Inês Echenique Mattos

Prevalência de fatores de risco para doenças cardiovasculares na população Guaraní-Mbyá do Estado do Rio de Janeiro

Social change has been involved in the unequal distribution patterns of chronic diseases in several populations. Among Indian communities experiencing life pattern changes, international studies have reported increased prevalence of hypertension and other cardiovascular risk factors. Such increased prevalence was ascertained in a survey conducted in 1999 in selected Guaraní-Mbyá communities (Sapukai, Paraty-Mirim, and Araponga) in the State of Rio de Janeiro, Brazil. A population census was carried out and interviews and clinical and biochemical evaluations were conducted with 80 men and 71 women. Observed prevalence of selected risk factors in the overall sample, including men and women, was as follows for the three communities: hypertension (4.8%, 2.6%, 7.4%); overweight (26.7%, 19.5%, 34.8%); total cholesterol levels (2.8%, 2.7%, 2.9%), and increased triglyceride levels (12.6%, 9.5%, 15.9%). All prevalence rates were higher among women and at older ages. The results suggest that the Guaraní communities have a moderate risk of chronic diseases and that measures to reduce these risk factors should be adopted.

Confiabilidade e validade das declarações de óbito por câncer de boca no Município do Rio de Janeiro

Mortality statistics are frequently employed in cancer epidemiology studies. The aim of this research was to evaluate the reliability and validity of oral cavity cancer as the underlying cause of death reported on death certificates in the Municipality of Rio de Janeiro, Brazil. All death certificates since 1999 reporting this underlying cause of death were selected from the Municipal Mortality Information System. The death certificates were re-coded by an independent technician, and a standardized questionnaire was designed to collect clinical and laboratory data for diagnostic confirmation from patient records. Histopathological results and/or clinical history were considered as the gold standard to establish the diagnosis of cancer of the mouth. Reliability analysis showed a simple percentage agreement of 95.1% and a kappa coefficient of 0.93. Positive predictive value was 86.5%. Mortality statistics for oral cancer in Rio de Janeiro Municipality demonstrate good reliability and validity, possibly because diagnostic confirmation is facilitated by easy access to the tumor site.

Mortalidade por câncer de cólon e reto nas capitais brasileiras no período 1980-1997

BACKGROUND In Brazil, colorectal tumors are among the five more important sites of neoplasms, for both sexes, in terms of mortality. The etiology of colon and rectal cancer is complex and some of the factors involved in its genesis are related to diet. Brazilian geographic regions present heterogeneous alimentary profiles, that could be influencing the distribution of the mortality rates for these tumors. OBJECTIVE To describe the patterns of mortality from cancers of the colon and the rectum in Brazilian State capitals in the period 1980-1997. MATERIAL AND METHODS Mortality data for individuals of both sexes, residents in Brazilian State capitals (except Palmas, Tocantins) was obtained from the Ministry of Health Mortality System (SIM/MS). We considered as death from colon and rectum cancers those whose underlying cause of death was coded as 153.0 to 153.9, 154.0 and 154.1, according to ICD 9, in the period 1980-95; C18.0 to C18.9, C19 and C20,according to ICD 10, in the period 1996-97. The trends of the standardized mortality rates from colon and rectum cancer were analyzed through linear regression models. RESULTS The highest standardized mortality rates for colorectal cancer were observed in the South and Southeastern regions and varied between 8,0 and 10,7/100000 inhabitants. Porto Alegre (11,9), São Paulo (10,8) and Rio de Janeiro (9,6) presented the greatest rates among the State capitals in the study period. In the South region, rates of mortality for Porto Alegre and Florianópolis presented an increasing trend in the study period and the same behavior was observed for São Paulo and Vitória in the Southeastern region. Brasilia and the other capitals of the Midwest, with the exception of Goiânia, showed a tendency of increment of the mortality rates. Among the capitals of the North and Northeast regions, an increasing trend of mortality was observed in Rio Branco and Fortaleza. The separate analysis of the mortality rates for tumors of the colon and for tumors of the rectum showed a similar pattern, with higher values being observed for colon neoplasia. DISCUSSION Regional differences in the mortality rates for colon and rectum neoplasias have been discussed for different authors, who point to the contribution of cultural and alimentary habits, and differences of life style and socioeconomic status to this heterogeneity, besides other aspects related to access to health services and quality of hospital care and preventive services. These factors must be considered in the evaluation of the differences observed in Brazilian capitals. Although the State capitals situated in South and Southeastern regions presented higher rates than the others, mortality rates of Porto Alegre (9,8/100.000) and Rio de Janeiro (9,0/100.000), in period 1983- 85, were about three times lower than those observed in the United States, Canada and France, in 1985. The sex distribution pattern of the mortality rates in Brazilian capitals was not uniform, with higher rates in men. We observed a trend of increment of the mortality rates of colorectal cancer in all Brazilian regions, similar to that was observed in some countries of the world, although with different gradients. CONCLUSIONS The standardized mortality rates for colon and rectum neoplasias presented important regional differences among Brazilian State capitals. The highest rates were observed in the South and Southeastern regions. A trend of increment of the standardized mortality rates for cancers of the colon and the rectum was observed in all Brazilian regions in the period 1980-1997.

