Luiz Alberto de Souza Ciorlia

Hepatitis B in healthcare workers: prevalence, vaccination and relation to occupational factors

The prevalence of hepatitis B virus (HBV) in healthcare workers (HCW) in Brazilian university hospitals is high. However, vaccination of these workers and relations with occupational factors are not well documented. A prospective study was made of 1,433 HCW and 872 administrative employees of the Hospital de Base (HB), São José do Rio Preto, SP, Brazil, and 2,583 blood donor candidates from the Hospital Blood Bank. HCW were observed from January 1994 to December 1999. Data were obtained from exams made when a worker entered hospital service, periodically and after work-related injuries. Serological reactions were analyzed in HCW who received HBV vaccine. Occupational and non-occupational information was obtained through a questionnaire. The prevalence of HBV among HCW (0.8%) was significantly higher than in blood-donor candidates (0.2%). Among the HCW who were vaccinated, 86.4% were immunized. Multivariate analysis revealed that increased age reduced the chance of immunization. Among the occupational factors, time in service contributed to a 14% increase in the chances of having positive serology, and work-related injuries increased the risk of HBV infection 4.29 times. The maximum risk sector presented a larger number of HCW with positive anti-HBc serology. There was a higher seroconversion in HCW who received the full set of HBV vaccines. In HCW with positive serology, the factors that presented greatest risks were time in service, work-related injuries and maximum risk sector.

Prevalência e fatores sociodemográficos em hipertensos de São José do Rio Preto - SP

BACKGROUND: Systemic arterial hypertension (SAH) is one of the greatest problems of public health in Brazil. Its detection and early treatment should be a priority to reduce the morbimortality of the cardiovascular diseases. OBJECTIVE: This study aimed at assessing the prevalence of SAH and the sociodemographic factors in a population of hypertensive individuals from Sao Jose do Rio Preto, Sao Paulo, Brazil. METHODS: A cross-sectional study was carried out in a stratified sample of 1,717 people, representative of the urban adult population from the city of Sao Jose do Rio Preto, between 2004 and 2005. RESULTS: The sample consisted of 1,717 people, with 762 of them (25.2%) being characterized as hypertensive. The following results were observed: 54.6% were women; 78.4% were caucasian; 66.1% were illiterate or had not finished Elementary School; 63.9% were married, 40.9% belonged to social classes D and E; 37.9% were self-employed or wage earners. CONCLUSION: The results of study on SAH in the city of Sao Jose do Rio Preto shows the need for early-onset continuous educational interventions.BACKGROUND Systemic arterial hypertension (SAH) is one of the greatest problems of public health in Brazil. Its detection and early treatment should be a priority to reduce the morbimortality of the cardiovascular diseases. OBJECTIVE This study aimed at assessing the prevalence of SAH and the sociodemographic factors in a population of hypertensive individuals from São José do Rio Preto, São Paulo, Brazil. METHODS A cross-sectional study was carried out in a stratified sample of 1,717 people, representative of the urban adult population from the city of São José do Rio Preto, between 2004 and 2005. RESULTS The sample consisted of 1,717 people, with 762 of them (25.2%) being characterized as hypertensive. The following results were observed: 54.6% were women; 78.4% were caucasian; 66.1% were illiterate or had not finished Elementary School; 63.9% were married, 40.9% belonged to social classes D and E; 37.9% were self-employed or wage earners. CONCLUSION The results of study on SAH in the city of São José do Rio Preto shows the need for early-onset continuous educational interventions.

Prevalência e fatores de risco para hipertensão em uma população urbana brasileira

