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PubMed2003

Occupational asthma in the city of São Paulo, 1995-2000, with special reference to gender analysis.

BACKGROUND: Occupational asthma (OA) is the leading occupational respiratory disease in the area of São Paulo Municipality. Understanding its characteristics can provide useful information for better interventions. METHODS: From a joint registry of OA from five outpatient public clinics for occupational respiratory diseases, data on occupation, with job titles corrected by an expert evaluation, agents, exposure and symptom duration, and spirometry were analyzed by gender. Data on employment for São Paulo Municipality were used to calculate expected ratios for men/women in broad economical sectors. RESULTS: Three hundred and ninety four OA cases were reported with a ratio of men/women of 1.5. Women had significantly shorter exposure duration (5.6 +/- 5.2 vs. 8.9 +/- 9.0 years, P = 0.0005), shorter symptoms duration (2.6 +/- 3.7 vs. 3.2 +/- 3.5 years, P = 0.1270), and higher prevalence of previous atopy (27.0 vs. 18.4%, P = 0.0485). The main occupations related to OA cases were cleaning activities, working in plastics manufacture and in chemical and pharmaceutical plants. Women reported significantly more exposures to cleaning products, biologic agents, and textile fibers, whereas men reported more exposures to isocyanates, metal dusts and fumes, oil mists, wood dusts and anhydrides. Women presented an increased risk of OA in the service sector (odds ratio (OR) = 1.77, confidence interval (CI) = 1.61-1.96). CONCLUSIONS: Cleaning services was the main reported occupation and cleaning products the main reported agents. Women had significantly shorter exposure duration possibly due to difference in exposures, previous atopy, and behavior. There was an excess of cases of women in the service sector.

Adult↗
PubMed2000

Overview: epilepsy surgery in developing countries.

Epilepsy surgery (ES) is addressed in relation to economic classifications of national resources and welfare in developing countries. A decade ago, ten developing countries conducted ES; now 26 such countries have reported results of ES. A number of international authorities define indicators of national economic welfare. Adopting the economic classification of the International Monetary Fund. we find that ES is nonexistent in 98% of African countries, 76% of Asian countries, 58% of European countries, 82% of Middle East countries, and in 86% of countries of the Western Hemisphere. The 1980-1990 global ES survey conducted by the International League Against Epilepsy identified ten developing countries reporting ES (DCRES): Brazil, China, Czechoslovakia, Hungary, Mexico, Poland, Taiwan, the U.S.S.R., Yugoslavia, and Viet Nam. The present survey based on the proceedings of the 19th-23rd International Epilepsy Congresses and Medline reports from 1991 to November 1999 revealed at least 26 (18.3%) DCRES of 142 developing countries: Argentina, Brazil, Chile, China, Colombia, Czech Republic, Egypt, Estonia, Hungary, India, Iran, Israel, Korea, Lithuania, Mexico, P.R.China, the U.S.S.R., Singapore, Slovenia, South Africa, South Korea, Taiwan, Turkey, Ukraine, Uruguay, and former Yugoslavia. National vital statistics expose the hardships of developing countries. The population ratio of developed countries to developing countries is approximately 1:5. The reverse per capita Gross Domestic Product ratio is 20:1. Great disparities exist in vital statistics, all to the disadvantage of the DCRES. The World Health Organization defines health-related sectors geographically, then divides developing countries into several subgroups. Disability caused by length of disease and years lived with disability can be quantified monetarily for epilepsy, and the total health expenditures of developed and developing countries can be compared. The DCRES are short of technology, and their ES teams must choose from an excess of surgical candidates, investigating with computed tomography, magnetic resonance imaging, noninvasive video-electroencephalography, and neuropsychology. The surgical outcomes achieved are similar to those in the developed world, but at a fractional cost. To internationalize ES, outcome, cost, and savings from care, evolution of assessment methodology is needed. Also needed is general support from the developed world.

Adolescent↗
PubMed2006

[Survival study of breast cancer patients treated at the hospital of the Federal University in Santa Maria, Rio Grande do Sul, Brazil].

This retrospective hospital-based study aimed to describe health conditions and to estimate the survival of 252 patients diagnosed with breast cancer and treated at the Mastology Outpatient Clinic at the University Hospital of the Federal University in Santa Maria, Rio Grande do Sul, Brazil, from 1980 to 2000. Analysis followed the Kaplan-Meier and Cox model. Mean age was 54, and 73.4% of the patients had a histological diagnosis of invasive ductal carcinoma, 63.9% showed no lymph node involvement, and 57.6% were clinical stage II. At the end of the study, 64.7% were alive and free of breast cancer and 5.1% had died of other causes. Five-year survival was 87.7% for all women, and prognostic factors associated with survival were tumor size (HR = 12.03; > 5cm), lymph node involvement (HR = 3.08; N1) and number (HR = 4.66; None), and estrogen (HR = 0.34) and c-erbB-2 (HR = 2.51) receptors. Based on the results, intensive awareness-raising campaigns are vitally important for implementing breast cancer screening to achieve early diagnosis.

