Impact of health legislation on the sale of anorectics in a city in the Amazon region

OBJECTIVES: The International Narcotics Control Board released its 2005 annual report, highlighting the Brazil population as one of the largest consumers of anorectics. In Brazil, the National Health Surveillance Agency issued the resolution RDC 58/2007 in order to control the prescription and sale of such drugs. In Belém, the biggest city in the Brazilian Amazon region, this resolution came into force in 2008, leading to inspections of drugstores and magistral pharmacies. The aim of this work was to evaluate the consumption of psychotropic anorectic drugs and the impact of RDC 58/2007 on the prescription and dispensing of anorectics in drugstores and magistral pharmacies in Belém. METHODOLOGY: A retrospective quantitative and descriptive study was conducted of records from the Municipal Department of Health Surveillance of Belém, for 2005 to 2008. The differences in findings were regarded significant when p < 0.05. RESULTS: A total of 1,641 balance sheets of drugstores and magistral pharmacies were analyzed. Amfepramone was the most dispensed medication, followed by fenproporex and mazindol. The highest consumption of anorectics occurred in magistral pharmacies. In 2008, there was a significant reduction in dispensing of anorectics, in drugstores as well as in magistral pharmacies. CONCLUSIONS: This study showed that there was a decrease in the dispensing of anorectics after RDC 58/2007 came into force, and that the magistral pharmacies dispensed more of these drugs. This resolution is a remarkable tool in health control, where it is of great benefit to public health and contributes substantially to the rational use of medicines in Brazil.

Parasite-host relationship between the tambaqui (Colossoma macropomum Cuvier 1818) and ectoparasites, collected from fish farms in the city of Rolim de Moura, State of Rondônia, Western Amazon, Brazil

In this study we investigated the relationship between tambaqui fish (Colossoma macropomumi Cuvier 1818) and parasites in two fish farms (L204S and L180N) in the state of Rondônia, Brazil, during a 1-year period. The objective of the study was to describe the relationships between parasites, hosts and the environment. From the 80 fish specimens collected, 100% were parasitized by at least one parasite species. Seven ectoparasites species were recorded, six of the class Monogenea: Anacanthorus spathulatusi, Mymarothecium spp. (Mymarothecium sp. 1, Mymarothecium sp. 2 and M. viatorum), Notozothecium sp. and Linguadactyloides brinkimanni, classified as dominants, and the copepod Perulernaea gamitanae, classified as subordinate. Despite their high prevalence, the parasites were not abundant. A. spathulatus presented positive and significant correlations between the abundance of parasitism and the standard length of the hosts in the two fish farms; Mymarothecium spp. showed significant correlations, negative in L180N, and positive in L204S; significant positive correlations were observed for Notozothecium sp. in L204S, and for L.brinkimanni in L180N. Young monogeneans were found; these parasites presented a negative correlation in L180N and a significant negative correlation in L204S. The results of the correlation between the relative condition factor (Kn) and the abundance of parasites were not significant for the recorded parasite species. Regarding the hepatosomatic relation (HSR) of fish and the abundance of parasites, Anacanthorus spathulatusi showed a significant negative correlation with the HSR in L180N, and a positive correlation in L204S. Mymarothecium spp. and Notozothecium sp. presented significant positive correlations in L204S. Considering the correlation of the fish splenosomatic relation (SSR) and the abundance of parasites, L. brinkimanni presented significant correlations, positive in L180N and negative in L204S. Despite 100% prevalence, the high water quality contributes to infracommunities with low parasite abundance and good levels of Kn, HSR and SSR, allowing good tambaqui development.

Relation between oral health and socioeconomic variables among schoolchildren aged 12 in the City of Manaus - AM

Studies have shown that the age of 12 was determined as the age of global monitoring of caries for international comparisons and monitoring of disease trends. The aimed was to evaluate the prevalence of dental caries, fluorosis and periodontal condition and their relation with socioeconomic factors among schoolchildren aged twelve in the city of Manaus, AM. This study with a probabilistic sample of 661 children was conducted, 609 from public and 52 from private schools, in 2008. Dental caries, periodontal condition and dental fluorosis were evaluated. In order to obtain the socioeconomic classification of each child (high, upper middle, middle, lower middle, low and lower low socioeconomic classes), the guardians were given a questionnaire. The mean decayed teeth, missing teeth, and filled teeth (DMFT) found at age twelve was 1.89. It was observed that the presence of dental calculus was the most severe periodontal condition detected in 39.48%. In relation to dental fluorosis, there was a low prevalence in the children examined, i.e., the more pronounced lines of opacity only occasionally merge, forming small white areas. The study showed a significant association of 5% among social class with dental caries and periodontal condition. In schoolchildren of Manaus there are low mean of DMFT and fluorosis, but a high occurrence of gingival bleeding.

