Prevalence and factors associated with HCV infection among elderly individuals in a southern Brazilian city

Introduction Few Latin American studies have assessed the prevalence of hepatitis C virus (HCV) infection in elderly individuals, in whom the highest rates are expected. We aimed to investigate the prevalence of and factors associated with HCV infection in elderly residents in the municipality of Tubarão, Santa Catarina. Methods This cross-sectional study included 820 individuals (aged ≥ 60 years) who were selected by simple random sampling. The presence of anti-HCV antibodies was tested by chemiluminescence, and HCV RNA detection was performed for the anti-HCV-reactive subjects. Those individuals who were anti-HCV reactive but had undetectable HCV RNA levels were tested using a third-generation recombinant immunoblot assay. The variables were compared using the chi-squared test or Fisher's exact test, and those variables with p < 0.05 were included in the logistic regression model. Results The mean patient age was 68.6 years (SD 7.0 years); 39% were men, and 92% were Caucasian. Eighteen subjects were anti-HCV positive. Among these individuals, 4 were characterized as false-positives, leaving 14 (1.7%) individuals with confirmed infections for analysis. HCV infection was associated with an age older than 65 years, households with 3 or more residents and the previous transfusion of blood products. In the logistic regression analysis, the following variables were independently associated with HCV infection: households with 3 or more residents (OR 7.9, 95% CI 1.7–35.9, p = 0.008) and previous blood transfusion (OR 6.2, 95% CI 2.1–18.6, p = 0.001). Conclusions The HCV prevalence in the elderly population in the municipality of Tubarão was higher than that found in previous studies of blood donors in the same region. Although exposure to contaminated blood products remained important, other transmission routes, such as household transmission, could play a role in HCV infection.

Epidemiological aspects of schistosomiasis in workers of the Movement of Landless Rural Workers

Introduction Schistosomiasis is endemic in 74 countries and is considered a serious public health problem in some locations. Methods A transverse study was performed of 13 landless settlements in southern Sergipe from February to December 2009. The study included 822 settlers, of whom 601 underwent stool testing. Results The prevalence of schistosomiasis in landless workers was 4.3%. The population has a low education level, and basic sanitation services are not available to all residents. Conclusions The prevalence of schistosomiasis was low in the population and among different settlements, possibly because of different forms of water use by the settlers.

Lack of evidence for human infection with Xenotropic murine leukemia virus-related virus in the Brazilian Amazon basin

Introduction This study confirmed the absence of natural infection with Xenotropic murine leukemia virus-related virus (XMRV) or XMRV-related disease in human populations of the Brazilian Amazon basin. We demonstrated that 803 individuals of both sexes, who were residents of Belem in the Brazilian State of Pará, were not infected with XMRV. Methods Individuals were divided into 4 subgroups: healthy individuals, individuals infected with human immunodeficiency virus, type 1 (HIV-1), individuals infected with human T-lymphotrophic virus, types 1 or 2 (HTLV-1/2), and individuals with prostate cancer. XMRV infection was investigated by nested PCR to detect the viral gag gene and by quantitative PCR to detect pol. Results There was no amplification of either gag or pol segments from XRMV in any of the samples examined. Conclusions This study supports the conclusions of the studies that eventually led to the retraction of the original study reporting the association between XMRV and human diseases.

Teste de um modelo preditor de satisfação com a vida em adultos idosos

Dissertação de Mestrado apresentada ao ISPA - Instituto Universitário

Memórias autobiográficas de adultos idosos : Comparações quanto ao género e ao meio sociocultural de residência

Dissertação de Mestrado apresentada no Instituto Superior de Psicologia Aplicada para a obtenção de grau de Mestre na especialidade de Psicologia Clínica.

