Underreporting of mesothelioma, asbestosis and pleural plaques in Brazil.

BACKGROUND: Brazil has a long history of heavy asbestos consumption. However, the number of asbestos-related diseases (ARDs) falls far below the one expected compared with other asbestos consumer countries. AIMS: To examine underreporting of ARDs, that is mesothelioma, asbestosis and pleural plaques, in Brazil's Mortality Information System (SIM). METHODS: Health information systems (HIS) were mapped, datasets retrieved and records of ARD deaths extracted. Records were pair-matched using anonymous linkage to create a single database. ARD-reported cases missing in SIM were considered unreported. The study's period ranged from 2008 to 2014, when every HIS contributed to the ARD records pool. RESULTS: A total of 1298 registered ARD deaths were found, 996 cases of mesothelioma (77%) and 302 (23%) of asbestosis and pleural plaques. SIM was the major single data source of ARD but 335 mesothelioma deaths were missing, an average underreporting of 33%, with no clear time trend. For asbestosis and pleural plaques, underreporting of ARD oscillated from 55% in 2010 to 25% in 2014, a declining trend. ARD underreporting was not associated with sex or age. CONCLUSIONS: One-third of underreported ARD deaths in the universal SIM is unacceptably high and, apparently, it has not been improving substantially over time. After recoveries from multiple databases, the number of cases is still below, which could be expected based on asbestos consumption. Interoperability of multiple information systems could enhance case detection and improve the precision of mortality estimates, which are crucial for surveillance and for evaluation of remedial policies.

Crystal structure of Jararacussin-I: the highly negatively charged catalytic interface contributes to macromolecular selectivity in snake venom thrombin-like enzymes.

Snake venom serine proteinases (SVSPs) are hemostatically active toxins that perturb the maintenance and regulation of both the blood coagulation cascade and fibrinolytic feedback system at specific points, and hence, are widely used as tools in pharmacological and clinical diagnosis. The crystal structure of a thrombin-like enzyme (TLE) from Bothrops jararacussu venom (Jararacussin-I) was determined at 2.48 Å resolution. This is the first crystal structure of a TLE and allows structural comparisons with both the Agkistrodon contortrix contortrix Protein C Activator and the Trimeresurus stejnegeri plasminogen activator. Despite the highly conserved overall fold, significant differences in the amino acid compositions and three-dimensional conformations of the loops surrounding the active site significantly alter the molecular topography and charge distribution profile of the catalytic interface. In contrast to other SVSPs, the catalytic interface of Jararacussin-I is highly negatively charged, which contributes to its unique macromolecular selectivity.

Housework, paid work and psychiatric symptoms.

OBJECTIVE: To evaluate the hypothesis that work burden, the simultaneous engagement in paid work and unpaid family housework, is a potential risk factor for psychiatric symptoms among women. METHODS: A cross-sectional study was carried out with 460 women randomly selected from a poor area of the city of Salvador, Brazil. Women between 18 to 70 years old, who reported having a paid occupation or were involved in unpaid domestic activities for their families, were eligible. Work burden-related variables were defined as: a) double work shift, i.e., simultaneous engagement in a paid job plus unpaid housework; and b) daily working time. Psychiatric symptoms were collected through a validated questionnaire, the QMPA. RESULTS: Positive, statistically significant associations between high (>7 symptoms) QMPA scores and either double work shift (prevalence ratio - PR=2.04, 95% confidence interval - CI: 1.16, 2.29) or more than 10 hours of daily work time (PR=2.29, 95% CI: 1.96, 3.43) were found after adjustment for age, marital status and number of pre-school children. CONCLUSIONS: Major correlates of high QMPA scores are work burden variables. Being married or having pre-school children are also associated with high QMPA scores only when associated with work burden.

[Morbidity among job applicants in the Metropolitan Region of Salvador, Bahia, Brazil]. / Morbidade em candidatos a emprego na região metropolitana de Salvador, Bahia, Brasil.

