Prevalência da deficiência visual e fatores associados no município de Pratânia - SP

Pós-graduação em Bases Gerais da Cirurgia - FMB

Síndrome metabólica e fatores associados em populações da Amazônia oriental brasileira: um estudo transversal

Introdução: a síndrome metabólica (SM) desempenha papel fundamental na origem das doenças cardiovasculares. Estudos sobre a SM no Brasil ainda são recentes, e em regiões mais isoladas como na Amazônia, o seu comportamento epidemiológico ainda é desconhecido. O estudo objetivou estimar a prevalência da SM e fatores associados em adultos da Amazônia Brasileira. Métodos: realizou-se no período de 2012 a 2013 um estudo transversal de base populacional, com a participação de 787 adultos selecionados aleatoriamente da área urbana de quatro cidades do estado do Pará, Amazônia Oriental Brasileira. Os participantes foram submetidos a avaliação antropométrica, laboratorial e interrogados sobre o estilo de vida. A síndrome metabólica foi definida pelo critério clínico harmonizado - Joint Interim Statement, sendo utilizada a regressão logística múltipla para verificar o potencial de associação dos fatores de risco com a presença da SM. Resultados: A prevalência geral da SM foi de 34,1% (IC 95%= 30,8-37,4), aumentando linearmente com aumento do índice de massa corporal e idade. A partir da faixa etária de 40-49 anos a SM atingiu aproximadamente metade das mulheres (46,0%), enquanto que os homens só experimentaram prevalência similar na quinta década de vida (43,3%). O HDL-c baixo (64,4%) e a obesidade abdominal (58,9%) são mais elevadas nas mulheres (p < 0,0001), já para os homens, a pressão arterial elevada é significativamente superior (p < 0,0009). Foram mais propensos a ter SM quem estava na faixa etaria de 40–59 anos (odds ratio [OR]= 3,35 [IC 95%= 2,30-4,90]); ou ≥ 60 anos (OR= 5,80 [3,63-9,27]); ou com sobrepeso (OR= 4,17 [2,77-6,29]); ou obeso (OR= 8,82 [5,56-13,98]). Conclusão: A população estudada experimenta elevado risco cardiometabólico, nescessitando de esforços governamentais para o controle da SM e dos fatores de risco relacionados, especialmente da obesidade.

The AIDS epidemic in the Amazon region: a spatial case-control study in Rondonia, Brazil

OBJETIVO Analisar mudanças espaciais no risco de Aids e a relação entre incidência da doença e variáveis socioeconômicas. MÉTODOS Estudo caso-controle espacial, de base populacional, realizado em Rondônia, Brasil, com 1.780 casos notificados pelo Sistema de Vigilância Epidemiológica e os controles a partir de dados demográficos de 1987 a 2006. Os casos foram agrupados em cinco períodos de cinco anos consecutivos. Um modelo aditivo generalizado foi ajustado aos dados. O status dos indivíduos (caso ou controle) foi considerado como a variável dependente e independente: um alisamento ( spline ) bidimensional das coordenadas geográficas e variáveis socioeconômicas municipais. Os valores observados para o teste Moran I foram comparados com a distribuição de referência dos valores obtidos em condições de aleatoriedade espacial. RESULTADOS O risco de Aids apresentou padrão espacial e temporal marcado. A incidência associou-se a indicadores socioeconômicos municipais, como urbanização e capital humano. As maiores taxas de incidência de Aids ocorreram em municípios ao longo da rodovia BR-364; os resultados do teste Moran I mostram correlação espacial positiva associada à contiguidade dos municípios com a rodovia, no terceiro e quarto períodos (p = 0,05). CONCLUSÕES A incidência da doença foi maior em municípios de maior riqueza econômica e urbanização e naqueles cortados pelas estradas principais de Rondônia. O rápido desenvolvimento associado à ocupação de regiões remotas pode ser acompanhado por aumento de riscos à saúde.

