Tenth Asian and Oceanic Congress of Obstetrics and Gynaecology

The 10th Asian and Oceanic Congress of Obstetrics and Gynecology, held in Sri Lanka in September 1985, was entitled Health of the Mother and Child by the Year 2000. Most of the 300 participating physicians were from developing countries. Particular emphasis was placed on the high rates of maternal mortality in developing countries. Even where maternal-child health programs have been established, maternal health tends to be neglected. In some developing countries, maternal mortality rates are 500 times greater than those in developed countries. Training of traditional birth attendants and better provision of family planning were urged to reduce maternal morbidity and mortality. Other actions proposed at the conference included health education, mobile antenatal clinics in rural areas, establishment of more peripheral hospitals, and improvement in social and economic conditions. To reduce infant mortality, growth surveillance, oral rehydration, breastfeeding, and immunization were urged. A special session on planned parenthood for maternal-child health noted family planning's potential for preventing the complications of childbearing and abortion. Finally, it was pointed out that although family planning is supposed to be a basic human right for individuals and couples, political constraints on the manufacture, delivery, and free choice of methods persist in many countries.     

BTEX Emissions from the Largest Landfill in Operation in Rio de Janeiro,Brazil

The emission rates and the ambient air concentrations of benzene, toluene, ethyl benzene and xylenes (BTEX) were measured over the intermediate cover layer and atmosphere of the Seropédica landfill, Rio de Janeiro, Brazil. BTEX were sampled using coconut shell charcoal cartridges, followed by extraction with dichloromethane and analysis by gas chromatography with mass spectrometry. Thirteen samples were collected in areas with and without cracks in the cover layer, and six samples were collected from the ambient air. The average emission rates were 11.7, 492.2, 153.7, 67.2, and 21.7 µg m^??2 day^??1, respectively, for benzene, toluene, ethyl benzene, m?+?p-xylenes and o-xylene. No benzene concentrations above the detection limit were observed in ambient air samples. The average concentrations of toluene, ethyl benzene, m?+?p-xylenes and o-xylene in ambient air samples were 2.14, 1.35, 0.49 and 0.08 µg m^??3, respectively. Higher emissions were found in locations containing larger cracks during the collection.     

Contraceptive prevalence in the slums of Rio de Janeiro

A community-based family planning operations research project was undertaken in selected low income communities of Rio de Janeiro; project field work began in February 1982. Prevalence data were collected and service delivery strategies were tested, including home visits promoting family planning, home distribution of condoms, and the introduction of community family planning depots. A high baseline contraceptive prevalence rate (CPR) of 70.1 percent was found for nonpregnant women currently in union, as well as substantial use of the private sector for contraceptive supply, despite the presence of free or subsidized sources within the communities. However, the most economically disadvantaged subgroups made the greatest use of the subsidized sources. The provision of additional service delivery sites may have contributed to a small increase in contraceptive prevalence noted over the life of the project; however, the high baseline CPR precluded a large increase in contraceptive use as a result of the program.     

Monitoring the hepatitis A virus in urban wastewater from Rio de Janeiro, Brazil

Hepatitis A is a viral disease with a significant public health impact, especially in developing countries. Improvements in sewage services could prevent hepatitis A virus (HAV) dissemination into the environment and minimize the risk of infection. The aim of this study was to monitor HAV for one year in urban sewage samples from the largest wastewater treatment plant in Rio de Janeiro, Brazil, to assess environmental contamination with HAV and its dissemination after treatment by an activated sludge process. For this purpose, 48 samples (24 raw sewage samples and 24 treated effluent samples) were collected from August 2009 to July 2010 for HAV detection. Using quantitative real-time PCR 14 (58%) raw sewage samples were positive for HAV, and the highest viral genome loads were detected in the spring and summer. HAV was not detected in treated effluent samples, which suggests that the viral loads observed could be easily removed by the activated sludge process, thus preventing the dissemination of HAV into the environment. All of the HAV strains sequenced belonged to subgenotype IA, which clustered closely with Brazilian and Argentine HAV strains. These data demonstrate that environmental monitoring can be a useful tool in epidemiological studies.     

