Trabalho industrial e câncer de pulmão

Com base em populações hospitalares, foram entrevistados 316 casos e 536 controles para obtenção de informações sobre histórias de trabalho, tabagismo, tabagismo passivo, ocorrência de outros cânceres na família, migração e situação socioeconômica. Os entrevistadores utilizaram um questionário padronizado. Casos e controles foram emparelhados por hospital, sexo e idade. O estudo foi desenvolvido entre 1º de julho de 1990 e 31 de janeiro de 1991 em 14 hospitais da Região Metropolitana de São Paulo, SP (Brasil). Foi elaborada uma classificação por escores como forma de ordenar os indivíduos estudados segundo suas histórias de exposições ocupacionais a cancerígenos, conhecidos para o pulmão, acumulando informações sobre a exposição nos locais de trabalho durante a vida, considerando o tipo de atividade, setor de trabalho e tempo em cada emprego. A análise de regressão logística não-condicional mostrou odds ratio: 1,97 (95% IC: 1,52 a 2,55) para os trabalhadores com maiores escores de exposição. Os resultados permitiram inferir que trabalhadores ligados aos setores de produção de diferentes ramos industriais têm duas vezes o risco de desenvolverem neoplasia pulmonar quando comparados aos trabalhadores envolvidos em atividades não-industriais.

Mortalidade por leucemias relacionada à industrialização

OBJETIVO: Analisar a distribuição espacial da mortalidade por leucemia na população, buscando identificar agregados e estabelecer sua relação com os níveis de industrialização. MÉTODOS: O estudo foi realizado nas 43 regiões de governo do Estado de São Paulo, no qüinqüênio 1991-1995. Foi construído um "índice de industrialização relativo à leucemia" (IIRL) baseado no número de indústrias e empregos industriais por 100.000 habitantes, valor adicionado fiscal, variedade de ramos industriais e indústrias com potenciais exposições de risco para a leucemia. O IIRL foi distribuído em cinco categorias. Verificaram-se os coeficientes padronizados de mortalidade por leucemia em cada uma das regiões, também distribuídos em cinco categorias e comparados ao mapa IIRL. RESULTADOS: As regiões mais industrializadas em ordem decrescente foram Campinas, Piracicaba, Jundiaí, Sorocaba e São Paulo. Não foi encontrada associação entre mortalidade, por nenhum tipo de leucemia, e industrialização. A região de Jales foi a que apresentou o mais alto coeficiente padronizado de mortalidade por leucemia. CONCLUSÕES: A distribuição da mortalidade por leucemia ocorreu de forma homogênea no Estado de São Paulo, não apresentando correlação com o nível de industrialização. Entretanto, aspectos relacionados ao método epidemiológico adotado -- estudo ecológico -- e ao uso do parâmetro "mortalidade por leucemia", doença cujo prognóstico tem mudado muito nas últimas décadas, limitaram a interpretação dos resultados.

Exposure to larva migrans syndromes in squares and public parks of cities in Chile

Between November 2001 and December 2002, 600 dog fecal samples were collected in main squares and public parks of 13 cities in Chile, from the extreme north to the extreme south of the country. The samples were processed in the laboratory by centrifugal sedimentation and the Harada-Mori methods. T. canis eggs were found in 12 cities. Detection rates ranged from 1.9 to 12.5% with an average of 5.2%. Seven percent of the samples had eggs and 9.5% had rhabditoid and/or filariform larvae of Ancylostomatidae. Strongyloides stercoralis were not found. Squares and public parks in Chile pose a potential risk of exposure to visceral, ocular, and/or cutaneous larva migrans syndromes.