FUNDAMENTO: Os estudos disponiveis nao analisaram de modo abrangente os varios fatores envolvidos na genese da hipertensao (HT), especialmente a associacao entre pressao arterial, excrecao urinaria de sodio e disfuncao renal. OBJETIVO: Avaliar a prevalencia dos fatores de risco para HT em diferentes grupos etarios em uma amostra representativa da uma populacao urbana brasileira. METODOS: A populacao estudada (1.717 individuos adultos) foi avaliada por grupos etarios: 18 a 39 anos; 40 a 49; 50 a 59; 60 a 69 e > 70 anos. As medias das variaveis quantitativas e as variaveis categoricas dos grupos normotenso e hipertenso foram comparadas. RESULTADOS: A prevalencia geral ajustada para HT foi de 25,23%. A prevalencia aumentou com a idade e era mais alta em individuos com baixo nivel educacional. Indice de massa corporal e circunferencia abdominal aumentados estavam positivamente associados com uma maior prevalencia de HT. Havia uma associacao positiva significante entre HT e excrecao urinaria de sodio. Os individuos hipertensos apresentavam maior frequencia de disfuncao renal, definida como clearance de creatinina <60 ml/min/m2. A prevalencia de diabetes mellitus na populacao geral era de 5,6% e 14,5% nos individuos hipertensos. A hipertensao era uma condicao conhecida por 74,4% dos individuos hipertensos. Entre os individuos hipertensos tratados, 52,4% tinham a hipertensao controlada e apenas 34,3% dos pacientes hipertensos no geral (tratados ou nao) tinham a pressao arterial controlada. CONCLUSAO: Esse estudo de base populacional e especial devido ao fato de agregar diferentes fatores demograficos, epidemiologicos e de risco envolvidos na genese da hipertensao na avaliacao de uma unica amostra com um calculo populacional que pode ser extrapolado para outras populacoes hipertensas.BACKGROUND The available studies have not fully analyzed the several factors involved in the genesis of hypertension (HT), especially the association among blood pressure, urinary sodium excretion and renal dysfunction. OBJECTIVE To assess the HT prevalence and risk factors in different age groups in a representative sample of an urban Brazilian population. METHODS The studied population (1717 adult individuals) was evaluated by age groups: 18 to 39 years; 40 to 49; 50 to 59; 60 to 69 and > 70 years. Quantitative variable means and categorical variables of the hypertensive and normotensive groups were compared. RESULTS The adjusted overall prevalence of HT was 25.23%. The prevalence increased with age and was higher in individuals with low educational level. Increased body mass index and abdominal waist were positively related to a higher prevalence of HT. There was a significant positive association between HT and urinary sodium excretion. Hypertensive individuals presented higher frequency of renal dysfunction, defined as measured creatinine clearance <60 ml/min/m(2). The prevalence of diabetes mellitus was 5.6% in the overall population and 14.5% in hypertensive individuals. Hypertension was a known condition to 74.4% of the hypertensive individuals. Among treated hypertensive individuals, 52.4% achieved controlled blood pressure and only 34.3% of the overall hypertensive patients (treated or not) had blood pressure controlled. CONCLUSION This population-based is unique by gathering different demographic, epidemiologic and risk factors involved in the genesis of hypertension in a single sample assessment with a population calculation, which might be extrapolated to other hypertensive populations.

Hypertension prevalence and risk factors in a Brazilian urban population

FUNDAMENTO: Os estudos disponiveis nao analisaram de modo abrangente os varios fatores envolvidos na genese da hipertensao (HT), especialmente a associacao entre pressao arterial, excrecao urinaria de sodio e disfuncao renal. OBJETIVO: Avaliar a prevalencia dos fatores de risco para HT em diferentes grupos etarios em uma amostra representativa da uma populacao urbana brasileira. METODOS: A populacao estudada (1.717 individuos adultos) foi avaliada por grupos etarios: 18 a 39 anos; 40 a 49; 50 a 59; 60 a 69 e > 70 anos. As medias das variaveis quantitativas e as variaveis categoricas dos grupos normotenso e hipertenso foram comparadas. RESULTADOS: A prevalencia geral ajustada para HT foi de 25,23%. A prevalencia aumentou com a idade e era mais alta em individuos com baixo nivel educacional. Indice de massa corporal e circunferencia abdominal aumentados estavam positivamente associados com uma maior prevalencia de HT. Havia uma associacao positiva significante entre HT e excrecao urinaria de sodio. Os individuos hipertensos apresentavam maior frequencia de disfuncao renal, definida como clearance de creatinina <60 ml/min/m2. A prevalencia de diabetes mellitus na populacao geral era de 5,6% e 14,5% nos individuos hipertensos. A hipertensao era uma condicao conhecida por 74,4% dos individuos hipertensos. Entre os individuos hipertensos tratados, 52,4% tinham a hipertensao controlada e apenas 34,3% dos pacientes hipertensos no geral (tratados ou nao) tinham a pressao arterial controlada. CONCLUSAO: Esse estudo de base populacional e especial devido ao fato de agregar diferentes fatores demograficos, epidemiologicos e de risco envolvidos na genese da hipertensao na avaliacao de uma unica amostra com um calculo populacional que pode ser extrapolado para outras populacoes hipertensas.BACKGROUND The available studies have not fully analyzed the several factors involved in the genesis of hypertension (HT), especially the association among blood pressure, urinary sodium excretion and renal dysfunction. OBJECTIVE To assess the HT prevalence and risk factors in different age groups in a representative sample of an urban Brazilian population. METHODS The studied population (1717 adult individuals) was evaluated by age groups: 18 to 39 years; 40 to 49; 50 to 59; 60 to 69 and > 70 years. Quantitative variable means and categorical variables of the hypertensive and normotensive groups were compared. RESULTS The adjusted overall prevalence of HT was 25.23%. The prevalence increased with age and was higher in individuals with low educational level. Increased body mass index and abdominal waist were positively related to a higher prevalence of HT. There was a significant positive association between HT and urinary sodium excretion. Hypertensive individuals presented higher frequency of renal dysfunction, defined as measured creatinine clearance <60 ml/min/m(2). The prevalence of diabetes mellitus was 5.6% in the overall population and 14.5% in hypertensive individuals. Hypertension was a known condition to 74.4% of the hypertensive individuals. Among treated hypertensive individuals, 52.4% achieved controlled blood pressure and only 34.3% of the overall hypertensive patients (treated or not) had blood pressure controlled. CONCLUSION This population-based is unique by gathering different demographic, epidemiologic and risk factors involved in the genesis of hypertension in a single sample assessment with a population calculation, which might be extrapolated to other hypertensive populations.

