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.     

Integrated assessment of multilevel biomarker responses and chemical analysis in mussels from São Sebastião, São Paulo, Brazil

The aim of the present study was to investigate the presence of contaminants in the mussel Perna perna from S?o Sebasti?o Channel, S?o Paulo, Brazil, and to evaluate the effects of these contaminants on these organisms at biochemical (catalase [CAT], glutathione-S-transferase [GST], and cholinesterase [ChE]), cellular (neutral red retention time [NRRT] assay), and physiological (cardiac monitoring) levels. Two sampling surveys were performed (winter of 2001 and summer of 2002) at six stations along the channel: Cigarras, station 1; Iate Clube de Ilhabela, station 2; Oil Terminal, station 3; Toque Toque, station 4; Ponta da Sela, station 5 (reference station); and Taubaté, station 6. Differences in CAT activity were observed between mussels from stations 3 and 5 during the winter, but no differences were detected in the summer. No differences in GST activity were found among stations during the winter, although animals from station 3 showed higher activity during the summer. The ChE activity was significantly higher in the mussels from stations 1 and 2 during the winter and from stations 1 and 3 during the summer. Organisms from stations 1 through 4 showed statistically lower NRRT in both seasons. Similar heart rates were observed in the mussels from all stations. Hydrocarbons were detected in organisms from all the stations in both seasons. During the winter, higher polycyclic aromatic hydrocarbon (PAH) levels were observed in organisms from station 3, whereas during the summer, higher levels of metals were found in organisms from stations 1, 3, and 4. The multivariate analyses showed a strong influence of PAHs on the winter biological results, but metals showed higher influence on these responses in the summer, indicating multiple contaminant sources.     

Epidemiology of tegumentary leishmaniasis in São João, Manaus, Amazonas, Brazil

In Manaus, Amazonas State, Brazil, the degree of individual exposure to leishmaniasis is related to disorganized land occupation. In order to evaluate predisposing factors for an outbreak, confirm the parasitological diagnosis, treat patients, and assess etiological agents, reservoirs, and vectors, a 12-month study was conducted in Manaus in a community located along the BR-174 federal highway. Some 451 individuals were studied, among whom 17 cases of American tegumentary leishmaniasis (ATL) were diagnosed (six women and 11 men). Age varied from one to 64 years. Eleven patients had from one to three lesions. As for reservoirs, three opossums were captured. No hemoflagellates were found in the blood tests. Lutzomyia umbratilis was the predominant vector species captured. Many ATL patients were engaged in activities that exposed them to Leishmania vectors. Some patients may have been infected in the household and peridomiciliary environments. The epidemiological profile of ATL in this community is similar that of other foci in the region. This case series characterizes ATL as an endemic local public health problem.     

Characteristics of adolescent pregnancy in São Luís, Maranhão, Brazil

OBJECTIVE: To identify the main socioeconomic, demographic, anthropometric and behavioral characteristics, and pregnancy outcomes of adolescent pregnancy and to assess health services used by pregnant adolescents. METHODS: Data were collected from a cross-section of 2,429 deliveries by women residing in the municipality of S?o Luís, Brazil, of which 94% were hospital births. Women were categorized into six age groups. The two groups of teenagers (under 18 and 18-19 years) were compared to four groups of older women. Comparison was also made between the two teenage groups. The chi-square test was used to compare proportions and prevalence ratio was used as an effect measure. RESULTS: Of 2,429 women, 714 (29.4%) were adolescents. Their specific fertility coefficient was higher than in other regions of the country. Adolescents showed lower socioeconomic and reproductive conditions than older women and a higher proportion of inadequate prenatal care. The majority had no partner. They had the lowest percentages of caesarean section and smokers. CONCLUSIONS: Despite their equally unfavorable socioeconomic situation, 18-19 year-old adolescents had pregnancy outcomes comparable to the age group 25-29, whereas those under 18 had the highest proportions of low birth weight, preterm birth, and infant mortality rate. This suggests that biologic immaturity may be associated with adverse pregnancy outcomes.     

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.     

