Risk factors for atherosclerosis in an elderly outpatient population in the city of São Paulo.

OBJECTIVE: To analyze in out clinic elderly patients of both sexes for the prevalence of risk factors for atherosclerosis and study their association with the complications of atherosclerosis. METHODS: Five hundred and sixteen outpatients, 152 men and 364 women, 60 years or older, were studied. The prevalences of hypertension, dyslipidemia, diabetes mellitus, cigarette smoking and obesity were determined in both sexes and compared using the chi-square test. The association between these factors and the presence of atherosclerotic complications was analyzed by logistic regression. RESULTS: The comparative analysis of the factors in both sexes showed that hypertension, total cholesterol > or = 240 mg/dL, LDL-cholesterol > or = 160 mg/dL, and body mass index > 27.5 were more frequent among women, but HDL-cholesterol < 35 mg/dL and cigarette smoking were more frequent among men, and no difference occurred between sexes in relation to the frequency of triglycerides > or = 250 mg/dL and diabetes mellitus. After adjustment of the variables in the regression model, we observed that in the total of elderly patients, risk factors for complications of atherosclerosis were: triglycerides > or = 250 mg/dL, hypertension, and male sex. Among men, the risk factors were: LDL-cholesterol > or = 160 mg/dL, diabetes mellitus, HDL-cholesterol < 35 mg/dL and hypertension. Among women, the risk factors were: triglycerides > or = 250 mg/dL and hypertension. CONCLUSION: The results showed that, in the elderly, the risk factors for atherosclerosis persist, but with different behaviors between men and women. The study suggests that the relative importance of the risk factors can change with the aging process.

[Physical aggression and social class]. / Agressão física e classe social.

OBJECTIVE: Considering the increase of violence and the scarcity of informations about the relation between social class and victimization by physical aggression, a study was conducted to investigate this association. METHODS: A hospital-based case-control study. Cases and controls were recruited at a hospital, first-aid clinic, from 1/10/93 to 19/1/95. The study included 191 cases and 222 controls selected from among patients with non-violent clinical-surgical complaints, frequency-matched to cases by sex and age. Using a standardized questionnaire applied by trained interviewers, information obtained included social class, skin color, marital status, smoking habits, alcohol consumption and illicit drug use. RESULTS: Adjusting for sex and age, the risk of victimization by physical aggression was significantly higher for the subproletariat, Odds Ratio (OR) 4.20, 95% Confidence Interval (95% CI) 1.99-8.84; single (OR = 2.10) or informal union (OR = 2.62) as marital status (reference group = married); smokers of more than 10 cigarettes/day (OR = 2.75); alcohol consumption (OR = 2.08 for < or = 240 grams/week and OR = 24.05 for > 240 grams/week); and illicit drug users (OR = 3.07). After adjusting for all factors studied a significant risk remained for the subproletariat (OR = 3.28, 95% CI 1.42-7.59); single as marital status (OR = 2.05, 95% CI 1.09-3.88); and alcohol consumption (OR = 2.01, 95% IC 1.07-3.77 for < or = 240 and OR = 15.93, 95% CI 5.09-49.8 for > 240 grams/week) CONCLUSION: Social class is an important factor in the phenomenon of victimization by physical aggression, with the subproletariat deserving special attention in the strategies of intervention regarding this problem.

[Chagas' disease as main cause of death in the southeastern region of Brazil: presence of contributory causes]. / Doenca de Chagas como causa básica de óbito na região sudeste do Brasil: presença de causas contributárias.

Death certificates of all persons who died in in the State of S.Paulo, Brazil and which presented Chagas' disease as the principal cause of death, were studied with a view to analysing the existing additional information available as to contributory causes. After a direct reading of the 1,308 death certificates, the contributory causes were identified and registered. They were mentioned in 261 (20%) of the certificates, 185 of them presenting only one, and 75 two of them. The 6 more frequent contributory causes were: "megas", embolism, chronic pulmonary disease, infections (other than Chagas' disease), arterial hypertension and malnutrition. When analysing the presence of the contributory causes in two groups-persons of less than 50 years old, and those older than 50 a higher proportion of them was observed in the older group and a distinct profile of causes was found for each group. No statistic association was observed between contributory causes and sex or site of residence.

[Study of morbidity in patients hospitalized at the Clinic Hospital at the Medical School of the USP-1989]. / Estudo da morbidade dos pacientes internados no Hospital das Clínicas da Faculdade de Medicina da USP-1989.

