Liz Maria de Almeida

The Brazil SimSmoke policy simulation model: the effect of strong tobacco control policies on smoking prevalence and smoking-attributable deaths in a middle income nation.

David Levy and colleagues use the SimSmoke model to estimate the effect of Brazils recent stronger tobacco control policies on smoking prevalence and associated premature mortality, and the effect that additional policies may have.

Importância da análise de água para a saúde pública em duas regiões do Estado do Rio de Janeiro: enfoque para coliformes fecais, nitrato e alumínio

In developing countries, due to poor sanitation conditions and poor quality of drinking water, typical water-borne diseases and more recently diseases caused by drinking water with high concentrations of nitrates and certain metals like aluminum have increased the concern over the health effects of these compounds. Several articles have shown associations between nitrates and methemoglobinemia in children, and aluminum and Alzheimer disease in adults. This study identified water quality with several parameters in non-conformity with Brazilian drinking water standards (Ruling 36/90): more than 50% of all samples from both regions contained fecal coliforms; some 31% of water samples from wells in Duque de Caxias had excessive nitrate concentrations; 100% of all groundwater samples from both regions showed aluminum concentrations not conforming to the norm, with the same result for 100% of samples from the drinking water distribution system in São Gonçalo and 75% of same in Duque de Caxias. This lack of conformity poses several health risks for the local population.Nos paises em desenvolvimento, onde ainda podemos encontrar areas urbanas densamente povoadas com precarias condicoes de saneamento basico, a agua e responsavel por um grande numero de doencas de veiculacao hidrica. Varios artigos tem apontado para as doencas causadas pelas altas concentracoes de nitrato e aluminio na agua, tais como a metemoglobinemia e Mal de Alzheimer, respectivamente. Este estudo mostrou que a qualidade da agua de poco e de rede, consumidas em duas micro-regioes dos municipios de Duque de Caxias e Sao Goncalo apresentou varias nao conformidades com a Portaria 36/90: mais de 50% das amostras de agua de poco nas duas areas apresentaram contaminacao por coliformes fecais; cerca de 31% das amostras de agua de poco de Duque de Caxias apresentaram niveis de nitrato acima do valor maximo permissivel; 100% das amostras de agua de rede das duas regioes apresentaram concentracoes de aluminio acima da norma; mesmo resultado em 100% das amostras de agua de poco em Sao Goncalo e 75% em Duque de Caxias. Estas nao conformidades podem representar possiveis riscos a saude dessas populacoes.

Prevalência de consumo de bebidas alcoólicas e de alcoolismo em uma região metropolitana do Brasil

Foi realizado Inquerito epidemiologico com o objetivo de estimar o uso de substâncias psicoativas e a prevalencia de alcoolismo. Tomou-se como referencia a populacao de maiores de 13 anos de idade de regiao administrativa da cidade do Rio de Janeiro, RJ (Brasil), da qual se extraiu uma amostra aleatoria de 1.459 individuos. Os resultados referentes ao uso de bebidas alcoolicas e alcoolismo, identificados atraves do teste CAGE, mostraram: prevalencia de 51% para o consumo de alcool e de 3% para alcoolismo, sendo 4,9% em homens e 1,7% em mulheres; maior proporcao de consumidores de alcool e de alcoolistas entre homens de 30 e 49 anos; abstinencia mais frequente entre os viuvos, protestantes e individuos com niveis de renda inferiores.An epidemiological survey was carried out for the purpose of estimating the use of psychoactive substances and the prevalence of alcoholism. The target population consisted of people over 13 years old living in a district of Rio de Janeiro city - Brazil. A random sample of 1,459 people was researched. Data on the use of alcohol and on alcoholism are presented. The diagnosis of this latter, based upon the CAGE Test, showed that 51% used alcohol and 3% were suspected of alcoholism: 4.9% and 1.7% among men and women, respectively. The greatest prevalence of the use of alcohol and of alcoholism was found among men between 30 and 49 years of age. Abstinence from alcohol was more frequent among widowed, Evangelical and low-income groups.