Estudo dos fatores de risco e prevalência de cervicite por Chlamydia trachomatis em adolescentes do município de Botucatu, São Paulo

Some characteristics and behaviors, that are of young, as a tendency to rebel and take risks, deviating from the rules of society, makes it vulnerable to many detrimental aspects, such as may indiscriminate use of alcohol and drugs, practicing unsafe sex and having multiple partners, which cause, among another complications, sexually transmitted diseases (STD). The Chlamydia trachomatis causes chlamydial infection, is one of the most recurrent STD of the world. Several risk factors are already defined for Chlamydial infection, among them, age under 25 years old and sexual behavior of the risk. The objective was to determine the prevalence of Chlamydia infection cervicitis in adolescent females of the Botucatu, São Paulo, and risk factors associated with this infection. It is cross-sectional study, of the populational basis, performed together the nineteen basic health units of the Botucatu, São Paulo. The data were obtained through clinical interviews and gynecological examination on samples collected for laboratory analysis. The research of C. trachomatis was performed by polymerase chain reaction (PCR). This report presents preliminary data, which represent 19% of the sample checked. Were interviewed 37 adolescents with a mean age of 17 years (between 15th and 19th years old), average of years studied of the 8,19, 40% of the families lived on less than a minimum wage by person and 24,3% dosen’t has ownership of the house where they live. Mean age of first sexual intercourse of 14 years (between 12th and 16th years old), 24,3% regularly used condoms, 5,4% had a premature birth and 8,1% reported abortion. 75,7% had any complaints in the gynecological exam, pain in lower abdomen, the most prevalent. The prevalence of vulvovaginitis or vaginal flora altered was 54,1%. The prevalence of infection by C. trachomatis was 58%. Presence content was associated infection chlamydial and age... (Complete abstract click electronic access below)

Prevalência e fatores associados à inatividade física em escolares do ensino médio das escolas do município de Rio Claro - SP

Cerca de um terço do total de doenças em adultos estão associadas a condições ou comportamentos que começaram na juventude. No Brasil, a porcentagem de Inatividade Física (IF) nos adolescentes varia entre 29% a 94%, que é um dado alarmante, pois esses adolescentes provavelmente serão adultos inativos fisicamente e com um risco maior de adquirirem uma doença de agravo não transmissível. Desse modo, o objetivo do estudo foi verificar a prevalência e os fatores associados à IF em escolares do Ensino Médio do município de Rio Claro- SP. Estudo do tipo transversal, de base populacional, realizado no primeiro semestre letivo de 2009 contou com a participação de 467 alunos (213 homens e 254 mulheres) das escolas particulares e estaduais do Ensino Médio do município de Rio Claro-SP. Para avaliar o de nível de Atividade Física (AF) dos adolescentes foi utilizado o Physical Activity Questionnarie-Children (PAQ-C). Foi aferido a circunferência de abdômen e calculado o Índice de Massa Corpórea (IMC). Os pais responderam um questionário para avaliar o nível de AF através do International Physical Activity Questionnarie (IPAQ) e o nível socioeconômico. Para verificar a associação entre as variáveis (sexo, nível socioeconômico, IMC e circunferência de abdômen) com o nível de AF dos adolescentes foi realizado a Regressão Logística e para verificar a associação entre o nível de AF dos adolescentes e dos pais foi realizado o Teste Qui-Quadrado. A prevalência de IF dos adolescentes foi de aproximadamente 83% e, dentre as variáveis analisadas, apenas sexo mostrou-se significante (p=0,00), sendo o sexo feminino com maior chance de IF.

Incidência, fatores de risco e consequências de defeitos congênitos em recém-nascidos e natimortos

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Prevalence of low back pain and associated factors in adults from a middle-size Brazilian city

Objective: To determine the prevalence of low back pain and some related variables among adults of both genders. Methods: Was conduct a cross-sectional study of population-based in the urban area of Presidente Prudente, São Paulo. The sample consisted of 743 adult residents for over two years in this city. Low back pain, quality of sleep and physical activity were collected through face to face interview at the residence of respondents. Was used the chi-square test to analyze the association between variables, later was created tree multivariate models with hierarchical inclusion of confounding factors. Results: The prevalence of low back pain reported last year was 50.2% (95% CI: 46.6, 53.8), and the last week 32.3% (95% CI: 28.9, 35.6). Was association among low back pain and females (p-value = 0.031), older age, lower education, altered sleep and overweight, the adjusted model found that people over the age of 45 years (45 to 59.9 years, OR = 13.1 [1.72-98.5] and ≥ 60 years, OR = 9.10 [1.15-71.7]), with some alteration of sleep (OR = 3.21 [1.84-5.61]) and obese (OR = 2.33 [1:26 to 4:33]) seems to be a risk group for low back pain. Conclusion: The prevalence of low back pain is high and obese people aged over 45 years, with any sleep disturbance are a group at higher risk for low back pain.

