Modelling the population control of the domestic cat: an example from an island in Brazil.

The domestic cat is an invasive species that often causes great impacts where introduced due to its high predatory and reproductive potential, especially on islands. In this study, carried out on Ilha Grande (RJ, Brazil), we aimed to: i) estimate the population density of domestic cats, ii) calculate the number of animals preyed upon annually by domestic cats, and iii) evaluate the efficiency of methods to control the cat population. We used the Vortex program to project the population growth of domestic cats in fifty years, and simulated different scenarios of population control (without control, castration, spay and harvest). Population density of owned cats was 662 cats/km². The annual predation rate was 1.97 prey animals/cat which is an average of 1497.96 prey/year. The population would only be reduced if 70% of females were spayed or removed annually. Measures to control the domestic cat population must be undertaken urgently, since uncontrolled growth of this predator has the potential to seriously impact the biodiversity of Ilha Grande.

Implementation of a systematic approach to diabetes in primary care in Bahia, Brazil improves metabolic outcomes: PRODIBA-Programa de Interiorização da Assistência ao Diabetes na Bahia (Project for Dissemination of Diabetes Care in the State of Bahia).

BACKGROUND: Staged Diabetes Management (SDM) improves glycaemic control and reduces diabetes-related complications in primary care. METHODS: An 18-month randomized controlled cohort study was conducted in two municipalities in the state of Bahia, Brazil, involving 100 patients with Type 2 diabetes in each municipality. In one municipality, healthcare professionals were trained to use SDM customized protocols for clinical decisions and, in the other municipality, no protocols for diabetes care were implemented. We hypothesized that, in the municipality with SDM trained professionals, patients would have better outcomes, including a fall in glycated haemoglobin (HbA(1c)). RESULTS: Improvements in some metabolic parameters were observed in the SDM group, including a 22% decrease in mean random glucose, a significant 15% decrease in mean HbA(1c), a 6% decrease in systolic blood pressure and an 11% decrease in diastolic blood pressure. There were no differences in body mass index and lipid profile. CONCLUSIONS: SDM customized algorithms are effective, practical and easy to use in primary healthcare teams with very limited resources.

Capture-recapture method to estimate lower extremity amputation rates in Rio de Janeiro, Brazil.

OBJECTIVE: To estimate rates of lower extremity amputations (LEAs) in persons with peripheral vascular disease, diabetes mellitus, trauma, neoplasm, osteomyelitis, or emphysematous gangrene. METHODS: Regional amputee registries were used to estimate the rate of lower extremity amputations with the capture-recapture (CR) technique. Data were extracted from three amputee registries in Rio de Janeiro: source 1, with 1,191 cases from 23 hospitals; source 2, with 157 cases from a limb-fitting center; and source 3, with 34 cases from a rehabilitation center. Amputee death certificates from source 1 identified 257 deaths from 1992 to 1994. Three CR models were evaluated using sources 2 and 3. In order to avoid an overestimation of the rate of LEAs, two models were applied for the data analysis: in one case, deceased patients listed in source 1 were excluded from the model, and in the other case, deceased patients were included as well. RESULTS: Excluding the 257 deaths, the estimated number of amputations in the municipality of Rio de Janeiro from 1992 to 1994 was 3,954, for a mean annual incidence rate of 13.9 per 100,000 inhabitants. Among persons with diabetes, the annual incidence rate of lower extremity amputations was substantially higher (180.6 per 100,000 persons per year), representing 13 times the risk of individuals without diabetes. The yearly rate of LEAs according to the routine surveillance system was estimated at 5.4 and 96.9 per 100,000 in the general population and in diabetics, respectively. If data from the three registries are added, 1,382 patients with LEAs were identified, with the reasons for the amputations distributed as follows: peripheral vascular disease = 804 (58.1%); diabetes mellitus = 379 (27.4%); trauma = 103 (7.4%); osteomyelitis = 44 (3.1%); gangrene = 36 (2.6%), and neoplasm = 16 (1.1%). CONCLUSIONS: These findings show a high incidence of LEAs in Brazil, when compared to countries such as Spain, that is attributable mainly to peripheral vascular disease and diabetes mellitus.