The epidemiology of hepatitis A in Rio de Janeiro: environmental and domestic risk factors

A serological study of hepatitis A was carried out in low-income areas scheduled for a major sanitation programme in Rio de Janeiro, Brazil. Blood spots were collected by finger puncture and transported on filter paper, and total antibodies to hepatitis A virus were detected by ELISA. Households were also interviewed to collect information on their environmental conditions and socio-economic status. A generalized linear model using a complementary log-log function was fitted to the data, using the logarithm of age as an explanatory variable to derive adjusted rate ratios (RR). The risk of infection was greater among households with 2-3 members per room (RR = 1.4; 95% CI = 1.04-1.8) or more than three per room (RR = 1.5; 95% CI = 1.2-2.0). People living on hilltops (RR = 1.5; 95% CI = 1.02-2.2), near to open sewers (RR = 1.2; 95% CI = 1.03-1.5) or lacking a kitchen (RR = 1.4; 95% CI = 1.08-1.9) were also at greater risk than others. The number of taps and water-using fittings in the house was associated with a protective effect (RR = 0.9 for each tap; 95% CI = 0.9-0.98). A significant protective association was found with maternal education but not with gender or household income. The results do not suggest a strong association with water quality. Ownership of a ceramic water filter was associated with a protective effect on the margin of significance, but the practice of boiling drinking-water was not, nor was the type of water source used. The results suggest that that the risk of infection with hepatitis A is determined by environmental variables in the domestic and public domains.

Censo dos pacientes internados em uma instituição asilar no Estado do Rio de Janeiro: dados preliminares

O Estado do Rio de Janeiro concentra uma das maiores redes de hospitais psiquiatricos do pais, sendo um deles a Casa de Saude Dr. Eiras/Paracambi (CSDE-P). A atual Assessoria de Saude Mental da Secretaria de Estado de Saude do Estado do Rio de Janeiro, realizou em fins de 2000, o Censo Clinico e Psicossocial dos Pacientes Internados na CSDE-P. Encontrou uma populacao de 1494 individuos, com predominio de homens (53,4%), solteiros (81,6%), faixa etaria produtiva (66,4%) e baixa escolaridade (11,5% com primeiro grau completo ou mais). A maioria tinha um tempo de internacao superior/igual a 2 anos (77,6%), recebiam visitas de familiares (60,5%) mas nao saiam de licenca (73,8%). Os diagnosticos predominantes foram as esquizofrenias (53,6%) e o retardo mental (26,4%). A principal abordagem terapeutica foi a psiquiatrica (84,1%). Realizavam atividades sistematicas durante o dia 13,3% dos pacientes, embora cerca de 36% apresentassem bons indicativos de condicoes de autonomia. A CSDE-P e um macro hospital, onde a maioria dos pacientes encontra-se desterritorializada e com lacos sociais precarios, exigindo a construcao de estrategias de cuidados que levem em conta essa particularidade.Rio de Janeiro State has one of the largest networks of psychiatric hospitals in Brazil, one of them the Dr. Eiras Paracambi Hospital (CSDE-P). In late 2000, the current Mental Health Advisory Division of the Rio de Janeiro State Health Department conducted a clinical and psychosocial census of patients hospitalized in the CSDE-P. The hospital population consisted of 1,494 individuals, the majority men (53.4%), single (81.6%), working-age (66.4%), and with limited schooling (only 11.5% with a complete primary education or more). Most had been in hospital for at least two years (77.6%), received visits from relatives (60.5%), but did not have hospital leave (73.8%). The predominant diagnoses were schizophrenia (53.6%) and mental retardation (26.4%). The main therapeutic approach was psychiatric (84.1%). Only 13.3% took part in systematic activities during the day, although 36% were in a condition to do so. CSDE-P is a mega-hospital where most patients have precarious social links, demanding treatment strategies which take this characteristic into account.

