Conhecimentos sobre VIH sida nos clientes de um hospital de Lakes State, Sudão do Sul

Enquadramento: O VIH/Sida exige uma ação direcionada na vertente da prevenção, cujo suporte integra a transmissão de conhecimentos promotores da adoção e manutenção de comportamentos seguros, em conformidade com as características sociais e culturais dos indivíduos. Objetivos: Validar, para a população do Sudão do Sul, a Escala de Conhecimentos sobre VIH/Sida, The HIV Knowledge Questionnaire: HIV-KQ-45, de Carey et al. (1997); analisar de que forma as variáveis sociodemográficas influenciam os conhecimentos sobre VIH/Sida, dos cidadãos de Mapuordit Sudão do Sul; verificar se a frequência de formação sobre VIH/Sida influencia o seu nível de conhecimentos. Metodologia: Estudo quantitativo, descritivo-analítico e transversal, com 232 clientes do Mary Immaculate de Mapuordit Hospital. Foi utilizado um Questionário de caracterização sociodemográfica e do contexto de formação sobre o VIH/Sida, e o HIV Knowledge Questionnaire (HVI-K-Q) de Carey, Morrison-Beedy e Johnson (1997). Resultados: Amostra é maioritariamente masculina (74.6%), com uma média de idade 22,83 (±5.793 anos). A análise fatorial confirmatória do HIV-K-Q permitiu apurar 5 fatores, cujos valores médios mais significativos foram nos fatores preconceitos/medos (média=80.60%), conhecimentos sobre os comportamentos de risco (média=76.58%) e vias de transmissão (média=70.36%). Os sudaneses pontuaram maioritariamente com razoáveis conhecimentos sobre a Sida (média=68.08%). As mulheres, os participantes mais velhos, com companheiro(a), mais escolarizados, profissionalmente ativos, a distar do hospital =<20 Km, deslocando-se num veículo não motorizado e com diagnóstico de VIH relataram mais conhecimentos sobre a Sida. Os participantes com informação sobre a prevenção do VIH/Sida e frequência em workshop na área demonstraram melhores conhecimentos. Revelaram-se preditivas dos conhecimentos acerca da doença as habilitações literárias (β=0.32) e o diagnóstico de VIH/Sida (β=0.14) revelou-se preditor dos conhecimentos sobre os comportamentos de risco. Conclusão: As casuísticas significativas do VIH/Sida justificam considerar as habilitações literárias e a presença de diagnóstico VIH/Sida como variáveis a avaliar previamente ao planeamento estratégico das ações de educação para a prevenção do VIH/Sida no Sudão do Sul. Palavras-chave: Conhecimentos; VIH/Sida; Sudão do Sul.

Pesticides and respiratory symptoms among farmers

OBJECTIVE: Despite the intensive use of pesticides in agriculture there are few studies assessing the risk of respiratory conditions from this exposure. The study aimed at quantifying the prevalence of respiratory symptoms among farmers and evaluating its relationship with occupational use of pesticides and the prevalence of respiratory symptoms. METHODS: A cross-sectional study was conducted among 1,379 farmers from two municipalities of Southern Brazil in 1996. Frequency and type of chemical exposure and pesticide poisoning were recorded for both sexes. All subjects aged 15 years or older with at least 15 weekly hours of agricultural activity were interviewed. An adapted questionnaire developed by the American Thoracic Society was used for the assessment of respiratory symptoms. Multivariate logistic regression analysis was carried out. RESULTS: More than half (55%) of interviewees were male. The prevalence of asthma symptoms was 12% and chronic respiratory disease symptoms was 22%. Higher odds ratios for both asthma (OR=1.51; 95% CI: 1.07-2.14) and chronic respiratory disease (OR=1.34; 95% CI 1.00-1.81) symptoms were found in women. Logistic regression analysis identified associations between many forms of exposure to pesticides and increased respiratory symptoms. Occurrence of pesticide poisoning was associated with higher prevalence of asthma symptoms (OR=1.54; 95% CI: 1.04-2.58) and chronic respiratory disease symptoms (OR=1.57; 95% CI: 1.08-2.28). CONCLUSIONS: In spite of causality limitations, the study results provide evidence that farming exposure to pesticides is associated with higher prevalence of respiratory symptoms, especially when the exposure is above two days per month.

