Investigation of occupational risk factors for the development of non-Hodgkin's lymphoma in adults: A hospital-based case-control study

Non-Hodgkin's Lymphoma (NHL) is a malignancy of the lymphoid lineage of the hematopoietic system has worldwide, especially in developed countries. Better diagnostic and recording techniques, longer life expectancy, and greater exposure to risk factors are hypotheses for this growing incidence curve. Occupational exposures to chemical, biological, and physical agents have also been associated with NHL development, but the results are still controversial. We have investigated the occupational and lifestyle case-control study design with 214 adult patients and 452 population controls. Socio-demographic, clinical, and occupational exposure data were obtained through individual interviews with a standardized questionnaire. Clinical, laboratory, and histopathological data were obtained through medical records. Risk of NHL (any subtype), B-cell lymphoma, DLBCL, Follicular lymphoma and T-cell lymphoma was elevated among the those who had ever been exposed to any solvents, hydrocarbon solvents, pesticides, meat and meat products, and sunlight and tended to increase by years of exposure. A significant upward trend with years of exposure was detected for any solvents and hydrocarbon solvents (NHL (any subtype) p-value for trend<0.001), B-cell lymphoma (p-value for trend<0.001), and T-cell lymphoma (p-value for trend<0.023), pesticides (NHL (any subtype), p for trend<0.001) and T-cell lymphoma (p for trend<0.002), meat and meat products (NHL (any subtype) (p for trend<0.001) and DLBCL (p for trend<0.001), and sunlight (B-cell lymphoma (p for trend<0.001). The results of this study agree line with other international studies, can be extrapolated to other countries that have the same socio-demographic and occupational characteristics as Brazil and support strategies for surveillance and control of work-related cancer.

Hematological Changes in Gas Station Workers

(1) Background: Benzene, toluene, and xylene isomers (BTX) are present in gasoline. Exposure to benzene may lead to the appearance of a series of signs, symptoms, and complications, which are characterized by benzene poisoning, which is an occupational disease. This study evaluated the presence of signs and symptoms related to occupational exposure and whether occupational exposure to BTX is associated with the development of hematological changes. (2) Material and Methods: This cross-sectional epidemiological study included 542 participants, in which 324 were gas station workers (GSWs) and 218 were office workers (OWs) with no occupational exposure to benzene. To characterize the type of exposure (exposed and not exposed), trans,trans-Muconic acid (tt-MA), Hippuric acid (HA), and Methylhippuric acid (MHA) were used as exposure biomarkers. The tt-MA analysis revealed that the GSWs had 0.29 mg/g of urinary creatinine and the OWs had 0.13 mg/g of urinary creatinine. For HA, the GSWs presented 0.49 g/g of creatinine while the OWs presented 0.07. MHA analysis revealed that the GSWs had 1.57 g/g creatinine and the OWs had 0.01 g/g creatinine. Occupation habits and clinical symptoms were collected by questionnaire and blood samples were analyzed for hematological parameters. The persistence of hematological changes was evaluated with three serial blood collections every 15 days followed by laboratory hematological analysis. A descriptive analysis by the Chi-square test method was performed to evaluate the association between occupational exposure to fuels and the occurrence of changes in hematological parameters. (3) Results: In the GSWs, the most described signs and symptoms were somnolence (45.1%), headache (38.3%), dizziness (27.5%), tingling (25.4%), and involuntary movement (25%). Twenty GSWs that presented hematological alterations performed serial collections fifteen days apart. In addition, these workers presented total leukocyte counts above the upper limit and lymphocyte counts close to the lower limit. Leukocytosis and lymphopenia are hematological alterations present in chronic benzene poisoning. (4) Conclusions: The results found an initial change in different hematological parameters routinely used in clinics to evaluate health conditions. These findings reveal the importance of valuing clinical changes, even in the absence of disease, during the health monitoring of gas station workers and other groups that share the same space.

