Sífilis congênita: evento sentinela da qualidade da assistência pré-natal

OBJETIVO: Analisar a assistência pré-natal na prevenção da transmissão vertical da sífilis. MÉTODOS: Estudo transversal representativo para as gestantes de baixo risco atendidas em unidades de saúde do município do Rio de Janeiro, RJ, período de 2007 a 2008. A identificação de gestantes com diagnóstico de sífilis na gestação foi feita por meio de entrevistas, verificação do cartão de pré-natal e busca de casos notificados em sistemas públicos de informação em saúde. Os casos de sífilis congênita foram identificados por meio de busca nos sistemas de informação em saúde: Sistema de Informação de Agravos de Notificação (Sinan), Sistema de Informação sobre Mortalidade (SIM) e Sistema de Informações Hospitalares (SIH) do SUS. RESULTADOS: Foram identificados 46 casos de sífilis na gestação e 16 casos de sífilis congênita com uma prevalência estimada de 1,9% (IC95% 1,3;2,6) de sífilis na gestação e de 6/1.000 (IC95% 3;12/1.000) de sífilis congênita. A taxa de transmissão vertical foi de 34,8% e três casos foram fatais, um abortamento, um óbito fetal e um óbito neonatal, com proporções elevadas de baixo peso e prematuridade. A trajetória assistencial das gestantes mostrou falhas na assistência, como início tardio do pré-natal, ausência de diagnóstico na gravidez e ausência de tratamento dos parceiros. CONCLUSÕES: Estratégias inovadoras, que incorporem melhorias na rede de apoio diagnóstico, são necessárias para enfrentamento da sífilis na gestação, no manejo clínico da doença na gestante e seus parceiros e na investigação dos casos como evento sentinela da qualidade da assistência pré-natal.

Via, homem e veiculo: fatores de risco associados a gravidade dos acidentes de transito

OBJETIVO Analisar as características das vítimas, vias e veículos envolvidos em acidentes de trânsito e os fatores de risco de acidentes com ocorrência de óbito.  MÉTODOS Estudo de coorte não concorrente considerando os acidentes de trânsito em Fortaleza, CE, de janeiro de 2004 a dezembro de 2008. Foram utilizados dados do Sistema de Informação de Acidente de Trânsito de Fortaleza, do Sistema de Informações de Mortalidade, do Sistema de Informações Hospitalares e dos bancos de dados de Habilitação e Veículos do Departamento Estadual de Trânsito. Técnicas de relacionamento determinístico e probabilístico foram aplicadas para integrar as bases de dados. Efetuou-se a análise descritiva das variáveis relativas às pessoas, às vias, aos veículos e ao tempo. Foram utilizados os modelos lineares generalizados na investigação de fatores de risco para óbito por acidente de trânsito. O ajuste do modelo foi verificado pela razão de verossimilhança e análise ROC.  RESULTADOS Registraram-se 118.830 acidentes no período. Predominaram colisão/abalroamento (78,1%), atropelamentos (11,9%) e choque com obstáculo fixo (3,9%) e com motocicletas (18,1%). Ocorreram óbitos em 1,4% dos acidentes. Estiveram independentemente associados ao óbito por acidente de trânsito: bicicletas (OR = 21,2; IC95% 16,1;27,8), atropelamentos (OR = 5,9; IC95% 3,7;9,2), choque com obstáculo fixo (OR = 5,7; IC95% 3,1;10,5) e acidentes com motociclistas (OR = 3,5; IC95% 2,6;4,6). Os principais fatores contribuintes foram envolvimento de uma única pessoa (OR = 6,6; IC95% 4,1;10,73), presença de condutores não habilitados (OR = 4,1; IC95% 2,9;5,5) um único veículo envolvido (OR = 3,9; IC95% 2,3;6,4), sexo masculino (OR = 2,5; IC95% 1,9;3,3), tráfego em vias de jurisdição federal (OR = 2,4; IC95% 1,8;3,7), horário madrugada (OR = 2,4; IC95% 1,8;3,0) e dia de domingo (OR = 1,7; IC95% 1,3;2,2), todas ajustadas segundo modelo log-binomial.  CONCLUSÕES As ações de promoção e prevenção de acidentes no trânsito devem focar os acidentes com veículos de duas rodas, que mais frequentemente envolvem uma única pessoa, não habilitada, do sexo masculino, em horários noturnos, em finais de semana e nas vias onde se desenvolvem maiores velocidades.