Female gender but not season of birth is associated with mood seasonality in a near-equatorial Brazilian city

OBJECTIVE: Studies conducted mainly in countries located in the Northern Hemisphere have shown that season of birth influences mood seasonality. Greater mood seasonality has been observed for individuals born during spring/summer months than those born during autumn/winter months. Expanding past research to the Southern Hemisphere, in this study we examine the influence of season of birth on mood seasonality in a sample of 1,247 healthy young Brazilians. METHOD: The Seasonal Pattern Assessment Questionnaire was used to compute a global seasonality score as a measure of mood seasonality in a cross-sectional study. RESULTS: Analysis of covariance was conducted to examine the effects of month of birth and gender on mood seasonality, with age entered as a covariate. A main effect of gender was observed, F (1, 1197) = 17.86, p < .01; partial Eta-squared = .02, with mood seasonality being higher for females (M = 8) than for males (M = 7). Contradicting previous findings, no significant main effect for month of birth was observed, F (1, 1197) = 0.65, p > .05. CONCLUSION: The unexpected finding is tentatively explained by differences in geographic location and weather fluctuations between the sampling location in Brazil and other countries where season of birth has been found to influence mood seasonality. Additional studies with larger samples from the Southern Hemisphere are necessary to shed additional light on the possible significant influence of season of birth on mood.

Benzodiazepine use and associated factors in elderly in the city of Dourados, MS, Brazil

ABSTRACT Objective The use of benzodiazepines (BZD) and associated factors in the elderly of Dourados, MS, Brazil was investigated. Methods This is a cross-sectional population-based study using a multistage sampling design. Participants were 1,022 individuals aged ≥ 60 years. Measurements socioeconomic status, schooling, demographic aspects, marital status, physical activity, hospitalizations, self-rated health, use of alcohol beverages and smoking were assessed by standard questionnaire. The drugs used were obtained by checking the prescription or package and classified according to the Anatomical Therapeutic Chemical Index. Chi-square test, Chi-square for linear tendency, Fisher's exact test and Poisson regression were used to assess association between variables. Results The prevalence of use of BZD was 6.5% (CI95%: 5.1-8.2%). The oldest group (PR: 1.60 for 70-79 years and PR: 1.79 for ≥ 80 years), non-use of alcohol (PR: 4.14) and use of antidepressants (PR: 8.73) were the statistically associated characteristics. Conclusions The prevalence of use of BZD in the study population was low, similar to findings of more recent Brazilian studies and lower than those obtained in international studies. The prevalence of use of BZD increased with aging and use of antidepressants.

Prevalence of depressive and anxiety symptoms in medical students in the city of Santos

ABSTRACT Objective Ascertain the prevalence of depressive and anxiety symptoms in medical students, considering data in the literature that indicate higher vulnerability to emotional disorders in this population. Methods A descriptive cross-sectional study with a sample of 657 (98%) students. The instruments used were: questionnaire of socioeconomic-demographic characteristics, Beck Depression Inventory and Beck Anxiety Inventory. Results Predominance of the female gender (61%), aged between 17 and 30 years (98%), Catholic religion (64.2%) from the city of São Paulo (40.7%) and other cities in the state (35.7%); 30% presented depressive symptoms and 21% anxiety symptoms. Female students had higher scores both for depression (34.8%) and for anxiety (26.8%). As regards the course year, the highest rates were found in the 5th year (40.7%) for depression and in the 2nd year for anxiety (28.8%). Conclusion The data obtained in this study (30%) agreed with the literature regarding the prevalence of depressive symptoms in medical students, but this index was higher compared to the population in general (15.1% to 16.8%), and related to people in São Paulo city (18.5%). Concerning anxiety the rates found were slightly lower than those in specific literature but higher than those in literature for the population in general (8% to 18%) and in city São Paulo (16.8%). These indices indicate that the school of medicine may play a role as a predisposing and/or triggering factor in some students. The results suggest that more attention should be directed to 5th year students, who are beginning the internship period.