Accident and social security benefits granted to cancer patients in Brazil, 2008-2014

This article aims to describe the distribution of cancer among the benefits granted by the General Social Security Registry, from 2008 to 2014, in Brazil. Ecological study using data given by the National Social Security Institute. The proportion of accidental (work-related) and social security (general) benefits granted by cancer in Brazil was determined, among the benefits granted for all causes, and a spatial analysis was conducted to assess the geographical distribution of these proportions, with the states Brazilians as a unit of analysis. Cancer was the reason for granting 533,438 benefits (2.9% of the total benefits granted for all causes), with a predominance of females in social security benefits (53.7%) and males in accidental benefits (71.6 %). The highest proportions of social security benefits for cancer occurred in North and Midwest regions. In 19 of the 26 Brazilian states (including all states in the southern region) and in the Federal District, there was no granting of accident benefits for cancer. The analysis of the occurrences of cancer that generated benefit concessions suggests a disproportionality in granting of social security benefits in relation to accident workers, mainly in North, Northeast and South regions of Brazil.

Accident and social security benefits granted to cancer patients in Brazil, 2008-2014

Abstract This article aims to describe the distribution of cancer among the benefits granted by the General Social Security Registry, from 2008 to 2014, in Brazil. Ecological study using data given by the National Social Security Institute. The proportion of accidental (work-related) and social security (general) benefits granted by cancer in Brazil was determined, among the benefits granted for all causes, and a spatial analysis was conducted to assess the geographical distribution of these proportions, with the states Brazilians as a unit of analysis. Cancer was the reason for granting 533,438 benefits (2.9% of the total benefits granted for all causes), with a predominance of females in social security benefits (53.7%) and males in accidental benefits (71.6 %). The highest proportions of social security benefits for cancer occurred in North and Midwest regions. In 19 of the 26 Brazilian states (including all states in the southern region) and in the Federal District, there was no granting of accident benefits for cancer. The analysis of the occurrences of cancer that generated benefit concessions suggests a disproportionality in granting of social security benefits in relation to accident workers, mainly in North, Northeast and South regions of Brazil.

Risks related to the domestic laundering of filling station attendant uniforms: advances and uncertainties

Gasoline is the most common transportation fuel in Brazil, with up to 1% of benzene. Benzene is a health-damaging organic solvent that is extensively used worldwide, being classified as a human carcinogen by the International Agency for Research on Cancer (Group 1). Many workers at filling stations are exposed to benzene, present in gasoline. The main routes of exposure and absorption of benzene are inhalation, oral, and dermal routes. The penetration and maintenance of benzene and other chemicals on personal protective equipment and clothing of workers who manipulate these solvents may increase their levels of exposure and offer risks to their family members, since contaminated clothing is laundered at their homes, which goes against legislative framework (Annex 2, Regulatory Standard No. 9). This way, the objective of this work was to discuss the importance of periodic changes and cleaning of filling station attendant uniforms performed by employers as preventive measures against the deterioration of the health of workers and their family members. We performed a narrative review; no systematic criteria were used in the search for national and international studies. After critical reading, we observed a lack of consistent data on this theme. Laundering of uniforms worn by filling station attendants should take place outside the domestic environment in order to protect the health of workers and their family members and avoid possible cross-contamination.

Gasoline-station workers in Brazil: Benzene exposure; Genotoxic and immunotoxic effects

Chronic exposure to benzene is a risk factor for hematological malignancies. Gasoline-station workers are exposed to benzene in gasoline, via both inhalation and dermal contact (attendants and managers) or inhalation (workers in the on-site convenience stores and offices). We have studied the exposure of these workers to benzene and the resulting genotoxic and immunotoxic effects. Levels of urinary trans, trans-muconic acid were higher among gasoline-station workers than among office workers with no known exposure to benzene (comparison group). Among the exposed workers, we observed statistically significant biological effects, including elevated DNA damage (comet assay); higher frequencies of micronuclei and nuclear buds (CBMN assay); lower levels of T-helper lymphocytes and naive Th lymphocytes; lower CD4 / CD8 ratio; and higher levels of NK cells and memory Th lymphocytes. Both groups of exposed workers (inhalation and inhalation + dermal routes) showed similar genotoxic and immunotoxic effects.