Mortality attributed to myocardial infarction in the male and female population of Salvador, BA, between 1981 and 1996.

OBJECTIVE: To describe according to gender the trend in mortality attributed to myocardial infarction (MI) in the population of Salvador, Bahia between 1981 and 1996. METHODS: This study was on mortality due to MI estimates by period and gender of the city of Salvador, Bahia. Data from 1981 to 1996 were stratified by quadrienia, and the percentage reduction in death rate due to MI relative to the preceding period (PRR) was determined. Comparisons between genders were expressed by the male/female death ratio (DR) based on the gender-related PPR. RESULTS: An overall increase of approximately 8% was observed in the death rate attributed to MI for the period 1985-1988 (89.2/10 5 individuals / year) versus the period 1981-1984 (82.1/10(5)/ year). In the subsequent periods, overall reductions of 10% and 20.3% were observed for the periods 1989-1992 and 1993-1996, respectively. For men, the PPRs were 11.1 in the period 1989-1992 and 22.7% in the period 1993-1996. The PPRs in women were lower: 8.6% and 17.4% between 1989 and 1992, and 1993 and 1996, respectively. Death rate reduction was greater for men than women, then the male/female DR decreased from 1.66 in 1981-1984 to 1.35 in 1993-1996. CONCLUSION: The results indicate a trend towards a reduction in the death rate attributed to myocardial infarction in the city of Salvador from the second half of the 1980s onwards, striking in men.

[Association of signs and symptoms with cerebral neoplasms in infancy] / Associação de sinais e sintomas com neoplasias cerebrais na infância.

OBJECTIVE: To validate groups of cerebral neoplasia symptoms/signs capable of performing diagnosis of children with neoplasia, with a higher reliability. METHODS: Cross-sectional survey, clinical-epidemiological, and double-blind survey for cerebral neoplasia diagnosis based on data from encephalic and cranial computered tomography scanning (ECCT) and/or magnetic resonance imaging (MRI) services in the state of Bahia, first semester of 1995. A total of 753 children from 1 to 15 years of age, with exams and information regarding symptoms/signs were included. These were classified in 4 groups (1 to 4), according to location of the cerebral tumor. The ECCT and/or MRI were the gold standard and independent evaluation for each group. Basic calculation: sensibility, specificity, negative and positive predictive values (PPV), accuracy, pretest prevalence, and confidence interval (CI) at 95%. Complementary: Bias, odd ratio (OR), prevalence ratio (PR) and Kappa (k) with qualification of validation. RESULTS: 34 cases of tumors were detected, with the loss of one; prevalence of 4,4%. Evaluation results >/= 90% for group 2 symptoms/signs (ataxia and/or cranial nerves palsy), except PPV = 82%; elevated k, and "optimal" evaluation. It was the best tumor predictive group. The prevalence CI was significant, with small amplitudes. Group 3 (endocrine/visual dysfunction), was optimal for k, but with a lower PPV. CONCLUSION: Symptoms/signs of group 2 are important for cerebral tumor diagnosis, followed by group 3. A complete anamneses and neurological examination of children with cephalea and/or seizures are important for screening and reference to bioimaging services. High number of normal exams increases assistance costs, becoming a negative factor for children who really need the exams.

[Estimated prevalence of cerebral neoplasm of childhood from the capture-recapture method]. / Estimativa da prevalência de neoplasia cerebral na faixa etária pediátrica pelo método de captura-recaptura.

