Neonatal mortality in Londrina, Paraná State, Brazil, in 1994, 1999, and 2002

Despite technological progress in recent decades, neonatal mortality accounts for some two-thirds of infant deaths where the infant mortality rates are low. This study analyzes neonatal deaths in Londrina, Paraná, Brazil, during three periods, beginning with 1994, the year when pediatric and neonatal intensive care beds were created in the city. The data were collected from live birth certificates in the National Information System on Live Births (SINASC) and individual analysis of neonatal death certificates. Births declined in the city, but the low birthweight rate increased from 7.7 to 8.8% and the preterm birth rate from 6.3 to 8.4%. Multiple births also increased. Caesarian sections varied from 48 to 52%. The percentage of deaths from congenital malformations increased. The vast majority of neonatal deaths are preventable, mainly by providing specialized care during pregnancy. The neonatal mortality rate has declined recently, from 10.1 to 6.4 per 1,000 live births. The authors conclude that neonatal care is improving in Londrina.     

Trends in dental caries rates in schoolchildren 12 and 13 years old in Florianópolis, Santa Catarina, Brazil, 1971-2002, in Florianópolis, Santa Catarina, Brazil

The goal of this study was to identify dental caries prevalence and severity among all 12 and 13-year-old schoolchildren enrolled in a public school in 2002 and to establish comparisons with the results of studies conducted previously in the same school in 1971 and 1997. A cross-sectional study involving 181 children was performed. Clinical data were collected by one examiner under World Health Organization (WHO) criteria. The examiner had been through calibration training. The project was approved by the Research Ethics Committee of the Federal University in Santa Catarina. The response rate was 93.8%. Intra-examiner agreement, on a tooth-by-tooth basis, was high (Kappa> or =0.73). The prevalence rates for dental caries were 98%, 93.7% or 80.0%, and 57.4% in 1971, 1997, and 2002, respectively. The mean DMF-T index was 9.2 in 1971, 6.2 or 3.0 in 1997, and 1.4 in 2002, taking both ages as a whole. The first value from 1997 was recorded under the Klein & Palmer diagnostic criterion and the second according to the WHO criterion. Between 1971 and 2002 there was a real reduction in caries prevalence and severity among the schoolchildren, even though different diagnostic criteria were used.     

What's in a country average? Wealth, gender, and regional inequalities in immunization in India

Recent attention to Millennium Development Goals by the international development community has led to the formation of targets to measure country-level achievements, including achievements on health status indicators such as childhood immunization. Using the example of immunization in India, this paper demonstrates the importance of disaggregating national averages for a better understanding of social disparities in health. Specifically, the paper uses data from the India National Family Health Survey 1992-93 to analyze socioeconomic, gender, urban-rural and regional inequalities in immunization in India for each of the 17 largest states. Results show that, on average, southern states have better immunization levels and lower immunization inequalities than many northern states. Wealth and regional inequalities are correlated with overall levels of immunization in a non-linear fashion. Gender inequalities persist in most states, including in the south, and seem unrelated to overall immunization or the levels of other inequalities measured here. This suggests that the gender differentials reflect deep-seated societal factors rather than health system issues per se. The disaggregated information and analysis used in this paper allows for setting more meaningful targets than country averages. Additionally, it helps policy makers and planners to understand programmatic constraints and needs by identifying disparities between sub-groups of the population, including strong and weak performers at the state and regional levels.     

Lead, mercury, and organochlorine compound levels in cord blood in Québec, Canada

