Suplementos fluorados pós-natais: recomendações de pediatras, entidades profissionais e instituições públicas de saúde

OBJETIVOS: identificar a opinião de pediatras e conhecer as recomendações de entidades profissionais e instituições públicas de saúde quanto à prescrição de suplementos fluorados. MÉTODOS: um questionário foi enviado a médicos pediatras. Informações adicionais sobre recomendações de suplementos fluorados foram obtidas junto a sete entidades profissionais e quatro instituições públicas de saúde. RESULTADOS: aproximadamente um em cada dez pediatras declarou prescrever algum suplemento contendo flúor. Risco de fluorose dentária, porque a água é fluoretada, foi a principal razão para afirmar que isso não deve ser feito. Quanto às entidades profissionais, duas deram respostas apropriadas. As respostas das demais não foram satisfatórias quanto ao uso racional de flúor. As respostas das instituições públicas foram apropriadas, embora o Ministério da Saúde não tenha se posicionado a respeito. CONCLUSÕES: um em cada 10 pediatras declarou prescrever suplementos contendo flúor para crianças residentes em São Paulo, cidade com água fluoretada. Em consequência, é necessário que o poder público e as entidades odontológicas assumam suas responsabilidades quanto ao uso dos suplementos fluorados.

Avaliação da qualidade da atenção básica utilizando a doença respiratória da infância como traçador, em um distrito sanitário do município de São Paulo

OBJECTIVES: to assess quality of the primary care using respiratory diseases as a tracer. METHODS: the evaluative approach is based on Donabedian's referencial connected to Kessner's tracers methodology. The sample is formed by 768 children from 0 to 5 years old, presenting respiratory symptoms, attended at seven basic health units from the Sanitary District of Brasilândia, in the city of São Paulo, State of São Paulo, Brazil. Medical registrations and interviews with mothers or responsibles were the information sources. RESULTS: more accurate child medical examination evidences significant association with favorable evolution, mainly on moderate clinical forms. Although aspects related to the accessibility demonstrated by the health team seem to influence decisively on care quality evaluated by users, mainly the medical doctor. Mothers education level appears to have no influence in the favorable evolution. CONCLUSIONS: the tracer methodology has the potentiality to facilitate the critical analysis of the health care. It is important to focus on the outcome of the health care. The children respiratory diseases are important tracer for the quality assessment on health services.

Contraceptive use and associated factors among adolescents on Santiago Island - Cape Verde - Western Africa

OBJECTIVE: to estimate the prevalence of contraceptive use and associated factors among adolescents attending public schools on Santiago Island, Cape Verde. METHODS: a cross-sectional study was carried out with 368 sexually active adolescents aged 13-17years attending eight public elementary and high schools, randomly selected, on Santiago Island, Cape Verde, between January and March 2007. Poisson regression with robust variance was used for the multiple analysis of risk factors, at a 5% level of significance. RESULTS: among 368 adolescents, 69.3% reported having used a contraceptive method during the last act of sexual intercourse. The most frequently used method were condom (94.9%) and pill (26.4%). Factors significantly and positively associated with contraceptive use were: living in the capital (PR=1.23; CI95%: 1.07; 1.39); having dated and had sexual intercourse (PR =1.53; CI95%: 1.14;2.06); and having more than nine years of schooling (PR=1.19; CI95%: 1.02; 1.38). CONCLUSIONS: more educated adolescents who studied in Praia (the capital city) and were dating at the time of the study were more likely to use contraception. The high prevalence of condom use and the association between contraception use and years of schooling among adolescents may indicate that sexual and reproductive health policies have produced positive outcomes that may account for the decrease in HIV infection.

Peso insuficiente ao nascer e crescimento alcançado na idade pré-escolar, por crianças atendidas em creches filantrópicas do município de Santo André, São Paulo, Brasil

OBJETIVOS: comparar o crescimento alcançado e a prevalência de baixa estatura na idade pré-escolar entre recém-nascidos de peso insuficiente (PNI) e de peso adequado (PNA). MÉTODOS: foram estudadas 323 crianças com PNI e 886 com PNA de famílias de baixa renda de quinze creches filantrópicas de Santo André, São Paulo, Brasil, em 2001 e 2002. As variáveis foram o escore Z de peso e de estatura para a idade, pelo referencial Center for Disease Control (CDC) and National Center for Health Statistics (NCHS) 2000, comparando-se as médias dos dois grupos. Calculou-se a razão de prevalência (RP) de baixa estatura na idade pré-escolar em decorrência do peso insuficiente ao nascer. RESULTADOS: o escore z médio de peso foi -0,09 e 0,39 e o escore z médio de estatura foi de -0,06 e de 0,24 para as crianças de PNI e de PNA, respectivamente. A prevalência de baixa estatura foi de 2,78% para as crianças com PNI e de 0,79% para aquelas com PNA. A RP de baixa estatura na idade pré-escolar para as crianças de PNI foi de 3,5 (IC95% 1,3-9,4). CONCLUSÕES: as crianças com PNI apresentaram crescimento inferior e maior risco de falhas de crescimento até a idade pré-escolar, sugerindo um efeito negativo do peso insuficiente ao nascer sobre o crescimento infantil.

