Assessing occupational exposure as risk for tuberculous infection at a teaching hospital in São Paulo, Brazil.

OBJECTIVE: To determine the risk for TB infection among nurses exposed to TB patients and non-exposed employees, and to evaluate associated aspects to initiate TB prevention in a teaching hospital in Brazil. DESIGN: A cross-sectional tuberculin skin test (TST) survey and assessment questionnaire of 169 nurses exposed to patients (exposed group [EG]) and 164 administrative employees (comparative group [CG]). RESULTS: The prevalence of positive TST was 59.7% in the EG and 53.7% in the CG (P = 0.26). Univariate analysis revealed, in the CG, association of TST positivity with BCG scar (P = 0.002), and, in the EG, with male sex (P = 0.02) and working at that hospital for >2 years (P < 0.001). On multivariate analysis, male sex (P = 0.0444), working at the institution for >2 years (P < 0.0001) and BCG scar (P = 0.0004) were associated with positive TST, while occupational exposure was not. CONCLUSIONS: The results suggest that all health care workers should be evaluated in an institutional TB prevention programme because community exposure to TB and BCG vaccination may have influenced TST positivity in the studied population.

Optimal age for vaccination against measles in the State of São Paulo, Brazil, taking into account the mother's serostatus.

In order to investigate if the changing levels of measles antibody in women resulting from extensive vaccination programs influence the susceptibility of children, we measured the seroprevalence of measles virus antibody of children in the first year of life and of their mothers. We compared maternal antibody decay of two groups of children: those whose mothers were 25 years old or more (mothers born in the pre-vaccination era), and less than 25 years old (mothers born in the vaccination era). Therefore, the 25-year-age cut-off was chosen to distinguish between vaccinated and non-vaccinated mothers. We also compared the immunogenicity of measles vaccine in children from 6 to 12 months of age, in these two groups and also according to their mother's serostatus. The optimal age of vaccination for a routine program was estimated by means of mathematical models. This study was carried out in a sample of 1216 mothers and their respective children. Our results indicate that the optimal age for vaccination of the whole sample was 15 months, 17 months for children born from older mothers, 14 months for children born from younger mothers, 17 months for children born from seropositive mothers and 12 months for children born from seronegative mothers. Therefore, a change to an earlier age of routine vaccination is not justified by our results.

Gastric and colorectal cancer mortality in an urban and industrialized area of Brazil.

PURPOSE: To study the gastric and colorectal cancer mortalities and their relation to the urban-industrialization in Baixada Santista, located in the southeastern region of Brazil. METHODS: Selected from the registries of the State System of Data Analysis Foundation (SEADE) were 1105 deaths due to gastric cancer (ICD 153 - 154) and 690 due to colorectal cancer (ICD 151) that occurred from 1980 to 1993 in males, above 10 years of age, residing in Baixada Santista. For each of these types of cancer, the standardized mortality rates, age-adjusted by world population in the 1960s, for 4 industrialized and 4 non-industrialized urban communities in that region were calculated. The ratios among those rates were calculated in order to compare the mortality in the periods 1980 - 93, 1980 - 1986, and 1987 - 1993. RESULTS: Standardized mortality rates for colorectal cancer were significantly higher in industrialized area, with ratios of 1.6 [95% CI 1.22 - 2.29], 1.6 [95% CI 1.2 - 2.0], and 1.6 [95% CI 1.3 - 2.0] in the periods 1980 - 86, 1987 - 1993 and 1980 - 93, respectively. Gastric cancer did not show any statistical difference between the industrialized and non-industrialized areas, but there was a significant decrease in BS from the period 1980 - 1986 to 1987 - 1993. CONCLUSIONS: The significant elevation of colorectal cancer mortality in the industrialized area could be related to exposure to numerous carcinogens such as aromatic hydrocarbon, organic-chloride, metals, and industrial-port dust present in the region. Alternatively, the non-significant difference in gastric cancer between industrialized and non-industrialized areas and significant decrease in the last few years could be predominately reflecting the advances in the quality of life in urban areas. These results require further case-control studies that could help with the analysis of the associations among cancer and environmental factors (occupational, urban-industrial, habit, and life condition) and genetic susceptibility.

Nervous system cancer mortality in an industrialized area of Brazil 1980-1993.

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.

Three year seroepidemiological study of varicella-zoster virus in São Paulo, Brazil.

