Methodology in the epidemiological research of respiratory diseases and environmental pollution

There are complex and diverse methodological problems involved in the clinical and epidemiological study of respiratory diseases and their etiological factors. The association of urban growth, industrialization and environmental deterioration with respiratory diseases makes it necessary to pay more attention to this research area with a multidisciplinary approach. Appropriate study designs and statistical techniques to analyze and improve our understanding of the pathological events and their causes must be implemented to reduce the growing morbidity and mortality through better preventive actions and health programs. The objective of the article is to review the most common methodological problems in this research area and to present the most available statistical tools used.

Influence of Immunopreventable Diseases and AIDS on the Demand of an Infectious Diseases Department in Rio de Janeiro State, Brazil, in the Course of Thirty Years (1965-1994)

Brazil's nosologic profile has been sustaining profound modifications. Some occurred because of massive immunization campaigns and socioeconomic and demographic trends. Some yet were pure nosologic transitions, such as the emergence of AIDS. In this demand study it is described how these changes reflected on the 8,630 admissions of an Infectious Diseases Department in Niterói, along a thirty year period. Brazilian rural endemic diseases were infrequent (3.45%). Men predominated (62%) all the time, in all age strata and in nearly all diseases. Children under fifteen predominated until 1983. There was, in the case of tetanus, a striking rise in age strata. Institutional mortality dropped from 31% in 1965 to 10% in 1984, but rose since then to 15% in 1994. However, if AIDS patients had not been computed, mortality would have kept descending till 8% at the end of the study period. The crescent unimportance of immunopreventable diseases paralleled with the growing prominence of AIDS. In less than a decade, AIDS ranked fifth among the most frequent diseases in the whole period of thirty years. As opposed to the immunopreventable diseases, neither meningitides nor pneumonia appear to be in decline. AIDS, by its exponential incidence, by its chronic character, and by the uncountable opportunistic infections it determines, imposes itself as a challenge for the coming years.

Impact of the antipneumococcal conjugate vaccine on the occurrence of infectious respiratory diseases and hospitalization rates in children

INTRODUCTION: In 2010, to reduce the occurrence of serious pneumococcal disease, the Ministry of Health in Brazil incorporated the 10-valent pneumococcal vaccine in the immunization schedule of children younger than two years of age. The objective of this study was to evaluate the impact of vaccination on the incidence of infectious respiratory diseases in infants before and after the introduction of the 10-valent pneumococcal vaccine. METHODS: This cross-sectional study involved primary care and hospital networks from a city in Minas Gerais State, Brazil, between 2009 and 2012. RESULTS: A 40% reduction in the prevalence of community-acquired pneumonia (CAP) was observed after introducing the pneumococcal conjugate vaccine. Male children were 28% more likely to develop the disease. The prevalence ratio ([PR] = 1.96, 95% CI: 1.52 to 2.53, p < 0.05) suggested that not being vaccinated was associated with the occurrence of pneumonia. The prevalence of CAP was 70% lower (PR 0.30, 95% CI: 0.24 to 0.37, p<0.05) in children vaccinated as recommended compared to children with delayed vaccination, suggesting that the updated vaccine schedule improves protection. CONCLUSIONS: Immunization with the 10-valent pneumococcal vaccine appeared to reduce the number of pneumonia cases in children during the study period. Prospective studies are needed to confirm the efficacy of the vaccine against the occurrence of pneumococcal pneumonia.

Mortality from Circulatory System Diseases and Malformations in Children in the State of Rio de Janeiro

Abstract Background: The epidemiological profile of mortality in a population is important for the institution of measures to improve health care and reduce mortality Objective: To estimate mortality rates and the proportional mortality from cardiovascular diseases and malformations of the circulatory system in children and adolescents. Methods: This is a descriptive study of mortality from cardiovascular diseases, malformations of the circulatory system, from all causes, ill-defined causes and external causes in children and adolescents in the state of Rio de Janeiro from 1996 to 2012. Populations were obtained from the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística - IBGE) and deaths obtained from the Department of Informatics of the Unified Health System (DATASUS)/Ministry of Health. Results: There were 115,728 deaths from all causes, 69,757 in males. The annual mortality from cardiovascular diseases was 2.7/100,000 in men and 2.6/100,000 in women. The annual mortality from malformations of the circulatory system was 7.5/100,000 in men and 6.6/100,000 in women. Among the specific causes of circulatory diseases, cardiomyopathies had the highest rates of annual proportional mortality, and from malformations of the circulatory system, it occurred due to unspecified malformations of the circulatory system, at all ages and in both genders. Conclusion: Mortality from malformations of the circulatory system was most striking in the first years of life, while cardiovascular diseases were more relevant in adolescents. Low access to prenatal diagnosis or at birth probably prevented the proper treatment of malformations of the circulatory system.

