Euclides Ayres de Castilho

Mortalidade infantil no Brasil: Belíndia ou Bulgária?

Neste trabalho, descreve-se a evolucao da mortalidade infantil no Brasil na decada de 80. Diante da elevada proporcao de obitos nao registrados no Pais, a caracterizacao do risco de morrer entre as criancas menores de um ano de idade e realizada por um conjunto de indicadores de saude elaborados com base na distribuicao por causa de morte e por componente etario. Por meio de uma analise estatistica por componentes principais, desenvolve-se um indice sintetizador que permite expressar quantitativamente as diferentes situacoes de saude nas Unidades Federadas. Atraves desta escala de valores, dividindo-se o territorio nacional em tres grandes grupos, demonstra-se que a parte mais pobre persiste com padrao similar ao da India. Adicionalmente, a analise da mortalidade neonatal nos estados mais desenvolvidos mostra reducao pouco expressiva nos coeficientes na primeira semana de vida, demonstrando-se que o padrao observado, mesmo nos estados em situacao privilegiada em relacao aos demais, sequer se aproxima do que ocorre no mundo desenvolvido. De maneira geral, o confronto com a experiencia internacional leva a constatar que o declinio da mortalidade infantil na decada de 80 foi pobre, ficando evidente que o rumo a ser seguido envolve intervencoes especificas sobre ambos os componentes, o neonatal e o tardio.

Mortalidade por armas de fogo no estado do Rio de Janeiro, Brasil: uma análise espacial

Mortality caused by firearms has been increasing at an alarming rate in the state of Rio de Janeiro, Brazil. This study analyzes the gradual evolution of firearm mortality rates in this Brazilian state from 1979 to 1992, according to sex, age, and area of residence (capital city, metropolitan area, or the states interior), and uses spatial statistical techniques to describe the propagation of this firearm mortality epidemic in time and space. During the period analyzed, mortality due to firearms showed the greatest increase among 15- to 19-year-old male adolescents, with yearly rates ranging from 13 to 16%, according to area of residence. For children 10 to 14 years of age, mortality caused by firearms increased by 10% annually in the same period. The highest annual increase occurred in the states interior. At the beginning of the period studied, dissemination of firearm mortality was observed to follow a definite direction parallel to the federal road that runs along the east coast of the state. Between 1990 and 1992, however, the increase in deaths by firearms spread out in practically every direction. Empirical confirmation of a general expansion of firearm wound mortality contradicts the usual claim that violence is concentrated in areas of extreme poverty within Brazils largest cities. Programs for prevention and control of this epidemic should focus on its various aspects and take into consideration both collective issues (such as proliferation of firearms among persons involved with international firearm smuggling, increases in criminal activity, expansion of drug trafficking, and exclusion from social opportunities) and personal issues (relationships and interaction of young people with their families, schools, and social environment).

Mortalidade por causas externas no estado do Rio de Janeiro no período de 1976 a 1980

O presente trabalho teve por objetivo o de determinar as tendencias da mortalidade por causas externas no periodo de 1976 a 1980, no Estado do Rio de Janeiro. Foram estudadas as principais causas externas de obito e sua distribuicao temporal e espacial. Os acidentes de trânsito de veiculo a motor se revelaram como a principal causa externa de morte e, entre eles, os atropelamentos mostraram-se de real gravidade, sobretudo entre as criancas em idade escolar (5 a 14 anos). O estudo revelou um aumento de 70% na taxa de homicidios nos 5 anos pesquisados, e estes ja se constituem no principal f ator de mortalidade entre os adultos jovens de 20 a 29 anos. Evidenciou-se, tambem, grande numero de obitos classificados como lesoes ignoradas se acidental ou intencionalmente infligidas, apontando para falhas no sistema de classificacao dos obitos por causas externas no Estado do Rio de Janeiro.

Estimativas da mortalidade infantil no Brasil, década de oitenta: proposta de procedimento metodológico

A procedure for the estimation of the infant mortality rate in Brazil, in the 1980s, based only on the age distribution of registered deaths, is here proposed. Using this technique, it is possible to estimate the probabilities of dying in the first year of life in a continuous way, year by year, for different regions of the country. The space-time distribution of the main causes of infant deaths is analysed and the relevance of using this coefficient to express the social and economic conditions of the Brazilian population from 1979 to 1989 is discussed.

