Prevalência e fatores associados à morbidade materna: inquérito populacional em Natal/RN

INTRODUCTION: Severe maternal morbidity , also known as maternal near miss , has been used as an alternative to the study of maternal mortality , since being more frequent shares the same determinants and enables the implementati on of epidem iological surveillance of cases . Since then, hospital audits ha ve been carried out to determine the rates of maternal near miss, its mai n causes and associated factors . More recently, population surveys based on self - reported morbidity have als o been presented as vi able in identifying these cases . OBJECTIVE: The aim of this study was to determine the prevalence and associated factors of maternal near miss and complications during pregnancy and puerperal period in Natal/RN. METHODS: A cross - secti onal population - based study was conducted in Natal /RN , Brazil, which has as its target population women aged 15 to 49 years who were pregnant in the last five years. It was carried out a probabilistic sam pling design based on a multi - stage complex sample , in which 60 census tracts were selected from three strata (north , south - east and west). Afterwards, domiciles were visited in order to obtain a sample of the 908 eligible women in whom a questionnaire was applied. The descriptive analyzes and bivariate ass ociations were performed using the Chi - square test and the estimate of the prevalence ratio (PR ) with 95% confidence interval (CI) and considering the weights and design effects . The Poisson regression analysis , also with 5% significance and 95% CI, was us ed for analyzes of associated factors. RESULTS: 848 women were identified and interviewed after visits in 8.227 households corresponding to a response rate of 93 . 4 %. The prevalence of maternal near miss was 41 . 1 /1 000NV, being the Intensive Care Unity stay i ng (19 . 1 /1 000 LB ) and eclampsia (13 . 5/1000LB) the most important marker s . The prevalence of complications in the puerperal peri od was 21 . 2 %, and hemorrhage (10 . 7%) and urinary tract infection (10 . 7%) the most frequently reported clinical conditions and rema in ing in the hospital for over a week after delivery the mo st frequent intervention (5.4%) . Regarding associated factors , the bivariate analysis showed an association between the increased number of complications in women of black/brown race ( PR= 1 . 23; CI95 % : 1 . 04 - 1 . 46) and lower socioeconomic status ( PR= 1 . 33; CI95%: 1 . 12 - 1 . 58) in women who had pre natal care in public service ( PR= 1 . 42; CI95%: 1 . 16 to 1 . 72 ) and that were not advised during prenatal about where they should do the d elivery (PR= 1 . 24; CI95%: 1 . 05 - 1 . 46), made the del ivery in the public service (PR= 1 . 63; CI95%: 1 . 30 - 2 . 03), had to search for more than one hospital for delivery (PR=1 . 22; CI95%: 1 . 03 - 1 . 45) and had no companion during childbirth ( PR =1 . 19; CI95%: 1 . 01 - 1 . 41) or at all times of childbirth c are - before, during and after childbirth - ( PR= 1 . 25, CI95%: 1 . 05 - 1 . 48) . Moreover, the number of days postpartum hospitalization was higher in women who had more complications (P R= 1 . 59 ; CI95%: 1 . 36 - 1 . 86). In the final regression model for both birth place (P R= 1 . 21 ; CI 95% : 1 . 02 to 1 . 44 ) and socioeconomic status (PR = 1.54 ; CI95%: 1 . 25 - 1 . 90 ) the association remained. CONCLUSION : Conducting population surveys using the pragmatic definition of near miss is feasible and may add importa nt information about this ev ent . It was possible to find the expression of health inequalities related to maternal health in the analysis of both socioeconomic conditions and on the utilization of health services.

