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OBJECTIVES: In the clinical routine of pediatricians, height is the most reliable indicator for assessing growth. However, there are situations where it is not possible to measure this parameter directly, making the estimation of height or length a useful alternative. The main goal of this study is to identify which segmental measure, including upper arm length (UAL), tibial length (TL), and knee-heel length (KHL), provides the stature estimate that most closely approximates directly measured height in the study participants. METHODS: Analytical cross-sectional study of the anthropometric and segmental measures of 248 participants, aged 0 to 14 years old, using Stevenson's and Kihara's equations to estimate indirectly measured height. RESULTS: The segmental measure that provided a measurement that deviated the least from the actual height was the KHL, followed by TL, both calculated using Stevenson's equations. CONCLUSION: The use of segmental measures to infer a child's stature is valuable in clinical practice, particularly in bedridden and incapacitated patients. Based on the present findings, the KHL and TL segments yielded more accurate results than the UAL.
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Antropometría , Estatura , Humanos , Estudios Transversales , Niño , Adolescente , Preescolar , Masculino , Femenino , Lactante , Antropometría/métodos , Recién Nacido , Valores de Referencia , Tibia/anatomía & histologíaRESUMEN
The aim of this study was to evaluate the time elapsed from first symptoms to the treatment of oral and oropharyngeal cancer (OOC) and to identify variables associated with treatment delay. This is an observational study with retrospective and prospective data collection. Patients with a diagnosis of OOC seen at the Head and Neck Surgery outpatient clinic of a Brazilian public hospital were included and followed up to treatment initiation. Participants answered a questionnaire for the collection of socioeconomic, demographic, cultural, and clinical information, as well as information about the time elapsed from first symptoms to the first appointment with a head and neck surgeon. Time to treatment was classified into four intervals: 1- first symptoms to first medical appointment; 2- first medical appointment to specialized medical care; 3- specialized medical care to preparation for treatment; and 4- preparation for treatment to treatment initiation. Bivariate statistics were computed. Out of 100 participants, nine died before treatment. Mean time to treatment was 217 days. Highest mean time was observed for interval 2 (94 days), followed by interval 1 (63 days), interval 4 (39 days), and interval 3 (21 days). At interval 1, a longer time was associated with severe alcohol consumption, severe smoking, and family history of cancer. At interval 2, the delay was associated with appointment with a general practitioner, clinical diagnosis of disease other than cancer, and antibiotic prescription. At interval 4, delay in treatment was associated with surgical treatment. Patients with OOC experience delays from symptom onset to treatment initiation. The longest interval was associated with professional delay, followed by patient delay in help-seeking.
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Neoplasias Orofaríngeas , Humanos , Estudios Retrospectivos , Neoplasias Orofaríngeas/terapia , Aceptación de la Atención de Salud , Fumar , BrasilRESUMEN
Introdução: O ensino do suporte básico de vida (SBV) para leigos é fundamental na redução das taxas de mortalidade de vítimas de parada cardiorrespiratória (PCR), sendo crianças e adolescentes alvos importantes deste treinamento. Apesar de sua relevância, o SBV ainda não foi incorporado à educação escolar. Objetivo: Avaliar os conhecimentos prévios e a apreensão sobre o SBV após treinamento por meio do ensino a distância (EAD), categorizando a evolução imediata dos alunos. Material e Métodos: Trata-se de um estudo descritivo transversal realizado com 268 alunos entre o sétimo ano do ensino fundamental e o terceiro ano do ensino médio em escolas pertencentes à rede pública e privada. Foram organizados encontros online, onde os alunos responderam um questionário sobre SBV e, em seguida, foram ministradas três videoaulas sobre este tema. Por fim, responderam imediatamente a um questionário.Resultados: No geral, a média de acerto no pós-teste foi significativamente superior se comparado ao pré-teste, sendo, respectivamente, de 8,13 (IC95% 7,91 a 8,35) e 10,35 (IC95% 10,12 a 10,58), p <0,001. Em relação à evolução, a maioria dos estudantes obteve evolução positiva (50,7%); 28,4% evolução positiva com retrocesso; 13,4% nenhuma evolução ou resposta aleatória; e apenas 7,5% evolução negativa. Conclusão: Após o treinamento, a maioria dos estudantes apresentou aumento de seu conhecimento sobre SBV, o que pode ser evidenciado pelo aumento da mediana de acerto e sobretudo pela distribuição percentual das categorias de evolução.
Introduction: Teaching Basic Life Support (BLS) to laypeople is essential in reducing mortality rates of victims of Cardiopulmonary Resuscitation (CPR), with children and adolescents being important targets of this training. Despite its relevance, BLS has not yet been incorporated into school education. Objective: To analyze prior knowledge and apprehension about BLS after training through Distance Learning (EAD), categorizing students' immediate evolution.Material and Methods: This is a cross-sectional descriptive study carried out with 268 students between the seventh year of elementary school and the third year of high school in public and private schools. Online meetings were organized, where students answered a questionnaire about BLS and then three video classes were given on this topic. Finally, they immediately responded to a questionnaire. Results: Overall, the average number of correct answers in the post-test was significantly higher compared to the pre-test, being, respectively, 8.13 (95%CI 7.91 to 8.35) and 10.35 (95%CI 10.12 to 10.58), p <0.001. In relation to evolution, the majority of students achieved positive evolution (50.7%); 28.4% positive evolution with setback; 13.4% no evolution or random response; and only 7.5% negative evolution. Conclusion: After the training, the majority of students showed an increase in their knowledge about BLS, which can be evidenced by the increase in the median number of correct answers and above all by the percentage distribution of the evolution categories.
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Educación en Salud , Enseñanza , Educación a Distancia , Educación Primaria y Secundaria , Educación MédicaRESUMEN
Abstract The aim of this study was to evaluate the time elapsed from first symptoms to the treatment of oral and oropharyngeal cancer (OOC) and to identify variables associated with treatment delay. This is an observational study with retrospective and prospective data collection. Patients with a diagnosis of OOC seen at the Head and Neck Surgery outpatient clinic of a Brazilian public hospital were included and followed up to treatment initiation. Participants answered a questionnaire for the collection of socioeconomic, demographic, cultural, and clinical information, as well as information about the time elapsed from first symptoms to the first appointment with a head and neck surgeon. Time to treatment was classified into four intervals: 1- first symptoms to first medical appointment; 2- first medical appointment to specialized medical care; 3- specialized medical care to preparation for treatment; and 4- preparation for treatment to treatment initiation. Bivariate statistics were computed. Out of 100 participants, nine died before treatment. Mean time to treatment was 217 days. Highest mean time was observed for interval 2 (94 days), followed by interval 1 (63 days), interval 4 (39 days), and interval 3 (21 days). At interval 1, a longer time was associated with severe alcohol consumption, severe smoking, and family history of cancer. At interval 2, the delay was associated with appointment with a general practitioner, clinical diagnosis of disease other than cancer, and antibiotic prescription. At interval 4, delay in treatment was associated with surgical treatment. Patients with OOC experience delays from symptom onset to treatment initiation. The longest interval was associated with professional delay, followed by patient delay in help-seeking.