Seroprevalencia de rubeola en Colombia: un análisis por cohorte de nacimiento

OBJETIVO : Estimar la seroprevalencia de rubéola y factores asociados. METODOS : Estudio de seroprevalencia poblacional con una muestra aleatoria de 2.124 individuos de seis a 64 años, representativa por edad, sexo y área en Medellín, Colombia, 2009. Se analizó la asociación de variables biológicas y socioeconómicas con la seroprotección para rubéola, según la cohorte del año de nacimiento antes (1954 a 1990) y después (1991 a 2003) del inicio de la vacunación universal. Se determinaron los títulos de IgG con pruebas de alta sensibilidad (AxSYM ® Rubella IgG – Laboratorio Abbott) y especificidad (VIDAS RUB IgG II ® – Laboratorio BioMerieux). Se estimaron proporciones y promedios ponderados derivados de un muestreo complejo incluyendo un factor de corrección por las diferencias en la participación por sexo. Se analizó la asociación de la protección por grupos de variables biológicas y sociales con un modelo de regresión logística, según la cohorte de nacimiento. RESULTADOS : Los títulos promedio de IgG fueron más altos en los nacidos antes del inicio de la vacunación (media 110 UI/ml; IC95% 100,5;120,2) que en los nacidos después (media 64 UI/ml; IC95% 54,4;72,8), p = 0,000. La proporción de protección fue creciente de 88,9% en los nacidos en 1990-1994, de 89,2% en 1995-1999 y de 92,1% en 2000 a 2003, posiblemente relacionado con la administración del refuerzo desde 1998. En los nacidos antes del inicio de la vacunación, la seroprotección estuvo asociada con el antecedente de contacto con casos (RD 2,6; IC95% 1,1;5,9), el estado de salud (RD 2,5; IC95% 1,05;6,0), el nivel de escolaridad (RD 0,2; IC95% 0,08;0,8) y los años de residencia del hogar en el barrio (RD 0,96; IC95% 0,98;1,0), luego de ajustar por todas las variables. En los nacidos después se asoció con el tiempo de sueño efectivo (RD 1,4; IC95%1,09;1,8) y el estado de salud (RD 5,5; IC95%1,2;23,8). CONCLUSIONES : La vacunación masiva generó un cambio en el perfil de seroprevalencia, siendo mayores los títulos en quienes nacieron antes del inicio de la vacunación. Se recomienda monitorear el sostenimiento del nivel de protección a largo plazo y concertar acciones para el mejoramiento de las condiciones socioeconómicas potencialmente asociadas.

Fatores de risco para absenteísmo com licença médica em trabalhadores da indústria de petróleo

OBJETIVO : Identificar fatores de risco para o absenteísmo com licença médica em trabalhadores de empresa de petróleo. MÉTODOS : Estudo caso-controle (120 casos e 656 controles) aninhado a um estudo de coorte retrospectivo com todos os trabalhadores de uma empresa de petróleo na Região Norte-Nordeste do Brasil entre 2007 e 2009. A variável resposta utilizada para representar o absenteísmo com licença médica foi a incidência média de faltas com licenças médicas no período, definida pela razão entre o total de dias de licenças médicas e os dias potencialmente trabalháveis no período. Análise de regressão logística foi utilizada para investigar a associação entre incidência média de faltas > 5,0% no período e as variáveis sexo, cargo, idade, tempo de atuação, regime de trabalho, tabagismo, hipertensão arterial, índice de massa corporal, atividade física, risco coronariano, sono, glicemia, diabetes não controlado, doença do aparelho cardiovascular, digestivo, aparelho locomotor, neurológica, neoplasia, posturas forçadas no trabalho, satisfação com o trabalho, relacionamento com a chefia e atenção concentrada no trabalho. RESULTADOS : A incidência média de faltas com licenças médicas > 5,0% no período da coorte foi 15,5%. O modelo logístico revelou que trabalhadores com incidência média de faltas > 5,0% tiveram 2,6 vezes mais chance de ser do sexo feminino; 2,0 vezes mais chance de ser fumante; 1,8 vez mais chance de ser ex-fumante, 2,2 vezes mais chance de relatar sono anormal e 10,5 vezes mais chance de estarem insatisfeitos com o trabalho do que trabalhadores com incidência média de faltas ≤ 5,0% no período. CONCLUSÕES : Sexo feminino, ser fumante ou ex-fumante, estar insatisfeito com o trabalho e relatar sono anormal são bons preditores de absenteísmo ao trabalho por doença.