Evaluation of the awareness, control and cost-effectiveness of hypertension treatment in a Brazilian city: populational study.

Objectives Hypertension is a highly prevalent disease worldwide, constituting one of the main risk factors for cardiovascular morbidity and mortality. The aims of this study were to evaluate the level of awareness and control of hypertension comparing sex, socioeconomic and educational level, BMI and drug therapy in over 40-year-old patients. The cost-effectiveness of the main pharmacologic classes of antihypertensives, as monotherapy and combination therapy, was also assessed. Methods In this randomized and cross-sectional populational study, a sample of 738 hypertensive adults with ages at least 40 years were evaluated. Of these, 345 (46.7%) were men and 393 (53.3%) were women. Results A total of 72.9% of the hypertensives knew about their disease. Women in the 40–49 and 50–59 age groups and obese individuals had a higher rate of awareness of their hypertensive status. The rates of awareness were similar in different social classes and educational levels, however, blood pressure control varied. β-Blockers were the most effective drugs to control blood pressure with no differences being observed between monotherapy and combinations. Diuretics were the most cost-effective. Conclusion Approximately half of the participants received monotherapy. The best percentage of control with monotherapy was obtained with β-blockers but the diuretics treatment was the most cost-effective. The levels of awareness and control were high compared with developed countries, most evident in the higher social classes and higher education levels.

Prevalence of metabolic syndrome: association with risk factors and cardiovascular complications in an urban population.

Introduction Metabolic syndrome (MS) is a set of cardiovascular risk factors and type 2 diabetes, responsible for a 2.5-fold increased cardiovascular mortality and a 5-fold higher risk of developing diabetes. Objectives 1-to evaluate the prevalence of MS in individuals over 18 years associated with age, gender, socioeconomic status, educational levels, body mass index (BMI), HOMA index and physical activity; moreover, to compare it to other studies; 2-to compare the prevalence of elevated blood pressure (BP), high triglycerides and plasma glucose levels, low HDL cholesterol and high waist circumference among individuals with MS also according to gender; 3-to determine the number of risk factors in subjects with MS and prevalence of complications in individuals with and without MS aged over 40 years. Methods A cross-sectional study of 1369 Individuals, 667 males (48.7%) and 702 females (51.3%) was considered to evaluate the prevalence of MS and associated factors in the population. Results The study showed that 22.7% (95% CI: 19.4% to 26.0%) of the population has MS, which increases with age, higher BMI and sedentary lifestyle. There was no significant difference between genders until age ≥70 years and social classes. Higher prevalence of MS was observed in lower educational levels and higher prevalence of HOMA positive among individuals with MS. The most prevalent risk factors were elevated blood pressure (85%), low HDL cholesterol (83.1%) and increased waist circumference (82.5%). The prevalence of elevated BP, low HDL cholesterol and plasma glucose levels did not show significant difference between genders. Individuals with MS had higher risk of cardiovascular complications over 40 years. Conclusion The prevalence of MS found is similar to that in developed countries, being influenced by age, body mass index, educational levels, physical activity, and leading to a higher prevalence of cardiovascular complications after the 4th decade of life.