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ABSTRACT Purpose: The high prevalence and severity of congenital toxoplasmosis in Brazil, with several affected individuals progressing to low vision, emphasize the importance of evaluating their quality of life. In this study, the Children's Visual Function Questionnaire (CVFQ) was adapted to the sociocultural context of Brazilian children, and its psychometric properties were investigated for evaluating the vision-related quality of life of these individuals. Methods: This was a nested cross-sectional epidemiological study that prospectively monitored a cohort of 142 preschool children at a single referral university hospital in Belo Horizonte, Brazil. All children underwent complete ophthalmological examination, including visual acuity testing and binocular indirect ophthalmoscopy. Questionnaires were applied to their parents and caregivers to evaluate quality of life perception, as well as socioeconomic status of their families. Psychometric properties of the quality of life scale were evaluated by multivariate statistical analyses. Results: Adaptation to the Brazilian version of CVFQ-7 resulted in CVFQ-BR-toxo, a questionnaire for evaluating the perception of parents/caregivers about the vision-related quality of life of preschool children with congenital toxoplasmosis. The following six subscales were identified based on description, variability structure, and interpretation/grouping of items: general health, visual acuity, visual performance/functional vision, personal and social behavior, impact on family, and treatment. Children with low vision related to congenital toxoplasmosis had significantly lower scores for the following subscales: visual acuity (p=0.004), visual performance/functional vision (p=0.008), impact on family (p=0.001), and overall health (p=0.001). Conclusion: Psychometric properties were appropriate concerning the validity of the quality of life construct. CVFQ-BR-toxo could demonstrate the impact of vision impairment on families of children with congenital toxoplasmosis.
RESUMO Objetivo: A alta prevalência e gravidade da toxoplasmose congênita no Brasil, com muitos indivíduos afetados desenvolvendo baixa visão, reforça a importância da avaliação da sua qualidade de vida. Este estudo tem como objetivo adaptar o Children's Visual Function Questionnaire (CVFQ) para a realidade sociocultural de crianças brasileiras e investigar suas propriedades psicométricas para avaliação da qualidade de vida relacionada à visão nesses indivíduos. Métodos: Estudo epidemiológico transversal aninhado de coorte de 142 crianças pré-escolares acompanhadas prospectivamente em hospital universitário de referência em Belo Horizonte, Brasil. Todas foram submetidos a exame oftalmológico completo, incluindo medida da acuidade visual e oftalmoscopia binocular indireta. Questionários foram aplicados aos pais e cuidadores, para avaliar a percepção da qualidade de vida, bem como o nível sócio-econômico das famílias. Análise estatística multivariada foi realizada para avaliar as propriedades psicométricas da escala de qualidade de vida. Resultados: Adaptações na versão brasileira do Children's Visual Function Questionnaire-7 originaram o Children's Visual Function Questionnaire-7-BR-toxo, um questionário para avaliar a percepção de pais/cuidadores sobre a qualidade de vida relacionada à visão de crianças pré-escolares com toxoplasmose congênita. Pela descrição, estrutura de variabilidade, e interpretação do agrupamento dos itens do questionário adaptado, identificaram-se seis subescalas: saúde geral, capacidade visual, desempenho visual/visão funcional, comportamento social e pessoal, impacto na família e tratamento. Crianças com baixa visão associada a toxoplasmose congênita tiveram escores mais baixos nas seguintes subescalas: acuidade visual (p=0,004), desempenho visual/visão funcional (p=0,008), impacto na família (p=0,001) e saúde geral (p=0,001). Conclusão: As propriedades psicométricas foram adequadas no tocante à validade do construto. O Children's Visual Function Questionnaire-7-BR-toxo foi capaz de registrar o impacto da deficiência visual nas famílias de crianças com toxoplasmose congênita.
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PURPOSE: The high prevalence and severity of congenital toxoplasmosis in Brazil, with several affected individuals progressing to low vision, emphasize the importance of evaluating their quality of life. In this study, the Children's Visual Function Questionnaire (CVFQ) was adapted to the sociocultural context of Brazilian children, and its psychometric properties were investigated for evaluating the vision-related quality of life of these individuals. METHODS: This was a nested cross-sectional epidemiological study that prospectively monitored a cohort of 142 preschool children at a single referral university hospital in Belo Horizonte, Brazil. All children underwent complete ophthalmological examination, including visual acuity testing and binocular indirect ophthalmoscopy. Questionnaires were applied to their parents and caregivers to evaluate quality of life perception, as well as socioeconomic status of their families. Psychometric properties of the quality of life scale were evalua-ted by multivariate statistical analyses. RESULTS: Adaptation to the Brazilian version of CVFQ-7 resulted in CVFQ-BR-toxo, a questionnaire for evaluating the perception of parents/caregivers about the vision-related quality of life of preschool children with congenital toxoplasmosis. The following six subscales were identified based on description, variability structure, and interpretation/grouping of items: general health, visual acuity, visual performance/functional vision, personal and social behavior, impact on family, and treatment. Children with low vision related to congenital toxoplasmosis had significantly lower scores for the following subscales: visual acuity (p=0.004), visual performance/functional vision (p=0.008), impact on family (p=0.001), and overall health (p=0.001). CONCLUSION: Psychometric properties were appropriate concerning the validity of the quality of life construct. CVFQ-BR-toxo could demonstrate the impact of vision impairment on families of children with congenital toxoplasmosis.