Diferenciais regionais de mortalidade por câncer no Estado do Rio de Janeiro, Brasil, 1979-1981

In 1980, malignant neoplasms ranked 3rd as a cause of death in the State of Rio de Janeiro, Brazil, with a crude mortality rate of 89.8 per 100,000. Cancer mortality data for 1979-1981 are presented for the State, with the objective of analyzing regional differentials. For the purpose of comparing mortality from the most important cancers, the State was divided into three regions: Capital, Metropolitan Belt and Interior, on the basis of the geographical structure of the State--which gave rise to the present urbanization patterns. Average annual age and sex-specific mortality rates per 100,000 were calculated for the period 1979-1981 for each cancer site and for 5-year age groups up to 79 years and for 80 years and above. Age standardized rates (ASR) were calculated by direct standardization to the world population and standardized mortality ratios (SMR) were also calculated with the objective of comparing different geographical areas. It was found that the most important malignant neoplasms among males were those of the lung (ASR 27.9), stomach (ASR 24.0), prostate, oesophagus and liver. The breast was the most important site for females (ASR 16.0), followed by the stomach (ASR 10.8), lung, cervix uteri and uterus (unspecified). The highest ASR were in the Capital (164.4 in males, 106.2 in females) and the lowest in the Interior (126.5 in males, and 91.3 in females). The highest SMR were found for breast (1.28), colon (1.71) and lung (1.70) cancers, the mortality rates for which were almost two-times higher in the Capital than in the Interior.(ABSTRACT TRUNCATED AT 250 WORDS)

Os caminhos da estatística e suas incursões pela epidemiologia

Neste trabalho, contempla-se o desenvolvimento da Estatistica, desde suas origens probabilisticas ate os atuais modelos de dependencia no tempo e no espaco. Avalia-se a evolucao do metodo quantitativo na abordagem epidemiologica, como tambem procura-se estabelecer limites das tecnicas estatisticas habituais, discutindo-se suas suposicoes teoricas e sua adequacao ao tratamento analitico das informacoes. Enfatizam-se a importância do desenvolvimento e/ou generalizacao de procedimentos que possam ajudar a superar as dificuldades metodologicas ainda encontradas em diversos estudos de inferencia causal em Epidemiologia.

Proposta de um modelo para desagregar projeções demográficas de grandes áreas em seus componentes geográficos

The problem of the preparation of estimates of the total population of geographic subdivisions after the 1980 census is studied with a view to the tabulation on mortality data of Rio de Janeiro State (Brazil) by municipal districts and the estimation of regional mortality rates. In Brazil, the calculation of the official population estimates is undertaken by the Brazilian Institute of Geography and Statistics. The method employed to estimate the population of geographic subdivisions is known as the AiBi method. This procedure is analysed and an alternative mathematical model is proposed that also satisfies the closure condition, that is, the projected values for the sum of the segments up to the total population projection. As an application of the proposed model, estimates of the population of the municipal districts of Rio de Janeiro State were prepared covering the period from 1981 to 1990.

Evaluation of enzyme-linked immunosorbent and alternative assays for detection of HIV antibodies using panels of Brazilian sera

Sera from 472 Brazilian subjects, confirmed to be either positive or negative for HIV antibodies and comprising the total clinical spectrum of HIV infection, were utilized in the evaluation of six commercially available enzyme-linked immunosorbent assays (ELISA), as well as of four alternative assays, namely indirect immunofluorescence (IIF), passive hemagglutination (PHA), dot blot and Karpas AIDS cell test. The sensitivities ranged from 100% (Abbott and Roche ELISA) to 84.2% (PHA) and the specificities ranged from 99.3% (IIF) to 80.2% (PHA). The sensitivity and specificity of the PHA and the sensitivity of the Karpas cell test were significantly lower than those of the other tests. Although the IFF and dot blot had good sensitivities and specificities, the six ELISA were more attractive than those tests when other parameters such as ease of reading and duration of assay were considered.