The aim of the study was to estimate the prevalence and fatality rate of primary cerebral neoplasms among children between 1 and 15 years old, State of Bahia, Brazil, 1995. It was a cross-sectional study which includes all cases of brain tumors diagnosed by several sources. From these cases the capture-recapture method was used to estimate the probable number of cases and measure the prevalence and confidence intervals at 95%. By this method it was estimated the existence of 87 cases (CI = 64; 111) of brain tumors in the State, being 72 (CI = 54; 91) in the capital. The estimated prevalence was 1.85/100,000 for children between 1 to 15 years old (CI = 1.36; 2.36/100,000) for the State, and 10.1/100,000 (CI = 7.58; 12.77/100,000) for the capital. The fatality rate was 5.4 percent (CI = 4%; 8%), and 8.9% (CI = 7%; 13%) for the capital and the State respectively. The capture-recapture method showed high precision to estimate the total number of cases. Possible causes of no diagnostic nor treatment of cerebral neoplasms are discussed.

[Clinical epidemiological aspects of cerebral neoplasms in childhood in the State of Bahia, Brazil]. / Aspectos clínico-epidemiológicos das neoplasias cerebrais na faixa etária pediátrica no estado da Bahia, Brasil.

The aim of this study is to describe the relevant aspects of the medical treatment and epidemiology of brain tumors in children between 1 and 15 years old in the State of Bahia, Brazil, first semester of 1995. A cross-sectional design was used for the survey of all new cases and preexisting cases of brain tumors diagnosed through neuroimage among all the children who completed these examinations. Forty eight out of 2,128 were diagnosed as brain tumors, 19 of which being incident cases. In the clinical epidemiological study, the prevalence was 2.3 percent, and the incidence was 0.9 percent. In the prevalent cases, males predominated (1.4:1), and the average age of 10-15 years old (65%). Among the 1-4 years old group predominated incident cases. The astrocytoma was the most frequent brain tumor (41%), and the supratentorial localization predominated by 52%. The ataxia and/or paralysis of cranial nerve and the endocrine and/or visual disturbance symptomatic groups were the most prevalent (82% and 43%, respectively). We discuss the supratentorial localization and the adolescent group predomination in cerebral neoplasms in childhood.

[Prevalence of dyslipidemias in adult ambulatory laboratory tests from different health care providers]. / Prevalência de dislipidemias na demanda laboratorial de três diferentes prestadores de assisência.

OBJECTIVE: To detect differences in the prevalence of dyslipidemia in adult ambulatory laboratory tests from three different health care providers, in Salvador-Brazil, 1995. METHODS: The study was carried out using a probabilistic sample of 24 out of 104 laboratories (approximately equal to 25%) which performed the same enzymatic method for lipid tests with the same quality control. Laboratory tests results were separated into three groups, according to health care provider: Sistema Unico de Saúde (SUS, governamental), Health Maintenance Organizations (HMO), and Private or Patients Health Insurance (PHI). Criteria for dyslipidemias in mg/dl were: total cholesterol > or = 240; LDL-c > or = 160; HDL-c < 35 and triglycerides > or = 200. Prevalence rates, 95% confidence intervals (CI) and chi (2) test were used in the analysis. RESULTS: From the 5464 adult subjects, 14.8% were from SUS, 31.6%. from HMO and 53.6% PHI. The highest prevalence for hypercholesterolemia--28.0% (CI 24.0; 32.0) and for LDL-c > or = 160mg/dL--30.4% (CI 27.6; 33.2), were found in the HMO group. PHI had the highest prevalence for HDL-c < 35mg/dL--12.3% (CI 10.0; 13.8), and for hypertrygliceridemia--17.8% (CI 16.3; 19.3). Most of the differences among health providers were statistically significant. CONCLUSION: The best lypid profile observed in subjects from SUS suggests social differences in the prevalence of dyslipidemias. As compared to other dyslipidemias, HDL-c < 35mg/dL prevalence was lower than expected in all three groups. The data may provide insights to medical doctors and other health care professionals regarding the questions of dyslipidemias. It can also provide objective information to the patients and encourage them to change their life styles.