A comparative analysis of caries and fluorosis among cities with and without public water supply fluoridation in São Paulo State, Brazil

Purpose: This population-based, cross-sectional study aimed to record the DMFT index for 12 year-old children with dental caries and fluorosis levels in cities with and without public water supply fluoridation. Methods: From the 101 municipalities belonging to the Health Regional Department XV (DRSXV-SJRP) of the São Paulo state in the Southeast region of Brazil, 85 cities were selected after exclusion of those with incomplete data and less than ten years of fluoridation treatment in 2004. The criteria adopted for the assessment of dental caries and fluorosis levels were based on the guidelines published in the WHO Manual 4th edition. The data were analyzed using Fisher’s exact tests at a significance level of 5%. Results: The prevalence of caries in 12 year-old children had no significant association with fluoridated water, and was considered “moderate” and “high” in cities without fluoridation and “low” and “moderate” in cities with fluoridation. A significant association was found between water fluoridation and fluorosis (P=0.001), but not between water fluoridation and the DMFT index (P=0.119). Conclusion: The prevalence of fluorosis was related to water fluoridation in this study. However, fluorosis was also observed in non-fluoridated cities, which may result from fluoride intake through other sources.

Bullying e má oclusão relacionados a autoestima e qualidade de vida em adolescentes

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Características do processo de diagnóstico de hanseníase no atendimento primário e secundário

Contexto e objetivo: A hanseníase caracteriza-se por ter diagnóstico eminentemente clínico, principalmente através da constatação de hipo ou anestesia das lesões, ou seja, sem necessariamente o uso de exames adicionais, como baciloscopia e biópsia, utilizados para classificação clínica da doença. Buscou-se definir se há tendência à desvalorização da avaliação clínica em favor do excesso de exames complementares, investigar a adequação do registro nos atendimentos da atenção básica e compará-los com o obtido em serviço de média complexidade. Desenho e local: Estudo transversal, de base populacional, utilizando registros de prontuários, realizado em dois âmbitos de atendimentos de saúde da cidade de Campinas (SP): os Centros de Saúde e a assistência dermatológica especializada de hospital de ensino. Métodos: Os registros foram investigados por meio da aplicação de checklist, contendo itens indispensáveis ao atendimento a hansenianos. Associações foram testadas pela prova de Goodman e ao nível de 5% de significância. Resultados: Foram avaliados 33 prontuários oriundos dos centros de saúde e 36 do hospital, observou-se polarização entre registros adequados e ausentes, evidenciando a presença de efeito tudo ou nada nos atendimentos; de 26 variáveis, apenas em 5 (19,23%) obteve-se predomínio da avaliação do hospital sobre os centros de saúde; evidenciou-se dependência de exames complementares, solicitados em 67 dos 69 atendimentos (97,10%), para diagnóstico da doença. Conclusão: Confirmou-se, neste estudo, déficit da avaliação médica e indicação inadequada de exames adicionais. Por associar-se com excesso de solicitação de exames, a observação clínica mostrou-se incompleta, comprometendo a capacidade diagnóstica dos atendimentos a hansenianos.

Prevalência de sintomas clínicos e fatores associados à ocorrência de síndrome do túnel do carpo na gravidez

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Prescription patterns for diabetes mellitus and therapeutic implications: a population-based analysis

Objective: To analyze drug prescriptions for insulin and oral antidiabetic drugs in type 1 and type 2 diabetes mellitus patients seen in the Brazilian Public Healthcare System (Unified Health System - SUS) in Ribeirao Preto, SP, Brazil. Subjects and methods: All the patients with diabetes seen in the SUS in the western district of Ribeirao Preto, SP, Brazil between March/2006 and February/2007 were included in the study. Results: A total of 3,982 patients were identified. Mean age of the patients was 60.6 years, and 61.0% were females. Sixty percent of the patients were treated with monotherapy. Doses of oral antidiabetic drugs were lower in monotherapy than in polytherapy. Ten patients received doses of glibenclamide or metformin above the recommended maximum doses, and in elderly patients there was no reduction in drug doses. Conclusion: Monotherapy with oral antidiabetic drugs was the predominant procedure, and the doses were not individualized according to age. Arq Bras Endocrinol Metab. 2012;56(2):120-7

