Scielo RSS <![CDATA[Revista de Saúde Pública]]> http://www.scielosp.org/rss.php?pid=0034-891019840004&lang=en vol. 18 num. 4 lang. en <![CDATA[SciELO Logo]]> http://www.scielosp.org/img/en/fbpelogp.gif http://www.scielosp.org <![CDATA[<B>Perinatal health</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0034-89101984000400001&lng=en&nrm=iso&tlng=en <![CDATA[<B>Hematological changes induced by industrial pollution in residents and industrial workers in Cubatão, SP (Brazil)</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0034-89101984000400002&lng=en&nrm=iso&tlng=en Foram analisados 496 indivíduos de Cubatão, SP (Brasil), cidade com alto teor de poluição industrial, com o objetivo de verificar alterações hematológicas induzidas por poluentes industriais. Dos estudos citológicos dos eritrócitos dessa população estudada, foram observadas 188 (38%) com alterações, isoladas ou combinadas em um único indivíduo, das quais 26% apresentaram policromatofilia, 24% com pontilhados basófilos, 15% com corpos de Heinz, e 8% com reticulocitose. As freqüências de metahemoglobinemia e sulfohemoglobinemia foram,respectivamente, de 35% e 32% em moradores da vila Parisi - um bairro cercado pela maioria das indústrias de Cubatão - 15% e 5% em operários das indústrias, e 12% e 4% em habitantes de áreas distantes entre 3 e 8 km do polo industrial. Esses resultados indicam que as alterações são causadas por poluentes tóxico-oxidantes e que as conseqüências fisio-patológicas no sangue dos moradores de Cubatão parecem indicar que estão relacionadas com o tempo de exposição e com a proximidade dos focos emissores de poluentes.<hr/>Blood samples from 496 people living or working in Cubatão, SP, Brazil, a city with high levels of industrial pollution, were analysed in order to verify hematological changes induced by industrial pollution. Citological studies of erythrocytes showed that 188 people (38%) had hematological changes, single or compound. Of the total sample 26% had polychromatophilic red cells, 24% had basophilic stippling, 15% had Heinz bodies, and 8% had reticulocytosis. The frequencies of methemoglobinemia and sulfohemoglobinemia were; respectively, 35% and 32% in inhabitants of vila Parisi a township in the neighbourhood of Cubatão surrounded by various industries; 15% and 5% in industrial workers, and 12% and 4% inhabitants that live between 3 and 8 km from the industrial complex. These results indicate that the hematological changes are caused by toxi-oxidant polluents and that the physio-pathological consequences in the blood of the population of Cubatão show a direct relationship to exposure time and to proximity to the sites of origin of the polluents. <![CDATA[<B>Analysis of bacterial pollution indicators in the Anil and Bacanga rivers, on the Island of S. Luís, Maranhão State, Brazil</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0034-89101984000400003&lng=en&nrm=iso&tlng=en Para o conhecimento do estado de poluição bacteriológica dos rios Anil e Bacanga, Estado do Maranhão (Brasil), coletaram-se amostras de água em 5 pontos, no Rio Anil, e 3 pontos, no Rio Bacanga, mensalmente, durante 12 meses, nas fases enchente e vazante da maré. Foram determinados números de bactérias totais/ml; índice de coliformes/100ml e índice de coliformes fecais/100ml, em ágar simples, caldo lactosado, verde brilhante - bile e E. C. Os resultados mostraram que os índices bacterianos de poluição dos rios sofrem variações sazonais, diretamente relacionadas às fases da maré. As localidades que apresentaram maiores concentrações bacterianas foram as nascentes. As águas destes rios, de acordo com o padrão ditado pelo Ministério do Interior, demonstraram alto grau de poluição microbiana de origem fecal.