Effects of an intervention in eating habits and physical activity in Japanese-Brazilian women with a high prevalence of metabolic syndrome in Bauru, São Paulo State, Brazil

We evaluated the impact of a lifestyle intervention on the cardiometabolic risk profile of women participating in the Study on Diabetes and Associated Diseases in the Japanese-Brazilian Population in Bauru. This was a non-controlled experimental study including clinical and laboratory values at baseline and after a 1-year intervention period. 401 Japanese-Brazilian women were examined (age 60.8±11.7 years), and 365 classified for metabolic syndrome (prevalence = 50.6%). Subjects with metabolic syndrome were older than those without (63.0±10.0 vs. 56.7±11.6 years, p < 0.01). After intervention, improvements in variables were found, except for C-reactive protein. Body mass index and waist circumference decreased, but adiposity reduction was more pronounced in the abdominal region (87.0±9.7 to 84.5±11.2cm, p < 0.001). Intervention-induced differences in total cholesterol, LDL, and post-challenge glucose were significant; women who lost more than 5% body weight showed a better profile than those who did not. The lifestyle intervention in Japanese-Brazilian women at high cardiometabolic risk improved anthropometric and laboratory parameters, but it is not known whether such benefits will persist and result in long-term reduction in cardiovascular events.

O impacto da osteoporose no Brasil: dados regionais das fraturas em homens e mulheres adultos - The Brazilian Osteoporosis Study (BRAZOS)

INTRODUÇÃO/OBJETIVOS: O BRAZOS (The Brazilian Osteoporosis Study) é um estudo epidemiológico, de base populacional, realizado em amostra representativa de mulheres e homens brasileiros, de idade superior a 40 anos, com o objetivo de identificar os principais fatores clínicos de risco associados com fratura por baixo impacto. Nesse artigo são apresentados os principais resultados do estudo, de acordo com cada região do país. PACIENTES E MÉTODOS: Um total de 2.420 indivíduos, provenientes das cinco regiões do país e de todas as classes socioeconômicas foram incluídos no estudo. Foram avaliados dados antropométricos, bem como aspectos relacionados aos hábitos de vida, fraturas, ingestão alimentar, atividade física, quedas e qualidade de vida por meio de entrevista individual e quantitativa. Fratura por baixo impacto foi definida como aquela decorrente de queda da própria altura ou menos. Valor de P < 0,05 foi considerado como estatisticamente significante. RESULTADOS: Não houve diferença estatisticamente significativa da prevalência de fratura nas cinco regiões do Brasil, de acordo com o sexo ou classe social. No entanto, nas mulheres, houve maior ocorrência de fraturas na região metropolitana do que nos municípios do interior dos estados e tendência a maior frequência de fraturas em homens da região nordeste. Não foi verificada diferença estatisticamente significativa de fraturas se os homens eram provenientes das capitais ou do interior dos estados. CONCLUSÕES: De acordo com os nossos resultados, não foi observada diferença significativa da prevalência de fraturas por baixo impacto nem da frequência ou relevância de fatores de risco entre as cinco regiões do Brasil.

Gender and schooling inequalities in risk and protective factors for chronic diseases among Brazilian adults, through telephone survey

OBJECTIVES: To assess risk and protective factors for chronic noncommunicable diseases (CNCD) and to identify social inequalities in their distribution among Brazilian adults. METHODS: The data used were collected in 2007 through VIGITEL, an ongoing population-based telephone survey. This surveillance system was implemented in all of the Brazilian State capitals, over 54,000 interviews were analyzed. Age-adjusted prevalence ratios for trends at different schooling levels were calculated using Poisson regression with linear models. RESULTS: These analyses have shown differences in the prevalence of risk and protective factors for CNCD by gender and schooling. Among men, the prevalence ratios of overweight, consumption of meat with visible fat, and dyslipidemia were higher among men with more schooling, while tobacco use, sedentary lifestyle, and high-blood pressure were lower. Among women, tobacco use, overweight, obesity, high-blood pressure and diabetes were lower among men with more schooling, and consumption of meat with visible fat and sedentary lifestyles were higher. As for protective factors, fruit and vegetables intake and physical activity were higher in both men and women with more schooling. CONCLUSION: Gender and schooling influence on risk and protective factors for CNCD, being the values less favorable for men. vigitel is a useful tool for monitoring these factors amongst the Brazilian population.

