Anemia em crian��as de 6 a 59 meses e fatores associados no Munic��pio de Jord��o, Estado do Acre, Brasil

Examinou-se a preval��ncia e fatores associados �� anemia em estudo transversal com 429 crian��as de 6 a 59 meses do Munic��pio de Jord��o, Estado do Acre, Brasil. Modelos m��ltiplos de regress��o de Poisson foram utilizados com sele����o hier��rquica das vari��veis independentes. A anemia foi altamente prevalente (57,3%; IC95%: 52,5%-62,1%). Ter idade entre 6 e 23,9 meses [raz��o de preval��ncia - RP (IC95%): 1,40 (1,09-1,74)], morar na ��rea rural [RP: 1,23 (1,04-1,44)], morar em domic��lio com 5 a 14 crian��as [RP: 1,23 (1,04-1,44)], ter m��e que fumou na gravidez [RP: 1,29 (1,09-1,53)], m��e an��mica [RP: 1,18 (1,00-1,39)] e apresentar d��ficit de altura para idade [RP: 1,19 (1,01-1,39)] foram fatores associados ao risco de anemia, e ter m��e que trabalha fora [RP: 0,78 (0,64-0,94)] foi fator de prote����o. A anemia �� um grave problema de sa��de p��blica nesse munic��pio. Estrat��gias multissetoriais de combate �� pobreza, aumento da cobertura e qualidade de servi��os de assist��ncia �� sa��de materno-infantil devem ser implementados.

Alimenta����o complementar e estado nutricional de crian��as menores de dois anos atendidas no Programa Sa��de da Fam��lia em Acrel��ndia, Acre, Amaz��nia Ocidental Brasileira

Com objetivo de investigar o estado nutricional e alimenta����o complementar em crian��as de 6 a 24 meses, residentes na Amaz��nia Ocidental Brasileira, um estudo transversal foi realizado na ��rea urbana do Munic��pio de Acrel��ndia, Estado do Acre, com 164 crian��as. As preval��ncias de d��ficit de estatura/idade e anemia foram de 12% e 40%, respectivamente, e de defici��ncia de ferro isolada, de 85%. Os n��veis s��ricos das vitaminas A e B12 estavam baixos em 15% e 12% das crian��as, respectivamente. Houve baixo consumo alimentar dos seguintes nutrientes (% de crian��as abaixo das recomenda����es): ��cido f��lico (33%), vitamina C (40%), vitamina A (42%), zinco (46%) e ferro (71%). A biodisponibilidade de ferro da dieta foi de 8%. Observou-se baixo consumo de frutas, hortali��as e carnes, com consumo excessivo de leite de vaca e mingau.

Anemia e defici��ncia de ferro em pr��-escolares da Amaz��nia Ocidental brasileira: preval��ncia e fatores associados

Estudo transversal de base populacional que investigou preval��nciasde anemia e fatores associados �� anemia, anemia ferropriva e defici��ncia de ferro entre crian��as de 6 a 60 meses da ��rea urbana de dois munic��pios do Acre, Brasil (N = 624). Dosagens de hemoglobina sangu��nea, ferritina e receptor sol��vel de transferrina plasm��ticas foram realizadas mediante sangue venoso. Condi����es s��cio-econ��micas, demogr��ficas e de morbidade foram obtidas por question��rio. Raz��es de preval��ncias foram calculadas por regress��o de Poisson em modelo hier��rquico. As preval��ncias de anemia, anemia ferropriva e defici��ncia de ferro foram de 30,6%, 20,9% e 43,5%, respectivamente. Menores de 24 meses apresentaram maior risco para anemia, anemia ferropriva e defici��ncia de ferro. Pertencer ao maior tercil do ��ndice de riqueza conferiu prote����o contra anemia ferropriva (RP = 0,62; IC95%: 0,40-0,98). Pertencer ao maior quartil do ��ndice estatura/idade foi protetor contra anemia (0,62; 0,44-0,86) e anemia ferropriva (0,51; 0,33-0,79), e ocorr��ncia recente de diarr��ia representou risco (anemia: 1,47; 1,12-1,92 e anemia ferropriva: 1,44; 1,03-2,01). A infesta����o por geohelmintos conferiu risco para anemia, anemia ferropriva e defici��ncia de ferro.