Prevalência da síndrome metabólica e seus componentes nos estágios pubertários de escolares do sexo feminino norte-rio-grandenses

The diagnosis of nutritional status is extremely re levant in clinical practice and population assessment, due to the association betwe en body fat and metabolic alterations. The aim of this study is to analyze th e prevalence of metabolic syndrome (MS) and its components in the pubertal stages of f emale students in Rio Grande do Norte state, Brazil, in accordance with Internation al Diabetes Federation criteria. This is a cross-sectional study with 449 students aged betw een 8 and 19 years, stratified into pubertal stages systematized by Marshal and Tanner (1969), as follows: 27.6% prepubertal, 44.3% pubertal and 28.1% postpubertal, with mean ages of 9.4±1.27, 12.4±2.23 and 15.1±1.88 years, respectively. Preval ences were analyzed using distribution of frequencies and their respective 95 % confidence intervals, while the chi- square test and odds ratio were applied to analyze the associations between variables. The general prevalence of MS was 3.3% (CI: 2% - 5%) , without occurrences in the prepubertal stage, observing that it emerges from t he pubertal stage onwards with a prevalence of 2.5% (CI 95% 0.1% - 5%), 1% (CI 95% 0.4% - 2.3%) of cases with overweight and 1.5% (CI 95% -0.1% - 3.2%) with obes e individuals, while in the postpubertal stage the prevalence is 7.9% (CI 95% 3 .2% - 12.6%), 0.8% (CI 95% -0.8% - 2.3%) normal weight cases, 4% (CI 95% 0.6% - 7.4% ) overweight and 3.1% (CI 0.1% - 6.2%) obese individuals. There was an association (p<0.02) between pubertal stages and MS ( x 2 =5.2), with an OR of 3.3 (CI: 1.2 - 5), showing tha t postpubertal adolescents are more prone to SM than pubertals, while the OR i n obese individuals was 2.1 (CI: 2– 2.2) compared to the overweight. Body mass index (B MI) ( x 2 = 29.4; p<0.001) and age range ( x 2 = 13.1; p<0.001) showed a significant linear assoc iation with MS. Of the adolescents with MS, those aged ten years or younge r exhibited higher %G. The most prevalent components in all the stages were altered waist circumference (27.2% [CI 23% - 31%]) and low HDL cholesterol (39.6% [CI 35% – 44%]), which, coupled with hypertension, displayed significant differences in the postpubertal stage in relation to the other stages. The results show that MS emerges from the pubertal stage onwards in proportion to excess childhood body fat, a fact tha t calls for prevention strategies using an educational approach, reducing the large demand on the National Health System. Keywords: Metabolic syndrome, pubertal stages, risk factors.

Manifestações oculares em mulheres com síndrome dos ovários policísticos: prevalência e associação com fatores de risco metabólicos e inflamatórios

Objetivos: Estimar a prevalência de alterações do filme lacrimal e da doença do olho seco (DOS), comparar as mudanças na pressão intraocular (PIO) e comparar as espessuras macular e da camada de fibras nervosas da retina (CFNR), entre mulheres com síndrome dos ovários policísticos (SOP) e mulheres saudáveis, estratificando-as em condições clínicas, metabólicas e inflamatórias. Metodologia: O estudo incluiu 45 mulheres com SOP e 47 mulheres saudáveis ovulatórias submetidas a avaliações clínico-ginecológicas e oftalmológicas, incluindo propedêuticas para a avaliação do filme lacrimal e medida da PIO, e medição da espessura macular, da CFNR e parâmetros do disco óptico usando tomografia de coerência óptica. Resultados: Tempo de ruptura do filme lacrimal (TRFL; p=0.001) e impregnação por fluoresceína (p=0.006) apresentaram diferenças estatisticamente significantes entre os grupos estudados. A prevalência de DOS foi de 44,4% nas portadoras de SOP. Houve redução estatisticamente significativa do TRFL na presença de SOP (p=0.001). Além disso, houve efeito estatisticamente significativo de intolerância à glicose e síndrome metabólica/inflamação na impregnação por fluoresceina (p=0.004; p=0.015, respectivamente). A PIO encontrou-se estatisticamente mais elevada no grupo SOP que no grupo controle (p=0.011). Houve um aumento na média do IPC (índice pressão-córnea) com a associação entre SOP e da síndrome metabólica (p = 0.005); A média da espessura da CNFR superior ao redor do nervo óptico foi estatisticamente mais espessa nas voluntárias com SOP que nas voluntárias saudáveis (p=0.036); Após estratificação pela presença de resistência insulínica, as médias dos subcampos das espessuras maculares “macular interno temporal, macular interno inferior, macular interno nasal e macular externo nasal, foram mais espessas no grupo SOP que no grupo controle (p<0.05); Houve associação significativa entre obesidade e resistência insulínica (p=0.037), e intolerância à glicose (p=0.001), com aumento médio do componente principal 1 (CP1), e, na presença de síndrome metabólica (p<0.0001), com aumento médio do componente principal 2 (CP2), respectivamente, em relação à espessura macular total. Na presença de obesidade e inflamação, houve redução no escore médio da CP2 (p=0.034), em relação à espessura da CFNR na mácula. xviii Conclusões: Há uma associação da SOP, suas alterações metabólicas e inflamatórias com alterações do filme lacrimal e com mudanças na PIO. A diminuição na espessura da CFNR macular e aumento da espessura total macular estão possivelmente associadas às alterações metabólicas, e, o aumento na espessura da CFNR ao redor do nervo óptico estão provavelmente associadas às alterações hormonais, inerentes à SOP.