This cross-sectional study evaluates the pre-employment health status of job applicants, based on prevalence estimates of abnormal laboratory test results, clinical diagnosis, and a physician-signed fit-for-work assessment, which is mandatory in Brazil. The study population was a random sample of 1,237 male workers selected from medical records (1988-1996) from an Occupational Medical Center located in Salvador, the capital of Bahia State, Brazil. The data were from a single pre-employment medical assessment for each individual. The most common diseases were intestinal parasites (51.7%), anemia (12.8%), and hypertension (12.7%). Drivers showed a high prevalence of overweight (38.2%) and hypertension (16.2%). In addition to work-related risks and diseases, occupational hygiene and safety programs need to address prevailing illnesses and risk factors, which in this population are typical of poor living conditions. Special attention should to be given to drivers, who are at increased risk of cardiovascular disease.

[Acid mist occupational exposure and oral disease: a review]. / Exposição ocupacional a névoas ácidas e alterações bucais: uma revisão.

This study is a review of published research findings on the oral effects of occupational exposure to acid mists. A literature search was conducted on MEDLINE, LILACS, SciELO, BBO, and DEDALUS, identifying eight articles and a doctoral dissertation focusing on this association. Findings were consistent with a positive association between occupational exposure to acid mists and dental erosion, according to the literature published since 1919. Studies on the association between acid mist exposure in the workplace and periodontal disease, or oral mucous lesions, were more recent and scarce, and their findings remain controversial. Several methodological drawbacks were observed, such as small sampling size and poorly developed analysis, as exemplified by little or no attention to confounding variables. These findings support the relevance of this research area and the need for improved research design. They also highlight the importance of considering oral health as a component of workers' health in effective preventive programs.

[Cancer mortality among Brazilian Navy personnel]. / Mortalidade por câncer em militares da Marinha do Brasil.

OBJECTIVE: To identify differences in cancer proportionate mortality among male servicemen of the Brazilian Navy when compared to a referent population and to detect potential occupational risk factors. METHODS: Cancer proportionate mortality was estimated using death certificates and occupational histories of Brazilian navy servicemen aged 19 or more in the period of 1991 to 1995. The population of Rio de Janeiro (Brazil) was chosen as referent group because this city concentrates 70% of all Navy servicemen. RESULTS: Servicemen are more likely to die from brain neoplasm (age-adjusted cancer proportionate mortality ratio - ACPMR=339.27), prostate cancer (ACPMR=135.04), and non-Hodgkin lymphoma (ACPMR=152.28) than the referent population. Health-related occupations show an excess of brain neoplasm (ACPMR=2.7, 95% confidence interval, CI: 1.1-6.5) and liver cancer (ACPMR=2.9; 95% CI: 1.1-7.8); colon-rectal cancer was higher among officials of the Army Corp and other administrative occupations (ACPMR=2.4, 95% CI: 1.3-4.5); larynx cancer (ACPMR=2.3, 95% CI; 1.1-5.0) is more common among men working in maintenance and repair occupations. CONCLUSIONS: In this study, servicemen of the Brazilian Navy Force have a distinct cancer mortality profile from the general reference population. Risk factors for cancer need to be further evaluated, by using more specific diagnosis and occupational-related exposure data.

Bahia-Carolina Program in Environmental and Occupational Health: A North-South partnership for workplace and environmental justice.

The Bahia-Carolina Program in Environmental and Occupational Health is an interdisciplinary collaborative program in research and training linking the Institute for Collective Health (ISC), the Federal University of Bahia, Brazil, and the School of Public Health, University of North Carolina at Chapel Hill. An important goal of this Fogarty Center-funded project is to improve workplace and environmental conditions and the well-being of the general population, particularly those workers in the informal sector. Major accomplishments include training taking place in the United States, training in Brazil, and support of Brazilian institutions. Brazilians studying in the United States have researched occupational risk factors for non-Hodgkin's lymphoma, the effectiveness of an environmental sanitation program, the health of refinery workers, and statistical methods for multilevel analysis, among other topics. The program also emphasizes the opportunity for U.S. faculty and students to learn from Brazilian colleagues. Challenges encountered in the collaboration process are described.

Brain neoplasms among naval military men.

