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1.
J. pediatr. (Rio J.) ; 87(3): 219-224, maio-jun. 2011. ilus, tab
Article in Portuguese | LILACS | ID: lil-593187

ABSTRACT

OBJETIVO: Avaliar a prevalência e a sazonalidade do vírus respiratório sincicial humano (VRSH) em crianças de 0 a 6 anos hospitalizadas por infecção aguda das vias aéreas inferiores (IVAI) em São José do Rio Preto (SP) e a associação entre faixa etária, diagnóstico e VRSH. MÉTODOS: Entre maio de 2004 e setembro de 2005, foram estudados 290 episódios consecutivos de IVAI adquiridos na comunidade em crianças de 0 a 6 anos internadas no Hospital de Base de São José do Rio Preto. Para identificação do VRSH, foram coletadas amostras de secreção de nasofaringe e realizou-se análise molecular por meio da técnica de RT-PCR. RESULTADOS: A prevalência de VRSH foi de 29,3 por cento nos episódios de IVAI hospitalizados. A IVAI foi frequente em lactentes (mediana de idade = 13,5 meses). O VRSH foi mais frequente nos casos de bronquiolite (64 por cento) e no primeiro ano de vida (35 por cento). Os episódios de infecção por VRSH ocorreram entre o outono e a primavera, com frequência maior em 2004 do que em 2005. Os critérios clínicos e radiológicos não foram suficientes para o diagnóstico de infecção pelo VRSH. Em 78,8 por cento dos episódios de VRSH, houve tratamento com antibiótico. CONCLUSÕES: A prevalência do VRSH em crianças de 0 a 6 anos hospitalizadas por IVAI foi elevada, com predomínio nas mais jovens ou com bronquiolite. A circulação do vírus variou nos dois anos estudados. Os resultados sugerem necessidade de diagnóstico laboratorial do VRSR na prática clínica.


OBJECTIVE: To evaluate the prevalence and seasonality of human respiratory syncytial virus (HRSV) in children aged 0 to 6 years, hospitalized with acute lower respiratory infection (ALRI) in São José do Rio Preto, SP, Brazil, and the association between age, diagnosis, and HRSV. METHODS: Between May 2004 and September 2005, we studied 290 consecutive episodes of community-acquired ALRI in children aged 0 to 6 years admitted to the Hospital de Base of São José do Rio Preto. In order to detect HRSV, nasopharyngeal secretion samples were collected and RT-PCR molecular analysis was performed. RESULTS: The HRSV prevalence was 29.3 percent for the cases of hospitalized patients with ALRI. ALRI was common in infants (median age = 13.5 months). HRSV was more frequent in cases of bronchiolitis (64 percent) and during the first year of life (35 percent). Episodes of HRSV infection occurred between fall and spring, showing higher frequency in 2004 than in 2005. Clinical and radiological criteria were not sufficient to establish the diagnosis of infection with HRSV. Antibiotic therapy was used in 78.8 percent of episodes of HRSV. CONCLUSIONS: There was a high prevalence of HRSV in children aged 0 to 6 years who were hospitalized for ALRI, predominantly in younger patients or those with bronchiolitis. The circulation of the virus varied in the two years studied. Our results suggest the need for laboratory diagnosis of HRSV in the clinical practice.


Subject(s)
Child , Child, Preschool , Humans , Infant , Infant, Newborn , Bronchiolitis/virology , Hospitalization/statistics & numerical data , Respiratory Syncytial Virus Infections/epidemiology , Seasons , Brazil/epidemiology , Bronchiolitis/epidemiology , Prospective Studies , Respiratory Syncytial Virus Infections/pathology , Respiratory Syncytial Virus, Human/isolation & purification , Statistics, Nonparametric
2.
Arq. ciênc. saúde ; 15(1): 17-23, jan.-mar. 2008. tab
Article in Portuguese | LILACS | ID: lil-516789

