Drug addiction and alcoholism as predictors for tuberculosis treatment default in Brazil: a prospective cohort study.

This study aimed to evaluate the risk factors for tuberculosis (TB) treatment default in a priority city for disease control in Brazil. A cohort of TB cases diagnosed from 2008 to 2009 was followed up from patients' entry into three outpatient sites, in Juiz de Fora, Minas Gerais (Brazil), until the recording of the outcomes. Drug addiction, alcoholism and treatment site appeared to be independently associated with default. Current users of crack as the hardest drug (odds ratio (OR) 12·25, 95% confidence interval (CI) 3·04-49·26) were more likely to default than other hard drug users (OR 5·67, 95% CI 1·34-24·03), former users (OR 4·12, 95% CI 1·11-15·20) and those not known to use drugs (reference group). Consumers at high risk of alcoholism (OR 2·94, 95% CI 1·08-7·99) and those treated in an outpatient hospital unit (OR 8·22, 95% CI 2·79-24·21%) also were more likely to default. Our results establish that substance abuse was independently associated with default. National TB programmes might be more likely to achieve their control targets if they include interventions aimed at improving adherence and cure rates, by diagnosing and treating substance abuse concurrently with standard TB therapy.

Development and evaluations of the ancestry informative markers of the VISAGE Enhanced Tool for Appearance and Ancestry.

The VISAGE Enhanced Tool for Appearance and Ancestry (ET) has been designed to combine markers for the prediction of bio-geographical ancestry plus a range of externally visible characteristics into a single massively parallel sequencing (MPS) assay. We describe the development of the ancestry panel markers used in ET, and the enhanced analyses they provide compared to previous MPS-based forensic ancestry assays. As well as established autosomal single nucleotide polymorphisms (SNPs) that differentiate sub-Saharan African, European, East Asian, South Asian, Native American, and Oceanian populations, ET includes autosomal SNPs able to efficiently differentiate populations from Middle East regions. The ability of the ET autosomal ancestry SNPs to distinguish Middle East populations from other continentally defined population groups is such that characteristic patterns for this region can be discerned in genetic cluster analysis using STRUCTURE. Joint cluster membership estimates showing individual co-ancestry that signals North African or East African origins were detected, or cluster patterns were seen that indicate origins from central and Eastern regions of the Middle East. In addition to an augmented panel of autosomal SNPs, ET includes panels of 85 Y-SNPs, 16 X-SNPs and 21 autosomal Microhaplotypes. The Y- and X-SNPs provide a distinct method for obtaining extra detail about co-ancestry patterns identified in males with admixed backgrounds. This study used the 1000 Genomes admixed African and admixed American sample sets to fully explore these enhancements to the analysis of individual co-ancestry. Samples from urban and rural Brazil with contrasting distributions of African, European, and Native American co-ancestry were also studied to gauge the efficiency of combining Y- and X-SNP data for this purpose. The small panel of Microhaplotypes incorporated in ET were selected because they showed the highest levels of haplotype diversity amongst the seven population groups we sought to differentiate. Microhaplotype data was not formally combined with single-site SNP genotypes to analyse ancestry. However, the haplotype sequence reads obtained with ET from these loci creates an effective system for de-convoluting two-contributor mixed DNA. We made simple mixture experiments to demonstrate that when the contributors have different ancestries and the mixture ratios are imbalanced (i.e., not 1:1 mixtures) the ET Microhaplotype panel is an informative system to infer ancestry when this differs between the contributors.

High incidence of adverse reactions to initial antiretroviral therapy in Brazil.

A concurrent prospective study was conducted from 2001 to 2003 to assess factors associated with adverse reactions among individuals initiating antiretroviral therapy at two public referral HIV/AIDS centers in Belo Horizonte, MG, Brazil. Adverse reactions were obtained from medical charts reviewed up to 12 months after the first antiretroviral prescription. Cox proportional hazard model was used to perform univariate and multivariate analyses. Relative hazards (RH) were estimated with 95% confidence intervals (CI). Among 397 charts reviewed, 377 (95.0%) had precise information on adverse reactions and initial antiretroviral treatment. Most patients received triple combination regimens including nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors and protease inhibitors. At least one adverse reaction was recorded on 34.5% (N = 130) of the medical charts (0.17 adverse reactions/100 person-day), while nausea (14.5%) and vomiting (13.1%) were the most common ones. Variables independently associated with adverse reactions were: regimens with nevirapine (RH = 1.78; 95% CI = 1.07-2.96), indinavir or indinavir/ritonavir combinations (RH = 2.05; 95% CI = 1.15-3.64), female patients (RH = 1.93; 95% CI = 1.31-2.83), 5 or more outpatient visits (RH = 1.94; 95% CI = 1.25-3.01), non-adherence to antiretroviral therapy (RH = 2.38; 95% CI = 1.62-3.51), and a CD4+ count of 200 to 500 cells/mm3 (RH = 2.66; 95% CI = 1.19-5.90). An independent and negative association was also found for alcohol use (RH = 0.55; 95% CI = 0.33-0.90). Adverse reactions were substantial among participants initiating antiretroviral therapy. Specially elaborated protocols in HIV/AIDS referral centers may improve the diagnosis, management and prevention of adverse reactions, thus contributing to improving adherence to antiretroviral therapy among HIV-infected patients.

