Assessing levels of uric acid and other cardiovascular markers in prehypertensive and hypertensive adults.

INTRODUCTION: Although some studies have reported the association between uric acid (UA) and hypertension, evidence on prehypertension is still lacking. Therefore, the objective of this study was to determine the levels of UA and other cardiovascular markers among prehypertensive and hypertensive patients and assess their risk for developing arterial hypertension. METHODS: 157 individuals were recruited: 67 normotensive, 23 pre-hypertensive and 67 hypertensive. Blood samples were collected to measure biochemical parameters and anthropometric measurements and blood pressure were evaluated. We calculated the product of lipid accumulation and the visceral adiposity index to assess cardiovascular risk. RESULTS: Our data showed an increase in UA levels in normotensives (4.9±1.3mg/dL), prehypertensives (5.2±1.3mg/dL) and hypertensives (5.9±1.6mg/dL) (p=0.004). We found a higher frequency of hyperuricemia in the hypertensive group (34.3%) than in the normotensive group (13.4%, p<0.05). Hypertensive volunteers had lower levels of HDL-C (p=0.004 and p=0.003) and higher body mass indexes (p<0.001 and p=0.007), glucose (p<0.001 and p=0.033), triglycerides (p=0.001 and p=0.005), visceral adiposity index (p<0.001 and p=0.002) and lipid accumulation product (p<0.001 and p=0.007) than normotensive and prehypertensive participants. We also observed that individuals with UA≥6.2mg/dL had an increased risk of hypertension of 4.77 (p=0.003) compared to individuals with levels≤4.3mg/dL. CONCLUSION: Our results showed that UA is associated with increased blood pressure and unfavorable changes in anthropometric and biochemical parameters, which represent risk factors for hypertension and cardiovascular diseases.

Different visitation frequencies of native and non-native bees to vines: how much vegetation is necessary to improve fruit production?

Pollination is provided by biodiversity and maintains global food production. We investigated the effects of vegetation cover on the abundance of floral visitor and vine (Vitis labrusca Raf.) production. We expected an increase in both floral visitor frequencies and vineyard yields with an increase in native vegetation cover in the landscape. We also investigated different scenarios of visitor abundance with and without honeybees (Apis mellifera L.). We surveyed floral visitors from ten vineyard plots with different native cover surrounding them and related both visitors and native vegetation to fruit set. Considering some of these vineyards, we compared physical and chemical traits of berries to understand how they vary according to native vegetation. Floral visitor abundance was positively related to native vegetation cover. However, considering only native bee abundance, we found a dual (hyperbolic) response. Apis mellifera (L.) Africanized was the most abundant species and had the highest number of interactions; however, when removed from the network analysis, the relationship between vineyards and native bees became more specialized. The fruit size and mass of berries differed among vineyards, as did some chemical traits related to commercial quality of fruits, such as soluble solids, pH and flavonoids. Vineyards surrounded by intermediate areas of native vegetation present a balance between resource availability from vineyards and native vegetation. Apis and non-Apis (such as flies and small bees) floral visitors, known to have different effects on vine pollination, could hypothetically provide variation in vine production and quality. Considering a near 20% native vegetation increment, there was an enhancement, on average, of ten-fold more berries per bunch, the changing physical and chemical fruit traits by vegetation increment could also increase the aggregate value of vines and the value of pollination services in the economy.

Persistence or clearance of human papillomavirus infections in women in Ouro Preto, Brazil.

Persistent high-risk (HR) human papillomavirus (HPV) infection is necessary for development of precursor lesions and cervical cancer. We investigate persistence and clearance of HPV infections and cofactors in unvaccinated women. Cervical samples of 569 women (18-75 years), received for routine evaluation in the Health Department of Ouro Preto, Brazil, were collected and subjected to PCR (MY09/11 or GP5+/6+ primers), followed by RFLP or sequencing. All women were interviewed to collect sociodemographic and behavioral information. Viral infection persistence or clearance was reevaluated after 24 months and was observed in 59.6% and 40.4% of women, respectively. HPVs 16, 33, 59, 66, 69, and 83 (HR) were the most persistent types whereas HPVs 31, 45, and 58 were less persistent. Clearance or persistence did not differ between groups infected by HPVs 18, 53, and 67. In low-risk (LR) types, HPV 6 infected samples were associated with clearance, while HPV 11, 61, 72, or 81 infected samples were persistent in the follow-up. No statistically significant association was detected between persistent HPV infections and sociodemographic and behavioral characteristics analyzed. To study persistence or clearance in HPV infection allows the identification of risk groups, cofactors, and strategies for prevention of cervical cancer.

Human papillomavirus infection in Brazilian women with normal cervical cytology.