<hr/>Sampling of liquids was carried out monthly at both high and low tide, for one year, at 5 sites on the Anil river and at 3 sites on the Bacanga river, for bacteriological pollution study. Total viable bacteria/100ml, MPN (Most Probable Numbers) of coliforms/100ml and MPN fecal coliforms/100ml were determined by the use of nutrient agar, lactose broth, brilliant green - lactose bile broth and E C broth. The results indicated that both rivers contained a higher bacterial concentration at the sources and showed a seasonal bacteriological pollution variation directly related to the tidal phases. According to the Brazilian Ministry of the Interior's standards, the water of both rivers presented a high degree of microbial pollution. <![CDATA[<B>Multivariate analysis techniques for the assessment of the health status of the "counties" of State of Rio Grande do Sul, Brazil</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0034-89101984000400004&lng=en&nrm=iso&tlng=en Estudou-se a estrutura de correlação de variáveis da área de Saúde Pública para a obtenção de um "Índice do Nível de Saúde" para os municípios do Rio Grande do Sul. Utilizando o valor deste índice para cada município formamos 18 grupos homogêneos ("clusters") ordenados de forma decrescente de carência quanto ao nível de saúde. Outros índices foram encontrados: "Índice de Imunização" e "Índice de Não-Assistência Médico-Hospitalar". A variável mortalidade proporcional para menores de 5 anos, do conjunto total das variáveis trabalhadas, foi a que apresentou maior poder discriminativo e de diagnóstico; o peso ao nascer com menos de 2.700g, foi de menor poder diagnóstico.<hr/>The correlation structure of variables in the Public Health field were studied in order to obtain a "Health Status Index" for the "counties'' (municípios) of Rio Grande do Sul State. By using the value of this index for each one of the counties it was possible to built up 18 homogeneous groups (Clusters) which were ordered in the reverse magnitude of their health status index. Additional indices were found: "Imunization Index" and "Non-Medical-Hospital Care Index". The variable proporcional mortality for the under 5 year-olds, was the one that showed itself to be the most sensive diagnostic discriminator among the series of variables that were studied, and the birth weight of less than 2,700g the least sensitive. <![CDATA[<B>Perinatal health in Pelotas, Rio Grande do Sul, Brazil</B>: <B>social and biological factors</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0034-89101984000400005&lng=en&nrm=iso&tlng=en Todos os nascimentos ocorridos em hospitais na cidade de Pelotas, RS, Brasil, durante 1982, foram estudados através de entrevistas hospitalares e de visitas domiciliares de uma amostra dos recém-nascidos e revisão mensal de atestados de óbito. A mortalidade perinatal para recém-nascidos de partos únicos foi de 31,9/1.000 nascidos totais, sendo a mortalidade fetal de 16,2/1.000 e a mortalidade neonatal precoce de 15,9/1.000. A incidência de baixo peso ao nascer (peso abaixo de 2.500g) foi de 8,1% para partos únicos.<hr/>All hospital births occurring during 1982 in Pelotas, Southern Brazil (pop. 260,000) were studied. This a highly representative perinatal population, since in this city less than 1% of the deliveries occur at home. The study was performed through: hospital interviews with mothers and evaluation of the newborn; home visits of a random sample of 15% of the births after the seventh day of life; and monthly checking of birth and death certificates. Overall, the perinatal mortality rate (PNMR) for singletons was 31.9/1,000 births, fetal mortality rate (FMR) being 16.2/1,000 and early neonatal mortality rate (ENMR) 15.9/1,000. The incidence of low birth weight (LBW) babies was 8.1%. Main causes of death were immaturity, anoxia and hyaline membrane disease. In 40% of the deaths the actual cause was not clarified. Social factors were strongly associated with perinatal health indicators. Babies whose families earned up to 1 minimum wage per month presented a PNMR of 44.0/1,000 and LBW in 12.6% of the cases, whereas those newborns of high income families (more than 10 minimum wages/month) showed a PNMR of 13.2/1,000 and 4.2% of LBW. The association of perinatal performance with maternal age and provenience, birth order and smoking was also studied. When a comparison was made between the perinatal outcome of Pelotas babies with that of a highly developed country (Sweden), using standardization techniques, it was seen that although our birth weight distribution may be held responsible for part of our poor performance, failures in our health services are probably still more important. <![CDATA[<B>Assessment of maternal nutritional condition and duration of breast-feeding</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0034-89101984000400006&lng=en&nrm=iso&tlng=en Estudou-se o estado nutricional de 190 mães de baixa renda, primíparas