To evaluate risk factors for primary brain tumors, a case-control study was carried out with all death certificates and corresponding occupational histories of males registered in the Brazilian Navy Insurance from 1991 to 1995. Cases were 40 individuals with ICD-9 codes 191, 192.1, and 192.0 (brain and CNS tumors). Controls were 671 subjects who had other reported cancer sites. Men less than 56 years of age (odds ratio, OR = 4.63; 95% confidence interval, CI: 2.54, 8.45) and unmarried men (OR = 3.18; 95% CI: 1.69, 5.99) had higher mortality from brain tumors. After adjustment of age, marital status, and socioeconomic status, more brain tumors were found among health personnel (OR = 2.13; 95% CI: 1.07, 4.97) than in other occupational categories. Infantry servicemen engaged in combat training had borderline excess brain tumor mortality (OR = 2.30; 95% CI: 0.89, 5.99). More detailed occupational data on exposures and potential confounders are necessary to improve research on occupational risk factors.

Efetividade do Programa de Comunicação e Educação em Saúde no controle da infecção por S. mansoni em algumas areas do Estado da Bahia / The effectiveness of the Program of Communication and Education in Health on the control of S. mansoni infection in some areas of the state of Bahia

O Programa de Controle da Esquistossomose (PCE) vem sendo desenvolvido em áreas da Bahia pela Fundação Nacional de Saúde (FNS). Em 1989, ações de Informação, Educação, Comunicação e Mobilização Comunitária (IEC/MC) foram iniciadas. Neste estudo avalia-se o impacto epidemiológico do IEC/MC, adotando-se um desenho quasi-experimental, comparando-se prevalências de infecção por S. mansoni em áreas IEC/MC com estimativas de áreas referentes. Os dados são secundários, coletados rotineiramente pela FNS. Verificou-se uma redução da prevalência da esquistossomose em todas as áreas, que alcança maior intensidade nas áreas com IEC/MC. Aparentemente, ações de controle rotineiras realizadas isoladamente são mais efetivas entre escolares e pessoas do sexo masculino, enquanto que nas áreas com IEC/MC, observou-se maior impacto entre as mulheres, refletindo, provavelmente, as distintas estratégias adotadas. Aponta-se para a necessidade de estudos de avaliação qualitativos, além de estimativas do custo-benefício e custo-efetividade de modo a aprimorar o processo de tomada de decisões.

The Program for S. mansoni Control (PCE) has been developed in some areas of the State of Bahia by the Fundação Nacional de Saúde (FNS). In 1989, activities on Information, Education, Communication and Community Mobilization (IEC/MC) were initiated. This study evaluates the epidemiological impact of the IEC/MC, using a quasi-experimental study design strategy, comparing the prevalences of infection for S. mansoni in areas of IEC/MC and estimates of other areas. The data used were routinely collected by the local staff of the FNS. A decrease on the prevalence of S. mansoni infection was found in all study areas, specially in those of IEC/MC activities. Findings indicate that PCE activities are more effective among school-age individuals and male adults, although IEC/MC allows for higher epidemiological impact among women, reflecting the differences among the strategies. These findings point out the need for qualitative evaluation research, as well as cost benefit and cost effectiveness analyses, that are more appropriate for decision making processes.

[Ratio of proportions and the use of the delta method for confidence intervals in logistic regression]. / Razões de proporções e uso do método delta para intervalos de confiança em regressão logística.

OBJECTIVE: To present an application of logistic regression modelling to estimate ratios of proportions, such as prevalence ratio or relative risk, and the Delta Method to estimate confidence intervals. METHOD: The Delta Method was used because it is appropriate for the estimation of variance of non-linear functions of random variables. The method is based on Taylor's series expansion and provides a good approximation of variance estimates. A computer program, utilizing the matrix module of SAS, was developed to compute the variance estimates. A practical demonstration is presented with data from a cross-sectional study carried out on a sample of 611 women, to test the hypothesis that the lack of housework sharing is associated with high scores of psychological symptoms as measured by a validated questionnaire. RESULTS: Crude and adjusted prevalence ratio estimated by logistic regression were similar to those estimated by tabular analysis. Also, ranges of the confidence intervals of the prevalence ratio according to the Delta Method were nearly equal to those obtained by the Mantel-Haenszel approach. CONCLUSIONS: The results give support to the use of the Delta Method for the estimation of confidence intervals for ratios of proportions. The method should be seen as an alternative for situations in which the need to control a large number of potential confounders limits the use of stratified analysis.