Occurrence of severe dengue in Rio de Janeiro: an ecological study

Introduction This study aimed to analyze the relationship between the incidence of severe dengue during the 2008 epidemic in Rio de Janeiro, Brazil, and socioeconomic indicators, as well as indicators of health service availability and previous circulation of the dengue virus serotype-3 (DENV-3). Methods In this ecological study, the units of analysis were the districts of Rio de Janeiro. The data were incorporated into generalized linear models, and the incidence of severe dengue in each district was the outcome variable. Results The districts with more cases of dengue fever in the 2001 epidemic and a higher percentage of residents who declared their skin color or race as black had higher incidence rates of severe dengue in the 2008 epidemic [incidence rate ratio (IRR)= 1.21; 95% confidence interval (95%CI)= 1.05-1.40 and IRR= 1.34; 95%CI= 1.16-1.54, respectively]. In contrast, the districts with Family Health Strategy (FHS) clinics were more likely to have lower incidence rates of severe dengue in the 2008 epidemic (IRR= 0.81; 95%CI= 0.70-0.93). Conclusions At the ecological level, our findings suggest the persistence of health inequalities in this region of Brazil that are possibly due to greater social vulnerability among the self-declared black population. Additionally, the protective effect of FHS clinics may be due to the ease of access to other levels of care in the health system or to a reduced vulnerability to dengue transmission that is afforded by local practices to promote health.

Using mobile technology to conduct epidemiological investigations

INTRODUCTION : The aim of this study was to report the experience of an epidemiological field survey for which data were collected and analyzed using tablets. METHODS : The devices used Epi Info 7 (Android version), which has been modeled a database with variables of the traditional form. RESULTS : Twenty-one households were randomly selected in the study area; 75 residents were registered and completed household interviews with socioeconomic and environmental risk variables. CONCLUSIONS : This new technology is a valuable tool for collecting and analyzing data from the field, with advantageous benefits to epidemiological surveys.

Evaluation of the reference value for the Montenegro skin test

Abstract:INTRODUCTION:The Montenegro skin test (MST) has good clinical applicability and low cost for the diagnosis of American tegumentary leishmaniasis (ATL). However, no studies have validated the reference value (5mm) typically used to discriminate positive and negative results. We investigated MST results and evaluated its performance using different cut-off points.METHODS:The results of laboratory tests for 4,256 patients with suspected ATL were analyzed, and 1,182 individuals were found to fulfill the established criteria. Two groups were formed. The positive cutaneous leishmaniasis (PCL) group included patients with skin lesions and positive direct search for parasites (DS) results. The negative cutaneous leishmaniasis (NCL) group included patients with skin lesions with evolution up to 2 months, negative DS results, and negative indirect immunofluorescence assay results who were residents of urban areas that were reported to be probable sites of infection at domiciles and peridomiciles.RESULTS:The PCL and NCL groups included 769 and 413 individuals, respectively. The mean ± standard deviation MST in the PCL group was 12.62 ± 5.91mm [95% confidence interval (CI): 12.20-13.04], and that in the NCL group was 1.43 ± 2.17mm (95% CI: 1.23-1.63). Receiver-operating characteristic curve analysis indicated 97.4% sensitivity and 93.9% specificity for a cut-off of 5mm and 95.8% sensitivity and 97.1% specificity for a cut-off of 6mm.CONCLUSIONS:Either 5mm or 6mm could be used as the cut-off value for diagnosing ATL, as both values had high sensitivity and specificity.

Incidence of hepatitis C in Brazil

Abstract INTRODUCTION: Hepatitis C is a public health problem of global dimensions, affecting approximately 200 million people worldwide. The main objective of this study was to estimate the incidence rate of hepatitis C in Brazil during the period between 2001 and 2012. METHODS: An epidemiological, temporal, and descriptive study was performed using data from the Information System for Reportable Diseases. RESULTS: Between 2001 and 2012, a total of 151,056 hepatitis C cases were recorded, accounting for 30.3% of all hepatitis notifications in Brazil. The average gross coefficient for the analysis period was 6.7 new cases per 100,000 inhabitants. The regions with the highest rates were the Southeast region (8.7 new cases/100,000 inhabitants) and the South (13.9 new cases/100,000 inhabitants). There was a predominance of men with respect to the incidence rate (8.0 new cases/100,000 inhabitants) compared to women (5.5 new cases/100,000 inhabitants). Injection drug use was the most common source of infection, and members of the white race, residents of urban areas, and those aged 60 to 64 years had the highest incidences. CONCLUSIONS: Over the last 10 years, the incidence of hepatitis C in Brazil has increased, mainly in the South and Southeast. The adoption of fast, accurate diagnostic methods, together with epidemiological awareness, can facilitate early intervention measures for adequate control of the disease.

