Gulnar Azevedo e Silva Mendonça

Organochlorines and breast cancer: a case-control study in Brazil.

Breast cancer is an important cause of morbidity and mortality in Brazil. Some studies have analyzed the potential role of organochlorine compounds in breast cancer etiology. These chemical compounds have been widely used in agriculture and in vector‐control programs in Brazil. A case‐control study was carried out in the main cancer hospital of the Instituto Nacional de Câncer in Rio de Janeiro to investigate exposure to organochlorinated pesticides as a risk factor for breast cancer. We investigated 177 cases of invasive breast cancer at the hospital, between May 1995 and July 1996, and 350 controls selected among female visitors at the same hospital. In addition to information obtained from interviews, blood samples were taken, to analyze residual amounts of organochlorine by gas chromatography using an electron capture detector. [1,1‐Dichloro‐2,2‐bis(p‐chlorophenyl)ethylene] (DDE) was determined in sera of 457 women from a total of 493 participants who had serum samples available. Residues of hexachlorobenzene were found in 11 women only. No statistically significant association was found between breast cancer risk and serum level of DDE or history of exposure to pesticides. Serum levels of DDE (ng/ml) were similar in patients (median = 3.1, mean = 5.1) and controls (median = 3.1, mean = 4.8) (p = 0.93). The age‐adjusted odds ratio of breast cancer for women in the upper quintile compared with those in the lowest quintile was 0.90 (95% confidence interval 0.47–1.73). When adjusted for other variables, the risk remained not statistically significant (upper quintile odds ratio = 0.79, 95% confidence interval 0.39–1.60). In our hands, exposure to organochlorinated pesticides measured by history or serum analysis was thus not a risk factor for breast cancer. Int. J. Cancer 83:596–600, 1999.

CYP1A1, GSTM1, and GSTT1 polymorphisms and breast cancer risk in Brazilian women

The frequency of CYP1A1 (CYP1A1*2A), GSTM1, and GSTT1 polymorphisms, as well as the main risk factors associated with breast cancer were studied in Brazilian women, with malignant breast cancer (n=128), or age-matched controls (n=256). Only a family history of breast cancer presented a significant risk (OR=3.00, CI=1.27-7.06). Among non-whites, the CYP1A1*2A allele was underrepresented among patients. Statistical analysis indicated that this polymorphism may decrease the risk of breast cancer among these individuals, particularly after adjusting for the risk presented by selected risk factors (OR=0.30, 95% CI=0.12-0.76).

Qualidade do ar e transtornos respiratórios agudos em crianças

OBJETIVO: Avaliar a relacao entre poluicao do ar e efeitos respiratorios agudos em criancas. METODOS: Foi realizado um estudo ecologico de series temporais em tres unidades publicas de saude do bairro de Jacarepagua, municipio do Rio de Janeiro, entre abril de 2002 e marco de 2003. Foram analisados dados diarios de PM10, SO2, NO2, CO e O3, e como variaveis de desfecho 45.595 atendimentos pediatricos de emergencia por sintomas respiratorios ou especificos por transtornos nas vias aereas superiores e nas vias aereas inferiores. Foram incluidas no modelo para controle de confundimento as variaveis referentes a tendencia temporal, sazonalidade, temperatura, umidade relativa do ar, precipitacao de chuva, infeccoes respiratorias e os efeitos do calendario (como feriados e finais de semana). Foi empregada a regressao de Poisson via modelos aditivos generalizados para estimar os efeitos dos poluentes e dos fatores de confusao. RESULTADOS: Somente o O3 apresentou resultado positivo e estatisticamente significativo, tanto com todos os atendimentos de emergencia por queixas respiratorias como com os atendimentos motivados por sintomas nas vias aereas inferiores. O efeito foi no mesmo dia da exposicao (lag 0). Associacao significativa e de sentido inverso ocorreu com o CO e os atendimentos pediatricos por queixas respiratorias. Nao se observou resultado significativo com os demais poluentes atmosfericos. CONCLUSOES: Foram encontradas associacoes entre indicadores de poluicao atmosferica e o numero de atendimentos pediatricos de emergencia por motivos respiratorios em Jacarepagua, apesar de os niveis de todos os poluentes monitorados permanecessem abaixo dos limites recomendados durante todo o periodo de estudos.

