Scielo RSS <![CDATA[Revista de Saúde Pública]]> http://www.scielosp.org/rss.php?pid=0034-891019850004&lang=en vol. 19 num. 4 lang. en <![CDATA[SciELO Logo]]> http://www.scielosp.org/img/en/fbpelogp.gif http://www.scielosp.org <![CDATA[<B>Data analysis on the prevalence of dental caries in Barretos city (S. Paulo, Brazil) after ten years of water fluoridation</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0034-89101985000400001&lng=en&nrm=iso&tlng=en Foram analisados os resultados dos dados de prevalência da cárie dental de crianças de 3 a 14 anos de idade e adultos jovens de 15 a 19 anos, da cidade de Barretos, SP, Brasil. Objetivou-se verificar as reduções de cárie dental encontradas em dentes primários e permanentes durante o período de dez anos de fluoretação da água de abastecimento público. A redução observada na prevalência de cárie para os dentes primários e permanentes foi similar à constatada em outros estudos, quer no Brasil ou no Exterior. No grupo etário de 7 a 10 anos, 50% das crianças não tiveram nenhum dente permanente atacado pela cárie, e nas crianças de 3 a 5 anos, 51,6% não tiveram nenhum dente primário atacado pela cárie.<hr/>Data of baseline and ten-year surveys of the prevalence of dental caries in children 3 to 14 years old, and young adults of 14 to 19, in Barretos (S. Paulo State, Brazil), were analysed to verify the reduction observed in caries in the primary and permanent teeth during the ten-year period of water fluoridation. The reduction in the prevalence of dental caries observed is similar to the ones obtained in the pilot studies in Brazil and other countries. In the age group 7 to 10, 50% of children do not have any permanent teeth attacked by caries, and 51.6% in the group 3 to 5 are in the same condition as regards their primary teeth. <![CDATA[<B>A clinical evaluation of the use of decamethrin in the treatment of pediculus of the scalp</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0034-89101985000400002&lng=en&nrm=iso&tlng=en A decametrina, um inseticida piretróide sintético, foi avaliada no tratamento da infestação por Pediculus humanus capitis em 54 crianças. Foi empregada emulsão a 0,0025 mg/ml da decametrina em tratamento tópico único ou repetido após 8 dias, se ainda persistissem sinais do Pediculus humanus capitis. O resultado após o 16.&deg; dia do tratamento foi considerado satisfatório em 98,2% dos casos observados, sendo que 28 crianças, 47,4% dos casos, não apresentaram nenhum sinal de infestação e os demais apresentaram lêndeas secas, em sua maioria e, portanto, inviáveis. A toxicidade foi avaliada pelo exame clínico nos indivíduos tratados e nos aplicadores, não sendo constatadas alterações tróficas locais ou à distância no exame clínico, nem ocorrido queixas. Pela eficácia apresentada, pela ausência de toxicidade e pelo baixo custo do tratamento, concluiu-se pela grande aplicabilidade da decametrina no controle da infestação por Pediculus humanus capitis, em nosso meio.<hr/>Fifty four children showing Pediculus humanus capitis infestation were treated with decamethrin, a synthetic pyrethoid inseticide. Decamethrin emulsion of 0.0025 mg/ml was used in a single topical treatment or repeated if the infestation signs were still present after 8 days. The results were considered positive for 98.2% of subjects after 16 days of treatment. Twenty eight children, i.e. 47.4%, had no more signs of head lice and the others still presented at the end of evaluation the presence of unviable ova of Pediculus humanus capitis. Toxicity was evaluated by clinical examination of the subjects with head lice and of those people who had participated in the treatment and whose skin had been in contact with the emulsion. No adverse reaction was reported. Since decamethrin has been showed effective in the treatment of head lice, with no signs of toxicity, and also because of its low cost, the author concluded that decamethrin in useful for the control of Pediculus humanus capitis infestation. <![CDATA[<B>Effect of time of alcoholism on the development of organic diseases in women treated at the University Hospital of Ribeirão