ABSTRACT

Objetivos: Identificar o perfil sócio-demográfico; características da vida sexual e reprodutiva; características do pré-natal, intercorrências e tipo de parto; tipo de orientações recebidas no pré-natal; freqüência de baixo peso, prematuridade e Apgar. Método: Estudo descritivo, de 84 mães adolescentes com parto entre 01/10/2004 a 01/12/2004. Resultados: Das adolescentes estudadas, 96,4% tinham entre 15 a 19 anos; 73,8% viviam com o companheiro; 65% recebiam até três salários mínimos; 79,3% nunca tinham trabalhado; 52,4% freqüentavam a escola quando engravidaram. A média de idade da primeira relação sexual foi de 15 anos; 64,3% faziam uso de contraceptivo; apenas 9,5% usavam-no quando engravidaram; 100% das adolescentes fizeram pré-natal; 58,5% iniciaram no primeiro trimestre de gravidez; 84,6% fizeram de seis a doze consultas; 83,3% eram primíparas e 83,3% não planejaram a gravidez. As complicações maternas foram: 44% anemia; 35,7% infecção urinária; 14,3% sangramento vaginal; 14,2% pressão alta; 2,4% diabetes gestacional e 1,2% eclampsia. Parto cesárea foi feito em 61,9%. Receberam orientação para não fazer uso de medicação sem ordem médica 85,7% das adolescentes; para não usar drogas 73,8%; quanto aos prejuízos do fumo e bebida alcoólica 72,6%; em relação ao tipo de alimentação na gestação 70,2%; sobre os cuidados com os dentes 54,8%; sobre os sinais do início do trabalho de parto 72,6%; quanto aos tipos de parto 60,7%; sobre a importância do aleitamento materno 76,2%; quanto ao banho do bebê 17,9% e 18,3% sobre o curativo doumbigo. Encontrou-se 6% de recém-nascidos de baixo peso e prematuros; o Apgar foi superior a 8 em 86,9%dos casos no primeiro minuto e 95,1 % no quinto minuto. Neste grupo de adolescentes, a assistência pré-natal adequada (início no primeiro trimestre e número mínimo de seis consultas) permitiu bons resultados, apesar da idade das mães estar associada com gravidezes de risco.


Objectives: To describe the socio demographic profile; sexual and reproductive life; prenatal care, event and labor type; kind of orientations received in the prenatal period; low weight frequency, pre-term and Apgar..Methods: Descriptive study of 84 adolescent mothers with childbirth between the 1st October 2004 to the 1st December 2004. Results: Of the studied adolescents, 96.5% were aged between 15 to 19 years; 73.8% lived with their partner; 65% earned up to three minimum wages; 79.3% have never worked; 52.4% were attending school when they have got pregnant. The mean age at the first sexual intercourse was 15 years; 64.3% have been using contraceptive; only 9.5% were using it when got pregnant; 100% made prenatal visits; 58.5% initiated them in the first quarter of gestation; 84.6% had six to twelve consultations; 83.3% were primiparas and 83.3% have not planned their pregnancy. Maternal complications were: 44% anemia; 35.7% urinary tractinfection; 14.3% vaginal bleeding; 14.2% high blood pressure; 2.4% gestational diabetes and 1.2% eclampsia. Caesarian labor was performed in 61.9%. A total of 85.7% of adolescents have received orientations for not using any medication without medical prescription; 73.8% for not using drugs; 72.6% in relation to smokingand alcoholic drink damages; 70.2%, in relation to the kind of diet during gestation; 54.8% on dental care;72.6% on signals of the labor starting; 60.7% the labor types; 76.2% on the importance of maternal breastfeeding; 17.9% on the baby’s bath and 18.3% on the umbilicus dressing. Six percent of newborns werelow birth weight and preterm; Apgar was superior to 8 in 86% of the cases in the first minute, and 95.1% in thefifth minute. In this group of adolescents, the proper prenatal assistance( beginning in the first quarter and six consultation at least) has allowed good results, although, the association of the mothers´age with risks in the pregnancy.


Subject(s)
Humans , Female , Adolescent , Adult , Adolescent/physiology , Prenatal Care/statistics & numerical data , Pregnancy in Adolescence/statistics & numerical data , Mothers/statistics & numerical data
3.
Arq. neuropsiquiatr ; 65(supl.1): 5-13, jun. 2007. tab
Article in English | LILACS | ID: lil-452666