Consumo de psicofármacos em uma região administrativa do Rio de Janeiro: a Ilha do Governador

Em 1988, um inquerito epidemiologico foi realizado para se estimar a prevalencia de alcoolismo cronico e uso de alcool na populacao da XX Regiao Administrativa da cidade do Rio de Janeiro. O instrumento incluiu perguntas sobre o consumo de psicofarmacos, cafe e cigarros. Este trabalho analisa os dados referentes ao consumo de psicofarmacos nos 30 dias anteriores a pesquisa. A amostra representativa da populacao acima de 13 anos foi composta por 1.459 pessoas, Os resultados mostram uma prevalencia de consumo global de 5,2% (3,1% para homens e 6,7% para mulheres). As mulheres, as pessoas mais velhas (especialmente pessoas entre 60 e 69 anos), os separados e viuvos, e as pessoas de renda mais baixa apresentaram prevalencias mais elevadas. Avaliou-se a associacao de cada variavel demografica atraves do calculo deodds ratio ajustado por regressao logistica. Os tranquilizantes derivados dos benzodiazepinicos predominaram entre os tipos de psicofarmacos referidos (85,23%), seguidos pelos antiepilepticos (5,68%) e pelos hipnoticos e sedativos (4,54%). Os clinicos nao-especializados em neurologia ou psiquiatria lideraram as prescricoes (65,8%). Oitenta por cento dos medicamentos foram obtidos na rede privada, enquanto 13,16% foram adquiridos na farmacia publica, quase todos mediante a apresentacao do receituario controlado. Os resultados sao discutidos e novas linhas de pesquisa sao apontadas.

The intensity of transmission of hepatitis A and heterogeneities in socio-environmental risk factors in Rio de Janeiro, Brazil

The objective of this work was to assess the intensity of transmission of hepatitis A in Rio de Janeiro, Brazil. We also used the estimation of the parameters of a deterministic model to study the effects of risk factors. Age-specific seroprevalence of antibodies against hepatitis A virus (HAV) was obtained from a survey screening in a city of the metropolitan area of Rio de Janeiro, in 1997. From the seroprevalence data, we estimated the age-dependent force of infection (lambda) and the average age of first infection (A), using a deterministic model. To evaluate the influence of the environmental risk factors, we estimated the same parameters stratifying the sample for the selected socio-environmental risk factors: the number of years of schooling of the female responsible for the house, crowding within the bedroom, number of water taps and fittings, and the presence of sewage in front of the house. For the whole sample, the maximum force of infection estimated was 0.12/year and the average age of infection was 10.1 years. This last parameter decreased as the number of persons per bedroom increased, and also when the number of water taps and the number of years of schooling of the woman responsible for the house decreased. The proposed environmental interventions may lead to a decrease in the intensity of transmission of HAV and an increase in the average age of first infection in the next few years. This may have public health implications, since hepatitis A is more severe in adults. In this context, specific vaccination programmes may be necessary, as in developed countries.

Parasitismo por Ascaris lumbricoides em crianças menores de dois anos: estudo populacional em comunidade do Estado do Rio de Janeiro

Prevalence and intensity of Ascaris lumbricoides infection were analyzed by a cross-sectional study in children addressed in the city of Duque de Caxias, Rio de Janeiro State, from July to December 1997. The study population consisted of children under two years of age (N=387) and mothers of children under one year of age (N=104). Coproparasitologic tests were run using the MIFC and the Kato thick smear (Kato-Katz) methods. Prevalence was 3.3% (95% CI: 1.0-7.8) for children under one year, 30.7% (95% CI: 25.4-36.4) for one-year-olds, and 42.3% (95% CI: 33.0-51.9) for mothers of children under one. Some 38.0% of children under one year of age showed medium-to-heavy infection. These results indicated that ascariasis was an important problem in the first year of life and demonstrated the need for research in the area of maternal and infantile ascariasis.