Brazilian doctors' perspective on the second opinion strategy before a C-section

OBJECTIVE: To describe the opinion of doctors who participated in the Latin American Study on Cesarean section in Brazil regarding the second opinion strategy when faced with the decision of performing a C-section. METHODS: Seventy-two doctors from the hospitals where the study took place (where the second opinion was routinely sought) and 70 from the control group answered a pre-tested self-administered structured questionnaire. Descriptive tables were prepared based on the frequency of relevant variables on opinion of physicians regarding: effectiveness of the application of the second opinion strategy; on whether they would recommend implementation of this strategy and reasons for not recommending it in private institutions; feasibility of the strategy implementation and reasons for not considering this implementation feasible in private institutions. RESULTS: Half of the doctors from the intervention hospitals (50%) and about two thirds of those in the control group (65%) evaluated the second opinion as being or having the potential of being effective/very effective in their institutions. The great majority of those interviewed from both intervention and control hospitals considered this strategy feasible in public (87% and 95% respectively) but not in private hospitals (64% and 70% respectively), mainly because in the latter the doctors would not accept interference from a colleague in their decision-making process. CONCLUSION: Although the second opinion strategy was perceived as effective in reducing C-section rates, doctors did not regard it feasible outside the public health system in Brazil.

Tradução e validação de conteúdo da versão em português do Childhood Trauma Questionnaire

OBJETIVO: O Childhood Trauma Questionnaire é um instrumento auto-aplicável em adolescentes e adultos que investigam história de abuso e negligência durante a infância. O objetivo do trabalho foi de traduzir, adaptar e validar o conteúdo do questionário para uma versão em português denominada Questionário Sobre Traumas na Infância. MÉTODOS: O processo de tradução e adaptação envolveu cinco etapas: (1) tradução; (2) retradução; (3) correção e adaptação semântica; (4) validação do conteúdo por profissionais da área (juízes) e (5) avaliação por amostra da população-alvo, por intermédio de uma escala verbal-numérica. RESULTADOS: As 28 questões e as instruções iniciais traduzidas e adaptadas criaram o Questionário Sobre Traumas na Infância. Na avaliação pela população-alvo, 32 usuários adultos do Sistema Único de Saúde responderam a avaliação, com boa compreensão do instrumento na escala verbal-numérica (média=4,86±0,27). CONCLUSÕES: A versão mostrou ser de fácil compreensão obtendo-se adequada validação semântica. Entretanto, ainda carece de estudos que avaliem outras qualidades psicométricas.

Re-evaluation of a reported increased micronucleus frequency in lymphocytes of workers occupationally exposed to formaldehyde

A replicate evaluation of increased micronucleus (MN) frequencies in peripheral lymphocytes of workers occupationally exposed to formaldehyde (FA) was undertaken to verify the observed effect and to determine scoring variability. May–Grünwald–Giemsa-stained slides were obtained from a previously performed cytokinesis-block micronucleus test (CBMNT) with 56 workers in anatomy and pathology laboratories and 85 controls. The first evaluation by one scorer (scorer 1) had led to a highly significant difference between workers and controls (3.96 vs 0.81 MN per 1000 cells). The slides were coded before re-evaluation and the code was broken after the complete re-evaluation of the study. A total of 1000 binucleated cells (BNC) were analysed per subject and the frequency of MN (in ‰) was determined. Slides were distributed equally and randomly between two scorers, so that the scorers had no knowledge of the exposure status. Scorer 2 (32 exposed, 36 controls) measured increased MN frequencies in exposed workers (9.88 vs 6.81). Statistical analysis with the two-sample Wilcoxon test indicated that this difference was not significant (p = 0.17). Scorer 3 (20 exposed, 46 controls) obtained a similar result, but slightly higher values for the comparison of exposed and controls (19.0 vs 12.89; p = 0.089). Combining the results of the two scorers (13.38 vs 10.22), a significant difference between exposed and controls (p = 0.028) was obtained when the stratified Wilcoxon test with the scorers as strata was applied. Interestingly, the re-evaluation of the slides led to clearly higher MN frequencies for exposed and controls compared with the first evaluation. Bland–Altman plots indicated that the agreement between the measurements of the different scorers was very poor, as shown by mean differences of 5.9 between scorer 1 and scorer 2 and 13.0 between scorer 1 and scorer 3. Calculation of the intra-class correlation coefficient (ICC) revealed that all scorer comparisons in this study were far from acceptable for the reliability of this assay. Possible implications for the use of the CBMNT in human biomonitoring studies are discussed.