We conducted this study to evaluate blood levels of lead, mercury, and organochlorine compounds in newborns in the Province of Quebec. During 1993 to 1995, we carried out a survey in 10 hospitals located in southern Quebec. During that time, umbilical cord blood samples were obtained from 1109 newborns, and we analyzed each for lead, mercury, 14 polychlorinated biphenyl congeners, and 11 chlorinated pesticides. We used the geometric mean and 95% confidence interval (CI) to describe the results. Mean concentrations of lead and mercury in cord blood were 0.076 micromol/l (95% CI = 0.074, 0.079) and 4.82 nmol/l (95% CI = 4.56, 5.08), respectively. The mean concentrations of total polychlorinated biphenyls (Aroclor 1260) and dichlorodiphenyl dichloroethylene were 0.514 microg/I (95% CI = .493, 0.536) and 0.412 microg/l (95% CI = 0.390, 0.435), respectively. We observed a statistically significant relationship between maternal age and cord blood concentrations of (a) lead, (b) mercury, (c) polychlorinated biphenyls, and (d) dichlorodiphenyl dichloroethylene. In addition, maternal smoking during pregnancy was associated with cord blood lead levels. The cord blood concentrations of lead, mercury, polychlorinated biphenyls, and dichlorodiphenyl dichloroethylene we measured in our study were the lowest levels recently reported in industrialized countries. The results of this study underline the role of public health authorities in the evaluation of biological levels of environmental contaminants among children for the assessment of risk of adverse health effects.     

Liver Lead Concentrations in Raptors in New Jersey,USA, 2008—2010

Lead exposure in New Jersey raptors was assessed by analyzing liver samples from carcasses obtained from wildlife rehabilitators. Samples were collected from 221 individuals representing 13 species. Concentrations were within the range of normal background exposure in 12 species. One red-tailed hawk had a liver lead concentration consistent with clinical poisoning (7.4 μg/g wet weight), which represents an incidence of 1% (1/104) in that species and 0.5% (1/221) in the overall sample. A second red-tailed hawk had a liver lead concentration consistent with subclinical exposure (2.1 μg/g wet weight). The combined incidence of elevated exposure (subclinical exposure + clinical poisoning) was 2% (2/104) in red-tailed hawks and 1% (2/221) in the overall sample.     

Survival in gastric cancer patients in Campinas, São Paulo, Brazil

This study analyzes the survival of gastric cancer patients in the city of Campinas, S?o Paulo State, Brazil. Data from the Campinas Population-Based Cancer Registry (RCBP) related to gastric cancer cases diagnosed from 1991 to 1994 were analyzed. Observed and relative survival rates were calculated, and to compare rates between different groups and international populations, the relative mortality risk was used. One-year relative survival rate for patients with gastric cancer was 33%, and five-year relative survival was 9%, confirming the poor prognosis of gastric cancer. Gender had no influence on survival, while the prognosis was better for young people. There was a gradient of severity from the localized to the metastatic state, not statistically significant. The group with undifferentiated adenocarcinomas had longer survival, with 47% of patients alive after the first year, whereas only 7% of those without a histological classification survived the first year after diagnosis. Compared with international results like the pool of European registries, the risk was greater, especially considering the five-year survival rates.     

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.     

Trachoma prevalence in preschoolers and schoolchildren in Botucatu,São Paulo State,Brazil, 1992

Trachoma dispensaries were created in the State of S?o Paulo in 1938, when the incidence of trachoma was 10.9% in Botucatu. During the 1970s trachoma ceased to pose a public health problem. The disease reappeared in the 1980s, leading the S?o Paulo State Health Department to establish a control program as new cases were being detected in various parts of the State, including Botucatu. This study aimed to determine the prevalence of trachoma in preschoolers and schoolchildren and to implement a program to control the disease in Botucatu. A cluster sample of children were submitted to external ocular examination to detect signs of trachoma according to WHO criteria. Trachoma prevalence was 11.9% among the 1,393 children examined. All cases were treated with 1.0% tetracycline ointment and followed up periodically. Loss to follow-up increased from 1.6% for the first return visit to 62.4% for the last visit. The results showed the need to investigate the causes of non-compliance with the control program and the impact and effectiveness of treatment.     

Ethnic variations in mortality in pre-school children in Denmark, 1973–2004

The objective of the study was to describe ethnic differences in under-five-years mortality in Denmark according to maternal country of origin. We conducted a large registry-linkage study of all singleton live-born children from mothers born in Denmark and from the ten largest migrant groups (n = 1,841,450). Study outcomes were death before the age of 5 years from all causes combined and the most frequent death causes. Results showed that children of mothers of Turkish, Pakistani, Somali and Iraqi origin had an elevated risk of dying before the age of five compared to offspring of mothers born in Denmark, with hazards ratios and 95% confidence intervals of 1.48 (1.31–1.67), 1.97 (1.68–2.32), 1.70 (1.29–2.25), and 1.92 (1.41–2.62), respectively. Ethnic differences were also observed in the underlying causes of death. Children of mothers born in Former Yugoslavia, Lebanon, Norway, Sweden, Iran, and Afghanistan did not differ in under-five-years mortality from ethnic Danish children. Adjustments for household income did not attenuate the risk estimates. In conclusion, we found excess child mortality in some migrant groups, but not in all. The differences could not be explained by socioeconomic status.     