Risk factors for preterm births in São Luís, Maranhão, Brazil

Preterm birth continues to be one of the main causes of neonatal morbidity and mortality. The objective of the present study was to identify risk factors for preterm birth in S?o Luís, Maranh?o, Brazil. The sample consisted of hospital births at 10 public and private hospitals from March 1, 1997 to February 28, 1998. A total of 2,443 live births were randomly selected, excluding multiple deliveries and stillbirths. Preterm birth rate in S?o Luís was 12.7%. Risk factors for preterm delivery were maternal age below 18 years, family income equal to or less than one minimum wage/ month, primiparity, vaginal delivery at a public hospital, single mothers (or living without a partner), and absence of prenatal care. The following factors remained associated with preterm birth after multivariate analysis to control for confounding: maternal age below 18 years (OR=1.9), primiparity (OR=1.5), and failure to appear for scheduled prenatal care visits (OR=1.5).     

Social representations concerning dengue, dengue vectors, and control activities among residents of São Sebastião on the northern coast of São Paulo State, Brazil

This study sought to identify people's knowledge on dengue and its vector biology, aimed at promoting a communications channel between technical and lay reasoning in order to foster community involvement in dengue and dengue vector control activities. A survey was conducted in an Aedes aegypti-infested area with dengue transmission in S?o Sebasti?o on the northern coast of S?o Paulo State, Brazil. One hundred interviews were held, with five open questions on topics related to dengue and vector control. Collective Subject Discourse methodology was used in the analysis. People were not able to properly identify the kinds of accumulated water sources that serve as breeding places for mosquitoes and were unaware of the egg phase in vector development. There was inadequate awareness of vector biology and a need for greater government-community integration. Educational activities should incorporate the study results as insight for improving the social efficiency and efficacy of joint actions to fight dengue and control the mosquito vector.     

Neonatal mortality trends in São Luís, Maranhão, Brazil, from 1979 to 1996

This study examined neonatal mortality trends in S?o Luís in the last 18 years. The early and late components were assessed and causes were classified according to SEADE Foundation criteria based on reducibility of deaths and timing of prevention (during prenatal care, childbirth, or neonatal care). Data were derived from official live birth and death records. We detected an unexpected increase in the neonatal mortality rate, due primarily to a steep rise in early neonatal deaths. Causes reducible by early diagnosis and treatment (other specific infections and other neonatal respiratory causes) and those partially reducible by adequate monitoring of pregnancy (preterm births, low birth weight, and respiratory distress syndrome) showed the largest increase. Conversely, the post-neonatal mortality rate fell. The infant mortality rate remained the same, reflecting these antagonistic trends. The important rise in the neonatal mortality rate from 1995 onwards suggests a deterioration in the quality of obstetric and neonatal services. The high cesarean rate and overcrowded neonatal services (i.e., unable to cope with increasing demands foe specialized neonatal care) indicate the urgent need for restructuring the mother and child health care system.     

Rapid assessment of current infant feeding practices in São José do Rio Preto, São Paulo, Brazil

This paper describes a rapid assessment of current infant feeding practices conducted during a mass immunization campaign in an urban area of S?o José do Rio Preto, S?o Paulo State, Brazil. Parents or guardians of all infants (<1 year) attending the 8 randomly-selected health centers were interviewed. Median duration of breastfeeding practices was estimated by probit analysis. Of the 719 infants, 692 (96.2%) began breastfeeding, and only 63 (8.9%) were in exclusive breastfeeding. Median duration of total breastfeeding (exclusive plus partial) was 205.93 days. Infants born by cesarean section showed a higher risk of early weaning: OR (95%CI)=1.51 (1.09-2.09) after adjusting for confounding variables (mother's educational level, gestational age, birth weight, whether breastfed). Median duration of total breastfeeding was higher among infants born by vaginal delivery (227.38 days; 95%CI=195.19-271.16) as compared to cesarean section (192.84 days; 95%CI=128.23-273.34). Early introduction of weaning foods such as water/herbal tea and cow's milk was observed with a median age at introduction of 30 days. These findings indicate the need to improve strategies by the public health services to promote exclusive breastfeeding.     

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.     