Declarações de nascidos mortos no município de São Paulo: avaliação descritiva do preenchimento

OBJECTIVES: to study the information contained in Stillbirth Registers (SBRs) in the Municipality of São Paulo. METHODS: the adequacy of the filling out of SBR forms was assessed on the basis of the SBRs (6722) made available by the FSEADE (Foundation for Statistical Data Analysis System), using a Data Completion Index (DCI), making it possible to compare the three years studied (2001-3). Variables relating to the mother and the fetus were included where the DCI was greater than 10%. Education, parity, place of residence, birth type, for the mother and weight, gestational age and underlying cause of death, for the fetus. RESULTS: the absolute stillbirth component changed little in the first two of the three years, falling slightly in the third. The variable most frequently registered was sex (98%), followed by place of residence (82.9%) and parity (70%). The data least often registered were those relating to the mother's age and schooling, 20.0% and 16.7%, respectively. The underlying cause was recorded in 46.7%, fetal weight in 37% and type of birth in 25.3%. CONCLUSIONS: the data demonstrate that the difficulty encountered in incorporating this health indicator into the traditional set of indicators is in part due to the inadequacy of the data provided on the SBR form.

Associação entre o índice de massa corporal de pais e de escolares de 7 a 14 anos de Florianópolis, SC, Brasil

OBJETIVOS: verificar a associação entre o Índice de Massa Corporal (IMC) de escolares de 7 a 14 anos e dos respectivos pais. MÉTODOS: estudo transversal com 886 escolares de quatro escolas de Florianópolis, SC. Diagnóstico antropométrico dos escolares e dos pais definido, respectivamente, a partir do IMC para idade de acordo com Centers for Disease Control and Prevention e dos pontos de corte da Organização Mundial da Saúde. A associação entre o IMC dos pais e dos escolares foi estimada por meio da razão de prevalência (RP) com intervalo de confiança (IC) de 95% e teste qui-quadrado com valor de significância de p< 0,05. RESULTADOS: identificou-se prevalência de sobrepeso/obesidade mais elevada em meninos (29,9%) quando comparada a de meninas (17,7%) (p<0,001). Observou-se relação estatisticamente significante entre o IMC de escolares do sexo feminino com o IMC das mães (RP=1,63; IC95%=1,1-3,0; p=0,02) e dos pais (RP=1,78; IC95%= 1,1-3,5; p=0,01). Nos escolares do sexo masculino a associação observada não foi estatisticamente significante. CONCLUSÕES: identificou-se que a prevalência do sobrepeso ou obesidade é 1,63 vezes maior, entre as meninas, quando a mãe também apresenta esse distúrbio e 1,78 vezes maior quando o pai o apresenta, em comparação a mães e pais eutróficos ou de baixo peso.

Observations on Haemagogus janthinomys Dyar (Diptera: Culicidae) and other mosquito populations within tree holes in a gallery forest in the northwestern region of Sao Paulo state, Brazil

In 2000, an outbreak of sylvatic yellow fever possibly occurred in gallery forests of the Grande river in the Paraná basin in the northwestern region of São Paulo state. The aim of this study was to obtain information on the bionomics of Haemagogus and other mosquitoes inside tree holes in that area. Eighteen open tree holes were sampled for immature specimens. Adults were collected twice a month in the forest in Santa Albertina county from July 2000 to June 2001. The seasonal frequency of fourth instars was obtained by the Williams geometric mean (Mw), while the adult frequency was estimated either by hourly arithmetic or the Williams' means. Cole's index was applied to evaluate larval inter-specific associations. Among the ten mosquito species identified, the most abundant was Aedes terrens Walker followed by Sabethes tridentatus Cerqueira and Haemagogus janthinomys Dyar. Larval and adult abundance of these species was higher in summer than in winter. Although larval abundance of Hg. janthinomys peaked in the rainy season, correlation with rainfall was not significant. Six groups of larval associations were distinguished, one of which the most positively stable. The Hg. janthinomys and Ae. terrens association was significant, and Limatus durhamii Theobald was the species with most negative associations.