The diagnostic categories of the patients discharged from the "Hospital das Clínicas" of the University of São Paulo in 1989 were arranged according the International Classification of Diseases (I.C.D.) and analysed. In each Group sex, age and the reason of discharge or death was indicated. The data concerning 39,601 cases were provided by the Medical Data Service of the "Instituto Central" of the "Hospital das Clínicas". Only the principal diagnosis was taken into account. In the "Instituto de Psiquiatria" most the patients (55.4%) were males between 20 and 49 years of age. The main diagnostic categories were affective psychoses (20.3%), schizophrenic disorders (15%), and disorders related to alcoholism (9.5%). The mortality rate was 0.27%. In the "Instituto da Criança" 56% of the patients that left the hospital were male children and 45.8% of them were less than one year old. Regarding to the diagnostic categories the most important one was that of the diseases of the respiratory system with 27.1% of cases, followed by that of infectious and parasitic diseases with 16.0% of cases. Within the respiratory diseases the most important were the pneumonias caused by not specified microorganisms, and within the infectious diseases the most important was the diarrhea of presumably infectious origin. The mortality rate in this Institute was 9.4%. The "Instituto de Ortopedia e Traumatologia" left 3,825 patients 61.7% males, and 46.9% of them were aged between 20 and 49 years. The greatest number of cases (57.1%) belonged to the Chapter "Injury and Poisoning" followed by that of "Diseases of the Muscoleskeletal System" and Connective Tissue Diseases (23.5%). In this Institute the mortality rate was 1.2%. From the "Instituto do Coração" 7,194 patients were discharged; 65% of them were males, varying their age between 50 and 69 years. The diseases of the circulatory system were mostly ischemic heart disease, miocardiopathies and rheumatic heart diseases. Mortality rate in this Institute was 10.8%. The "Instituto Central" was responsible for 65.6% of all the patients discharged from the "Hospital das Clínicas" (26,015 cases). As to the diagnostic categories the predominant chapter was that of "Injury and Poisoning" (12.8% of cases) followed by the "Diseases of the Digestive System" (10.9%) "Neoplasms" (10.8%) and the "Diseases of Circulatory System" (9.2%). The mortality rate in the "Instituto Central" was 7.2%.

[Mortality due to Chagas disease in São Paulo State (Brazil): subsidy for the planning of chagasic patient care]. / Mortalidade por doença de Chagas no Estado de São Paulo (Brasil): subsídios para o planejamento da assistência ao chagásico.

In order to estimate the size of the population with Chagas' disease, an essential parameter for the establishment of an adequate health care policy for this group of patients, data from 1,646 death certificates from the "Fundação Sistema Estadual de Análises de Dados" in which Chagas' disease was mentioned in the State of S. Paulo in 1987 were examined. The population under study comprised adults between 15 and 70 years of age. Objectives also included the determination of Proportional Mortality, Potentially Lost Years of Life and regional distribution of the events in the counties of the State of S. Paulo. Chagas disease accounted for 0.9% of the totality of the causes of death, Proportional Mortality was 1.2% and the proportional participation of Chagas' disease in the Potentially Lost Years of Life was 1.1%. Corresponding data for Ischemic Heart Disease were, 4.0% and 1.2%. 20.8% of the deaths occurred in counties other than the county of residence, the indexes of evasion varying from 17.8% to 29.1% for different regions. Males (22.8%) more often than females (17.4%) died outside their county of residence. The largest number of deaths occurred in the metropolitan area of S. Paulo, although Ribeirão Preto county presented the highest mortality indexes.

[Epidemiology of tetanus in São Paulo State (Brazil)]. / Aspectos epidemiológicos do tétano no Estado de São Paulo (Brasil).

Tetanus is a reportable disease in the State of São Paulo since 1978. The data from this source show a trend toward a decrease in the incidence of tetanus, although it is still higher than in the developed countries. There is a constantly high mortality rate. We have studied 133 cases of non-neonatal tetanus that had been reported to the Epidemiology Surveillance Center of the State of São Paulo in 1989. The data we analysed were obtained from the epidemiological report form routinely used during the investigation and confirmation of the cases. The incidence was 0.41 per 100.000 population and the mortality rate was 44.36%. It was possible to identify some groups under a higher risk like old-aged, those living in the western and north-western regions of the State and those classified occupationally as "domestic activities", "rural workers" and "pensioners". We propose that these groups deserve special attention, together with pregnant women and children. In 18.3% of the cases the incubation period could not be determined. The peak incidence occurred in May. We also compared the mortality rate in the group of patients in the Hospital das Clínicas da FMUSP (the only hospital in the State of São Paulo with an Intensive Unit Care designed exclusively to the treatment of the patients with tetanus) and the group of patients that were admitted to other hospitals. The mortality rate in the HC-FMUSP was 34.5% and in the other hospitals was 49.5%, but this was not statistically significant. The role of the medical facilities in the prognosis of the patient with tetanus specially the importance of considering at the same time the severity of the disease and the characteristics of the therapy deserve further study in order to contribute to the development of the medical assistance to the patients with tetanus.

[Determinants of the process of domiciliary infestation by Panstrongylus megistus: the role of housing and deforesting]. / Determinantes do processo de infestação domiciliar por Panstrongylus megistus: o papel da habitação e do desmatamento.

This study investigates the housing conditions and deforesting in Caconde and São José do Rio Pardo, neighbouring towns located in the northeastern region of the State of São Paulo, Brazil. These localities have had different dwelling infestation rates by Panstrongylus megistus and they also show distinct socioeconomic development. The housing conditions were studied by the analysis of data collected during the 1970's by the Superintendência de Controle de Endemias (SUCEN), a government agency. Aerial photographs taken during flights performed by the Agricultural Department of the State were used to analyse the deforesting. The socioeconomic analysis was based on Agricultural Census and interview with agronomic officials. The study showed more precarious housing conditions in Caconde than in São José do Rio Pardo. It was related to lower socioeconomic development in Caconde, confirming a trend showed by previous studies. The deforesting was more intense in São José, where socioeconomic development has been higher and the infestation rates were lower, what demonstrates opposite behaviour between the two determinants in these towns. The links between deforesting and higher socioeconomic development can also be showed by the relation between productive activity and destruction of the natural agricultural covering. It is emphasized that the tendency of opposite effect of the deforesting did not change the final result, that is, the confrontation of these determinant forces resulted in higher infestation rates in Caconde than in São José do Rio Pardo. The existence of these opposite trends between the determinants disclosed therefore more complexity in the infestation process of P. megistus, although the final result was not reverted changed.