[Correlation between homicide rates and economic indicators in São Paulo, Brazil, 1996]. / Relação entre homicídios e indicadores econômicos em São Paulo, Brasil, 1996.

Around 30% of the deaths due to violent causes in Brazil result from homicides. Violence has traditionally been related to larger social problems, such as poverty. Recently, however, a positive correlation has been observed between higher incomes and an increase in the homicide rate, so that some researchers have begun to consider inequality, rather than poverty, as an explanation for the epidemic of violence. The objective of this study was to investigate the correlation between urbanization, poverty, and economic inequality and homicide rates in the state of São Paulo, Brazil, in 1996. Information regarding population size, average monthly income of household heads, income distribution, and Gini index was obtained for each municipality, based on the demographic census. Homicide rates were calculated based on official data. Data were analyzed in terms of correlation and relative risk with 95% confidence intervals. Homicide rates rose in direct proportion to city population and ranged from 6.96 (per 100,000 inhabitants) in municipalities with a population smaller than 10,000 inhabitants, to 55.54 in municipalities with more than 1 million inhabitants. Relative risk ranged from 1.35 to 7.98. A significant correlation with population size was found only for incomes above 3.11 times the minimum wage and a Gini index greater than 0.50. There was a strong, direct, and significant correlation between homicide rates and the income ratio between the ninetieth and the twentieth percentiles of the population. It is necessary to probe more deeply into the macrosocial determinants of homicide rates in order to identify indicators of inequality that can generate meaningful data for developing public health strategies.

[Time trends in death rates from homicides in the city of Sao Paulo, Brazil, 1979-1994]. / Tendencia temporal da mortalidade por homicidios na cidade de Sao Paulo, Brasil, 1979-1994.

To study homicide trends by gender and age, 1979-1994, São Paulo, Brazil, cubic polynomials were used to determine the best model for adjusting to time trends in homicide mortality rates by age and gender in the city of São Paulo, Brazil, 1979-1994. The model best adjusted to each group was selected considering the regression coefficient (Beta) , R2 value, residual analysis, and model's simplicity. The results show linear growth for total rates and rates by gender due to behavior of rates in the 20-29 and 30-39 year age groups. The reciprocal model adjusted best to rates for the 40-49 and 50-59 year age groups, while rates for adolescents followed the multiplicative model. There was no significant relationship between homicide rates and time for the remaining groups (under 10 and over 59 years). Rates for males were considerably higher in all age groups. The remarkably steady growth in homicide rates among adolescents and young adults is consistent with trends observed in other urban areas in developing and developed countries and denotes deteriorating living conditions and increased poverty.

Intra-urban differentials in death rates from homicide in the city of São Paulo, Brazil, 1988-1994.

The objective of this research was to analyze the relationship between socioeconomic statistics and homicide mortality rates in the city of São Paulo between 1988 and 1994. City districts were grouped into five geographic areas. A socioeconomic indicator (ISE) was constructed with census information combining average income of the family head, illiteracy rate for the population over 5 yr of age, average number of rooms and number of persons per household. The higher the score, the better the socioeconomic situation (possible values: 4 to 384). Deaths from homicide were grouped by residential areas, and the rates for these areas were calculated. The association between homicide rates and the socioeconomic situation was analyzed with Spearman correlation coefficients. Average ISE scores varied from 291 in the Central area (homicide rate = 27.96 deaths per 100000) to 119.9 in the East area (homicide rate = 40.38). The Spearman coefficient between ISEs and homicide rates was -0.98 (p < 0.05). Due to the heterogeneity inside the areas, the median ISE is a better indicator of the socioeconomic conditions yielding an rs = -1.0. Almost half the population resides in areas with the highest risk of homicide mortality (East and South). Taking the Central area as a reference, we found risks of 1.36 in the Western, 1.37 in the Northern, 1.44 in the Eastern and 2.67 in the Southern areas.

Technologic organization of malaria control in São Paulo, Brazil, 1930-1990.

Since the 1970s, when the world seemed on the threshold of malaria eradication, the incidence of the disease has increased in several countries. The upturn in cases raised a series of questions, and for some time malariologists and public health authorities scarcely understood what was happening. In an attempt to better comprehend the process, this article reviews the frequency of malaria cases in São Paulo, Brazil, between 1930 and 1990, examining the following factors in each of three 20-year time periods: the importance of malaria in the society, the conditions under which the disease occurred, the epidemiologic knowledge of the time, the technical instruments available to fight it, and the control strategies that were used. Through the construction of technological models based on these factors, it became clear that the occurrence of the disease, knowledge about it, and, consequently, the ways it was dealt with changed over time. In light of this research, the article discusses current options for the control of malaria.

[Technological organization of malaria control in São Paulo, Brazil, from 1930 to 1990]. / Organización tecnológica del control de la malaria en São Paulo, Brasil, de 1930 a 1990.

Since the 1970s, when malaria had seemed at the threshold of eradication, its incidence has increased in several countries of the world. This situation posed a series of questions, and for some time malariologists and public health authorities scarcely understood what was happening. In order to better comprehend the process, the author of this article studied the frequency of malaria cases in São Paulo, Brazil, from 1930 to 1990, attempting to examine the following factors in each of the periods studied: the importance of malaria in the society, the conditions under which the disease occurred, the epidemiologic knowledge of the time, the available technical instruments, and the control strategies that were used. Through the construction of technological models based on these factors, it became clear that the occurrence of the disease, knowledge about it, and, consequently, the ways it was dealt with changed over time. In light of this research, the paper discusses current options for the control of malaria.

[Trends in the teaching of epidemiology in Brazil]. / Tendências no ensino da epidemiologia no Brasil.

The teaching of epidemiology in Brazil began in the 1920s and has always been connected to public health. The 1970s witnessed an expansion in the number of graduate-level courses in epidemiology. The 1980s were characterized by "social epidemiology," which incorporated the social sciences and their methods into epidemiology; the second half of the decade was marked by the development of biostatistical techniques. Currently, the definition of guidelines for the teaching of epidemiology in Brazil depends on careful reflection regarding a number of issues, among which are the reformulation or elimination of medical residency programs in preventive medicine, social medicine, and collective health; the creation of masters and doctoral programs exclusively in epidemiology; the conflict between a theoretical emphasis and a technical emphasis; and the development of strategies to strengthen new instructional groups that are being created in teaching institutions in less developed regions of the country. A positive trend is that teaching institutions are working more closely with health services, both for training personnel and for providing technical support in planning, organizing, and evaluating health programs. Regarding the teaching of health service professionals, successful training depends on how well teachers can provide in-service training that ties students' learning to real work situations, where the application of theories can be understood in the natural context of real problems.