Mortalidade por câncer gástrico no estado do Pará, 1980-1997

RATIONALE Gastric cancer incidence and mortality have been declining in many countries, including Brazil. Nevertheless, it still constitutes an important public health problem in our country, particularly in the state of Pará where mortality rates present values over the Brazilian average rates. AIM To analyze the patterns of gastric cancer mortality in Pará State and in the City of Belém, in the last two decades. MATERIAL AND METHODS Mortality data were obtained through Brazils Mortality Information System and population data came from the Brazilian Institute of Geography and Statistics. Age standardized mortality rates were calculated for the whole population and by sex, for every triennium in the period 1980-97 for Pará State and City of Belém. Trends of the standardized mortality rates from stomach cancer were analyzed through linear regression models. RESULTS In comparison with other state Capitals and countries, standardized mortality rates for stomach cancer in Belém were elevated (27.2 a 15.8/100,000) during all the study period. Rates in men were higher than for women with a sex ratio of 3.0 in Belém, in all study periods, except 1995-97. During the study period, it was observed a decreasing trend in the mortality rates for both sexes, although more prominent in men, in the State of Pará. In Belém, it was also seen a decline in rates for all age groups. CONCLUSION In spite of the observed trend, gastric cancer mortality rates in Belém at the last period of the series (1995-97) were still higher than those exhibited by some of the other State Capitals in 1980-82.

Prevalência e fatores associados à incapacidade funcional em idosos institucionalizados no Município de Cuiabá, Estado de Mato Grosso, Brasil, 2009-2010

Objective: to evaluate the prevalence of disability and associated factors in institutionalized elders. Methods: crosssectional study with 154 elders (≥60 years) in long term care institutions in the municipality of Cuiaba-MT, Brazil, since November 2009 to January 2010; prevalences of dependency in Basic Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) were estimated by Katz and Lawton scales, and prevalence ratios by strata of independent variables; Poisson regression was used for adjustment. Results: prevalence of dependence in ADL was 44.0%; individuals without family contact and reporting regular/bad health were twice as likely to have ADL dependency; prevalence of dependence in IADL was 88.7%, associated with female sex, absence of family contact and cognitive impairment. Conclusion: the prevalence of dependency in ADL in institutionalized elders was 6.4 times higher than observed in those living in the community, and IADL dependence was 3.0 times higher, although risk factors associated are similar in both groups.