Risk factors for atherosclerosis in an elderly out patient population in the City of São Paulo

OBJECTIVE: To analyze in out clinic elderly patients of both sexes for the prevalence of risk factors for atherosclerosis and study their association with the complications of atherosclerosis. METHODS: Five hundred and sixteen outpatients, 152 men and 364 women, 60 years or older, were studied. The prevalences of hypertension, dyslipidemia, diabetes mellitus, cigarette smoking and obesity were determined in both sexes and compared using the chi-square test. The association between these factors and the presence of atherosclerotic complications was analyzed by logistic regression. RESULTS: The comparative analysis of the factors in both sexes showed that hypertension, total cholesterol > or = 240mg/dL, LDL-cholesterol > or = 160mg/dL, and body mass index >27.5 were more frequent among women, but HDL-cholesterol <35mg/dL and cigarette smoking were more frequent among men, and no difference occurred between sexes in relation to the frequency of triglycerides > or = 250mg/dL and diabetes mellitus. After adjustment of the variables in the regression model, we observed that in the total of elderly patients, risk factors for complications of atherosclerosis were: triglycerides > or = 250mg/dL, hypertension, and male sex. Among men, the risk factors were: LDL-cholesterol > or = 160mg/dL, diabetes mellitus, HDL-cholesterol <35mg/dL and hypertension. Among women, the risk factors were: tryglicerides > or = 250mg/dL and hypertension. CONCLUSION: The results showed that, in the elderly, the risk factors for atherosclerosis persist, but with different behaviors between men and women. The study suggests that the relative importance of the risk factors can change with the aging process.

Increase in mortality due to myocardial infarction in the Brazilian city of São Paulo during winter

OBJECTIVE: To study the seasonal variation in mortality due to myocardial infarction in the city of São Paulo. METHODS: We analyzed the database of PROAIM (Programa de Aprimoramento de Informações de Mortalidade) containing the registrations of the certificates of deaths due to myocardial infarction (International Classification of Diseases, 10th edition, classification I21) of the residents of the municipality of São Paulo during 12 months (from December 1996 to November 1997). The number of deaths was corrected for a standard period of 90 days and then it was divided by the corresponding population to obtain the event rate per 10 thousand inhabitants. The magnitude of the seasonal variation, which was defined by the difference of the relative risks between the seasons with higher and lower mortality, was estimated. RESULTS: A total of 5,615 deaths due to myocardial infarction were included in the study. Sixty-one per cent occurred in the male sex, and the mean age was 68 years. The mortality rate during winter was always higher and that during summer was lower than that during the other seasons (P<0.01), independent from age and sex. Seasonal variations in deaths due to myocardial infarction was 30% in the general group, being 23% in individuals who died younger than 75 years, and 44% in the older ones. CONCLUSION: A marked seasonal variation in mortality due to myocardial infarction was observed in the city of São Paulo, with a significant increase in its magnitude and age distribution during the winter, similar to those reported in regions of North America and Europe with temperate climates.

Electrocardiographic Alterations in Patients Hospitalized with Leptospirosis in the Brazilian City of Salvador

OBJECTIVE: To report the frequency and types of electrocardiographic alterations in patients with leptospirosis in the first 24 hours of hospitalization. METHODS: We analyzed the electrocardiograms of 157 patients admitted to the Hospital Couto Maia in the city of Salvador, in the State of Bahia, Brazil, from March 1998 to June 1999. The electrocardiograms were performed in the first 24 hours after hospital admission, independent of the clinical manifestations of the patients. RESULTS: The mean ± SD for patients' age was 35.5± 13.7 (median = 32) years, and jaundice was present in 95.5% of them. Alterations in the electrocardiogram were detected in 68.2% (107/157) of the patients (95% confidence interval = 60.6% - 75.1%). Atrial fibrillation was the most frequent arrhythmia, occurring in 10.8% (17/157) of the patients. Other frequent findings were alterations in ventricular repolarization detected in 38.9% (61/157) of patients and first-degree atrioventricular block in 10.2% (16/157). The patients with atrial fibrillation were older and had higher levels of creatinine and aminotransferases. CONCLUSION: In this sample, approximately 2/3 of the patients had electrocardiographic alterations after hospital admission. Of the major arrhythmias, atrial fibrillation was the most frequent, and the patients with this arrhythmia had evidence of more severe disease. The relation between the presence and type of electrocardiographic alteration and the prognosis of leptospirosis is yet to be assessed.