Delineamento e validação de matriz de exposição ocupacional à sílica

OBJETIVO: Desenvolver matriz de exposição ocupacional de base populacional para a sílica cristalina no Brasil e estimar sua validade. MÉTODOS: A matriz de exposição ocupacional foi desenvolvida por um epidemiologista e um higienista ocupacional em quatro etapas: a) codificação da variável ocupação; b) codificação da variável setor econômico; c) classificação da exposição por consenso entre os pesquisadores e; d) estimativa do número de trabalhadores registrados, em 1995, para cada nível de exposição. As 8.675 células da matriz, formadas pela intersecção das variáveis setor econômico (25 colunas) e ocupação (347 linhas), foram classificadas de acordo com a freqüência da exposição à sílica em quatro níveis: não expostos, possivelmente expostos, provavelmente expostos e definitivamente expostos. Para a validação da matriz de exposição ocupacional, cinco setores econômicos (extração mineral, construção civil, metalurgia, administração de serviços de pessoal técnico e indústria têxtil) foram re-codificados quanto à exposição por peritos convidados. Avaliou-se a confiabilidade pela proporção de acordos e o grau de concordância pelo Kappa. RESULTADOS: A matriz de exposição ocupacional apresentou alta concordância geral, variando de 64,0% na metalurgia a 94,4% na extração mineral. O Kappa revelou boa concordância no setor de extração mineral (0,9) e baixa ou regular nos demais (variação de 0,1 a 0,5). A especificidade foi alta para os setores de metalurgia (86,5%) e extração mineral (100,0%). A construção civil apresentou especificidade de 56,0%. CONCLUSÕES: A matriz de exposição ocupacional apresentou boa acurácia, revelando-se adequada para estimar a exposição à sílica na força de trabalho ocupada no País.

Modern cancer epidemiological research: genetic polymorphisms and environment

Individual cancer susceptibility seems to be related to factors such as changes in oncogenes and tumor suppressor genes expression, and differences in the action of metabolic enzymes and DNA repair regulated by specific genes. Epidemiological studies on genetic polymorphisms of human xenobiotics metabolizing enzymes and cancer have revealed low relative risks. Research considering genetic polymorphisms prevalence jointly with environmental exposures could be relevant for a better understanding of cancer etiology and the mechanisms of carcinogenesis and also for new insights on cancer prognosis. This study reviews the approaches of molecular epidemiology in cancer research, stressing case-control and cohort designs involving genetic polymorphisms, and factors that could introduce bias and confounding in these studies. Similarly to classical epidemiological research, genetic polymorphisms requires considering aspects of precision and accuracy in the study design.

Mortalidade por câncer em trabalhadores da indústria da borracha de São Paulo

OBJETIVO: Avaliar as mortes por câncer em trabalhadores da indústria da borracha de acordo com o tamanho da empresa. MÉTODOS: Coorte histórica com 9.188 trabalhadores masculinos, matriculados em sindicato de trabalhadores da indústria de borracha do Estado de São Paulo entre 1975 e 1985, sobreviventes em janeiro de 1990 e acompanhados até o final de 2000. As mortes por câncer foram comparadas internamente à coorte, cujos membros foram subdivididos em estratos por porte e sub-ramo da empresa, setor de trabalho e qualificação profissional. A abordagem por conjuntos de risco e regressão logística condicional foi utilizada para o cálculo dos riscos relativos, ajustados por idade, tempo desde o primeiro emprego e tempo de trabalho na indústria da borracha. RESULTADOS: Quando comparados aos empregados de grandes empresas, trabalhadores de pequenas empresas mostraram excesso de mortes por todos tipos de câncer (RR=2,33; IC 95%: 0,90-6,03); tumores de estômago (RR=3,47; IC 95%: 2,57-4,67) e do trato aero-digestivo superior (RR=2,49; IC 95%: 1,78-3,48). Identificou-se excesso de mortes por câncer nos trabalhadores dos setores de manutenção (RR=2,23; IC 95%: 0,73-6,76); expedição, armazenamento e transporte (RR=2,97; IC 95%: 0,77-11,38); e produção (RR=3,51; IC 95%: 1,07-11,57), comparados aos trabalhadores dos setores administrativos. CONCLUSÕES: Os resultados mostram evidências de aumento do risco de tumores de estômago e do trato aero-digestivo superior e, possivelmente, por câncer em geral em trabalhadores de empresas de pequeno porte da indústria da borracha quando comparados aos trabalhadores das grandes empresas.

