HIV/AIDS: use of the ICF in Brazil and South Africa--comparative data from four cross-sectional studies.

INTRODUCTION: Human immunodeficiency virus (HIV) is a serious disease which can be associated with various activity limitations and participation restrictions. The aim of this paper was to describe how HIV affects the functioning and health of people within different environmental contexts, particularly with regard to access to medication. METHOD: Four cross-sectional studies, three in South Africa and one in Brazil, had applied the International Classification of Functioning, Disability and Health (ICF) as a classification instrument to participants living with HIV. Each group was at a different stage of the disease. Only two groups had had continuing access to antiretroviral therapy. The existence of these descriptive sets enabled comparison of the disability experienced by people living with HIV at different stages of the disease and with differing access to antiretroviral therapy. RESULTS: Common problems experienced in all groups related to weight maintenance, with two-thirds of the sample reporting problems in this area. Mental functions presented the most problems in all groups, with sleep (50%, 92/185), energy and drive (45%, 83/185), and emotional functions (49%, 90/185) being the most affected. In those on long-term therapy, body image affected 93% (39/42) and was a major problem. The other groups reported pain as a problem, and those with limited access to treatment also reported mobility problems. Cardiopulmonary functions were affected in all groups. CONCLUSION: Functional problems occurred in the areas of impairment and activity limitation in people at advanced stages of HIV, and more limitations occurred in the area of participation for those on antiretroviral treatment. The ICF provided a useful framework within which to describe the functioning of those with HIV and the impact of the environment. Given the wide spectrum of problems found, consideration could be given to a number of ICF core sets that are relevant to the different stages of HIV disease.

[HIV, HPV, and syphilis prevalence in a women's penitentiary in the city of São Paulo, 1997-1998]. / Prevalência de HIV, papilomavírus humano e sífilis na Penitenciária Feminina da Capital, São Paulo, 1997-1998.

Incarcerated women as a group are particularly vulnerable to infections. The lack of public programs for prevention, early diagnosis, and treatment contribute to the increase in the incidence and prevalence of diseases in general and especially sexually transmitted diseases. This article aims to estimate the prevalence of infection by the human immunodeficiency virus (HIV), human papillomavirus (HPV), and syphilis among inmates at the Women's Penitentiary in the State capital of São Paulo, Brazil. All inmates were invited to participate in the study, which was divided into two stages: 1. STD/AIDS preventive workshops including interviews and 2. laboratory tests. The interview covered knowledge of STD/AIDS, risk behavior, and individual reproductive health history. A total of 262 women, with a mean age of 32.4 years and limited schooling, participated in more than one stage of the study. Prevalence rates were 14.5% for HIV, 16.3% for high-oncogenic-risk HPV probes, 4.8% for low-oncogenic-risk HPV probes, and 5.7% for syphilis. The authors conclude that STD/HIV constitute a serious health problem in the prison system, requiring urgent preventive measures.

Ischemic heart disease. Hospitalization, length of stay and expenses in Brazil from 1993 to 1997.

OBJECTIVE: To identify characteristics of the hospitalizations due to ischemic heart disease (IHD) made by the Single Health System--"Sistema Unico de Saúde (SUS) in Brazil from 1993 to 1997. METHODS: The information used came from records of permissions for hospitalization due to IHD (diseases codified from 410 to 414 by the International Disease Classification--9th Revision) furnished by the data bank DATA-SUS. The material studied was classified according to age, sex and length of hospitalization of the patients, and expenses to the system for IHD. RESULTS: IHD represents 1.0% of total hospitalizations. Angina pectoris was the most frequent type, occurring in 53.3% of the cases, followed by acute myocardial infarct (26.6%). This later was more frequent in men and angina in women. The majority of patients with IHD stayed hospitalized from 5 to 8 days. In the years of 1997 the expenses due to hospital treatment for IHD reach to 0.01% of Brazil's Gross Internal Product. In the studied period (1993-1997), IHD was responsible by 1.0% of hospitalizations, however it was 3.3% of the expenses of SUS. CONCLUSION: IHD is an important cause of hospitalization by the SUS; it has a rather high cost, indicating the need for preventive measures aimed at reducing exposure to risk factors and to decrease the incidence of this group of diseases in the nation.

[Use of the disease family classification in epidemiology and health related problems]. / O uso em epidemiologia da família de classificações de doenças e problemas relacionados à saúde.

This paper describes the evolution of disease frequency statistics and techniques used to present them. Beginning in the 17th century were the first specific references to causes of death and proceeding practically until the mid-20th century as mortality statistics by causes, the instrument for a methodical description of diseases was classification of causes of death. From the latter half of the 20th century on, in addition to mortality statistics by cause, morbidity statistics became routine, with the adoption of disease classification and no longer only classification by cause of death. More recently, classification has been adapted to medical specialties, resulting in what has been termed "disease family classification", including classification of the consequences of diseases, with statistics on disability. Disease classification, both for mortality and morbidity, fostered the development of various types of epidemiological studies (both descriptive and analytical) that expanded knowledge on health.

[Indicators of maternal and infant health: implications of the 10th revision of the International Classification of Diseases]. / Indicadores da saúde materna e infantil: implicações da décima revisõ da Classificação Internacional de Doenças.