Occurrence of green tobacco sickness and associated factors in farmers residing in Dom Feliciano Municipality, Rio Grande do Sul State, Southern Region of Brazil

This study aimed to evaluate the occurrence of the green tobacco sickness (GTS) and its associated factors in tobacco familiar farmers residing in Dom Feliciano, Rio Grande do Sul State, Brazil. A cross-sectional study was conducted evaluating the sickness in 354 small tobacco farmers, between October 2011 and March 2012. The urinary concentration of cotinine, a biomarker of exposure to nicotine, was determined during the tobacco harvest period. Subjects presenting cotinine urinary levels ≥ 50ng/mL, that had contact with tobacco leaves up to 48 hours before the sample collection and reported at least one disease symptom were deemed as cases. A non-conditional logistic analysis was performed to evaluate the association between GTS and the population characteristics. A total of 122 (34.5%) cases were identified, with 39% of them being smokers and 61% being males. The median cotinine urinary concentrations were 75.6ng/mL (74.1ng/mg of creatinine) for non-cases and 755.8ng/mL (632.1ng/mg of creatinine) for the cases (p-value ≤ 0.01). The multivariate analysis showed a positive association between GTS and sunlight exposure time, exposure to pesticides, worse health status, and inverse association with wood cultivation. This study presented a high GTS prevalence and suggest that the use of urinary cotinine is a significant biomarker to determine GTS cases, influencing in the distribution by sex. Once the tobacco production involves health hazards, is important to implement measures to prevent the harm caused to tobacco farmers, as set in articles 17 and 18 of the World Health Organization Framework Convention on Tobacco Control.

Profile of healthcare workers involved in accidents with exposure to biological materials in Brazil from 2011 through 2015: surveillance aspects

Background

Accidents involving biological materials among healthcare providers represent a significant public health problem since they increase the risk of acquisition of viral infections considered to be risk factors for cancer.

Objective

To describe the profile of workplace accidents involving biological materials for healthcare providers.

Method

The profile of accidents for the period from 2011 to 2015 was described based on several sociodemographic, occupational and health variables. Specific incidence rates were stratified in three levels to categorize the Brazilian municipalities as a function of the frequency of events.

Results

Victims were mainly female, nursing technicians and assistants, events mostly occurred during surgical procedures or intravenous medication administration, however, underreporting cannot be ruled out.

Conclusion

The results point to the need for preventive programs to ensure the physical integrity of healthcare professionals, including continuous training, discussion and participation of the involved parties to achieve a positive impact.

Hypermethylation in Gene Promoters Are Induced by Chronic Exposure to Benzene, Toluene, Ethylbenzene and Xylenes

BACKGROUND AND OBJECTIVE

Gas station attendants are occupationally exposed to benzene, toluene, ethylbenzene and xylene (BTEX) compounds and thus more susceptible to the biological effects of this mixture present in gasoline, especially due to the carcinogenicity of benzene. Furthermore, the harmful effects of BTEX exposure may be potentiated by genetic and epigenetic inactivation of critical genes. The objective was to evaluate such gene-BTEX interactions accessing the promoter methylation status of p14ARF, p16INK4A and GSTP1 in peripheral blood leukocyte samples.

MATERIALS AND METHODS

The 59 exposed and 68 unexposed participants from Rio de Janeiro, Brazil, were included. The promoter methylation status was accessed by methylation-specific PCR (MSP) and GSTP1 Ile105Val polymorphism was investigated by PCR-restriction fragment length polymorphism (PCR-RFLP) technique.