Anemia e deficiência de ferro em pré-escolares da Amazônia Ocidental brasileira: prevalência e fatores associados

Estudo transversal de base populacional que investigou prevalênciasde anemia e fatores associados à anemia, anemia ferropriva e deficiência de ferro entre crianças de 6 a 60 meses da área urbana de dois municípios do Acre, Brasil (N = 624). Dosagens de hemoglobina sanguínea, ferritina e receptor solúvel de transferrina plasmáticas foram realizadas mediante sangue venoso. Condições sócio-econômicas, demográficas e de morbidade foram obtidas por questionário. Razões de prevalências foram calculadas por regressão de Poisson em modelo hierárquico. As prevalências de anemia, anemia ferropriva e deficiência de ferro foram de 30,6%, 20,9% e 43,5%, respectivamente. Menores de 24 meses apresentaram maior risco para anemia, anemia ferropriva e deficiência de ferro. Pertencer ao maior tercil do índice de riqueza conferiu proteção contra anemia ferropriva (RP = 0,62; IC95%: 0,40-0,98). Pertencer ao maior quartil do índice estatura/idade foi protetor contra anemia (0,62; 0,44-0,86) e anemia ferropriva (0,51; 0,33-0,79), e ocorrência recente de diarréia representou risco (anemia: 1,47; 1,12-1,92 e anemia ferropriva: 1,44; 1,03-2,01). A infestação por geohelmintos conferiu risco para anemia, anemia ferropriva e deficiência de ferro.

Saúde bucal em Diadema: da odontologia escolar à estratégia saúde da família

Embora a política de saúde bucal no Município de Diadema, SP, no período de 1972 a 2007, objeto deste artigo, tenha acompanhado o processo de transformação das práticas do setor no Brasil, sua evolução nesta cidade industrial na Região Metropolitana da Grande São Paulo foi marcada pela singularidade do processo histórico local. Neste artigo analisa-se essa evolução, relacionando-a com o processo de lutas sociais que levou à criação do Sistema Único de Saúde (SUS) e com as políticas nacionais, estaduais e municipais de saúde bucal. Trata-se de um estudo qualitativo do tipo exploratório. Os dados foram obtidos em documentos oficiais e fontes bibliográficas variadas e por meio de entrevistas semiestruturadas com prefeitos, secretários municipais de saúde, coordenadores de saúde bucal e cirurgiões dentistas que vivenciaram as diversas fases das políticas de saúde bucal no município. Identificam-se as características mais marcantes na organização das práticas assistenciais em saúde desenvolvidas na cidade, localizando-as no cenário estadual e nacional. Conclui-se que, não obstante a consolidação da inserção da saúde bucal no SUS e a experiência adquirida no Município com a gestão dessa modalidade assistencial, também em Diadema observam-se dificuldades para superar o modelo de atenção focado nos grupos populacionais tradicionalmente priorizados, com destaque para escolares, pré-escolares e bebês. Nesse sentido, Diadema compartilha com os demais municípios brasileiros o desafio de reestruturar a atenção básica em saúde bucal, superar o tradicional modelo da odontologia escolar e criar novas possibilidades, como a abordagem familiar, com a finalidade de assegurar a universalidade e a integralidade da atenção.

Monitoring Millennium Development Goals in Brazilian municipalities: challenges to be met in facing up to iniquities

The Healthy Cities and Agenda 21 programs improve living and health conditions and affect social and economic determinants of health. The Millennium Development Goals (MDG) indicators can be used to assess the impact of social agendas. A data search was carried out for the period 1997 to 2006 to obtain 48 indicators proposed by the United Nations and a further 74 proposed by the technical group for the MDGin Brazil. There is a scarcity of studies concerned with assessing the MDG at the municipal level. Data from Brazilian health information systems are not always consistent or accurate for municipalities. The lack of availability and reliable data led to the substitution of some indicators. The information systems did not always provide annual data; national household surveys could not be disaggregated at the municipal level and there were also modifications on conceptual definitions over time. As a result, the project created an alternative list with 29 indicators. MDG monitoring at the local community can be important to measure the performance of actions toward improvements in quality of life and social iniquities.