Viral diseases and human evolution

The interaction of man with viral agents was possibly a key factor shaping human evolution, culture and civilization from its outset. Evidence of the effect of disease, since the early stages of human speciation, through pre-historical times to the present suggest that the types of viruses associated with man changed in time. As human populations progressed technologically, they grew in numbers and density. As a consequence different viruses found suitable conditions to thrive and establish long-lasting associations with man. Although not all viral agents cause disease and some may in fact be considered beneficial, the present situation of overpopulation, poverty and ecological inbalance may have devastating effets on human progress. Recently emerged diseases causing massive pandemics (eg., HIV-1 and HCV, dengue, etc.) are becoming formidable challenges, which may have a direct impact on the fate of our species.

Cytopathological characterization of Mal de Río Cuarto virus in corn, wheat and barley

The Mal de Río Cuarto disease is caused by Mal de Río Cuarto virus (MRCV) transmitted by Delphacodes kuscheli. Comparative studies were carried out on the cytopathological alterations produced by MRCV in corn (Zea mays), wheat (Triticum aestivum) and barley (Hordeum vulgare), as seen with a transmission electron microscope. Corn plants were infected with viruliferous D. kuscheli collected from the endemic disease area (i.e. Río Cuarto County, Córdoba, Argentina). For the viral transmission to small grain cereal plants, laboratory rared insects were used. In this case, the inoculum source was wheat and barley plants infected with MRCV isolate grown in a greenhouse. Leaf samples with conspicuous symptoms were collected: enations and size reduction in corn; crenatures, swelling veins and dark green color in small grain cereals. Viral infection was corroborated by DAS-ELISA. Viroplasms containing complete and incomplete virus particles and fibrillar material were found in the cytoplasm of infected cells in all species. Mature virions were between 60 and 70 nm diameter. In wheat and barley, viroplasms and dispersed particles were observed only in phloem, while in corn virions were also found in cells of the bundle sheath. Crystalline arrays of particles were detected in corn enation constitutive cells. Tubular inclusions were found only in wheat samples. The three species showed abnormalities in the chloroplasts of affected cells. The results showed that MRCV cytopathology has similarities with other viruses from the genus Fijivirus, family family Reoviridae, but slight differences depending upon the host plant.

Growth and yield of corn grain and green ear in competition with weeds

Studies on plant growth are interesting because they provide explanations for the factors that influence yield in various crops. The objective of this work was to evaluate growth and yield in corn cultivar AG1051, when in competition with weeds. Cultivar AG 1051 was submitted to two groups of treatments: weed control, and sampling periods for dry biomass evaluation. The weed control treatments consisted of hoeing (two hoeings performed at 20 and 40 days after sowing) and no hoeing. Sampling periods consisted of collecting the above-ground part and roots of corn every fifteen days, until 105 days after sowing (DAS); the first sampling was performed 30 DAS. A completely randomized block design with ten replicates was used. For the characteristics evaluated in a single season, statistical analyses were carried out as a random block experiment. For the characteristics evaluated in several periods, statistical analyses were carried out as random blocks with split-plots (weed control assigned to plots). Fourteen weed species, unevenly distributed throughout the experimental area, were the most important. The growth observed for the above-ground part and root system of corn was 30% smaller in the non-hoed plots, compared to the hoed plots. Lack of weed control increased dry matter of the above-ground part of the weeds and reduced the number of unhusked and husked marketable green ears by 23% and 49%, respectively. Grain yield reduction caused by lack of weed control reached 38%.