Prevalence of asthma and risk factors associated: population based study in Sao Paulo, Southeastern Brazil, 2008-2009

OBJECTIVE: To assess the prevalence of asthma and risk factors associated in children and adolescents. METHODS: Population-based cross-sectional study with 1,185 female and male children and adolescents carried out in the city of Sao Paulo, Southeastern Brazil, from 2008 to 2009. Data were collected through home interviews. Respondents were selected from two-stage (census tract, household) cluster random sampling stratified by gender and age. Multiple Poisson regression was used in the adjusted analysis between the outcome and socioeconomic, demographic, lifestyle and health condition variables. RESULTS: Of all respondents, 9.1% (95%CI 7.0; 11.7) reported asthma. After adjustment, the following variables were found independently associated with asthma: age (0 to 4 years vs. 15 to 19) (PR 3.18, 95%CI 1.20;8.42); age (5 to 9 years vs. 15 to 19) (PR 6.37, 95%CI 2.64;15.39); age (10 to 14 years vs. 15 to 19) (PR 4.51,95%CI 1.95;10.40); allergy (yes vs. no) (PR 2.22, 95%CI 1.24;4.00); rhinitis (yes vs. no) (PR 2.13, 95%CI 1.22;3.73); health conditions in the 15 days preceding the interview (yes vs. no) (PR 1.96, 95%CI 1.23;3.11); number of rooms in the household (1 to 3 vs. 4 and more) (PR 1.67, 95%CI 1.05;2.66); and skin color (black and mixed vs. white) (PR 2.00, 95%CI 1.14;3.49). CONCLUSIONS: This study showed the importance of factors associated with asthma including rhinitis and allergy; age between 5 to 9 years old; black and mixed skin color; and household with few rooms. Frequent health problems are seen as a common consequence of asthma.

Prevalence of hepatitis B virus infection and carriage after nineteen years of vaccination program in the Western Brazilian Amazon

Introduction: Reductions in the prevalence of hepatitis B virus (HBV) infection and carriage, decreases in liver cancer incidence, and changes in patterns of liver dysfunctions are described after hepatitis B vaccination. Methods: We conducted a population-based seroprevalence study aimed at estimating the HBV prevalence and risk of infection in the rural area of Labrea following nineteen years of HBV vaccination. Results: Half of the subjects showed total anti-HBc of 52.1% (95% CI 49.6-54.7). The HBsAg prevalence was 6.2% (95% CI 5.1-7.6). Multivariate analysis showed an inverse association between HBV infection and vaccination (OR 0.62; 95% CI 0.44-0.87). HBsAg remained independently associated with past hepatitis (OR 2.44; 95% CI 1.52-3.89) and inversely to vaccination (OR 0.43; 95% CI 0.27-0.69). The prevalence of HBeAg among HBsAg-positive individuals was 20.4% (95% CI 12.8-30.1), with the positive subjects having a median age of 11 years (1-46) p=0.0003. Conclusions: We demonstrate that HBV infection is still an important public health issue and that HBV vaccination could have had better impact on HBV epidemiology. If we extrapolate these findings to other rural areas in the Brazilian Amazon, we can predict that the sources of chronic infected patients remain a challenge. Future studies are needed regarding clinical aspects, molecular epidemiology, surveillance of acute cases, and risk groups.

Men's health: a population-based study on social inequalities

This study evaluates social inequalities in health according to level of schooling in the male population. This was a cross-sectional, population-based study with a sample of 449 men ranging from 20 to 59 years of age and living in Campinas, Sao Paulo State, Brazil. The chi-square test was used to verify associations, and a Poisson regression model was used to estimate crude and adjusted prevalence ratios. Men with less schooling showed higher rates of alcohol consumption and dependence, smoking, sedentary lifestyle during leisure time, and less healthy eating habits, in addition to higher prevalence of bad or very bad self-rated health, at least one chronic disease, hypertension, and other health problems. No differences were detected between the two schooling strata in terms of use of health services, except for dental services. The findings point to social inequality in health-related behaviors and in some health status indicators. However, possible equity was observed in the use of nearly all types of health services.