Prevalência e fatores associados à diminuição da função pulmonar em obesos em pré-operatório de cirurgia bariátrica

Introduction: Obesity shows changes in pulmonary function and respiratory mechanics, however, little is known regarding the prevalence of worsening respiratory function when considering the increase in central or peripheral adiposity or general obesity. Objectives: To analyze the association between anthropometric adiposity and decreased lung function in obese. Materials and Methods: Patients eligible for this study obese individuals (IMC≥30kg/m2) in pre-bariatric surgery and referred for Treatment Clinic of Obesity and Related Diseases, located at the University Hospital Onofre Lopes (HUOL), from October 2005 and July 2014. The evaluation included clinical information and measurement of anthropometric measures (body mass index (BMI), body fat index (BFI) and waist circumference (WC) and neck (NC)) and spirometric. The prevalence and analysis by Poisson regression was performed considering the following outcome variables: forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and Maximum Voluntary Ventilation (MVV) and as predictor variables were considered: BMI, IAC, WC and NC and as control variables: age, gender, smoking history and comorbidities (diabetes mellitus, dyslipidemia and hypertension). Statistical analysis was performed using Statistical Package for Social Sciences software (SPSS - version 20.0). Results: We analyzed 384 individuals, 75% women, mean BMI: 46.6 (± 8.7) kg/m2, IAC: 49.26 (± 9.48)%, WC: 130.84 (± 16.23) cm and NC: 42.3 (± 4.6) cm. The higher prevalence of FVC and FEV1 <80% was observed in individuals with NC above 42 cm, followed those with a BMI above 45 kg/m2. Multivariate analysis using Poisson regression showed as risk factors associated with FVC <80%, the variables: NC above 42 cm (odds ratio (OR) 2.41) and BMI over 45Kg/m2 (OR 1.71 ). As for FEV1 <80% predicted, all predictor variables were associated, with the largest odds presented by the NC (3.40). MVVV was not associated with any studied varaible. Conclusion: Individuals with NC above 42 cm had higher prevalence of reduced lung function and the NC was the measure with the highest association with reduced lung function in obese.

Prevalência e fatores associados à alteração vocal em idosos institucionalizados com capacidade cognitiva preservada