Causas do decl��nio acelerado da desnutri����o infantil no Nordeste do Brasil (1986-1996-2006)

OBJETIVO: Descrever a varia����o temporal na preval��ncia de desnutri����o infantil na regi��o Nordeste do Brasil, em dois per��odos sucessivos, identificando os principais fatores respons��veis pela evolu����o observada em cada per��odo. M��TODOS: Os dados analisados prov��m de amostras probabil��sticas da popula����o de crian��as menores de cinco anos estudadas por inqu��ritos domiciliares do programa Demographic Health Surveys realizados em 1986 (n=1.302), 1996 (n=1.108) e 2006 (n=950). A identifica����o dos fatores respons��veis pela varia����o na preval��ncia da desnutri����o (altura para idade < -2 z) levou em conta mudan��as na freq����ncia de cinco determinantes potenciais do estado nutricional, modelagens estat��sticas da associa����o independente entre determinante e risco de desnutri����o no in��cio de cada per��odo e c��lculo de fra����es atribu��veis. RESULTADOS: A preval��ncia da desnutri����o foi reduzida em um ter��o de 1986 a 1996 (de 33,9 por cento para 22,2 por cento ) e em quase tr��s quartos de 1996 a 2006(de 22,2 por cento para 5,9 por cento ). Melhorias na escolaridade materna e na disponibilidade de servi��os de saneamento foram particularmente importantes para o decl��nio da desnutri����o no primeiro per��odo, enquanto no segundo per��odo foram decisivos o aumento do poder aquisitivo das fam��lias mais pobres e, novamente, a melhoria da escolaridade materna. CONCLUS��ES: A acelera����o do decl��nio da desnutri����o do primeiro para o segundo per��odo foi consistente com a acelera����o de melhorias em escolaridade materna, saneamento, assist��ncia �� sa��de e antecedentes reprodutivos e, sobretudo, com o excepcional aumento do poder aquisitivo familiar, observado apenas no segundo per��odo. Mantida a taxa de decl��nio observada entre 1996 e 2006, o problema da desnutri����o infantil na regi��o Nordeste poderia ser considerado controlado em menos de dez anos. ) Para se chegar a este resultado ser�� preciso manter o aumento do poder aquisitivo dos mais pobres e assegurar investimentos p��blicos para completar a universaliza����o do acesso a servi��os essenciais de educa����o, sa��de e saneamento

Oral findings and dental care in a patient with myelomeningocele: case report of a 3-year-old child

Myelomeningocele (MMC) is a congenital malformation of the neural tube that occurs in the first weeks of pregnancy. This malformation refers to the caudal non-closure of the neural tube and neural tissue exposure, which lead to neurological problems, such as hydrocephalus, motor disability, genitourinary tract and skeletal abnormalities and mental retardation. Patients with MMC have an acknowledged predisposition to latex allergy and are usually at a high caries risk and activity due to poor oral hygiene, fermentable carbon hydrate-rich diet and prolonged use of sugar-containing medications. This paper addresses the common oral findings in pediatric patients with MMC, discusses the strategies and precautions to deal with these individuals and reports the dental care to a young child diagnosed with this condition.

Adversidade familiar e problemas comportamentais entre adolescentes infratores e n��o-infratores

O presente estudo comparou adolescentes infratores e n��o-infratores com rela����o a dois aspectos: grau de adversidade familiar e grau de concord��ncia entre a autopercep����o e a percep����o dos pais sobre problemas de comportamento dos jovens. Participaram deste estudo 40 adolescentes, 23 atendidos no Centro de Aten����o e Apoio ao Adolescente (UNIFESP) e 17 adolescentes considerados infratores sob interven����o da Vara da Inf��ncia e da Juventude da comarca de Santos. Os instrumentos utilizados foram o Child Behavior Checklist (CBCL), Youth Self Report (YSR) e o ��ndice de Adversidade Familiar de Rutter. O ��ndice de Adversidade Familiar do grupo de adolescentes infratores foi significativamente maior. Os resultados apontaram ainda que, embora a diferen��a n��o tenha sido estatisticamente significante, a porcentagem dos escores de discord��ncia nas percep����es sobre problemas de comportamento foi maior entre os adolescentes infratores e seus pais.

Narrowing socioeconomic inequality in child stunting: the Brazilian experience, 1974���2007

Objective To assess trends in the prevalence and social distribution of child stunting in Brazil to evaluate the effect of income and basic service redistribution policies implemented in that country in the recent past. Methods The prevalence of stunting (height-for-age z score below \22122 using the Child Growth Standards of the World Health Organization) among children aged less than 5 years was estimated from data collected during national household surveys carried out in Brazil in 1974\201375 (n = 34 409), 1989 (n = 7374), 1996 (n = 4149) and 2006\201307 (n = 4414). Absolute and relative socioeconomic inequality in stunting was measured by means of the slope index and the concentration index of inequality, respectively. Findings Over a 33-year period, we documented a steady decline in the national prevalence of stunting from 37.1 per cent to 7.1 per cent. Prevalence dropped from 59.0 per cent to 11.2 per cent in the poorest quintile and from 12.1 per cent to 3.3 per cent among the wealthiest quintile. The decline was particularly steep in the last 10 years of the period (1996 to 2007), when the gaps between poor and wealthy families with children under 5 were also reduced in terms of purchasing power; access to education, health care and water and sanitation services; and reproductive health indicators.Conclusion In Brazil, socioeconomic development coupled with equity-oriented public policies have been accompanied by marked improvements in living conditions and a substantial decline in child undernutrition, as well as a reduction of the gap in nutritional status between children in the highest and lowest socioeconomic quintiles. Future studies will show whether these gains will be maintained under the current global economic crisis