Adult↗
PubMed1994

Approaches to the treatment of scorpion envenoming.

A total of 3866 patients stung by Tityus serrulatus scorpion was admitted to Hospital João XXIII, in Belo Horizonte, Brazil, over a 16-year period (an average of 241 cases per year). Of these, 73% were adults and 27% were children aged less than 14 years. The moderate or benign cases were treated with symptomatic measures and/or i.v. antivenom, whereas 168 severely envenomed children were treated in the Intensive Care Unit. Lung oedema was unilateral in several cases, with the presence of air bronchograms and a peripheral distribution, suggesting that a noncardiogenic factor is also involved in the genesis of lung oedema. The treatment consisted of symptomatic measures, support of vital functions and i.v. antivenom. The mortality was 1% among children and 0.28% for the total number of patients.

Adolescent↗
PubMed2006

Maximal static mouth respiratory pressure in spinal cord injured patients: correlation with motor level.

STUDY DESIGN: Transversal. OBJECTIVES: The few studies concerning maximal static mouth respiratory pressures in patients with spinal cord lesions suggest a marked reduction. We studied the correlation of these parameters with the motor level of injury. SETTING: Rehabilitation Center, Brasília/DF, Brazil. METHODS: One hundred and thirty-one patients with traumatic spinal cord injury (C4-L3) were recruited. The participants were assessed by standard spirometry and maximal static mouth respiratory pressure. RESULTS: Forced vital capacity was most reduced in tetraplegics (subgroup C4-C5, 49%+/-25 predicted) and increase successively for each descending subgroup (C6-C8, 61%+/-22 predicted; T1-T6, 70%+/-15 predicted), becoming normal in low paraplegia (T7-L3, 84%+/-15 predicted). There is no evidence of an obstructive disturbance throughout all groups. The lowest average percent predicted of maximal static inspiratory pressure (MIP) was in the subgroup C4-C5 (50%+/-23). The average percent predicted of maximal static expiratory pressure (MEP) improved from 19%+/-14 in the C4-C5 subgroup to 51%+/-19 for T7-L3 subgroup. The average percent predicted of all participants for MIP was 74%+/-30 and for MEP was 37%+/-21. In patients with complete motor lesion, the correlation with the level of injury was stronger for MEP (r=0.81, P<0.0001; r (2)=0.65) than for MIP (r=0.62, P=0.004; r (2)=0.38). No correlation was found among incomplete motor lesion patients. CONCLUSIONS: The linear regression equations for the relationship of percent predicted MIP or MEP to level of injury are applicable only to complete motor lesions and may be useful to establish normative association between them.

Adult↗
PubMed2003

[Prenatal care, low birth weight and prematurity in São Paulo State, Brazil, 2000].

OBJECTIVE: The historical evolution of infant mortality rate and neonatal mortality according to birth weight and term of delivery in the state of S o Paulo are presented to assess the role of the number of prenatal visits and others factors for determining mortality. METHODS: Based on data available from the Seade Institute of Vital Statistics, four variables (maternal age, marital status, education, and childbirth order) were analyzed and divided into two categories according to the relative risk of low birth weight and/or preterm prevalence. Sixteen specific groups were created from crossing the four variables into two categories. Low birth weight and/or preterm prevalence per number of prenatal visits and the relative risk were calculated for all sixteen groups. RESULTS: For all sixteen groups, the higher the number of prenatal visits the lower the prevalence of low birth weight and/or prematurity. Additionally, there was an overall reduction of the difference of low birth weight and/or preterm prevalence among the 16 groups from 14% to 4% with an increase from 0-3 to 7 visits or more. CONCLUSIONS: Due to the current infant mortality composition in the state of Sao Paulo, increasing the number of prenatal visits and accessibility of women at risk would probably lead to a reduction in intrauterine growth retardation, prematurity, low birth weight and deaths associated to conditions originated in the perinatal period.

Brazil↗
PubMed2004

Portal vein thrombosis in children and adolescents: the low prevalence of hereditary thrombophilic disorders.