A serosurvey of varicella has been carried out in children attending the public school network of São Paulo city, Brazil, from 1992 to 1994. This study was performed in order to establish the age related prevalence of antibodies against varicella-zoster virus (VZV) and its age specific transmission dynamics pattern in these children. Among 2500 schools in the city of São Paulo public network, 304 were randomly selected; 7 children of a given age (ranging from 1 to 15 years) were randomly selected in each school, and blood samples were obtained by fingerprick into filter paper. Blood eluates were analyzed for the presence of antibodies to VZV by ELISA. Proportion of seropositivity were calculated for each age group. Samples consisted of 1768 individuals in 1992, 1758 in 1993, and 1817 in 1994, resulting in 5343 eluates. A high proportion of seropositive children from 1 to 3 years of age was observed, ascending until 10 years of age and reaching a plateau around 90% afterwards. VZV transmission in this community was similar along the three years of the study. In children attending public schools in the city of São Paulo, contact with VZV occurs in early childhood. If immunization against VZV is considered it should be introduced as soon as possible.

Risk factors for death and changing patterns in leptospirosis acute renal failure.

The risk factors for death and changes in clinical patterns in leptospirosis (Weil's disease) have not been well studied. We retrospectively studied 110 patients with Weil's disease hospitalized in Brazil between 1985 and 1996. Univariate statistical analysis showed that nonsurvivors were older than survivors, and had higher frequency of oliguria, cardiac arrhythmia, dyspnea, and pulmonary rales. Logistic regression showed that the only independent factor associated with death was oliguria (odds ratio [OR] = 8.98). The presence of arthralgia (OR = 4.71), dehydration (OR = 6.26), dyspnea (OR = 17.7), and pulmonary rales (OR = 9.91) increased after 1994. These data suggest that in Weil's disease the clinical patterns have changed and the presence of oliguria is a risk factor for death.

[Cancer mortality in urban-industrial area of the Baixada Santista, Sao Paulo, (Brazil)]. / Mortalidade por câncer na região urbano-industrial da Baixada Santista, SP (Brasil).

INTRODUCTION: In order to study the relationship between cancer and industrialization the cancer mortality in the an urban area (Baixada Santista, Brazil), an important industrial-harbour complex, two distinct groups: industrialized and non-industrialized, is analyzed. METHODS: A total of 8,546 cancer death registers (according to ICD-9) in males over 10 years old, resident in the that area, were obtained from "Fundação Sistema Estadual de Análise de Dados (SEADE)", during the period 1980-1993. The average mortality rates, standardized on the basis of the to 1960 world population for the area studied, and their strata: Stratum I (inside the industrial area - Santos, S. Vicente, Cubatão and Guarujá) and Stratum II (outside the industrial area - Praia Grande, Mongaguá, Itanhaém and Peruíbe) and the ratios among these rates were calculated adopting the 95% confidence interval. RESULTS: The annual average mortality rate was high, 197.9/100,000 and there was a statistically significant difference between the mortality rates observed in Stratum I and those in Stratum II, 209.2 and 146.7/100,000, respectively, with a ratio of 1.42 (CI 1.36 - 1.51). CONCLUSIONS: It seems that environmental and occupational exposure to carcinogenic chemical agents, related to the productive process in the industrial complex, is a significant factor in mortality due to cancer.

HIV infection and related risk behaviours in a disadvantaged youth institution of São Paulo, Brazil.

In order to study the prevalence of HIV and related risky behaviours among disadvantaged youth, we interviewed and bled, between December 1994 and April 1995, 1122 young males and 93 young females who were serving time in FEBEM, a state institution that cares for homeless and offender youth of São Paulo, Brazil. Our questionnaire covered the following areas: sexual practices and use of illicit drugs; knowledge of HIV and STDs and their prevention; and myths and beliefs about AIDS. Seroprevalence of HIV was assessed and related with risk-taking behaviours by means of uni-, bi- and multivariate analysis. We found 2.6% of the males and 10.3% of the females to be positive to HIV. The prevalence of hepatitis C virus (HCV) antibodies resulted in 5.9% for males and 4.6% for females, respectively. The risk for parenterally transmitted HIV among the males was higher than that for sexually related transmission. The inverse relationship was found among the females.

Obsessive-compulsive and related symptoms in children and adolescents with rheumatic fever with and without chorea: a prospective 6-month study.

OBJECTIVE: The incidence and course of neuropsychiatric symptoms were determined in pediatric patients with rheumatic fever. METHOD: The Leyton Obsessional Inventory and National Institute of Mental Health Global Obsessive-Compulsive Scale were used to evaluate children and adolescents who had rheumatic fever with Sydenham's chorea (N=30) or without chorea (N=20). They were assessed three times over 6 months from the onset of rheumatic fever. Psychiatric diagnoses were also determined. RESULTS: Obsessive-compulsive symptoms abruptly appeared and peaked during the 2 months after the onset of rheumatic fever in 21 patients with chorea (70.0%) and were absent in all patients without chorea. Obsessive-compulsive disorder (OCD) was diagnosed in five patients with chorea (16.7%). CONCLUSIONS: The association between Sydenham's chorea and OCD supports suggestions that similar mechanisms involving the basal ganglia underlie both disorders. Obsessive-compulsive symptoms occurred at the beginning of rheumatic fever, so early psychopathological assessments are essential.