Central obesity and dietary intake in HIV/AIDS patients

OBJECTIVE: To assess the association between dietary intake and central obesity among people living with HIV/AIDS and receiving highly active antiretroviral therapy. METHODS: A cross-sectional study was conducted involving 223 adult individuals in the city of São Paulo city in 2002. The study population was classified according to central obesity, defined as waist-to-hip ratio >0.95 for men and >0.85 for women. The dietary variables studied were energy consumption (in calories and calories/kilo of body weight), macronutrients (in grams and % of energy intake), total fiber (grams) and fruit and vegetables intake (grams). The potential confounders examined were sex, skin color, age, schooling, income, body mass index, physical activity, smoking habits, peripheral CD4+ T lymphocyte count and length of protease inhibitor use. The multiple logistic regression model was performed in order to evaluate the association between central obesity and dietary intake. RESULTS: The prevalence of central obesity was 45.7% and it was associated with greater consumption of lipids: for every increase of 10g of lipid intake the odds of central obesity increased 1.28 times. Carbohydrate consumption showed negative association (OR=0.93) with central obesity after adjustment for control variables. CONCLUSIONS: The results suggest that the amount of carbohydrates and lipids in the diet, regardless of total energy intake, may modify the chance of developing central obesity in the studied population. Nutritional interventions may be beneficial for preventing central obesity among HIV/AIDS patients.

Mudanças comportamentais ao longo da gestação: gravidez activa e saudável

Objectivos: verificar a frequência dos comportamentos de risco para a saúde ao longo da gestação e verificar as alterações ocorridas na actividade física ao longo da mesma. Métodos: Realizou-se um estudo longitudinal prospectivo numa coorte constituída por 76 gestantes. Foram aplicados dois questionários (questionário de actividade física para gestantes e questionário de comportamentos relacionados com a saúde) em três momentos diferentes. O primeiro momento com menos de 14 semanas de gestação; o segundo entre a 14ª e 28ª semana e o terceiro entre a 29ª e 40ª semana de gestação. Resultados: Verificou-se uma tendência para a diminuição de comportamentos de risco ao longo da gestação, nomeadamente no consumo de álcool, tabaco, café assim como uma tendência para hábitos alimentares mais equilibrados. No que diz respeito aos níveis de actividade física, estes diminuem significativamente ao longo da gestação (p<0,05). Constatou-se que os gastos energéticos médios semanais (MET-h.semana-1) com as actividades ocupacionais e desportivas diminuíram entre o 1º e 2º trimestre e entre o 1º e 3º trimestre (p<0,001). Nas actividades domésticas os METh. semana-1 são maiores no 1º que no 3º trimestre (p=0,01). Conclusão: Com os resultados obtidos parece poder-se concluir-se que a gravidez está associada a mudanças de comportamento para estilos de vida mais saudáveis, porém essas mudanças não se constataram na prática de actividade física.

Diagnosis of Tinea pedis and onychomycosis in patients from Portuguese National Institute of Health: a four-year study

ABSTRACT - Tinea pedis and onychomycosis are two rather diverse clinical manifestations of superficial fungal infections, and their etiologic agents may be dermatophytes, non-dermatophyte moulds or yeasts. This study was designed to statistically describe the data obtained as results of analysis conducted during a four year period on the frequency of Tinea pedis and onychomycosis and their etiologic agents. A questionnaire was distributed from 2006 to 2010 and answered by 186 patients, who were subjected to skin and/or nail sampling. Frequencies of the isolated fungal species were cross-linked with the data obtained with the questionnaire, seeking associations and predisposing factors. One hundred and sixty three fungal isolates were obtained, 24.2% of which composed by more than one fungal species. Most studies report the two pathologies as caused primarily by dermatophytes, followed by yeasts and lastly by non-dermatophytic moulds. Our study does not challenge this trend. We found a frequency of 15.6% of infections caused by dermatophytes (with a total of 42 isolates) of which T. rubrum was the most frequent species (41.4%). There was no significant association (p >0.05) among visible injury and the independent variables tested, namely age, gender, owning pet, education, swimming pools attendance, sports activity and clinical information. Unlike other studies, the variables considered did not show the expected influence on dermatomycosis of the lower limbs. It is hence necessary to conduct further studies to specifically identify which variables do in fact influence such infections.

