Cardiovascular Mortality During the COVID-19 Pandemics in a Large Brazilian City: A Comprehensive Analysis.

Introduction: The impact of COVID-19 pandemics on cardiovascular diseases (CVD) may be caused by health system reorganization and/or collapse, or from changes in the behaviour of individuals. In Brazil, municipalities were empowered to define regulatory measures, potentially resulting in diverse effects on CVD morbimortality. Objective: To analyse the impact of COVID-19 pandemics on CVD outcomes in Belo Horizonte (BH), the sixth greater capital city in Brazil, including: mortality, mortality at home, hospitalizations, intensive care unit utilization, and in-hospital mortality; and the differential effect according to sex, age range, social vulnerability, and pandemic's phase. Methods: Ecological study analysing data from the Mortality and Hospital Information System of BH residents aged ≥30 years. CVD was defined as in Chapter IX from ICD-10. Social vulnerability was classified by a composite socioeconomic index as high, medium and low. The observed age-standardized rates for epidemiological weeks 10-48, 2020, were compared to the expected rates (mean of 2015-2019). Risk ratios (RiR) were analysed and 95% confidence intervals were calculated for all estimates. Population projected to 2020 for BH and its census tracts were used to calculate rates. Results: We found no changes in CVD mortality rates (RiR 1.01, 95%CI 0.96-1.06). However, CVD deaths occurred more at homes (RiR 1.32, 95%CI 1.20-1.46) than in hospitals (RiR 0.89, 95%CI 0.79-0.99), as a result of a substantial decline in hospitalization rates, even though proportional in-hospital deaths increased. The rise in home deaths was greater in older adults and in had an increasing gradient in those more socially vulnerable (RiR 1.45); for high (RiR 1.45), medium (RiR 1.32) and low vulnerability (RiR 1.21). Conclusion: The greater occurrence of CVD deaths at home, in parallel with lower hospitalization rates, suggests that CVD care was disrupted during the COVID-19 pandemics, which more adversely affected older and more socially vulnerable individuals, exacerbating health inequities in BH.

Higher mortality during COVID-19 pandemic in socially vulnerable areas in Belo Horizonte: implications for vaccination prioriti / Maior mortalidade durante a pandemia de COVID-19 em áreas socialmente vulneráveis em Belo Horizonte: implicações para priorização da vacinação

Objective: To assess mortality during the COVID-19 pandemic according to social vulnerability by areas of Belo Horizonte (BH), aiming at strategies for vaccination. Methods: Ecological study with mortality analysis, according to census tracts classified by the Health Vulnerability Index, a composite indicator that includes socioeconomic and sanitation variables. Deaths due to natural causes and COVID-19 were obtained from the "Mortality Information System", between the 10th and 43rd epidemiological weeks (EW) of 2020. Excess mortality was calculated by a time series model, considering observed deaths by EW, between 2015 and 2019, for census tracts. Mortality rates (MR) were calculated and age-standardized =using population estimates from 2010 census. Results: Excess mortality in BH was 16.1% (n =1524): 11.0%, 18.8% and 17.3% in the low, intermediate and high vulnerability areas, respectively. The differences between observed and expected age-standardized MR by natural causes were equal to 59/100,000 inhabitants in BH, increasing from 31 to 77 and 95/100,000 inhabitants, in the areas of low, intermediate and high vulnerability, respectively. There was an aging gradient in COVID-19 MR, ranging from 4 to 611/100,000 inhabitants among individuals of 20-39 years and 75+ years. The COVID-19 MR per 100,000 elderly (60+ years) was 292 in BH, increasing from 179 to 354 and 476, in the low, intermediate and high vulnerability areas, respectively. Conclusion: Inequalities in mortality, particularly among the elderly, combined with the limited supply of doses, demonstrate the importance of prioritizing socially vulnerable areas during vaccination against COVID-19.

