Studies on mosquitoes (Diptera: Culicidae) and anthropicenvironment: 5- Breeding of Anopheles albitarsis in flooded rice fields in South-Eastern Brazil

Studies on breeding Anopheles albitarsis and association with rice growth in irrigated paddy fields were carried out during the rice cultivation cycle from December 1993 to March 1994. This period corresponded to the length of time of permanent paddy flooding. Breeding occurred in the early stage up until five weeks after transplantation when rice plant height was small. That inverse correlation may give potential direction to control measures.

Studies on mosquitoes (Diptera: Culicidae) and anthropic environment: 6 - Breeding in empty conditions of rice fields in South-Eastern Brazil

Studies on culicid breeding in empty rice fields were carried out during the cultivation cycle from May to November 1993. This period corresponded to stages 1 and 2, when empty conditions prevailed. Breeding occurred in stage 1 and the first part of stage 2, corresponding respectively to fallow uncultivated and ploughing situations. No breeding was found to take place during the second part of stage 2 when transient floods and harrowing occurred. The predominant species were Aedes scapularis, Culex nigripalpus and Cx. mollis. The Pilosus Group of Culex (Melanoconion) was found at lower densities. Some epidemiological considerations are presented.

Studies on mosquitoes (Diptera: Culicidae) and anthropic environment: 7- Behaviour of adults Nyssorhynchus anophelines with special reference to Anopheles albitarsis s.l. in South-Eastern Brazil

Results obtained with catches performed at several sites of the Ribeira Valley, SP (Brazil) are reported. Collections with Shannon type traps showed a concentration of An.albitarsis s.l. in the Experimental Farm of Pariquera-Açu County, associated with the development of irrigated rice cultivation. Two species of the complex, named A and B, were recognized. Species B predominated in the samples. Indoor and outdoor crepuscular human bait captures were performed a the domiciliary environment. The two species showed a generally low William's media valve of 0.2, the highest value obtained was 1.6. No differences were found between indoor and outdoor behaviours between the two species of the complex.

Studies on mosquitoes (Diptera: Culicidae) and anthropic environment: 8- Survey of adult behaviour of Spissipes Section species of Culex (Melanoconion) in South-Eastern Brazil

A study of Spissipes Section of Culex (Melanoconion) adults behaviour was carried out from August 1992 through December 1993 in human dominated (anthropic) environment in the Ribeira Valley, S.Paulo State, Brazil. By sampling at several sites it the dominance of Culex ribeirensis and Cx. sacchettae became evident even through a total number of ten species was recorded. Those two mosquitoes showed a clear tendency to frequent the domiciliary environment where they were caught, both indoor and outdoor, through the use of the human bait. In the outside environments, the residual patchy forests seems to display a concentration role, from which these adults spread to the open land and reach the dwellings. As their vector competence has been demonstrated through the virus isolations in natural conditions, it is advisable to pay attention to the presence of these mosquitoes in the man-made environment.

Studies on mosquitoes (Diptera: Culicidae) and anthropic environment: 9- Synanthropy and epidemiological vector role of Aedes scapularis in South-Eastern Brazil

Behaviour comparisons of Aedes scapularis and Ae. serratus are presented. Results were obtained by sampling Aedes adult mosquitoes at several places in the rural anthropic environment in the Ribeira Valley region of S. Paulo State, Brazil. Aedes dominance was shared by those two species, but Ae. scapularis Sshowed a clear tendency to frequent the modified environment, while Ae. serratus was to be found in the more preserved ones, here represented by the vestigial patchy forests. Regarding the open cultivated land and the dwelling environments, Ae. scapularis preponderates. Considering the regional developmental phases, this mosquito showed a remarkable increase in the modified environment differently from Ae. serratus that underwent a considerable decrease in migrating from the forest to the anthropic environment. As a consequence of these results it is reasonable to conclude that Ae. scapularis may be considered as an epidemiologically efficient vector and that it quite probably played this role in the Rocio encephalitis and other arbovirus epidemics.

Studies on mosquitoes (Diptera: Culicidae) and anthropic environment: 10- survey of adult behaviour of Culex nigripalpus and other species of Culex (Culex) in South-Eastern Brazil

A survey of adult behaviour of Culex (Culex) species was carried out from August 1992 through December 1993 in a human modified (anthropic) environment in the Ribeira Valley, S.Paulo State, Brazil. Culex nigripalpus dominated the catches at several sites and it's tendency to increase in the anthropic environment became quite clear. Nevertheless no high level of synanthropy was demonstrated. So it seems that the mosquito may have a restricted role in natural arbovirus cycles. Nonetheless, Cx. nigripalpus must be considered a potential vector of arboviruses, especially St. Louis encephalitis virus outside dwellings.

Cost of diseases in Brazil: breast cancer, enteritis, cardiac valve disease and bronchopneumonia

The results from the need to develop methodologies for performing cost analysis in developing countries, principally in the region of Latin America, were studied. It, furthermore, serves to generate knowledge from an economic evaluation in order to support decision-making related to the organization of health systems, particularly in the efficient use of resources which are allocated for the provision of medical services. Two chronic diseases (breast cancer and cardiac valve disease) and two infections (enteritis and bronchopneumonia) were selected for the study. The results recommend the use of a valid methodology for economic cost analysis of any disease to be studied and the use of this information in the decision-making process.