Voice disorders (VD) in the elderly can interfere negatively in communication, emotional well-being and quality of life, conditions that correspond to greater exposure to illness and social isolation bringing consequent economic impact for the health system. It is assumed that institutionalized confinement, weakness and morbidity associated to nursing home (NH) contribute to transform VD an especially prevalent condition in institutionalized elderly, including those without cognitive impairment. Thus, the aim of this study was to determine the prevalence and associated factors of VD in NH elderly residents without cognitive impairment. There is no epidemiological diagnostic instruments of VD for elderly populations, so the first step of this study was dedicated to prepare and analyze the psychometric properties of a short, inexpensive and easy to use questionnaire named Screening for Voice Disorders in Older Adults (Rastreamento de Alterações Vocais em Idosos—RAVI). The methodological procedures of this step followed the guidelines of the Standards for Educational and Psychological Testing and contemplated validity evidence based on test content, based on response processes, based on internal structure and based on relations with other variables, as well as reliability analysis and clinical consistency. The result of the validation process showed that the RAVI final score generate valid and reliable interpretations for the epidemiological diagnosis of VD in the elderly, which endorsed the use of the questionnaire in the second stage of the study, performed in ten NH located in the city of Natal, Rio Grande do Norte. At this stage, data from socioeconomic and demographic variables, lifestyle, general health conditions and characterization of the institution were collected. It was performed a bivariate analysis and it was calculated the prevalence ratio as a magnitude association measure, with a confidence interval of 95%. The variables with p-value less than 0.20 were included in the multiple logistic regression model that followed the Forward selection method. The odds ratio found in the multivariate model was converted into prevalence ratio and the level of significance was 5%. The sample consisted of 117 subjects with predominance of females and average of 79.68 (± 7.92) years old. The prevalence of VD was 39.3% (95% CI: 30.4-48.1%). The multivariate model showed statistically significant association between VD and depressive symptoms, smoking for a year or more and selfreported hearing loss. In conclusion, VD is a prevalent health condition in NH elderly residents without cognitive impairment and is associated with factors involving psychosocial, lifestyle and communicative disability that require attention of managers and professionals involved with NH environment. Strategies to encourage communication and social integration, actions to combat smoking and minimizing the effects of hearing loss could stimulate the physical well-being, emotional and mental health of institutionalized elderly population, contributing to the vocal and communicative maintenance, a more effective social inclusion and better overall health condition.

Prevalência e fatores associados à síndrome da fragilidade em idosos: inquérito populacional em Campina Grande-PB

The frailty syndrome is a geriatric medical condition of vulnerability resulting in the decline of physiological reserves, characterized by high-risk consequences as falls, disability, hospitalization, institutionalization and death. Although the presence of comorbidities is not always accompanied by fragility, this presence could also indicate an increased risk of adverse health events, taking the elderly to a greater likelihood of becoming brittle due to the physical limitations that may occur with emergence of diseases, which are strongly predictive of Fragility Syndrome. This study aimed to assess the prevalence of frailty syndrome in the elderly and associated factors. The specific objectives were to identify the prevalence of frailty syndrome in the elderly and their associations with demographic, economic, health, functional and psychological; identify the reasons for the prevalence of frailty syndrome with the demographic profile, health problems, use of legal drugs and problems with sleep of older people. The study was cross-sectional and composed of 385 elderly aged 65 or more. Multivariate Poisson regression models were used to check conditions associated with fragility and determine the prevalence ratio (α = 0.05). The prevalence of fragility was 8.7% and pre-fragility of 50.4%. Fragile and pre-frail elderly presented, bigger and increasing prevalence ratio for marital status, difficulty in performing instrumental activities of daily living, old age, involuntary loss of stool, depression and negative affect. Elderly people who do not work have a higher prevalence of fragility, as well as those who reported having had a stroke / stroke / ischemia, those who suffered falls in the last 12 months and those with sleep problems. It is considered that the results, together with other available in the literature, can contribute to the understanding of the fragility epidemiology and also in the implementation of specific programs aimed at reducing the prevalence of frailty, optimizing the quality of life. It is suggested that future programs have special attention to the profiles of elderly people who have not yet developed fragility, i.e., pre-fragile. This could prevent the elderly from becoming frail.

