Aspectos da mortalidade atribuível ao tabaco: revisão sistemática / Aspects of tobacco attributable mortality: systematic review

O artigo teve por objetivo analisar as metodologias publicadas e empregadas no cálculo da mortalidade atribuível ao fumo. Foram pesquisadas as bases de dados eletrônicas MEDLINE, LILACS entre 1990 e 2006. Foram encontrados 186 estudos que apresentaram a mensuração de mortalidade a partir do cálculo da fração atribuível ao fumo. Desses, foram selecionados 41 artigos. Os estudos realizados nos Estados Unidos e Canadá apresentaram metodologia uniformizada e taxas de mortalidade entre 18 por cento-23 por cento; 25 por cento-29 por cento no sexo masculino e 14 por cento-17 por cento no feminino. As variações metodológicas podem justificar as diferenças da mortalidade entre os estudos e nas estimativas para as principais doenças tabaco-relacionadas.

The objective of the article was to assess methodologies published and applied in calculating mortality attributable to smoking. A review of the literature was made for the period 1990 to 2006, in the electronic databases MEDLINE and LILACS. A total of 186 studies were found, which measured mortality based on calculating the smoking-attributable risk. Of these, a total of 41 were selected. The studies that were carried out in the United States and Canada presented a more standard methodology and reported smoking attributable mortality to be 18 percent-23 percent, with male mortality being 25 percent-29 percent and female mortality 14 percent-17 percent. The variations can be attributed to methodological differences and to different estimates of the main tobacco-related illnesses.

[Aspects of tobacco attributable mortality: systematic review]. / Aspectos da mortalidade atribuível ao tabaco: revisão sistemática.

The objective of the article was to assess methodologies published and applied in calculating mortality attributable to smoking. A review of the literature was made for the period 1990 to 2006, in the electronic databases MEDLINE and LILACS. A total of 186 studies were found, which measured mortality based on calculating the smoking-attributable risk. Of these, a total of 41 were selected. The studies that were carried out in the United States and Canada presented a more standard methodology and reported smoking attributable mortality to be 18%-23%, with male mortality being 25%-29% and female mortality 14%-17%. The variations can be attributed to methodological differences and to different estimates of the main tobacco-related illnesses.

Transmission of Hansen's disease and unscreened household contacts.

INTRODUCTION: Leprosy household contact investigation has been recommended as an epidemiological surveillance strategy for more than 50 years. OBJECTIVE: The purpose of this study was to estimate the yield that could be achieved in case detection if four contacts could be examined for every case found. METHODS: For the estimation of the number of cases not detected (lost) and yield per contact investigation in Mato Grosso, the incidence rates and yield calculations from a cohort study conducted in Rio de Janeiro by Matos et al (1999) were applied to data from the state of Mato Grosso. Also, to identify high-risk groups for leprosy, a cross-sectional study was conducted in which leprosy cases found as a result of a contact investigation were compared with index cases detected by other means. RESULTS: The lost cases among household contacts were at least 4 per every 10 new cases detected. This is the result of insufficient contact investigations--it being 0.8 instead of 4 contact investigations per each case as recommended by the Brazilian Ministry of Health. Up to 60% of the incidence of leprosy could be explained by the high number of lost cases among household contacts not examined. Women and children are more likely to be contacts. CONCLUSION: The lost cases due to insufficient contact investigation represent lost opportunities in early detection and treatment, thus losing the opportunity to reduce leprosy transmission.

Waist circumference and waist-to-hip ratio as predictors of serum concentration of lipids in Brazilian men.

OBJECTIVE: It is unknown whether waist circumference can predict a lipid profile beyond that predicted by body fatness alone, after adjustment for important confounding variables such as smoking, alcohol intake, and physical activity. The purpose of this non-clinical, healthy-subject study was to test this hypothesis. METHODS: Data refer to 416 men, ages 20 to 58 y with a body mass index between 18.5 and 29.9 kg/m(2), who were blood donors living in a Brazilian city. Alcohol consumption, smoking, and physical activity were evaluated by interview; body fat was measured by electrical bioimpedance, and weight, height, and waist and hip circumferences were measured by trained anthropometrists. Multiple linear regression analysis was performed to quantify the association between measurements of fat distribution (waist circumference and waist-to-hip ratio) and the ratio of total cholesterol to high-density lipoprotein cholesterol and triacylglycerols independently of measurements of fatness and potentially confounding factors. RESULTS: Waist circumference was strongly correlated with percentage of body fat (r = 0.90), whereas waist-to-hip ratio was less correlated (r = 0.55). After adjustment for age, percentage of body fat, smoking, alcohol intake, and physical activity, waist circumference was not significantly related to the ratio of total cholesterol high-density lipoprotein cholesterol, whereas the waist-to-hip ratio was strongly associated among the youngest subjects (beta = 3.51, P = 0.005). CONCLUSION: Although several studies have analyzed the association between serum lipids with anthropometric markers, few, including the present one, support waist circumference as a good predictor of lipid profile.