Assessment of the Cardiovascular Risk and Physical Activity of Individuals Exercising at a Public Park in the City of São Paulo

OBJECTIVE: Physical exercise helps to prevent cardiovascular disorders. Campaigns promoting exercise have taken many people to the parks of our city. The most appropriate exercise for preventing cardiovascular disorders is the aerobic modality; inappropriate exercise acutely increases cardiovascular risk, especially in individuals at higher risk. Therefore, assessing the cardiovascular risk of these individuals and their physical activities is of practical value. METHODS: In the Parque Fernando Costa, we carried out the project "Exercício e Coração" (Exercise and Heart) involving 226 individuals. Assessment of the cardiovascular risk and of the physical activity practiced by the individuals exercising at that park was performed with a questionnaire and measurement of the following parameters: blood pressure, weight, height, and waist/hip ratio. The individuals were lectured on the benefits provided by exercise and how to correctly exercise. Each participant received a customized exercise prescription. RESULTS: In regard to risk, 43% of the individuals had health problems and 7% of the healthy individuals had symptoms that could be attributed to heart disorders. High blood pressure was observed in a large amount of the population. In regard to the adequacy of the physical activity, the individuals exercised properly. The project was well accepted, because the participants not only appreciated the initiative, but also reported altering their exercise habits after taking part in the project. CONCLUSION: Data obtained in the current study point to the need to be more careful in assessing the health of individuals who exercise at parks, suggesting that city parks should have a sector designated for assessing and guiding physical activity.

Chest Pain Units: A Modern Way of Managing Patients with Chest Pain in the Emergency Department

It is estimated that 5 to 8 million individuals with chest pain or other symptoms suggestive of myocardial ischemia are seen each year in emergency departments (ED) in the United States 1,2, which corresponds to 5 to 10% of all visits 3,4. Most of these patients are hospitalized for evaluation of possible acute coronary syndrome (ACS). This generates an estimated cost of 3 - 6 thousand dollars per patient 5,6. From this evaluation process, about 1.2 million patients receive the diagnosis of acute myocardial infarction (AMI), and just about the same number have unstable angina. Therefore, about one half to two thirds of these patients with chest pain do not have a cardiac cause for their symptoms 2,3. Thus, the emergency physician is faced with the difficult challenge of identifying those with ACS - a life-threatening disease - to treat them properly, and to discharge the others to suitable outpatient investigation and management.

Acute myocardial infarction: predictors of mortality at a public hospital in the city of Fortaleza, Ceará state

OBJECTIVE: To identify the clinical and demographic predictors of in-hospital mortality in acute myocardial infarction with elevation of the ST segment in a public hospital, in the city of Fortaleza, Ceará state, Brazil. METHODS: A retrospective study of 373 patients experiencing their first episode of acute myocardial infarction was carried out. Of the study patients, 289 were discharged from the hospital (group A) and 84 died (group B). Both groups were analyzed regarding: sex; age; time elapsed from the beginning of the symptoms of myocardial infarction to assistance at the hospital; use of streptokinase; risk factors for atherosclerosis; electrocardiographic location of myocardial infarct; and Killip functional class. RESULTS: In a univariate analysis, group B had a greater proportion of the following parameters as compared with group A: non-Killip I functional class; diabetes; age >70 years; infarction of the inferior wall associated with right ventricular impairment; time between symptom onset and treatment at the hospital >12 h; anteroseptal or extensive anterior infarction; no use of streptokinase; and no tobacco use. In a multivariate logistic regression analysis, only non-Killip I functional class, diabetes, and age >70 years persisted as independent factors for death. CONCLUSION: Non-Killip I functional class, diabetes, and age >70 years were independent predictors of mortality in acute myocardial infarction with elevation of the ST segment.