Hepatitis C in health care professionals: prevalence and association with risk factors

OBJECTIVE To evaluate the prevalence and risk factors for hepatitis C virus infection among health care professionals. METHODS The study was carried out at a university hospital in the municipality of São José do Rio Preto, Southeastern Brazil, between January 1994 and December 1999. There were included 1,433 health care professionals, 872 administrative workers, and 2,583 blood donor candidates. Data were collected during admission examinations, periodic screenings, and after occupational accidents. Occupational and non-occupational information was obtained by means of a questionnaire. Data were analyzed using Chi-square and Kruskal-Wallis tests and logistic regression analysis. RESULTS Prevalence of hepatitis C infection among health care professionals (1.7%) was significantly higher than among administrative workers (0.5%; p=0.007) and blood donor candidates (0.2%; p=0.001). Regarding occupational factors, time in the job was significantly longer (p=0.016) among health care professionals with positive serology than among those with negative serology. Multiple regression analysis showed a 50% increase in risk for every five years of age. There was a significant association between blood transfusion and positive serology among health care workers. CONCLUSIONS Health care professionals show greater prevalence of hepatitis C than administrative workers and blood donation candidates. Among those with positive serology, occupational and non-occupational factors of greatest risk were age, time in the job, and blood transfusion.

Cardiovascular risk factors and mortality: long-term follow-up (up to 20 years) in a preventive program carried out by occupational medicine

OBJECTIVE The decrease in mortality due to cardiovascular diseases (CVD) has been achieved in the United States and the same decrease has been happening in developing countries, thanks to favorable changes in lifestyle and risk factors. Despite such consideration, the volume of information available on the distribution and behavior of that type of disease and its risk factors in Brazil is still little. METHODS The assessment of changes in total cholesterol (TC), levels of blood pressure (BP), body mass index (BMI) and smoking was carried out, besides the occurrence of fatal (F) and non-fatal (NF) cardiovascular events, under dietary and behavioral intervention and long-term follow-up (up to 20 years) in a closed group, consisting of 621 electric power company workers of both sexes, with average age of 29.1 +/- 7.1 years old, varying from 15 to 59 years old. Actuarial curves were obtained to analyze the F and NF cardiovascular events. RESULTS The TC mean showed significant reduction due to dietary guidance. The smoking habit decreased significantly with behavioral changes. The mean of the BPs decreased significantly with a better detection and hygienic measures, and the adhesion by definite hypertensive people to the treatment showed an index of 56.6%. On the other hand, the BMI showed an expressive and gradual increase. The probability for the individuals to remain free of any cardiovascular event was of 98.1%, whereas for the fatal events, it was 99.2%. CONCLUSION Those results prove that initiatives directed towards the prevention must be priorities, aiming at modifying the morbimortatility rates of CVD.

Hepatite C em profissionais da saúde: risco de exposição e infecção

This review article discusses aspects of hepatitis C in healthcare workers and its risk of exposure and infection. Association between bloodborne pathogens and healthcare workers, hepatitis C (epidemiology, diagnosis, and prevention), communication and record of occupational injuries with biological material (blood and body fluids), and relationship between extension and consequences of accidents with cut and puncture objects and mucocutaneous exposure and the hepatitis C were described.

Prevalence of Physical Inactivity and its Effects on Blood Pressure and Metabolic Parameters in a Brazilian Urban Population

Mailing Address: José Fernando Vilela-Martin Av. Anisio Haddad, 7700, Casa: 129. Postal Code: 15093-000, Jardim das Palmeiras, São José do Rio Preto, SP Brazil. E-mail: vilelamartin@cardiol.br, vilelamartin@uol.com.br Prevalence of Physical Inactivity and its Effects on Blood Pressure and Metabolic Parameters in a Brazilian Urban Population Geiza da Graça Leite Rissardi,1 José Paulo Cipullo,1 Gisela Cipullo Moreira,1 Luiz Alberto Souza Ciorlia,1 Cláudia Bernardi Cesarino,1 Luiz Tadeu Giollo Junior,1 Angelina Zanesco,2 José Fernando Vilela-Martin1 Faculdade de Medicina de São José do Rio Preto (FAMERP),1 São José do Rio Preto, SP Brazil Universidade do Estado de São Paulo (UNESP),2 Rio Claro, SP Brazil