Objetivo: Avaliar a mortalidade por áreas de Belo Horizonte (BH) durante a pandemia de COVID-19 conforme vulnerabilidade social, visando estratégia de vacinação. Métodos: Estudo ecológico com análise de mortalidade, segundo setores censitários classificados pelo Índice de Vulnerabilidade da Saúde, composto por indicadores de saneamento e socioeconômicos. Óbitos por causas naturais e COVID-19 foram obtidos do Sistema de Informação sobre Mortalidade, entre a 10ª e 43ª semana epidemiológica (SE) de 2020. Calculou-se o excesso de mortalidade por modelo de série temporal, considerando as mortes observadas por SE, entre 2015 e 2019, por setor censitário. Taxas de mortalidade (TM) foram calculadas e padronizadas por idade a partir de estimativas populacionais do IBGE. Resultados: Houve 16,1% (n=1524) de excesso de mortalidade em BH: 11,0%, 18,8% e 17,3% nas áreas de baixa, média e elevada vulnerabilidade, respectivamente. As diferenças entre TM observadas e esperadas por causas naturais, padronizadas por idade, foi igual a 59/100.000 habitantes em BH, aumentando de 31 para 77 e 95/100.000, nas áreas de baixa, média e elevada vulnerabilidade, respectivamente. Houve gradiente de aumento com a idade nas TM por COVID-19, variando de 4 a 611/100.000 habitantes entre as idades de 20-39 anos e 75+ anos. A TM por COVID-19 por 100.000 idosos (60+ anos) foi igual a 292, aumentando de 179 para 354 e 476, nos setores de baixa, média e elevada vulnerabilidade, respectivamente. Conclusão: Desigualdades na mortalidade, mesmo entre idosos, aliadas à baixa oferta de doses, demonstram importância de priorizar áreas socialmente vulneráveis durante a vacinação contra COVID-19.

The impact of COVID-19 pandemic course in the number and severity of hospitalizations for other natural causes in a large urban center in Brazil.

The COVID-19 pandemic may indirectly impact hospitalizations for other natural causes. Belo Horizonte is a city with 2.5 million inhabitants in Brazil, one of the most hardly-hit countries by the pandemic, where local authorities monitored hospitalizations daily to guide regulatory measures. In an ecological, time-series study, we investigated how the pandemic impacted the number and severity of public hospitalizations by other natural causes in the city, during 2020. We assessed the number and proportion of intensive care unit (ICU) admissions and in-hospital deaths for all-natural causes, COVID-19, non-COVID-19 natural causes, and four disease groups: infectious, respiratory, cardiovascular, and neoplasms. Observed data from epidemiological week (EW) 9 (first diagnosis of COVID-19) to EW 48, 2020, was compared to the mean for the same EW of 2015-2019 and differences were tested by Wilcoxon rank-sum test. The five-week moving averages of the studied variables in 2020 were compared to that of 2015-2019 to describe the influence of regulatory measures on the indicators. During the studied period, there was 54,722 hospitalizations by non-COVID-19 natural causes, representing a 28% decline compared to the previous five years (p<0.001). There was a concurrent significant increase in the proportion of ICU admissions and deaths. The greater reductions were simultaneous to the first social distancing decree or occurred in the peak of COVID-19 hospitalizations, suggesting different drivers. Hospitalizations by specific causes decreased significantly, with greater increase in ICU admissions and deaths for infectious, cardiovascular, and respiratory diseases than for neoplasms. While the first reduction may have resulted from avoidance of contact with healthcare facilities, the second reduction may represent competing causes for hospital beds with COVID-19 after reopening of activities. Health policies must include protocols to address hospitalizations by other causes during this or future pandemics, and a plan to face the rebound effect for elective deferred procedures.

The Global Burden of Disease Study Estimates of Brazil's Cervical Cancer Burden.

Background: Cervical cancer represents an important preventable cause of morbidity and mortality in developing countries such as Brazil. Investigating temporal evolution of a disease burden in the different realities of the country is essential for improving public policies. Objective: To describe the national and subnational burden of cervical cancer, based on the estimates of the 2017 Global Burden of Disease study. Methods: Descriptive study of premature mortality (years of life lost [YLL]) and burden of disease (disability-adjusted life years [DALYs]) associated with cervical cancer among Brazilian women aged 25-64 years, between 2000 and 2017. Findings: During the study period, age-standardized incidence decreased from 23.53 (22.79-24.26) to 18.39 (17.63-19.17) per 100,000 women, while mortality rates decreased from 11.3 (11.05-11.56) to 7.74 (7.49-8.02) per 100,000 women. These rates were about two to three times greater than equivalent rates in a developed country, such as England: 11.98 (11.45-12.55) to 10.37 (9.85-10.9), and 3.75 (3.68-3.84) to 2.82 (2.75-2.9) per 100,000 women, respectively. Poorer regions of Brazil had greater rates of the disease; for instance, Amapá State in the Northern Region had rates twice as high as the national rates during the same period. Cervical cancer was the leading cause of premature cancer-related mortality (YLL = 100.69, 91.48-110.61 per 100,000 women) among young women (25-29 years) in Brazil and eight federation units of all country regions except the Southeast in 2017. There was a decrease in the burden of cervical cancer in Brazil from 339.59 (330.82-348.83) DALYs per 100,000 women in 2000 to 238.99 (230.45-247.99) DALYs per 100,000 women in 2017. Conclusion: Although there has been a reduction in the burden of cervical cancer in Brazil, the rates remain high, mainly among young women. The persistence of inequalities between regions of Brazil suggests the importance of socioeconomic determinants in the burden for this cancer.