Brote de faringo-amigdalítis por estreptococo ?-hemolítico grupo A

El objetivo fue describir un brote de faringo-amigdalitis causado por estreptococos β-hemolíticos del grupo A (EGA) en profesionales de la salud. El estudio que se transmite de persona-persona o por vía alimentaria. El estudio transversal descriptivo se realizó en 17 clientes, localizados en la misma mesa, que participaron de una cena en restaurante de Barcelona, España, en julio de 2012. Se analizaron, la frecuencia de síntomas de los afectados, el tiempo y la severidad de los síntomas, variables demográficas y alimentos ingeridos, entre otros factores. La tasa de ataque (TA) en los comensales fue del 58,8% (10/17). El 60,0% (6/10) de los comensales fueron positivos para EGA. El 46,2% (6/13) de los manipuladores de alimentos suministrados en la cena presentaron síntomas. No se identificó asociación con los alimentos ingeridos. Existen evidencias epidemiológicas de la transmisión alimentaria del EGA, pero no podría descartarse la transmisión respiratoria.

Screening for depressive symptoms in older adults in the Family Health Strategy, Porto Alegre, Brazil

OBJECTIVE To analyze the prevalence of depression in older adults and associated factors. METHODS Cross-sectional study using a stratified random sample of 621 individuals aged ≥ 60 from 27 family health teams in Porto Alegre, RS, Southern Brazil, between 2010 and 2012. Community health agents measured depression using the 15-item Geriatric Depression Scale. Scores of ≥ 6 were considered as depression and between 11 and 15 as severe depression. Poisson regression was used to search for independent associations of sociodemographic and self-perceived health with both depression and its severity. RESULTS The prevalence of depression was 30.6% and was significantly higher in women (35.9% women versus 20.9% men, p < 0.001). The variables independently associated with depression were: female gender (PR = 1.4, 95%CI 1.1;1.8); low education, especially illiteracy (PR = 1.8, 95%CI 1.2;2 6); regular self-rated health (OR = 2.2, 95%CI 1.6;3.0); and poor/very poor self-rated health (PR = 4.0, 95%CI 2.9;5.5). Except for education, the strength of association of these factors increases significantly in severe depression. CONCLUSIONS A high prevalence of depression was observed in the evaluations conducted by community health agents, professionals who are not highly specialized. The findings identified using the 15-item Geriatric Depression Scale in this way are similar to those in the literature, with depression more associated with low education, female gender and worse self-rated health. From a primary health care strategic point of view, the findings become still more relevant, indicating that community health agents could play an important role in identifying depression in older adults.

Gender differences in social support and leisure-time physical activity

OBJECTIVE To identify gender differences in social support dimensions’ effect on adults’ leisure-time physical activity maintenance, type, and time.METHODS Longitudinal study of 1,278 non-faculty public employees at a university in Rio de Janeiro, RJ, Southeastern Brazil. Physical activity was evaluated using a dichotomous question with a two-week reference period, and further questions concerning leisure-time physical activity type (individual or group) and time spent on the activity. Social support was measured with the Medical Outcomes Study Social Support Scale. For the analysis, logistic regression models were adjusted separately by gender.RESULTS A multinomial logistic regression showed an association between material support and individual activities among women (OR = 2.76; 95%CI 1.2;6.5). Affective support was associated with time spent on leisure-time physical activity only among men (OR = 1.80; 95%CI 1.1;3.2).CONCLUSIONS All dimensions of social support that were examined influenced either the type of, or the time spent on, leisure-time physical activity. In some social support dimensions, the associations detected varied by gender. Future studies should attempt to elucidate the mechanisms involved in these gender differences.