Estudo histomorfométrico do baço de ratos Wistar sadios e diabéticos suplementados ou não pela vitamina C

O objetivo deste trabalho foi de analisar morfometricamente fragmentos histológicos do baço de animais normais e diabéticos, comparando os resultados encontrados e relacionando-os ao sexo e a suplementação da vitamina C. Foram utilizados 32 ratos Wistar, os quais foram analisados número de vasos, o número de folículos germinativos (polpa branca) e o diâmetro dos vasos de cada animal. As análises histológicas e morfometricas foram feitas em amostras de 5µm de espessura demonstrando que: na quantidade de folículos germinativos, observamos resultados comparando, independente do sexo, animais controles suplementados com vitamina C e controles não suplementados (p≤0,05; F=0,1452); na quantidade de vasos, observamos resultados comparando, fêmeas diabéticas suplementadas pela vitamina C e fêmeas diabéticas não suplementadas (pd"0,05; F=6.8893); e no diâmetro dos vasos, observamos resultados comparando fêmeas, tanto no grupo controle quanto ao grupo diabético, suplementadas pela vitamina C quando comparadas às fêmeas não suplementadas pela vitamina C (p<0,05; U=121.50; Z(U)=2.1234) e (p<0,05; F=4.8134). De um modo geral, a indução de diabetess modifica o diâmetro vascular nas fêmeas e que a administração de vitamina C interfere nos dados métricos relativos ao diâmetro vascular somente nas fêmeas.

Biópsia hepática por laparotomia paracostal em bovinos e búfalos

A técnica de biópsia hepática em ruminantes tem importante valor no diagnóstico clínico de doenças tóxicas e metabólicas, em especial nos desequilíbrios minerais. As técnicas mais comumente utilizadas restringem análises devido ao limitado volume de tecido obtido. No presente trabalho, avaliou-se o uso de uma técnica de biópsia hepática por laparotomia paracostal em bovinos e búfalos. Foram utilizados 10 bovinos e 10 búfalos hígidos. Os animais foram mantidos em estação, sedados com xilazina e infiltrados localmente com lidocaína e epinefrina. O acesso à cavidade abdominal foi realizado por meio de uma incisão dorso-ventral de 15cm no flanco direito, iniciada ventralmente (cerca de 4-5cm) ao processo transverso da 2a ou 3a vértebra lombar e situada caudalmente (cerca de 4cm) e paralelamente à 13a costela, obtendo-se visualização do fígado. Foi então realizado pinçamento do bordo caudal do órgão com pinça Doyen para remoção de fragmento hepático (2 a 4g). Procedeu-se o fechamento da cavidade abdominal como de rotina. Foram analisados os parâmetros bioquímicos e hematológicos antes do procedimento (tempo zero) e após 24 horas, 48 horas, 5 dias e 10 dias após a biópsia. Todas as variáveis bioquímicas estudadas retornaram aos valores basais 5 e 10 dias após o procedimento nos bovinos e búfalos, respectivamente. O tempo médio de cirurgia por animal foi de 25 minutos. A biópsia hepática por laparotomia paracostal demonstrou ser uma técnica eficaz e de baixo risco à saúde dos animais, permitindo a coleta de suficiente quantidade de tecido hepática para realização de múltiplas análises.

Ehrlichiosis in Brazil

Ehrlichiosis is a disease caused by rickettsial organisms belonging to the genus Ehrlichia. In Brazil, molecular and serological studies have evaluated the occurrence of Ehrlichia species in dogs, cats, wild animals and humans. Ehrlichia canis is the main species found in dogs in Brazil, although E. ewingii infection has been recently suspected in five dogs. Ehrlichia chaffeensis DNA has been detected and characterized in mash deer, whereas E. muris and E. ruminantium have not yet been identified in Brazil. Canine monocytic ehrlichiosis caused by E. canis appears to be highly endemic in several regions of Brazil, however prevalence data are not available for several regions. Ehrlichia canis DNA also has been detected and molecularly characterized in three domestic cats, and antibodies against E. canis were detected in free-ranging Neotropical felids. There is serological evidence suggesting the occurrence of human ehrlichiosis in Brazil but its etiologic agent has not yet been established. Improved molecular diagnostic resources for laboratory testing will allow better identification and characterization of ehrlichial organisms associated with human ehrlichiosis in Brazil.