Prevalência e fatores associados ao Near Miss Materno: inquérito populacional em uma capital do Nordeste Brasileiro

The scope of this study was to determine the prevalence of near misses and complications during pregnancy and the puerperal period, identifying the main clinical and intervention markers and socioeconomic and demographic factors associated with near misses. It involved a cross-sectional, population-based and probabilistic study with multi-stage complex sampling design conducted in Natal, State of Rio Grande do Norte, Brazil. A validated questionnaire was given to 848 women aged 15 to 49 identified in 8,227 households in 60 census sectors. In theanalysis of associations, the Chi-square test applied and calculated the prevalence ratio (PR) with Confidence Interval (CI) of 95% and 5% significance. The prevalence of maternal near misses was 41.1/1000LB, with hospitalization in an Intensive Care Unit (19.1/1000LB) and eclampsia (13.5/1000LB) being the most important markers. The prevalence of complications during pregnancy and the puerperal period was 21.2%. The highest prevalence of near misses was observed in older women, of black/brown race and low socioeconomic status. Conducting population surveys is feasible and may add important information to the study of near misses and the markers highlight the need for enhancing maternal care to reduce health inequality.

Prevalência e fatores associados ao Near Miss Materno: inquérito populacional em uma capital do Nordeste Brasileiro

The scope of this study was to determine the prevalence of near misses and complications during pregnancy and the puerperal period, identifying the main clinical and intervention markers and socioeconomic and demographic factors associated with near misses. It involved a cross-sectional, population-based and probabilistic study with multi-stage complex sampling design conducted in Natal, State of Rio Grande do Norte, Brazil. A validated questionnaire was given to 848 women aged 15 to 49 identified in 8,227 households in 60 census sectors. In theanalysis of associations, the Chi-square test applied and calculated the prevalence ratio (PR) with Confidence Interval (CI) of 95% and 5% significance. The prevalence of maternal near misses was 41.1/1000LB, with hospitalization in an Intensive Care Unit (19.1/1000LB) and eclampsia (13.5/1000LB) being the most important markers. The prevalence of complications during pregnancy and the puerperal period was 21.2%. The highest prevalence of near misses was observed in older women, of black/brown race and low socioeconomic status. Conducting population surveys is feasible and may add important information to the study of near misses and the markers highlight the need for enhancing maternal care to reduce health inequality.

Reflexões metodológicas sobre prevalência da fluorose dentária nos inquéritos de saúde bucal

OBJETIVO: Analizar limitaciones del estudio de fluorosis dentaria en pesquisas transversales. MÉTODOS: Se utilizaron datos de estudios de de Condiciones de Salud Bucal de la Población Brasileña (SBBrasil 2003) y de la Investigación Nacional de la Salud Bucal (SBBrasil 2010). La estimativa de tendencia epidemiológica de la fluorosis en la población de 12 años, aspectos de la confiabilidad de los datos, así como la precisión de las estimativas, fueron evaluadas en estas dos investigaciones. La distribución de la prevalencia de la fluorosis fue hecha de acuerdo con los dominios de estudio (capitales y regiones) y el año estudiado. Se expresaron también los intervalos de confianza (IC95%) para la prevalencia simple (sin considerar las fases de la gravedad). RESULTADOS: La prevalencia de la fluorosis dentaria presentó una variación considerable, de 0 a 61% en 2003 y de 0 a 59% en 2010. Se observaron inconsistencias en los datos en términos individuales (por año y por dominio) y en el comportamiento de la tendencia. Considerando la expectativa de prevalencia y los datos disponibles en las dos investigaciones, el tamaño mínimo de la muestra debería ser de 1.500 individuos para obtener intervalos de 3,4% y 6,6% de confianza, considerando un coeficiente de variación mínimo de 15%. Dada la subjetividad en la naturaleza de su clasificación, exámenes de fluorosis dentaria pueden presentar más variación de los realizados para otras condiciones de salud bucal. El poder para establecer diferencias entre los dominios del estudio con la muestra de SBBrasil 2010 es bastante limitado. CONCLUSIONES: No fue posible analizar la tendencia de la fluorosis dentaria en Brasil con base en los estudios de 2003 y 2010; esos datos son sólo indicadores exploratorios de la prevalencia de la fluorosis. La comparación se hace imposible por el hecho de haber sido utilizado modelos de análisis diferentes en las dos pesquisas. La investigación de la fluorosis dentaria en pesquisas de base poblacional no es viable técnica y económicamente, la realización de estudios epidemiológicos localizados con plan de muestreo es más adecuada.