Differential susceptibility according to gender in the association between air pollution and mortality from respiratory diseases

This study analyzed the association between air pollution and deaths from respiratory diseases, considering differential susceptibility according to gender. The authors used daily deaths from respiratory diseases (ICD-10, J00-J99), PM(10), SO(2), and O(3) levels, and meteorological indicators in Volta Redonda, Rio de Janeiro State, Brazil, from January 2002 to December 2006. The association was estimated by Poisson regression using generalized additive models, where the increase in risk of deaths from PM(10) to lag 1 was 10.01% (95%CI: 1.81-18.88%) in the total female population and 10.04% (95%CI: 0.90-20.02%) in elderly women. The increase in risk of deaths from PM(10) to lag 9 was 8.25% in the total male population (95%CI: 0.86-16.18%) and 10.80% (95%CI: 2.18-20.15%) in elderly men. For exposure to SO(2) and O(3), the risk was significant in the total male population and the elderly, respectively. The results emphasize the need for further studies, focusing on modification of the effects of air pollution on health.

Factors associated with functional incapacity in elders living in long stay institutions in Brazil: a cross-sectional study.

BackgroundThe increase of the elderly population and the high prevalence of chronic diseases have contributed to the increasing importance of functional ability as a global public health problem. This study aimed to assess functional capacity in institutionalized elders, as well as undertake an exploratory analysis of its associated factors.MethodsThis is a cross-sectional study with institutionalized Brazilian elders. Functional capacity was assessed using the Katz Index for Activities of Daily Living (ADL) and the Lawton Scale for Instrumental Activities of Daily Living (IADL). The characteristics of dependent individuals were described and logistic regression models were developed for both scales. Multiple models that included all selected variables were developed using a hierarchical approach. We considered the results from the Wald test (p < 0.05) as a rule for progressing to the next level.ResultsA population of 760 elders was considered. The prevalence of dependence was 50.3% for ADL and 81.2% for IADL. We observed associations between ADL dependence and the following factors: self-report of stroke, difficulty of walking 400 meters, lower total scores in questions related to the temporal orientation section of the cognition test, and self-reports of frequently feeling upset. IADL dependence was associated with educational level, self-report of cancer, difficulty of walking 400 meters, use of glasses, and self-reported memory problems.ConclusionsSociodemographic and health conditions were associated with functional incapacity in institutionalized elders. Based on these findings, we emphasize the importance of both prevention and treatment of chronic conditions as well as social support in the maintenance of individuals’ autonomy.

Material particulado originario de queimadas e doencas respiratorias

OBJECTIVE: To analyze the effects of exposure to fine particulate matter from burning on hospital admissions due to respiratory diseases in children and the elderly. METHODS: This is an ecological time series study that took place in the city of Cuiaba, Mato Grosso, in Brazils Amazon Region, in 2005. Information on the daily levels of fine particulate matter PM2.5 was made available by the Brazilian National Institute for Spatial Research. The model included variables related to temperature, relative humidity and adjusts for seasonality and calendar effects. Poisson regression with generalized additive models was used. RESULTS: A 10 µg/m3 increase in the level of exposure to PM2.5 was associated with increases of 9.1%, 9.2% and 12.1% in hospital admissions due to respiratory diseases in children for moving averages of 1, 2 and 5 days, respectively. For the dry season, the level of exposure to particulate matter was associated with increases of 11.4%, 21.6% and 22.0% in hospital admissions in children for moving averages of 1, 5 and 6 days, respectively. No significant link was noticed in the elderly. CONCLUSIONS: The results show the influence of PM2.5 on hospitalizations for respiratory disease in children under 5 in the region studied.

Prevalence of non-utilization of mammography and associated factors in elderly women