Postcoital vaginal bleeding as a risk factor for transmission of the human immunodeficiency virus in a heterosexual partner study in Brazil. Rio de Janeiro Heterosexual Study Group.

BACKGROUND: Several risk factors for male-to-female human immunodeficiency virus (HIV) transmission are well established, but few studies have examined the role of postcoital vaginal bleeding. METHODS: Couples recruited from AIDS centers in Rio de Janeiro, Brazil, were interviewed for risk factors and had blood collected for examinations. Eligibility criteria included confirmed HIV positivity for the male partner, aged 18 years of older, heterosexual contact in the past year, and no other risk factor for female partners except sexual contact with the HIV-infected male partner. Logistic regression was used to assess the association between HIV serostatus and risk factors in the female partners. RESULTS: The prevalence of HIV infection was 47.6% among the 418 women available for analysis. The following factors were independently associated with HIV infection; anal sex (odds ratio [OR], 3.06), condom use during vaginal sex sometimes (OR, 1.42) and rarely to never (OR, 2.00) compared with always, frequency of sexual contacts (> 100 in the previous year) (OR, 1.71), HIV-infected male partners with symptoms of acquired immunodeficiency syndrome (OR, 1.70), and postcoital vaginal bleeding (OR, 1.89). The association of postcoital bleeding and HIV infection was more pronounced among women who did not engage in anal sex. CONCLUSIONS: The results support previous studies showing that advanced HIV infection in the male partner, anal sex, inconsistent condom use, and frequent sex are associated with HIV infection among the female partners of HIV-infected men. Postcoital vaginal bleeding was also identified as a risk factor for infection. In addition to other established preventive measures, a recommendation for seeking diagnosis and treatment of sexually transmitted diseases that are associated with postcoital bleeding and using water-soluble lubricants during sex to minimize trauma seems prudent.

V3 region polymorphisms in HIV-1 from Brazil: prevalence of subtype B strains divergent from North American/European prototype and detection of subtype F.

Viral DNA sequences were determined over the V3 region of env from 28 infected individuals living in the high HIV-1 prevalence Brazilian cities of Rio de Janeiro and São Paulo. Twenty-six belonged to envelope sequence subtype B, prevalent in North America and Europe, and one was classified as subtype F, found recently in Brazil and in Romania (one appeared to be a B/F recombinant). Octameric sequences at the tip of the subtype B V3 loops were variable and distinct from those prevalent in North America and Europe. The GPGR motif, prevalent in North American/European strains, was found in only 8 (28.5%) sequences, whereas GWGR was found in 12 (43%) and novel sequences in 8 (28.5%). Brazilian subtype B sequences also diverged from the consensus North American/European strains over the remainder of the V3 loop. These results suggest that Brazilian HIV-1 B strains may have important antigenic differences from prototype subtype B strains currently being evaluated for use in HIV vaccines. These results should be taken into account for future vaccine programs in Brazil.

Risk assessment for acquiring meningitis tuberculosis among children not vaccinated with BCG: a case-control study.