Prevalence of anemia and associated factors in older adults: evidence from the SABE Study

OBJECTIVE To assess the prevalence of anemia and associated factors in older adults. METHODS The prevalence and factors associated with anemia in older adults were studied on the basis of the results of the Saúde, Bem-Estar e Envelhecimento (SABE – Health, Welfare and Aging) study. A group of 1,256 individuals were interviewed during the third wave of the SABE study performed in Sao Paulo, SP, in 2010. The study included 60.4% females; the mean age of the participants was 70.4 years, and their average education was 5.3 years. The dependent variable was the presence of anemia (hemoglobin levels: 12 g/dL in women and 13 g/dL in men). Descriptive analysis and hierarchical logistic regression were performed. The independent variables were as follows: a) demographics: gender, age, and education and b) clinical characteristics: self-reported chronic diseases, presence of cognitive decline and depression symptoms, and body mass index. RESULTS The prevalence of anemia was 7.7% and was found to be higher in oldest adults. There was no difference between genders, although the hemoglobin distribution curve in women showed a displacement toward lower values in comparison with the distribution curve in men. Advanced age (OR = 1.07; 95%CI 0.57;1.64; p < 0.001), presence of diabetes (OR = 2.30; 95%CI 1.33;4.00; p = 0.003), cancer (OR = 2.72; 95%CI 1.2;6.11; p = 0.016), and presence of depression symptoms (OR = 1.75; 95%CI 1.06;2.88; p = 0.028) remained significant even after multiple analyses. CONCLUSIONS The prevalence of anemia in older adults was 7.7% and was mainly associated with advanced age and presence of chronic diseases. Thus, anemia can be an important marker in the investigation of health in older adults because it can be easily diagnosed and markedly affects the quality of life of older adults.

The influence of health expenditures on household impoverishment in Brazil

OBJECTIVE To analyze the variation in the proportion of households living below the poverty line in Brazil and the factors associated with their impoverishment. METHODS Income and expenditure data from the Household Budget Survey, which was conducted in Brazil between 2002-2003 (n = 48,470 households) and 2008-2009 (n = 55,970 households) with a national sample, were analyzed. Two cutoff points were used to define poverty. The first cutoff is a per capita monthly income below R$100.00 in 2002-2003 and R$140.00 in 2008-2009, as recommended by the Bolsa Família Program. The second, which is proposed by the World Bank and is adjusted for purchasing power parity, defines poverty as per capita income below US$2.34 and US$3.54 per day in 2002-2003 and 2008-2009, respectively. Logistic regression was used to identify the sociodemographic factors associated with the impoverishment of households. RESULTS After subtracting health expenditures, there was an increase in households living below the poverty line in Brazil. Using the World Bank poverty line, the increase in 2002-2003 and 2008-2009 was 2.6 percentage points (6.8%) and 2.3 percentage points (11.6%), respectively. Using the Bolsa Família Program poverty line, the increase was 1.6 (11.9%) and 1.3 (17.3%) percentage points, respectively. Expenditure on prescription drugs primarily contributed to the increase in poor households. According to the World Bank poverty line, the factors associated with impoverishment include a worse-off financial situation, a household headed by an individual with low education, the presence of children, and the absence of older adults. Using the Bolsa Família Program poverty line, the factors associated with impoverishment include a worse-off financial situation and the presence of children. CONCLUSIONS Health expenditures play an important role in the impoverishment of segments of the Brazilian population, especially among the most disadvantaged.

