BackgroundThe human immunodeficiency virus (HIV) fuels tuberculosis (TB) epidemics. In controlled clinical trials, antiretroviral therapy (ART) reduces TB incidence in HIV-infected patients. In this study we determine if, under programmatic conditions, Brazil's policy of universal ART access has impacted TB incidence among HIV-infected patients.MethodsWe abstracted clinical information from records of HIV-infected patients managed in the public sector in 11 Brazilian states between 1/1/1995 and 12/31/2001. Case ascertainment (TB and HIV) utilized guidelines (with added stringency) published by Brazil's Ministry of Health. We determined TB incidence and hazards ratio (HR) for ART-naïve and ART-treated [including highly active ART (HAART)] patients employing Cox proportional hazards analysis.ResultsInformation from 463 HIV-infected patients met study criteria. The median age of the study population was 34 years, 70% were male, and mean follow-up to primary endpoints—TB, death, and last clinic visit—was 330, 1059, and 1125 days, respectively. Of the 463 patients, 76 (16%) remained ART-naïve. Of the patients who never received HAART (n = 157) 81 were treated with ART non-HAART. Of the patients who received any ART (n = 387), 306 were treated with HAART (includes those patients who later switched from ART non-HAART to HAART). Tuberculosis developed in 39/463 (8%) patients. Compared to HAART- and ART non-HAART-treated patient groups, TB incidence was 10- (p<0.001) and 2.5-fold (p = 0.03) higher in ART-naïve patients, respectively. The median baseline absolute CD4+ T-lymphocyte count for patients who developed TB was not significantly different from that of patients who remained TB free. In multivariate analysis, the incidence of TB was statistically significantly lower in HAART-treated [HR 0.2; 95% (CI 0.1, 0.6); p<0.01] compared to ART naïve patients. A baseline CD4+ T-lymphocyte count <200 cells/mm3 [HR 2.5; (95% CI 1.2, 5.4); p<0.01], prior hospitalization [HR 4.2; (95% CI 2.0, 8.8); p<0.001], prior incarceration [HR 4.1; 95% CI 1.6, 10.3); p<0.01], and a positive tuberculin skin test [HR 3.1; (95% CI 1.1, 9.0); p = 0.04] were independently and positively associated with incident TB.ConclusionIn this population-based study we demonstrate an 80% reduction in incident TB, under programmatic conditions, in HAART-treated HIV-infected patients compared to ART-naïve patients.

This study of 230 Brazilian mothers examined the associations of several sociodemographic variables, maternal attitudes and perceptions with intended breast feeding duration. The usual relationships of sociodemographic variables such as mother's age, education, smoking, parity and infant birth weight with intended breast feeding duration were not found. However, mother's intentions were related to gender role attitudes with both the least and the most traditional women intending to breast feed longer than women with moderately traditional gender role attitudes. Mother's attitude toward breast feeding, help with household tasks, and the attitudes of friends and relatives toward breast feeding were also very significantly related to intended breast feeding duration. Women who did not work outside the home intended to breast feed significantly longer than those who were employed.

Based on social learning theory, the construct of health locus of control has proven valuable in predicting a wide variety of health-related behaviors. In studying this concept among Brazilians, the psychometric properties of the Multidimensional Health Locus of Control Scale translated into Brazilian Portuguese were investigated in a sample of 280 middle-class persons. Three types of health locus of control were verified, internal, powerful others, and chance. Further refinement of subscales is needed to improve internal consistency reliabilities.

This study examines the effects of dietary, cultural, and educational intervention on physical growth and cognition in Brazilian children aged from 7 to 10 years. A group of 38 domestic servants' children who had resided and studied for an average of three years in upper-middle class environments were compared with 88 upper-middle class children and 100 slum-dwelling (favela) children using the following measures: weight-for-height, height-for-age, Goodenough-Harris Drawing Test, the Brazilian Non-verbal Intelligence Test (INV), Raven Coloured Progressive Matrices (CPM), WISC-R Coding and Block Design subtest. Although domestic servants' children were significantly taller and heavier than their group of origin (slum-dwelling children) they continued to be significantly shorter than the middle class. Domestic servants' daughters scored significantly better than their slum-dwelling counterparts on cognitive tests measuring speed and accuracy (WISC-R Coding) and analogical reasoning (Raven Coloured Progressive Matrices), however, girls from both lower socioeconomic groups were similar in their performances on the Goodenough-Harris Drawing Test, Non-verbal Intelligence Test (INV), and WISC-R Block Design subtest. Domestic servants' sons were similar to slum-dwelling boys in performance on all cognitive measures. The length of time domestic servants' children had resided in middle class homes was positively and significantly correlated with their weight-for-height and two of the five cognitive tests. Among domestic servants, mothers' egalitarian sex role and less orthodox religious attitudes were positively correlated with children's cognitive performance. The experience of living and studying in a middle class environment resulted in greater gains in physical than in cognitive development.

In a 20% random sample of University of Brasilia medical students no association was found between student and parental smoking behaviour. A low prevalence of habitual smoking (14.0%) and a low mean daily cigarette consumption (8.9 cigarettes per smoker, per day) characterized this population.

Human figure drawings of 12 pediatric oncology patients were significantly smaller in height, width, and area than were drawings of 12 school children and 12 pediatric general surgery patients paired for sex and age. The Goodenough-Harris scores of the cancer patients' drawings were also significantly lower than those of both school and general surgery groups. It is hypothesized that anxiety, lowered self-esteem, and the effects of chemotherapy contributed to these findings.

In a sample of 245 Brazilian infants, the effects of intrauterine growth and gestational age upon psychomotor development were studied through ages 4 to 18 mo. Gestational age was more important than intrauterine growth in determining psychomotor development in the first 18 mo. of life. Intrauterine growth had a significant but smaller and more stable effect than gestational age upon psychomotor development at all ages. Maternal parity, interval between the birth of the child studied and the next oldest sibling, 5-min. Apgar score, and socioeconomic status were also relevant to psychomotor development at these early ages.

132 full-term healthy infants were studied for the first 18 months of life and parents were interviewed regarding their child's acceptance of solid foods. Results indicate that infants breast fed for less than 3 months showed a better acceptance of solid foods at 18 months than those breast fed for 6 months or more. It would appear that prolonged breast feeding increases resistance to weaning, and that later feeding problems can be reduced if chewable foods are introduced at an appropriate age.