RESULTS

Both p14ARF and p16INK4A were significantly hypermethylated in exposed subjects compared to unexposed (p = 0.004 and p<0.001, respectively). Additionally, p16INK4A hypermethylation in the exposed group was correlated with chromosomal abnormalities (CAs) (p = 0.018), thus highlighting the influence of the gene-environment interactions on genome instability. Noteworthy, p16INK4A methylation was significantly associated with miscarriage among female attendants (p = 0.047), in which those who reported miscarriage exhibited hypermethylation in at least 2 of the 3 genes analyzed. The GSTP1 heterozygote genotype, which could affect the metabolism of benzene detoxification, was found in both groups but was more frequent in those occupationally exposed. No significant association was observed between GSTP1 genotypes and methylation status.

CONCLUSION

Together, these findings indicate that gas station attendants with the aforementioned epigenetic and genetic profiles may be at greater risk of occupational BTEX exposure-induced genome instability, which could require concerted efforts to establish more preventive actions and constant biomonitoring in gas station attendants.

Analysis of individuals with leukemia: cancer surveillance system limitations

Cancer is the second leading cause of death in the world with great impact on public health and leukemia is a hematological cancer directly related to different exposures at work. This study aimed to describe the occupational profile of individuals diagnosed with leukemia. This is a cross-sectional study of cases registered between 2007 and 2011 in the Integrador RHC database. Individuals from 26 Brazilian states, aged 20 years or older, were included. Of the 7,807 cases of leukemia, Minas Gerais recorded the highest occurrence (1,351). Only 52% of the cases had information on occupation. Occupations with the greatest number of cases of leukemia were agricultural, forestry and fishing workers; services, stores and markets vendors; and workers in the production of industrial goods and services. These occupations are exposed to substances considered by literature as carcinogenic agents to humans. There was a high underreporting of occupational data, compromising the quality of information and, therefore, the effectiveness of the Brazilian health surveillance system. The RHC also does not provide information about the agent used during the working day, the exposure time during working life and data from previous occupations.

Avaliação ambiental de BTEX (benzeno, tolueno, etilbenzeno, xilenos) e biomarcadores de genotoxicidade em trabalhadores de postos de combustíveis

Resumo Introdução: trabalhadores de postos de combustíveis estão expostos às diversas substâncias químicas presentes no ambiente de trabalho, destacando-se entre elas o benzeno, devido às suas propriedades carcinogênicas. Objetivo: avaliar os danos genotóxicos relacionados à exposição ocupacional ao BTEX (benzeno, tolueno, etilbenzeno, xilenos) em trabalhadores de cinco postos de combustíveis do município do Rio de Janeiro, RJ. Metodologia: foram analisadas concentrações de BTEX no ar; atividades das enzimas catalase e glutationa S-transferase; e ensaio cometa em amostras de sangue total de 97 trabalhadores. Resultados: as concentrações de BTEX estavam dentro dos valores preconizados pela NR 15, incluindo Anexo 13-A. Entretanto, uma oscilação nos resultados de ensaio cometa foi observada entre os trabalhadores dos diferentes postos de combustíveis, principalmente em trabalhadores de postos com menores concentrações de benzeno. Discussão: esse resultado está de acordo com a literatura científica atual, que indica uma curva dose-resposta supralinear para o benzeno, observando-se em baixas concentrações um aumento não linear do risco de leucemia, provavelmente relacionado à maior metabolização do benzeno e à maior produção de seus metabólitos tóxicos nessas concentrações. Conclusão: os resultados deste estudo sugerem que a exposição ao BTEX, mesmo em baixas concentrações, contribui para o risco genotóxico à saúde humana.

Benzene poisoning, clinical and blood abnormalities in two Brazilian female gas station attendants: two case reports

BACKGROUND

Brazilian gas station workers are chronically exposed to benzene, toluene, xylene (BTX) during their working time. Describe below two cases of latin female gas station workers with benzene poisoning symptoms and miscarriage history.