ou não, residentes no município de São Paulo (Brasil), e sua relação com a duração do aleitamento natural. Na avaliação do estado nutricional empregou-se o critério de adequação de peso para a estatura. Investigou-se a participação do setor Saúde no processo de desmame. Descreveu-se também a prevalência de desnutrição no período pré-gestacional, no pós-parto e no pós-desmame, verificando-se o comportamento do estado nutricional nos três períodos. Observou-se que apenas entre as mulheres não-primíparas houve diferença estatisticamente significante do estado de nutrição nos períodos analisados. Quanto ao estudo da duração do aleitamento natural com o estado nutricional materno, não se encontrou associação significante entre estes eventos. Na tentativa de explorar outras variáveis, que estariam associadas com a ocorrência de desmame precoce na amostra estudada, enfocou-se a influência do setor Saúde, percebendo-se a falha qualitativa do mesmo quanto a orientação sobre aleitamento natural.<hr/>The nutritional condition of one hundred and ninety (190) low income parturients of the city of S. Paulo (Brazil) was measured and correlated to the duration of breast-feeding. The nutritional status was measured using the weight for height adequacy ratio. The role of health services in the weaning process was also investigated. The prevalence of protein-energy malnutrition in the pre-gestational, post-delivery and post-weaning periods was described and the nutritional status pattern during these periods was discussed: only the non-primiparous group of women showed a statistically significant difference in their nutritional status as between the three periods; no relationship between the mother's nutritional status and the duration of breast-feeding was observed. Health services' activities, and pre-natal and nursery routines were analized and showed a qualitative faillure that best explains the early weaning in the sample population studied. <![CDATA[<B>Encephalitis in the Ribeira Valley (S. Paulo, Brazil) in the post-epidemic period of 1978-1983</B>: <B>a discussion on aspects of etiological diagnosis and epidemiological characteristics</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0034-89101984000400007&lng=en&nrm=iso&tlng=en Relatam-se os resultados do levantamento de dados referentes ao diagnóstico etiológico, distribuição e letalidade das encefalites na região do Vale do Ribeira, São Paulo, Brasil, no período de 1978 a 1983, após uma epidemia de encefalite por arbovírus. Verificou-se que não foi possível o diagnóstico etiológico em nenhum dos 80 casos conhecidos. Em apenas 9 doentes (11,25%) foram coletadas duas amostras pares de soro, não se tendo observado conversão sorológica, Em 29 dos 33 pacientes em que se dispunha de pelo menos uma amostra de soro realizou-se teste de inibição de hemaglutinação para os flavivírus Rocio, Ilhéus e St. Louis, observando-se em 8 a presença de títulos > 20 para esses vírus. Testes para os alphavírus VEE, EEE e Mucambo foram efetuados em quatro dos 33 pacientes, com resultados negativos. A distribuição espacial, etária e por sexo dos casos apresentou padrões semelhantes aos do período epidêmico, ao contrário de letalidade que mostrou um aumento significante, de 9,9% para 25,0%. Os autores enfatizam a urgência no incremento da Vigilância epidemiológica das encefalites por arbovírus na região, sugerindo medidas dirigidas ao diagnóstico etiológico.<hr/>The results of observations on encephalitis etiology, distribution and case fatality ratio in the Ribeira Valley, S. Paulo, Brazil, in the period ranging from 1978 to 1983, after an arbovirus encephalitis epidemic, are reported. In none of the eighty known cases was it possible to make the arbovirus etiological diagnosis as only 9 patients (11.25%) had two sera samples collected and no serological conversion was observed. Hemagglutination-inhibition tests for flavivirus Rocio, Ilheus and St. Louis were performed on the 33 patients who had at least one serum sample. In 8 sera titles >20 were observed. Alphavirus VEE, EEE and Mucambo were tested for in 4 of the 33 patients, with negative results. The distribution of cases according to geography, age and sex showed patterns similar to those of the epidemic period. There was a progressive decrease of morbidity during the period 1978-1983, but a significant