52 resultados para cross-sectional study

em Repositório Institucional UNESP - Universidade Estadual Paulista "Julio de Mesquita Filho"


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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

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Background: In 2000, the eight Millennium Development Goals (MDGs) set targets for reducing child mortality and improving maternal health by 2015.Objective: To evaluate the results of a new education and referral system for antenatal/intrapartum care as a strategy to reduce the rates of Cesarean sections (C-sections) and maternal/perinatal mortality.Methods: Design: Cross-sectional study. Setting: Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University/UNESP, Brazil. Population: 27,387 delivering women and 27,827 offspring. Data collection: maternal and perinatal data between 1995 and 2006 at the major level III and level II hospitals in Botucatu, Brazil following initiation of a safe motherhood education and referral system. Main outcome measures: Yearly rates of C-sections, maternal (/100,000 LB) and perinatal (/1000 births) mortality rates at both hospitals. Data analysis: Simple linear regression models were adjusted to estimate the referral system's annual effects on the total number of deliveries, C-section and perinatal mortality ratios in the two hospitals. The linear regression were assessed by residual analysis (Shapiro-Wilk test) and the influence of possible conflicting observations was evaluated by a diagnostic test (Leverage), with p < 0.05.Results: Over the time period evaluated, the overall C-section rate was 37.3%, there were 30 maternal deaths (maternal mortality ratio = 109.5/100,000 LB) and 660 perinatal deaths (perinatal mortality rate = 23.7/1000 births). The C-section rate decreased from 46.5% to 23.4% at the level II hospital while remaining unchanged at the level III hospital. The perinatal mortality rate decreased from 9.71 to 1.66/1000 births and from 60.8 to 39.6/1000 births at the level II and level III hospital, respectively. Maternal mortality ratios were 16.3/100,000 LB and 185.1/100,000 LB at the level II and level III hospitals. There was a shift from direct to indirect causes of maternal mortality.Conclusions: This safe motherhood referral system was a good strategy in reducing perinatal mortality and direct causes of maternal mortality and decreasing the overall rate of C-sections.

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

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Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

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Background: The use of multiple medicines is very frequent among the elderly, allowing them to perceive more often adverse side effects from drugs and present undesirable drug interactions.Methods: This article presents a cross-sectional survey about the use of medicines among 300 elderly Brazilians, equally divided into institutionalized and community-dwelling groups.Results: The average daily intake of medicines is 3.2 among institutionalized elderly, a higher (p < 0.001) number when compared with community-dwelling elderly, who takes an average of 1.8 medicines daily. The most commonly used medications are antihypertensives (58.0%), diuretics (23.0%), nonsteroidal anti-inflammatory drugs (22.7%), supplements (21.7%), antidiabetics (16.3%), and antiulcerants (14.0%). Antiulcerants, diuretics, supplements, and central nervous system drugs are more frequently used by institutionalized than by community-dwelling elderly.Conclusion: In this Brazilian elderly sample, the most widely used medicines were antihypertensives, diuretics, and nonsteroidal anti-inflammatory drugs, and institutionalized used more medications than community-dwelling elderly. Copyright (C) 2011, Taiwan Society of Geriatric Emergency & Critical Care Medicine. Published by Elsevier Taiwan LLC. All rights reserved.

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In addition to providing nutrition and immunological protection, breast-feeding has positive effects on the development of the infant's oral cavity. The aim of the present study is to assess breast-feeding patterns and to analyze the influence of breast-feeding practices and maternal sociodemographic variables on the prevalence of non-nutritive sucking habits in a sample of Brazilian infants. This cross-sectional study was carried out in Southern Brazil. A random sample of 100 mothers of infants up to 12 months of age was interviewed during the National Vaccination Campaign Day. The prevalence and median duration of breast-feeding were assessed. Breast-feeding practice, the exposure factor, was categorized as exclusive breast-feeding, predominant breast-feeding, complementary breast-feeding, or weaning. Maternal sociodemographic variables included age, race, marital status, educational level, profession, and family income. The outcome investigated was the prevalence of sucking habits (pacifier use and thumb sucking). We used two-sample tests, the chi-square test and Fisher exact test0 for statistical analyses of the data. The study revealed that 75% of infants were being breast-fed. Pacifier use and thumb sucking were common in 55%. Bottle-feeding was prevalent in 74% of infants. Breast-feeding was negatively correlated with pacifier use and thumb sucking (OR = 0.11; 95% CI: 0.03 to 0.4). Bottle-feeding was strongly associated with weaning (p = 0.0003). Among the sociodemographic variables, only marital status showed a statistical association with sucking habits (p = 0.04). These findings suggest that breast-feeding can prevent the occurrence of sucking habits. Although we could not evaluate causality assessment, malocclusion prevention seems to be yet one more reason for promoting breast-feeding practices.