PURPOSE: The aim of this study was to determine the frequency of thrombophilic disorders in children and adolescents with portal vein thrombosis (PVT) as well as assessing the hereditary character of this disorder. METHODS: A 2-year prospective study was carried out in pediatric PVT patients (n = 14), their parents (n = 25), and an age-matched control group free of liver disease (n = 28). The presence of PVT was assessed by means of Doppler ultrasound scan or angiography. None of the PVT patients presented biochemical or histologic signs of liver disease. RESULTS: The frequency in PVT patients of protein C (PC), protein S (PS) and antithrombin (AT) deficiency was 42.9% (P <.05 v controls), 21.4% (P >.05) and 7.1% (P >.05), respectively. None of the controls or parents of PVT patients presented hereditary PC, PS, or AT deficiency. One PVT patient and one control (P =.999) presented prothrombin G20210A mutation. Homozygous methylenetetrahydrofolate reductase C677T genotype was observed in 3 of 14 (21.4%) PVT patients and in 5 of 28 (17.9%; P =.356) controls. None of these patients presented factor V G1691A mutation. CONCLUSIONS: PC deficiency was frequent in pediatric PVT patients and does not seem to be an inherited condition. The hereditary prothrombotic disorders do not seem to play a vital role in thrombosis in children and adolescents with PVT.

Adolescent↗
PubMed1999

[Profile of HIV-positive women hospitalized in a public maternity ward in Rio de Janeiro].

AIDS has been scaring the world population for the last decades. The writers of this article decided to investigate and research into the high incidente of women HIV+ hospitalized in a public maternity in the district of Rio de Janeiro, showing the profile of pregnant women from 1987 to 1996. After a thorough analysis of a total of 102 cases this number was eventually broken down showing that the majority of the female population are single, between the ages of 19 and 33 years, have low schooling, mainly housewives and were sexually contaminated. The results show that the affected groups lack the knowledge as to how they could protect themselves against contamination. It is, therefore, of vital importance to take the necessary measures to help prevent contamination and to focus on health education.

Adolescent↗
PubMedDate not supplied

Efficacy, safety and tolerability of sildenafil in Brazilian hypertensive patients on multiple antihypertensive drugs.

OBJECTIVE: To evaluate the efficacy, safety and tolerability of sildenafil among Brazilian patients with hypertension treated with combinations of anti-hypertensive drugs. MATERIALS AND METHODS: One hundred twenty hypertensive men aged 30 to 81 years old under treatment with 2 or more anti-hypertensive drugs and with erectile dysfunction (ED) lasting for at least 6 months were enrolled at 7 research centers in Brazil. Patients were randomized to receive treatment with either sildenafil or placebo taken 1 hour before sexual intercourse (initial dose of 50 mg, adjusted to 25 mg or 100 mg according to efficacy and toxicity). During the following 8 weeks, patients were evaluated regarding vital signs, adverse events, therapeutic efficacy, satisfaction with treatment and use of concurrent medications. RESULTS: The primary evaluation of efficacy, which was based on responses to questions 3 and 4 of the International Index of Erectile Function, showed significant differences regarding treatment with sildenafil (p = 0.0002 and p < 0.0001, respectively). In the assessment of global efficacy, 87% of the patients treated with sildenafil reported improved erections, as compared with 37% of patients given placebos (p < 0.0001). The other secondary evaluations supported the results favoring sildenafil. The most frequent adverse events among patients treated with sildenafil were headaches (11.4%), vasodilation (11.4%) and dyspepsia (6.5%). There were no significant changes in blood pressure measurements in both groups. CONCLUSION: Sildenafil is efficacious and safe for the treatment of hypertensive patients with ED who receive concurrent combinations of anti-hypertensive drugs.

Adult↗
PubMed2004

Effect of episodic tension-type headache on the health-related quality of life in employees of a Brazilian public hospital.

OBJECTIVE: To evaluate the impact of ETTH on HRQoL in a sample of employees of a Brazilian public hospital. METHOD: Three hundred and sixty Mário Gatti Hospital employees were asked about headache occurrence in the previous 6 months and completed a SF-36 and a pain questionnaires concerning impact of pain (0 to 10 scale) on daily activities, work efficiency, leisure and social activities in previous six months. Two groups were studied: 1. Episodic Tension-type headache group: 127 employees -- 81 (63.8%) female and 46 (36.2%), male. 2. CONTROL GROUP: 124, 71 (57.3%) female and 53 (42.7%) male. RESULTS: ETTH had lowers scores than control in all domains of SF-36; in vitality and bodily pain the difference was statistically significant. CONCLUSION: Our results indicate that ETTH suffers have impact on HRQoL predominantly in vitality. Psychological factors associated to pain may explain this finding.

Brazil↗
PubMed2003

Risk factors for cardiovascular disease in a Brazilian population-based cohort study.