Corn growth and yield in competition with weeds

Although labor is intensive, evaluating the growth of crops may allow a better understanding of crop performance, including the reasons why certain cultivars can compete better with weeds. This study aims at evaluating growth, green ear yield, and grain yield in corn when in competition with weeds. Cultivars AG 1051 and BRS 106 were grown with (two hoeings, at 20 and 40 days after sowing) or without weed control. In order to evaluate crop growth, six collections of the above-ground part and the root system of corn were performed, every 15 days, with the first collection made 30 days after sowing. A randomized complete block design was adopted, with split-split plots (weed control in plots, cultivars in subplots, and collections in sub-subplots) and ten replicates. Eighteen weed species were found in the experiment area. Increased values of corn leaf area, above-ground part and root system, due to plant age function, were smaller in non-hoed plots than in hoed plots and were dependent upon cultivar. The lack of weed control increased dry matter of weeds aboveground part and decreased green ear yield and grain yield. Cultivar AG 1051 had higher increases in leaf area, above-ground part of the plant and root system, due to plant age function, and controlled weeds better than cultivar BRS 106. In addition, cultivar AG 1051 was superior to other cultivars with respect to most traits used for green corn yield and grain yield assessment.

Hepatitis C virus seroprevalence and genotypes in patients with diffuse connective tissue diseases and spondyloarthropathies

Many extrahepatic manifestations, including rheumatic diseases, have been reported to be associated with hepatitis C virus (HCV) infection. In order to investigate the prevalence of HCV infection among patients with rheumatic diseases, in the present study we interviewed 367 patients and tested their blood samples for HCV antibodies (anti-HCV) by an enzyme-linked immunosorbent assay. Anti-HCV-reactive samples were retested for confirmation by a line immunoassay and also for HCV RNA detection by the polymerase chain reaction. HCV RNA-positive samples were genotyped by INNO-LIPA. An overall HCV infection prevalence of 1.9% (7/367) was found. Of the 7 HCV-infected patients, 4 had systemic lupus erythematosus and 3 rheumatoid arthritis, resulting in positivity rates of 2.3 and 3.4%, respectively. HCV RNA genotyping revealed the presence of subtypes 1a (57.1%), 1b (28.6%) and 3a (14.3%). The clinical course was favorable for all HCV-infected patients, except one, who died due to renal insufficiency related to lupus nephritis. These results demonstrate a low HCV infection prevalence among the population studied. In the few positive cases, we observed no adverse influence of this infection on the clinical evolution of the rheumatic disease.

Implications of infectious diseases and the adrenal hypothesis for the etiology of childhood acute lymphoblastic leukemia

Acute leukemia is the most frequent cancer in children. Recently, a new hypothesis was proposed for the pathogenesis of childhood acute lymphoblastic leukemia (ALL). The so-called "adrenal hypothesis" emphasized the role of endogenous cortisol in the etiology of B-cell precursor ALL. The incidence peak of ALL in children between 3 to 5 years of age has been well documented and is consistent with this view. The adrenal hypothesis proposes that the risk of childhood B-cell precursor ALL is reduced when early childhood infections induce qualitative and quantitative changes in the hypothalamus-pituitary-adrenal axis. It suggests that the increased plasma cortisol levels would be sufficient to eliminate all clonal leukemic cells originating during fetal life. Because Brazil is a continental and tropical country, the exposure to infections is diversified with endemic viral and regionally non-viral infections, with some characteristics that support the recent adrenal hypothesis. Here we discuss this new hypothesis in terms of data from epidemiological studies and the possible implications of the diversity of infections occurring in Brazilian children.

Pain-related diseases and sleep disorders

Pain and sleep share mutual relations under the influence of cognitive and neuroendocrine changes. Sleep is an important homeostatic feature and, when impaired, contributes to the development or worsening of pain-related diseases. The aim of the present review is to provide a panoramic view for the generalist physician on sleep disorders that occur in pain-related diseases within the field of Internal Medicine, such as rheumatic diseases, acute coronary syndrome, digestive diseases, cancer, and headache.