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Calidad de Vida , Toxoplasmosis Congénita , Brasil/epidemiología , Preescolar , Estudios Transversales , Humanos , Psicometría , Encuestas y Cuestionarios , Toxoplasmosis Congénita/epidemiologíaRESUMEN
PURPOSE: To investigate visual-related quality of life (VRQL) and prevalence and severity of depressive symptoms in Brazilian individuals with toxoplasmic retinochoroiditis (TRC). DESIGN: Comparative observational cross-sectional study. The National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25) and Beck Depression Inventory-II (BDI-II) were applied to respectively assess VRQL and depression in individuals consecutively seen at a uveitis referral center. Clinical/demographical data were collected. Descriptive/analytic statistics were employed, with P<0.05. RESULTS: Patients and controls were comparable concerning age, sex and socioeconomic level. VRQL scores for all subscales were significantly lower in TRC when compared with controls, particularly associated (P<0.05) with female sex, history of ≥2 prior TRC recurrences, concomitant use of systemic corticosteroids, monocular vision and blindness. Depressive symptoms were more prevalent in TRC (55/188; 29.2%) than in controls (34/182; 18.7%) (P=0.023), also being associated with lower VRQL scores (P<0.001). Seropositive and seronegative controls for toxoplasmosis had similar VRQL scores and comparable rates of depressive symptoms. CONCLUSION: TRC affects VRQL in Brazilian individuals, particularly women, using systemic corticosteroids, with visual impairment and presenting recurrences of TRC. One-third of patients with TRC had evidence of depression, which was also associated with lower VRQL scores. Mental health issues in subjects with TRC should not be overlooked.
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Depresión , Calidad de Vida , Estudios Transversales , Depresión/epidemiología , Femenino , Humanos , Encuestas y Cuestionarios , Visión OcularRESUMEN
OBJECTIVE: To review studies that evaluate the correspondence between the estimate height via segmental measures and the actual height of children with cerebral palsy. DATA SOURCES: Systematic literature review between 1995-2018, guided by the PRISMA criteria (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), in PubMed, BVS, MEDLINE and Lilacs databases. The descriptors, connected by the AND Boolean Operators, were: anthropometry, cerebral palsy, child and body height. The research comprised papers in Portuguese, English and Spanish, with Qualis-CAPES equal or superior to B3 that addressed the question: "Is there any correlation between estimate height by equations and direct height measures in children with cerebral palsy?" 152 studies were recovered and seven were selected. Their methodological quality was assessed by the scale of the Agency for Healthcare Research and Quality (AHRQ). DATA SYNTHESIS: Most studies showed no correspondence between estimated and real height. Studies that showed coincidence of the measures contain limitations that could jeopardize the results (sample losses, small samples and exclusion of patients with severe contractures, scoliosis and severe cerebral palsy). Japanese researchers developed an equation which harmoniously aligns the statures; the study comprised only Japanese patients, though. CONCLUSIONS: Given the importance of accuracy in height measures to evaluate infant health, it is crucial to carry out more researches in order to safely establish an association between both estimate and real statures. The development of anthropometric protocols, emerged from such researches, would benefit the follow-up of children with severe psychomotor disabilities.
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Antropometría/métodos , Pueblo Asiatico/estadística & datos numéricos , Estatura/fisiología , Parálisis Cerebral/epidemiología , Adolescente , Adulto , Niño , Preescolar , Femenino , Humanos , Lactante , Salud del Lactante/normas , Recién Nacido , Masculino , Adulto JovenRESUMEN
ABSTRACT Objective: To review studies that evaluate the correspondence between the estimate height via segmental measures and the actual height of children with cerebral palsy. Data sources: Systematic literature review between 1995-2018, guided by the PRISMA criteria (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), in PubMed, BVS, MEDLINE and Lilacs databases. The descriptors, connected by the AND Boolean Operators, were: anthropometry, cerebral palsy, child and body height. The research comprised papers in Portuguese, English and Spanish, with Qualis-CAPES equal or superior to B3 that addressed the question: "Is there any correlation between estimate height by equations and direct height measures in children with cerebral palsy?" 152 studies were recovered and seven were selected. Their methodological quality was assessed by the scale of the Agency for Healthcare Research and Quality (AHRQ). Data synthesis: Most studies showed no correspondence between estimated and real height. Studies that showed coincidence of the measures contain limitations that could jeopardize the results (sample losses, small samples and exclusion of patients with severe contractures, scoliosis and severe cerebral palsy). Japanese researchers developed an equation which harmoniously aligns the statures; the study comprised only Japanese patients, though. Conclusions: Given the importance of accuracy in height measures to evaluate infant health, it is crucial to carry out more researches in order to safely establish an association between both estimate and real statures. The development of anthropometric protocols, emerged from such researches, would benefit the follow-up of children with severe psychomotor disabilities.
RESUMO Objetivo: Revisar estudos que avaliam correspondência entre a altura estimada por medidas segmentares e a estatura real de crianças com paralisia cerebral. Fonte de dados: Revisão sistemática da literatura entre 1995 e 2018, guiada pela diretriz Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), nas bases de dados PubMed, Biblioteca Virtual em Saúde (BVS), Medical Literature Analysis and Retrieval System Online (MEDLINE) e Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). Os descritores, combinados pelo operador booleano "and", foram: "anthropometry", "cerebral palsy", "child" e "body height". A pesquisa englobou artigos em português, inglês e espanhol, classificadas pelo Quali-CAPES igual ou superior a B3 e que respondiam à questão guia: "Existe correlação entre a altura estimada por equações em crianças com paralisia cerebral e as medidas diretas de altura?". Dos 152 artigos inicialmente recuperados, sete foram selecionados e sua qualidade metodológica foi avaliada pela escala da Agency for Healthcare Research and Quality (AHRQ). Síntese dos dados: A maioria dos trabalhos não encontrou correspondência entre altura real e estimada. Estudos que exibiram coincidência das medidas apresentaram limitações que poderiam comprometer os resultados (perda de amostra, amostra pequena e exclusão de indivíduos com contraturas severas, escoliose e paralisia cerebral grave). Pesquisadores japoneses desenvolveram equação que apresenta boa concordância entre as estaturas. Contudo, o estudo compreendeu apenas indivíduos japoneses. Conclusões: Dada a importância da precisão das medidas de estatura para avaliar a saúde infantil, tornam-se necessárias mais pesquisas visando estabelecer, de maneira mais segura, a associação entre a estatura estimada e a real. O desenvolvimento de protocolos antropométricos, resultantes dessas pesquisas, beneficiaria o acompanhamento de crianças com sequelas psicomotoras graves.