Occurrence of Mansonella ozzardi diagnosed using a polycarbonate membrane in a riverside population of Lábrea in the Western Brazilian Amazon

Abstract: INTRODUCTION Mansonella ozzardi is a widely distributed filaria worm in the Amazon region. This study aimed to determine the prevalence of M. ozzardi infection in riverine communities of Lábrea municipality, Amazonas State, Brazil. METHODS A diagnostic blood filtration method in a polycarbonate membrane was used. RESULTS M. ozzardi was found in 50.3% of the sample, with the highest prevalence in farmers/fishermen (69.4%; χ 2 = -19.14, p<0.001). The prevalence was higher in longer-term residents (≥11 years; 60.2%). CONCLUSIONS M. ozzardi infection rates are high near the Purus River, much greater than those previously reported based on diagnosis using thick blood smears.

Spatial distribution of disseminated histoplasmosis and AIDS co-infection in an endemic area of Northeastern Brazil

Abstract: INTRODUCTION: The spatial distribution of disseminated histoplasmosis (DH) and acquired immunodeficiency syndrome (AIDS) co-infection in adult residents of Fortaleza, Ceará, Brazil was evaluated. METHODS: Socio-demographic data for the DH/AIDS cases were obtained from a reference hospital, and socio-environmental indicators were obtained from an official Brazilian institute. Kernel analysis and local indicators of spatial autocorrelation (LISA) cluster maps were used to estimate the case density within the city. RESULTS: DH/AIDS cases were concentrated in the Northwestern and Southwestern peripheral areas of the city, related with low human development indices, but different from AIDS cases distribution. CONCLUSION: Risk factors other than AIDS infection must affect histoplasmosis development in this area.

Mortalidade por neoplasias malignas na população residente próximo de minas de urânio em Portugal : Epidemiologia

