[Molecular biomarkers in cancer: implications for epidemiological research and public health]

Identification of molecular biomarkers is a common result of current cancer epidemiological research. Both genetic and molecular epidemiology have enjoyed impressive developments in recent decades, with important repercussions on traditional epidemiological approaches. In this paper we evaluate the new frontiers of cancer epidemiology, incorporating both genetic and molecular biology approaches. We examine the current knowledge of molecular biomarkers for exposure and susceptibility to cancer, the role of gene mutations in carcinogenesis, and their application to epidemiological studies. By exploring the status of relevant biomarkers, these approaches become effective in evaluating exposure and susceptibility and show enormous potential for elucidating mechanisms of carcinogenesis and the effect of risk factors in cancer. However, these approaches are necessarily more invasive and raise several ethical issues for consideration by both researchers in public health and society as a whole.

[Restructuring of production and occupational accidents in Brazil: structure and trends]

During the last two decades, incidence rates of occupational accidents have been decreasing in Brazil. Mortality has also decreased, but not as sharply as incidence. Changes in reporting of occupational accidents have been the main argument used to explain such trends. This time-series study covering occupational accidents from 1970 to 1995 clearly shows the link between occupational accidents and social and economical determinants. Comparing 14 Brazilian States, a positive linear regression (r=0.80) was detected between proportion of workers in industrial production and accidents. In the 1980s, Brazil's economic recession led to an increase in unemployment. The decline in industrial jobs - those with a higher risk of accidents ( was accented by the restructuring of production and increased use of computer and robotics technologies in various manufacturing sectors. The result was a heavy shift of the work force from industry to commerce and services - jobs entailing lower risk of accidents. These factors influenced trends in occupational accidents in Brazil during this 25-year period.

[Industrial work and lung cancer]

In a hospital-based case-control study, 316 lung cancer cases and 536 controls were interviewed for their occupational, smoking, passive smoking, cancer in the family and residential histories as well as social economic status, by trained interviewers, using a standardized questionnaire. Cases and controls were matched by hospital, sex and age. The study was carried out between 1st July 1990 and 31st January 1991 in 14 hospitals in the Metropolitan Region of S. Paulo, the most highly industrialized and urbanized region in Brazil. Score criteria were developed for the ordering of the individuals of the study by occupational exposure to know carcinogens to the lung, in order to evaluate this exposure during the occupational life of each person. The criteria accumulated information on exposure to carcinogens as regards type, sector of work and time in each employment. The unconditional logistic regression analysis showed an odds ratio of 1.97 (95% IC: 1.52 to 2.55) for the highest exposure group. This result showed that workers linked to the production sectors of several industries have about twice the risk of developing lung cancer as workers involved in non-industrial activities.

Sistema de informação para a ação: subsídios para a atuação prática dos programas de saúde dos trabalhadores a nível local

Nas últimas décadas o Brasil transformou-se em uma sociedade industrializada. A partir da perspectiva epidemiológica e considerando as mudanças que estão ocorrendo a população brasileira, particularmente nos aspectos da transição demográfica, discute-se neste trabalho a necessidade de repensar a abrangência e prioridade do sistema de vigilância epidemiológica no país. O estudo avalia o sistema de informação para a ação de acidentes do trabalho a nível local, implantado no Programa de Saúde dos Trabalhadores do SUDS-R-6 (Mandaqui), tendo por base os dados de uma empresa metalúrgica da região que o sistema identificava como apresentando um processo de produção com alto risco de acidentes. A participação dos trabalhadores acidentados na discussão sobre os riscos ambientais e processo de trabalho, permitiu esclarecer a multicausalidade envolvida nos acidentes ocorridos nesta empresa. É destacada a importância da participação dos trabalhadores organizados - através de seus sindicatos, nas ações de controle dos acidentes. Embora, nem sempre essa participação organizada seja possível, o setor saúde deve buscar formas de atuação que resgatem a experiência concreta dos trabalhadores.

[Epidemiological surveillance system for occupational accidents: experience in the northern area of the municipality of São Paulo (Brazil)]

The epidemiological approach to occupational accidents and diseases adopted in Brazil is inadequate for many reasons, among them being: 1) the fact that only employers may notify work accidents, thus permitting notorious undernotification of these occupational hazards; 2) the available information does not permit a better understanding of the causal relationship between work accidents and diseases; 3) the official policy exists only for purposes of insurance compensation. The official documents for occupational disease and accident registration are the CTA (Work accident report) and FTA (Casualty treatment card). The Worker's Health Program of SUDS-R-6 proposed, in October, 1988 a method for the codification, registration in a micro-computer data bank and analysis of this information, based on the records presently in use (CAT) for public health service planning and accident prevention purposes. The major interest was in identifying the most common types of accidents in the region and the work environments in which they most frequently occur. The target population were the workers who attended the health units lisenced to deal with work accidents and diseases, in the Northern region of S. Paulo City. The data presented below refer to the months of October, November and December, 1988, the first three months of the project. During that period a total of 2,339 accidents were registered. They were classified as: typical work accidents - 87%: commuting accidents which occurred between the home and the work-place--18% and work diseases (only 2 cases). The majority of workers (50%) were between 25 and 45 years of age, approximately 7% were under 18. Male workers represented 83.2% of accident cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Effectiveness of BCG vaccination against tuberculous meningitis: a case-control study in São Paulo, Brazil

A case-control study was carried out in the Metropolitan Region of São Paulo, Brazil, to determine the protection against tuberculous meningitis conferred by BCG vaccination to children aged less than 5 years. The BCG vaccination coverage in the study area was about 88%. A total of 72 tuberculous meningitis patients were studied as well as 505 neighbourhood and 81 hospital controls. Analysis of the data using a conditional logistic regression for matched case-control studies indicated that the efficacy of BCG was similar for both groups of controls, that for neighbourhood controls (84.5%) being slightly greater than that for hospital controls (80.2%). No significant interactions were found between vaccination status and sex, age, or socioeconomic status.