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PubMed2005

[Dimensions and potentialities of the geographic information system on indigenous health].

OBJECTIVE: To discuss the potentials of the Geographic Information System in the analysis of the epidemiological and socio-demographic profiles of indigenous peoples and of the organization of health services directed towards their care. METHODS: Geoprocessing analysis of tuberculosis, malaria and mortality notification of 374,123 indigenous people distributed in 36 Distritos Sanitários Especiais Indígenas (Special Indigenous Sanitary Districts) in Brazil was conducted. A gradient of risk intensity for tuberculosis, malaria, and infant mortality among indigenous populations was defined for the years 2000 to 2002. These coefficients were then compared with those of non-indigenous populations, during the same period. RESULTS: The analysis showed that the previous available data are fragmentary and do not allow for a comprehensive assessment of life conditions and health situations of these ethnic groups. The construction of gradients of risk indicated incidence of tuberculosis coefficients among the indigenous population more than 1,000 times greater than those found among the general population in Brazil. The mean malaria API among the indigenous population was up to 10 times greater than the mean values found among the non-indigenous population and the coefficient of infant mortality among the indigenous population varied from 74.7/1,000 live births in 2000 to 56.5/1,000 live births in 2001, exceeding the national average (31.8/1,000) for the same period in more than 100%. CONCLUSIONS: The Geographic Information System is a useful administrative tool for assessing health conditions, evaluating population risks, constructing scenarios, and planning intervention strategies in several levels, shifting quickly and efficiently between macro- and micro-level realities.

Brazil↗
PubMed2001

[Depression in adolescence treated at primary care centres: size of a hidden problem of general health].

OBJECTIVES: To investigate the prevalence of depression and its relationship to the reason for the consultation and to the medical diagnosis. DESIGN: Descriptive, cross-sectional design. SETTING: Primary care units of a community in Brazil. PATIENTS AND OTHER PARTICIPANTS: Individuals between 13 and 19 years old, who attended 10 primary care units to consult with a non-psychiatric doctor between October 1997 and January 1998 (n = 463). MAIN MEASUREMENTS AND RESULTS: The CET-DE (Alonso-Fernández, 1986) was used to measure depression, jointly with a questionnaire for evaluating social and demographic details and data pertinent to the consultation. Prevalence ran at 26.5% (95% CI: 22.6-30.4%). 99.2% cases of depression had not been identified. Complaints were spread over the somatic field (61.1%), or were sex-related (49.5%), mainly pregnancy (31.7%), especially among the cases of depression (p < 0.001). There were few psychiatric-social complaints (1.5%). Diagnoses often coincided with complaints: 59.9% somatic, 38.4% sex-related (pregnancy = 21.6%) and 1.7% psychiatric-social. CONCLUSIONS: Adolescent depression is common in primary care, but is not usually identified. The reason for this may be the kind of depression, which is usually light or focused on just one dimension of human vitality; the doctors tendency to centre his/her attention on the complaint without broadening the clinical spectrum; or even because the adolescent expresses his/her emotional problems poorly, which often contributes to the depression not being diagnosed.

Adolescent↗
PubMed1998

Computed tomography of the head by the accident and emergency department--why 24 hour access is vital.

OBJECTIVE: To examine the use made of 24 hour access to computed tomography from an accident and emergency (A&E) department and to assess whether clear benefits for patients could be identified by having such a service. METHODS: Retrospective review of 176 cases where computed tomography was ordered by A&E staff of a large teaching hospital over a one year period. RESULTS: 53% of scans were done "out of hours"; 97% of scans performed (171/176) were studies of the brain. Three examinations were of the cervical spine and two were of the chest. 54% of head scans (93/171) were performed for either confirmed or suspected trauma with 46% (78/171) done for medical indications. Only 16% (11/71) of patients who had a head scan for acute trauma required transfer to the regional neurosurgical unit after consultation. Computed tomography was 100% sensitive in the diagnosis of sub-arachnoid haemorrhage. In cases where computed tomography was performed for coma of undetermined origin the pathology causing coma was identified on computed tomography in 50% of cases. CONCLUSIONS: Computed tomography facilities allow comprehensive initial evaluation of the head injured patient and minimise hazardous and expensive transfer of these seriously ill patients. Experience shows that it is a vital tool in the initial differential diagnosis of the comatose patient and therefore must be available for use by senior and middle grade A&E staff on a 24 hour basis.

Craniocerebral Trauma↗
PubMed2004

[Caring for children and adolescents with cancer: the intrathecal chemotherapy phase].