RESUMO - Introdução: O encerramento das minas de urânio em Portugal tem suscitado preocupação no que respeita aos eventuais efeitos que as radiações emitidas e os agentes químicos presentes terão na saúde das populações. Para esclarecer a existência de tal efeito foi delineado um programa de investigação em que o presente estudo se enquadra. Sendo conhecido que as populações expostas a minas de urânio, nomeadamente os mineiros, têm risco acrescido de sofrer de neoplasias, especialmente de «neoplasias da traqueia, dos brônquios e do pulmão», foi este o grupo de neoplasias seleccionado para constituir a hipótese principal do estudo. Assim, o estudo pretendeu verificar se existe associação entre exposição a minas de urânio e suas escombreiras (especialmente à mina da Urgeiriça, no concelho de Nelas) e a mortalidade por alguns grupos de neoplasias malignas, nomeadamente as «neoplasias malignas da traqueia, dos brônquios e do pulmão». Material e métodos: Trata-se de um estudo «ecológico» em que se consideraram «expostos» os residentes no concelho de Nelas, bem como no conjunto de concelhos com minas de urânio, e «não expostos» os residentes nos restantes concelhos das NUTS Dão-Lafões e Beira Interior Norte e Serra da Estrela. A análise centrou-se no cálculo, para cada concelho ou grupo de concelhos, das razões padronizadas de mortalidade (RPM) por «neoplasias malignas da traqueia, dos brônquios e do pulmão», por «neoplasia maligna do estômago» e por «todas as neoplasias malignas » no período de vinte anos compreendido entre 1980 e 1999. Resultados: Tomando os dois sexos em conjunto, o concelho de Nelas teve a RPM mais elevada para as «neoplasias malignas da traqueia, dos brônquios e do pulmão» (RPM = 133; p = 0,003). Teve também o valor mais elevado no sexo masculino (RPM = 126, não significativo) e o segundo mais elevado no sexo feminino (RPM = 142, não significativo). A razão das RPM concelho de Nelas/concelhos limítrofes de Nelas foi 1,46, p = 0,002 (homens: 1,50 p = 0,003; mulheres: 1,27, não significativo). As razões das RPM concelho de Nelas/concelhos com minas (1,94, p = 0,001) e concelho de Nelas/concelhos sem minas (1,57, p = 0,001) foram claramente superiores a 1. Pelo contrário, as RPM por «neoplasia maligna do estômago » foram sobretudo elevadas nos concelhos da NUTS Beira Interior Norte, que inclui grande parte do distrito da Guarda, (Trancoso: 154, p = 0,000; Sabugal: 146, p = 0,000), embora se tenham observado valores elevados em alguns concelhos da NUTS Dão-Lafões (Vila Nova de Paiva: 154, p = 0,001). Saliente-se que os dois valores mais baixos ocorreram nos concelhos de Tábua (RPM = 57; p = 0,000) e de Nelas (RPM = 60; p = 0,000). Para o conjunto de «todas as neoplasias malignas» as RPM dos vários concelhos variaram entre 62 e 100 sem que a distribuição desses valores sugerisse qualquer associação positiva relevante. Discussão: Os resultados mostraram que a população do concelho de Nelas teve, no período estudado, um risco acrescido de morrer por «neoplasias malignas da traqueia, dos brônquios e do pulmão» quando comparado com a dos concelhos limítrofes e restantes concelhos das NUTS estudadas. A existência da mina da Urgeiriça e da sua escombreira é uma possível causa desse excesso de mortalidade. Ele poderá ter sido gerado, por um lado, através da existência de uma percentagem elevada de ex-mineiros, bem como, por outro lado, através de uma exposição ambiental geral, facto este que é sustentado pela ocorrência de excesso de mortalidade tanto em homens como em mulheres. O excesso de mortalidade por aquele grupo de neoplasias pode ainda ter origem noutras exposições cujo potencial papel é discutido.

The general practitioner and the surgeon: stereotypes and medical specialties

OBJECTIVE: To investigate and characterize the professional stereotypes associated with general medicine and surgery among Brazilian medical residents. METHODS: A randomized sample of residents of the General Medicine and Surgery Residence Programs were interviewed and their perceptions and views of general and surgical doctors were compared. RESULTS: The general practitioner was characterized by the residents in general to be principally a sensitive and concerned doctor with a close relationship with the patient; (45%); calm, tranquil, and balanced (27%); with intellectual skills (25%); meticulous and attentive to details (23%); slow to resolve problems and make decisions (22%); and working more with probabilities and hypotheses (20%). The surgeon was considered to be practical and objective (40%); quickly resolving problems (35%); technical with manual skills (23%); omnipotent, arrogant, and domineering (23%); anxious, stressed, nervous, and temperamental (23%); and more decided, secure, and courageous (20%). Only the residents of general medicine attributed the surgeon with less knowledge of medicine and only the surgeons attributed gender characteristics to their own specialty. CONCLUSION: There was considerable similarity in the description of a typical general practitioner and surgeon among the residents in general, regardless of the specialty they had chosen. It was interesting to observe that these stereotypes persist despite the transformations in the history of medicine, i.e. the first physicians (especially regarding the valorization of knowledge) and the first surgeons, so-called "barber surgeons" in Brazil (associated with less knowledge and the performance of high-risk procedures).