Prevalência de dislipidemias na demanda laboratorial de três prestadores de assitência / Prevalence of dyslipidemias in adult ambulatory laboratory tests from different health care providers

OBJETIVO - Detectar diferenças nas prevalências das dislipidemias em adultos da demanda laboratorial de três diferentes prestadores de assistência médica, em Salvador, 1995. MÉTODOS - Estudo seccional, clínico epidemiológico, baseado em resultados das dosagens de lípides séricos de uma amostra probabilística de 25 'por cento' dos 104 laboratórios que usavam o mesmo método de dosagem e o mesmo padräo para controle de qualidade. O critério de dislipidemias foi o do II Consenso Brasileiro de Dislipidemias para adultos. Os resultados foram agrupados conforme procedência: Sistema Unico de Saúde (SUS), convênios (C) e seguros privados + particulares (SP). Análise: prevalência com intervalos de confiança (IC) a 95 'por cento', e teste do X². RESULTADOS - Dos 5.464 adultos com mensäo da procedência, 14,8 'por cento' do SUS, 31,6 'por cento' dos C e 53,6 'por cento' S + P. As mais elevadas prevalências de hipercolesterolemia - 28,0 'por cento' (IC 24,0; 32,0) e de LDL-c elevado - 30,4 'por cento' (IC 27,6; 33,2) foram detectados no grupo C. No grupo S + P concentram-se as maiores prevalências de HDL-c anormal - 12,3 'por cento' (IC 10,0; 13,8) e hipertrigliceridemia - 17,8 'por cento' (IC 16,3; 19,3). Quase todas as diferenças entre as prevalências foram estatisticamente significantes, favoráveis às taxas mais baixas do SUS. CONCLUSÄO - O melhor perfil lipídico do grupo SUS sugere diferenças sociais nas prevalências das dislipidemias. Para os três prestadores de assistência, a prevalência do HDL-c menor que 35mg/dL foi baixa quando comparada às das demais dislipidemias. Os resultados podem ser inferidos para a prática médica dos respectivos prestadores de assistência e indicam a necessidade de informaçäo e de orientaçäo dos usuários para a reduçäo das dislipidemias e melhoria do estilo de vida.

Prevalência de dislipidemias em adultos da demanda laboratorial de Salvador, Brasil / Prevalence of dyslipidemias in non-hospital laboratory tests of adults from Salvador, Brazil

OBJETTIVO - Determinar a prevalência das dislipidemias em adultos da demanda laboratorial não-hospitalar da cidade de Salvador (BA). MÉTODOS - Casuística procedente de amostra probalística de 25 'por cento' dos laboratórios não-hospitalares da cidade que usavam o método enzimático para dosagem dos lípides séricos e controle de qualidade da Sociedade Brasileira de Patologia Clínica (93 'por cento'); LDL estimado pela fórmula de Friedewald. Sorteados os meses ímpares de 1995 para o estudo. Critérios para dislipidemias, em mg/dl: colesterol 'maior ou igual' 240; LDL 'maior ou igual' 160; HDL 'menor' 35 e triglicérides 'maior ou igual' 200. Análise: prevalências. seus intervalos de confiaça (IC) a 95 'por cento' e qui-quadrado (X²). RESULTADOS - Excluídos uma recusa e um laboratório que arquivava laudos só por 3 meses, foram analisados dados de 24 dos 26 laboratórios amostrados. Dos 7392 adultos, 65,5 'por cento' eram mulheres. Prevalências estimadas e valores ... "Fórmulas"... Todas as prevalências diferiram significantemente inter-gênero (p,0,05 a p<0,001). Também foram mais freqüentes nas mulheres os níveis indesejáveis do colesterol e LDL. CONCLUSÄO - As dislipidemias são importante fator de risco para aterosclerose na demanda laboratorial de Salvador em ambos os gêneros. Os resultados subsidiam os médicos para incentivar mudanças no estilo de vida que conduzam seua pacientes a níveis lipídicos desejáveis

[Race, compliance to treatment and/or consultation and control of arterial hypertension]. / Raça, aderência ao tratamento e/ou consultas e controle da hipertensão arterial.