Studies on mosquitoes (Diptera: Culicidae) and anthropic environment: 11 - Biting activity and blood-seeking parity of Anopheles (Kerteszia) in South-Eastern Brazil

An. (Ker.) cruzii and An. (Ker.) bellator were monitored by the use of human bait and Shannon trap collections during a one-year period in 1994. Indoor and outdoor collections were made on human bait and inside the forest environment a Shannon trap was used. Both were undertaken in the evening crepuscular period. Results showed a greater abundance of An. cruzii in the forest, where as An. bellator was more abundant in the domiciliary environment. Through the application of the Polovodova method an age grading was established. Computing the parous and nulliparous females with Christopher's Stage III and above, more than 30.0% of blood-seeking specimens of both anophelines had had a previous blood meal. The higher abundance of An. bellator as compared with that of An. cruzii in the domiciliary environment may be explained by the influence of the neighboring low-lying coastal islands of the estuary system.

Studies on mosquitoes (Diptera: Culicidae) and anthropic environment. 12- Host-seeking behaviour of Anopheles albitarsis s.l. in South-Eastern Brazil

Results obtained with Anopheles albitarsis s.l. catches mainly performed through human bait at the Ribeira Valley region, SP (Brazil), are reported. Two species of the complex were recognized, namely An. albitarsis s.s. and species B. This latter predominated both in the rice fields and in the dwelling environments. The crepuscular rhythms showed an unimodal sunset pattern with most blood-seeking females caught during dusk. The absence of differences between indoor and outdoor behavior was confirmed for both species of the complex.

Hospital visitors as controls in case-control studies

OBJECTIVE: Selecting controls is one of the most difficult tasks in the design of case-control studies. Hospital controls may be inadequate and random controls drawn from the base population may be unavailable. The aim was to assess the use of hospital visitors as controls in a case-control study on the association of organochlorinated compounds and other risk factors for breast cancer conducted in the main hospital of the "Instituto Nacional de Câncer" -- INCA (National Cancer Institute) in Rio de Janeiro (Brazil). METHODS: The study included 177 incident cases and 377 controls recruited among female visitors. Three different models of control group composition were compared: Model 1, with all selected visitors; Model 2, excluding women visiting relatives with breast cancer; and Model 3, excluding all women visiting relatives with any type of cancer. Odds ratios (OR) and 95% confidence intervals were calculated to test the associations. RESULTS: Age-adjusted OR for breast cancer associated with risk factors other than family history of cancer, except smoking and breast size, were similar in the three models. Regarding family history of all cancers, except for breast cancer, there was a decreased risk in Models 1 and 2, while in Model 3 there was an increased risk, but not statistically significant. Family history of breast cancer was a risk factor in Models 2 and 3, but no association was found in Model 1. In multivariate analysis a significant risk of breast cancer was found when there was a family history of breast cancer in Models 2 and 3 but not in Model 1. CONCLUSIONS: These results indicate that while investigating risk factors unrelated to family history of cancer, the use of hospital visitors as controls may be a valid and feasible alternative.

Cost of schizophrenia: direct costs and use of resources in the State of São Paulo

OBJECTIVE: To estimate the direct costs of schizophrenia for the public sector. METHODS: A study was carried out in the state of São Paulo, Brazil, during 1998. Data from the medical literature and governmental research bodies were gathered for estimating the total number of schizophrenia patients covered by the Brazilian Unified Health System. A decision tree was built based on an estimated distribution of patients under different types of psychiatric care. Medical charts from public hospitals and outpatient services were used to estimate the resources used over a one-year period. Direct costs were calculated by attributing monetary values for each resource used. RESULTS: Of all patients, 81.5% were covered by the public sector and distributed as follows: 6.0% in psychiatric hospital admissions, 23.0% in outpatient care, and 71.0% without regular treatment. The total direct cost of schizophrenia was US$191,781,327 (2.2% of the total health care expenditure in the state). Of this total, 11.0% was spent on outpatient care and 79.2% went for inpatient care. CONCLUSIONS: Most schizophrenia patients in the state of São Paulo receive no regular treatment. The study findings point out to the importance of investing in research aimed at improving the resource allocation for the treatment of mental disorders in Brazil.