Population biology, evolution, and immunology of vaccination and vaccination programs.

The purpose of prophylactic vaccination is to reduce morbidity and mortality in a population. Many questions related to the design of vaccines and vaccination programs require a population standpoint for their sharp formulation and laboratory and field studies to understand their immunologic background. Practical suggestions of the workshop included increased studies of age-specific immunity, better immunoepidemiologic surveillance, better design of efficacy studies, and more systematic sampling of parasite strains to study the evolutionary pressure exerted by vaccines. Theoretical immunology has much to contribute. One of the realizations of the workshop was the value of a strong interdisciplinary approach in vaccine development, utilizing relevant contributions from immunology, population biology, mathematical modeling, epidemiology, molecular biology, and virology.

Assessing the efficacy of a mixed vaccination strategy against rubella in São Paulo, Brazil.

BACKGROUND: In 1992 a major vaccination strategy against measles-mumps-rubella was introduced in the State of Saão Paulo, Brazil. This strategy was based on mathematical models and comprised a pulse vaccination covering all children aged 1-10 years, followed by the inclusion of this vaccine in the routine calendar at 15 months of age. The present work reports the evaluation of the efficacy of this mixed vaccination strategy. METHODS: A rubella seroprevalence survey was carried out immediately and one year after the campaign, comprising 4953 children aged 1-15 years. RESULTS: We show that average rubella seroprevalence increased from 0.40 to 0.97 and that the reported number of congenital rubella syndrome (CRS) cases dropped dramatically. CONCLUSIONS: The mixed vaccination strategy adopted against rubella has proved to be very effective in reducing the number of CRS cases in São Paulo.

[Mortality trends due to myocardial ischemia in capital cities of the metropolitan areas of Brazil, 1979-89]. / Tendência da mortalidade por doença isquêmica do coração nas capitais de regiões metropolitanas do Brasil, 1979-89.

PURPOSE: To study the trends of mortality rates from cardiovascular diseases (CVD) and coronary heart disease (CHD) in eight capitals of Brazil. METHODS: Death rates for these cities were studied in men (M) and female (F), standardized using the population of São Paulo, SP, 1980. Rates were calculated for CVD (ICD-9: 390-459) and CHD (ICD-9:410-414). The cities were Belém, Recife, Salvador, Belo Horizonte, Rio de Janeiro, São Paulo, Curitiba and Porto Alegre. Using simple linear regression, we obtained the annual difference in rates with a confidence interval of 95%. RESULTS: For CVD a decline was detected of -2.6% (M) and -2.69% (F) in Belém; in Salvador, -1.53% (M) and -1.70% (F) and in São Paulo, -1.27% (M) and -1% (F) and for F in Belo Horizonte (-0.82%) and in Curitiba (-1.52%). Recife, Porto Alegre and Curitiba (M) showed stability during the period. There was a rise of the rates in Rio de Janeiro +1.37% (M) and +0.84% (F) and for M in Belo Hozironte (1%). The rates for CHD showed a decline in Belém-2.64% (M) and -2.74% (F); São Paulo, -1.4% (M) and -1.06% (F) and for F in Belo Horizonte. A stable trend was detected in Salvador, Curitiba, Porto Alegre and for M in Belo Horizonte. There was a rise in the rates of Recife +3.5% (M) and +4.4% (F) and in Rio de Janeiro +2.34% (M) and +2.53% (F). CONCLUSION: The magnitude of death rates and of the time trends showed in this paper reveal important regional differences. Questions related to the different assignment of diagnosis in the chapter of CVD could explain some of the observed trends. However, the rise of mortality rates in Rio de Janeiro could hardly be explained by classificatory matters. Tobacco, diet and medical care could explain the rise of mortality from CVD and CHD in Rio de Janeiro.

A model-based design of a vaccination strategy against rubella in a non-immunized community of São Paulo State, Brazil.

A mixed vaccination strategy against rubella is proposed. We describe how the vaccination strategy was designed with the help of mathematical techniques. The strategy was designed for application in a non-immunized community of the State of São Paulo, Brazil, and was implemented by local health authorities in 1992. This strategy comprises a pulse vaccination campaign, covering the age interval between 1 and 10 years, followed by the introduction of the vaccine in the immunization calendar at 15 months of age. The expected impact of the proposed strategy is discussed.