PURPOSE: To compare racial differences on hypertension (Hy) control and compliance to appointments and/or treatment. METHODS: Between November/94 to January/95, 200 low social strata hypertensive outpatients were interviewed (cross-sectional clinical-epidemiologic study) and had their blood-pressure measured (double-blind) in Salvador, Brazil. Compliance to treatment criteria: > or = 50% appointments/year; compliance to treatment = Hy control-WHO and NIH criteria. Means, frequency ratios (FR) and chi 2 were used in the analysis. RESULTS: Most of the hypertensives (88%) were women. Race: 45.5% were mulatoes (M) and 40.5% blacks (B). Compliance to appointments and treatment (A + T) was 30.5%, to treatment (T) 11%, to appointments, 37%, and noncompliance = 21.5%. Compliance was 53.6% for whites (W) and 19.7% for B (p < 0.001); 40% of hypertensives were controlled by WHO criteria and 24% by the NIH (p < 0.001). Frequency ratios for SBP, NIH criteria: W/B = 2.9, W/M = 2.6; WHO: W/B and B/M = 1.7 and for DBP, NIH criteria: W/B = 1.6, W/M = 1.9 and WHO = W/B and W/M = 1.4. Main reason for compliance = Hy control; main reason for noncompliance forgetting the appointment date and/or disease in the appointment day. CONCLUSION: Compliance to appointment did not seem an advantage for treatment adherence and the results pointed out some characteristics of patients that need special attention to improve appointments and treatment compliance.

[Prevalence of dyslipidemias in adults in laboratory tests from Salvador, Brazil]. / Prevalência de dislipidemias em adultos da demanda laboratorial de Salvador, Brasil.

PURPOSE: To determine the prevalence of dyslipidemia in non-hospital laboratory tests of adults from Salvador, Brazil. METHODS: The study was carried out in subjects from a probabilistic sample of 25% of a total of 104 local laboratories that used the same enzymatic method for lipid analysis with the quality control as recommended by the Brazilian Society of Clinical Analyses. These represented 93% of all non-hospital laboratories of Salvador in 1995. The odd months of 1995 were selected for sampling in the present study. Criteria for dyslipidemias were: total cholesterol > or = 240; LDL > or = 160; HDL < 35 and triglycerides > or = 200 mg/dl. Prevalence rates and their 95% confidence intervals (CI) and chi 2 test were used in the analyses. RESULTS: Tests from two of the 26 laboratories were not used in the analyses due to file problems or refusal. 7,392 adults were screened, 65% female. We observed prevalence (95% CI) of hypercholesterolemia in 30.0 (27.8; 32.2)%, high LDL in 30.1 (30.8; 35.4)% and hypertriglyceridemia in 30.4 (29.0; 31.4)% of the females. As to the male subjects, prevalences were; 24.0 (20.5; 27.5)% for hypercholesterolemia, 26.1 (22.4; 29.3)% for high LDL, 27.6 (25.7; 29.5)% for hypertriglyceridemia. All gender differences were significant. Low HDL occurred in 15.9 (14.2; 17.8)% of males and in 8.0 (7.1; 8.9)% of females. CONCLUSION: Dyslipidemia is an important risk factor observed in non-hospital laboratory tests of men and women in Salvador. Our data may provide physicians and other health care professionals with objective information to encourage life-style changes.

[Acute embolic stroke treated with rt-PA during elective coronary angiography]. / Acidente vascular cerebral isquêmico agudo embólico tratado com rt-PA durante cinecoronariografia eletiva.

A 56-year-old female with unstable angina, presented an acute embolic ischaemic stroke of right medium cerebral artery during elective coronary angiography. Complete patency was achieved after an intraarterial infusion of rt-PA (60mg/60min) with important functional improvement.