Prevalência, fatores associados e efeitos da violência doméstica na mobilidade em idosos: evidências do estudo imias (international mobility in aging study) sob a perspectiva epidemiológica do curso da vida

A capacidade de mover-se com independência e segurança é fundamental para a execução das atividades de vida diária e manutenção da qualidade de vida do indivíduo. Diversos fatores, dentre eles o envelhecimento podem contribuir para seu declínio. Estudos têm demonstrado associação entre experiências de violência doméstica (VD) e diversos problemas de saúde física e mental. Até o momento, não há estudos que tenham avaliado a associação entre experiências de VD no curso de vida e limitações de mobilidade na senescência. OBJETIVOS: estimar a prevalência da VD (física e psicológica) em idosos, e avaliar o impacto da VD no curso de vida na limitação de mobilidade. MATERIAIS E MÉTODO: Estudo observacional analítico a partir da primeira coleta de dados do estudo longitudinal International Mobility in Aging Study (IMIAS). Idosos (n = 1995) de ambos os sexos entre 65 e 74 anos de cinco localidades distintas (Kingston e Saint-Hyacinthe, Canadá; Tirana, Albânia; Maniazales, Colômbia; e Natal, Brasil) participaram do estudo. Dados sobre variáveis sociodemográficas, econômicas, condições de saúde e experiências de VD (física e psicológica) durante o curso de vida foram coletados. A limitação de mobilidade na senescência foi avaliada pelo Short Physical Performance Battery (SPPB) e pela dificuldade de andar 400 metros e/ou subir um lance de escadas. As prevalências foram avaliadas mediante frequências absolutas e relativas das exposições à VD, limitação de mobilidade e co-variáveis. Diferenças de gênero, bem como entre cidades foram analisadas utilizando o teste de qui-quadrado. Associação entre exposição à VD e limitação de mobilidade foi avaliada utilizando a regressão logística binária multivariada, ajustando pelas co-variáveis. Análise de mediação foram utilizadas, para avaliar possíveis caminhos entre a exposição à VD no curso de vida e a limitação de mobilidade. RESULTADOS: A violência física foi rara, com valores entre 0,63 e 0,85%. Relatos de violência psicológica variaram entre 3,2% e 23,5% (homens) e de 9% para 26% (mulheres). Mulheres experimentaram mais violência do que os homens em Saint-Hyacinthe (homens: 3,2% vs mulheres: 14%, p <0,001), Tirana (homens: 4,3% vs mulheres: 10,3%, p = 0,017), em Manizales (homens: 8,3 % vs mulheres: 18,3%, p = 0,004) e Natal (homens: 11,1% vs mulheres: 26%, p = 0,002). Em geral, o baixo suporte social pelo parceiro foi associado com a VD. Estar trabalhando foi associado a vitimização entre os homens, enquanto o oposto foi verdade para as mulheres. Arranjos de vida Multi-familiares e baixo suporte pelos parceiros, filhos e família foram associados com a VD. Baixo suporte social foi da maior importância para as mulheres do que os homens. A VD física foi associada tanto com o SPPB < 8 (OR 1,623 95%IC 1,161-2,269) como com a dificuldade para andar 400 metros e/ou subir um lance de escadas (OR 1,394 95%IC 1,063-1,829). A limitação de mobilidade decorrente da violência física no curso de vida pelo parceiro íntimo foi mediada pelas condições crônicas (efeito 25,56% 95%IC 0,036-0,277) e depressão (efeito 33,05% 95%IC 0,087-0,333). No caso da violência física por outros familiares, a limitação de mobilidade foi mediada pelas condições crônicas (efeito 20,85% 95%IC 0,022-0,202), não adesão à prática de atividades físicas (efeito 34,14% 95%IC 0,076-0,351) e depressão (efeito 44,40% 95%IC 0,144-0,315). CONCLUSÕES: A violência doméstica no curso de vida é uma realidade, que pode acarretar consequências que favorecem a limitação de mobilidade em idosos. São necessárias políticas públicas que combatam efetivamente a violência doméstica, garantindo um envelhecimento mais digno e independente funcionalmente.