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Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Adulto , Adulto Joven , Estatura/fisiología , Parálisis Cerebral/epidemiología , Antropometría/métodos , Pueblo Asiatico/estadística & datos numéricos , Salud del Lactante/normasRESUMEN
Abstract Introduction: In Brazil, congenital toxoplasmosis (CT) is the main cause of visual impairment in childhood. It causes retinochoroiditis, which should lead to blindness. Minas Gerais has a prevalence of 1 newborn with congenital toxoplasmosis for every 770 live births. Objective: To evaluate visual functionality and tasks of self-care with TC classified in groups according to a visual acuity. Method: A cross-sectional study with 96 preschoolers with CT. Ophthalmologic examination and assessment of some functionalities were performed: The Functional Vision Evaluation (AVIF-2 at 6 years) and the Pediatric Disability Assessment Inventory (PEDI-Brazilian version). Results: Children were classified into three groups according to visual acuity: moderate / severe visual loss (n=16), low level (n=39) and normal vision (n=41). The chance of difference is not greater than AVIF-2 at 6 years among the three groups (p=0.001), being (p <0.0001) between the groups with moderate/severe visual and normal vision. The domain scores are displayed as the end result (p=0.022). The test PEDI is not able to make a difference between the groups. It is not different between the scores of the tests carried out. Conclusion: Children with CT without moderate / severe visual impairment, compromising visual functionality with greater impairment without visual accompaniment. The AVIF-2 at 6 years test demonstrated the impairment between groups with different visual acuities. The PEDI (self-care) test was not performed with a significant difference in scores between the groups. The AVIF-2 at 6 years test may contribute to the more effective intervention in the visual habilitation of children with CT and low vision.
Resumo Introdução: No Brasil, a toxoplasmose congênita (TC) é a principal causa de deficiência visual na infância. É causa de retinocoroidite, que pode levar à cegueira. Minas Gerais apresenta prevalência de um neonato com TC para cada 770 nascidos vivos. Objetivo: Avaliar funcionalidade visual e tarefas do autocuidado de crianças com TC classificadas em grupos de acordo com a acuidade visual. Método: Estudo transversal com 96 pré-escolares com TC. Realizado exame oftalmológico e avaliada a funcionalidade por dois instrumentos: O teste Avaliação da Visão Funcional (AVIF-2 a 6 anos) e Inventário de Avaliação Pediátrica de Incapacidade (PEDI-versão brasileira). Resultados: As crianças foram classificadas em três grupos conforme a acuidade visual: perda visual moderada/grave (n=16), perda leve (n=39) e visão normal (n=41). Houve diferença significativa no escore total do AVIF-2 a 6 anos entre os três grupos (p=0,001), e entre os grupos com perda visual moderada/grave e visão normal (p<0,0001). Os escores do domínio seguimento visual apresentaram pior resultado (p=0,022). O teste PEDI não mostrou diferença significativa entre os grupos. Não houve correlação entre os escores dos testes aplicados. Conclusão: Crianças com TC e perda visual moderada/grave apresentaram comprometimento da funcionalidade visual com maior prejuízo no seguimento visual. O teste AVIF-2 a 6 anos demonstrou esse comprometimento entre os grupos com diferentes acuidades visuais. O teste PEDI (autocuidado) não mostrou diferença estatística significativa dos escores entre os grupos. O teste AVIF- 2 a 6 anos pode contribuir para intervenção mais objetiva na habilitação visual de crianças com TC e baixa visão.
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Control of Culex quinquefasciatus using chemical insecticides may result in the selection of resistant mosquito strains. Thus, the use of plant-derived products has been studied as alternative for the mosquito control. Fatty acid methyl esters (FAMEs) obtained by transesterification of vegetable oils may result in compounds with larvicidal potential against C. quinquefasciatus. However, little is known about the morphological, physiological or biochemical effects that these FAMEs may have on mosquito larvae. The present study reports the effects of these FAMEs in mosquito larvae. The FAMEs were obtained by transesterification of canola, corn, sunflower, and soybean oils with acid catalysis and the determination of FAMEs composition was done by gas chromatography-mass spectrometry (GC-MS). Larvae of C. quinquefasciatus were exposed to different concentrations of the vegetable oils and FAMEs. Thereby, different FAMEs showed LC50 values ranging from 42.32 to 196.27mg/L against C. quinquefasciatus larvae. The methyl ester obtained from sunflower oil showed the lowest LC50. Histology of C. quinquefasciatus larvae exposed to LC50 of FAMEs was performed and changes in the midgut and fat body morphology were identified. Therefore, larval mortality and changes in the internal organs suggested that FAMEs might be a promising new class of larvicidalcompounds. Cytotoxicity of FAMEs compounds was assessed with the HeLa human cell line and no effect was observed.
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Culex/efectos de los fármacos , Ácidos Grasos/farmacología , Insecticidas/farmacología , Control de Mosquitos/métodos , Aceites de Plantas/farmacología , Animales , Supervivencia Celular/efectos de los fármacos , Ácidos Grasos/química , Ácidos Grasos/toxicidad , Cromatografía de Gases y Espectrometría de Masas , Células HeLa , Humanos , Insecticidas/química , Larva/efectos de los fármacos , Dosificación Letal Mediana , Aceites de Plantas/química , Aceites de Plantas/toxicidad , Aceite de GirasolRESUMEN
Objetivo: estimar a prevalência e os fatores associados à prematuridade em Divinópolis, Minas Gerais, Brasil, 2008-2011. Métodos: estudo transversal, com dados de 9.987 registros da base do Sistema de Informações sobre Nascidos Vivos (Sinasc); foi empregado modelo de regressão logística múltipla. Resultados: a prevalência de prematuridade foi de 8,0%, significativamente maior entre nascidos por parto cesáreo (8,9%), filhos de mães com 15 ou menos (14,4%) e 35 ou mais anos (9,3%), que fizeram 6 ou menos consultas de pré-natal (16,0%) e que tiveram quatro ou mais filhos vivos (11,7%); após o ajuste, a chance de prematuridade foi maior entre filhos de mães menores de 15 anos (OR=1,22; IC95% 1,01;1,49), com 6 ou menos consultas de pré-natal (OR=3,76; IC95% 3,24;4,38) e nascidos por parto cesáreo (OR=1,73; IC95% 1,48;2,04). Conclusão: a prematuridade esteve associada ao parto cesáreo, à realização de menos de sete consultas pré-natal e à menor idade materna.
Objetivo: estimar la prevalencia y factores asociados con prematuridad en Divinópolis, Minas Gerais, Brasil, 2008-2011. Métodos: estudio transversal de 9987 nacimientos de la base de datos del Sistemas de Informaciones sobre Nacidos Vivos (Sinasc); se utilizó un modelo de regresión logística múltiple. Resultados: la prevalencia de partos prematuros fue 8,0%; siendo significativamente mayor en partos por sección cesárea (8,9%), madres con 15 o menos (14,4%) y 35 o más años (9,3%), que hicieron 6 o menos consultas prenatales (16,0%) y tenían cuatro o más hijos vivos (11,7%); después del ajuste, las probabilidades fueron mayores entre madres menores de 15 años (OR=1,22; IC95% 1,01;1,49), con 6 o menos consultas prenatales (OR=3,76; IC95% 3,24;4,38) y cesarianas (OR=1,73; IC95% 1,48;2,04). Conclusión: la prematuridad se asocia al parto por cesáreo, menos de 7 citas prenatales y menor edad materna.