As Comissões Parlamentares de Inquérito no Portugal democrático, 1976-2015

As transformações operadas no mundo contemporâneo, em especial no que respeita às estruturas do poder, à sua maior autonomização e diferenciação, tiveram particulares reflexos ao nível dos Parlamentos e das funções que prosseguem. Desde a sua origem, no passado século XIII, à atualidade, grandes acontecimentos, clivagens e factos históricos estão presentes na sua linha evolutiva. A democratização do regime parlamentar e a legitimidade outorgada através de eleições democráticas e concorrenciais são um marco ímpar na sua história. A complexidade das sociedades hodiernas catapultou o Poder Executivo em detrimento do Parlamento, enquanto órgão legislativo por excelência. Tal circunstancialismo levou, não ao proclamado declínio dos Parlamentos, mas a reformas estruturantes. Outras e mais importantes funções seriam prosseguidas. Se as iniciativas legislativas e a definição das políticas públicas passaram a ser quase um exclusivo do Governo, havia que desenvolver e ampliar, por parte dos Parlamentos, os instrumentos de controlo, fiscalização e escrutínio da ação governativa. Entre os clássicos instrumentos de controlo avulta o Inquérito Parlamentar, materializado em Comissões Parlamentares de Inquérito, dotadas de poderes especiais para recolha de informação e para investigação. No seu percurso parlamentar, também as Comissões de Inquérito foram sendo alvo de constantes aperfeiçoamentos, de ordem constitucional, legal e regimental. A excessiva partidarização da atividade parlamentar de outrora e sobretudo a confusão entre o governo e o partido que o sustentava a nível parlamentar, o confronto desequilibrado de meios entre as maiorias e as minorias, levaram a um reposicionamento do inquérito parlamentar enquanto garante do direito das minorias. Não sendo expectável que as grandes iniciativas de controlo sejam tomadas pelo partido maioritário, cabe à oposição esse papel. Em Portugal, diminuta era a tradição do instituto do inquérito parlamentar, razão porque foi efémera e sem resultado a sua utilização no tempo da monarquia constitucional. O regime democrático, abraçado com o 25 de abril de 1974, relançou o órgão de soberania Parlamento e estabeleceu prioridades. Até ao amadurecimento da democracia viveram-se tempos mais conturbados mas de grande aprendizagem. O inquérito Parlamentar, a partir da revisão constitucional de 1982, passou conceptualmente a integrar um dos meios mais relevantes da fiscalização política. É, pois, o levantamento exaustivo e a análise das Comissões Parlamentares de Inquérito no Portugal democrático, período de 1976-2015, o objetivo a que nos propomos neste estudo.

The influence of low-frequency noise pollution on the quality of life and place in sustainable cities: a case study from northern Portugal

Discussing urban planning requires rethinking sustainability in cities and building healthy environments. Historically, some aspects of advancing the urban way of life have not been considered important in city planning. This is particularly the case where technological advances have led to conflicting land use, as with the installation of power poles and building electrical substations near residential areas. This research aims to discuss and rethink sustainability in cities, focusing on the environmental impact of low-frequency noise and electromagnetic radiation on human health. It presents data from a case study in an urban space in northern Portugal, and focuses on four guiding questions: Can power poles and power lines cause noise? Do power poles and power lines cause discomfort? Do power poles and power lines cause discomfort due to noise? Can power poles and power lines affect human health? To answer these questions, we undertook research between 2014 and 2015 that was comprised of two approaches. The first approach consisted of evaluating the noise of nine points divided into two groups â near the sourceâ (e.g., up to 50 m from power poles) and â away from the sourceâ (e.g., more than 250 m away from the source). In the second approach, noise levels were measured for 72 h in houses located up to 20 m from the source. The groups consist of residents living within the distance range specified for each group. The measurement values were compared with the proposed criteria for assessing low-frequency noise using the DEFRA Guidance (University of Salford). In the first approach, the noise caused discomfort, regardless of the group. In the second approach, the noise had fluctuating characteristics, which led us to conclude that the noise caused discomfort.