Association between diabetes and cognitive function at baseline in the Brazilian Longitudinal Study of Adult Health (ELSA- Brasil).

Diabetes has been associated with cognitive changes and an increased risk of vascular dementia and Alzheimer's disease, but it is unclear whether there are associations between diabetes and early alterations in cognitive performance. The present study consisted of a cross-section analysis of 14,444 participants aged 35-74 years and from a developing country at baseline in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil); these participants were recruited between 2008 and 2010. We investigated whether there was an association between diabetes and early changes in the cognitive performance of this Brazilian population. To assess cognitive domains, we used the word-list learning, word-list delayed recall and word recognition tests along. Phonemic verbal fluency tests included semantic phonemic test (animals) and a phonemic test (words beginning with the letter F). Executive functions associated with attention, concentration and psychomotor speed were evaluated using the Trail Making Test B. The exposure variable in the study was defined as diabetes. Multiple linear regression was used to estimate the association between diabetes and cognitive performance. The results were adjusted for age, sex, education, hypertension, coronary disease, depression, physical activity, smoking, alcohol consumption, and the cholesterol/HDL-C ratio. We found a significant association between diabetes and decreased memory, language and executive function (attention, concentration and psychomotor speed) performance in this population from a country with a distinct epidemiological profile, even after adjusting for the main intervening variables.

Anemia and Cognitive Performance in the ELSA-Brasil Cohort Baseline.

OBJECTIVE: The association between cognitive performance and hemoglobin concentration has long been a topic of debate, but few data for middle-aged persons have been explored. The authors examined the association between anemia and cognitive performance at baseline assessment in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a multicenter cohort study of individuals from six Brazilian cities. METHODS: A total of 13,624 participants (mean age=51.6 years [SD=9.0]) were included in this cross-sectional study. Cognitive performance was evaluated by using standardized scores for verbal learning, late recall, word recognition, a semantic verbal fluency test, and the Trail-Making Test, Part B (TMT-B). The association between anemia and cognitive performance was examined by using linear regression models adjusted for sociodemographic characteristics and cardiovascular risk factors. RESULTS: Anemia was diagnosed in 713 (5.2%) participants. No association was found between anemia and worse cognitive performance for the main models. Global cognitive scores were similar between participants with and without anemia in adjusted models for the entire sample (ß=-0.004; 95% CI=-0.052, 0.044) or for men (ß=0.047; 95% CI=-0.053, 0.146) and women (ß=-0.015; 95% CI=-0.070, 0.040) separately. In addition, hemoglobin levels (in quintile groups) were not associated with global cognitive scores. Similarly, no significant associations with anemia or hemoglobin levels were observed when each cognitive performance test was evaluated separately. CONCLUSIONS: Anemia and hemoglobin levels were not associated with worse cognitive performance in this large cohort.

Consistent declining trends in stroke mortality in Brazil: mission accomplished?

Stroke mortality rates are declining in Brazil, but diferences among regions need to be better investigated. The age-adjusted stroke mortality trends among adults (30-69 years-old) from Brazilian regions were studied between 1996 and 2011. Method Data were analyzed after: 1) reallocation of deaths with non-registered sex or age; 2) redistribution of garbage codes and 3) underreporting correction. A linear regression model with autoregressive errors and a state space model were fitted to the data, aiming the estimation of annual trends at every point in time. Results Although there were high values, a steady decrease of rates was observed. The decreasing trends among all regions were statistically significant, with higher values of decline among the Northeast and Northern regions, where rates were the highest. Conclusion Standardized methodology use is mandatory for correct interpretation of mortality estimates. Although declining, rates are still extremely high and efforts must be made towards prevention of stroke incidence, reduction of case-fatality rates and prevention of sequelae.

Consistent declining trends in stroke mortality in Brazil: mission accomplished? / Tendências decrescentes constantes na mortalidade por AVE no Brasil: missão cumprida?

