Falling diarrhoea mortality in Northeastern Brazil: did ORT play a role?

The impact of oral rehydration therapy (ORT) on the recent decline in diarrhoea mortality in the northeast of Brazil was studied. Proportionate infant mortality fell from 32% in 1980 to 17% in 1989 and infant deaths attributed to diarrhoea dropped from 41% to 25%, resulting in an overall reduction of 57%. Similar decreases were observed for children aged 1-4 years. Diarrhoea admissions also fell from 57% of infant hospitalizations in 1980 to 30% in 1990. None of the other major causes of death or admissions showed such decline. ORT was introduced in the early 1980s, being used in 35% of all episodes in 1991 and in 62% of those regarded as severe by the mother. Other changes included a worsening of socioeconomic conditions and increases in water supply, vaccine coverage, breastfeeding duration and nutritional status. A simulation model estimated that changes in factors other than ORT would lead to a 21% reduction in infant diarrhoea mortality, or about one-third of the actual decline. Finally, an ecological analysis showed that ORT use rates were inversely correlated to infant diarrhoea mortality (r=-0.61; p=0.04). Despite the shortcomings of the available data, these findings suggest an important impact of ORT on diarrhoea mortality.     

Socioeconomic situation and living conditions: comparison of two population-based cohorts from southern Brazil

Socioeconomic and family characteristics of two cohorts of babies born in 1982 and 1993 in Pelotas (Southern Brazil) were compared. There were 6,011 births in 1982 and 5,304 in 1993. In relation to family income, there were fewer poor babies in 1993; 60.8 % of the families earned less than 3 times the monthly minimum wage in 1993, as compared to 69.5% in 1982. Sanitary conditions also improved over the decade, and the proportion of families with running water and flush toilets increased by 10%. On the other hand, there were no changes in the proportion of single-parent families or availability of home appliances like radios, stoves, and refrigerators. The mean number of persons per household increased from 3.0 in 1982 to 3.2 in 1993. In general, comparison of the two birth cohorts in this city suggests an improvement in quality of living over the time period for families with newborns. This finding should be taken into account when studying the evolution of health indicators over the course of the decade.     

Regional trends in Portuguese gastric cancer mortality (1984-1999).

The international decline in gastric cancer is mainly attributed to improved socio-economic conditions. However, some southern and eastern European countries showed slower and later decline, reflecting a less favourable general environment The same probably applies to regional differences within countries, making national indicators potentially misleading. Fitting log-linear Poisson models we compared trends in gastric cancer mortality (1984-1999) across 18 Portuguese regions. Pearson correlation coefficients were computed to assess the regional association between decline in cancer mortality and baseline cancer mortality and variation in indices of social development and medical care. National gastric cancer mortality changed -2.0% year in men and -2.2% year in women. The regional yearly variation in mortality ranged from -3.5% [95% confidence interval (CI) -4.5 to -2.5] to -0.6% (95% CI -1.4 to 0.2) in men, and from -3.7% (95% CI -4.8 to -2.7) to -0.8% (95% CI -1.6 to 0.0) in women. Regional variation was not significantly associated with baseline gastric cancer mortality (r = 0.18, P = 0.47), but with the variation in post-neonatal mortality (r = 0.59, P = 0.01). In Portugal, gastric cancer shows a wide regional variation in frequency trends. The correlation with known indicators of social and economic development indicates that future improvement in gastric cancer rates is expected in parallel with a more widespread development.     

Social, familial, and behavioral risk factors for obesity in adolescents]

OBJECTIVE: To examine the impact of different social, familial, and behavioral factors on the risk of developing obesity in adolescents. METHODS: We performed a case-control study nested in a population-based cohort that was followed from birth in 1982. Cases were adolescents with obesity, as defined by the World Health Organization. Controls came from a randomly chosen sample of members of the cohort, examined in 1997 and 1998. Information concerning risk factors was obtained from cohort records that were collected at different ages. Multivariate analysis was carried out using logistic regression. RESULTS: Risk factors varied according to sex. Among boys, a family income at birth above one minimum wage was associated with a six-fold increase in obesity, and the presence of trait anxiety in adolescence with a four-fold increase. In both sexes, a one-unit increase in pre-pregnancy maternal body mass index was associated with a 10% increase in obesity. Smoking, fat consumption, time spent watching television or performing physical activity, and concurrent maternal weight were not associated with obesity. CONCLUSIONS: Our results show that it is important to stratify data from obesity studies according to sex. In addition, early-life factors were more strongly associated with obesity than factors present during adolescence. However, the possibility of reporting bias cannot be ruled out, especially in terms of the information provided on diet and physical exercise. Whenever possible, the study of concurrent risk factors for obesity in adolescence should take into account the confounding effect of early-life factors.     

In Vitro and In Vivo Evaluations of Dihydroquinoline- and Dihydroisoquinoline-based Targetor Moieties for Brain-specific Chemical Delivery Systems

Brain-targeted delivery of various drugs can be successfully achieved by chemical delivery systems (CDS) that contain a 1,4-dihydropyridine-based redox targetor moiety and undergo a sequential metabolism. However, the susceptibility of this moiety toward hydration in acidic media may limit the shelf-life of such compounds in aqueous formulation. Here, a systematic investigation of the chemical stability toward oxidation and hydration of ester and amide derivatives of 3-substituted 1,4-dihydropyridine, 1,4-dihydroquinoline, and 4-substituted 1,2-dihydroisoquinoline is reported, together with the in vitro stability and in vivo (rat) distribution of isoquinoline-based testosterone and hydrocortisone chemical delivery systems, which were selected as having the most suitable acid-resistant targetor moieties.     

Genetic Analysis of PARK2 and PINK1 Genes in Brazilian Patients with Early-Onset Parkinson's Disease

Parkinson''s disease is the second most frequent neurodegenerative disorder in the world, affecting 1-2% of individuals over the age of 65. The etiology of Parkinson''s disease is complex, with the involvement of gene-environment interactions. Although it is considered a disease of late manifestation, early-onset forms of parkinsonism contribute to 5–10% of all cases. In the present study, we screened mutations in coding regions of PARK2 and PINK1 genes in 136 unrelated Brazilian patients with early-onset Parkinson''s disease through automatic sequencing. We identified six missense variants in PARK2 gene: one known pathogenic mutation, two variants of uncertain role, and three nonpathogenic changes. No pathogenic mutation was identified in PINK1 gene, only benign polymorphisms. All putative pathogenic variants found in this study were in heterozygous state. Our data show that PARK2 point mutations are more common in Brazilian early-onset Parkinson''s disease patients (2.9%) than PINK1 missense variants (0%), corroborating other studies worldwide.