Recent trends in maternal, newborn, and child health in Brazil: progress toward Millennium Development Goals 4 and 5

We analyzed Brazil's efforts in reducing child mortality, improving maternal and child health, and reducing socioeconomic and regional inequalities from 1990 through 2007. We compiled and reanalyzed data from several sources, including vital statistics and population-based surveys. We also explored the roles of broad socioeconomic and demographic changes and the introduction of health sector and other reform measures in explaining the improvements observed. Our findings provide compelling evidence that proactive measures to reduce health disparities accompanied by socioeconomic progress can result in measurable improvements in the health of children and mothers in a relatively short interval. Our analysis of Brazil's successes and remaining challenges to reach and surpass Millennium Development Goals 4 and 5 can provide important lessons for other low- and middle-income countries

A novel mutation in the glycogen synthase 2 gene in a child with glycogen storage disease type 0

Background: Glycogen storage disease type 0 is an autosomal recessive disease presenting in infancy or early childhood and characterized by ketotic hypoglycemia after prolonged fasting and postprandial hyperglycemia and hyperlactatemia. Sixteen different mutations have been identified to date in the gene which encodes hepatic glycogen synthase, resulting in reduction of glycogen storage in the liver. Case Presentation: Biochemical evaluation as well as direct sequencing of exons and exon-intron boundary regions of the GYS2 gene were performed in a patient presenting fasting hypoglycemia and postprandial hyperglycemia and her parents. The patient was found to be compound heterozygous for one previously reported nonsense mutation (c. 736 C>T; R243X) and a novel frameshift mutation (966_967delGA/insC) which introduces a stop codon 21 aminoacids downstream from the site of the mutation that presumably leads to loss of 51% of the COOH-terminal part of the protein. The glycemia and lactatemia of the parents after an oral glucose tolerance test were evaluated to investigate a possible impact of the carrier status on the metabolic profile. The mother, who presented a positive family history of type 2 diabetes, was classified as glucose intolerant and the father, who did not exhibit metabolic changes after the glucose overload, had an antecedent history of hypoglycemia after moderate alcohol ingestion. Conclusion: The current results expand the spectrum of known mutations in GYS2 and suggest that haploinsufficiency could explain metabolic abnormalities in heterozygous carriers in presence of predisposing conditions.

Age of Child, More than HPV Type, Is Associated with Clinical Course in Recurrent Respiratory Papillomatosis

Background: RRP is a devastating disease in which papillomas in the airway cause hoarseness and breathing difficulty. The disease is caused by human papillomavirus (HPV) 6 or 11 and is very variable. Patients undergo multiple surgeries to maintain a patent airway and in order to communicate vocally. Several small studies have been published in which most have noted that HPV 11 is associated with a more aggressive course. Methodology/Principal Findings: Papilloma biopsies were taken from patients undergoing surgical treatment of RRP and were subjected to HPV typing. 118 patients with juvenile-onset RRP with at least 1 year of clinical data and infected with a single HPV type were analyzed. HPV 11 was encountered in 40% of the patients. By our definition, most of the patients in the sample (81%) had run an aggressive course. The odds of a patient with HPV 11 running an aggressive course were 3.9 times higher than that of patients with HPV 6 (Fisher's exact p = 0.017). However, clinical course was more closely associated with age of the patient (at diagnosis and at the time of the current surgery) than with HPV type. Patients with HPV 11 were diagnosed at a younger age (2.4y) than were those with HPV 6 (3.4y) (p = 0.014). Both by multiple linear regression and by multiple logistic regression HPV type was only weakly associated with metrics of disease course when simultaneously accounting for age. Conclusions/Significance Abstract: The course of RRP is variable and a quarter of the variability can be accounted for by the age of the patient. HPV 11 is more closely associated with a younger age at diagnosis than it is associated with an aggressive clinical course. These data suggest that there are factors other than HPV type and age of the patient that determine disease course.