This case-control study was conducted to assess the risk, among children aged 0-12 years, of developing meningitis tuberculosis (MT) associated with a lack of intradermal BCG vaccination. Cases (45) of MT admitted for treatment at the Fundacao Benjamin Guimaraes Hospital (Belo Horizonte, MG, Brazil), from 1975 to 1981, were matched for age at hospitalization, date of hospitalization and nutritional status, with two types of controls--patients with acute diarrhoea (AD) and patients with acute non-tuberculous bacterial pneumonias (BP)--admitted to the same hospital. Vaccination status was ascertained from the patients' medical records. Results showed a risk for MT, estimated by the odds ratio, between BCG non-vaccinated and BCG vaccinated patients, of 6.7 (95% Cl 2.3-19.0) comparing cases and AD controls, of 4.0 (95% Cl 1.5-11.0) comparing cases and BP controls and 5.7 (95% Cl 2.3-14.0) comparing cases with both controls. When adjustments were made for place of residence (Metropolitan Region of Belo Horizonte and other regions of Minas Gerais State), the risks decreased to 5.2 (95% Cl 1.9-14.0) and 2.9 (95% Cl 1.2-7.3) comparing cases with AD and BP controls, respectively.

A case-control study of risk factors for breast cancer in Brazil, 1978-1987.

BACKGROUND: There are still controversies regarding the role of many risk factors assessed for breast cancer worldwide. In Brazil, it represents a major cause of death among women but yet few analytical studies have been published to date. METHODS: The association of selected factors with breast cancer was assessed in a case-control study of 300 women, aged 25-75 years, treated at the Federal University Hospital, Belo Horizonte, Brazil, from 1978 to 1987. In all, 300 cases with diagnosed breast carcinoma were compared with 600 controls matched on age and date of diagnosis. Socio-economic, demographic and reproductive factors were analysed. RESULTS: Multiple logistic regression analysis showed the following factors to be independently associated with increased risk of breast cancer: a) monthly family income (odds ratio [OR] = 1.69, 95% confidence interval [CI]: 1.18-2.42); b) being a housewife (OR = 2.86, 95% CI: 1.83-4.47; c) parity of less than six deliveries and nulliparous women (OR = 5.06, 95% CI: 3.01-8.52 and OR = 2.42, CI: 1.64-3.59, respectively); d) history of breast cancer among first degree female relatives (OR = 9.35, 95% CI: 3.22-27.14); and e) oral contraceptive use (OR = 1.81, 95% CI: 1.15-2.85). Irregular menstrual cycle (OR = 0.44, 95% CI: 0.25-0.75) was associated with breast cancer as a protective effect. CONCLUSIONS: The study has confirmed most risk/protective factors previously demonstrated elsewhere in the world and provides clear documentation of breast cancer epidemiology in Brazil.

Factors associated with AIDS and AIDS-like syndrome among homosexual and bisexual men in Minas Gerais, Brazil.

A case-control study to determine factors associated with AIDS and AIDS-like syndrome among homosexual/bisexual men was conducted in the State of Minas Gerais (Brazil). Eighty-three per cent (45 patients) of all AIDS/AIDS-like syndrome cases in homosexual/bisexual men reported in Minas Gerais between February, 1986 and June, 1987 were compared to 133 seronegative controls seen at the same clinic. Blood samples were tested by ELISA and confirmed by Western blot. Sex with men from the USA, sex with someone who developed AIDS, number of male partners (greater than or equal to 100 lifetime), age (greater than or equal to 30 years old) and ethnicity (white) were independently associated with AIDS/AIDS-like syndrome (Odds Ratios = 5.5, 4.3, 3.9, 3.5 and 2.7, respectively). Thirty-nine per cent of cases and 44% of controls reported bisexual activity during the previous two years. From these, a high proportion reported anal intercourse with women in the same period (53% of bisexual cases and 33% of bisexual controls). Bisexual men had more male partners than female partners in the previous two years (median male partners = 20 for cases and five for controls; median female partners = three for both cases and controls). This explains in part why the epidemic has increased more rapidly among men then among women in Minas Gerais, despite the large proportion of bisexuals with the disease.

PIP: A case control study to determine factors associated with AIDS and AIDS- like syndrome among homosexual/bisexual men was conducted in the state of Minas Gerais, Brazil. 83% (45 patients) of all AIDS/AIDS-like syndrome cases in this group of men reported in Minas Gerais between February 1986-June 1987 were compared to 133 seronegative controls seen at the same clinic. Blood samples were tested by ELISA and confirmed by western blot. Sex with men from the US, with someone who developed AIDS, number of male partners ( or = 100 lifetime), age ( or = 30 years old), and ethnicity (white) were independently associated with AIDS/AIDS-like syndrome (odds ratio=5.5, 4.3, 3.9, 3.5, and 2.7, respectively). 39% of cases and 44% of controls reported bisexual activity over the previous 2 years. From these, a high proportion reported anal intercourse with women in the same period (53% of bisexual cases and 33% of bisexual controls). Bisexual men had more male partners than female ones in the previous 2 years (median number=20 for cases and 5 for controls; median number of female partners=3 for both cases and controls). This explains in part why the epidemic has increased more rapidly among men than women in Minas Gerais, despite the large proportion of bisexuals with the disease.