Tabagismo e escolaridade no Brasil, 2006

OBJETIVO: Analisar a prevalencia de tabagismo e uso acumulado de cigarro na vida e fatores associados. METODOS: Foram analisados dados referentes aos 54.369 individuos com idade >18 anos entrevistados pelo sistema de Vigilância de Fatores de Risco e Protecao para Doencas Cronicas por Inquerito Telefonico (VIGITEL), realizado nas capitais brasileiras e Distrito Federal em 2006. Foram calculadas as prevalencias de tabagismo estratificadas por escolaridade segundo sexo para as cidades de cada regiao e as razoes de prevalencia brutas e ajustadas por numero de pessoas e de comodos no domicilio. O consumo de cigarros na vida (macos-ano) foi analisado segundo escolaridade e sexo por regiao. RESULTADOS: No Brasil, a prevalencia de tabagismo foi significativamente maior entre homens e mulheres com baixa escolaridade (ate oito anos de estudo = 24,2% e nove ou mais = 15,5%). Esta diferenca diminuiu com a idade ou se inverteu entre os mais idosos. Observou-se diminuicao de risco de ser fumante para a populacao de maior escolaridade, independentemente do numero de pessoas e de comodos por domicilio. A prevalencia de fumantes com consumo intenso de cigarros foi maior entre os de escolaridade mais baixa, principalmente entre mulheres da regiao Norte. A excecao foram os homens da regiao Sul, onde esse percentual foi maior entre aqueles com maior escolaridade. CONCLUSOES: Confirmou-se haver maior concentracao de fumantes na populacao de menor escolaridade, principalmente entre homens mais jovens. E necessario compreender melhor a dinâmica da epidemia de tabagismo para adequar medidas preventivas especificas para individuos conforme idade e estrato social.OBJECTIVE To analyze smoking prevalence and cumulative cigarette consumption and factors associated. METHODS Data from 54,369 respondents aged > or = 18 years were analyzed. Data was collected through interviews using the Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL--Telephone-Based Surveillance of Risk and Protective Factors for Chronic Diseases) conducted in Brazilian state capitals and Federal District in 2006. Smoking prevalence rates were estimated stratified by level of education and gender in all cities studied and prevalence ratios, crude and adjusted for number of adults living in the same household and number of rooms per household, were also calculated. Lifetime cigarette consumption (pack-years) was analyzed by level of education and gender in all macroregions studied. RESULTS In Brazil, overall smoking prevalence was significantly higher among men and women with lower education (eight years of schooling = 24.2%; nine years and more = 15.5%). This difference tended to decrease with age and an inverse proportion was seen among the elderly. Reduced risk of smoking was found associated to higher education regardless of the number of adults living in the same household and the number of rooms per household. The prevalence of heavy smokers was higher among those with lower education, especially among women in the Northern region, except for the Southern region, where it was higher among men with higher education. CONCLUSIONS The study results confirmed higher smoking prevalence among those with lower education, especially among younger males. Further studies are needed to better understand the dynamics of tobacco epidemic for developing specific prevention actions targeting different age and social groups.

Probabilistic linkage in household survey on hospital care usage

OBJECTIVE To evaluate the potential advantages and limitations of the use of the Brazilian hospital admission authorization forms database and the probabilistic record linkage methodology for the validation of reported utilization of hospital care services in household surveys. METHODS A total of 2,288 households interviews were conducted in the county of Duque de Caxias, Brazil. Information on the occurrence of at least one hospital admission in the year preceding the interview was obtained from a total of 10,733 household members. The 130 records of household members who reported at least one hospital admission in a public hospital were linked to a hospital database with 801,587 records, using an automatic probabilistic approach combined with an extensive clerical review. RESULTS Seventy-four (57%) of the 130 household members were identified in the hospital database. Yet only 60 subjects (46%) showed a record of hospitalization in the hospital database in the study period. Hospital admissions due to a surgery procedure were significantly more likely to have been identified in the hospital database. The low level of concordance seen in the study can be explained by the following factors: errors in the linkage process; a telescoping effect; and an incomplete record in the hospital database. CONCLUSIONS The use of hospital administrative databases and probabilistic linkage methodology may represent a methodological alternative for the validation of reported utilization of health care services, but some strategies should be employed in order to minimize the problems related to the use of this methodology in non-ideal conditions. Ideally, a single identifier, such as a personal health insurance number, and the universal coverage of the database would be desirable.