CASE PRESENTATION

In both cases were identified complex chromosomal rearrangements (CCR) with fluorescence in situ hybridization, applied to whole chromosome paints by chromosomes 1, 2 and 4. The lower natural killer cell (NK) cells have also been observed in cases correspondents, especially the rare type of NK (NKbright) in their peripheral blood cells.

CONCLUSIONS

It is known that acquired chromosomal aberrations are positively correlated with cancer and reproductive risk. In concordance, lower NK cytotoxicity increases the risk for cancer, as well. Thus, this is the first study providing hints on a possible causative relation of lower NK cytotoxicity and increase rates of chromosomal rearrangements including CCRs.

Fração Atribuível a Fatores de Risco Ocupacionais para Câncer no Brasil: Evidências e Limitações

O estudo destaca a contribuição dos fatores ocupacionais que apresentam posição de destaque frente a outros fatores como uso de álcool e contraceptivos orais. Aponta para a necessidade de avanços na área da saúde do trabalhador, especificamente nas questões sobre câncer relacionado ao trabalho. 

Metabolic Polymorphisms and Clinical Findings Related to Benzene Poisoning Detected in Exposed Brazilian Gas-Station Workers

Benzene is a ubiquitous environmental pollutant and an important industrial chemical present in both gasoline and motor vehicle emissions. Occupational human exposure to benzene occurs in the petrochemical and petroleum refining industries as well as in gas-station workers, where it can lead to benzene poisoning (BP), but the mechanisms of BP are not completely understood. In Brazil, a significant number of gas-station service workers are employed. The aim of the present study was to evaluate alterations related to BP and metabolic polymorphisms in gas-station service workers exposed to benzene in the city of Rio de Janeiro, Brazil. Occupational exposure was based on clinical findings related to BP, and metabolic polymorphisms in 114 Brazilian gas-station attendants. These workers were divided into No Clinical Findings (NCF) and Clinical Findings (CF) groups. Neutrophil and Mean Corpuscular Volume (MCV) showed a significant difference between the two study groups, and neutrophil has the greatest impact on the alterations suggestive of BP. The clinical findings revealed higher frequencies of symptoms in the CF group, although not all members presented statistical significance. The frequencies of alleles related to risk were higher in the CF group for GSTM1, GSTT1, CYP2E1 7632T > A, but lower for NQO1 and CYP2E1 1053C > T genotypes. Moreover, an association was found between GSTM1 null and alterations related to BP, but we did not observe any effects of other polymorphisms. Variations in benzene metabolizing genes may modify benzene toxicity and should be taken into consideration during risk assessment evaluations.

Lesões Cutâneas Pré-Malignas em Residentes de um Município Rural do Rio Grande do Sul, Brasil

Introdução: O câncer de pele e um problema de saúde pública relevante; mas; apesar disso, há poucos estudos disponibilizados no Brasil que discorrem sobre as lesões pré-malignas da pele. Objetivos: Descrever as características de uma população rural, que exerce suas atividades laborais ao ar livre, e analisar a associação quanto a presença de lesões cutâneas pré-malignas. Método: Inquérito populacional realizado em um município rural do Sul do país, entre 2010-2011. Participaram desse estudo 242 indivíduos com idade ≥40 anos, de ambos os sexos, que relataram trabalhar ao ar livre. Entrevistas foram realizadas e médicos dermatologistas da Rede de Referência Hospitalar Regional avaliaram presença de lesões na pele. Foram definidas como desfecho todas as lesões cutâneas pré-malignas encontradas nessa população. Resultados: A prevalência de lesões cutâneas na população de estudo foi de 29,3% (71 casos). Na analise de associação ajustada, observou-se que a chance dos indivíduos com idade ≥60 anos terem lesões cutâneas foi quatro vezes maior em relação aos que tinham menor idade (OR=4,05; IC95% 1,89-8,70). Uma maior chance de desenvolver lesões cutâneas também foi observada entre os participantes classificados como fototipo de pele I -II em relação aos de outros tipos de pele (OR=2,99; IC95% 1,58- 5,66), e os que trabalhavam na agricultura e/ou pecuária em relação as outras atividades (OR=2,04; IC95% 1,01-4,14). Conclusão: Indivíduos com fototipo de pele I- II e trabalhadores que exercem suas funções ao ar livre fazem parte de grupos específicos com maior risco para cancer de pele. Estratégias de prevenção e detecção precoce das lesões cutâneas devem ser prioritariamente implementadas nesses grupos.  