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The aim of the present study was to radiographically evaluate the effect of smoking on bone loss resulting from chronic periodontitis. Periapical radiographs were analyzed of 80 patients with chronic periodontitis (40 current or former smokers and 40 never-smokers) that attended a private periodontal practice. The smokers or former-smokers with a minimum consumption of 10 cigarettes/day for a period of over 10 years were selected. Interproximal radiographic bone loss was considered as the distance between the cementum-enamel junction and the alveolar bone crest. Bone loss for smokers was higher than that observed in never-smokers (p < 0.05) (3.33 ± 1.09 mm and 2.24 ± 0.76 mm; mean ± standard deviation for smokers and non-smokers, respectively). When each region of the mouth was comparatively evaluated, it was observed that the smokers' incisors presented the highest bone loss when compared with the other groups of teeth (p < 0.01). Within the limits of the present investigation it can be concluded that smoking enhances the bone loss resulting from periodontitis and that the incisors are the teeth most affected.

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Background. Temporomandibular disorder (TMD) development in fibromyalgia syndrome (FMS) is not yet fully understood, but altered neuromuscular control in FMS may play a role in triggering TMD. Objective. The purpose of this study was to verify the association between neuromuscular control and chronic facial pain in groups of patients with FMS and TMD. Design. A cross-sectional study was conducted. Methods. This study involved an analysis of facial pain and electromyographic activity of the masticatory muscles in patients with FMS (n=27) and TMD (n=28). All participants were evaluated according to Research Diagnostic Criteria for Temporomandibular Disorders and surface electromyography (SEMG). Myoelectric signal calculations were performed using the root mean square and median frequency of signals. Results. The data revealed premature interruption of masticatory muscle contraction in both patient groups, but a significant correlation also was found between higher median frequency values and increased facial pain. This correlation probably was related to FMS because it was not found in patients with TMD only. Facial pain and increased SEMG activity during mandibular rest also were positively correlated. Limitations. Temporal conclusions cannot be drawn from the study. Also, the study lacked a comparison group of patients with FMS without TMD as well as a control group of individuals who were healthy. Conclusions. Altered neuromuscular control in masticatory muscles may be correlated with perceived facial pain in patients with FMS. © 2013 American Physical Therapy Association.

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CONTEXTO E OBJETIVO:Há poucos estudos sobre os fatores de risco para os subgrupos de gagueira. O objetivo deste estudo foi caracterizar os fatores de risco para a gagueira desenvolvimental familial em meninos que gaguejam e que não gaguejam como tipologia das disfluências, fatores qualitativos e comunicativos associados, estresse físico e emocional, atitude familiar e reação pessoal.TIPO DE ESTUDO E LOCAL:Estudo transversal analítico com um grupo controle, realizado no Laboratório de Estudo da Fluência, que faz parte do Departamento de Fonoaudiologia de uma universidade pública.MÉTODOS:Pais de 40 meninos com e sem gagueira pareados por idade fizeram parte do estudo. Os participantes foram divididos em dois grupos: crianças com gagueira e crianças sem gagueira, com idades entre 6 anos 0 meses e 11 anos 11 meses Inicialmente todos os participantes foram submetidos a uma avaliação de fluência e depois os dados foram coletados por meio do Protocolo de Risco para a Gagueira do Desenvolvimento.RESULTADOS:Não foi observada diferença nos fatores de estresse físicos e reações pessoais entre os grupos. As atitudes inadequadas familiares foram apresentadas por 95% das crianças com gagueira e 30% das crianças sem gagueira. Quatro fatores de risco analisados não ocorreram nas crianças sem gagueira, a saber, disfluências gagas, fatores qualitativos, estresse físico e emocional.CONCLUSÕES:Os achados sugerem que a presença de disfluências gagas, fatores qualitativos e comunicativos associados, estresse emocional e atitude familiar inadequada são fatores de risco importantes para a gagueira desenvolvimental familial em meninos.