Preto, S. Paulo, Brazil</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0034-89101985000400003&lng=en&nrm=iso&tlng=en Com o objetivo de conhecer o tempo de ingestão freqüente de bebidas alcoólicas (ingestão média de mais de 100 ml de etanol por dia, pelo menos três dias por semana), até o aparecimento de sinais e sintomas de doenças orgânicas conseqüentes ao hábito, estudamos 95 mulheres tratadas entre 1978 e 1982 no Hospital das Clínicas de Ribeirão Preto, portadoras de doenças orgânicas associadas ao alcoolismo. Foi feito diagnóstico clínico e laboratorial de cirosse hepática em 32 pacientes, de pancreatite crônica em 13 e de outras doenças (pelagra, desnutrição, neurite periférica e hepatite alcoólica) em 50. Pacientes com apenas sintomas psiquiátricos não foram estudadas. A obtenção das informações ocorreu após alguns dias de tratamento. Em média a idade em que começaram a ter sinais e sintomas das doenças que motivaram a procura de hospital para tratamento foi de 35,30 &plusmn; 7,72 anos na pancreatite crônica, 36,53 &plusmn; 8,39 anos na cirrose hepática e de 33,90 &plusmn; 11,27 anos nas outras doenças. O tempo de ingestão da bebida foi de 15,92 &plusmn; 7,15 anos na pancreatite crônica, 14,62 &plusmn; 8,70 anos na cirrose hepática e 13,24 &plusmn; 9,58 anos nas outras doenças. Antecedentes familiares de alcoolismo estiveram presentes em 64,2% dos casos, geralmente marido ou companheiro. Nenhuma delas tinha outras mulheres na família com problemas de alcoolismo. A média do tempo de alcoolismo para o aparecimento de cirrose hepática nas mulheres (14,62 anos) foi menor do que a encontrada para homens da mesma população (21,10 anos), estudados em trabalhos anteriores.<hr/>To determine the period of frequent alcoholic drink intake (mean intake of 100 ml of ethanol per day on at least three days a week) up to the onset of signs and symptoms of organic diseases caused by the habit, 95 women treated at the University Hospital of the Faculty of Medicine of Ribeirão Preto for organic diseases associated with alcoholism between 1978 and 1982, we studied. Clinical and laboratory diagnosis of cirrhosis of the liver was made in 32 patients, of chronic pancreatitis in 13, and of other diseases (pellagra, malnutrition, peripheral neuritis, and alcoholic hepatitis) in 50. Patients showing only psychiatric symptoms were excluded from the study. Patient history was obtained after a few days of treatment. On average, the age when signs and symptoms of the diseases that motivated them to seek hospital treatment began to appear was 35.30 &plusmn; 7.72 years for chronic pancreatitis patients, 36.53 &plusmn; 8.39 for patients with cirrhosis of the liver, and 33.90 &plusmn; 11.27 for the patients with other diseases. Time of alcohol intake was 15.92 &plusmn; 7.15 years for chronic pancreatitis patients, 14.62 &plusmn; 8.70 years for patients with cirrhosis of the liver, and 13.24 &plusmn; 9.58 years for patients with other diseases. A family history ol afcoholism was present in 64.2% of cases and generally involved the husband. None of the patients reported other women with problems of alcoholism in the family. The period of alcoholism before the onset of cirrhosis of the liver among the women studied (14.62 years) was shorter than that encountered for men from the same population (21.10 years), studied in previous investigations. <![CDATA[<B>Multivariate analysis of risks factors for low birthweight in livebirths in the city of S. Paulo, SP (Brazil)</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0034-89101985000400004&lng=en&nrm=iso&tlng=en Em casuística de 20.850 nascidos vivos não gemelares ocorridos em 31 maternidades do Município de São Paulo, SP, Brasil (parte da casuística total do Estudo Antropométrico do Recém-nascido Brasileiro), procurou-se identificar fatores de risco para o baixo peso ao nascer (peso < 2.500 g), tendo sido estipulados a priori, para estudo, os fatores escolaridade materna, estado marital, idade materna, paridade, peso pré-gestacional, tabagismo na gravidez e assistência pré-natal. A partir de análise multivariada pela técnica de modelos