ABSTRACT

PURPOSE: To provide a situation assessment of services for people with epilepsy in the context of primary health care, as part of the Demonstration Project on Epilepsy in Brazil, part of the WHO/ILAE/IBE Global Campaign 'Epilepsy out of the shadows'. METHODS: We performed a door-to-door epidemiological survey in three areas to assess the prevalence of epilepsy and its treatment gap. We surveyed a sample of 598 primary health care workers from different regions of Brazil to assess their perceptions of the management of people with epilepsy in the primary care setting. RESULTS: The lifetime prevalence of epilepsy was 9.2/1,000 people [95 percent CI 8.4-10.0] and the estimated prevalence of active epilepsy was 5.4/1,000 people. Thirty-eight percent of patients with active epilepsy were on inadequate treatment, including 19 percent who were taking no medication. The survey of health workers showed that they estimated that 60 percent of patients under their care were seizure-free. They estimated that 55 percent of patients were on monotherapy and that 59 percent had been referred to neurologists. The estimated mean percentage of patients who were working or studying was 56 percent. Most of the physicians (73 percent) did not feel confident in managing people with epilepsy. DISCUSSION: The epidemiological survey in the areas of the Demonstration Project showed that the prevalence of epilepsy is similar to that in other resource-poor countries, and that the treatment gap is high. One factor contributing to the treatment gap is inadequacy of health care delivery. The situation could readily be improved in Brazil, as the primary health care system has the key elements required for epilepsy management. To make this effective and efficient requires: i) an established referral network, ii) continuous provision of AEDs, iii) close monitoring of epilepsy management via the notification system (Sistema de Informação da Atenção Básica - SIAB) and iv)...


OBJETIVO: Avaliar a situação da assistência à epilepsia no contexto da atenção primária sob o Projeto Demonstrativo em epilepsia no Brasil, parte da Campanha Global Epilepsia Fora das Sombras da WHO/ILAE/IBE. MÉTODO: Fizemos um levantamento epidemiológico para definir a prevalência e lacuna de tratamento em epilepsia. Avaliamos a percepção de 598 profissionais de saúde da atenção básica de diferentes regiões do Brasil sobre epilepsia e seu manejo na rede básica de saúde. RESULTADOS: A prevalência acumulada de epilepsia foi de 9,2/1000 pessoas (95 por centoIC= 8,4-10) e a prevalência estimada de epilepsia ativa foi de 5,4/1000 pessoas. Trinta e oito porcento dos pacientes com epilepsia ativa estavam sendo tratados inadequadamente, incluindo 19 por cento que estavam sem medicação. A enquete com os profissionais de saúde mostrou que a média estimada de pacientes livre de crises sob os cuidados dos mesmos era de 60 por cento. A média estimada de porcentagem em monoterapia era de 55 por cento. A média estimada de porcentagem de referência para neurologistas era de 59 por cento. A média estimada de porcentagem de pacientes que estavam trabalhando ou estudando era de 56 por cento. A maioria dos médicos não se sente confiante em atender uma pessoa com epilepsia. DISCUSSÃO: A análise situacional da Fase I - estudo epidemiológico nas áreas de interesse do PD mostrou que a prevalência da epilepsia é similar a outros países em desenvolvimento e a lacuna de tratamento é grande. Um dos fatores importantes para a lacuna de tratamento é a falta de adequação à assistência na atenção básica. Essa situação pode ser revertida no Brasil, pois os elementos chaves existem na rede básica para o manejo de pessoas com epilepsia. Entretanto, para torna efetivo e eficiente é preciso i) estabelecimento de um sistema de referência e contra-referência, ii) fornecimento contínuo de medicação anti-epiléptica, iii) monitorização de manejo de pessoas com epilepsia através...


Subject(s)
Humans , Anticonvulsants/therapeutic use , Epilepsy/drug therapy , Health Personnel , Process Assessment, Health Care , Primary Health Care/standards , Brazil/epidemiology , Epilepsy/epidemiology , Prevalence , Primary Health Care/statistics & numerical data , Socioeconomic Factors
4.
Arq. neuropsiquiatr ; 65(supl.1): 58-62, jun. 2007. graf
Article in English | LILACS | ID: lil-452674