Objective: to estimate prematurity prevalence and associated factors in Divinópolis, Minas Gerais state, Brazil, 2008-2011. Methods: this is a cross-sectional study with data from 9,987 records held on the Information System on Live Births; a multiple logistic regression model was used. Results: prevalence of preterm births was 8.0%; the higher likelihood of premature newborns were found to cesarean section (8.9%), mothers aged 15 or less (14.4%) and aged 35 or more (9.3%), mothers who went to 6 or fewer prenatal care visits (16.0%), and had had 4 or more live births (11.7%); after adjustment, the odds of preterm birth was higher among mothers aged under 15 years old (OR=1.22; 95%CI 1.01;1.49), mothers with 6 or fewer prenatal care visits (OR=3.76; 95%CI 3.24;4.38) and mothers undergoing cesarean section (OR=1.73; 95%CI 1.48;2.04). Conclusion: prematurity was associated with cesarean delivery, having fewer than 7 prenatal care visits and lower maternal age.
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Humanos , Embarazo , Recién Nacido , Salud Infantil , Nacimiento Prematuro , Prevalencia , Estudios Transversales , Sistemas de Información en SaludRESUMEN
BACKGROUND: There are few studies reporting frequency and control of adverse events associated with congenital toxoplasmosis treatment. The objective of this study is to describe treatment adherence and adverse hematologic events in a cohort of children identified with congenital toxoplasmosis in Minas Gerais, Brazil. METHODS: Children were treated with sulfadiazine, pyrimethamine and folinic acid and were evaluated clinically and by laboratory tests at regular intervals. RESULTS: Of 146,307 live newborns who participated in the Neonatal Screening Program in Minas Gerais in 2006-2007, 190 had congenital toxoplasmosis. Among the 171 children whose treatment data were available, 73.1% completely adhered to antiparasitic therapy. Hematologic adverse events (macrocytic anemia and/or neutropenia and/or thrombocytopenia) were diagnosed in 44% of them. The most common adverse event was neutropenia (31%). In most cases, it was not severe and reversed after increase in folinic acid dosage (25.7%) or temporary treatment suspension (1.8%). No infections were observed in association with neutropenic events. Significant associations were detected between macrocytic anemia and lower weight Z score at first medical appointment (P = 0.03), and between severe neutropenia (<500/mm) and lower weight Z score toward the end of treatment (P = 0.04). CONCLUSIONS: The high frequency of hematologic adverse events found, especially in malnourished children, highlight the importance of careful monitoring of these children throughout treatment, as well as considering nutritional aspects and the need for higher doses of folinic acid. With adequate monitoring, antiparasitic treatment was feasible and relatively safe in the setting of this large screening program for congenital toxoplasmosis.
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Antiprotozoarios/efectos adversos , Médula Ósea , Neutropenia/inducido químicamente , Toxoplasmosis Congénita/tratamiento farmacológico , Toxoplasmosis Congénita/epidemiología , Antiprotozoarios/uso terapéutico , Médula Ósea/efectos de los fármacos , Médula Ósea/fisiopatología , Brasil/epidemiología , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Tamizaje Neonatal , Neutropenia/diagnóstico , Neutropenia/epidemiología , Estudios Prospectivos , Pirimetamina/efectos adversos , Pirimetamina/uso terapéutico , Sulfadiazina/efectos adversos , Sulfadiazina/uso terapéutico , Toxoplasmosis Congénita/complicacionesRESUMEN
OBJECTIVE: to estimate prematurity prevalence and associated factors in Divinópolis, Minas Gerais state, Brazil, 2008-2011. METHODS: this is a cross-sectional study with data from 9,987 records held on the Information System on Live Births; a multiple logistic regression model was used. RESULTS: prevalence of preterm births was 8.0%; the higher likelihood of premature newborns were found to cesarean section (8.9%), mothers aged 15 or less (14.4%) and aged 35 or more (9.3%), mothers who went to 6 or fewer prenatal care visits (16.0%), and had had 4 or more live births (11.7%); after adjustment, the odds of preterm birth was higher among mothers aged under 15 years old (OR=1.22; 95%CI 1.01;1.49), mothers with 6 or fewer prenatal care visits (OR=3.76; 95%CI 3.24;4.38) and mothers undergoing cesarean section (OR=1.73; 95%CI 1.48;2.04). CONCLUSION: prematurity was associated with cesarean delivery, having fewer than 7 prenatal care visits and lower maternal age.
Asunto(s)
Cesárea/estadística & datos numéricos , Nacimiento Prematuro/epidemiología , Atención Prenatal/estadística & datos numéricos , Adolescente , Adulto , Brasil/epidemiología , Estudios Transversales , Femenino , Humanos , Recién Nacido , Sistemas de Información , Nacimiento Vivo , Modelos Logísticos , Masculino , Edad Materna , Embarazo , Prevalencia , Factores de Riesgo , Adulto JovenRESUMEN
Culex quinquefasciatus (Say, 1823), known as the domestic mosquito, is a common and abundant species throughout the world, and a cosmopolitan species. The adults of this mosquito are important in terms of public and animal health since they display adaptability to different hosts. In humans, they are responsible for the transmission of various diseases. One manner of control of this vector is the use of insecticidal or larvicidal products, which may have the drawback of toxicity to mammals and can be harmful to the environment. The present work evaluated the larvicidal potential of the essential oil (EO) and ascaridole-enriched fraction (EF4-5) obtained from the leaves of Peumus boldus Molina (boldo). The EO, obtained by steam distillation, was analyzed by GC/MS and fractionated on silica gel. EO and EF4-5, containing 31.4% and 89.5% ascaridole, respectively, were evaluated against C. quinquefasciatus at concentrations of 100, 50 and 25 µg/ml on the third and fourth instars. They showed lethal concentrations (LC50) of 82.14 and 41.85 µg/ml, respectively. Larvae treated with the EF4-5 showed morphological changes in the midgut, with cells possessing a cytoplasm that contained small vacuole-like structures, as well as a nucleus with decondensed chromatin and a cell apex with a short brush border. The cells of the fat body showed larger protein granules, which were acidophilic relative to the larvae of the control group. Moreover, the enriched fraction at a dose of 50 µg/ml showed a residual larvicidal effect according to exposure time on C. quinquefasciatus. This residual effect deserves consideration, since a long-term larvicidal product may be a useful tool for vector control.