[Liver cirrhosis in Brazil: mortality and productive years of life lost prematurely]. / Cirrose hepática no Brasil: mortalidade eanos produtivos de vida perdidos precocemente.

This descriptive study was done using official data on mortality from cirrhosis of the liver for the year 1989. Its objectives were: (a) to describe mortality from cirrhosis of the liver in Brazilian adults; (b) to estimate the productive years of life lost (PYLL) prematurely (between 20 and 59 years of age) from this cause; and (c) to identify any regional differences in mortality or PYLL. The crude data were adjusted by age and sex, using the 1980 population of Brazil as the standard. Calculation of PYLL was based on the formula of Romeder and McWhinnie for years of potential life lost, modified by the author to express productive years of life lost. The crude death rates were higher in the Southeast and North, and in all regions they were higher in males, the countrywide male/female ratio being 4.5. Mortality rates among males varied from 14.37 per 100,000 in the Center-West to 35.86 per 100,000 in the Southeast; for females the rates ranged from 3.49 to 8.5 per 100,000 in the Center-West and North, respectively. The mortality curves by age for men showed a decline or stabilization after age 60, except in the North. For men in that region, the curve continued to rise, and the rate reached 86.37 per 100,000 after age 70. The curves for women also rose, most markedly in the North and Northeast. The age-adjusted rates showed a reduction for women in the Southeast, while rates in the North remained higher. Mortality from cirrhosis of the liver accounted for 48.7% of deaths from disorders of the digestive system among men and 24.1% among women. Of the 138,860 PYLL from cirrhosis of the liver in 1989, 83.2% were lost among males, while the average for the country, around 15.5 years, was similar for both sexes. However, the average PYLL for men and women in the North and women in the Center-West was much higher than in the other regions. The data suggest that cirrhosis of the liver among men in all the regions, except the North, is probably attributable to alcoholism. Among males from the North, there is strong evidence that cirrhosis with a viral etiology (hepatitis B and C virus) also exists. For women, the evidence suggests that cirrhosis of viral etiology predominates.

[Non-communicable chronic diseases in Brazil: from risk factors to social impact]. / Doenças crônicas não-transmissíveis no Brasil: dos fatores de risco ao impacto social.

The current epidemiologic profile of Brazil includes both the diseases of underdevelopment and those associated with modern life. Consequently, the country faces the difficult task of carrying out health promotion and protection activities aimed at controlling communicable diseases as well as noncommunicable chronic diseases (NCDs). This study sought to describe the epidemiologic situation of Brazilian adults with regard to NCDs and to present available data on the quality of care provided for these diseases and their social impact. To these ends, a literature review was conducted for the period 1964-1995--that is, since the beginning of the production and dissemination of data on cardiovascular diseases, cancer, and diabetes. Of the 153 bibliographic references that were discovered, 97 were used. The social, political, economic, and health inequities that exist among Brazil's geographic regions are reflected in the national scientific production, which is concentrated in the Southeast and South. Most of the studies based on primary data come from those regions. Information is scarce from the North-east, except the city of Salvador. Therefore, the health profile of adults--including risk factors and morbidity and mortality--can be better delineated for residents of the South and Southeast of the country, whereas for the other regions the necessary information is practically nonexistent. Risk factors linked to life-style are as widespread and important in Brazil as they are in industrialized countries. Prevalence and mortality rates among persons with or without certain socio-environmental risks (such as low level of schooling or unskilled occupations) indicate that NCDs predominate in the lowest social strata. Inter-regional differences in the prevalence of arterial hypertension and diabetes mellitus, the most common fatal cardiovascular causes, and the predominant cancers, as well as morbidity and mortality in both sexes, illustrate the political, social, and economic inequities of development in each region. Comparisons with other countries of the incidence of cardiovascular diseases in a capital in the Northeast or mortality from cardiovascular diseases in the capitals in the South and Southeast show, in the first case, that Salvador has the highest incidence among the Western countries analyzed and, in the second case, that the mortality data rank among the top seven. Cardiovascular diseases and diabetes show increasing trends, with the exception of a small decline for ischemic heart disease and cerebrovascular disease in the municipality of São Paulo. Deaths rates in hospitals from specific cardiovascular diseases and avoidable complications of diabetes are high, especially among indigent patients as opposed to private patients. Premature mortality, as measured by productive years of life lost, reflects the poor quality of medical care and the absence of targeted control programs. These data, combined with other sources of information, such as consents for treatment and pensions paid for illness, give some idea of the impact of NCDs on the society. The authors point to the basic research that could be done in all the country's regions to serve as a basis for planning and implementing populational strategies to reduce risk factors and to treat and control chronic noncommunicable diseases in Brazil.