This study aims to explore the experiences of children and adolescents with cancer during the intrathecal chemotherapy phase, by means of a qualitative approach. Empirical data were collected on the basis of semi-structured interviews. Study participants were eleven children/adolescents who received intrathecal chemotherapy, between 07 and 16 years old, from both genders, attended at a hospital school in the interior of São Paulo State, Brazil. Results converged towards the following issues: intrathecal routine; fear, pain and relief fantasies and strategies. This study gave access to important information with a view to caring for children/adolescents during the intrathecal chemotherapy phase, which is considered as one of the most stressing situations. With respect to nursing implications, we identified the vital nature of information for children/adolescents with cancer since this makes it possible to minimize uncertainties and negative feelings and makes them collaborate and participate in treatment.

Adaptation, Psychological↗
PubMed2006

Cholinergic bronchomotor tone and airway caliber in tetraplegic patients.

STUDY DESIGN: Case-control study. OBJECTIVES: To evaluate the resting airway caliber in subjects with tetraplegia; to define the participation of cholinergic innervation in this condition; and to determine if baclofen modifies this pattern. SETTING: A rehabilitation hospital, Brasília, Brazil. METHODS: We studied 18 tetraplegic patients, with complete motor loss between C4 and C8, and 18 healthy control subjects by measuring airway conductance, before and after inhaled ipratropium bromide. RESULTS: At baseline, the pulmonary function parameters revealed mild-to-moderate restrictive impairment in tetraplegic patients as defined by decreases in total lung capacity and predicted percent of slow vital capacity. The average baseline specific airway conductance (sGaw) was less in tetraplegic patients (0.25+/-0.11) than in the control group (0.41+/-0.10 l/s/cm H(2)O) (P<0.0001). All patients had improved post-bronchodilator sGaw >or=40% compared with only four of the 18 controls (P<0.001). The average increase for tetraplegic patients was 235% (+/-93) versus 25% (+/-24) for controls (P<0.0001). Analysis of variance for repeated measurements showed significant difference in sGaw between the control and spinal cord injury (SCI) groups (P<0.0001) following bronchodilator challenge, but found no difference for total gas volume. No difference for mean basal sGaw and bronchodilator challenge was encountered comparing tetraplegic patients using baclofen to those not using it. CONCLUSIONS: Cervical SCI patients have a reduced baseline conductance compared to controls. Marked improvement occurs after an inhaled anticholinergic drug. This behavior was not affected by the use of baclofen. The study adds support to the hypothesis of an increased cholinergic bronchomotor tone in tetraplegic patients.

Adolescent↗
PubMed1997

[Pneumoconiosis and exposure to wood].

The authors report a case of an employee in the wood processing industry. The clinical presentation was respiratory with dyspnoea on effort. The chest x-ray showed bilateral interstitial changes. Following bronchioalveolar lavage electron microscopic studies showed evidence of silica particles. Respiratory function tests showed pulmonary performance of 51%-64% of theoretical values depending on the test used. His working position involved the up keep of the boilers and also the drainage of the silos for wood dust. The wood used was corupixa, a brazilian wood containing crystalline silica; 0.1% in fresh wood dust. Numerous analyses have specified the percentage of silica in the ashes in magma. The diagnosis of pneumoconiosis of the silicotic type was sustained. The occupational risk linked to using this type of wood should be understood and the need to take protective measures for the employees concerned.

Adult↗
PubMedDate not supplied

[Hematologic aspects of the national hockey team athletes].

Athletes tend to have lower hemoglobin (Hb) concentrations than sedentary counterparts. Sports anemia is used to describe both pseudodilutional anemia and the true anemia of athletes. Pseudodilutional anemia is a beneficial adaptation to endurance training; the two most common causes of true anemia are iron deficiency and intravascular hemolysis. We used questionnaires, physical examination and laboratory investigation to study 19 highly trained hockey athletes and laboratory investigation to study 32 outpatients without hematological diseases. One athlete had anemia (Hb 10.5 g/ dL; 5.44 million red cells/mL; serum iron-13 micrograms/dL; without parasites in the stools); the athletes had Hb = 14.88 +/- 1.33 g/dL and the outpatients had 15.24 +/- 0.74 g/dL; the maximal oxygen uptake of the athletes was 54.0 +/- 6.03 ml/kg/min (112.15 +/- 14.35% of the predicted values). The maximal oxygen uptake of the anemic athlete was 86% of the predicted value. The three athletes with the best maximal uptake had a mean Hb = 15.8 g/dL. In São Paulo-Brazil anemia is uncommon among males but elite athletes are in a borderline anemic state, that may impair the physical fitness.