Hospital costs related to streptococcal meningitis among children in São José dos Campos, São Paulo State, Brazil

Knowledge of hospital costs is highly important for public health decision-making. This study aimed to estimate direct hospital costs related to pneumococcal meningitis in children 13 years or younger in the city of S?o José dos Campos, S?o Paulo State, Brazil, from January 1999 to December 2008. Data were obtained from medical records. Hospital costs were calculated according to the mixed method for measurement of quantities of items with identified costs and value attribution to items consumed (micro-costing and gross-costing). All costs were calculated according to monetary values for November 2009 and in Brazilian currency (Real). Epi Info 3.5.1 was used for frequencies and means analysis. Forty-one cases were reported. Direct hospital costs varied from R$ 1,277.90 to R$ 19,887.56 (mean = R$ 5,666.43), or 10 to 20 times the mean cost of hospitalization for other diseases. Hospital staff labor was the highest cost, followed by medication, procedures, supplies, and lab tests.     

Health resort, industrial city: urban space and health policy in São José dos Campos, São Paulo, Brazil

This study is part of the renewed theoretical and conceptual approach to space in health policies. The key potential of this approach lies in dealing with the organization of space as a product of relations between society and state power, influenced by the economy and enabled by politics. When understood as a social construction, such space provides the material basis for a historical narrative, allowing a better understanding of how policies are formulated and implemented in urban space. Based on this space, we investigate the policy governing the configuration of health services in the city of S?o José dos Campos, S?o Paulo, Brazil, during two different periods: the 1920s, in which the town became a health resort, and the early 1980s, when the municipal public health system was organized. A historical and geographic social reconstitution revealed both ambiguities and consistencies in a town whose health profile acquired the characteristics of an industrial city.     

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.     

Accidental home deliveries in southern São Paulo, Brazil

OBJECTIVE: To identify the frequency, risks of fetal and early neonatal mortality and the determinants of accidental home deliveries. METHODS: A population-based case control study of fetal and early neonatal deaths was carried out in the southern area of S?o Paulo, Brazil. Data were collected through home interviews and hospital record reviews. The reasons reported by the mothers were obtained from interviews and risk factors for home delivery were obtained comparing home to hospital deliveries. Data were analyzed separately for fetal and early neonatal deaths and survivors. Odds ratios, 95% confidence intervals and Fisher's exact test were used in estimating risk factors and mortality risk. RESULTS: The 0.2% frequency of home deliveries was underestimated in the live births information system. After adjustment, it reached 0.4%, comparable to other urban areas in Europe. All home deliveries identified were accidental and were associated to an increased fetal and early neonatal mortality. Mothers' social conditions and pregnancy characteristics were associated to accidental home deliveries and these factors are different outcomes studied (fetal losses, early neonatal deaths and survivors). In 30%, mothers reported lack of available transportation to the hospital as a reason for home delivery. Failure of health services in identifying labor women and non-availability of emergency care contributed to accidental home deliveries. CONCLUSIONS: Though rare events in urban areas, accidental home deliveries should be of special concern to health services because they seem to be avoidable and imply in increased risk of death.     

Microbiological evaluation of sugarcane juice sold at street stands and juice handling conditions in São Carlos, São Paulo, Brazil

Fresh sugarcane juice is sold by street vendors without any heat treatment in S?o Carlos, S?o Paulo, Brazil. Twenty-four samples of point-of-sale juice were tested by standard methods to determine heterotrophic bacteria, total and thermo-tolerant coliform counts, Salmonella, and parasites in the juice. 25% of samples showed poor sanitary conditions, with thermo-tolerant coliform levels higher than allowed by Brazilian standards. Salmonella spp. and parasites were absent in all samples. Thermo-tolerant coliforms were detected on the hands of 37% of juice handlers, and heterotrophic bacterial counts reached 2.0 x 10(3) cfu/per hand. Escherichia coli was detected in one hand sample, and no Salmonella spp. was detected. Screening questionnaires were used to interview the vendors, and 62% of interviewees were either unfamiliar with or failed to adopt adequate hygiene for food handling.     

The population's knowledge concerning dengue fever, vectors, and control measures in São José do Rio Preto, São Paulo state

Educational campaigns to inform the population about dengue fever, vectors, and related control measures have been carried out since 1985 by health services. In order to assess knowledge levels in S?o José do Rio Preto, S?o Paulo, a household survey was performed with a sample of 537 households in the urban area of S?o José do Rio Preto, S?o Paulo, in April and May 1995, where the same number of women were interviewed with questions about dengue fever, vectors, and control measures. Knowledge as displayed was satisfactory, except for that concerning hemorrhagic dengue. However, acquisition of knowledge was not followed by adoption of necessary control measures was insufficient to decrease infestation rates for dengue vectors in the city.