This study analyzes the prevalence of non-utilization of mammography among older women, according to socio-demographic variables, health status, and use of preventive health services. This was a cross-sectional study including women 60 years or older. We interviewed 4,621 women 60 to 106 years of age; the majority were widows (51.8%) and had little or no schooling (53.8%). Most (89%) reported health problems, and 66.4% used private medical care. Prevalence of self-reported mammography was 72.1%. Gynecological visits (PR = 2.39; 95%CI: 2.04-2.80), Pap smear (PR = 3.24; 95%CI: 2.89-3.63), years of schooling (PR = 1.07; 95%CI: 1.02-1.12), health care insurance (PR = 1.16; 95%CI: 1.11-1.20), physician visits (PR = 1.23; 95%CI: 1.11-1.37), age (PR = 1.12; 95%CI: 1.08-1.17), marital status (PR = 1.05; 95%CI: 1.00-1.09), and barriers to health services (PR = 0.94; 95%CI: 0.89-0.98) were also associated with non-utilization of mammography. These associations may be partially explained by lack of knowledge, poor access to public health services, and cultural factors related to the aging process and reproductive incapacity.

Mortalidade por câncer em trabalhadores de companhia geradora de eletricidade do Estado de São Paulo, Brasil

A number of epidemiologic studies have observed an association between exposure to 50-60 Hz electromagnetic fields and the development of specific types of cancer. In Brazil, a preliminary report from a study of electricity facility workers in Rio de Janeiro (RJ) has mentioned relatively similar results. An exploratory analysis of death certificates obtained from a sample of electricity workers in S. Paulo was made. Data was analysed by using the Proportional Mortality Ratio (PMR) and the Proportional Cancer Mortality Ratio (PCMR). A slightly elevated all-sites cancer mortality was observed among these workers (PMR 1.11; 95% CI 0.91-1.35). Site specific analysis has shown a statistically significant higher mortality of laryngeal cancer (PCMR 2.04; 95% CI 1.05-4.20). An excess of deaths was also seen for cancers of the buccal cavity/pharynx, prostate, bladder, brain and Hodgkins disease, although the results lacked statistical significance. When analysed by categories of estimated exposure to magnetic fields, an excess of deaths from bladder cancer (PCMR 4.17; 95% CI 1.35-9.72), neoplasms of the brain (PCMR 7.7; 95% CI 1.02-9.65) and Hodgkins disease (PCMR 5.55; 95% CI 1.14-16.21) was observed in the group with probably higher exposure to EMF. A comparison of cancer mortality between these workers and petrochemical employees has shown a higher PCMR for larynx tumours (PCMR 3.51; 95% CI 3.02-15.51) and bladder cancer (PCMR 7.53; 95% CI 3.02-15.51). For brain tumours, however, a PCMR of 0.74 (95% CI 0.27-1.61) was noted. Although restrictions related to sample size in the study and the lack of information about known confounders must be considered, the results of this study do not fully disagree with others previously mentioned in the literature.Realizou-se a analise exploratoria de um conjunto de atestados de obito de eletricitarios do Estado de Sao Paulo (Brasil), atraves da Razao de Mortalidade Proporcional (PMR) e da Razao de Mortalidade Proporcional por Câncer (PCMR). Foi observado um discreto excesso de mortalidade por todas as localizacoes de câncer (PMR 1,11; IC 95% 0,91-1,35), estatisticamente nao significativo. Encontrou-se elevacao da PCMR, estatisticamente significativa, para câncer de laringe (PCMR 2,04; IC 95% 1,05-4,20). Um excesso de obitos, embora sem significacao estatistica, foi observado para cavidade oral/faringe, prostata, bexiga, cerebro e doenca de Hodgkin. A analise por categorias de exposicao estimada a campos magneticos mostrou PCMRs persistentemente elevadas para cancer de bexiga (PCMR 4,17; IC 95% 1,35-9,72), cerebro (PCMR 3,77; IC 95% 1,02-9,65) e doenca de Hodgkin (PCMR 5,55; IC 95% 1,14-16,21), no grupo com exposicao provavelmente alta. Uma comparacao com a mortalidade por câncer, de um grupo de trabalhadores petroquimicos, mostrou mortalidade elevada por neoplasma de laringe (PCMR 3,51; IC 95% 1,75-6,28) e bexiga (PCMR 7,53; IC 95% 3,02-15,51). Para tumores de cerebro, observou-se PCMR de 0,74 (IC 95% 0,27-1,61).