Anemia↗
PubMed2006

[Accuracy of the probabilistic record linkage methodology to ascertain deaths in survival studies].

Probabilistic record linkage methodology has been increasingly used to ascertain outcomes in cohort studies. However, only a few studies have evaluated its accuracy. The aim of this study was to evaluate the accuracy of probabilistic record linkage methodology to ascertain deaths in a cohort of 250 elderly people hospitalized for fractures caused by falls. The vital status of cohort members was determined through household visits conducted at one and six months after hospital admission. Record linkage was used to link records from the cohort to the Rio de Janeiro State mortality database. Deaths identified by the latter process were compared to the results obtained by active follow-up (gold standard). The vital status of 20 cohort members could not be determined by active follow-up. Among the remaining 230, 60 died within 180 days after hospital admission. Record linkage had a sensitivity of 85.5%, specificity of 99.4%, positive predictive value of 98.1%, and negative predictive value of 94.9%. In conclusion, probabilistic record linkage appears to be a useful tool for identifying deaths in cohort studies conducted in Brazil.

Accidental Falls↗
PubMed2005

Chronic obstructive pulmonary disease in five Latin American cities (the PLATINO study): a prevalence study.

BACKGROUND: Both the prevalence and mortality attributable to chronic obstructive pulmonary disease (COPD) seem to be increasing in low-income and middle-income countries, but few data are available. The aim of the PLATINO study, launched in 2002, was to describe the epidemiology of COPD in five major Latin American cities: São Paulo (Brazil), Santiago (Chile), Mexico City (Mexico), Montevideo (Uruguay), and Caracas (Venezuela). METHODS: A two-stage sampling strategy was used in the five areas to obtain probability samples of adults aged 40 years or older. These individuals were invited to answer a questionnaire and undergo anthropometry, followed by prebronchodilator and postbronchodilator spirometry. We defined COPD as a ratio less than 0.7 of postbronchodilator forced expiratory volume in the first second over forced vital capacity. FINDINGS: Complete information, including spirometry, was obtained from 963 people in São Paulo, 1173 in Santiago, 1000 in Mexico City, 885 in Montevideo, and 1294 in Caracas. Crude rates of COPD ranged from 7.8% (78 of 1000; 95% CI 5.9-9.7) in Mexico City to 19.7% (174 of 885; 17.2-22.2) in Montevideo. After adjustment for key risk factors, the prevalence of COPD in Mexico City remained significantly lower than that in other cities. INTERPRETATION: These results suggest that COPD is a greater health problem in Latin America than previously realised. Altitude may explain part of the difference in prevalence. Given the high rates of tobacco use in the region, increasing public awareness of the burden of COPD is important.

Adult↗
PubMed2004

[Peri-menopausal and post-menopausal experience among women with and without hormone replacement therapy].

This qualitative study focuses on peri-menopausal and post-menopausal experience and its signs and symptoms for women with and without use of hormone replacement therapy (HRT). Empirical data were obtained through interviews with 11 women (range: 45 to 59 years) with or without HRT at different health clinics in the Municipality of Sao Paulo, Brazil. The analysis used the hermeneutic method. Most significantly, women who are not on HRT present peri-menopausal symptoms, but they "live with" such symptoms; meanwhile, women in use of isoflavone rely on alternative therapies for the bothersome symptoms; women using HRT report a feeling of wellbeing. The article suggests the importance of training health professionals to understand the peri-menopausal and post-menopausal periods as part of the aging process, and thus as a vital rather than pathological process.

Estrogen Replacement Therapy↗
PubMed2006

Seasonal timing of pseudoviviparous reproduction of Leiothrix (Eriocaulaceae) rupestrian species in South-eastern Brazil.