Asunto(s)
Culex/efectos de los fármacos , Monoterpenos/química , Aceites Volátiles/farmacología , Peróxidos/química , Peumus/química , Animales , Monoterpenos Ciclohexánicos , Cromatografía de Gases y Espectrometría de Masas , Larva/efectos de los fármacos , Dosificación Letal Mediana , Espectroscopía de Resonancia Magnética , Monoterpenos/farmacología , Aceites Volátiles/química , Peróxidos/farmacología , Extractos Vegetales/farmacología , Hojas de la Planta/químicaRESUMEN
Introdução: A elevada prevalência da toxoplasmose congênita (TC) no Brasil, verificada também no estado de Minas Gerais, associada ao maior comprometimento ocular observado nas crianças brasileiras comparadas às europeias; e a evolução de muitos desses indivíduos para a baixa visão (BV), nos remetem à necessidade de compreender o impacto da perda visual na qualidade de vida em uma coorte de crianças infectadas identificadas no período neonatal e tratadas com antiparasitários durante o primeiro ano de vida. Objetivo: Adaptar o questionário Children's Visual Function Questionnaire (CVFQ) à realidade sociocultural de crianças brasileiras com toxoplasmose congênita e investigar as propriedades psicométricas para mensuração da qualidade de vida (QV) relacionada à visão nesses pacientes; descrever as lesões retinocoroideanas observadas em uma coorte de crianças pré-escolares com TC em Minas Gerais; avaliar quantitativamente o déficit visual e investigar sua correlação com a pontuação na percepção da QV relacionada à perda visual (CVFQ7-BR-toxo). Método: Estudo epidemiológico transversal aninhado, em uma coorte de 142 crianças acompanhadas prospectivamente nos Serviços de Infectologia Pediátrica e Oftalmologia do Hospital das Clínicas da UFMG. Questionários foram aplicados aos pais e cuidadores para avaliar a percepção sobre a QV de suas crianças com TC e para verificar a situação socioeconômica das famílias. Oftalmologistas do setor de uveite avaliaram a retina das crianças e descreveram as lesões de retinocoroidite quanto à localização, número de lesões, tamanho e lateralidade. No setor de baixa visão, oftalmologistas avaliaram a acuidade visual. Foram usadas técnicas de estatística multivariada para avaliar as propriedades psicométricas da escala de QV e testes de Kruskal Wallis e Mann Whitney para a comparação dos escores medianos da escala de QV em crianças com visão normal, perda visual leve e baixa visão. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da UFMG. Resultado: Adaptações no CVFQ versão brasileira deram origem ao CVFQ7-BR-toxo, questionário para avaliar a percepção de pais/cuidadores sobre qualidade de vida relacionada a baixa visão de crianças com toxoplasmose congênita pré-escolares. Na análise fatorial exploratória o resultado do teste Kaiser-Meyer-Olkin Measure of Sampling Adequacy (KMO) foi de 0,74, indicando boa adequabilidade do modelo fatorial. Seis componentes (fatores) extraídos correspondem a 46,3% da variância total explicada, e são compostos por itens com coeficiente de saturação (carga fatorial) maior ou igual a 0,45. Pela descrição, estrutura de variabilidade, e interpretação do agrupamento dos itens do questionário CVFQ adaptado (CVFQ7-BR-toxo) identificaram-se seis subescalas: saúde geral; capacidade visual; desempenho visual/visão funcional; comportamento social e pessoal, impacto na família e tratamento. A homogeneidade das medidas para o construto QV no CVFQ adaptado foi avaliada pela consistência interna das subescalas. As subescalas Desempenho visual - visão funcional e o Impacto na família se mostraram adequadas, com coeficiente alfa de Cronbach de 0,75 e 0,77 respectivamente. As subescalas comportamento pessoal e social e, tratamento apresentaram valores de alfa de Cronbach menores que 0,7 (0,68 e 0,61 respectivamente). A correlação entre as subescalas e a escala global foram todas significativas (p-valor <0,001) variando de 0,42 a 0,75. As correlações item-escala globais foram significativas (p-valor <0,01) e maiores do que 0,20, sendo estes valores considerados aceitáveis. Verificou-se a validade discriminante do instrumento pelas diferenças significativas (p<0,005) na comparação das escalas do CVFQ7-BR-toxo para escores relatados pelo pai/cuidador de crianças com e sem baixa visão. A validação convergente foi verificada pela correlação (r=0,58; p<0,001) entre o escores globais do CVFQ7-BR-toxo e do PedsQL, com resultado moderado. Para análise dos exames clínicos oftalmológicos, das 142 crianças, duas foram excluídas por não terem realizado todos os exames. Das 140 crianças, 87,1% (121/139) apresentaram pelo menos uma lesão de retinocoroidite e, dentre elas, 20,7% (25/121) foram diagnosticadas com baixa visão (BV). A retinocoroidite esteve presente em ambos os olhos de 81,0% (98/121) das crianças com lesões, sendo que 25,5% (25/98) destas tinham BV. Lesão macular (foveal e/ou extrafoveal) em ambos os olhos ocorreu em 43,9% (43/98) das crianças e 51,2% (22/43) destas apresentaram BV. Pelo menos 50% das crianças com BV apresentaram lesões com tamanho médio superior a 3,0 diâmetros de disco óptico (DD). Ausência de lesão ocorreu em apenas 12,9% (18/140) das crianças. Na percepção dos pais cuidadores (CVFQ7-BR-toxo) das crianças diagnosticadas com BV, os escores medianos foram menores nas dimensões capacidade visual (p=0,002), desempenho funcional/visão funcional (p=0,002), impacto na família (p=0,001) e na QV global (p=0,009) quando comparados às crianças com perda visual leve e com visão normal. Conclusão: As propriedades psicométricas do CVFQ7-BR-toxo se mostraram adequadas quanto à validade do construto QV. O instrumento foi capaz de registrar o impacto no comprometimento da visão funcional e na família de crianças com toxoplasmose congênita. Na avaliação oftalmológica dessa população foram observadas lesões retinocoroideanas de maior gravidade, por serem em sua maioria maculares, múltiplas, bilaterais, resultando em comprometimento da função visual e menor acuidade visual. Na percepção dos pais e cuidadores sobre a QV relacionada a baixa visão, estas crianças apresentaram pior capacidade visual, pior desempenho funcional / visão funcional, com maior impacto nas suas famílias e piora da qualidade de vida global. Esses resultados podem subsidiar políticas para melhor controle e prevenção da toxoplasmose congênita.