ABSTRACT

PURPOSE: To assess the outcome of patients with epilepsy treated at primary care health units under the framework of the demonstration project on epilepsy in Brazil, part of the WHO/ILAE/IBE Global Campaign Against Epilepsy. METHOD: We assessed the outcome of patients treated at four primary health units. The staff of the health units underwent information training in epilepsy. The outcome assessment was based on: 1) reduction of seizure frequency, 2) subjective perception from the patients and the physicians point of view, 3) reduction of absenteeism, 4) social integration (school and work), and 5) sense of independence. RESULTS: A total of 181 patients (93 women - 51 percent) with a mean age of 38 (range from 2 to 86) years were studied. The mean follow-up was 26 months (range from 1 to 38 months, 11 patients had follow-up of less than 12 months). Seizure frequency was assessed based on a score system, ranging from 0 (no seizure in the previous 24 months) to 7 (>10 seizure/day). The baseline median seizure-frequency score was 3 (one to three seizures per month). At the end of the study the median seizure-frequency score was 1 (one to three seizures per year). The patients and relatives opinions were that in the majority (59 percent) the health status had improved a lot, some (19 percent) had improved a little, 20 percent experienced no change and in 2 percent the health status was worse. With regard to absenteeism, social integration and sense of independence, there were some modest improvements only. DISCUSSION: The development of a model of epilepsy treatment at primary health level based on the existing health system, with strategic measures centred on the health care providers and the community, has proved to be effective providing important reductions in seizure frequency, as well as in general well being. This model can be applied nationwide, as the key elements already exist provided that strategic measures are put forward...


OBJETIVO: Avaliar o resultado do tratamento de pacientes com epilepsia na atenção básica sob o modelo proposto pelo Projeto Demonstrativo no Brasil, como parte da Campanha Global Contra a Epilepsia da WHO/ILAE/IBE. MÉTODO: Avaliamos o resultado do tratamento nos pacientes acompanhados em quatro unidades básicas de saúde. As equipes de saúde fizeram um treinamento padrão. O resultado do tratamento foi baseado em cinco aspectos: 1) redução da freqüência das crises, 2) percepção subjetiva dos pacientes e dos médicos, 3) redução de absenteísmo, 4) integração social (escola, trabalho), e 5) senso de independência. RESULTADOS: Um total de 181 pacientes (93 mulheres - 51 por cento), com uma média de 38 anos (variando de 2 a 86 anos) entraram nesta análise. O tempo médio de seguimento foi de 26 meses (variou de 1 a 38 meses, 11 pacientes tinham seguimento menos de 12 meses). A freqüência das crises foi categorizada variando de 0 (sem nenhuma crise nos últimos 24 meses) a 7 (>10 crises/dia). O escore mediano da freqüência de crises no começo era de 3 (uma a três crises por mês). O escore mediano da freqüência de crises no final era de 1 (uma a três crises por ano). A opinião dos pacientes e familiares é que a maioria (106 casos) houve uma melhora importante na saúde, 34 tiveram pouca melhora, 37 não tiveram mudanças e em quatro houve piora. Em relação ao absenteísmo, integração social e senso de independência houve pouca melhora. DISCUSSÃO: O modelo desenvolvido de tratamento de epilepsia na atenção primária com base na estrutura de saúde existente, com estratégias centradas nos profissionais de saúde e na comunidade, provou ser efetivo com redução importante na freqüência das crises bem como na melhora em geral da saúde. Esse modelo pode ser aplicado em âmbito nacional, pois os elementos chaves já existem, desde que essas estratégias sejam pactuadas com os organismos locais de saúde.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged, 80 and over , Epilepsy/therapy , Outcome Assessment, Health Care , Primary Health Care/standards , Absenteeism , Adaptation, Psychological , Brazil , Epilepsy/psychology , Follow-Up Studies , Interviews as Topic , Program Evaluation , Quality of Life , Social Adjustment , Treatment Outcome
5.
Braz. j. infect. dis ; 9(5): 384-389, Oct. 2005. tab
Article in English | LILACS | ID: lil-419647