HIV vaccine evaluation center in Rio de Janeiro, Brazil

We conducted an HIV seroincidence study among high-risk men who have sex with men in Rio de Janeiro to determine whether this population would be suitable for vaccine and non-vaccine HIV prevention studies. There were 34 HIV seroconversions during the follow-up period, for a seroincidence of 3.1 per 100 person-years. The incidence among the youngest members of our cohort was over 8%, an extraordinarily high transmission rate for a homosexual male population. We have used the sensitive/less sensitive ELISA assay to identify a high-risk heterosexual population for intervention studies in Brazil. The estimated seroincidence was 1.9 and 2.8 per 100 person-years among heterosexual females and males, respectively. We are presently conducting a study to investigate behavior changes among 202 participants of a post-sexual-exposure chemoprophylaxis (PEP) study. During a median follow-up of 24 months, there were 11 HIV seroconversions, 10 of which were among non-PEP users. Additionally, we are conducting a phase 2 HIV vaccine trial of the ALVAC-HIV vector vCP1452 alone and in combination with a subunit vaccine, MN rgp120, in healthy adult volunteers. The primary goal of this trial is to define the immunogenicity and confirm the safety of the most promising vector-based vaccine alone and in combination with a recombinant envelope protein vaccine with an established safety and immunogenicity profile. A phase 3 HIV vaccine trial is planned to begin in the next 18-24 months.     

Middle-class teenage sexuality and pregnancy in Rio de Janeiro, Brazil

The subject of this paper is teenage pregnancy among middle-class youth, a topic not sufficiently studied in Brazil. The paper is based on a qualitative, socio-anthropological study of 14 middle-class families in Rio de Janeiro, Brazil, whose children have remained single, living with their parents after the child's birth. A total of 25 in-depth interviews were conducted with 6 young men and 7 young women, ages 18 to 24, and their parents (11 mothers, one father), to examine the event in retrospect and its impact on these young people and their families. Three aspects are analyzed: difficulties young people face in internalizing contraception as a norm; late discovery of pregnancy; and how the decision to either have an abortion or give birth is made by young people and their parents. This research allows seeing teenage pregnancy as an event that hinges on the process of constructing a young person's autonomy, in which sexuality plays a prominent role. Concluding, the phenomenon should be analyzed in a specific historical and cultural context, with changes over the decades in the rules underlying the process of individualization among young people.     

Hemophilia care in the state of Rio de Janeiro, Brazil.

In the developing countries of the world, few people with hemophilia receive adequate care. Nevertheless, Brazil has made significant advances in the treatment of hemophilia over the last decade. The provision of factor concentrates imported by the Government of Brazil is gradually increasing, and patients receive the concentrates for free. A national register was established as well as a coordinated program for comprehensive care. Of the 6 297 persons with hemophilia in Brazil who were registered as of January 2001, 689 of them (11.1%) were registered in the state of Rio de Janeiro. Of those 689, 664 of them were being monitored at the state's coordinating blood transfusion center, which is located in the city of Rio de Janeiro. Among those 664, factor VIII inhibitors were identified in 81 of them (12.2%). Among 653 of the Rio de Janeiro patients who were tested for transfusion-transmitted diseases, the overall prevalence found was 41.5%, with the specific rates being 13.3% for human immunodeficiency virus (HIV), 2.9% for hepatitis B virus (HBV), and 39.4% for hepatitis C virus (HCV). The state of Rio de Janeiro has adopted a comprehensive hemophilia management approach that includes medical, psychological, and social care. As a result, the quality of life of hemophilia patients has improved noticeably. For example, the rate of hospitalization among patients fell by 30% between 1998 and 2001, and there has also been a decline in the school and work activities that they have missed.     

Spatial distribution of mortality from acute myocardial infarction in Rio de Janeiro, Brazil

The study analyzes the spatial distribution of mortality from acute myocardial infarction (AMI) in Rio de Janeiro, Brazil. Data from the Mortality Information System refers to the year 2000. Empirical Bayes smoothing technique was used to minimize random variation in mortality coefficients due to the population size in the geographic analytical units. Spatial distribution of AMI mortality in the city of Rio de Janeiro is heterogeneous and displays a pattern associated with a strong socioeconomic gradient. The decreased AMI risk in the West Side of the city fails to reflect the social inequality and limited access to healthcare services observed there. A more likely hypothesis is that the risk of AMI death was underestimated in the West Side, due to the high proportion of ill-defined causes of death in that region. In the rest of the city, the spatial pattern of AMI mortality showed higher values in poorer areas. The various hospitals treating AMI also show a clear pattern in their areas of influence.     