Organochlorine pesticides in anhingas, white ibises, and apple snails collected in Florida, 1989–1991

Apple snails (Pomacea paludosa) and eggs and nestlings of anhingas (Anhinga anhinga) and white ibises (Eudocimus albus) were collected in Palm Beach County, Florida from 1989–1991 and analyzed for organochlorine pesticide (OCP) residues. Pesticide residues were not detected in the apple snails. Residues of DDT, with maximum concentrations of 1,200 g/kg wet weight occurred in 50% of the ibis samples but were not present in the anhinga samples. DDE occurred in 100% of avian samples at concentrations up to 2,100 g/kg and was at significantly greater concentration in the anhingas. Dieldrin was not detected in the first year of the three-year study, but occurred in the majority of avian samples in the last two years at concentrations up to 610 g/kg. Additionally, residues of seven pesticides and Aroclor^® 1016 were detected infrequently at very low concentrations in the birds. While it is possible that nearby municipal solid waste landfills were the source of the pesticides, no corroborating evidence was found to support this speculation.     

Pesticides in Fresh Potatoes Sold in Farmers’ Markets in Alberta,Canada

Fresh potatoes (228 samples) from 34 farmers’ markets in Alberta were analyzed for 29 pesticides. Residues of three different pesticides were found in the samples tested with chlorpropham being most frequently detected (n = 13) at concentrations ranging from 15 to 7,600 μg kg⁻¹. Azoxystrobin (n = 11) and imidacloprid (n = 8) were found at concentrations ranging from 0.6 to 5.1 and 15–31 μg kg⁻¹, respectively. All pesticide concentrations were below Canadian maximum residue limits as established for potatoes. No pesticide residues were detected in 23 potato samples obtained from certified organic farmers.     

Trends in breast-conserving surgery in Denmark, 1982–2002

Using hospital discharge data from the counties in Northern Denmark and the Danish Cancer Registry, we examined the trend in the prevalence of breast-conserving surgery (BCS) to treat primary breast cancer from 1982 through 2002, with an emphasis on publications that may have influenced surgical practice in Denmark. Overall, the prevalence of BCS increased from less than 1% of breast cancer operations in 1982 to approximately 25% by 2002. The rise in prevalence was most pronounced for the treatment of young women and women with early-stage breast cancer. Of three pivotal clinical trials, the most significant trigger of the upward trend appeared to be a study conducted by the Danish Breast Cancer Cooperative Group, published in 1988. After 1988, there was a steep rise in the prevalence of BCS. By 2002, BCS prevalence appeared to reach a threshold at 25% of breast cancer operations, seemingly defined by the proportion of new breast cancer cases who are good candidates for BCS.     

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.     

Development of children enrolled in preschools in Cuiabá, Mato Grosso State, Brazil

The aim of this study was to assess the neuropsychomotor development of children enrolled in daycare centers and preschools. This cross-sectional study used 38 items from the Denver II test to assess four and five-year-olds enrolled in the municipal school system in Cuiabá, Mato Grosso State, Brazil, from August 2002 to November 2003. There were 960 children enrolled in 27 daycare centers and two public preschools. Statistical analysis used the C2 test with a 95% confidence interval and +/- = 5%. Logistic regression was used to calculate the percentages with which the preschoolers passed the test at each respective age. Of the 960 preschoolers tested, 67% showed normal performance, 30.2% borderline, and 2.8% abnormal. In 27 of the 38 items, the proportion of correct answers was greater than 90%. Altered performance was more common in five-year-old boys. Performance in this sample was quite similar to that of preschoolers in Denver, Colorado, USA. The best results by gender were for girls, and by age in four-year-olds.