Completude da Informação “Ocupação” nos Registros Hospitalares de Câncer do Brasil: Bases para a Vigilância do Câncer Relacionado ao Trabalho

Introdução: A abordagem da ocupação em pacientes com câncer, especialmente de pulmão, de bexiga, leucemias e mesoteliomas, entre outros, pelos profissionais de saúde, e insuficiente e repercute negativamente na busca do nexo causal. Objetivo: Quantificar o percentual de ausência de informação sobre ocupação nos Registros Hospitalares de Câncer do Brasil. Método: Trata-se de um estudo epidemiológico do tipo ecológico. Foi avaliada a completude da informação “ocupação” nos Registros Hospitalares de Cancer no Brasil, estratificados por macrorregião, entre os anos de 2000 e 2008. Foram analisados, para cada sexo, os casos com idade maior ou igual a 30 anos e os seguintes tumores: pulmão, bexiga, cavidade oral, faringe, laringe e leucemias. Resultados: O percentual medio de ausência de informação sobre ocupação foi superior a 45% para todas as topografias selecionadas; mas, em mulheres, esse percentual foi ainda maior. Ao longo dos anos estudados, observou-se pouca melhora na qualidade da informação, com a maioria das regiões apresentando proporções superiores a 30% desse indicador, independente da neoplasia investigada. Conclusão: Os resultados apresentados são preocupantes do ponto de vista da saúde pública, especialmente da saúde dos trabalhadores. A falta dessa informação nos registros dificulta a identificação da ocupação como fator de risco importante para o desenvolvimento do câncer, o estabelecimento do nexo causal entre exposição e doença, e a elaboração e implementação de estratégias de vigilância do cancer relacionado ao trabalho no país.  

Monitoring of gas station attendants exposure to benzene, toluene, xylene (BTX) using three-color chromosome painting

BACKGROUND

Chronic exposure of BTX (benzene, toluene, xylene) may lead to progressive degeneration of bone marrow, aplastic anemia and/or leukemia. In Brazil there is no self-service fuel in gas stations and attendants fill the fuel themselves. Due to this they are chronically exposed to high concentration of BTX. Occupational exposure to benzene has been associated with increased chromosomal aberrations in peripheral blood lymphocytes. Fluorescence in situ hybridization (FISH) using whole chromosome painting (wcp) probes allows the rapid detection of chromosomal aberration. In the present study three-color wcp probes for chromosomes 1, 2 and 4 were used for monitoring 60 gas station attendants.

RESULTS

Blood tests were done and interviews were conducted for each worker. For searching for possible associations between the clinical characteristics and the frequency of chromosomal aberrations the workers were divided into two groups (≤ 10 chromosomal abnormalities per 1,000 metaphases and > 10 chromosomal abnormalities per 1,000 metaphases).The studied workers had a low median age (36 year), albeit long period of BTX exposure (median was 16 years). Low prevalence of smoking and moderate consumption of alcoholic beverages were found in this population. The cytogenetic analysis showed 16.6% (10/60) of workers with a high frequency of chromosomal abnormalities (>10 chromosomal abnormalities per 1,000 metaphases). Translocations were the most frequently observed chromosome aberration. The statistical analysis revealed highly significant differences in skin color (p = 0.002) and a weak significant differences in gender (p = 0.052) distribution between the two groups.