[Proxy informant reliability and bias in epidemiological research: analysis of a screening questionnaire for mental disorders]. / Confiabilidade e viés do informante secundário na pesquisa epidemiológica: análise de questionário para triagem de transtornos mentais.

OBJECTIVES: To evaluate the reliability, magnitude and direction of the resulting bias in the application of a screening instrument for mental disorders by considering proxy informants in comparison to primary informants. METHODS: Data are taken from a general morbidity community-based survey carried out in 520 randomly selected households of an industrial area of the Metropolitan Region of Salvador, the capital of Bahia state, Brazil. During the pilot phase, the first 70 families of the total sample were asked to participate in the evaluation of research instruments. The Questionnaire of Adult Psychiatric Morbidity, QAPM, consists of 44 questions about psychiatric symptoms widely used in Brazil. The husbands and wives of the selected families answered QAPM questions regarding themselves and their respective partners. One family refused to participate. The Kappa index was estimated for each QAPM question. To assess the magnitude and direction of bias, the proportional variation of prevalence was estimated from proxy and primary respondents. Each informant was analyzed as a primary informant when answering about his/her own symptoms and as a proxy informant when answering those about his/her partner. RESULTS: Proxy informants as compared to primary informants show weak reliability, as measured by the Kappa Index, particularly when husbands reported on their wives' symptoms. An overall underestimation of prevalence estimates was found, which reveals the potential negative bias with the use of proxy informants for psychological symptoms. No bias was found for only two questions (lack of appetite and globus hystericus) when women were taken as proxy informants for their husbands. In addition, departures of proxy informants from primary informant-based estimates were greater among men than to women. CONCLUSIONS: Proxy informants underestimate the occurrence of psychological symptoms in this community-based study. When the feasibility of a research project, based on the QAPM depends on the use of proxies, wives may be recommended as better informants than their husbands.

[The effectiveness of the Program of Communication and Education in Health on the control of S. mansoni infection in some areas of the state of Bahia]. / Efetividade do Programa de Comunicação e Educação em Saúde no controle da infecção por S. mansoni em algumas areas do Estado da Bahia.

The Program for S. mansoni Control (PCE) has been developed in some areas of the State of Bahia by the Fundação Nacional de Saúde (FNS). In 1989, activities on Information, Education, Communication and Community Mobilization (IEC/MC) were initiated. This study evaluates the epidemiological impact of the IEC/MC, using a quasi-experimental study design strategy, comparing the prevalences of infection for S. mansoni in areas of IEC/MC and estimates of other areas. The data used were routinely collected by the local staff of the FNS. A decrease on the prevalence of S. mansoni infection was found in all study areas, specially in those of IEC/MC activities. Findings indicate that PCE activities are more effective among school-age individuals and male adults, although IEC/MC allows for higher epidemiological impact among women, reflecting the differences among the strategies. These findings point out the need for qualitative evaluation research, as well as cost benefit and cost effectiveness analyses, that are more appropriate for decision making processes.

Informal jobs: another occupational hazard for women's mental health?

OBJECTIVES: The hypothesis that informal jobs, which imply absence of formal labour contracts, instability and the absence of fringe benefits, are positively associated with psychiatric symptoms was evaluated in a poor urban area of Brazil. METHODS: With data from a cross-sectional study, the association between informal jobs and high number of psychological symptoms was estimated. The study population was composed of 327 women randomly selected from a community in the city of Salvador, Brazil. Women who reported having a job without a formal contract were classified as informal workers. Psychological symptoms were collected through a validated questionnaire, the QMPA. RESULTS: A positive association between informal work and a high number of psychological symptoms was found (crude prevalence ratio = 1.88, 95% confidence interval [CI]: 1.24-2.85). More than 4 hours of housework a day and being a family head were confounders, although adjustment for these variables did not significantly change the results (adjusted prevalence ratio = 1.97, 95% CI: 1.26-3.09). CONCLUSIONS: These findings are suggestive that informal work may be a risk for mental symptoms. Reinforcement of universal labour rights coverage and improvement in housework sharing are recommended.

[Control of schistosomiasis infection in the localities of Cachoeira-Bahia, basin of the Paraguaçu, 1982-1992]. / Avaliação das ações de controle da infecção esquistossomótica nas localidades de Cachoeira-Bahia, bacia do Paraguaçu, 1982-1992.