Dietary patterns and risk of oral cancer: a case-control study in São Paulo, Brazil

OBJECTIVE: To analyze the association between dietary patterns and oral cancer. METHODS: The study, part of a Latin American multicenter hospital-based case-control study, was conducted in São Paulo, Southeastern Brazil, between November 1998 and March 2002 and included 366 incident cases of oral cancer and 469 controls, frequency-matched with cases by sex and age. Dietary data were collected using a food frequency questionnaire. The risk associated with the intake of food groups defined a posteriori, through factor analysis (called factors), was assessed. The first factor, labeled "prudent," was characterized by the intake of vegetables, fruit, cheese, and poultry. The second factor, "traditional," consisted of the intake of rice, pasta, pulses, and meat. The third factor, "snacks," was characterized as the intake of bread, butter, salami, cheese, cakes, and desserts. The fourth, "monotonous," was inversely associated with the intake of fruit, vegetables and most other food items. Factor scores for each component retained were calculated for cases and controls. After categorization of factor scores into tertiles according to the distribution of controls, odds ratios and 95% confidence intervals were calculated using unconditional multiple logistic regression. RESULTS: "Traditional" factor showed an inverse association with cancer (OR=0.51; 95% CI: 0.32; 0.81, p-value for trend 0.14), whereas "monotonous" was positively associated with the outcome (OR=1.78; 95% CI: 1.78; 2.85, p-value for trend <0.001). CONCLUSIONS: The study data suggest that the traditional Brazilian diet, consisting of rice and beans plus moderate amounts of meat, may confer protection against oral cancer, independently of any other risk factors such as alcohol intake and smoking.

Oral health, hygiene practices and oral cancer

OBJECTIVE: To assess the association between oral health and hygiene practices and oral cancer. METHODS: Hospital-based case-control study in the metropolitan area of São Paulo, southeastern Brazil, from 1998 to 2002. A total 309 patients with squamous cell carcinoma of the mouth and the pharynx and 468 controls matched by sex and age were included in the study. Cases were recruited in seven reference hospitals and controls were selected in five out of the seven participating hospitals. Detailed information on smoking, alcohol consumption, schooling, oral health status and hygiene practices were obtained through interviews. Odds ratios (OR) and 95% confidence intervals (95% CI), adjusted by sex, age, schooling, smoking, alcohol consumption as well as the variables oral health status and hygiene practices were estimated using unconditional logistic regression analyses. RESULTS: The use of complete dental prosthesis was not associated with oral cancer but regular gum bleeding showed a strong association (OR 3.1; 95% CI 1.2-7.9). Those who never attended a dental visit were more likely to have oral cancer (OR 2.5; 95% CI 1.3-4.8). Daily mouthwash use showed a stronger association to pharynx (OR 4.7; 95% CI 1.8-12.5) than mouth cancer (OR 3.2; 95% CI 1.6-6.3). CONCLUSIONS: Gum bleeding, no dental care, and daily mouthwash use were factors associated with oral cancer regardless of tobacco and alcohol consumption.

Infection and childhood leukemia: review of evidence

OBJECTIVE : To analyze studies that evaluated the role of infections as well as indirect measures of exposure to infection in the risk of childhood leukemia, particularly acute lymphoblastic leukemia. METHODS : A search in Medline, Lilacs, and SciELO scientific publication databases initially using the descriptors “childhood leukemia” and “infection” and later searching for the words “childhood leukemia” and “maternal infection or disease” or “breastfeeding” or “daycare attendance” or “vaccination” resulted in 62 publications that met the following inclusion criteria: subject aged ≤ 15 years; specific analysis of cases diagnosed with acute lymphoblastic leukemia or total leukemia; exposure assessment of mothers’ or infants’ to infections (or proxy of infection), and risk of leukemia. RESULTS : Overall, 23 studies that assessed infections in children support the hypothesis that occurrence of infection during early childhood reduces the risk of leukemia, but there are disagreements within and between studies. The evaluation of exposure to infection by indirect measures showed evidence of reduced risk of leukemia associated mainly with daycare attendance. More than 50.0% of the 16 studies that assessed maternal exposure to infection observed increased risk of leukemia associated with episodes of influenza, pneumonia, chickenpox, herpes zoster, lower genital tract infection, skin disease, sexually transmitted diseases, Epstein-Barr virus, and Helicobacter pylori . CONCLUSIONS : Although no specific infectious agent has been identified, scientific evidence suggests that exposure to infections has some effect on childhood leukemia etiology.