ABSTRACT

The prevalence of hepatitis B virus (HBV) in healthcare workers (HCW) in Brazilian university hospitals is high. However, vaccination of these workers and relations with occupational factors are not well documented. A prospective study was made of 1,433 HCW and 872 administrative employees of the Hospital de Base (HB), São José do Rio Preto, SP, Brazil, and 2,583 blood donor candidates from the Hospital Blood Bank. HCW were observed from January 1994 to December 1999. Data were obtained from exams made when a worker entered hospital service, periodically and after work-related injuries. Serological reactions were analyzed in HCW who received HBV vaccine. Occupational and non-occupational information was obtained through a questionnaire. The prevalence of HBV among HCW (0.8 percent) was significantly higher than in blood-donor candidates (0.2 percent). Among the HCW who were vaccinated, 86.4 percent were immunized. Multivariate analysis revealed that increased age reduced the chance of immunization. Among the occupational factors, time in service contributed to a 14 percent increase in the chances of having positive serology, and work-related injuries increased the risk of HBV infection 4.29 times. The maximum risk sector presented a larger number of HCW with positive anti-HBc serology. There was a higher seroconversion in HCW who received the full set of HBV vaccines. In HCW with positive serology, the factors that presented greatest risks were time in service, work-related injuries and maximum risk sector.


Subject(s)
Female , Humans , Male , Accidents, Occupational/statistics & numerical data , Blood Donors , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Health Personnel/statistics & numerical data , Hepatitis B Vaccines/therapeutic use , Hepatitis B/epidemiology , Antigen-Antibody Reactions , Biomarkers/blood , Brazil/epidemiology , Enzyme-Linked Immunosorbent Assay , Epidemiologic Methods , Hepatitis B Antibodies/blood , Hepatitis B Antibodies/immunology , Hepatitis B Surface Antigens/blood , Hepatitis B Surface Antigens/immunology , Hepatitis B virus/chemistry , Hepatitis B virus/immunology , Hepatitis B/blood , Hepatitis B/prevention & control , Hospitals, Teaching/statistics & numerical data , Immunization Programs , Occupational Exposure/statistics & numerical data
6.
Arq. ciênc. saúde ; 12(1): 3-7, jan.-mar. 2005. tab
Article in Portuguese | LILACS | ID: lil-429589

ABSTRACT

O estudo teve como objetivo analisar a concordância de diagnósticos clínicos e atestados de óbitos comparados aos relatórios finais de autópsia. A pesquisa foi elaborada utilizando-se casos autopsiados maiores de 1 ano, apresentando diagnóstico da causa básica de morte, ocorridos em hospital universitário entre 1993 e 1995. Na análise de concordância foram aplicados os métodos estatísticos de qui-quadrado (c2), regressão logística multivariada e coeficiente kappa. A percentagem de autópsias em óbitos foi de 5,6. O principal motivo de solicitação para autópsias foi confirmação diagnóstica. A concordância dos diagnósticos clínicos e relatórios finais foi igual a 0,537 (IC 95 0,451 a 0,622), tendo sido influenciado pela alta concordância entre autópsias solicitadas para pesquisa. Entre atestados do óbito e relatórios finais obteve-se concordância igual a 0,651 (IC 95 0,510 a 0,792). Constatou-se baixa percentagem de autópsias no período de estudo para um hospital-escola. Os níveis de concordância entre diagnósticos obtidos mostram que a autópsia continua sendo importante para o diagnóstico correto da causa de óbito.


Subject(s)
Male , Female , Humans , Autopsy , Cause of Death , Death Certificates , Clinical Diagnosis/statistics & numerical data , Hospitals, University
7.
Arq. neuropsiquiatr ; 61(2A): 194-198, Jun. 2003. tab
Article in English | LILACS | ID: lil-339486

ABSTRACT

This study was done to evaluate the long-term patient's satisfaction after carpal tunnel syndrome (CTS) electrodiagnostic done between 1989 and 1994 (5 to 10 years follow-up). Mail contact was made to 528 consecutive cases with a questionnaire to be filled; 165 patients responded after 19 exclusions. CTS severity was graded from 0 (incipient) to 4 (severe) after a combination of median sensory distal latency, sensory median-radial latency difference and amplitude of the median compound muscle action potential. Current symptoms ("cure", improved, unchanged or worsed) and the therapy utilized, either surgical or conservative, were analyzed to the initial CTS severity, age and duration of symptomatology. Surgical release was done in 114 cases (69 percent). Patient's satisfaction after surgical and non-surgical were respectively, 77.6 percent and 16 percent ("cure"), 13.6 percent and 52 percent (much improved), 5.4 percent and 9.3 percent (little improved), 2.7 percent and 16 percent (unchanged), 0.7 percent and 6.7 percent (worsed). The frequency of "cure" versus unchanged/worsed or "cure"/much improved versus unchanged/worsed was highly significative (Fisher, P-value < 0.001) and was not influenced by the CTS electrophysiological severity. There was no relationship between the outcome after surgery and duration of symptomatology, age or CTS severity. Conservative benefice was more prevalent in those with shorter symptomatology and older age; the majority of conservative failure cases had mild initial CTS. We concluded the excellent surgical benefice described by patients and the absence of any predictive factors based on CTS severity, age or duration of symptomatology for outcome