Introduction: The high prevalence of congenital toxoplasmosis (CT) in Brazil, in addition to the high burden of ocular involvement in infected individuals, evolving to low vision (LV) in many of them, highlights the importance of assessing their quality of life (QOL). Objective:To adapt the Children's Visual Function Questionnaire (CVFQ) to the sociocultural reality of Brazilian children with CT, and to investigate the psychometric properties to measure vision-related quality of life (QOL) for these patients; to characterize retinochoroidal changes in a cohort of preschool children with CT in Minas Gerais; to quantitatively evaluate the visual deficit and to investigate its correlation with QOL perception scores (CVFQ7-BR-toxo instrument).Methods: Cross-sectional epidemiological study with nested cohort of 142 children prospectively followed at the Pediatric Infectious Disease and Ophthalmology Services of Hospital das Clínicas da Universidade Federal de Minas GeraisQuestionnaires were applied to parents and carers to evaluate QOL perception of their children with CT and to characterize the socioeconomic status of their families. Number, location, size and laterality of retinochoroidal lesions were recorded. Best-corrected visual acuity was also assessed. Multivariate statistical techniques were used to evaluate psychometric qualities of QOL scale. Kruskal Wallis and Mann Whitney test were employed for comparison of median scores of the QOL scale in children with normal visual, mild vision loss and low vision. Results: Adaptations in the CVFQ-Brazilian version originated the CVFQ7-BR-toxo, a questionnaire to evaluate perception of parents/carers about vision-related QOL of preschool children with CT. In the exploratory factor analysis, result of KaiserMeyer-Olkin Measure of Sampling Adequacy test (KMO) was 0.74, indicating good suitability of the factor model.Six extracted components (factors) explained 46.3% of total variance, consisting of items with saturation coefficient (factor load) ≥ 0.45. Six subscales were identified after description, variability structure and interpretation of grouping of items of CVFQ7-BR-toxo: Overall Health; Visual Acuity; Visual Performance/Functional Vision; Individual and Social Behavior, Impact on Family, and Treatment. Homogeneity of measures for the QOL construct in the adapted CVFQ was evaluated by internal consistency of the subscales: Subscales Visual Performance/Functional Vision and Impact on Family showed to be adequate, with Cronbach's alpha of 0.75 and 0.77 respectively.Subscales Individual and Social Behavior and Treatment showed Cronbach's alpha coefficient smaller than 0.7 (0.68 and 0.61 respectively). The correlations between subscales and the global scale were all statistically significant (p-value <0.001) ranging from 0.42 to 0.75. The global item-scale correlations were also significant (p-value <0.01) and greater than 0.20, with these values being considered acceptable. Discriminant validity of the instrument by significant differences (p <0.005) was verified in the comparison of CVFQ7-BR-toxo scales to the scores reported by the parent/carers of children with and without low vision.The convergent validity was verified by the moderate correlation (r = 0.58; p <0.001) between the overall scores CVFQ7- BR-toxo and PedsQL. For the analysis of the clinical examinations of the 142 children, two were excluded because they did not have all the exams. Of the 140 children, 87.1% (121/139) had at least one retinochoroidal lesion. Among them, 20.7% (25/121) were diagnosed with LV. Retinochoroiditis was found in both eyes in 81.0% (98/121), and 25.5% (25/98) of these had LV. Macular (foveal and/or extrafoveal) lesions in both eyes occurred in 43.9% (43/98); 51.2% (22/43) of these children had low LV. At least 50% of children with LV presented retinochoroidal lesions with an average size > 3 optic disc diameter. Absence of retinochoroidal lesions was recorded in only 12.9% (18/140) of children. In the perception of carers parents (CVFQ7-BR-toxo) of children diagnosed with LV, median scores were lower for visual ability dimensions (p = 0.002), functional performance- visual function (p = 0.002), impact on family (p = 0.001) and overall QOL (p = 0.009) when compared to those of children with mild visual loss and with normal vision. Conclusion: CVFQ7-BR-toxo psychometric properties were appropriate concerning the validity of the QOL construct. The questionnaire was able to register the impact of visual disability on families of children with CT. Retinochoroiditis, was more severe, with frequent multiple, bilateral and macular lesions, resulting in impaired visual function. According to QOL perception of parents and carers, children with LV presented worse scores for visual capacity, functional performance/functional vison, with greater impact on their families and decreased overall quality of life. These results can support policies for better control and prevention of CT.
Asunto(s)
Preescolar , Niño , Psicometría , Calidad de Vida , Toxoplasmosis Congénita/complicaciones , Baja Visión , Trastornos de la Visión , Coriorretinitis , Salud Infantil , Estudios Transversales , Encuestas y Cuestionarios , Tesis AcadémicaRESUMEN
O objetivo desse estudo foi identificar a prevalência e os fatores associados ao baixo peso ao nascer (PBN) em Divinópolis, Brasil. Método: Trata-se de estudo transversal que analisou 9.987 registros de nascidos vivos hospitalares e únicos ocorridos entre 2008 e 2011. Na análise univariada utilizou-se o teste qui-quadrado e a razão de chances fixando um nível de significância de 5%. Para o controle de possíveis fatores de confusão nas associações obtidas, usou-se o modelo de regressão logística binária. Resultados: A tendência do BPN no período estudado mostrou-se estável, variando entre 8,9 e 9,2%. Mais da metade das crianças nasceu prematuro (62,0%) e de parto cirúrgico (63,9%). Os fatores independentes foram: prematuridade, sexo feminino, realização de seis ou menos consultas de pré-natal, mães solteiras. Conclusão: O conhecimento dos determinantes do BPN permite aos profissionais de saúde organizar a rede assistencial na proporção da necessidade e para aqueles em situação de maior vulnerabilidade e risco de agravos à saúde.
The aim of this study was to identify the prevalence and the low birth weight (LBW) associated factors in Divinópolis, Brazil. Method: It is a cross-sectional study. 9,987 hospitalar birth records occurred between 2008 and 2011, were analysed. In univariate analysis, chi-square test and the odds ratio was used setting a significance level of 5%. To control for possible confounding factors in obtained associations, binary logistic regression model was used. Results: The LBW trend during studied period was stable, ranging between 8.9 and 9.2%. More than half of children were born preterm (62.0%) and through operative delivery (63.9%). Independent predictors were prematurity, female, performing six or fewer prenatal visits, single mothers. Conclusion: The knowledge of the determinants of LBW allows health professionals to organize health care network in proportion to the need for those most vulnerable and in risk of health problems.