Since the end of the 1940s, when the World Health Organization assumed responsibility for the decennial revisions of the Classification of Causes of Death, the Classification came to include diseases and definitions of use in vital statistics, resulting in the Sixth International Classification of Diseases (ICD-6). The most recent revision of this work, the International Statistical Classification of Diseases and Related Health Problems (ICD-10), is more significantly different than any revision since ICD-6, especially in the area of maternal and child health. Among the changes introduced in ICD-10 are the inclusion of obstetrical tetanus in the chapter on infectious diseases, which will facilitate the recording of this cause of maternal death; the incorporation of new definitions, such as late maternal death; and the redefinition of the perinatal period, which ICD-10 defines as starting at 22 completed weeks of gestation and ending 7 completed days after birth. This article seeks to highlight these changes and to discuss their consequences for the presentation and interpretation of indicators used in the evaluation of maternal and child health.

[Evaluation of the use of the International Classification of Diseases for the codification of AIDS]. / Avaliação do uso da Classificação Internacional de Doenças para codificar a síndrome da imunodeficiência adquirida.

The International Classification of Diseases (ICD) provides codes for all conditions and permits international comparisons of morbidity and mortality. Because it has to be used all over the world its codes are not always perfectly appropriate. There are revisions from time to time to bring up-to-date the classification. This has happened with AIDS, included in the chapter of infectious diseases in the last revision, ICD-10. The use of ICD-10 AIDS codes is here appraised. All surveillance report forms of one specialized hospital in infectious diseases, notified in 1994, have been codified, but it was found that many diagnoses could not be codified in accordance with a single ICD-10 AIDS code.

[Smoking prevalence in the urban locality of southeastern Brazil]. / Prevalência de tabagismo em localidade urbana da região sudeste do Brasil.

A cross-sectional study for prevalence of arterial hypertension in the population aged 15-74 years of age of the urban area of Araraquara County, 250 km from the city of S. Paulo, S. Paulo, State, Brazil, in 1987, was performed. The questionnaires presented to 1,199 people (533 men and 666 women) at the interview consisted of regarding sociodemographic variables, as well as the use of tobacco (smoking), the ways in which tobacco was used and the habit of inhaling the smoke. The sample was taken by the procedure of clustering, carried out in three stages. The sample was equiprobabilistic. The prevalence of tobacco smoking was very high being of 45.2% for men and 22.8% for women. The ex-smokers accounted for 15.9% of men and 8.0% of women. The men smoked much more than the women. The poorer smoked more than the richer, in both sexes. Among men, the prevalence of smoking was inversely proportional to duration of schooling, but that difference was not noted in women. As there have been other studies regarding the high prevalence of obesity and high blood pressure, it was concluded therefore that the population of Araraquara, an average town of the affluent urban interior of S. Paulo State, has a high frequency of risk factors for chronic non-transmissible diseases.

[Mortality among women in reproductive age in the municipality of São Paulo, Brazil, 1986. II. Deaths by maternal causes]. / Mortalidade de mulheres em idade fértil no município de São Paulo (Brasil), 1986 II--Mortes por causas maternas.

In continuation to the research project on the accuracy of the certification of the underlying causes of death in women of child-bearing age (10-49), resident in the Municipality of S. Paulo, Brazil, in 1986, "original" death certificates were compared with "revised" death certificates (including additional information). The maternal mortality rate rose from 44.5 per 100,000 live births (l.b.) to 99.6 per 100,000 l.b., a high rate when compared with that of other places. When these data were compared with those of previous, similar investigations in the same city, the maternal mortality rate rose in the period 1962/4 through 1972/4 and fell in 1986. The main causes of death were: hypertension complicating pregnancy, other conditions of the mother which complicated pregnancy and puerperal complications. The need to extend the 42-day period related to the concept of maternal death, as well as the relationship between the non-maternal conditions (cancer, violence) and the gravidic-puerperal cycle are discussed.

[Adolescent mortality in Brazil, 1977, 1980 and 1985. Magnitude and tendencies]. / Mortalidade de adolescentes no Brasil, 1977, 1980 e 1985. Magnitude e tendências.

Mortality among adolescents (10-19 yrs. of age), resident in 9 states of Brazil in 1977, 1980 and 1985, was analysed according to age (10-14 and 15-19 yrs. of age), sex (male, female) and underlying cause of death. The mortality was greater among males aged 15-19. External causes were responsible for the great mortality in all strata, mainly in the metropolitan regions of the urban southeast, rising throughout the period in these regions. The chronic diseases (cancer and cardiovascular diseases) were also frequent as the underlying cause of death in adolescents; though in much lesser proportion than the non-natural causes.

[Mortality of women in reproductive age in the municipality of São Paulo (Brazil), 1986. I. Methodology and general results]. / Mortalidade de mulheres em idade fértil no município de São Paulo (Brasil), 1986. I--Metodologia e resultados gerais.

The purpose of this study was to evaluate the accuracy of the death certificates of a sample of a quarter of all deaths in women of reproductive age (10-49 years) resident in the Municipality of S. Paulo, SP, Brazil, in 1986. For each death, further data were gathered by means of household interviews and from medical records and autopsy information where available. Nine hundred and fifty-three deaths were analysed, for whom there were good quality death certificates except with regard to maternal deaths an terminal respiratory diseases, the former being greatly under-reported. The official maternal mortality rate was 44.5 per 100,000 live births but the true rate was 99.6 per 100,000 live births. The three main causes of death were cardiovascular diseases, neoplasms and external causes. A great proportion of smokers was found among the deceased women (40.4%). Eleven percent of the deceased consumed large amounts of alcoholic beverages regularly.