Anastácio Ferreira Morgado

Cross-sectional study defines difference in malaria morbidity in two Yanomami communities on Amazonian boundary between Brazil and Venezuela

It is well established that immunity to malaria is short-lived and is maintained by the continuous contact with the parasite. We now show that the stable transmission of malaria in Yanomami Amerindian communities maintains a degree of immunity in the exposed population capable to reduce prevalence and morbidity of malaria. We examined 508 Yanomami Amerindians living along Orinoco (407) and Mucajaí (101) rivers, on the Venezuelan and Brazilian Amazon region, respectively. At Orinoco villages, malaria was hyperendemic and presented stable transmission, while at Mucajaí villages it was mesoendemic and showed unstable transmission. The frequency of Plasmodium vivax and P. falciparum was roughly comparable in Venezuelan and Brazilian communities. Malaria presented different profiles at Orinoco and Mucajaí villages. In the former communities, malaria showed a lower prevalence (16% x 40.6%), particularly among those over 10 years old (5.2% x 34.8%), a higher frequency of asymptomatic cases (38.5% x 4.9%), and a lower frequency of cases of severe malaria (9.2% x 36.5%). Orinoco villagers also showed a higher reactivity of the immune system, measured by the frequency of splenomegaly (72.4% x 29.7%) and by the splenic index (71.4% over level 1 x 28.6), and higher prevalence (91.1% x 72.1%) and mean titer (1243 x 62) of antiplasmodial IgG antibodies, as well as a higher prevalence (77.4% x 24.7%) and mean titer (120 x 35) of antiplasmodial IgM antibodies. Our findings show that in isolated Yanomami communities the stability of malaria transmission, and the consequent continuous activation of the immune system of the exposed population, leads to the reduction of malaria prevalence and morbidity.

Epidemiologia descritiva do alcoolismo em grupos populacionais do Brasil

A partir de estudos nacionais, publicados entre 1943 e 1985, que fornecem dados sobre o alcoolismo, foram utilizados no presente artigo, especialmente aqueles que tem algum cunho epidemiologico. Seus dados foram reanalisados e utilizados apenas em seus valores absolutos; recalcularam-se as taxas e porcentagens, aglutinando-as em resultados que tivessem as mesmas caracteristicas. Pelos dados analisados, encontramos maior predominância de alcoolismo em adultos jovens, concentrando-se entre 20 e 49 anos de idade, na razao de 10 homens para 1 mulher. No que diz respeito a taxas de prevalencia, verificou-se que em tres estudos em populacoes acima de 15 anos de idade, houve uniformidade para o alcoolismo-doenca, que no sexo masculino variou de 6% a 13%, e no feminino de 0,7% a 1,4%. Em relacao as internacoes, constatamos que o diagnostico de alcoolismo alcanca elevada proporcao nos estabelecimentos psiquiatricos do pais, a qual, somada a esquizofrenia, compreende 50% do total destas internacoes. Foi impossivel generalizar os dados para todo o Brasil, devido a heterogeneidade cultural e economica da populacao, a extensao territorial, aos criterios divergentes de classificacao utilizados pelos diferentes autores, e a escassez de estudos que fornecam taxas de prevalencia.

Dados de epidemiologia descritiva de transtornos mentais em grupos populacionais do Brasil