Psychometric properties of the Child Health Assessment Questionnaire (CHAQ) applied to children and adolescents with cerebral palsy

Background: Cerebral palsy (CP) patients have motor limitations that can affect functionality and abilities for activities of daily living (ADL). Health related quality of life and health status instruments validated to be applied to these patients do not directly approach the concepts of functionality or ADL. The Child Health Assessment Questionnaire (CHAQ) seems to be a good instrument to approach this dimension, but it was never used for CP patients. The purpose of the study was to verify the psychometric properties of CHAQ applied to children and adolescents with CP. Methods: Parents or guardians of children and adolescents with CP, aged 5 to 18 years, answered the CHAQ. A healthy group of 314 children and adolescents was recruited during the validation of the CHAQ Brazilian-version. Data quality, reliability and validity were studied. The motor function was evaluated by the Gross Motor Function Measure (GMFM). Results: Ninety-six parents/guardians answered the questionnaire. The age of the patients ranged from 5 to 17.9 years (average: 9.3). The rate of missing data was low(< 9.3%). The floor effect was observed in two domains, being higher only in the visual analogue scales (<= 35.5%). The ceiling effect was significant in all domains and particularly high in patients with quadriplegia (81.8 to 90.9%) and extrapyramidal (45.4 to 91.0%). The Cronbach alpha coefficient ranged from 0.85 to 0.95. The validity was appropriate: for the discriminant validity the correlation of the disability index with the visual analogue scales was not significant; for the convergent validity CHAQ disability index had a strong correlation with the GMFM (0.77); for the divergent validity there was no correlation between GMFM and the pain and overall evaluation scales; for the criterion validity GMFM as well as CHAQ detected differences in the scores among the clinical type of CP (p < 0.01); for the construct validity, the patients' disability index score (mean: 2.16; SD: 0.72) was higher than the healthy group ( mean: 0.12; SD: 0.23)(p < 0.01). Conclusion: CHAQ reliability and validity were adequate to this population. However, further studies are necessary to verify the influence of the ceiling effect on the responsiveness of the instrument.

Primary Hyperparathyroidism as the First Clinical Manifestation of Multiple Endocrine Neoplasia Type 2A in a 5-Year-Old Child

Background: Primary hyperparathyroidism occurs in only 10%-30% of patients with multiple endocrine neoplasia type 2A (MEN2A), rarely as the sole clinical manifestation, and is usually diagnosed after the third decade of life. Summary: A5-year-old girl was referred for prophylactic thyroidectomy as she carried the p.C634R RET mutation. She was clinically asymptomatic, with a normally palpable thyroid and with the cervical region free of lymphadenopathy or other nodules. Preoperative tests revealed hypercalcemia associated with elevation of parathyroid hormone (PTH) (calcium = 11.2mg/dL, calcium ion = 1.48mmol/L, phosphorus = 4.0 mg/dL, alkaline phosphatase = 625U/L, parathyroid hormone (PTH) PTH = 998 pg/mL). A thyroid ultrasound was normal and parathyroid scintigraphy with (99m)Tc-Sestamibi revealed an area of radioconcentration in the upper half of the left thyroid lobe suggesting hyperfunctioning parathyroid tissue. She underwent total thyroidectomy and parathyroidectomy and developed hypocalcemia. The anatomopathological examination showed no histopathological changes in the thyroid tissue and an adenoma of the parathyroid gland, confirming the diagnosis of hyperparathyroidism. Conclusions: Primary hyperparathyroidism can be a precocious manifestation of MEN2A. This case report highlights that asymptomatic hypercalcemia should be scrutinized in children related to patients with MEN2A who carry a mutation in the RET proto-oncogene, especially mutations in the codon 634, before the currently recommended age of 8 years.

Francoist Primary education: the schoolbook as an instrument of child indoctrination

The Francoist rule, mainly in its first decades, exerted a strong control upon education, which was left in the hands of the Catholic nationalist. Innumerous children`s schoolbooks were published driven by strong patriotic and religious bias. The authors aimed to shape the children`s minds based on the premises that supported the regimen: authority, hierarchy, order, abeyance, fear and devotion to God and the leader Francisco Franco. This paper analyzes the content of the elementary education books and shows how they were important instruments of child indoctrination marked by intolerance. The content and the images of the books contributed to construct an excluding national identity based on a heightened Catholic patriotism, stimulated heroism, martyrdom, child sacrifice, and hatred for the enemies of the religion and of ""mother Spain"".

Macrophage Activation Syndrome Associated with Etanercept in a Child with Systemic Onset juvenile Idiopathic Arthritis

Fundacao de Amparo a Pesquisa do Estado de Sao Paulo - FAPESP[06/61303-7]