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Carpal Tunnel Syndrome/therapy , Carpal Tunnel Syndrome/diagnosis , Carpal Tunnel Syndrome/physiopathology , Electrophysiology , Median Nerve , Neural Conduction , Patient Satisfaction , Retrospective Studies , Time Factors , Treatment Outcome
9.
Arq. neuropsiquiatr ; 58(2B): 412-7, jun. 2000. tab
Article in English | LILACS | ID: lil-264438

ABSTRACT

OBJECTIVES: The industrialization process and nervous system cancer (NSC) mortality in a urban region of Brazil. METHOD: From registries of the State System of Data Analysis Foundation (SEADE), 103 males deaths by NSC (ICD-9) in Baixada Santista (BS), from 1980 to 1993 were selected. Mortality ratios were calculated comparing the standardized mortality rate for ages over 10 years old (G1) and for the age group from 35 to 64 years old, in the industrialized and non-industrialized areas in three periods: 1980-1993, 1980-86, 1987-93. RESULTS: A statiscally significant high mortality was observed in the industrialized area, for ages over 10 in all periods and only from 1980 to 1993 for ages from 34 to 64. The highest mortality ratio occurred from 1980-86 for ages over 10 - 4.12 (CI 1.79-9.42). CONCLUSION: High mortality was probably related to the environmental and occupational exposure to many organic and inorganic chemical substances, considered carcinogenics, such as aliphatic and aromatic hydrocarbons, organochlorinated, formaldehyde, nitrogenated compounds and heavy metals, found in the port and industrial complex. We discuss the importance of case-control studies in characterizing the association of these and other risk factors in the determination of NSC.


Subject(s)
Humans , Male , Child , Adolescent , Adult , Middle Aged , Carcinogens/adverse effects , Industry , Nervous System Neoplasms/mortality , Occupational Diseases/mortality , Occupational Exposure , Brazil/epidemiology , Nervous System Neoplasms/chemically induced , Occupational Diseases/chemically induced , Risk Factors , Urban Health
10.
Rev. saúde pública ; 33(3): 255-61, jun. 1999. tab
Article in Portuguese | LILACS | ID: lil-242031

ABSTRACT

Introdução Visando a estudar a relação entre câncer e industrialização analisou-se a evolução da mortalidade por câncer da região na Baixada Santista, SP (Brasil), importante complexo industrial-portuário cujos municípios se agrupam em duas diferentes áreas quanto ao processo de industrialização. Métodos Selecionaram-se 8.546 óbitos por câncer (CID-9), de indivíduos do sexo masculino acima de dez anos de idade, residentes nos municípios da Baixada Santista, no período de 1980 a 1993. Calcularam-se as taxas de mortalidade padronizada pela população mundial e as respectivas razões entre as taxas para a região e seus estratos: Estrato I (complexo industrial-portuário - Santos, São Vicente, Cubatão e Guarujá), e Estrato II (não industrializado - Praia Grande, Mongaguá, Itanhaém e Peruíbe). Resultados A taxa anual média de mortalidade da Baixada Santista mostrou ­ se alta (197,9/100.000). Houve diferença estatisticamente significante entre as taxas de mortalidade observadas para os Estratos I e II, respectivamente 209,2 e 146,7/100.000, com razão de 1,42 (IC 1,36 - 1,51). Conclusões Supõe-se que a exposição ocupacional e ambiental a agentes químicos carcinogênicos relacionados ao processo produtivo do complexo industrial, vários deles já identificados, sejam fatores importantes na determinação da mortalidade por câncer. Nesse sentido outros estudos epidemiológicos são necessários para melhor caracterizar o excesso de mortalidade na área industrial da região estudada


Subject(s)
Humans , Male , Adult , Middle Aged , Adolescent , Child , Mortality/trends , Neoplasms/mortality , Urban Population , Brazil/epidemiology , Environmental Exposure , Occupational Exposure
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