of the disease is 82 per 100,000 which makes Brazil one of the countries moderately affected. There are considerable differences between regions in the frequency of cases, from 25 per 100,000 in the north and north east to 152 per 100,000 in the south east. Sexual intercourse is still the predominant means of transmission. Transmission in the early years of the epidemic was mostly between homosexuals and bisexuals, but transmission via heterosexual intercourse is increasing. The contribution made by intravenous drug use differs between the regions, and is particularly large in the mid-south region. A pilot project in the city of Fortaleza has shown that it is possible to successfully integrate the diagnosis of STD and AIDS in health care units at an intermediate level. This appears to be an appropriate strategy for the integration of STD treatment into primary health care in Ceará State. The non-uniform pattern of development of this epidemic must be taken into account in epidemiological analyses of AIDS in Brazil.