A influência da AIDS no processo de desenvolvimento organizacional das organizações não-governamentais: um estudo de caso sobre a Casa de Assistência Filadélfia

A AIDS foi um evento marcante tanto por sua capacidade devastadora como pela forma como estimulou a solidariedade e a mobilização da sociedade na defesa dos direitos de pessoas vivendo e convivendo com HIV/AIDS. De iniciativas para dar dignidade na morte, as ONG/AIDS passaram por mudanças estruturais para responder às demandas da epidemia. Este estudo descreve a trajetória da ONG/AIDS Casa de Assistência Filadélfia com relação à evolução da epidemia de AIDS ressaltando o desenvolvimento organizacional. Utilizou-se uma metodologia qualitativa com estudo de caso, sendo os dados colhidos por meio de análise documental e entrevistas semi-estruturadas com informantes-chave referidos pela organização. A análise dos dados baseou-se nas proposições teóricas de desenvolvimento organizacional e mostra como a organização saiu da fase pioneira marcada pela improvisação, se expandiu, indo para uma fase de regulamentação até chegar à fase de flexibilização e inovação com a diversificação dos projetos. O estudo aponta para a importância do desenvolvimento organizacional como elemento essencial na formação de organizações saudáveis e ágeis na resposta às suas demandas.

Brazilian scientific production on pharmaceutical care from 1990 to 2009

Brazilian scientific production on pharmaceutical care was identified based on articles indexed on the Medline, Embase, Lilacs, Web of Science and International Pharmaceutical Abstracts databases. Sixty-three articles published in both national and international journals were retrieved. With regard to authors, 72.3% were from the Southeast and South Regions, and 60.8% were affiliated to public universities. In relation to the type of studies, 85.7% were descriptive, and the most frequently researched fields were community pharmacies, hospitals and primary health care units. Articles were original in 65.1% of cases, updates in 20.6%, and reviews in 7.9%. An increase in publications commenced in 2006. In 31.7% of cases, authors had adopted a bibliographical study design, 28.6% qualitative study, 23.8% intervention, and 15.9% observational study design. The most researched subjects were elderly with chronic diseases. The importance of stimulating the conducting of experimental and qualitative studies, as well as amplifying authorship affiliated with the service area, foreign authors and with research in a wide variety of practice settings were highlighted. Despite the limited quantity of articles, an increase in their number as well as in their scope and quality is expected, so as to create further knowledge that contributes to the recognition of pharmacists' actions by patient healthcare teams.

Quality of water sources used as drinking water in a Brazilian peri-urban area

The objective of this paper was to assess bacteriological quality of drinking water in a peri-urban area located in the Metropolitan Region of São Paulo, Brazil. A total of 89 water samples were collected from community plastic tanks and 177 water samples from wells were collected bimonthly, from September 2007 to November 2008, for evaluating bacteriological parameters including: Escherichia coli, Enterococcus and heterotrophic plate count (HPC). Clostridium perfringens was investigated in a subsample (40 samples from community plastic tank and 40 from wells). E. coli was present in 5 (5.6%) samples from community plastic tanks (2.0 - 5.1x10(4) MPN/100mL) and in 70 (39.5%) well samples (2.0 - 8.6x10(4) MPN/100mL). Thus, these samples were not in accordance with the Brazilian Regulation. Enterococcus was detected in 20 (22.5%) samples of the community plastic tanks (1 to 79 NC/100mL) and in 142 (80.2%) well samples (1 to >200 NC/100mL). C. perfringens was detected in 5 (12.5%) community plastic tanks samples and in 35 (87.5%) wells samples (2.2 to >16 MPN/100mL). HPC were above 500 CFU/mL in 5 (5.6%) waters from community plastic tanks. In wells samples, the HPC ranged from <1 to 1.6x10(4) CFU/mL. The residual chlorine did not attend the standard established in the drinking water legislation (0.2 mg/L), except in 20 (22.5%) samples. These results confirm the vulnerability of the water supply systems in this peri-urban area what is clearly a public health concern.