log-lineares, foram identificados quatro fatores de risco significativos: "ausência de assistência pré-natal", "peso pré-gestacional < 50 kg", "tabagismo na gestação" e "idade materna < 20 anos". O risco relativo associado a "ausência de pré-natal" foi de 2,2 nas mães de escolaridade inferior ao ginásio completo e de 3,4 nas de escolaridade igual ou superior àquele nível. Os riscos associados às características maternas de peso, tabagismo e idade foram respectivamente 1,9, 1,7 e 1,4 e independentes da escolaridade materna. Considerando-se além da magnitude dos riscos detectados a freqüência com que os fatores de risco se apresentaram na população, constatou-se que o peso pré-gestacional insuficiente, o tabagismo na gestação e a ausência de assistência pré-natal, particularmente em mães de "baixa escolaridade", são fatores cujo controle exerceria importante decréscimo na incidência de recém-nascidos de baixo peso. Assim sendo, tais fatores deveriam ser cuidadosamente considerados em programas de intervenção.<hr/>An investigation, as part of a national study on anthropometric characteristics of livebirths, was carried out on 20,850 single livebirths born in 31 maternity hospitals in S. Paulo, Brazil, into risk factors for low birth weight (weight less than 2,501 gr.). The following factors were studied: maternal schooling, marital status, maternal age, parity, prepregnancy weight, smoking during pregnancy and prenatal care. Through multivariate analyses using log linear models, four significative risk factors for low birth weight were identified: "no prenatal care", prepregnancy weight < 50 kg", "smoking during pregnancy" and "maternal age < 20 years". The relative risk for "no prenatal care" was 3.4 in mothers with 8 or more years of schooling and 2.2 in mothers with less schooling. The risks associated with prepregnancy weight, smoking and maternal age were, respectively, 1.9, 1.7 and 1.4 and were found to be independent of maternal schooling. Considering simultaneously risks, magnitude and frequency of the risk factors in the population, it is evident that prepregnancy weight, smoking during pregnancy and prenatal care particularly for mothers with low socio-economic level, are factors whose control would result in considerable decrease in low birth weight incidence and, for that reason, they should be carefully considered by health intervention programs. <![CDATA[<B>The value of Rose Bengal as a screening aid to diagnosis of conjunctival xerosis</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0034-89101985000400005&lng=en&nrm=iso&tlng=en Demonstrou-se o valor do corante vital Rosa Bengala no diagnóstico da xerose conjuntival e determinou-se a prevalência de lesões oculares devidas à hipovitaminose A. Estudou-se uma amostra representativa (501 crianças) da população de 3 a 6 anos do Município de Cotia, SP (Brasil). Realizaram-se exames com e sem o uso de Rosa Bengala nas 501 crianças. As positivas para qualquer das técnicas foram submetidas a prova terapêutica (200.000 UI de vitamina A oral). Examinaram-se as córneas com fluoresceína, quando necessário. Realizou-se dosagem de vitamina A pelo método de Carr-Price. Não se observaram outras lesões, além de xerose conjuntival. Verificou-se que as prevalências de resultados positivos foram de 10,0% sem Rosa Bengala e 18,2% com o corante. As provas terapêuticas revelaram sensibilidade e especificidade baixas para o exame sem Rosa Bengala (18,5% e 14,3%, respectivamente) e altas para o exame com Rosa Bengala (81,5% e 89,0%, respectivamente), o que o indica como método diagnóstico auxiliar para provas de triagem.