ABSTRACT Stroke mortality rates are declining in Brazil, but diferences among regions need to be better investigated. The age-adjusted stroke mortality trends among adults (30-69 years-old) from Brazilian regions were studied between 1996 and 2011. Method Data were analyzed after: 1) reallocation of deaths with non-registered sex or age; 2) redistribution of garbage codes and 3) underreporting correction. A linear regression model with autoregressive errors and a state space model were fitted to the data, aiming the estimation of annual trends at every point in time. Results Although there were high values, a steady decrease of rates was observed. The decreasing trends among all regions were statistically significant, with higher values of decline among the Northeast and Northern regions, where rates were the highest. Conclusion Standardized methodology use is mandatory for correct interpretation of mortality estimates. Although declining, rates are still extremely high and efforts must be made towards prevention of stroke incidence, reduction of case-fatality rates and prevention of sequelae.

RESUMO Objetivos As taxas de mortalidade por acidente vascular encefálico (AVE) estão em declínio no Brasil, mas diferenças entre as regiões precisam ser melhor investigadas. Foram analisadas as tendências de mortalidade por AVE ajustadas por idade em adultos (30-69 anos) de regiões do Brasil, entre 1996 e 2011. Método Análise realizada após realocação dos óbitos sem registro de sexo ou idade; redistribuição de códigos mal definidos e correção do subregistro. Modelos de regressão linear e de espaço de estados foram utilizados visando estimativas de tendências anuais em todos pontos no tempo. Resultados Observou-se redução de cerca de 50% nas taxas de mortalidade em todas as regiões, para homens e mulheres, com maiores declínios nas regiões Norte e Nordeste, onde as taxas eram as mais elevadas. Conclusão Usar metodologia padronizada é fundamental para interpretação correta das estimativas de mortalidade. Esforços devem ser feitos para prevenção da incidência de AVE, redução das taxas de letalidade e prevenção de sequelas.

Insulin resistance and carotid intima-media thickness mediate the association between resting-state heart rate variability and executive function: A path modelling study.

BACKGROUND: Research has linked high-frequency heart rate variability (HF-HRV) to cognitive function. The present study adopts a modern path modelling approach to understand potential causal pathways that may underpin this relationship. METHODS: Here we examine the association between resting-state HF-HRV and executive function in a large sample of civil servants from Brazil (N=8114) recruited for the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). HF-HRV was calculated from 10-min resting-state electrocardiograms. Executive function was assessed using the trail-making test (version B). RESULTS AND CONCLUSIONS: Insulin resistance (a marker of type 2 diabetes mellitus) and carotid intima-media thickness (subclinical atherosclerosis) mediated the relationship between HRV and executive function in seriatim. A limitation of the present study is its cross-sectional design; therefore, conclusions must be confirmed in longitudinal study. Nevertheless, findings support that possibility that HRV provides a 'spark' that initiates a cascade of adverse downstream effects that subsequently leads to cognitive impairment.

Reproducibility of peripheral arterial tonometry for the assessment of endothelial function in adults.

OBJECTIVES: Endothelial dysfunction is associated to cardiovascular risk factors and predicts cardiovascular events. Peripheral arterial tonometry (PAT) is a novel noninvasive method to assess endothelial function. However, there is a paucity of data about its reproducibility. The aim of this study was to assess the feasibility and reproducibility of PAT in adults. METHODS: PAT exams were performed twice in the same day in 123 participants of a cohort about the determinants of diabetes and cardiovascular diseases (Brazilian Longitudinal Study of Adult Health--ELSA-Brasil). The interval between the exams was 2-6 h (mean=4 h). Endothelial function in PAT method is measured by reactive hyperemia index (RHI), which evaluates arterial pulsatile volume changes in response to hyperemia. Agreement of RHI values was compared by Bland-Altman method, coefficient of variation and coefficient of repeatability. Reliability was assessed by intraclass correlation coefficient (ICC). RESULTS: Mean values of RHI did not differ significantly between the exams of each participant (1.92±0.56 vs. 1.96±0.58, P=0.48). There were no systematic errors between the exams (mean of differences=-0.03±0.5). Measurement error was 0.35, coefficient of variation was 18.0% and ICC was 0.61. Sex, age or the presence of obesity did not have a considerable influence on the reproducibility of PAT. CONCLUSION: PAT exam is feasible and has acceptable reproducibility in adults when compared with other noninvasive methods for endothelial function assessment. This performance makes PAT a promising method for future clinical and epidemiological studies.

Smoking-attributable mortality and years of potential life lost in 16 Brazilian capitals, 2003: a prevalence-based study.