We examined the prevalence of human papillomavirus (HPV) infection in a sample of Brazilian women presenting normal cervical cytology. Possible interactions between patient characteristics and HPV infection were analyzed in order to provide background data to improve cervical cancer screening and prophylaxis. Cervical samples of 399 women, received for routine evaluation in the Health Department of Ouro Preto, MG, Brazil, were subjected to HPV-DNA testing by PCR with MY09/11 primers. HPV-positive specimens were typed by RFLP. A structured epidemiological questionnaire was administered to each woman. HPV prevalence among these cytologically normal women was 11%. Twelve viral types were detected, the most common being HPV-16, -6, -61, -83, and -66. HPV was more prevalent in younger women; high-risk viral types were detected in 61% of the infected women and 27% of the infected women had multiple HPV infections. Significant associations of HPV infection were found with age, literacy, residence, marital status, lifetime number of sexual partners, and parity. We detected a great diversity of HPV types in women with normal cytology. This kind of information about local populations is useful for HPV prevention and vaccination strategies.

Host-feeding patterns of potential human disease vectors in the Paraíba Valley region, State of Säo Paulo, Brazil.

Engorged females of Aedes albopictus, Ochlerotatus scapularis, Culex nigripalpus and Culex quinquefasciatus were collected by aspiration and sweep net during two years in Tremembé county, State of Säo Paulo, Brazil. Of the 1,092 specimens analyzed with the precipitin test, 87.6% reacted to one or more of the eight antisera tested. Of the four species for which the host determination was made, the reaction in 98.5% was to a single host. The application of the feeding index for four species of mosquitoes in Tremembe represented an attempt to measure and compare mosquito feeding patterns on these domestic hosts to evaluate the potential risk the region presents for the introduction and dissemination of arthropod-borne diseases. The results of the feeding index showed that Ae. albopictus commonly fed on humans and cattle; Oc. scapularis fed more upon cattleand dogs; Cx. nigripalpus fed on a wide range of hosts, and Cx. quinquefasciatus presented similar behavior but humans and dogs were the most common. The analysis of the feeding index agrees with the reported host feeding patterns of the four species investigated.

Host-feeding patterns of potential humam disease vectors in the Paraíba Valey Region, State of São Paulo, Brazil

Engorged females of Aedes albopictus, Ocherotatus scapularis, Culex nigripalpus and Culex quinquefasciatus were collected by aspiration and sweep net during two years in Tremembé County, State of Sao Paulo, Brazil. Of the 1,092 specimens analyzed with the precipitin test 87,6% reacted to one or more of the eight antisera tested. Of the four species for which the host determination was made, the reaction in 98,5% was to a single host. The application of the feeding index patterns on these domestic hosts to evaluate the potential risk the region presents for the introduction and dissemination of arthropod-borne diseases. The results of the feeding index showed that Ae. Albopictus commonly fed on humans and cattle; Oc. Scapularis fed more upon cattle and dogs; Cx. Nigripalpus fed on a wide range of hosts, and Cx. Quinquefasciatus presented similar behavior but humans and dogs were the most common. The analysis of the feeding index agrees with the reported host feeding patterns of the four species investigated.

[Simplifying the sampling method for evaluating the larval density of Aedes aegypti in São Paulo State, Brazil]. / Simplificação do método de estimação da densidade larvária de Aedes aegypti no Estado de São Paulo.

OBJECTIVE: To suggest changes in the sampling procedures for estimating the larval density of Aedes aegypti in the state of São Paulo, Brazil, by assessing the efficacy and level of complexity of the current procedures. METHODS: The "Superintendência de Controle de Endemias do Estado de São Paulo" - SUCEN's (Superintendence for Endemic Control of the State of São Paulo) sampling procedures for estimating the density of Aedes aegypti larvae was assessed. The Breteau index with one-stage cluster sampling was applied. An average of 35 blocks, 14 buildings per block, of a total of 510 buildings per sample, were assessed. One hundred and eleven samples were obtained in 6 municipalities of São José do Rio Preto. RESULTS: The Breteau index estimates higher than 3 had coefficients of variation smaller than 30% in 71% of the samples. The design effect was 1.19 and 1.79 for indexes lower and higher than 5, respectively. The estimates were obtained in less than 3 days, requiring a daily average of 5.5 men per sampling. CONCLUSION: This sampling design revealed to be a simplified one: fast, economic and easily managed. The operational easiness was due to the use of the one-stage cluster sampling, when there was not need to prepare lists of addresses and then sort and locate the buildings. Though the design effect shows a slight loss of the estimates' accuracy with the use of one-stage cluster sampling, this was proven to be under acceptable range. Simplifying changes in the process of determining the sample size and assessing sampling errors are proposed.