Síndrome metabólica em mulheres com síndrome dos ovários policísticos: prevalência em cidade da região nordeste do Brasil

Resumo

Prevalência de sintomas do climatério em mulheres dos meios rural e urbano no Rio Grande do Norte, Brasil

OBJETIVO: avaliar a sintomatologia climatérica e fatores relacionados entre mulheres dos meios urbano e rural do Rio Grande do Norte. MÉTODOS: estudo transversal, descritivo, envolvendo casuística de 261 mulheres climatéricas residentes em Natal e Mossoró (grupo urbano; n=130) e Uruaçu, em São Gonçalo do Amarante (grupo rural; n=131). A sintomatologia climatérica foi avaliada pelo Índice Menopausal de Blatt-Kupperman (IMBK) e Escala Climatérica de Greene (ECG). A análise estatística constou de comparações das medianas dos escores entre os grupos e regressão logística. Defi niram-se como “muito sintomáticas” as pacientes com escores ≥20, para ambos instrumentos (variável dependente). As variáveis independentes foram: idade, procedência, alfabetização, obesidade e prática de atividade física. RESULTADOS: o grupo urbano apresentou escores signifi cativamente superiores ao grupo rural, tanto para o IMBK (medianas de 26,0 e 17,0, respectivamente; p<0,0001), quanto para a ECG (medianas de 27,0 e 16,0, respectivamente; p<0,0001). Na amostra total, evidenciou-se que 56,3% (n=147) das mulheres foram classifi cadas como “muito sintomáticas”. Na comparação intergrupos, essa prevalência foi signifi cativamente mais elevada nas mulheres urbanas em relação às rurais (79,2 e 33,6%, respectivamente; p<0,05). Pela análise de regressão logística, evidenciou-se que a chance de pertencer ao grupo defi nido como “muito sintomáticas” foi maior para mulheres do meio urbano [odds ratio ajustado (OR)=7,1; 95% intervalo de confi ança a 95% (IC95%)=3,69-13,66] e alfabetizadas (OR=2,19; IC95%=1,16-4,13). A idade superior a 60 anos associou-se com menor chance de ocorrência de sintomas signifi cativos (OR=0,38; IC95%=0,17-0,87). CONCLUSÕES: a prevalência de sintomas climatéricos signifi cativos é menor em mulheres do meio rural, demonstrando que fatores socioculturais e ambientais estão fortemente relacionados ao surgimento dos sintomas climatéricos em nossa população.___________________________________ABSTRACT PURPOSE: to evaluate climacteric symptoms and related factors in women living in rural and urban areas of Rio Grande do Norte, Brazil. METHODS: a cross-sectional study involving 261 women in the climacteric was performed. A total of 130 women from Natal and Mossoró (urban group) and 131 from Uruaçu, in São Gonçalo do Amarante (rural group), were studied. Climacteric symptoms were assessed by the Blatt-Kupperman Menopausal Index (BKMI) and Greene Climacteric Scale (GCE). Statistical analysis involved comparison of median between groups and logistic regression analysis. Patients were defi ned as “very symptomatic” when the climacteric score was ≥20 for both questionnaires (dependent variable). Independent variables were: age, living area, schooling, obesity and physical activity. RESULTS: the urban group had signifi cantly higher scores than those of the rural group, both for BKMI (median of 26.0 and 17.0, respectively; p<0.0001) and for GCE (median of 27.0 and 16.0, respectively; p<0.0001). For the entire sample, a total of 56.3% (n=147) of the women were classifi ed as “very symptomatic”. This prevalence was signifi cantly higher in urban than in rural women (79.2 and 33.6%, respectively; p<0.05). Logistic regression analysis showed that the likelihood of belonging to the group defi ned as “very symptomatic” was greater for urban women [adjusted odds ratio (OR)=7.1; confi dence interval at 95% (95%CI)=3.69-13.66] who were literate (OR=2.19; 95%CI=1.16- 4.13). Individuals over the age of 60 years had less chance of having signifi cant symptoms (OR=0.38; 95%CI=0.17-0.87). CONCLUSIONS: the prevalence of signifi cant climacteric symptoms is less in women from a rural environment, showing that sociocultural and environmental factors are strongly related to the appearance of climacteric symptoms in our population