Trends in relative mortality from cerebrovascular diseases in Brazilian state capitals, 1950-1988.

This article seeks to describe trends in relative mortality from cerebrovascular diseases (CVDs) in Brazilian state capitals from 1950 through 1988. Absolute numbers of deaths from all causes; from CVDs; and from ill-defined signs, symptoms, and afflictions were obtained from official Brazilian mortality statistics. In calculating relative CVD mortality, deaths from ill-defined signs, symptoms, and afflictions were excluded. The collected data permitted calculation of relative CVD mortality in most state capitals for 1950, 1955, 1960, 1961-1965, 1966-1970, 1971-1975, 1977-1980, 1981-1985, and 1986-1988. During the study period CVD mortality was found to play an increasing role in overall mortality in all the state capitals. Regional grouping of data showed greater relative CVD mortality in the South and Southwest Regions toward the start of the study period. However, over the course of this period the part that CVD mortality played in overall mortality grew most rapidly in the less-developed North, Northeast, and Center-West Regions. In general, relative CVD mortality data in nearly all the state capitals demonstrate the attention that needs to be devoted to CVDs within the context of adult public health. In particular, there is a clear need to greatly strengthen and improve the marginal existing programs for detection and control of hypertension and diabetes in Brazil. This should be done by assessing international experience with programs of this type and adapting that experience to Brazilian conditions. Beyond that, it will be important to support health promotion and protection efforts that can deal with risk factors and secure prevention through lifestyle modification--something that can provide benefits in dealing not only with CVDs but also with diabetes, obesity, and certain neoplasias.

[Race and left ventricle hypertrophy without hypertension and pulmonary heart disease]. / Raça e hipertrofia do ventrículo esquerdo na ausência de hipertensão e de doenças cardiopulmonares.

PURPOSE: To analyze the association between black people and left ventricular hypertrophy (LVH) in the absence of hypertension and/or other cardiopulmonar disease. METHODS: Data were collected from necropsies carried out in the Anatomopathologic Service (APS). Hospital Edgard Santos from 1970 to 1986, Salvador. It were included only subjects at ages > or = 20 years and free of hypertension and any cardiopulmonar disease. A LV wall > 1.6cm was considered as LVH (standardized criteria of the APS). Controls variables were age, sex, and absence of the mentioned diseases. It was used a case-control epidemiological study design and the association measured by "odds ratio" (OR) for no matched case-control study. RESULTS: From the 208 subjects studied, 48 (23.1%) had LVH. There was no difference in the frequency of right ventricular hypertrophy between cases and controls (p > 0.05). The mean of heart weight was higher for LVH cases (p < 0.001), but there was no evidence of association between blacks and LVH (OR = 1.05, p > 0.05 and confidence interval at 95% = 0.8, 1.31. The highest odds possible for the association in this study (assuming that all 3 LVH losses were black subjects) would be 1.5, also no statistically significant. CONCLUSION: In the absence of hypertension and other cardiopulmonar diseases, LHV is common in necropsies in Salvador, Brazil, with similar frequencies in blacks, whites and mullatos and seems not be a risk factor for hypertension in black people.