[Leprosy surveillance in Olinda, Brazil, using spatial analysis techniques]. / Vigilância da hanseníase em Olinda, Brasil, utilizando técnicas de análise espacial.

In the State of Pernambuco, Brazil, leprosy has been mainly an urban disease, with an uneven geographical distribution related at least partially to the way urban space has been occupied and transformed. Spatial analysis may thus become an important tool to establish an epidemiological surveillance system for leprosy. Homogeneous micro-areas were defined in the city of Olinda through the integration of two databases, the Population Census and SINAN, and through the use of digital maps and geoprocessing techniques. Census tracts were classified according to a social deprivation index (SDI), and micro-area homogeneity was based on similar values for this indicator. Cluster analysis (K-means) was used to define cut-offs between strata. The same procedure was repeated using the income variable only. When the association was tested between the mean SDI value and the mean leprosy detection rate for the period 1991-1996, the value obtained for r2 was 66.1% in the multiplicative model, increasing to 84.3% when the income variable was used. To define different intervention strategies, census tracts were regrouped in three levels of risk: high, moderate, and low. The methodology enabled the identification (within each health district) of groups and/or areas with different risk of leprosy, hence allowing for the definition of control measures.

[Social inequalities and health services use: evidences from a stratified household survey]. / Desigualdades sociais e uso de serviços de saúde: evidências de análise estratificada.

OBJECTIVE: The study aims to identify children who are not benefited by local health programs, looking for to characterize the excluded segment of the population in order to broaden the access to and use of the main actions provided by local health programs. METHODS: A sample of 465 children aged less than 1 year was studied, living in the year of 1996 in Embu, a city of the metropolitan area of S. Paulo, Brazil. Our hypothesis was that there is a higher availability of private health care resources among families who haven't been using the local health program. The statistical analysis consisted of stratified association analysis to study the heterogeneity between and intra four strata of families defined by different socioeconomic conditions. RESULTS: Although only 85.4% of the study children were enrolled in local health services, 91.2% of them were being benefited by main health care actions. The analysis of differences intra strata revealed that our hypothesis was only corroborated in one stratum. It is in the stratum 3, which concentrates the peripheral population, where we could find children who have not been using the local health program in Embu city. CONCLUSIONS: In the same social segment it was detected some inner heterogeneity among families related to the availability of private resources for their children health care.

Assessing morbidity in the paediatric community.

INTRODUCTION: Morbidity information is easily available from medical records but its scope is limited to the population attended by the health services. Information on the prevalence of diseases requires community surveys, which are not always feasible. These two sources of information represent two alternative assessments of disease occurrence, namely demand morbidity and perceived morbidity. The present study was conceived so as to elicit a potential relationship between them so that the former could be used in the absence of the latter. METHODS: A community of 13,365 families on the outskirts of S. Paulo, Brazil, was studied during the period from 15/Nov/1994 to 15/Jan/1995. Data regarding children less than 5 years old were collected from a household survey and from the 2 basic health units in the area. Prevalence of diseases was ascertained from perceived morbidity and compared to estimates computed from demand morbidity. RESULTS: Data analysis distinguished 2 age groups, infants less than 1 year old and children 1 to less than 5. The most important groups of diseases were respiratory diseases, diarrhoea, skin problems and infectious & parasitical diseases. Basic health units presented a better coverage for infants. Though disease frequencies were not different within or outside these units, a better coverage was found for diarrhoea and infectious & parasitical diseases in the infant group, and for diarrhoea in the older age group. Equivalence between the two types of morbidity was found to be limited to the infant group and concerned only the best covered diseases. The odds of a disease being seen at the health service should be of at least 4:10 to ensure this equivalence. CONCLUSION: It was concluded that, provided that health service coverage is good, demand morbidity can be taken as a reliable estimate of community morbidity.

[Sampling design for the implementation of a national information system on the demand for ambulatory services]. / Delineamento amostral para a implantação de um sistema nacional de informações de demanda ambulatorial.

The principles and planning of a sample of consultations undertaken in the public health services belonging to or financed by INAMPS (Brazilian federal social welfare service), are gave. It was describe the epidemiological profile of the population assisted over a twelve-month period. The sampling technique of clustering in two stages, with probabilities proportional to size (PPS), was used. The health services are the Primary Sampling Unit (PSU) and the estimated number of consultations for each one, over the period, is the measure of its size (Mj). The Brazilian states were taken as strata named domains. The sample size of consultations of Health Services was defined by means of simulations studies. The overall sampling fraction was defined by f = n/N = a.Mj/epsilon Mj.b/Mj; where b = 250. The calculations, which include intervals for the systematic sampling of consultations (Ic) in the second stage of selection, defined by Ic = Mj/(epsilon Mj) : n/N; are also given.