PAHs and BTEX in Groundwater of Gasoline Stations from Rio de Janeiro City,Brazil

PAHs and BTEX were studied in groundwater from monitoring wells of gasoline stations of Rio de Janeiro City, Brazil during 2003 and 2004. Total PAH concentration ranged from 0.05 to 84.9 μg/L. Total BTEX concentration varied between not-detected to 3.6 × 10³ μg/L. Some samples exceeded the maximum concentration limit of Brazilian regulations for benzene in fresh or drinking water. Carcinogenic PAHs were found in few samples but only one sample in each year exceeded the regulated concentrations for benzo[a]pyrene. The concentrations of PAHs and BTEX indicate that some places may be contaminated by gasoline leakage.     

Neonatal screening for hemoglobinopathies in Rio de Janeiro, Brazil]

OBJECTIVE: To describe the main results obtained in the first 15 months of neonatal screening for sickle cell disease in the state of Rio de Janeiro, Brazil, from August 2000 to November 2001. METHODS: Starting in August 2000, blood samples began to be collected for sickle cell disease screening from all newborns receiving care in primary health care clinics in the state of Rio de Janeiro. The samples were submitted to high-resolution liquid chromatography. If the resulting chromatogram was compatible with sickle cell disease, the child and the parents were referred for diagnostic confirmation and treatment. RESULTS: Between August 2000 and November 2001, 99 260 newborns were screened. There was one case of homozygous Hb C. On average, one of every 27 newborns who were screened presented sickle cell trait (Hb AS). Sickle cell disease was observed in 83 cases, or one new case in each 1 196 births. The 83 consisted of: 62 Hb S, 18 Hb SC, and 3 Hb SD. One child did not appear for diagnostic confirmation. The 82 children who were followed up by the program presented 15 intercurrent illnesses (upper respiratory infections, fever, splenic sequestration crises, hand-foot syndrome, and vascular occlusion), resulting in seven hospital admissions. Blood transfusions were necessary with 15 children, but none developed alloimmunization. All the other babies were doing well with the use of prophylactic penicillin. CONCLUSIONS: Our data show the importance of early diagnosis for sickle cell disease, so as to prevent the frequent infectious complications faced by these patients.     

Organic micropollutants on river sediments from Rio de Janeiro State, Southeast Brazil

The paper is a contribution for the knowledge upon concentrations and fate of different kinds of organic micropollutants in Tropical River system from a very industrialized region in Brazil. The presented data was obtained during three years of an International Research Project between Brazilian and Dutch institutions. The sediments were sampled at the Paraiba do Sul-Guandu river watershed, the most important watercourse of Rio de Janeiro state, where up 90% of the population depends on its water for domestic uses. After extraction with non-polar solvents in a hot sohxlet device and clean up using chromatographic columns, three classes of organic micropollutants were analyzed: organochlorine insecticides (OCs), polychlorinated biphenyls (PCBs) and polynuclear aromatic hydrocarbons (PAHs). The organochlorines, including the PCBs were scarcely present in the collected samples probably reflecting the restrictions of use of this class of compounds in the Brazilian market. However, the PAHs levels were high at the vicinity of a huge steelworks located in the city of Volta Redonda. This contamination is probably due to the massive use of coal in the above-cited metallurgical plant.     

Food consumption by pregnant adolescents in Rio de Janeiro, Brazil

The increase in teenage pregnancy has been viewed with concern by public health experts. Food consumption to help maintain high nutrient demands has been identified as one of the most relevant components. This study aims to present the habitual consumption of food and energy-specific nutrients by pregnant adolescents. A total of 1,180 adolescent mothers were interviewed in maternity hospitals in the City of Rio de Janeiro, and a simplified questionnaire on semi-quantitative frequency of food consumption was applied. Lower consumption of fruit juice, vegetables, and fruits was observed among adolescent mothers over 15. Adolescent mothers classified in the lowest quartile of consumption lack the minimum recommended consumption of energy and nutrients. An inverse association was found between the number of household members and energy and nutrient consumption. Adolescent mothers who received dietary information and changed their eating habits during pregnancy showed better results concerning the consumption of energy and nutrients. Prenatal care was a key factor for improving the results of pregnancy, emphasizing the importance of providing dietary information.     