HTLV-1 and myelopathy in Salvador (northeastern Brazil): a case control study.

The principal aim of the study was to determine the degree of association between cerebrospinal fluid (CSF) that is positive for HTLV-1 and myelopathy in Salvador, Brazil. From the same hospital, twenty-eight cases of myelopathy and twenty-eight cases showing no neurological disorder were studied using blind selection matched 1:1 by age and sex. The twenty-eight pairs underwent HTLV-1 serology tests. In those with a positive result, anti-HTLV-1 antibodies were investigated in the CSF. The ELISA method was used, complemented by the Western-blot test. Myelopathy was considered associated with HTLV-1 only when the CSF was positive indicating neurotropism of the virus. The mean age of the cases was 44.6 +/- 15.6 years and the control group was 43.5 +/- 16.0 (p > 0.05). An OR of 9.0 was detected with a reliability interval (95%) of 1.652-48.866 and chi-square significant at the 0.02 level. Despite a strong degree of association and considering the low level of precision, there is a need for analytical studies with larger samples which besides improving the precision will allow for greater control of the confounding variables.

[Cerebrovascular diseases as multiple cause of death in Salvador: magnitude and space differences of mortality omitted in official statistics]. / Doenças cerebrovasculares como causa múltipla de morte em Salvador. Magnitude e diferenças espaciais da mortalidade omitida nas estatísticas oficiais.

Social inequalities and the excess (%) in mortality by cerebrovascular diseases (CVD) unregistered in the official death statistics were studied in Salvador, Brazil, 1988. In an ecological spacial (aggregate) desing, all death mentioning CVD as basic and as associated cause of death were reviewed and distributed, according to their addresses by 66 geographical zones. The mortality rates by CVD (basic+associated) ranged from 22.94 to 376.62/10,000 adults. The mortality fraction not included in the official statistics was 29.1% for Salvador with means between 16.12 and 33.72% in the group of zones of very low to those in the high mortality levels. Seven out of 16 zones included in the 4th quantil showed exceptionally high mortality rates (above those of Salvador + 1.64 x standard deviation corrected by the zones population). The authors discuss possible explanations for the social differences in the mortality profile.

Diferenças na medida da pressäo arterial em primeiras consultas pré e pós-implantaçäo do Programa Nacional de Controle da Hipertensäo / Differences in blood pressure measurement in first consultations pre and post implementation of the National Program of Hypertension Control

Considerando a implantaçäo do Programa Nacional de Educaçäo e Controle da Hipertensäo Arterial em Salvador, em 1990, e a disponibilidade de dados sobre a freqüência da medida da pressäo arterial em primeiras consultas de adultos para o ano de 1982, foram determinadas as diferenças entre estas medidas e as obtidas em 1991, pós-implantaçäo do programa. Os dados foram obtidos dos prontuário médicos dos pacientes adultos de diferentes modalidades assistenciais em censo parcial no dia 15/5/91. Dos 846 adultos atendidos, a PA foi medida em 29,1//, porém, em relaçäo aos mesmos serviços analisados em 1982, a freqüência de medidas atingiu 35,9//, resultando num incremento de 92,0// na freqüência, quando comparada aos 18,7// observados em 1982. Os serviços do Estado, vinculados ao Sistema Unico de Saúde (SUS), apresentaram o pior desempenho, com freqüências reduzidas em 10,7//, em relaçäo a 1982. Também os hospitais sem fins lucrativos, conveniados ao SUS, apresentram baixo desempenho. Pacientes com diagnósticos mal-definidos e os questionados sobre história prévia de hipertensäo arterial tiveram a PA medida em 85,4// e 83,3// dos casos, respectivamente. Os autores discutem a baixa freqüência das medidas pós-implantaçäo do programa e sugerem estratégias para reverter a situaçäo