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A síndrome das unhas frágeis caracteriza-se por fragilidade da lâmina ungueal, acometendo 27% das mulheres. Realizamos estudo transversal com pacientes dermatológicas sobre a percepção de fragilidade ungueal. Avaliamos 138 pacientes com idade mediana de 36,5 anos. Ao exame, 57% apresentavam alterações e 49% relatavam fragilidade ungueal. Os três primeiros dedos das mãos foram os mais acometidos. A onicosquizia associou-se com onicofagia (OR = 3,29), trabalhos domésticos (OR = 2,95) e contato com água (OR = 2,44). A onicorrexe teve a mais forte associação com a percepção de fragilidade ungueal (OR = 17,89). A fragilidade foi mais percebida em negras, pardas e atópicas e associou-se com humor depressivo.

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BACKGROUND: Acne vulgaris has an important genetic predisposition, as well as keratosis pilaris. Clinical observations suggest that patients with keratosis pilaris have less frequent or less severe acne breakouts; however, we found no studies on this regard OBJECTIVE: To determine if the presence of keratosis pilaris is associated with lower prevalence and severity of acne. METHODS: A cross-sectional study was conducted with dermatology outpatients aged between 14 and 35 years. We evaluated history and clinical grade of acne, demographic variables, history of atopy, smoking, and use of hormonal contraceptives. Two groups were defined by the presence or absence of moderate to severe keratosis pilaris on the arms and were compared by bivariate analysis and by conditional multiple logistic regression. RESULTS: We included 158 patients (66% women), with a median age of 23 +/- 11 years. Twenty-six percent of them had keratosis pilaris, which was associated with a history of atopy (odds ratio [OR]=2.80 [1.36 to 5.75]; p<0.01). Acne was present in 66% of subjects, and was related to family history of acne (OR=5.75 [2.47 to 13.37]; p<0.01). In bivariate and multivariate analysis, the group with keratosis pilaris had a less frequent history of acne (OR=0.32 [0.14 to 0.70]; p<0.01). CONCLUSION: The presence of moderate to severe keratosis pilaris on the arms was associated with lower prevalence of acne vulgaris and lower severity of facial lesions in adolescents and young adults.

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OBJECTIVE: This study aimed at evaluating the flora and bacterial load of chronic leg ulcers (CLUs) according to the clinical judgment of colonization or infection.DESIGN: This was an analytical and cross-sectional study.SETTING: This study was conducted in an outpatient wound care unit in the Dermatology Department of the Botucatu School of Medicine-UNESP, Brazil.PARTICIPANTS: The participants were patients with CLUs who did not use systemic antibiotics.METHODS: The ulcers were clinically divided into 3 groups: ulcers with good granulation tissue (GGT), critical colonization (CC), and infection. Secretion was collected from a 1-cm(2) area using a swab and seeded by the semiquantitative method.OUTCOME MEASURES: The main outcome measures were genus and species of the bacteria found in the cultures and result of the semiquantitative culture correlating with the clinical diagnosis of GGT, CC, and infection.MAIN RESULTS: Seventy-seven ulcers were evaluated: 27 with GGT, 29 with CC, and 21 with infection. Gram-negative bacteria were most often found in all groups (81%): Pseudomonas aeruginosa, in granulation and colonized ulcers, and Proteus mirabilis, in infected ulcers. Ulcers from the infected group showed higher bacterial load.CONCLUSIONS: The flora of CLUs was predominantly constituted by gram-negative bacteria, and P aeruginosa was the most prevalent. The bacterial load of infected ulcers was higher as compared with the others, although some ulcers with GGT also presented a high load. The interpretation of microbiologic tests based on the swab techniques and even on semiquantitative analysis requires close clinical correlation.

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

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