Neste trabalho sao apresentados tres tipos de dados sobre transtornos mentais: taxas de prevalencia em amostras representativas, taxas de prevalencia em estudos de familias e o indicador de morbidade proporcional isto e, de proporcoes por diagnostico entre pacientes internados em hospitais psiquiatricos do Brasil. Em relacao a um inquerito epidemiologico, realizado em amostra representativa, a taxa de prevalencia total foi de 20%, da qual 3,0%, 14,6%, 0,7%, 1,7% e 0,5% foram de alcoolismo, neuroses, psicoses, oligofrenia e sindrome orgânica do cerebro, respectivamente. A distribuicao por sexo mostrou uma clara e esperada predominância de alcoolismo nos homens e de neuroses nas mulheres. Em um estudo voltado para a familia de origem (pais e irmaos) de 150 grandes consumidores de drogas, a taxa de prevalencia total entre 796 familiares foi de 23,2% As taxas especificas de problemas associados ao alcool, dependencia de drogas, psicoses, neuroses, epilepsia, transtorno anti-social da personalidade e outros diagnosticos foram, respectivamente, de 8,4%; 5,3%; 3,1%; 4,0%; 0,8%; 0,9% e 0,8%. Os problemas associados ao alcool predominaram nos pais e neuroses nas maes, enquanto dependencia de drogas predominou nos irmaos dos 150 consumidores-indice. O perfil da assistencia psiquiatrica brasileira e parcialmente visto atraves do indicador de proporcoes de primeiras internacoes nos hospitais psiquiatricos nacionais. Esse indicador e distribuido por diagnostico, em serie historica, desde 1940 ate 1977. Tais dados mostram que as primeiras internacoes tem aumentado nas ultimas quatro decadas, com maiores proporcoes dos diagnosticos de esquizofrenia e alcoolismo e dependencia de drogas. Ha, porem, diferenca nas proporcoes de diagnostico entre o hospital publico e o particular-conveniado; tal diferenca e o referido aumento de primeiras internacoes sao de suma importância para os programas da area de Saude Mental.

A situação de saúde dos índios Yanomámi: diagnóstico a partir da casa do índio de Boa Vista, Roraima, 1987 - 1989

The change in the morbidity profile of the Yanomámi Indians admitted to the Casa do Indio, at Boa Vista, Roraima, from January 1987 to August 1989, is reported. The most frequent diseases observed in 495 patients were malaria, acute respiratory infections, tuberculosis, severe under nutrition, and sexually transmitted diseases. Malaria was the main cause of death of 114 Indians throughout the period. A striking increase in hospital admissions was noted in the population from the villages which were in closer contact with gold miners. The global impact of the invasion of the Yanomámi territory by miners on the quality of life and health levels of the Yanomámi is discussed.

The Guaraní-Kaiwá suicide epidemic: investigating its causes and suggesting the impossible return hypothesis

The suicide of six young Guaraní-Kaiwá Indians within the timespan of two weeks is enough to fulfill any criteria to define an epidemic. In a total population of 7,500 individuals, the available data account for 52 cases of suicide between 1987 and August 1991. The epidemic is more dramatic among the Kaiwá subgroup among which 14 individuals died in 1990 and a number of suicides were reported for the first semester of 1991. For both sexes, most deaths were observed in the age group 12-20 years. The author advances the hypothesis of the impossible return according to which, under extreme pressure exerted by western society, they see no possibility of returning to their traditional way of living. Under circumstances of extreme self-devaluation, suicide becomes the last alternative for the survival of their culture. Suicide epidemics have been reported among Amerindians in other countries suffering from the same kind of pressure. In Brazil and also in other countries, other tribes have been urbanized and yet did not experience the tragedy which the Kaiwá are going through because they had some kind of acceptable insertion in the national society.

Cultural factors associated with the seclusion disease in Alto Xingu (Central Brazil)

This article presents an anthropological approach to the symbolic aspects of the disease, considering traditional representations about the puberty seclusion syndrome which affects adolescent indians from the Upper Xingu region (Central Brazil), in a comparative perspective with the clinical-epidemiological approach. The traditional nosological category and its etiological implications in indigenous medicine and culture are contrasted with the western medical category - a peripheral neuropathy, possibly of toxic origin - identified in some cases of the syndrome. An epidemiological analysis of the data collected from the traditional point of view shows relations with events of cultural origin, associated with social and political contexts and with the nature of cross-cultural relations. Moreover, this culture-bound syndrome presents some methological issues for western medicine, particularly for biomedical and social-epidemiological approaches. Finally, the authors make explicit some cultural assumptions characteristic of modern western society, underlying the procedures used by the scientific disciplines involved.