BACKGROUND AND AIMS: Pseudovivipary is an asexual reproductive strategy. Leiothrix spiralis and L. vivipara (Eriocaulaceae) are pseudoviviparous and occur in rupestrian grasslands, a habitat that has a predominance of sandy and shallow soil, with low water retention. This study aims to investigate the seasonal variation effect of moisture availability on L. spiralis and L. vivipara pseudoviviparous reproduction, and to compare their life history attributes, on rupestrian grasslands in Southeastern Brazil. METHODS: A field study was conducted, including observations concerning pseudoviviparous reproduction and measurement of demographic variables in both L. spiralis and L. vivipara. Soil moisture measurements were also performed to study its effect on the pseudoviviparous reproduction of L. spiralis and L. vivipara. KEY RESULTS: Flower head and plantlet production in L. spiralis were highly correlated with soil moisture. All scapes split off in the drier period, indicating that this is a splitter ramet species. Plantlet mortality was positively correlated with scapes splitting off. The L. vivipara phenophases were not synchronized to the variation in soil moisture, since flower heads and plantlets were produced throughout the year. Moreover, the splitting off of scapes was not observed. In addition, plantlets were formed early, as soon as the flower heads appeared, and remained suspended. Therefore, this species was called 'canopy forming'. CONCLUSIONS: Seasonal timing of pseudoviviparous reproduction can be a vital component of the successful establishment of plantlets in L. spiralis, considering that in this species the plantlets are formed only after the flower head touches the ground. In contrast, in L. vivipara, the plantlets are formed early, without touching the ground. Moreover, L. spiralis is a splitter ramet species, while L. vivipara is a canopy-forming species. The pseudoviviparous canopy-forming strategy appears to be more advantageous than the splitter ramet strategy, because even under similar soil moisture conditions, the survival of L. vivipara plantlets was greater than that of L. spiralis.

Brazil↗
PubMed2005

[Quality of life and depressive symptoms in nursing residents].

This study aimed to evaluate quality of life and prevalence of dysphoria/depressive symptoms in nursing residents at a medical school in São Paulo, Brazil. An exploratory, descriptive and cross-sectional study was carried out, involving 68 nursing residents from the first and second year of residency from all specialty areas, by applying the Brazilian version of the quality of life questionnaire SF-36 (Medical Outcomes Study 36--Item Short-Form Health Survey) and the Brazilian Version of the Beck Depression Inventory (BDI). Aspects related to quality of life were at risk in the mental component of SF-36: emotional aspects, vitality and mental health. Dysphoria/depression were found in 27.9% of the nursing residents.

Depression↗
PubMed2005

Men's experiences of vasectomy in the Brazilian Public Health Service.

BACKGROUND: Vasectomy was legalized in Brazil in 1996 and is freely available in some public health institutions. Nevertheless, the prevalence of vasectomy is less than 4.4%, demonstrating how rarely this contraceptive resource is used. The promotion of greater male involvement in reproductive health was one of the recommendations of the Cairo International Conference of Population and Development (ICPD). RESEARCH OBJECTIVE: To describe the experiences of a group of men who had had vasectomy. METHOD: The thematic oral history method was used. Twenty men vasectomized in a Sao Paolo State Health Service Clinic were interviewed. Each tape-recorded narrative was analysed through transcription, textualization, and transcreation, a process used to transform the oral history into written narrative form. From each narrative a 'vital tone' was extracted, revealing the essence of the individual experience. All the data were analysed under an inductive and interpretative process. The similarities among histories were identified, and submitted to a process of reduction in order to develop descriptive categories. RESULTS: The following descriptive categories were developed from the men's experiences: Misconceptions regarding vasectomy that were overcome after hearing positive results expressed by other men; Vasectomy was the last solution for a couple's troubles related to contraceptive methods; Satisfaction related to professional support received during the process of searching for a method and deciding upon vasectomy; Satisfaction was the main feeling expressed following vasectomy and they recommended this contraceptive method to other men; Men's behaviours towards postvasectomy control was divergent despite the professional guidance. CONCLUSIONS: An integrated public policy is required to promote male involvement in reproductive health. Family planning programmes must be meaningful socioculturally and the inclusion of men in these programmes is recommended. The use of anonymized videotaped narratives or the recruitment of the men themselves during counselling about this method would be helpful for the resolution of reservations related to vasectomy. All the interviewed men expressed satisfaction with vasectomy and this feeling was mainly based on the certainty of the preservation of sexual performance. LIMITATIONS: A third of those invited for interview did not attend.

Adult↗
PubMed2004

[Relationship between psychosocial job satisfaction and health in white collar workers].