Fatores Associados à Prevalência de Sintomas Osteomusculares em Professores

FERNANDES, Marcos Henrique; ROCHA, Vera Maria da; RONCALLI, Angelo Giuseppe. Fatores Associados à Prevalência de Sintomas Osteomusculares em Professores. Revista de salud pública, v. 11, n. 2, p. 256-267, 2009.

Prevalência de alterações fundoscópicas em estudantes na cidade de Natal/Brasil

Objetivo: Determinar a prevalência de alterações fundoscópicas em estudantes de escolas das redes pública e privada de Natal-RN. Métodos: Avaliação oftalmológica foi realizada em 990 alunos, de 5 a 21 anos, matriculados nas escolas das redes públicas e privada do município de Natal- RN, que estiveram cursando alguma série do ensino fundamental ou médio, no período de 03 a 06 de 2001. Resultados: Alterações fundoscópicas foram observadas em 5,3% dos estudantes. As anormalidades encontradas, por ordem de freqüência, foram: branco sem pressão, 1,0%; cicatriz de retinocoroidite sugestiva de toxoplasmose, 1,0%; atrofia do epitélio pigmentado da retina, 0,8%; nevos da coróide, 0,4%; escavação da cabeça do nervo óptico aumentada, 0,4%; degeneração em treliça, 0,3%; buraco operculado, 0,2%; fundus miópico, 0,2%; tortuosidade vascular aumentada, 0,2%; granuloma sugestivo de toxocaríase, 0,2%; hipoplasia da cabeça do nervo óptico, 0,1%; persistência da artéria hialoidea, 0,1%; persistência de fibras de mielina, 0,1%; retina sal e pimenta, 0,1%; retinosquise, 0,1%. Conclusão: Houve uma baixa prevalência de alterações fundoscópicas na população estudada

Prevalência de alterações fundoscópicas em estudantes na cidade de Natal-Brasil

Objetivo: Determinar a prevalência de alterações fundoscópicas em estudantes de escolas das redes pública e privada de Natal-RN. Métodos: Avaliação oftalmológica foi realizada em 990 alunos, de 5 a 21 anos, matriculados nas escolas das redes públicas e privada do município de Natal-RN, que estiveram cursando alguma série do ensino fundamental ou médio, no período de 03 a 06 de 2001. Resultados: Alterações fundoscópicas foram observadas em 5,3% dos estudantes. As anormalidades encontradas, por ordem de freqüência, foram: branco sem pressão, 1,0%; cicatriz de retinocoroidite sugestiva de toxoplasmose, 1,0%; atrofia do epitélio pigmentado da retina, 0,8%; nevos da coróide, 0,4%; escavação da cabeça do nervo óptico aumentada, 0,4%; degeneração em treliça, 0,3%; buraco operculado, 0,2%; fundus miópico, 0,2%; tortuosidade vascular aumentada, 0,2%; granuloma sugestivo de toxocaríase, 0,2%; hipoplasia da cabeça do nervo óptico, 0,1%; persistência da artéria hialoidea, 0,1%; persistência de fibras de mielina, 0,1%; retina sal e pimenta, 0,1%; retinosquise, 0,1%. Conclusão: Houve uma baixa prevalência de alterações fundoscópicas na população estudada