BACKGROUND: To establish the impact of tobacco smoking on mortality is essential to define and monitor public health interventions in developing countries. METHODS: The Smoking-Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software was used to estimate the smoking attributable mortality (SAM) in 15 Brazilian State Capitals and the Federal District for the year 2003. Smoking prevalence and mortality data of people aged 35 years or older were obtained for each city from the Brazilian Household Survey on Non Communicable Diseases Risk Factors (2002-2003) and from the Brazilian Mortality System (2003), respectively. RESULTS: In 2003, of the 177,543 deaths of persons aged 35 years and older 24,222 (13.64%) were attributable to cigarette smoking. This total represents 18.08% of all male deaths (n = 16,896) and 8.71% (n = 7,326) of all female deaths in these cities. The four leading causes of smoking-attributable death were chronic airways obstruction (4,419 deaths), ischemic heart disease (4,417 deaths), lung cancer (3,682 deaths), and cerebrovascular disease (3,202 deaths). Cigarette smoking accounted for 419,935 years of potential life lost (YPLL) (279,990 YPLL for men and 139,945 YPLL for women) in the same period. CONCLUSION: Tobacco use caused one out of five male deaths and one out of ten female deaths in the sixteen cities in 2003. Four leading causes of smoking attributable deaths (ischemic heart disease, chronic airways obstruction, lung cancer and cerebrovascular disease) accounted for 64.9% of SAM. Effective and comprehensive actions must be taken in order to slow this epidemic in Brazil.

Health status indicators among community-dwelling elders with arthritis: the Bambuí health and aging study.

OBJECTIVE: To investigate the association of arthritis with health status indicators among elders living in Bambuí, Brazil. METHODS: A cross-sectional study was conducted among 1606 elders using baseline data from the Bambuí Health and Aging Study, a population based cohort study of older adults. Arthritis was self-reported and defined as a physician diagnosis of arthritis or rheumatism, and/or chronic hand and knee symptoms. Health status indicators, defined a priori as the main independent variables, were self-rated health, psychological distress (based on the General Health Questionnaire), report of sleep complaints, disability in activities of daily living (ADL), "2-week" disability, mobility disability, and 2 composite indexes of mental health problems and physical disability problems. Logistic regression compared health status indicators among elders reporting arthritis (N = 833) and non-arthritis subjects. RESULTS: After controlling for sociodemographics and chronic conditions, all measures were found to be associated with arthritis: sleep complaints (OR 1.81, 95% CI 1.43-1.92), fair (OR 2.17, 95% CI 1.62-2.90) and poor self-rated health (OR 3.48, 95% CI 2.46-4.94), ADL disability (OR 1.73, 95% CI 1.02-2.87), mobility disability (OR 2.65, 95% CI 2.06-3.41), 2-week disability (OR 1.86, 95% CI 1.35-2.57), 2 mental health problems (OR 2.25, 95% CI 1.67-3.04), and one (OR 2.46, 95% CI 1.91-3.16) and 2 physical disability problems (OR 4.19, 95% CI 2.02-8.59). CONCLUSION: Considering the paucity of similar studies addressing the impact of arthritis in developing nations, these findings may be applied to similar communities and support better planning of resource allocations to minimize the effects of arthritis among the elderly.

PCR-RFLP to identify Leishmania (Viannia) braziliensis and L. (Leishmania) amazonensis causing American cutaneous leishmaniasis.

A PCR-RFLP based method was developed to diagnose and identify the Leishmania species causing American cutaneous leishmaniasis (ACL) in a panel of clinical samples obtained from an endemic region of Brazil. The comparison of the results obtained by PCR-RFLP and PCR-hybridization in the identification of Leishmania (Viannia) braziliensis and L. (Leishmania) amazonensis were highly concordant (kappa=91.5%). The PCR-RFLP method was reliable, fast and easy to conduct on biopsies and presents potential value of utmost importance for the diagnosis and identification of Leishmania in clinical specimens, infected reservoirs and vectors.

Antibody subclass profile against Leishmania braziliensis and Leishmania amazonensis in the diagnosis and follow-up of mucosal leishmaniasis.