Fatores de risco associados à hipertensão arterial em adolescentes

OBJECTIVE To investigate the risk factors associated with essential arterial hypertension in adolescents. METHOD A case-control, outpatient-based study of adolescents aged 11 to 19 years treated at the Center for Studies into Adolescent Health (Núcleo de Estudos da Saúde do Adolescente) at the Universidade Estadual do Rio de Janeiro. Nutritional status was assessed by means of body mass index. Data were also obtained on waist circumference, height, family history of arterial hypertension, birth weight and pubertal development. The analysis was performed using unconditional logistic regression. RESULTS The study investigated 91 cases and 182 controls. Body mass index was associated with hypertension. Height had a positive association with hypertension only among the girls. There was no evidence of an association between pubertal development or birth weight with arterial hypertension in adolescence. In contrast, family history, particularly when both parents had hypertension, exhibited a robust association, both among the boys (OR = 13.32; 95%CI 2.25-78.94), and the girls (OR = 11.35; 95%CI 1.42-90.21). CONCLUSIONS In our study, overweight, obesity and family history of hypertension (father and mother with hypertension) were the principal risk factors for arterial hypertension in adolescents.

Fatores associados à morte neonatal em recém-nascidos de muito baixo peso em quatro maternidades no Município do Rio de Janeiro, Brasil

In Brazil, neonatal mortality is the most common cause of infant mortality. The majority of deaths occur in very low birthweight newborns. This longitudinal study assesses factors associated with mortality risk in very low birthweight newborns during the first 27 days of life. Relative risk of mortality was assessed for each variable, and the most statistically significant variables were selected for the multivariate model, in which odds ratios were calculated using logistic regression. Factors associated with decreased mortality risk were: prenatal corticosteroid (OR = 0.40; 90%CI: 0.23-0.74) and total parenteral nutrition (OR = 0.06; 90%CI: 0.02-0.15). Factors associated with increased mortality risk were: male gender (OR = 2.19; 90%CI: 1.27-4.00); maternal hemorrhage (OR = 4.28; 90%CI: 1.27-14.46); use of mechanical ventilation (OR = 18.83; 90%CI: 5.15-68.87); CRIB (OR = 4.48; 90%CI: 2.43-8.27); and birthweight. Selective use of prenatal corticosteroid should be encouraged in order to reduce neonatal mortality and morbidity.

Características tumorais e sobrevida de cinco anos em pacientes com câncer de mama admitidas no Instituto Nacional de Câncer, Rio de Janeiro, Brasil

Numerous factors have been studied to establish more secure prognostic criteria in breast cancer patients. This study estimates five-year survival rates and principal prognostic factors related to tumor characteristics in women with invasive breast cancer and submitted to surgery at the National Cancer Institute, Rio de Janeiro, Brazil, from May 1995 to July 1996. Study variables were: lymph node status, tumor size, aggressiveness grade, and presence of estrogen and progesterone receptors. Survival functions were calculated according to the Kaplan-Meyer method. The Cox proportional hazards model was used to evaluate prognostic factors. Five-year survival was 75% for all women and 64% for those with node involvement. Multivariate analyses identified node involvement as the strongest predictor of outcome; a positive estrogen receptor test was associated with a better prognosis. These findings highlight the need for studies to assess new variables to be added to known factors in order to better orient therapy for breast cancer.

Poluição do ar e efeitos na saúde nas populações de duas grandes metrópoles brasileiras

Com a crescente preocupacao acerca dos efeitos nocivos da poluicao do ar na saude da populacao, faz-se necessario a investigacao e quantificacao destes efeitos em nosso meio. Realizou-se um estudo de series temporais com esse objetivo nas duas maiores metropoles brasileiras: Sao Paulo e Rio de Janeiro. Informacoes diarias sobre mortalidade, internacoes hospitalares, niveis atmosfericos dos principais poluentes do ar e de variaveis meteorologicas foram obtidos nas duas cidades, a partir de fontes de informacao secundarias. Esses dados foram analisados utilizandose tecnicas de analise de series temporais em modelos lineares por meio de Equacoes de Estimacao Generalizada e/ ou por meio de modelos nao-parametricos, com a utilizacao de Modelos Aditivos Generalizados. Foram encontradas associacoes estatisticamente significantes entre aumentos nos niveis de poluentes atmosfericos e aumentos na mortalidade e nas hospitalizacoes, por causas respiratorias e cardiovasculares, em criancas e idosos, em ambos municipios, mesmo apos ajuste por tendencias de longo prazo, sazonalidade, dia da semana, feriados, temperatura e umidade. Conclui-se que os niveis de poluicao vivenciados atualmente em Sao Paulo e no Rio de Janeiro sao suficientes para causar agravos a saude da populacao. Medidas articuladas entre os diversos setores que gerenciam a vida urbana nessas metropoles sao fundamentais para buscar a melhoria da qualidade do ar e, consequentemente, da saude da populacao nessas cidades. Palavras-chave: poluicao do ar, efeitos na saude; mortalidade; morbidade, series temporais.