This study evaluates the effectiveness of the Schistosomiasis Control Program, PCE, in Cachoeira, state of Bahia-Brazil, in Paraguaçu Basin Area. Data comes from PCE-111 cards of SUCAM/FNS, which are routinely registered in the 111 villages identified during the study follow up, 1982-1992. The S. mansoni infection was diagnosed through Katz-Kato technique for stool exams. Temporal trends of the prevalence of infection were analyzed for each village. Four trend patterns were identified, and the most common was those of recurrence of infection prevalence (67.6%). Control of the endemics was achieved in 22.5% of the villages, while expansion trends were found in only 9.9% of them. In general, there was found a decrease in the prevalence, particularly, from 1982 to 1985, followed by an increase that do not reach the initial levels. It was observed a relative reduction on the number of villages that shows prevalence below or equal to 5%, that indicates control of the infection. It was not possible to evaluate trends of infection intensity neither the occurrence of severe shistossomiasis disease or related deaths, that may allow a more complete evaluation of this program.

[Occupational noise exposure and hypertension]. / Exposição ocupacional ao ruído e hipertensão arterial.

The hypothesis that occupational noise exposure is positively associated with hypertension was examined in a cross-sectional study carried out on a group of patients who were enrolled at the Occupational Health Unit of the Unified Health System, situated in Salvador city, the capital of Bahia state, Brazil. Data were obtained from 276 medical records, corresponding to all patients newly registered during the first six months of 1992. Data on noise exposure come from both reported occupational exposure history and clinical diagnosis of occupational noise-induced hearing loss. Hypertension diagnosis complies with World Health Organization criteria, as well as with the history of antihypertensive treatment. Stratified analysis and unconditional logistic regression modeling show results that do not support the study hypothesis: there are no differences between systolic or diastolic blood pressure or between proportion of hypertension for exposed and non exposed groups. However, statiscally significant (alpha = 0.05) increment of the effect measured was reported among workers who reported low educational level (below elementary). This could be another evidence of socially related inequalities underlying exposure distribution among workers at the workplace, which should be addressed, at greater depth, in future studies.

[Prevalence of headache as an symptom in a urban area of Salvador, Bahia]. / Prevalência de cefaléia como sintoma em um setor urbano de Salvador, Bahia.

The prevalence of headache was studied as part of an epidemiologic survey of neuropsychiatric disorders carried out with an adult sample (N = 1,511) of an urban area of Salvador City, Bahia, Brazil. The overall prevalence of headache complaints was 14.8%, significantly higher among the eldest, female, less educated, migrants, unemployed, low SES and married/divorced. Stratified analysis for age and gender as confounders erased out the effect of marital status and socio-economic status indicators. The presence of psychiatric disorders was strongly, significantly associated with the prevalence of headache (odds ratio of 4.2). These results are compared to the international literature, emphasizing the extremely lower rates found as well as the profiles of risk factors completely distinct from those reported in other sociocultural realities.

Is there an epidemic of drug misuse in Brazil? A review of the epidemiologic evidence (1977-1988).

A critical review is presented of methods and findings of epidemiological studies on drug use carried out in Brazil. Studies of the first phase (1977-1986) suffered from serious flaws but tended to produce inflated rates, as compared to studies conducted after 1987, which used better case definition criteria and sampling strategies. Prevalence of consumption of legal substances was comparable to industrialized countries but lifetime use of illicit drugs in the country tended to be much lower. In conclusion, there is no support from epidemiologic studies for the hypothesis of an epidemic of drug addiction in Brazil nowadays.

Estudo epidemiologico dos transtornos mentais em uma populacao de idosos Area urbana de Salvador - BA. / Epidemiological study of mental disorders in an aged population - Urban area of Salvador - BA

Os autores relatam os resultados de um estudo de prevalencia de desordens mentais, em uma amostra probablilistica de 139 habitantes de uma area de baixa renda de Salvador - BA, na faixa etaria acima de 55 anos. Analisa-se a influencia de algumas variaveis demograficas e socio-economicas sobre a distribuicao da morbidade psiquiatrica na amostra, por meio de analise estratificada. Algumas discrepancias entre estes achados e nocoes correntes na literatura clinica da area sao identificadas e discutidas