<hr/>The present paper was designed to demonstrate the value of Rose Bengal in the diagnosis of conjunctival xerosis and at the same time determine the prevalence of ocular lesions due to vitamin A deficiency. A representative sample (501 children) between 3 and 6 years of age drawn from the population of the city of Cotia, SP, Brazil, was studied. Ocular examinations with and without the aid of Rose Bengal were performed on the 501 children. Those that presented positive results were submitted to a therapeutic test (200.000 IU of vitamin A orally). Whenever necessary corneae were examined with fluorescein. Vitamin A blood levels were determined by the Carr-Price method. No lesions beyond conjunctival xerosis were found. Examinations performed without the aid of Rose Bengal rendered 10.0% positive results whereas Rose Bengal tests rendered 18.2% positive results. Therapeutic tests showed low sensitivity and low specificity for the examinations without Rose Bengal (18.5% and 14.3%, respectively) and high sensitivity and specificity for examinations performed with Rose Bengal (81.5% and 89.0%, respectively). Based on our results the ocular examinations without the aid of Rose Bengal are not recommended for screening tests, whereas those performed with Rose Bengal are. <![CDATA[<B>Blood levels of vitamin A and carotene in middle-aged and elderly individuals, in eleven localities of S. Paulo State, Brazil</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0034-89101985000400006&lng=en&nrm=iso&tlng=en Visando preencher lacuna no conhecimento da hipovitaminose A, no que concerne a estudos bioquímicos em idosos, foram analisados os resultados de dosagens sangüíneas de vitamina A e caroteno em 158 indivíduos de ambos os sexos, de 50 anos e mais, residentes em onze localidades do Estado de São Paulo (Brasil), divididos em 4 grupos etários (50-54, 55-59, 60-64 e 65 e mais anos). Não foram encontradas diferenças significativas para vitamina A entre as médias dos 4 grupos etários, nem entre os dois sexos. Entretanto, com relação ao caroteno sanguíneo, as mulheres apresentaram valores médios mais elevados nos 4 grupos etários, sendo significativa essa diferença. Segundo a classificação do Interdepartmental Committee on Nutrition for National Defense (ICNND), a população estudada não apresentou problema de Saúde Pública com relação à hipovitaminose A.<hr/>Seeking to fill in a gap in knowledge of vitamin A deficiency regarding biochemical status, carotene and vitamin A blood levels in 158 subjects, male and female, 50 years of age and over, were analysed. The subjects resided in 11 localities in the State of S. Paulo, Brazil. They were divided into 4 age groups: 50 to 54, 55 to 59, 60 to 64 and 65 and over. No significant differences were encountered between averages of vitamin A levels in the four age groups nor between sexes. However, concerning carotene, females presented significantly higher average levels than males in all age groups. According to the classification of the Interdepartmental Committee in Nutrition for National Defense (ICNND), the population studied did not present a Public Health problem regarding vitamin A status. <![CDATA[<B>Ranking of populations in broad classes of health levels according to a comprehensive indicador defined by a linear discriminant function</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0034-89101985000400007&lng=en&nrm=iso&tlng=en Utilizando a função discriminante linear, propõe-se um indicador de nível de saúde abrangente de vários indicadores usuais, a saber: o coeficiente de mortalidade geral (CMG), indicador quantificado de Guedes (IG), esperança de vida ao nascer (EV), coeficiente de natalidade (CN), coeficiente de mortalidade infantil (CMI) e coeficiente de mortalidade por doenças transmissíveis (CMDT). Para a padronização dos dois últimos, foi proposta e utilizada uma população padrão mediana; para sua formação, cada grupo etário concorre com a mediana das percentagens de participação desse grupo na composição da população de cada um dos 44 países estudados. A análise crítica das equações de funções discriminantes obtidas com a técnica passo a 2895 2060 1000 passo ascendente (stepwise), mostrou que o valor: Z = 2895/CMI + 2060/CN + 1000/CMDTp, pode ser utilizado como indicador abrangente, permitindo a ordenação de países em amplas classes de nível de saúde.