Diet and mortality from common cancers in Brazil: an ecological study

A prospective ecological evaluation of mortality from common malignancies with dietary risk factors and alcohol consumption was carried out among 10 state capitals of Brazil. Regression analysis was used to examine the association of dietary intake with mortality rates of the most common cancers among adults age 30 years and older. Age-adjusted cancer mortality rates varied 2.4 to 3.3 fold across the state capitals. A positive relationship was observed between energy intake and colon, lung, and esophageal cancer (p</=0.02 for each). Colon cancer mortality was positively associated with consumption of total fat, eggs, alcohol, mate tea, cereals, and vegetables (p</=0.01). Lung cancer was positively associated with mate and cereal intake (p<0.05). Stomach cancer was associated with consumption of eggs (p=0.04); and negatively associated with consumption of high fiber foods, fruits, and vitamin A and C (p</=0.05). Esophageal cancer was positively associated with fat intake, mate and cereals (p</=0.05) and negatively associated with vitamin A (p=0.02); prostate cancer was negatively associated with vitamin C (p=0.007). Breast cancer was not associated with any of the factors studied. The marked variation in cancer mortality rates in Brazil may be partially related to the high variation in dietary components or other diet associated factors.

Neurological manifestations in HTLV-I-infected blood donors

The human T-cell lymphotropic virus type 1 (HTLV-I) causes a neurological disease known as HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) in a minority of infected individuals. Although other neurological outcomes have been described their prevalence is presently unknown. To evaluate the frequency and characteristics of neurological involvement in a population of HTLV-I-infected blood donors we investigated 196 HTLV-I positive and 196 negative blood donors from a blood center of Rio de Janeiro, Brazil. Individuals with abnormalities at the neurological examination were examined by three neurologists, and when pertinent, additional neurological investigations were performed. Descriptive analysis, Students t-test and chi2 test were employed for statistical analysis. Neurological abnormalities were found in 71 (36.2%) of the HTLV-I positive blood donors and in only 29 (14.8%) of the HTLV-I negative donors (OR = 2.54, 95% CI = 1.67-3.59, p = 0.000002). Cases of myelopathy, motor neuron disease and myopathy were only found in the HTLV-I positive group. In addition, peripheral neuropathy (PN) was significantly more frequent in the positive group (p = 0.015). In summary, our data suggest that HTLV-I-infected individuals exhibit a wide variety of neurological manifestations apart from the classical picture of HAM/TSP.

Air quality and emergency pediatric care for symptoms of bronchial obstruction categorized by age bracket in Rio de Janeiro, Brazil

The objective of this study was to estimate the association between levels of air pollutants and respiratory symptoms in children. An ecological time-series study was conducted between April 2002 and March 2003 with daily data on PM10, SO2, CO, NO2, and O3 and paediatric care in emergency rooms due to symptoms indicating bronchial obstruction. The potential confounding factors considered were: time trend, seasonality, meteorological variables, respiratory infections and the effects of weekends and holidays. A semi-parametric Poisson regression was used to model the time series. Splines (data smoothing functions), indicator variables and cubic polynomials were used to adjust the effects of the confounding variables. A 5% significance level was adopted for the study. A statistically significant increase of 6.7% in paediatric visits of children of less than 2 years of age was associated with PM10. A 3% positive association with O3 showed borderline significance (p < 0.06) in this age bracket. Our findings highlight the existence of an acknowledged public health problem in Rio de Janeiro, Brazil, and also emphasize the need to identify the principal sources of air pollutants.