New tick records in Rondônia, Western Brazilian Amazon

In the present study, we provide new tick records from Vilhena Municipality, in the Southeast of the State of Rondônia, Northern Brazil. Ticks collected from a capybara, Hydrochoerus hydrochaeris (Linnaeus), were identified as Amblyomma romitii Tonelli-Rondelli (1 female), and Amblyomma sp. (1 larva). Ticks collected from a harpy eagle, Harpia harpyja (Linnaeus), were identified as Amblyomma cajennense (Fabricius) (16 nymphs) and Haemaphysalis juxtakochi Cooley (1 nymph). Ticks collected from a yellow-footed tortoise, Chelonoidis denticulada (Linnaeus), were identified as Amblyomma rotundatum Koch (10 females, 2 nymphs), and Amblyomma sp. (2 larvae). The present record of A. romitii is the first in the State of Rondônia, and represents the southernmost record for this tick species, indicating that its distribution area is much larger than currently recognized. Although both A. cajennense and H. juxtakochi have been reported parasitizing various bird species, we provide the first tick records on a harpy eagle. A. rotundatum is widespread in the State of Rondônia, and has been previously reported on the yellow-footed tortoise. The present records increase the tick fauna of Rondônia to 26 species.

Heartworm (Dirofilaria immitis) disease in a Brazilian oncilla (Leopardus tigrinus)

Heartworm disease is caused by the intravascular nematode Dirofilaria immitis, a pathogen of public health importance usually associated to domestic dogs and cats, and to a lesser extend to other mammal species. The oncilla (Leopardus tigrinus) is a threatened neotropic felid species that naturally occurs in Brazil. Here, we report the encounter of adult and larval stages of heartworms in a female specimen of L. tigrinus, probable of free-ranging origin, from Ubatuba, São Paulo, Brazil, which died showing clinical signals compatible with heartworm disease. This was the first reported case of D. immitis infection and associated disease in L. tigrinus, also suggesting that the oncilla acted as a definitive host for this parasite. The present findings confirmed D. immitis as a pathogenic agent for this felid species, thus supporting the recommendation for the inclusion of diagnostic testing for this pathogen in routine health screening procedures for captive and free-ranging oncillas in Brazil, especially in those localities where climate conditions support the occurrence of the parasite. Potential reservoirs as oncillas are established beyond the reach of veterinary care, thus representing a continuing risk for domestic animals and humans acquiring heartworm infection. We encourage further serologic and molecular studies aiming to establish D. immitis prevalences in L. tigrinus and other wild carnivores in the region of Ubatuba, as well as ecological and veterinary studies to access the role of this pathogen for the survival of this threatened felid species.

Experimental infection of dogs with a Brazilian strain of Rickettsia rickettsii: clinical and laboratory findings

The bacterium Rickettsia rickettsii is the etiological agent of an acute, severe disease called Rocky Mountain spotted fever in the United States or Brazilian spotted fever (BSF) in Brazil. In addition to these two countries, the disease has also been reported to affect humans in Mexico, Costa Rica, Panama, Colombia and Argentina. Like humans, dogs are also susceptible to R. rickettsii infection. However, despite the wide distribution of R. rickettsii in the Western Hemisphere, reports of R. rickettsii-induced illness in dogs has been restricted to the United States. The present study evaluated the pathogenicity for dogs of a South American strain of R. rickettsii. Three groups of dogs were evaluated: group 1 (G1) was inoculated ip with R. rickettsii; group 2 (G2) was infested by R. rickettsii-infected ticks; and the control group (G3) was infested by uninfected ticks. During the study, no clinical abnormalities, Rickettsia DNA or R. rickettsii-reactive antibodies were detected in G3. In contrast, all G1 and G2 dogs developed signs of rickettsial infection, i.e., fever, lethargy, anorexia, ocular lesions, thrombocytopenia, anemia and detectable levels of Rickettsia DNA and R. rickettsii-reactive antibodies in their blood. Rickettsemia started 3-8 days after inoculation or tick infestation and lasted for 3-13 days. Our results indicate that a Brazilian strain of R. rickettsii is pathogenic for dogs, suggesting that canine clinical illness due to R. rickettsii has been unreported in Brazil and possibly in the other South American countries where BSF has been reported among humans.