<hr/>There are, very often, considerable discrepancies when countries are ranked according to the values of each of the common health indicators. By the use of computed linear discriminant functions the authors developed a single indicator designed to convey the information gathered from the following health indicators: life expectancy at birth (LE), birth rate (BR), infant mortality rate (IMR), quantified indicator of Guedes (GI), general mortality rate (GMR) and mortality rate (MR) by infective and parasitic diseases (MRIPD), the last two age adjusted. For the construction of this adjustment a median standard population was suggested and used, each age group contributed with the average of the percentages of participation of the group in the composition of the population of each one of the 44 countries studied. These were those for which it was possible to get reliable data for the years around 1980. The contrasted groups in computing discriminant functions, each one consisting of 12 countries, were defined according to a criterion based on the rank of the sum of the normal reduced deviations calculated for the distributions of the values for each indicator. For the computation of discriminant function equations by the stepwise technique, reciprocal transformation was used for the four indicators expressed as ratios and for the other two their face values were used. Critical analysis of results as shown that the formula: Z = 2895/IMR + 2060/BR + 1000/MRIPD, can be used as a comprehensve indicator allowing the ranking of countries in broad classes of health levels, as follows: A - 737 or more; Denmark and Sweden; B - 637 |- 737: Australia, Netherland, England and Wales, Iceland, Luxembourg, Norway and Switzerland; C - 537 |- 637: Federal Republic of Germany, Canada, Scotland, Finland and Japan; D - 437 |- 537: Austria, Belgium, United States, France, Northern Ireland, Italy and New Zealand; E - 337 |- 437: Bulgaria, Spain, Greece, Hong Kong, Hungary, Ireland, Israel and Singapore; F - 237 |- 337: Barbados, Costa Rica, Yugoslavia, Poland, Portugal and Romania; G - 137 |- 237: Chile, Guyana, Mauritius, Panama, Trinidad and Tobago and Uruguay; H - < 137: Egygt, Guatemala and Mexico. <![CDATA[<B>Detection of carriers of abnormal haemoglobins, and their familiarization with their condition, in the population of the regions of S. José do Rio Preto and Presidente Prudente, S. Paulo (Brazil)</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0034-89101985000400008&lng=en&nrm=iso&tlng=en Foram analisadas 7.657 amostras de sangue provenientes de 48 cidades das regiões de São José do Rio Preto e de Presidente Prudente, com o objetivo de detectar e conscientizar os portadores de hemoglobinas anormais. As análises efetuadas mostraram que 3,47% tinham hemoglobinas anormais, sendo 2,26% portadores de variantes moleculares (Hbs, AS, AC, SS, SC, AJ, AB2) e 1,21% de talasse-mias (alfa e beta). Os resultados obtidos evidenciaram que estudos semelhantes, além de propiciar o melhor conhecimento das causas genéticas, bioquímicas e hematológicas dessas alterações hereditárias, oferecem também a oportunidade de estimar a importância que essas patologias representam para a saúde pública do nosso país. A ação preventiva foi estabelecida por meio de reuniões de esclarecimentos médicos e biológicos aos portadores de hemoglobinas anormais.<hr/>A study of abnormal haemoglobins among the inhabitants of S. José do Rio Preto and Presidente Prudente was conducted, using blood samples collected from 7,657 subjects attending health clinics in 48 towns of those regions during 1983-1984. For purposes of analysis the subjects were grouped by region of origin and racial features, 6,941 being classified as "caucasoid" and 716 as "negroid", the latter category including negroes, dark mulattoes, and light mulattoes. Electrophoretic techniques were used to detect abnormal haemoglobins, to determine the presence of haemoglobin types S and C, and isolate the polypeptide chains of other abnormal haemoglobins. Tests for quantification of haemoglobin A2 and fetal haemoglobin were performed as needed. Alpha and beta thalassaemias were diagnosed in accordance with principles established by the World Health Organization. These procedures detected abnormal haemoglobin in 266 (3.47%) of the study subjects. These included 173 specific molecular variants (169 of them being type S or type C