OBJECTIVE: To identify whether psychosocial satisfaction at work is associated with workers' health and to verify if sociodemographic characteristics have an impact on these associations. METHODS: A cross-sectional study was carried out in 224 employees of a private managed care and retirement savings company in São Paulo, Brazil. Four self-administered questionnaires on sociodemographic features, job satisfaction, and health (physical, mental, and work ability) were applied. Variables associations were analyzed using t-Student, Mann-Whitney and Kruskal-Wallis tests, Spearman correlation coefficient, and multiple linear regression analysis. RESULTS: Job satisfaction was associated with duration in the company (p <0.001) and job position (p=0.003), where greater satisfaction was observed among workers with shorter duration in the company and those in managing positions. Job satisfaction was associated with mental health and work ability (vitality: p<0.001; social aspects: p=0.055; emotional aspect: p=0.074; mental health: p<0.001; and work capacity: p=0.001). CONCLUSIONS: Job satisfaction is associated with workers' health regarding their "mental health" and "work ability", showing the importance of psychosocial factors for their health and well-being. Changes are suggested in work conception and organization to focus psychosocial factors. Longitudinal studies are recommended to investigate the causal direction of these associations.

Adult↗
PubMed2001

Evaluation of the quality of life in Brazilian women with fibromyalgia, through the medical outcome survey 36 item short-form study.

PURPOSE: The purpose of this study is to assess the impact of Fibromyalgia (FM) on the female patient's quality of life who attended the Rheumatology Outpatient Unit of Sorocaba Hospital Complex and compare it to the quality of life of healthy control group, through the Medical Outcome Study Short-form 36 item Survey (SF36). SUBJECTS: 32 women who fitted the American College of Rheumatology Classification Criteria for Fibromyalgia and 28 healthy women. MATERIALS AND METHODS: The groups were submitted to 'Medical Outcome Study 36 Item Short-form Survey' (SF36). This questionnaire is composed of 8 scales about several aspects of the quality of life. RESULTS: The SF36 scales in the Fibromyalgia group presented the following results: general health--43.3; functional ability--39.4; bodily pain--26.5; physical functioning--14.8 (0-75); vitality--38.5 (5-85); emotional functioning--32.2; mental health--44.2; social functioning--45.1. The SF36 scales in the control group presented the following results: general health--73.2; functional ability--86.6; bodily pain--68.9; physical functioning--82.4; vitality--59.6; emotional functioning--78.5; mental health--67.4; social functioning--77.9. Significant statistics variations in all evaluated scales were presented by the survey group. CONCLUSION: Fibromyalgia has had a negative impact on the quality of life.

Adaptation, Physiological↗
PubMed2025

Clinical and laboratory profiles of Oropouche virus disease from the 2024 outbreak in Manaus, Brazilian Amazon.

BACKGROUND: The 2024 Oropouche virus (OROV) outbreak in Brazil raised public health concerns due to its unprecedented rapid spread, high incidence, and potential neurological complications. OROV symptoms overlap with locally endemic arbovirus diseases, like dengue virus (DENV), complicating diagnosis. The study aimed to compare clinical, laboratory, and immunological profiles in OROV and DENV cases, crucial for improving diagnosis and management. METHODS: This study analyzed 51 OROV and 78 of DENV cases consecutively enrolled in Manaus, Amazonas, Brazil, and monitored for 28 days. OROV diagnosis was performed by real-time PCR (RT-PCR) using serum and urine samples. OROV RT-PCR positive samples were genotyped. A paired Plaque Reduction Neutralization Test (PRNT) was conducted on samples collected at D1 and D28. Patients with a&#x2009;&#x2265;&#x2009;4-fold increase in neutralizing antibody titer between D1 and D28 were considered OROV-positive. Clinical manifestations, hematology, biochemistry, and cytokine profiles were analyzed. Statistical analysis included comparison between OROV and DENV patients. RESULTS: Genome sequencing of OROV isolates confirmed presence of a previously reported novel reassortment event, consistent with ongoing localized transmission. Urine RT-PCR demonstrated low positivity compared to serum samples. The paired PRNT increased sensitivity in 45%. Clinically, OROV infection was associated with significantly higher frequencies of severe headache, myalgia, arthralgia, and rash compared to DENV infection (p&#x2009;<&#x2009;0.001). Elevated alanine aminotransferase (ALT) levels were also observed in OROV patients (p&#x2009;<&#x2009;0.001). Immunologically, OROV infection induced significantly increased levels of acute-phase CCL11 (eotaxin), CXCL10, IFN-&#x3b3;, IL-1RA, and IL-10, which declined by day 28, while IL-5 increased during recovery. In contrast, DENV patients exhibited elevated levels of CCL2, G-CSF, and CCL3 in recovery phase. CONCLUSION: OROV symptoms overlap with DENV underscores the need for syndromic diagnostic approach in endemic regions. Continued genomic surveillance and expanded clinical studies are vital to assess long-term consequences. Given OROV's expanding geographic range, targeted public health measures are essential to mitigate future outbreaks and better understand its pathophysiology.

Humans↗