Incidence and risk factors for intimate partner violence during the postpartum period

OBJECTIVE To estimate the incidence and identify risk factors for intimate partner violence during postpartum.METHODS This prospective cohort study was conducted with women, aged between 18-49 years, enrolled in the Brazilian Family Health Strategy in Recife, Northeastern Brazil, between 2005 and 2006. Of the 1.057 women interviewed during pregnancy and postpartum, 539 women, who did not report violence before or during pregnancy, were evaluated. A theoretical-conceptual framework was built with three levels of factors hierarchically ordered: women’s and partners’ sociodemografic and behavioral characteristics, and relationship dynamics. Incidence and risk factors of intimate partner violence were estimated by Poisson Regression.RESULTS The incidence of violence during postpartum was 9.3% (95%CI 7.0;12.0). Isolated psychological violence was the most common (4.3%; 95%CI 2.8;6.4). The overlapping of psychological with physical violence occurred at 3.3% (95%CI 2.0;5.3) and with physical and/or sexual in almost 2.0% (95%CI 0.8;3.0) of cases. The risk of partner violence during postpartum was increased for women with a low level of education (RR = 2.6; 95%CI 1.3;5.4), without own income (RR = 1.7; 95%CI 1.0;2.9) and those who perpetrated physical violence against their partner without being assaulted first (RR = 2.0; 95%CI 1.2;3.4), had a very controlling partner (RR = 2.5; 95%CI 1.1;5.8), and had frequent fights with their partner (RR = 1.7; 95%CI 1.0;2.9).CONCLUSIONS The high incidence of intimate partner violence during postpartum and its association with aspects of the relationship’s quality between the couple, demonstrated the need for public policies that promote conflict mediation and enable forms of empowerment for women to address the cycle of violence.

Gender differences in the association between tooth loss and obesity among older adults in Brazil

OBJECTIVE To analyze if differences according to gender exists in the association between tooth loss and obesity among older adults.METHODS We analyzed data on 1,704 older adults (60 years and over) from the baseline of a prospective cohort study conducted in Florianopolis, SC, Southern Brazil. Multivariable logistic regression models were used to assess the association between tooth loss and general and central obesity after adjustment for confounders (age, gender, skin color, educational attainment, income, smoking, physical activity, use of dentures, hypertension, and diabetes). Linear regressions were also assessed with body mass index and waist circumference as continuous outcomes. Interaction between gender and tooth loss was further assessed.RESULTS Overall mean body mass index was 28.0 kg/m2. Mean waist circumference was 96.8 cm for males and 92.6 cm for females. Increasing tooth loss was positively associated with increased body mass index and waist circumference after adjustment for confounders. Edentates had 1.4 (95%CI 1.1;1.9) times higher odds of being centrally obese than individuals with a higher number of teeth; however, the association lost significance after adjustment for confounders. In comparison with edentate males, edentate females presented a twofold higher adjusted prevalence of general and central obesity. In the joint effects model, edentate females had a 3.8 (95%CI 2.2;6.6) times higher odds to be centrally obese in comparison with males with more than 10 teeth present in both the arches. Similarly, females with less than 10 teeth in at least one arch had a 2.7 (95%CI 1.6;4.4) times higher odds ratio of having central obesity in comparison with males with more than 10 teeth present in both the arches.CONCLUSIONS Central obesity was more prevalent than general obesity among the older adults. We did not observe any association between general obesity and tooth loss. The association between central obesity and tooth loss depends on gender – females with tooth loss had greater probability of being obese.