Inequalities in health: living conditions and infant mortality in Northeastern Brazil

OBJECTIVE To analyze the variation of infant mortality as per condition of life in the urban setting.METHODS Ecological study performed with data regarding registered deaths of children under the age of one who resided in Aracaju, SE, Northeastern Brazil, from 2001 to 2010. Infant mortality inequalities were assessed based on the spatial distribution of the Living Conditions Index for each neighborhood, classified into four strata. The average mortality rates of 2001-2005 and 2006-2010 were compared using the Student’s t-test.RESULTS Average infant mortality rates decreased from 25.3 during 2001-2005 to 17.7 deaths per 1,000 live births in 2006-2010. Despite the decrease in the rates in all the strata during that decade, inequality of infant mortality risks increased in neighborhoods with worse living conditions compared with that in areas with better living conditions.CONCLUSIONS Infant mortality rates in Aracaju showed a decline, but with important differences among neighborhoods. The assessment based on a living condition perspective can explain the differences in the risks of infant mortality rates in urban areas, highlighting health inequalities in infant mortality as a multidimensional issue.

Pneumonia por Legionella pneumophila: relato do segundo caso brasileiro

Os autores relatam um caso de pneumonia por Legionella pneumophila, diagnosticado pela primeira vez em Porto Alegre, Rio Grande do Sul. A hipótese diagnóstica foi confirmada por imunofluorescência indireta nas amostras de soro do paciente enviadas ao C.D.C. (Atlanta — E.U.A.), com títulos de 1:128 na amostra da fase aguda e 1:512 na amostra da fase de convalescença.

Metodo para montaje permanente de huevos de helmintos enteroparasitos

Se comunican resultados obtenidos empleando Medio de Hoyer para el montaje de huevos de helmintos enteroparásitos, destinado a preparaciones para colecciones docentes y/o de investigación. La utilización de esta técnica en muestras fecales conteniendo huevos de A. lumbricoides, T. trichiura, Uncinaria sp., Taenia sp., Diphyllobothrium sp., H. nana, H. diminuta y F. hepática, permitió la correcta observación de ellos en lecturas iniciadas a las 24 horas y mantenidas hasta 180 días después.

Kinectics of the pulmonary phase of Schistosoma mansoni in mice treated with dexamethasone

In the experimental schistosomiasis mansoni glucocorticoids cause a reduction in the worm burden when administered in the week of infection or, the longest, at the next week. In order to determinate the probable(s) site(s) of reduction of the worm burden, mice were infected with cercariae of LE strain of S. mansoni and dexamethasone was administered daily (50 mg/kg, subcutaneously) starting 1 hour before infection until the eighth day. Mice were sacrificed daily starting on the third day after infection until the ninth day, and schistosomula from lungs were collected. Six weeks after infection, the remaining mice were sacrificed and perfused for adult worm recovery. Analysis of the results showed that the non-treated mice presented larger numbers of lung larvae than the treated ones, and this difference was also found later in the worm burden in the portal system. This difference may reflect the early death of larvae in treated animals, before or after reaching the lungs.

Schistosoma mansoni: the effect of dexamethasone on the cercaria-schistosomulum transformation, in vivo

Treatment with dexamethasone (DMS) in the early phases of the experimental Schistosoma mansoni infection causes an indirect effect on the cercaria-schistosomulum transformation process. This is observed when naive albino mice are treated with that drug (50 mg/Kg, subcutaneously) and infected intraperitonealy 01 hour later with about 500 S. mansoni cercariae (LE strain). An inhibition in the host cell adhesion to the larvae, with a simultaneous delay in the cercaria-schistosomulum transformation, is observed. This effect is probably due to a blockade of the neutrophil migration to the peritoneal cavity of mice, by an impairment of the release of chemotactic substances. Such delay probably favors the killing of S. mansoni larvae, still in the transformation process, by the vertebrate host defenses, as the complement system.

Oogram studies in mice infected with Schistosoma mansoni and treated with dexamethasone

Mice infected with about 90 cercariae of Schistosoma mansoni (LE strain) were treated during five consecutive days with dexamethasone (50 mg/Kg, subcutaneously), starting on the 42th day of infection. Groups of five mice were then daily sacrificed from the first day after onset of treatment until the first day after. The perfusion of the portal system was performed and a piece of the intestine was processed for qualitative and quantitative oograms. This treatment carries to larger numbers of eggs in the tissues of treated mice, when compared with untreated groups. No changes were observed in the kinetics of oviposition, as all stages of viable eggs were observed in the tissues of treated and control mice. These data reinforce the hypothesis of a partial blockade of the egg excretion in immunossupressed mice.