Safe sexual behaviour among female partners of HIV-infected men in Rio de Janeiro, Brazil.

A cross-sectional study was designed to assess safe sexual behaviour among heterosexual couples after the woman learned of her partner's infection with HIV. Female partners who had known their partners' serostatus for at least 4 weeks were eligible for participation. Couples were interviewed separately and independent predictors of safe sexual behaviour were identified using multiple logistic regression. Safe sexual behaviour was defined as no unprotected vaginal, oral, or anal intercourse. Of 328 women, 197 (60%) reported safe sexual behaviour since learning of their partners' infection. Significant independent predictors of safe sexual behaviour included older women (>30 years old) (odds ratio [OR]=1.89; 95% confidence intervals [CI]=1.01-3.51), current negative HIV serostatus (OR=2.72; 95% CI=1.50-4.94), advanced clinical stage of the index case (OR=1.96; 95% CI=1.07-3.59), longer duration of relationship (10+ years) (OR= 2.35; 95% CI=1.15-4.82), fewer sex contacts (<100) (OR=2.01; 95% CI=1.14-3.56), only one lifetime partner (OR=2.29; 95% CI=1.26-4.17), non-smoking (OR=2.67; 95% CI=1.43-4.99), not practising oral sex (OR=3.35; 95% CI=1.82-6.19) and previous HIV testing (OR=2.11; 95% CI=1.09-4.07). In addition, women who had known their partner's infection for longer were less likely to report safe sexual behaviour (P < 0.001). Our results indicate that among female partners of HIV-positive Brazilian men, learning of their partner's infection does not uniformly result in safe sexual behaviour. Counselling must emphasize disclosure of serostatus to female partners and target couples with short-term relationships, as well as those where the woman has known about her male partner's infection for a long time, because these are the least likely to maintain safe sexual behaviour.

Hepatitis C virus infection among Brazilian hemophiliacs: a virological, clinical and epidemiological study.

We determined and analyzed risk factors of hepatitis C virus (HCV)-infected Brazilian hemophiliacs according to their virological, clinical and epidemiological characteristics. A cross-sectional and retrospective study of 469 hemophiliacs was carried out at a Brazilian blood center starting in October 1997. The prevalence of HCV infection, HCV genotypes and factors associated with HCV RNA detection was determined. The seroprevalence of anti-HCV antibodies (ELISA-3.0) was 44.6% (209/469). Virological, clinical and epidemiological assessments were completed for 162 positive patients. There were seven (4.3%) anti-HCV seroconversions between October 1992 and October 1997. During the same period, 40.8% of the positive anti-HCV hemophiliacs had abnormal alanine transaminase (ALT) levels. Plasma HCV RNA was detected by nested-RT-PCR in 116 patients (71.6%). RFLP analysis showed the following genotype distribution: HCV-1 in 98 hemophiliacs (84.5%), HCV-3 in ten (8.6%), HCV-4 in three (2.6%), HCV-2 in one (0.9%), and not typeable in four cases (3.4%). Univariate analysis indicated that older age (P = 0.017) and abnormal ALT levels (P = 0.010) were associated with HCV viremia, while the presence of inhibitor antibodies (P = 0.024) and HBsAg (P = 0.007) represented a protective factor against the presence of HCV RNA. These findings may contribute to a better understanding of the relationship between HCV infection and hemophilia.

Exposure to acellular blood products and risk of HIV infection in hemophiliacs from Belo Horizonte, Brazil.

Results of a HIV prevalence study conducted in hemophiliacs from Belo Horizonte, Brazil are presented. History of exposure to acellular blood components was determined for the five year period prior to entry in the study, which occurred during 1986 and 1987. Patients with coagulations disorders (hemophilia A = 132, hemophilia B = 16 and coagulation disorders other than hemophilia = 16) were transfused with liquid cryoprecipitate, locally produced, lyophilized cryoprecipitate, imported from São Paulo (Brazil) and factor VIII and IX, imported from Rio de Janeiro (Brazil), Europe, and United States. Thirty six (22%) tested HIV seropositive. The univariate and multivariate analysis (logistic model) demonstrated that the risk of HIV infection during the study period was associated with the total units of acellular blood components transfused. In addition, the proportional contribution of the individual components to the total acellular units transfused, namely a increase in factor VIII/IX and lyophilized cryoprecipitate proportions, were found to be associated with HIV seropositivity. This analysis suggest that not only the total amount of units was an important determinant of HIV infection, but that the risk was also associated with the specific component of blood transfused.