CONCLUSION

16.6% of the studied population showed elevated frequencies of chromosomal abnormalities, which is highly likely to be correlated with their exposure to BTX during their work. Therefore, further studies are needed for better characterize the work associated damage of the genome in gas station workers. It is necessary to better understand the risks that these workers are exposed, so that we can be effective in preventing diseases and maintaining the health of these workers and possibly the offspring.

Association between socioeconomic position in earlier and later life and age at natural menopause: Estudo Pró-Saúde, Brazil

This study was based on a prospective cohort of university staff in Rio de Janeiro, Brazil (the Estudo Pró-Saúde). In this article the association between socioeconomic position (SEP) earlier and later in life and age at menopause is investigated. The main indicators investigated were for earlier SEP: mother's and father's schooling; stature; leg and trunk length. For later SEP they were: schooling; home and/or car ownership. Median age at menopause was estimated and survival curves were generated by the Kaplan-Meier method, while the association between indicators of SEP and age at menopause was explored by means of Cox semiparametric models. Associations were found between earlier SEP - represented by trunk length - and earlier menopause and between later SEP - represented by the indicator 'present schooling' - and earlier menopause. The association between earlier and later SEP was confirmed. Adverse situations over the life course can impact age at menopause and related health outcomes.

[Self-rated health and physical disabilities due to health (corrected) problems]

OBJECTIVE

To evaluate self-rated health and physical disabilities due to health problems.

METHODS

Population-based cross-sectional study carried out in 18 Brazilian cities between 2002 and 2005. There were interviewed 26,424 residents (aged 15 years or more) of households selected by a two-stage probabilistic sampling. Percentages and confidence intervals were calculated considering the study design effects.

RESULTS

Poorer self-rated health status and physical disabilities were found among women, those aged 50 years old or more and those with lower education. In addition, higher percentages of fair or poor self-rated health were found in cities in Northern and Northeastern Brazil compared to those in Southern and Southeastern Brazil.

CONCLUSIONS

Poorer health conditions in the North/Northeast compared to the South/Southeast regions reflect factors related to social inequalities, mainly lower education.

Perfil dos fumantes que não buscam tratamento para deixar de fumar, município do Rio de Janeiro

É fundamental compreender que os fumantes não são iguais e que determinados fumantes precisam ser conquistados como "potenciais clientes" de programas de intervenção voltados às suas necessidades específicas. O objetivo do estudo foi comparar os perfis de fumantes recrutados para um estudo de intervenção para cessação de fumar com os da população geral de fumantes no município do Rio de Janeiro, nos anos 2002-2003. As heterogeneidades encontradas indicam que diferentes estratégias de captação associadas às intervenções existentes devem ser elaboradas para motivar o maior e mais diversificado número possível de indivíduos elegíveis.

[Randomized clinical trial: effectiveness of the cognitive-behavioral approach and the use of nicotine replacement transdermal patches for smoking cessation among adults in Rio de Janeiro, Brazil]

Randomized clinical trial carried out to investigate the effectiveness of the cognitive-behavioral approach and nicotine replacement therapy with nicotine patches for smoking cessation. Participated 1,199 adults, volunteers, in Rio de Janeiro, Brazil, randomly assigned to 10 different groups: intensive brief counseling group (GB), with 1 or 2 sessions (G1-G2), and with 3 or 4 sessions (G3-G4), with/without nicotine replacement therapy (NRT). Abstinence proportions were estimated during 12 months. These proportions among participants not assigned to NRT were 20% (GB), 17% (G1-G2), and 23% (G3-G4); and among assigned NRT groups were 30% (GBA), 34% (G1A-G2A), and 33% (G3A-G4A). After multiple adjustments, the abstinence proportions ratios seemed to follow a "dose-response" pattern: compared to GB, the ratios were 0.85 (G1-G2), 1.13 (G3-G4), 1.51 (GBA), 1.66 (G1A-G2A), and 1.75 (G3A-G4A). The results suggest that use of NRT increases the abstinence proportion for cessation. The "dose-response" pattern suggests that cognitive-behavioral could be the reasonable option in the smoking cessation therapy.