Evolution of neonatal mortality in the state of Rio de Janeiro, Brazil

This paper reports the results of a study on neonatal mortality in the State of Rio de Janeiro (1979-1993), according to major causes of death, by age and region of residence. The authors suggest criteria for grouping neonatal deaths according to causes, taking into consideration frequency and preventability. For deaths which occurred in the first day of life, immaturity and fetal growth retardation were the only causes of death that showed significant decline. An increase in deaths due to respiratory affections of the fetus and newborns was observed. Causes of death said to be reducible by "adequate control of pregnancy and attention at delivery" and "early diagnosis and treatment" remained unaltered. The authors noted that a decrease in death rates took place starting with the 1-6 day age group. The comparison with other countries called attention to the high rates of neonatal death in Rio de Janeiro. It also pointed out an increase in the proportion of deaths classified as "respiratory problems of the newborn", demonstrating lack of specificity in defining the basic cause of death.     

Income inequality and homicide rates in Rio de Janeiro, Brazil.

OBJECTIVES: This study determined the effect of income inequality on homicide rates in the state of Rio de Janeiro, Brazil. METHODS: We conducted an ecological study at 2 geographical levels, municipalities in the state of Rio de Janeiro and administrative regions in the municipality of Rio de Janeiro. The association between homicide and income inequality was tested by multiple regression procedures, with adjustment for other socioeconomic indicators. RESULTS: For the municipalities of Rio de Janeiro State, no association between homicide and income concentration was found an outcome that can be explained by the municipalities' different degrees of urbanization. However, for the administrative regions in the city of Rio de Janeiro, the 2 income inequality indicators were strongly correlated with the outcome variable (P < .01). Higher homicide rates were found precisely in the sector of the city that has the greatest concentration of slum residents and the highest degree of income inequality. CONCLUSIONS: The findings suggest that social policies specifically aimed at low-income urban youth, particularly programs to reduce the harmful effects of relative deprivation, may have an important impact on the homicide rate.     

Enteroparasitosis in pregnant and post-partem women in Rio de Janeiro

From November 1989 to May 1991, in Rio de Janeiro, Brazil, the prevalence of intestinal parasitosis was investigated in 795 women coming from the Public Health Services, who were divided into three groups: 490 pregnant women in pre-natal care period, 104 after-delivery women and 201 non-pregnant women (control). Coproparasitologic tests were run using the Sedimentation through Centrifugation, Faust, Kato-Katz and Baermann-Moraes methods. Positivities were found ranging from 37.6% to 53.6% for pregnant women, 38.3% for non-pregnant women and 69.2% for after-delivery women, with statistically significant differences between the rates of pregnant women and after-delivery women, and with no statistic difference between the groups of pregnant and non-pregnant women. The most frequent parasites found were A. lumbricoides and T. trichiura. The conclusion was that the control of intestinal parasitosis is not a priority in the pregnant population studied because, in spite of the regular assistance provided during the pre-natal care period, they keep on infected.     

Epidemiology of childhood tuberculosis in the city of Rio de Janeiro, Brazil

Data was drawn from a study on the epidemiological trends of tuberculosis among children of Rio de Janeiro county, Brazil. There was an increased incidence of tuberculosis among children and epidemiological health indicators were above the national average.     

AIDS mortality in the State of Rio de Janeiro, 1991-1995

This article focuses on the AIDS mortality profile as related to socioeconomic and geographic variables, as well as evaluating the impact of deaths from AIDS in the State of Rio de Janeiro. The analysis included all death certificates for residents of the State from 1991-1995, 10,024 of which had AIDS recorded as the primary cause of death. In the 20-49-year age bracket, among individuals who had died of AIDS, the proportion of those with university schooling (14%) and the proportion of single individuals (75%) were greater than the respective proportions for all other causes of death (5.4% and 56.3%). For the population as a whole, the AIDS mortality rate increased from 1991 to 1995, from 20.6/100,000 to 30.2/100,000 for males and from 3.7/100,000 to 7.9/100,000 for females. For the year 1995 in the 20-49-year bracket, considering the 17 groups of causes from the ICD-9, AIDS was the third most common cause of death among men and the fifth most common among women. The proportion of Potential Loss of Life Years up to 65 years as a function of AIDS increased from 1991 to 1995, from 3.4% to 4.7% for men and from 1.4% to 2.9% for women. During this same period there was also an increase in the number of counties in the State of Rio de Janeiro with reported deaths from AIDS.