Human immunodeficiency virus/acquired immunodeficiency syndrome and tropical diseases: a Brazilian perspective

The paper summarizes recent findings on the epidemiology and pathogenesis of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/Aids), highlighting the role of co-infections with major tropical diseases. Such co-infections have been studied in the Brazilian context since the beginning of the Aids epidemic and are expected to be more frequent and relevant as the Aids epidemic in Brazil proceeds towards smaller municipalities and the countryside, where tropical diseases are endemic. Unlike opportunistic diseases that affect basically the immunocompromised host, most tropical diseases, as well as tuberculosis, are pathogenic on their own, and can affect subjects with mild or no immunossuppression. In the era of highly active anti-retroviral therapies (HAART), opportunistic diseases seem to be on decrease in Brazil, where such medicines are fully available. Benefiting from HAART in terms of restoration of the immune function, putative milder clinical courses are expected in the future for most co-infections, including tropical diseases. On the other hand, from an ecological perspective, the progressive geographic diffusion of Aids makes tropical diseases and tuberculosis a renewed challenge for Brazilian researchers and practitioners dealing with HIV/Aids in the coming years.

Association between self-reported health and sociodemographic characteristics with cardiovascular diseases in adults

OBJECTIVE To assess the association of sociodemographic and self-rated health in the presence of cardiovascular diseases and the association of this perception with the type of disease. METHODS A cross-sectional population survey study carried out with 1,232 individuals aged between 20 and 59 years of both genders living in the metropolitan region of Maringá-PR. Data were analyzed using multiple and simple logistic regression. RESULTS In multivariate analysis, the age range and self-rated health were associated with cardiovascular disease, and in the univariate analysis self-rated regular health was associated with arterial hypertension, while self-rated poor health was associated to heart failure, stroke, and to acute myocardial infarction (heart attack). CONCLUSION The differences in association of self-rated health with these diseases can indicate how individuals with certain characteristics cope with the disease, allowing for more individualized and specific health care.

Spatial relationships between soil attributes and corn yield in no-tillage system

Soil properties play an important role in spatial variability of crop yield. However, a low spatial correlation has generally been observed between maps of crop yield and of soil properties. The objectives of the present investigation were to assess the spatial pattern variability of soil properties and of corn yield at the same sampling intensity, and evaluate its cause-and-effect relationships. The experimental site was structured in a grid of 100 referenced points, spaced at 10 m intervals along four parallel 250 m long rows spaced 4.5 m apart. Thus, points formed a rectangle containing four columns and 25 rows. Therefore, each sampling cell encompassed an area of 45 m² and consisted of five 10 m long crop rows, in which the referenced points represented the center. Samples were taken from the layers 0-0.1 m and 0.1-0.2 m. Soil physical and chemical properties were evaluated. Statistical analyses consisted of data description and geostatistics. The spatial dependence of corn yield and soil properties was confirmed. The hypothesis of this study was confirmed, i.e., when sampling the soil to determine the values of soil characteristics at similar to sampling intensity as for crop yield assessments, correlations between the spatial distribution of soil characteristics and crop yield were observed. The spatial distribution pattern of soil properties explained 65 % of the spatial distribution pattern of corn yield. The spatial distribution pattern of clay content and percentage of soil base saturation explained most of the spatial distribution pattern of corn yield.

Effect of swine residue rates on corn, common bean, soybean and wheat yield

Swine residue (SR) applied as nutrient source of crops such as corn, bean, soybean and wheat, besides representing an environmental-friendly way of disposing of organic waste resulting from swine production, may significantly increase grain yields, replacing mineral fertilizer. The objective was to evaluate the effect of SR rates on corn, common bean, soybean and wheat yields from 2002 to 2007, in comparison with mineral fertilizer. The experiment was carried out at the Instituto Agronômico do Paraná - IAPAR, Pato Branco, PR and consisted of increasing SR rates (0, 15, 30, 45, and 60 m³ ha-1) and one treatment with mineral fertilizer (NPK 4-30-10), using 250 kg ha-1 for bean and 300 kg ha-1 for corn, soybean and wheat. Also, in the treatment with mineral fertilizer, 60, 120 and 90 kg ha-1 N was applied as topdressing to bean, corn and wheat, respectively. There were significant increases of grain yield in all evaluated years and crops with increasing SR rates, especially in the grass species under study. Also, with increasing SR rates applied every six months, K, P, Ca and Mg were accumulated in the soil and the pH increased. The application of 60 m³ ha-1 SR increased yields and exceeded the yield obtained with the recommended mineral fertilizer, indicating this amount as adequate for these crops.