Coronary heart disease clinical manifestation and risk factors in Japanese immigrants and their descendents in the city of São Paulo

OBJECTIVE: To assess whether a difference exists in coronary heart disease clinical manifestations and the prevalence of risk factors between Japanese immigrants and their descendents in the city of São Paulo. METHODS: Retrospective analysis of coronary artery disease clinical manifestations and the prevalence of risk factors, comparing 128 Japanese immigrants (Japanese group) with 304 Japanese descendents (Nisei group). RESULTS: The initial manifestation of the disease was earlier in the Nisei group (mean = 53 years), a difference of 12 years when compared with that in the Japanese group (mean = 65 years) (P<0.001). Myocardial infarction was the first manifestation in both groups (P = 0.83). The following parameters were independently associated with early coronary events: smoking (OR = 2.25; 95% CI = 1.35-3.77; P<0.002); Nisei group (OR = 10.22; 95% CI = 5.64-18.5; P<0.001); and female sex (OR = 5.04; 95% CI = 2.66-9.52; P<0.001). CONCLUSION: The clinical presentation of coronary heart disease in the Japanese and their descendents in the city of São Paulo was similar, but coronary heart disease onset occurred approximately 12 years earlier in the Nisei group than in the Japanese group.

Three new species of Mesabolivar (Aranea, Pholcidae) from leaf litter in urban environments in the city of São Paulo, São Paulo, Brazil

In this study we describe three new litter inhabiting species of Mesabolivar González-Sponga, 1998 from nine urban forest remnants in the metropolitan region of the city of São Paulo, Brazil: M. forceps, M. mairyara and M. cavicelatus. In three of these remnants, we conduced a three year sampling using pitfall traps. Mesabolivar forceps sp. nov. was the most abundant pholcid (n=273 adults), always present in the samples, but with highest numbers in spring and summer. Mesabolivar mairyara sp. nov. was the second most abundant species (n=32), but the majority of individuals were collected in March 2001. Only three individuals of M. cavicelatus sp. nov. were collected.