Species determination of Brazilian mammals implicated in the epidemiology of rabies based on the control region of mitochondrial DNA

Identification of animals that are decomposing or have been run over or burnt and cannot be visually identified is a problem in the surveillance and control of infectious diseases. Many of these animals are wild and represent a valuable source of information for epidemiologic research as they may be carriers of an infectious agent. This article discusses the results obtained using a method for identifying mammals genetically by sequencing their mitochondrial DNA control region. Fourteen species were analyzed and identified. These included the main reservoirs and transmitters of rabies virus, namely, canids, chiroptera and primates. The results prove that this method of genetic identification is both efficient and simple and that it can be used in the surveillance of infectious diseases which includes mammals in their epidemiologic cycle, such as rabies.

Serosurvey of selected avian pathogens in brazilian commercial Rheas (Rhea americana) and Ostriches (Struthio camelus)

Ratite farming of has expanded worldwide. Due to the intensive farming methods used by ratite producers, preventive medicine practices should be established. In this context, the surveillance and control of some avian pathogens are essential for the success of the ratite industry; however, little is known on the health status of ratites in Brazil. Therefore, the prevalence of antibodies against Newcastle Disease virus, Chlamydophila psittaci, Mycoplasma gallisepticum, Mycoplasma synoviae, and Salmonella Pullorum were evaluated in 100 serum samples collected from commercial ostriches and in 80 serum samples from commercial rheas reared in Brazil. All sampled animals were clinically healthy. The results showed that all ostriches and rheas were serologically negative to Newcastle disease virus, Chlamydophila psittaci, Mycoplasma gallisepticum, and Mycoplasma synoviae. Positive antibody responses against Salmonella Pullorum antigen were not detected in ostrich sera, but were detected in two rhea serum samples. These results can be considered as a warning as to the presence of Salmonella spp. in ratite farms. Therefore, the implementation of good health management and surveillance programs in ratite farms may contribute to improve not only animal production, but also public health conditions.

Emergence and disappearance of a virulent clone of Haemophilus influenzae biogroup aegyptius, cause of Brazilian Purpuric Fever

Summary: In 1984, children presented to the emergency department of a hospital in the small town of Promissão, São Paulo State, Brazil, with an acute febrile illness that rapidly progressed to death. Local clinicians and public health officials recognized that these children had an unusual illness, which led to outbreak investigations conducted by Brazilian health officials in collaboration with the U.S. Centers for Disease Control and Prevention. The studies that followed are an excellent example of the coordinated and parallel studies that are used to investigate outbreaks of a new disease, which became known as Brazilian purpuric fever (BPF). In the first outbreak investigation, a case-control study confirmed an association between BPF and antecedent conjunctivitis but the etiology of the disease could not be determined. In a subsequent outbreak, children with BPF were found to have bacteremia caused by Haemophilus influenzae biogroup aegyptius (H. aegyptius), an organism previously known mainly to cause self-limited purulent conjunctivitis. Molecular characterization of blood and other isolates demonstrated the clonal nature of the H. aegyptius strains that caused BPF, which were genetically distant from the diverse strains that cause only conjunctivitis. This led to an intense effort to identify the factors causing the unusual invasiveness of the BPF clone, which has yet to definitively identify the virulence factor or factors involved. After a series of outbreaks and sporadic cases through 1993, no additional cases of BPF have been reported