OBJECTIVE: Our aim was to investigate risk factors for cardiovascular disease (CVD) in a population-based Brazilian cohort. DESIGN AND METHODS: A cohort study was conducted with 1091 individuals identified through multi-stage probability sampling in Porto Alegre, Brazil. Risk factors were investigated among demographic and anthropometric characteristics, including education, smoking habits, income, alcoholic beverage consumption, and blood pressure. A fatal or non-fatal episode of myocardial infarction, stroke, or heart failure, and cases of sudden death comprised the composite endpoint. RESULTS: Vital status was determined in 982 (90.0%) of the participants of the original cohort after 6.0+/-1.7 years of follow-up. A total of 52 individuals presented a cardiovascular event. Male gender (hazard ratio (HR) 2.01, 95% CI 1.03-3.91), systolic blood pressure (mmHg) (HR 1.03, 95% CI 1.01-1.04) and alcohol consumption (g/day) (HR 1.001, 95% CI 1.00-1.003) were associated with the incidence of CVD after controlling for confounding. Body mass index (HR 1.05, 95% CI 0.99-1.11) and current or previous smoking (HR 1.65, 95% CI 0.83-3.26) showed a trend for a positive association. CONCLUSIONS: We confirmed that male gender, systolic blood pressure, obesity and smoking are risk factors for cardiovascular disease in a Brazilian population. The positive association between alcohol consumption and incident CVD was unexpected and deserves replication.

Adult↗
PubMed2005

Survival in idiopathic pulmonary fibrosis-cytotoxic agents compared to corticosteroids.

STUDY OBJECTIVE: To compare the survival of patients with IPF treated retrospectively with corticosteroids alone, to survival of patients treated with immunosuppressive and corticosteroids combined. DESIGN: Non-randomized retrospective cohort study. SETTING: Three tertiary centers in Brazil. PATIENTS: Eighty-two IPF patients were included. The diagnosis was confirmed by open lung biopsy in 48. Patients received either corticosteroids alone (group I) or cytotoxic agents in addition to corticosteroids (group II). MEASUREMENTS AND RESULTS: The primary end-point was mortality. Secondary outcome included longitudinal changes in FVC. Mean age was 66+/-8 years. FVC was 71+/-17% of predicted. There were 48 deaths during the study period (59%), 44 secondary to respiratory causes. From preliminary univariate analysis, for the group as a whole, worse survival was found to be associated with FVC% <70% of predicted (P=0.004), evidence of disease progression by follow-up FVC measurements (P=0.01), and pharmacologic treatment (P=0.014). Median survival was 25 months for the group I, and 45 months for the group II (Log-Rank=6.45, P=0.01). After adjusting for FVC > or =70% and<70% of predicted, there was evidence to indicate that survival was associated with recommended pharmacologic treatment only in patients with FVC> or =70% (Log Rank=6.84, P=0.009). CONCLUSIONS: The combination of immunosuppressive agents and prednisone results in better survival when compared to prednisone alone in patients with IPF. The benefit seems to occur only in patients with less severe disease, as reflected by FVC> or =70%.

Aged↗
PubMedDate not supplied

[Demographic information: what do we have, what do we use, and how do we use it?].

"The paper evaluates the Brazilian system of demographic information and analyses the available sources...and their utilization in published papers. The author has also done a survey asking [participants] about the utilization of this information. [The author concludes] that the information is underutilized." (SUMMARY IN ENG)

Americas↗
PubMed2000

Quality of life at the initiation of maintenance dialysis treatment--a comparison between the SF-36 and the KDQ questionnaires.

OBJECTIVE: To evaluate the construct validity of the Medical Outcomes Study Questionnaire 36-Item Short Form Health Survey (SF-36) and to assess the quality of life of patients with end-stage renal disease (ESRD) at the initiation of maintenance dialysis treatment. METHODS: Cross-sectional study. SETTING: Eight ambulatory dialysis units in São Paulo city, Brazil. STUDY PARTICIPANTS: Eighty ESRD patients at the initiation of chronic dialysis program and consecutively accepted for treatment in selected units in 1998. MAIN OUTCOME MEASURES: Quality of life as measured by the dimensions of the SF-36 questionnaire. The 'Kidney Disease Questionnaire' was used in a subgroup of patients to evaluate the validity of the SF-36. RESULTS: Median (range) scores of the SF-36 dimensions (ranging from 0 to 100, higher scores representing better quality of life) were: Physical Function 70 (0-100), Role Limitations due to Physical Problems 25 (0-100), Bodily Pain 62 (0-100), General Health 57 (5-100), Vitality 55 (10-100), Social Function 63 (0-100), Role Limitations due to Emotional Problems 34 (0-100) and Mental Health 68 (0-100). SF-36 dimensions correlated significantly with those of the 'Kidney Disease Questionnaire' (correlation coefficients ranging from 0.23 to 0.68). CONCLUSIONS: The SF-36 was shown to have construct validity when used in patients with ESRD in Brazil. The quality of life of ESRD patients is impaired at the initiation of dialysis treatment and this was clearly evidenced in the Role Limitations due to Physical Function and Emotional Function items. Greater attention should be given to interventions that could improve the quality of life parameters at the initiation of dialysis treatment.

Adult↗