[The epidemiological aspects of HIV/AIDS in Brazil]. / Aspectos epidemiológicos da AIDS/HIV no Brasil.

A trend analysis of the AIDS epidemics in Brazil is presented, emphasizing temporal changes among the population groups most affected. Regional comparisons as well as projections of the extension of HIV infection and AIDS cases are also reported. Amongst the most relevant conclusions the alarming increase of cases in heterosexual populations and intravenous drug users is emphasised, specially in the southeast region.

[Temporal study in AIDS-associated disease in Brazil, 1980-1999]. / Estudo temporal das doenças associadas à AIDS no Brasil, 1980-1999.

Trends in annual incidence of reported AIDS-associated opportunistic infections (OI/100 adults > 12 years old) among AIDS cases were estimated at the national level in Brazil from 1980 through May 1999. The analysis included chi-square and linear regression modeling. The opportunistic infections included: candidiasis (CD), tuberculosis (TB), Pneumocystis carinii pneumonia (PCP), neurotoxoplasmosis (NT), Kaposi sarcoma (KS), cryptococcal meningitis (CM), and protozoa infections (PI). The overall cumulative incidence rates/100 reported AIDS cases were: CD = 59, TB = 26, PCP = 23, NT = 15, KS = 5, CM = 4, and PI = 4. Annual trends indicated a statistically significant decline in all OIs. However, in the Northeast and Central-West regions there were increases in TB (b = 0.39) and NT (b = 0.20), respectively. TB showed a higher incidence among individuals with less schooling (< 8 years), while PCP and KS had higher incidence rates among those with 8 or more years of schooling, despite similar downward trends. Access to antiretroviral therapy and OI prophylaxis may partially explain these results. However, data reliability, delay in reporting, OI incidence after AIDS, and reporting and diagnostic criteria are factors that also need to be carefully assessed.

Health care utilization and survival among patients with AIDS in Belo Horizonte, Minas Gerais, Brazil.

A historical cohort study was conducted in three public AIDS referral services in Belo Horizonte, Minas Gerais, to assess the relationship between health care utilization and patient survival following AIDS diagnosis. A review of medical and laboratory records was performed for HIV-infected patients seeking care for the first time in 1989-92. Among 291 patients initially categorized as 'A' [asymptomatic, acute HIV, or persistent generalized lymphadenopathy-PGL] or 'B' [symptomatic, non-'A', or AIDS-indicator conditions] (CDC, 1992) and who progressed to AIDS, 57.0% died. Mortality rate was 34.9 person-months. Overall median survival time following AIDS diagnosis was 14.3 months. Multivariate analysis showed that lack of AZT use (RR=1.87; 95% CI=1.34-2.61), advanced initial staging (RR=1.68; 95% CI=1.20-2.35), 9 or more inpatient days (RR=1.55; 95% CI=1.11-2.17), and intervals between outpatient visits longer than 6 months (RR=0.30; 95%CI= 0.16-0.56) were associated with death. The analysis suggests that: Patients who used health services more often had poorer prognosis; Patients who received AZT survived longer than those who did not; and variables used to assess health care utilization actually express the end of a process involving seeking and obtaining care.

[Association between socioeconomic factors and infant deaths due to diarrhea, pneumonia, and malnutrition in a metropolitan area of Southeast Brazil: a case-control study]. / Associação entre fatores sócio-econômicos e mortalidade infantil por diarréia, pneumonia e desnutrição em região metropolitana do Sudeste do Brasil: um estudo caso-controle.

A population-based case-control study was carried out to identify determinant factors for post-neonatal infant deaths due to diarrhea, pneumonia, and malnutrition in Greater Metropolitan Belo Horizonte, Southeast Brazil. From May 1, 1991, to April 30, 1992, 511 post-neonatal deaths due to diarrhea, pneumonia, and malnutrition were selected after investigation of medical records to validate cause of death. Of this total, 396 deaths were compared to a neighborhood control group, matched for age. The study was carried out in a low-income area with a high proportion of families living in shantytowns. The article discusses the methodology and selected socioeconomic factors. Logistic regression analysis indicated that number of household appliances, mother's and father's education, and mother's marital and work status were significantly associated with risk of infant death, i.e., they were determinants of infant deaths due to avoidable causes.