Sensitivities and specificities of IgG subclasses-ELISA and IgG-indirect fluorescent antibody test (IFAT) against Leishmania braziliensis (Lb) and L. amazonensis (La) antigens were determined in 17 patients with mucosal (ML) and 19 with muco-cutaneous (MCL) leishmaniasis. Using IFAT-IgG both antigens gave high sensitivities and were statistically similar, being 89.5% with La and 100% with Lb. Using ELISA, the highest sensitivity was achieved with total IgG for ML (94.7% with both antigens) and MCL (100% with both antigens). Cross-reactivity, observed with Chagas disease and malaria sera reduced the specificity of the IgG-based assays, being 50 to 70% with IFAT and 40 to 70% with ELISA. An increase in specificity was obtained with IgG1-ELISA (90% with Lb and 100% with La). Serum levels of anti-Lb-IgG and IgG3 dropped 90 days after treatment. IgG subclasses antibody detection constitute an valuable alternative to increase the efficiency of sorological diagnostics of ML/MCL.

Obesity and underweight among Brazilian elderly: the Bambuí Health and Aging Study.

The coexistence of obesity (body mass index, BMI > or = 30kg/m ) and underweight (BMI <= 20kg/m ) and related factors were investigated among all residents aged 60+ years in Bambu , Minas Gerais State, using multinomial logistic regression. 1,451 (85.5%) of the town's elderly participated. Mean BMI was 25.0 (SD = 4.9kg/m ) and was higher for women and decreased with age. Prevalence of obesity was 12.5% and was positively associated with female gender, family income, hypertension, and diabetes and inversely related to physical activity. Underweight affected 14.8% of participants, increased with age, and was higher among men and low-income families. It was negatively associated with hypertension and diabetes and directly associated with Trypanosoma cruzi infection and > or = 2 hospitalizations in the previous 12 months. Both obesity and underweight were associated with increased morbidity. The association of underweight with T. cruzi infection, increased hospitalization, and low family income may reflect illness-related weight loss and social deprivation of elderly in this community. Aging in poverty may lead to an increase in nutritional deficiencies and health-related problems among the elderly.

Obesity and underweight among Brazilian elderly: the Bambuí Health and Aging Study

The coexistence of obesity (body mass index, BMI > or = 30kg/m²) and underweight (BMI <= 20kg/m²) and related factors were investigated among all residents aged 60+ years in Bambuí, Minas Gerais State, using multinomial logistic regression. 1,451 (85.5 percent) of the town's elderly participated. Mean BMI was 25.0 (SD = 4.9kg/m²) and was higher for women and decreased with age. Prevalence of obesity was 12.5 percent and was positively associated with female gender, family income, hypertension, and diabetes and inversely related to physical activity. Underweight affected 14.8 percent of participants, increased with age, and was higher among men and low-income families. It was negatively associated with hypertension and diabetes and directly associated with Trypanosoma cruzi infection and > or = 2 hospitalizations in the previous 12 months. Both obesity and underweight were associated with increased morbidity. The association of underweight with T. cruzi infection, increased hospitalization, and low family income may reflect illness-related weight loss and social deprivation of elderly in this community. Aging in poverty may lead to an increase in nutritional deficiencies and health-related problems among the elderly

Counseling blood donors seropositive for human T-lymphotropic virus types I and II in a developing country

Os vírus linfotrópico humano tipos I e II (HTLV-I/II) säo retrovírus transmitidos por componentes celulares sanguíneos e associados à ocorrência de leucemia, mielopatia e uveíte. De 51.135 doadores de sangue da Fundaçäo Hemominas testados em 1993, 689 (1,35 por cento) foram repetidamente reativos a anticorpos contra HTLV-I/II no ensaio imunoenzimático e foram devidamente notificados. As vias de transmissäo e medidas de controle foram enfatizadas na orientaçäo. Testes laboratoriais suplementares devem ser disponíveis e gratuitos. O uso de preservativos deve ser recomendado e os mesmos serem disponíveis nos serviços de saúde. O doador soropositivo e os serviços de saúde näo devem reutilizar agulhas e seringas. Sendo a desnutriçäo infantil um problema grave no país, o benefício da amamentaçäo sobrepöe-se ao risco de transmissäo de viroses. Baseados em experiência, recomenda-se: 1)a mesma orientaçäo deve ser dada por todos os trabalhadores de saúde envolvidos no aconselhamento do doador, 2) o nível educacional deve ser considerado e as informaçöes fornecidas de acordo com as necessidades individuais; 3) deve-se auxiliar o doador a compreender e criticar as informaçöes disponíveis e 4) fornecer assistência psicológica adequada a doadores ansiosos ou deprimidos e 5) se o doador tem um parceiro estável, as informaçöes devem ser dadas ao casal, simultaneamente.