Validade da escala de depressão do Center for Epidemiological Studies entre idosos brasileiros

OBJETIVO: Obter validade interna, de construto e de critério para a escala Center for Epidemiological Studies - Depression, em idosos. MÉTODOS: O instrumento foi aplicado a 903 idosos residentes em Juiz de Fora, Estado de Minas Gerais, entre os anos de 2002-2003. Os resultados foram comparados com a versão brasileira da Geriatric Depression Scale, aplicado a uma subamostra de 446 respondentes. A consistência interna das duas escalas foi aferida pelo coeficiente alfa de Cronbach, calculado para os itens em sua totalidade e para os itens de cada fator obtido para o instrumento avaliado. Para avaliar a validade de construto, seus 20 itens foram submetidos à análise fatorial exploratória a fim de conhecer o padrão de variação conjunta dos itens e a variância explicada por cada fator. RESULTADOS: O instrumento revelou índices satisfatórios de validade interna (alfa=0,860), sensibilidade (74,6%) e especificidade (73,6%), para nota de corte >11. Entretanto, apontou freqüência relativamente alta de falsos positivos em comparação à Geriatric Depression Scale: de 33,8% vs. 15%. A análise fatorial exploratória do instrumento gerou estrutura fatorial com três fatores: afetos negativos, dificuldades de iniciar comportamentos e afetos positivos. CONCLUSÕES: O instrumento mostrou-se psicometricamente adequado para uso entre idosos. Entretanto, estudos adicionais de natureza longitudinal e transversal, desenvolvidos em diferentes contextos, poderão esclarecer os efeitos de variáveis somáticas e situacionais sobre os resultados desse instrumento em pessoas idosas.

Care cost for pregnant and parturient women with diabetes and mild hyperglycemia

OBJECTIVE: To compare inpatient and outpatient care costs for pregnant/parturient women with diabetes and mild hyperglycemia. METHODS: A prospective observational quantitative study was conducted in the Perinatal Diabetes Center in the city of Botucatu, Southeastern Brazil, between 2007 and 2008. Direct and indirect costs and disease-specific costs (medications and tests) were estimated. Thirty diet-treated pregnant women with diabetes were followed up on an outpatient basis, and 20 who required insulin therapy were hospitalized. RESULTS: The cost of diabetes disease (prenatal and delivery care) was US$ 3,311.84 for inpatients and US$ 1,366.04 for outpatients. CONCLUSIONS: Direct and indirect costs as well as total prenatal care cost were higher for diabetic inpatients while delivery care costs and delivery-postpartum hospitalization were similar. Prenatal and delivery-postpartum care costs were higher for these patients compared to those paid by Brazilian National Health System.

Lifestyle factors, direct and indirect costs for a Brazilian airline company

OBJECTIVE To analyze lifestyle risk factors related to direct healthcare costs and the indirect costs due to sick leave among workers of an airline company in Brazil. METHODS In this longitudinal 12-month study of 2,201 employees of a Brazilian airline company, the costs of sick leave and healthcare were the primary outcomes of interest. Information on the independent variables, such as gender, age, educational level, type of work, stress, and lifestyle-related factors (body mass index, physical activity, and smoking), was collected using a questionnaire on enrolment in the study. Data on sick leave days were available from the company register, and data on healthcare costs were obtained from insurance records. Multivariate linear regression analysis was used to investigate the association between direct and indirect healthcare costs with sociodemographic, work, and lifestyle-related factors. RESULTS Over the 12-month study period, the average direct healthcare expenditure per worker was US$505.00 and the average indirect cost because of sick leave was US$249.00 per worker. Direct costs were more than twice the indirect costs and both were higher in women. Body mass index was a determinant of direct costs and smoking was a determinant of indirect costs. CONCLUSIONS Obesity and smoking among workers in a Brazilian airline company were associated with increased health costs. Therefore, promoting a healthy diet, physical activity, and anti-tobacco campaigns are important targets for health promotion in this study population.

Screening for frailty in older adults using a self-reported instrument

OBJECTIVE To validate a screening instrument using self-reported assessment of frailty syndrome in older adults.METHODS This cross-sectional study used data from the Saúde, Bem-estar e Envelhecimento study conducted in Sao Paulo, SP, Southeastern Brazil. The sample consisted of 433 older adult individuals (≥ 75 years) assessed in 2009. The self-reported instrument can be applied to older adults or their proxy respondents and consists of dichotomous questions directly related to each component of the frailty phenotype, which is considered the gold standard model: unintentional weight loss, fatigue, low physical activity, decreased physical strength, and decreased walking speed. The same classification proposed in the phenotype was utilized: not frail (no component identified); pre-frail (presence of one or two components), and frail (presence of three or more components). Because this is a screening instrument, “process of frailty” was included as a category (pre-frail and frail). Cronbach’s α was used in psychometric analysis to evaluate the reliability and validity of the criterion, the sensitivity, the specificity, as well as positive and negative predictive values. Factor analysis was used to assess the suitability of the proposed number of components.RESULTS Decreased walking speed and decreased physical strength showed good internal consistency (α = 0.77 and 0.72, respectively); however, low physical activity was less satisfactory (α = 0.63). The sensitivity and specificity for identifying pre-frail individuals were 89.7% and 24.3%, respectively, while those for identifying frail individuals were 63.2% and 71.6%, respectively. In addition, 89.7% of the individuals from both the evaluations were identified in the “process of frailty” category.CONCLUSIONS The self-reported assessment of frailty can identify the syndrome among older adults and can be used as a screening tool. Its advantages include simplicity, rapidity, low cost, and ability to be used by different professionals.