El objetivo de este estudio fue identificar la prevalencia y los factores asociados con el bajo peso al nacer (BPN) en Divinópolis, Brasil. Material y Método: Se trata de estudio transversal que analizó 9.987 registros de nacimientos individuales vivos que ocurrieron en hospitales entre 2008 y 2011. En el análisis univariado se utilizó la prueba de chi-cuadrado y odds ratio estableciendo un nivel de significación del 5%. Para controlar los posibles factores de confusión en las asociaciones obtenidas, se utilizó el modelo de regresión logística binaria. Resultados: La tendencia de BPN durante el período de estudio se mantuvo estable, oscilando entre el 8,9 y el 9,2%. Más de la mitad de los niños con bajo peso nació prematuro (62,0%) y a través de parto quirúrgico (63,9%). Los predictores independientes fueron la prematuridad, sexo femenino, realizar seis o menos consultas prenatales, madres solteras. Conclusión: El conocimiento de los factores determinantes permite a los profesionales de salud organizar una red de atención de salud proporcional a las necesidades de aquéllos en situación de mayor vulnerabilidad y riesgo de problemas de salud.
Asunto(s)
Humanos , Recién Nacido de Bajo Peso , Factores Epidemiológicos , Sistemas de Información en Salud , Brasil , Mortalidad Infantil , Epidemiología Descriptiva , Enfermería ObstétricaRESUMEN
To assess the factors associated with excess weight (overweight/obese) in school children enrolled in the public education network in Divinópolis, Minas Gerais, Brazil. Cross-sectional study with 1187 children between 6 and 14 years of age from municipal schools in Divinópolis, Minas Gerais. The prevalence of obesity and overweight was calculated based on the parameters of the World Health Organization, using the WHO Anthro-Plus Program. Logistic regression was used to identify the variables associated with excess weight, at a significance level of 5%. A prevalence of 24.4% of excess weight was identified. Family income and maternal education were determinants of overweight in the study population (p<0.05). Excess weight was configured as an important health problem among the students. The public power needs to implement intersectoral measures with a view to the prevention and reduction of the prevalence of overweight and obesity among school-aged children.
Evaluar los factores asociados con el exceso de peso (sobrepeso/obesidad) en los niños matriculados en una escuela primaria de la red pública de Divinópolis, Minas Gerais, Brasil. Estudio transversal con 1.187 escolares de 6 a14 años de edad de la red municipal de enseñanza de Divinópolis, Minas Gerais. La prevalencia de la obesidad y el sobrepeso se calculó a partir de los parámetros de la Organización Mundial de la Salud, mediante el Programa WHO Anthro-Plus. Se utilizó la regresión logística para identificar las variables asociadas con el exceso de peso, considerando un nivel de significación del 5%. Se observó una prevalencia de 24,4% de sobrepeso. Los ingresos familiares y la educación materna fueron determinantes con sobrepeso en la población estudiada (p<0,05). El exceso de peso fue configurado como el principal problema de salud en escolares. Medidas de orden intersectorial deben ser implementadas por el gobierno con el fin de prevenir y reducir la prevalencia del sobrepeso y la obesidad en la escuela.
Avaliar os fatores associados ao excesso de peso (sobrepeso/obeso) em escolares matriculados no ensino fundamental da rede pública de ensino de Divinópolis, Minas Gerais, Brasil. Estudo transversal com 1187 escolares de seis a 14 anos de idade da rede municipal de ensino de Divinópolis, Minas Gerais. Prevalência de obesidade e sobrepeso foi calculada a partir dos parâmetros da Organização Mundial de Saúde, utilizando-se o Programa WHO Anthro-Plus. Regressão logística foi usada para identificação das variáveis associadas ao excesso de peso, considerando um nível de significância de 5%. Foi identificada prevalência de 24,4% de excesso de peso. Renda familiar e escolaridade materna foram determinantes do excesso de peso na população do estudo (p<0,05). O excesso de peso configurou-se como importante problema de saúde entre os escolares. Medidas de ordem intersetorial necessitam ser implementadas pelo poder público, visando prevenir e reduzir as prevalências de sobrepeso e obesidade entre os escolares.
Asunto(s)
Humanos , Niño , Adolescente , Instituciones Académicas , Niño , Adolescente , Sobrepeso , ObesidadRESUMEN
This study aims to perform the first molecular and clinical-epidemiological analysis of dengue cases in Divinopolis, MG, Brazil. Data from 4,110 cases of dengue were accessed and 190 clinical samples were collected for molecular analyses. In this study, 2.7% of the men and 3.0% of the women were admitted to hospital. There was no association between gender and hospital admission. The symptoms observed in this study are according to the Health Ministry, but fever was present in 82.2% and not in 100% of cases. The chance of hospital admission was 1.55 higher in patients with any kind of bleeding (334) and 2.4% of individuals without bleeding were also hospitalized due to other warning signs. In the molecular analyses, 23% of the samples were positive for DENV. DENV-2 and DENV-3 were identified in 2010, DENV-3 in 2011, DENV-1 in 2012, and DENV-1 and DENV-4 in 2013. DENV detection was possible in samples with only one day of symptoms. This first report of dengue data in Divinópolis provided more insight into the viral types and effects of disease in the city, confirming the need for caution in assessing cases of suspected dengue and for revision of the criteria proposed by the Health Ministry to classify cases of the disease.
RESUMEN
Cervical uterine cancer is the second most frequent form of cancer in the female population and the fourth cause of cancer deaths among Brazilian women. In Divinópolis county, Minas Gerais state, cervical cancer accounted for 6.6% of deaths in 2007. The purpose of this study was to conduct an epidemiological and molecular investigation of samples of pre-neoplastic and neoplastic cervical uterine lesions from patients assisted at public healthcare services in the county. The study was based on clinical-epidemiological descriptions retrieved from cytological examination request forms from 2006 to 2010. For molecular analysis, samples from 95 patients were collected and DNA was extracted using the Chelex 100 method. PCR was performed for detection and typing of HPV 6/11, 16, 18, 31, and 33. Of the 52 168 patients who underwent cytological examination, 625 had pre-neoplastic or neoplastic lesions during the study period. Age distribution was consistent with the literature, with a predominance of patients aged 20-49 years. The microorganism found most frequently was Lactobacillus sp. (65%). Prominent among cellular alterations were cervical intraepithelial neoplasia I (39.7%) and atypical squamous cells of undetermined significance (32%). Molecular analysis revealed 72.6% of positive samples for HPV. HPV 16 (26.3%) was the most frequent type, followed by types 6/11 (7.4%), 18 (5.3%), 33 (2.1%), and 31 (1%). The results provided improved understanding of the association between HPV and cancer in Divinópolis, in addition to providing data that can contribute to the design of measures to prevent and control HPV infection in the county investigated.