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.     

Stroke mortality by residence and place of death: Paraná State, Brazil, 2007

This study analyzed stroke mortality in Paraná State, Brazil, in 2007, according to residence and place of death, using the official Mortality Information System. For deaths in individuals 65 years and older and from 45 to 64 years of age, 17.6% and 29.8%, respectively, occurred at home. An association was observed between region of residence and less than three years of schooling (OR = 3.96) four to seven years of schooling (OR = 1.75), and race or skin color (non-white: OR = 1.39). Place of death was associated with age over 65 (OR= 1.69), less than three years of schooling (OR = 1.70), and residence in municipalities other than the respective headquarters of the Regional Health offices (OR = 1.33). The results suggested inequalities in access to hospital care at the time of death from stroke, according to region of residence and socioeconomic variables. The study supports use of the Mortality Information System as a data source to back public health policies and interventions. Further studies are needed to evaluate the factors that influence quality of patient care for stroke and to verify whether the same pattern is repeated in mortality from other causes.     

Human and canine American cutaneous leishmaniasis in Mariluz, Paraná State, Brazil

An outbreak of American cutaneous leishmaniasis was reported in 2002 in Mariluz, northwestern Paraná State, Brazil. Of 38 humans who were investigated, four had healed lesions, ten showed lesions in the healing process, and 24 had active lesions. Of the 126 dogs, 20 (15.9%) presented suggestive lesions and 24 (19%) had positive serology. Parasites isolated from two patients and three dogs were identified as Leishmania (Viannia) braziliensis serodeme I. The captured sand flies were identified as Nyssomyia whitmani, N. neivai, and Migonemyia migonei. Considering that the region where the cases occurred is similar to other old human settlements in Paraná State, the environmental alterations and remaining forests facilitate the maintenance of the parasite's enzootic cycle and transmission to humans and domestic animals, thereby maintaining the endemicity of American cutaneous leishmaniasis.     

Spatial evolution of cardiovascular mortality in Paraná State, Brazil: 1989-1991 and 2006-2008

This ecological study aimed to describe the spatial distribution of cardiovascular mortality in Paraná State, Brazil (1989-1991 and 2006-2008) and its correlation with socioeconomic variables, using mortality data from the DATASUS database and population data from IBGE. Mortality rates were adjusted by the local empirical Bayesian method. Correlation analysis used the Moran I index and Spearman coefficient. There were no significant correlations or spatial dependence between mortality and socioeconomic variables. Mortality was higher in males in both periods. Cardiovascular mortality declined from 1989-1991 to 2006-2008 and was higher in females. Construction of thematic maps allowed visualization of the regions with highest cardiovascular risk. The decrease in mortality can be partially explained by expanded access to health services and improved living conditions and income.     

Multiple perceptions of infant mortality in Ceará State, Brazil

This qualitative study analyzes the perceptions of various social actors towards infant mortality and the program to reduce it in Ceará State, Northeast Brazil. The study compares two municipalities (counties) that showed opposite infant mortality trends from 1993 to 1997, during which time Ceará achieved international visibility for having reduced infant mortality statewide. A total of 48 semi-structured interviews with four groups of key informants health system managers, community health agents, mothers who had lost a child, and neighbor women with children in the same age bracket and content analysis revealed "multiple conflicting voices" on the issue. Although the level of political determination to implement the interventions varied between the two municipalities, the differences in perceptions concerning infant death were more striking between the various groups of social actors, regardless of the municipality. The study revealed a kind of authoritarian educational practice that jeopardizes acceptance of the Community Health Agents Program. Public policies are needed that give voice to the people closest to the experience of infant death.     

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.     

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.     

Systematic notes of Anopheles konderi and its first record in Paraná State, Brazil

We analyzed nuclear (second internal transcribed spacer and white gene) and mitochondrial (cytochrome c oxidase subunit I) data from Anopheles konderi collected in the Amazonian states of Acre, Amapá, and Rond?nia and the southern Brazilian state of Paraná. This was the first record of An. konderi in the state of Paraná. We found a high degree of genetic divergence within the Amazonian region and support for An. konderi as a species complex, possibly consisting of 3 species.     

Evaluation of sandfly control in Lobato municipality, Paraná State, southern Brazil

Sandfly control measures were evaluated at the Da Barra Ranch, Lobato municipality, Paraná State, Brazil. The insects were captured with Falc?o traps in houses, a cattle corral, and a forest area from July to November 1999 and from February to June 2000. In December 1999 and January 2000 the following measures were taken to decrease the sandfly density in peridomiciliary areas and domiciles: (i) screens were placed on windows of buildings (domiciles, dormitory, cafeteria); (ii) all organic material was cleaned from the peridomiciliary area; and (iii) buildings were sprayed for insects. There were more Nyssomyia whitmani, Pintomyia fischeri, P. monticola, and Brumptomyia brumpti specimens in the former period, while N. neivai, Migonemyia migonei, and N. pessoai predominated in the latter. In the initial period most of the sandflies were captured in the forest and in the latter period in the houses. The sandfly control measures did not reduce the sandfly population on the Da Barra Ranch, but they led to significant proportional changes in the insect fauna composition.     