Occurrence and molecular characterization of Cryptosporidium spp. isolated from domestic animals in a rural area surrounding Atlantic dry forest fragments in Teodoro Sampaio municipality, State of São Paulo, Brazil

The aim of this study was to assess the occurrence of Cryptosporidium in domestic animals in rural properties surrounding rain forest fragments within the municipality of Teodoro Sampaio, southeastern Brazil. Conventional sucrose flotation method followed by molecular characterization of the parasites by sequencing PCR products amplified from SSU rRNA gene were used. Stool samples were collected from domestic animals raised as pets and livestock in all rural properties surrounding three forest fragments. Samples from cattle (197), equine (63), pigs (25), sheep (11), and dogs (28) were collected from 98 rural properties. The frequency of occurrence of Cryptosporidium within each animal species was 3.0% (6/197) among cattle and 10.7% (3/28) among dogs. Cryptosporidium was not detected in stool samples from equine, sheep, and pigs. All sequences obtained from the six samples of calves showed molecular identity with Cryptosporidium andersoni while all sequences from dog samples were similar to C. canis. The frequency of occurrence of Cryptosporidium in these domestic animal species was low. The absence of C. parvum in the present study suggests that the zoonotic cycle of cryptosporidiosis may not be relevant in the region studied. The presence of Cryptosporidium species seldom described in humans may be, otherwise, important for the wild fauna as these animals are a source of infection and dissemination of this protozoan to other animal species. The impact and magnitude of infection by C. andersoni in wild ruminants and C. canis in wild canids have to be assessed in future studies to better understand the actual importance of these species in this region.

Rapid detection of bovine coronavirus by a semi-nested RT-PCR

Bovine coronavirus (BCoV) is a member of the group 2 of the Coronavirus (Nidovirales: Coronaviridae) and the causative agent of enteritis in both calves and adult bovine, as well as respiratory disease in calves. The present study aimed to develop a semi-nested RT-PCR for the detection of BCoV based on representative up-to-date sequences of the nucleocapsid gene, a conserved region of coronavirus genome. Three primers were designed, the first round with a 463bp and the second (semi-nested) with a 306bp predicted fragment. The analytical sensitivity was determined by 10-fold serial dilutions of the BCoV Kakegawa strain (HA titre: 256) in DEPC treated ultra-pure water, in fetal bovine serum (FBS) and in a BCoV-free fecal suspension, when positive results were found up to the 10-2, 10-3 and 10-7 dilutions, respectively, which suggests that the total amount of RNA in the sample influence the precipitation of pellets by the method of extraction used. When fecal samples was used, a large quantity of total RNA serves as carrier of BCoV RNA, demonstrating a high analytical sensitivity and lack of possible substances inhibiting the PCR. The final semi-nested RT-PCR protocol was applied to 25 fecal samples from adult cows, previously tested by a nested RT-PCR RdRp used as a reference test, resulting in 20 and 17 positives for the first and second tests, respectively, and a substantial agreement was found by kappa statistics (0.694). The high sensitivity and specificity of the new proposed method and the fact that primers were designed based on current BCoV sequences give basis to a more accurate diagnosis of BCoV-caused diseases, as well as to further insights on protocols for the detection of other Coronavirus representatives of both Animal and Public Health importance.

Etiologic diagnosis of bovine infectious abortion by PCR

Infectious abortion is a significant cause of reproductive failure and economic losses in cattle. The goal of this study was to detect nucleic acids of several infectious agents known to cause abortion including Arcanobacterium pyogenes, Bovine Herpesvirus 1, Brucella abortus, Campylobacter fetus subsp. venerealis, Chlamydophila abortus, Leptospira sp., Listeria monocytogenes, Salmonella sp., Mycoplasma bovis, Mycoplasma bovigenitalium, Neospora caninum, and Tritrichomonas foetus. Tissue homogenates from 42 fetuses and paraffin-embedded tissues from 28 fetuses and 14 placentas/endometrium were included in this study. Brucella abortus was detected in 14.2% (12/84) of the samples. Salmonella sp. DNA was amplified from 2 fetuses, and there was one positive for Neospora caninum, and another for Listeria monocytogenes. This PCR-based approach resulted in identification of the etiology in 19% of samples, or 20% if considered fetal tissues only.

Differentiation of Bovine coronavirus (BCoV) genotypes by a restriction enzyme assay

This article reports the use of the GsuI restriction enzyme to differentiate genotypes of Bovine Coronavirus (BCoV), based on an 18-nucleotide deletion of S1-coding region found in one of the two genotypes. It was concluded that this assay can be used as a rapid tool for BCoV genotypes differentiation.

A coronavirus detected in the vampire bat Desmodus rotundus

This article reports on the identification of a group 2 coronavirus (BatCoV DR/2007) in a Desmodus rotundus vampire bat in Brazil. Phylogenetic analysis of ORF1b revealed that BatCoV DR/2007 originates from a unique lineage in the archetypical group 2 coronaviruses, as described for bat species elsewhere with putative importance in Public Health.