ERICA: prevalence of metabolic syndrome in Brazilian adolescents

ABSTRACT OBJECTIVE To determine the prevalence of metabolic syndrome and its components in Brazilian adolescents. METHODS We evaluated 37,504 adolescents who were participants in the Study of Cardiovascular Risks in Adolescents (ERICA), a cross-sectional, school-based, national study. The adolescents, aged from 12 to 17 years, lived in cities with populations greater than 100,000 inhabitants. The sample was stratified and clustered into schools and classes. The criteria set out by the International Diabetes Federation were used to define metabolic syndrome. Prevalences of metabolic syndrome were estimated according to sex, age group, school type and nutritional status. RESULTS Of the 37,504 adolescents who were evaluated: 50.2% were female; 54.3% were aged from 15 to 17 years, and 73.3% were from public schools. The prevalence of metabolic syndrome was 2.6% (95%CI 2.3-2.9), slightly higher in males and in those aged from 15 to 17 years in most macro-regions. The prevalence was the highest in residents from the South macro-region, in the younger female adolescents and in the older male adolescents. The prevalence was higher in public schools (2.8% [95%CI 2.4-3.2]), when compared with private schools (1.9% [95%CI 1.4-2.4]) and higher in obese adolescents when compared with nonobese ones. The most common combinations of components, referring to 3/4 of combinations, were: enlarged waist circumference (WC), low HDL-cholesterol (HDL-c) and high blood pressure; followed by enlarged WC, low HDL-c and high triglycerides; and enlarged WC, low HDL-c, high triglycerides and blood pressure. Low HDL was the second most frequent component, but the highest prevalence of metabolic syndrome (26.8%) was observed in the presence of high triglycerides. CONCLUSIONS ERICA is the first Brazilian nation-wide study to present the prevalence of metabolic syndrome and describe the role of its components. Despite the prevalence of Metabolic Syndrome being low, the high prevalences of some components and participation of others in the syndrome composition shows the importance of early diagnosis of this changes, even if not grouped within the metabolic syndrome.

Occurrence of campylobacter jejuni in diarrhoeic and non-diarrhoeic children in Sao Paulo, Brazil

Campylobacter jejuni was looked for in the feaces of 262 children, beeing 189 with acute diarrhoea, 31 with chronic diarrhoea and 42 controls. The organism was isolated from 14 (7.4%), 2 (6.5%) and 6 (14.3%) of the children, and each group, respectively.

Alterações hematológicas na leptospirose

Foram estudadas as alterações hematológicas de 30 pacientes com diagnóstico de leptospirose internados na Clínica de Doenças Infecciosas e Parasitárias do Hospital das Clínicas da Faculdade de Medicina da Universidade de Sáo Paulo. Verificou-se que mais da metade dos pacientes 16 (53,3%) apresentavam contagem normal de leucócitos no momento da internação; 12 (40%) apresentavam leucócitos e 2 (6,6%) leucopenia. Vinte e cinco doentes (83,3%) apresentavam desvio à esquerda e 29 (96,6%) neutrofilia relativa. Vinte e quatro pacientes tiveram o diagnóstico de anemia. A plaquetopenia ocorreu em 26 (86,6%) dos doentes. Como alterações mais características no mielograma, ressaltamos a alteração da relação G/E (série Granulocítica/série Eritroblástica), às custas de hipercelula-ridade relativa e/ou absoluta da série granulocítica, e/ou hipocelularidade relativa e/ou absoluta da série vermelha; a eritropoese predominantemente microeritroblástica em vários doentes; o encontro de plasmocitose discreta ou moderada e, na série intersticial, o aumento da atividade macrofágica. A análise estatística da série megacariocitária do mielograma dos 30 pacientes revelou não existir relação de dependência significativa entre a celularidade da série megacariocitária e o número de plaquetas no sangue periférico; porém, verificou-se existência da relação de dependência entre a plaquetogênese medular e a contagem de plaquetas no sangue periférico. A possibilidade de haver inibição da plaquetogênese medular por algum produto bacteriano náo pode ser totalmente afastada, porém acreditamos que o exame estático da medula óssea não pode dar-nos uma idéia precisa do mecanismo dinâmico da formação de plaquetas na presença de "consumo periférico".

A serological investigation of rotavirus infections in a shanty town population in Rio de Janeiro

The presence of antibodies against rotavirus was investigated by enzyme immunosorbent assay (ELISA) in two distinct groups of children living in a shanty town in Rio de Janeiro. One hundred and thirty six plasma samples were randomly collected from children of 0 to 33 months (first group) and 255 serum samples were collected from other 85 children at ages of 2, 6 and 9 months (second group). A high percentage of antibodies were found in the newborn children and this rate decreased progressively until the age of 11 months, after which it increased again. At the age of 7 months, geometric mean antibody titers increased indicating that infection had occurred.