[Malnutrition mortality in the elderly, southeast Brazil, 1980-1997]

OBJECTIVE

To assess the frequency of nutritional disturbances as cause of death in elderly.

METHODS

Female and male subjects aged 60 years and more were selected from municipalities of the southeastern region between 1980 and 1997. Data was collected from death certificates provided by the Death Data System (1980-1998) and the population size was estimated using data provided by the Center for Regional Development and Planning (Cedeplar). Death categorization was performed using the ICD-9 (260 to 263.9) for the period 1980 to 1995 and ICD-10 (E40 to E46) for recent years.

RESULTS

In Brazil, between 1980 and 1997, there were 36,955 deaths associated to malnutrition among elderly. The southeast region concentrates the largest number of deaths, 23,968 (64.9%). In the state of São Paulo, there were 11,067 deaths caused by malnutrition in elderly and in the state of Rio de Janeiro, 7,763. These two regions are responsible for the highest values observed for the region. There are higher death proportions and mortality rates among subjects aged 70 years and more than in subjects of any sex of the age group 60 to 69 years.

CONCLUSION

The preliminary results of the study raise some issues as follows: the role of malnutrition as an associated cause of death; the trend of increased number of deaths for malnutrition among elderly people; distinctive death characteristics among states in the same geographic region. Statistical analysis such as time series analysis might explain better these issues. There is a need to further study the role of malnutrition among elderly aged 60 years and more to establish adequate intervention programs.

Óbitos por desnutrição em idosos, São Paulo e Rio de Janeiro: análise de séries temporais. 1980-1996

OBJETIVOS: Descrever a evolução da mortalidade por desnutrição em idosos nas Regiões Metropolitanas dos Estados do Rio de Janeiro (RMRJ) e São Paulo (RMSP), verificar as suas tendências, entre 1980 e 1996, e propor um modelo que permita prever a ocorrência de casos. METODOLOGIA: Trata-se de um estudo ecológico, de séries temporais, baseado em dados secundários. Foram incluídos no estudo indivíduos com 60 anos de idade ou mais, de ambos os sexos, das RMRJ e RMSP. A fonte de dados utilizada foi o Sistema de Informações sobre Mortalidade (SIM). Analisou-se a série de casos mensais, no período de janeiro de 1980 a dezembro de 1996. Para modelagem da série e predição de casos por desnutrição em idosos, utilizou-se o método Box and Jenkins, SARIMA (Sazonal Autoregressive Integrated Moving Average). RESULTADOS: Os resultados apontam a existência de sazonalidade, com maior número de óbitos nos meses de junho e julho na RMSP, no mês de janeiro na RMRJ, provavelmente, decorrente do clima frio, nestes meses, em São Paulo e do calor intenso no Rio de Janeiro. Este resultado pode ser explicado pela possibilidade de idosos, com estado nutricional comprometido, terem dificuldades em manter a temperatura corporal normal durante os meses de inverno, representando um estresse adicional a um organismo sem reservas. CONCLUSÕES: As séries apresentaram tendência de aumento e revelaram um padrão sazonal no inverno na RMSP e no verão na RMRJ. Ao estimar os modelos SARIMA para as Regiões para o ano de 1996, os resultados reforçaram a hipótese de que este método pode ser eficiente para fazer previsões futuras. Provavelmente um estudo que leve em consideração causas múltiplas de morte permitirá verificar a real contribuição da desnutrição como causa básica ou contributiva para a morte. Infelizmente, até este momento, esses dados não estão disponíveis para análise.