variants) and 93 thalassaemias (4 of them being alpha thalassaemia and 89 beta thalassaemia, both in heterozygous state). Overall, the prevalence of abnormal haemoglobins was found to be higher among negroids (7.68%) than among the caucasoids (3.02%), and this difference was statistically significant (x²1; 0.01 = 6.64 x²1; 0.05 = 3.84). While the overall prevalence of abnormal haemoglobins among the S. José do Rio Preto subjects did not differ from prevalence among Presidente Prudente subjects, the prevalence of the genotypes detected among the populations analysed of these two cities, and their respective regions, was different. For S. José do Rio Preto and region, the Hb AS was more prevalent among the abnormal haemoglobins (63%), next came heterozygous beta thalassaemia (17%). For Presidente Prudente the prevalences of Hb AS and heterozygous beta thalassaemia, among the abnormal haemoglobins, were 46% and 40%, respectively. The preventive action to be taken was established by means of meetings at which medical and biological explanations were given to the carriers of abnormal haemoglobins. Overall, the results showed that similar studies offer better knowledge of genetic, biochemical and haemotological causes of these hereditary anaemias, and also provide the opportunity of discovering the importance that these pathological states have in the public health of the Brazilian population. <![CDATA[<B>Penicillinase producing <I>Neisseria gonorrhoeae</B></I>: <B>the first strain isolated in S. Paulo, Brazil</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0034-89101985000400009&lng=en&nrm=iso&tlng=en Relata-se o primeiro caso identificado de Neisseria gonorrhoeae produtora de penicilinase (NGPP) no Estado de São Paulo, Brasil, demonstrando a necessidade de mensurar os índices de prevalência destas cepas na população.<hr/>This paper reports on the first case of penicillinase-producing Neisseria gonorrhoeae (PPNG) isolated in S. Paulo, Brazil, demonstrating the necessity of measuring the prevalence of these strains among the population. <![CDATA[<B>Considerations concerning the theoretical foundations of explanation in epidemiology</B>]]> http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0034-89101985000400010&lng=en&nrm=iso&tlng=en São analisadas as condições históricas do surgimento da epidemiologia como disciplina científica, em meados do século passado. É revista a evolução das bases teóricas do processo explicativo em epidemiologia até o momento atual. Especial atenção é dada ao papel da lógica positivista de Stuart Mill como base teórica da Epidemiologia até recentemente. São discutidas as alternativas teóricas correntes e proposta maior abertura da epidemiologia a diferentes correntes filosóficas como o caminho para o estabelecimento da epidemiologia como uma ciência madura.<hr/>The historical conditions surrounding the emergence, by the mid-19th century, of epidemiology as a scientific discipline, were analysed. Special consideration is given to the influence of the political milieu of Victorian England in the definition of the theoretical basis of epidemiology. The English Sanitary Movement is seen as a response of the emerging bourgeoise to problems created by industrialization and urbanization. As a consequence, epidemiology was strongly influenced by Stuart Mill's system of logic. During the latter part of the 19th century, bacteriology brought important transformations to epidemiology. However, its theoretical foundations suffered almost no change. Possibly the new challenges created by -the expanding colonial empires were the driving force in the evolution of epidemiology. As a science, it could not escape from the influence of social and political forces, It has only been recently, mainly in Latin America, that a search for alternatives to the dominating theoretical structure of epidemiology has taken place. The historical-materialist approach has given way to what is sometimes refered to as "social epidemiology". Epidemiology should be regarded as a science in which different theoretical approaches may coexist, as in history, sociology or physics.