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.     

Canine American cutaneous leishmaniasis in municipalities of northern Paraná State, Brazil

American cutaneous leishmaniasis (ACL) is an endemic disease in northern Paraná State, where it affects humans and dogs. This study aimed to verify the occurrence of the canine disease in ACL endemic areas. From September 1999 to July 2002, dogs were investigated in 7 rural areas of 5 municipalities where autochthonous human cases of ACL had been reported. Parasitological and serological methods were used. Fourteen of 67 dogs studied (20.9%) had lesions suggestive of ACL, of which 3 (21.4%) were infected with Leishmania sp. Indirect immunofluorescence for Leishmania (Viannia) braziliensis was positive in 37 (55.2%) of 67 dogs. The results showed that human and canine ACL occur simultaneously and indicate the need for additional studies to elucidate the role of dogs in the ACL transmission cycle in the area studied.     

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.     

Underreporting of maternal deaths in Paraná State, Brazil: 1991-2005

The objective of this article was to analyze the underreporting of maternal deaths in Paraná State, Brazil, from 1991 to 2005, identifying details on the basic causes that keep maternal deaths hidden and problems with completing items 43 and 44 on death certificates during a recent period (2003-2005). Data were obtained from the database of the Paraná State Committees for the Prevention of Maternal Mortality, which investigate maternal deaths using the Reproductive Age Mortality Survey (RAMOS). According to the data, maternal mortality decreased by 26% in 15 years, but the level of underreporting remained the same, generating adjustment factors ranging from 1.6 to 1.8. In conclusion, medical schools and the State medical board should provide more incisive and comprehensive orientation on completing death certificates in order to minimize this underreporting. The Paraná State Committees for the Prevention of Maternal Mortality help correct underreporting of maternal deaths by identifying their real causes and determinants and defining strategies to reduce them. More effective measures to reduce avoidable maternal deaths are still needed in the State.     

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.     

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.     

Socioeconomic trends and differentials in mortality due to cervical cancer in the State of Paraná (Brazil), 1980-2000

The scope of this paper is to discuss the evolution of mortality due to cervical cancer in the State of Paraná, Brazil, between 1980 and 2000 and analyze the socioeconomic differentials in each region of the State. Mortality data were gathered from the System for Information on Mortality by age and town of residence. Age-adjusted death rates were calculated for 22 regions of the state in each year. Comparative analysis evaluated socioeconomic indicators associated with regions that showed either stationary or increasing mortality trends. Cervical cancer deaths increased in the state of Paraná, with an annual percentage increase of 1.68% (1.20 to 2.17, 95% confidence interval). Most of the regions presented a stationary trend of cervical cancer deaths. The comparison of regions presenting an increasing trend indicated poorer socioeconomic indices for the former set: regions with an increase in cervical cancer mortality had a significantly higher illiteracy rate (p<0.001), percentage of individuals older than 15 years with less than 4 years schooling (p=0.001), and lower per-capita income (p=0.025) and human development index (p=0.023). An increasing mortality trend was thus observed throughout the State and areas with higher mortality rates had poorer socioeconomic indices.     

Factors associated with secondary breast cancer prevention in Maringá, Paraná State, Brazil

This study analyzed the prevalence of secondary breast cancer prevention and associated factors in women 40 to 69 years of age in Maringá, Paraná State, Brazil. Prevalence was 64.5% for breast self-examination, 71.5% for clinical examination, and 79% for mammography. The data suggest that age, schooling, ethnicity, socioeconomic status, religion, and prior hormone replacement therapy influenced the rates of the three types of examination. Preventive practices were significantly more common among women of higher socioeconomic status. Proper orientation and performance of preventive measures and tests should be at the reach of all women in the highest-risk age bracket, thereby decreasing late diagnosis and avoidable deaths and increasing the odds of curing breast cancer.     

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.     

Occupational violence problems in an emergency hospital in Londrina, Paraná, Brazil

Workplace violence is currently a worrying factor at many hospitals. The objectives of this study were to characterize the occupational violence problems detected by health workers in an emergency hospital. The study was exploratory and transversal, with a quantitative data approach. It took place at the emergency ward of a general hospital in Londrina, Paraná. The study population included 33 people from the nursing team and 14 medical doctors. Data were collected through interviews with health workers and staff managers, as well as assessment of violence records from the last seven years. 100% of nurses, 88.9% of technicians, 88.2% of nurse assistants, and 85.7 % of doctors said that they had been victims of workplace violence, although not documented. The types of violence suffered included verbal assault (95.2%) and moral and sexual battery (33.3%). Preventive measures to reduce occupational violence should be applied.