increase in the case fatality ratio as from the epidemic to the post-epidemic period: 9.9% to 25.0%. The need for urgent improvement in arbovirus encephalitis surveillance has been emphasized by the authors, who have suggested the adoption of measures with a view to etiological diagnosis. <![CDATA[<B>The influence of aerobic physical exercise in the prevention of coronary heart disease</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0034-89101984000400008&lng=en&nrm=iso&tlng=en A presente revisão enfatiza a função do EFA (Exercício Físico Aeróbico), moderado ou vigoroso, como um importante fator na profilaxia da AC (arteriosclerose coronariana), sobretudo quando associado a outras medidas profiláticas conhecidas. Esse efeito está provavelmente relacionado com o fato do EFA elevar a concentração de HDL-c. Esta, provavelmente, é a única medida a ser tomada naqueles casos onde não existe nenhum fator de risco associado, mas há forte história familiar de AC. Além do mais, o EFA regular tem importante papel no processo de reabilitação cardíaca nos pacientes portadores de DIM (doença isquêmica do miocárdio).<hr/>The present review emphazises the role of aerobic physical exercise (APE), of moderate or heavy intensity, as a fundamental tool in the prevention of coronary atherosclerosis (CA). There are evidences that this effect is mediated by the increase of HDL levels. On the other hand increased APE is, in some situations, the only way to prevent CA, specially in patients with no known risk factor but with a considerable family history of CA. In the same way the authors review the importance of APE in the cardiac rehabilitation of patients after myocardiac infarction. <![CDATA[<B>Experimental infection of Calomys callosus (Rodentia-Cricetidae) with Leishmania donovani</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0034-89101984000400009&lng=en&nrm=iso&tlng=en Foi descrita a infecção experimental em Calomys callosus com uma cepa de Leishmania donovani chagasi de caso humano. Um grupo de 22 roedores foi inoculado por via intraperitoneal com 0,1 ml de um macerado de baço em salina, rico em amastigotas. Esses animais foram sacrificados três meses após as inoculações, tendo sido realizado: cultura "in vitro" em meio acelular (LIT e NNN) e esfregaços, corados pelo Giemsa, de fígado, baço, medula óssea e sangue; cortes histológicos corados com hematoxilina-eosina de fígado e baço. Os resultados para fígado e baço foram: 67% de positividade nas culturas "in vitro"; esfregaços ricos em amastigotas intra e extra celular (inclui medula óssea); reações teciduais traduzidas por hepatomegalia com proliferação das células de Kupffer; reação granulomatosa das áreas portais, esplenomegalia com reações granulomatosas, abundância de formas amastigotas. Os resultados para o sangue foram negativos em todas as investigações.<hr/>In the current paper experimental infection of Calomys callosus with Leishmania donovani is reported for the first time. A group of 22 C. callosus aged 20 months and weighing 25 g were inoculated with 0.1 of a homogeneous saline preparation of infected spleens of homologous animals. The L. donovani strain used in the experiments was isolated from a case of human visceral leishmaniasis from the state of Maranhão, Brazil. The animals infected were weighed and killed 3 months after the experimental infection. Spleens and livers were also weighed and pieces from them were fixed in 10% formaline and stained with hematoxilin-eosin for histological studies. Impression smears stained with Giemsa were made and cultivation "in vitro" (NNN and LIT) was done, with material from blood, spleen, liver and bone marrow. At the end of the experiments the animals showed low of body weight. Splenomegaly was observed in all the inoculated animals. The "in vitro" cultures were positive from liver and spleen in 67% of the animals. Many extracellular and intracellular amastigote forms were seen in the smears of spleen, liver and bone marrow. Blood showed negative results. Histological studies of the liver showed proliferation of Kupffer cells and granulomatous reaction in the portal areas with multinucleated cells and amastigote forms of the parasites. Loss of folicular pattern with parasitism in great numbers of cells around which there were granulomatous reactions were observed in the spleen.