[AIDS mortality in the State of Rio de Janeiro, 1991-1995]. / Mortalidade por AIDS no Estado do Rio de Janeiro - 1991 a 1995.

This article focuses on the AIDS mortality profile as related to socioeconomic and geographic variables, as well as evaluating the impact of deaths from AIDS in the State of Rio de Janeiro. The analysis included all death certificates for residents of the State from 1991-1995, 10,024 of which had AIDS recorded as the primary cause of death. In the 20-49-year age bracket, among individuals who had died of AIDS, the proportion of those with university schooling (14%) and the proportion of single individuals (75%) were greater than the respective proportions for all other causes of death (5.4% and 56.3%). For the population as a whole, the AIDS mortality rate increased from 1991 to 1995, from 20.6/100,000 to 30.2/100,000 for males and from 3.7/100,000 to 7.9/100,000 for females. For the year 1995 in the 20-49-year bracket, considering the 17 groups of causes from the ICD-9, AIDS was the third most common cause of death among men and the fifth most common among women. The proportion of Potential Loss of Life Years up to 65 years as a function of AIDS increased from 1991 to 1995, from 3.4% to 4.7% for men and from 1.4% to 2.9% for women. During this same period there was also an increase in the number of counties in the State of Rio de Janeiro with reported deaths from AIDS.

Validation and calibration of mercury intake through self-referred fish consumption in riverine populations in Pantanal Mato-grossense, Brazil.

The objective of most epidemiological studies is to classify/rank people according to their relative quantity of consumption. In the specific case of quantifying fish consumption, in order to assess mercury intake rate, the method used must estimate the individual quantity consumed accurately, or from the self-referred quantity it must be possible to estimate the real consumption-termed calibration. Therefore, the objective of this study was to validate and calibrate the 24-h recall method for assessing the amount of fish consumed to estimate the mercury intake in riverine populations from Baixada Cuiabana, in Pantanal Mato-grossense, Brazil. The weighed dietary method was used as the reference standard, and the validity of the 24-h recall method was assessed using correlation coefficients (r), regression coefficients (beta), and the intraclass correlation coefficient (ICC). The results showed that the ICC, which assesses the agreement level between measures, was a more adequate measure than the correlation coefficient (r). Therefore, the calibration equation was calculated applying a multiple linear regression model using the consumption mean of the second and third days, which presented the highest ICC, stratified by sex and adjusted by age and season variables.

[Death certificates as a marker for under-recording of AIDS cases]. / A declaração de óbito como indicador de sub-registro de casos de AIDS.

This study aimed to estimate and evaluate the under-recording of AIDS cases that evolved to death. From 1991 to 1995, the Mortality Information System recorded 9,213 adult deaths due to AIDS, related by name, date of birth, and date of death to 15,505 AIDS recorded by the Disease Data Registration System from 1982 to 1996. This procedure showed that 51.9% of AIDS deaths recorded in the period were not recorded as AIDS cases as they should have been. Univariate and multivariate analysis showed that women had a greater chance of under-recording than men (OR = 1.27). A lower probability of proper recording was observed in individuals with less schooling, and illiterates had a two-fold chance of not being properly recorded, as compared to individuals with college degrees. Deaths that occurred in health facilities classified as private units had a greater probability of not being recorded than those occurring elsewhere (mainly those classified as public reference units) (OR = 2.58). Deaths occurring in the city of Rio de Janeiro had a greater probability of under-recording than those in other cities (OR = 2.20).

[Classification by occupation of AIDS cases in Brazil - 1995]. / Classificação por ocupação dos casos de AIDS no Brasil - 1995.

Based on occupational classification of AIDS cases reported in Brazil in 1995 and recorded in the Data Base for Reported Diseases (SINAN), AIDS incidence rates were estimated per 100 thousand inhabitants by occupation, according to the 1991 National Census. Nationwide rates for employed males and females were 25.0 and 9.1, respectively. Among males, and within the major occupational groups, the following sub-groups had the highest rates: personal hygiene services (268.1), social scientists (176.1), writers and journalists (114.3), medical and dental assistants (113.4), chemists, pharmacists, and physicists (111.9), teachers (87.3), artists (74.7), port services (65.6), maritime and fluvial transportation (57.5), and sales personnel (55.4). The results indicated the disease's magnitude in different occupational categories and highlighted certain occupations in which special preventive measures are justified, along with more in-depth studies focusing on other socioeconomic variables and the sociocultural behavior of their members.