[Mansonic neuroschistosomiasis: clinical, laboratory and therapeutic aspects]. / Neuroesquistossomose mansônica: aspectos clínicos, laboratoriais e terapêuticos.

The authors report 16 patients bearing the meningomyeloradicular form of Mansonic neuroschistosomiasis diagnosed according to clinical, laboratorial and image criteria. Patients have been observed at the Neurology Ambulatory of the Federal University of Bahia, within the period of April/91 to December/93. They have been treated with praziquantel, associated to corticosteroids. The aim has been to evaluate the drug's efficiency and safety in decreasing the neurological signs and symptoms.

[Utilization of prescribed drugs by HIV infected individuals: qualitative approach]. / Utilização de medicamentos por indivíduos HIV positivos: abordagem qualitativa.

OBJECTIVE: The assessment, in its qualitative dimension, of the utilization--by HIV infected individuals--of selected prescribed drugs during the process of the search for and the obtaining of care in public health services in Belo Horizonte, Brazil. METHODS: Fifty two semi-structured interviews with patients, health care workers and non-governamental organizations volunteers were carried out and 1,079 medical records were reviewed. Data were obtained on the utilization of prescribed drugs by HIV infected individuals, whose first visit to one of the public services studied occurred between January 1989 and December 1992. Problems related to the use of anti-retroviral and/or opportunistic infection medication were identified and a qualitative description of their possible causes and consequences was commented on. RESULTS: Refusal to use, difficulty in obtaining and in complying with the prescription were the main problems related to anti-retroviral drug use. Causes for such problems included: fear or occurrence of side effects, large number of daily capsules/pills, insufficient and/or irregular distribution of drugs by the public health services and the high cost of anti-retroviral therapy. Based on the reports, the main consequences are likely to be no or late use of anti-retroviral drugs, an increase in resistance and a worsening of the clinical course of the infection. Other problems identified were: self-medication, difficulty in obtaining medications for associated pathologies and in complying with sulfa prescription. CONCLUSION: A better understanding of the main obstacles and difficulties experienced by the user of the services, from the moment of the prescription and throughout the treatment, may contribute to an improvement in compliance and the availability and adequate distribution of drugs.

[Analysis of agreement between coding of underlying cause of death by traffic accidents]. / Análise da concordância da codificação de causa básica de óbito por acidentes de trânsito.

OBJECTIVE: An evaluation of information researched as to basic underlying cause of death by traffic accidents and a comparison with codings attributed on the basis of death certificates. MATERIAL AND METHOD: The official coding of underlying cause of death on Death Certificates was compared with coding based on primary data obtained from five hospitals and accident reports. Kappa statistics with 95% CI were used to assess the agreement between the two coding systems. RESULTS: The research covered 1,719 patients. 57 of whom died. Of these 57 deaths, the official coding for 50 was obtained. Data showed an underreporting of deaths by traffic accidents, since 32% of the 50 deaths were coded as non-specific accidents (E928.9) There were also 38% of deaths coded as non-specific traffic accidents (E 819.9). Using primary data, non-specific traffic accidents dropped to 4%, accidents to pedestrians (E814.7) being responsible for 48% of deaths. The Kappa coefficient (0.124), with 95% confidence interval (-.1533-0.4022) was calculated to assess the inter-rater reliability between the two codings, which was considered poor. CONCLUSION: It is concluded that coroners, who perform autopsies on casualties of traffic accidents, should dedicabe greater effort to filling out Death Certificates correctly.

[Mortality caused by pneumonia in children under 5 years of age in a locality of the State of Minas Gerais (Brazil), 1979-1985]. / Mortalidade por pneumonia em crianças menores de cinco anos de idade em localidade do estado de minas gerais (Brasil), 1979-1985.

Death rates due to pneumonia in children under five years old in Belo Horizonte, Minas Gerais State, Brazil, during the period from 1979 to 1985, were studied on the basis of official reports and death certificates. The data show that mortality was 35 times higher in Belo Horizonte than in developed countries in 1979. The annual reduction in the death rate in Belo Horizonte over the same period was two-thirds of that observed in the developed countries. The death rate was higher among children from lower-income families and those living in poor areas of the city, at least during 1985, but the difference was not statistically significant (Z = 1.2, p less than 0.05).