O que a epidemiologia pode ainda fazer de relevante

Trata-se de uma sucinta revisao de alguns aspectos da epidemiologia ainda mal conhecidos, - por serem polemicos ou cujo desenvolvimento e recente ou apenas se esboca. Enquanto metodo, haveria duas epidemiologias: uma em que se esmera cada vez mais no rigor metodologico e analise sofisticada dos dados em computador; a outra contenta-se com metodos simples, alia-se fortemente com as ciencias sociais, a economia e as ciencias do comportamento, - com o objetivo de achar solucoes para os problemas de saude. A importância das consequencias dos fatores socio-economicos sobre a saude foi avaliada a partir de publicacoes das pesquisas epidemiologica e clinica; aquela importância aumentou no primeiro tipo de pesquisa e tende a desaparecer no segundo. A questao de avaliar o estado de saude de populacoes ficou sem avancar, pois, sem operacionalizar indicadores de saude positiva, de fato avalia-se estado de doenca. Enfim, reconheceu-se o advento algo original de um desdobramento promissor da epidemiologia: o estudo das representacoes da Antropologia, tais como mitos, crencas, comportamento e instituicoes.

Surto epidêmico de gastrenterite, com identificação do provável alimento veiculador da infecção

This papes reports an outbreak of gastro-enteritis that occurred in 52 cases after a meai in a local restaurant. The clinical picture was characterised by sudden onset of diarrhea, cramps, nausea and fever (37.5 - 39°C). All cases were mild with in general a oneday duration. An epidemiological investigation was carried out based on attack rates that revealed roost boef as the source of the infection. The incubation period varied between 0.5 - 24.0 hours, with a median of 10.4 hours. The infectious agent was not determined because the remaining food had not been available for laboratory examination and patients were already in convalescence phase at the time of the investigation. There are evidences of a clinical and epidemiological picture resembling the foodborne outbreaks caused by Clostridium perfringens.

Epidemia de hepatite veiculada por gamaglobulina contaminada

The authors studied an epidemic of hepatitis B occurring in an institution located in the Sao Cristovao section of the city of Rio de Janeiro, Brasil. Of a total of 35 cases detected, 30 ocurred in employees of the institution and 5 in family members of the employees. All the cases were considered as benign acute hepatitis; all but two were iteric. Clinically, a marked articular involvement was noted, with intense arthralgia and pronounced restriction of movement, which regressed completely as soon as jaundice became evident. The chronological distribution was typical of simultaneous infection from a single source. Epidemiological investigation indicated that the source was commercially prepared pooled human gamma globulin. Ironically, injections were given, as prophylaxis against hepatitis with disposable syringes. During two days of application, approximately 120 employees received gamma globulin injections, among whom 27 developed hepatitis with a mean incubation period of 116 days. Twenty six patients were tested for HBAg, with positive results in 12 (46.2%); 8 patients tested during the first two weeks of overdisease were all positive. The epidemic outbreak occurred in conditions, though not premeditated, approximating to those of an experimental study. In addition to the Sao Cristovao epidemic, the authors studied 8 cases seen at the hospital Service where they worked. These cases presented characteristics distinguishing them from the the type of hepatitis case commonly treated in that hospital. All these 8 patients were of elevated socioeconomic conditions, and all had a history of having received injections of gamma globulin from the same commercial source as that which gave rise to the Sao Cristovao epidemic. In these cases the mean incubation period was 106 days, and 5 of 6 patients tested were positive for HB Ag. Eleven lots of gamma globulin were tested in reference laboratories of the World Health Organization, six of these (53,5%) were positive for HB Ag. The authors conclude that there was a serious lapse in the process of preparation of the gamma globulin in question. It is recommended that the widespread assumption that this product is free of risks of transmitting hepatitis virus should be accepted with reservation.

Testagem do 1 - beta - D - Ribofuranosil, 1.2.4 - triazole - 3 - carboxamide em pacientes com hepatite

A double-blind study was perfomed in 18 patients with infectious hepatitis; the experimental group was given 1 β-ribofuranosyl-1,2,4- triazole-3- carboxamide, a broad spectrum antiviral drug; the placebo group was given lactose. Patients were carefully selected, in order to fullfill the established criteria and were followed-up with clinical and labotorial examinations once a week. Results did not present significative differences; the authors suggest that a greater number of patients must be observed, specially considering in - patients, to evaluate the real efficacy and toxicity of the drug.