Plancto e hidrobiologia sanitária de tanques tropicais com dáfnias e rotíferos

The engineers of the modern University City are constructing a graceful bridge, named PONTE OSWALDO CRUZ, that crosses a portion of the Guanabara Bay (Fig. 1). The work at west pillar stopped for 3 years (The concret structure in Est. 1). As it will be seen from n.º 1 — 5 of the fig. 1, Est. I, the base of the structure will have five underground boxes of reinforcement, but, to-day they are just like as five uncovered water ponds, until at present: May 1963. (Est. I — fig. 3, n.º 3 — pond n.º 3; A. — old level of the water; B.— actual level of the water; c.— green water; E.— mass of bloom of blue algae Microcystis aeruginosa). Soon after SW portion, as 5 cells in series, of the pillar abutments, and also the NE portion nearly opposite in the Tibau Mount will be filled up with earth, a new way will link Rio City and the University City. We see to day Est. I, fig. 1 — the grasses on the half arenous beach of the Tibau Point. These natural Cyperaceae and Gramineae will be desappear because of so a new road, now under construction, when completed will be 33 feet above the mean sea level, as high as the pillar, covering exactly as that place. Although rainfall was the chief source of water for these ponds, the first water (before meterorological precipitations of whatever first rain it might fall) was a common tap water mixed with Portland Cement, which exuded gradually through the pores of the concret during its hardenning process. Some data of its first cement water composition are on the chemical table, and in Tab. n.º 4 and "Resultado n.º 1". The rain — receiving surface of each pond were about 15 by 16 feet, that is, 240 square feet; when they were full of water, their depth was of 2 feet 3", having each pond about 4,000 gallons. Climatic conditions are obviously similar of those of the Rio de Janeiro City: records of temperature, of precipitation and evaporation are seen on the graphics, figs. 2, 3, 4. Our conceptions of 4 phases is merely to satisfy an easy explanation thus the first phase that of exudation of concrete. We consider the 2nd. phase formation of bacterian and cyanophycean thin pellicel. 3rd. phase - dilution by rains, and fertilisation by birds; the 4th phase - plankton flora and fauna established. The biological material arrived with the air, the rains, and also with contaminations by dusts; with big portion of sand, of earth, and leaves of trees resulted of the SW wind actions in the storming days (See - Est. I, fig. 3, G. - the mangrove trees of the Pinheiro Island). Many birds set down and rest upon the pillar structure, its faeces which are good fertilizers fall into the ponds. Some birds were commonly pigeons, black ravens, swallows, sparrows and other sea mews, moor hens, and a few sea birds of comparatively rare occurence. We get only some examples of tropical dust contaminated helioplankton, of which incipient observations were been done sparcely. See the systematic list of the species of plankters. Phytoplankters - Cyanophyta algae as a basic part for food of zooplankters, represented chiefly by rotiferse, water-fleas Moinodaphnia and other Crustacea: Ostracoda Copepoda and Insecta: Chironomidae and Culicidae larvae. The polysaprobic of septic irruptions have not been done only by heating in summer, and, a good reason of that, for example: when the fifth pond was in polysaprobic phase as the same time an alike septic phase do not happened into the 3rd. pond, therefore, both were in the same conditions of temperature, but with unlike contaminations. Among the most important aquatic organisms used as indicatiors of pollution - and microorganisms of real importance in the field of sanitary science, by authorities of renown, for instance: PALMER, PRESCOTT, INGRAM, LIEBMANN, we choose following microalgae: a) The cosmopolite algae Scenedesmus quadricuada, a common indicator in mesosaprobio waters, which lives between pH 7,0 and it is assimilative of NO[3 subscripted] and NH[4 subscripted]. b) Species of the genus Chlamydomonas; it is even possible that all the species of theses genus inhabit strong-mesosaprobic to polysaprobic waters when in massive blooms. c) Several species of Euglenaceae in fast growing number, at the same time of the protozoa Amoebidae, Vorticellidae and simultaneous with deposition of the decaying cells of the blue algae Anacystis cyanea (= Microcystis) when the consumed oxygen by organic matter resulted in 40 mg. L. But, we found, among various Euglenacea the cosmopolite species (Euglena viridis, a well known polysaprobic indicatior of which presence occur in septic zone. d) Analcystis cyanea (= M. aeruginosa) as we observed was in blooms increasing to the order of billions of cells per litter, its maximum in the summer. Temperatures 73ºF to 82ºF but even 90ºF, the pH higher than 8. When these blue algae was joined to the rotifer Brachionus calyflorus the waters gets a milky appearance, but greenished one. In fact, that cosmopolite algae is used as a mesosaprobic indicator. Into the water of the ponds its predominance finished when the septic polysaprobic conditions began. e) Ankistrodesmus falcatus was present in the 5th pond from 26the. April untill the 26th July, and when N.NH[4 subscripted] gets 1.28 mg. L. and when chlorinity stayed from 0.034 to 0.061 mg. L. It never was found at N.NH[4 subscripted] higher than 1 mg. L. The green algae A. falcatus, an indicatior of pollution, lives in moderate mesosaprobic waters. f) As everyone knows, the rotifer eggs may be widely dispersed by wind. The rotifer Asplanchna brightwelli in our observation seemed like a green colored bag, overcharged by green cells and detritus, specially into its spacious stomach, which ends blindly (the intestine, cloaca, being absent). The stock of Asplanchna in the ponds, during the construction of the bridge "PONTE OSWALDO CRUZ" inhabits alkaline waters, pH 8,0 a 8,3, and when we observed we noted its dissolved oxygen from 3.5 to 4 mg. L. In these ponds Asplanchna lived in 0,2 P.PO[4 subscripted]. (Remember the hydobiological observations foreign to braslian waters refer only from 0.06 to 0,010 mg. L. P.PO[4 subscripted]; and they refer resistance to 0.8 N.NH[4 subscripted]). By our data, that rotiger resist commonly to 1.2 until 1.8 mg. L.N.NH[4 subscripted]; here in our ponds and, when NO[2 subscripted] appears Asplanchna desappears. It may be that Asplanchna were devoured by nitrite resistant animals of by Culicidae or other mosquitoes devoured by Due to these facts the number and the distribution of Asplanchna varies considerabley; see - plates of plankton successions. g) Brachionus one of the commonest members of class Rotatoria was frquently found in abundance into the ponds, and we notice an important biological change produce by the rotifer Brachonus colyciflorus: the occurence of its Brachionus clayciflorus forms pallas, is rare in Brazil, as we know about this. h) When we found the water flea MOinodaphnia we do not record simultanous presence of the blue algae Agmenellun (= Merismopedia).