[Eating habits among employees of a state-owned bank: food consumption profile]. / Hábitos alimentares entre funcionários de banco estatal: padrão de consumo alimentar.

In order to investigate the health conditions of current employees in a government-owned bank in the State of Rio de Janeiro, we performed a cross-sectional study in two departments where systematic sampling was applied. Among the health conditions, we focused on the employees' eating habit profile using a questionnaire on frequency of food group consumption analyzed through a summary measure (eating score). Although the majority of the study population display good eating habits, the results confirmed a major difference between genders. Some 60% of men had scores higher than the population mean (51.2), as compared to only 45% of women. In addition, we observed that men, and particularly younger men, consumed more foodstuffs that were rich in saturated fat, salt, and sugar as compared to women. The findings indicate that quality of one's diet along with changes in other habits and behaviors (like smoking and sedentary life style) should be part of programs to promote health in the workplace, with a view towards controlling cardiovascular and other diseases.

[Prognostic factors of hospital mortality from diarrhea or pneumonia in infants younger than 1 year old. A case-control study]. / Fatores prognósticos de letalidade hospitalar por diarréia ou pneumonia em menores de um ano de idade. Estudo de caso e controle.

Diarrhea and pneumonia are common diseases in children aged under one year, for which there are simple therapeutic measures. However, infant mortality due to these diseases is still very high, varying markedly according to socio-economic status. The characteristics of children who died (cases) and of those who were hospitalized with diarrhea or pneumonia, but survived (controls), were studied. The following groups of variables were studied: socio-economic, environmental and biological conditions, nutritional status and breast-feeding. Information on cases and controls was collected from hospital records and through home interviews. Important losses occurred in the latter: 40% of cases and 50% of controls were not interviewed. There were no significant differences between cases who were included and those who were not, in terms of age, sex or place of residence. To estimate relative risks of prognostic factors unconditional Logistic Regression was used to calculate the odds ratios and their 95% confidence intervals. Prematurity, low birth weight, weight/age deficit, presence of edema and poor general status at hospital admission were prognostic factors for hospital case-fatality. In relation to the anthropometric variables, it was not possible to conclude for certain whether the increased case-fatality was linearly or non-linearly (threshold) associated with nutritional deficit. The duration of breast-feeding was only associated with case-fatality for pneumonia. Socio-economic factors were not important for the prognosis of children admitted to hospital with diarrhea or pneumonia. Some of the expected risk factor associations were not detected, maybe due to the small sample size (resulting from the high losses) which was insufficient to show small differences. In this study the biological conditions of children with diarrhea or pneumonia appeared to be the important prognostic factors for hospital case-fatality.

[Risk factors for death caused by pneumonia in children younger than 1 year old in a metropolitan region of southeastern Brazil. A case- control study]. / Fatores de risco para morte por pneumonia em menores de um ano em uma região metropolitana do sudeste do Brasil. Um estudo tipo caso-controle.

In a case-control study, a sample of post-neonatal deaths from pneumonia occurring in the Metropolitan Area of Rio de Janeiro, Brazil (1986-1987) were compared with healthy controls who lived in the same neighborhood. Risk factors investigated were variables related to the mother's pregnancy history and the child's birth, to the family's social condition and to the use of health services. Using the univariate logistic regression model, the coefficients of each independent variable, the relative risk and its confidence limits were first estimated. Birth weight and age of weaning were strongly associated with the dependent variable. After adjustment by means of the multiple logistic regression model, only 4 variables remained statistically associated with mortality: age of weaning, birth weight, over crowding, and BCG vaccination. Based on the available data, it was concluded that mortality from pneumonia in children under 1 year of age is significantly related to the social condition of the family, particularly to that of the mother.

Avaliaçäo da cobertura de vacinaçäo em Teresina Piaui (Brasil - 1983)

O presente estudo avaliou a cobertura de avacinaçäo antipólio, DPT, BCG e anti-sarampo em crianças de um ano de idade, na área urbana do município de Teresina (Piauí), em 1983. Dosi métodos de amostragem, o de henderson e Sundaresan7 e uma modificaçäo deste foram utilizados posteriormente comparados quanto aos resultados. A análise de alguns indicadores sociais, como escolaridade dos pais e número de moradores e de crianças do domicílio, nos permitiu estabelecer diferenças entre os grupos de crianças que completaram e as que näo completaram o quadro de imuniaçöes. Uma parte do trabalho dirigiu-se todo geométrico *15, a partir das populaçöes de 1970 e 1980 publicadas pelos Censos Demográficos do IBGE*4,5