Intra- and interspecific mineral composition variability of commercial instant coffees and coffee substitutes: contribution to mineral intake

The present paper reports the amount and estimated daily mineral intake of nine elements (Ca, Mg, K, Na, P, Fe, Mn, Cr and Ni) in commercial instant coffees and coffee substitutes (n = 49). Elements were quantified by high-resolution continuum source flame (HR-CS-FAAS) and graphite furnace (HR-CS-GFAAS) atomic absorption spectrometry, while phosphorous was evaluated by a standard vanadomolybdophosphoric acid colorimetric method. Instant coffees and coffee substitutes are rich in K, Mg and P (>100 mg/100 g dw), contain Na, Ca and Fe in moderate amounts (>1 mg/100 g), and trace levels of Cr and Ni. Among the samples analysed, plain instant coffees are richer in minerals (p < 0.001), except for Na and Cr. Blends of coffee substitutes (barley, malt, chicory and rye) with coffee (20–66%) present intermediate amounts, while lower quantities are found in substitutes without coffee, particularly in barley. From a nutritional point of view the results indicate that the mean ingestion of two instant beverages per day (total of 4 g instant powder), either with or without coffee, cannot be regarded as important sources of minerals to the human diet, although providing a supplementation of some minerals, particularly Mg and Mn in instant coffees. Additionally, and for authentication purposes, the correlations observed between some elements and the coffee percentage in the blends, with particular significance for Mg amounts, provides a potential tool for the estimation of coffee in substitute blends.

Occupational exposure to particulate matter and respiratory symptoms in Portuguese swine barn workers

Certain environmental conditions in animal and plant production have been associated with increased frequency in respiratory illnesses, including asthma, chronic bronchitis, and hypersensitivity pneumonitis, in farmers occupationally exposed in swine production. The aim of this study was to characterize particulate matter (PM) contamination in seven Portuguese swine farms and determine the existence of clinical symptoms associated with asthma and other allergy diseases, utilizing the European Community Respiratory Health Survey questionnaire. Environmental assessments were performed with portable direct-reading equipment, and PM contamination including five different sizes (PM0.5, PM1.0, PM2.5, PM5.0, PM10) was determined. The distribution of particle size showed the same trend in all swine farms, with high concentrations of particles with PM5 and PM10. Results from the questionnaire indicated a trend such that subjects with diagnosis of asthma were exposed to higher concentrations of PM with larger size (PM2.5, PM5, and PM10) while subjects with sneezing, runny nose, or stuffy nose without a cold or flu were exposed to higher concentrations of PM with smaller size (PM0.5 and PM1). Data indicate that inhalation of PM in swine farm workers is associated with increased frequency of respiratory illnesses.

Determinants of salivary cotinine level: a population-based study in Brazil

OBJECTIVE: A cross-sectional population-based study was conducted to assess, in active smokers, the relationship of number of cigarettes smoked and other characteristics to salivary cotinine concentrations. METHODS: A random sample of active smokers aged 15 years or older was selected using a stepwise cluster sample strategy, in the year 2000 in Rio de Janeiro, Brazil. The study included 401 subjects. Salivary cotinine concentration was determined using gas chromatography with nitrogen-phosphorus detection. A standard questionnaire was used to collect demographic and smoking behavioral data. The relation between the number of cigarettes smoked in the last 24h and cotinine level was examined by means of a nonparametric fitting technique of robust locally weighted regression. RESULTS: Significantly (p<0.05) higher adjusted mean cotinine levels were found in subjects smoking their first cigarette within five minutes after waking up, and in those smoking 1-20 cigarettes in the last 24h who reported inhaling more than ½ the time. In those smoking 1-20 cigarettes, the slope was significantly higher for those subjects waiting for more than five minutes before smoking their first cigarette after waking up, and those smoking "light" cigarettes when compared with their counterparts. These heterogeneities became negligible and non-significant when subjects with cotinine >40 ng/mL per cigarette were excluded. CONCLUSIONS: There was found a positive association between self-reporting smoking five minutes after waking up, and inhaling more than ½ the time are consistent and higher cotinine levels. These can be markers of dependence and higher nicotine intake. Salivary cotinine proved to be a useful biomarker of recent smoking and can be used in epidemiological studies and smoking cessation programs.

Leisure-time physical activity during pregnancy in the 2004 Pelotas Birth Cohort Study

OBJECTIVE: Physical activity during pregnancy is a poorly investigated subject on population level. The study aimed to describe duration, type and frequency of leisure-time physical activity during pregnancy, and to explore its associated factors. METHODS: A population-based study was carried out during 2004 in Southern Brazil. A total of 4,471 mothers were interviewed soon after delivery. Physical activity was measured using a questionnaire, developed for the study. Results were obtained by Poisson regression. RESULTS: In the sample, 14.8% of women reported to engage in some type of physical activity prior to pregnancy and 12.9% during pregnancy. In the first trimester, 10.4% of all mothers engaged in some type of physical activity; 8.5% in the second trimester and 6.5% in the third trimester. Only 194 mothers (4.3%) were active during the whole pregnancy. In the adjusted analysis, leisure-time physical activity was positively associated with schooling, physical activity advice during prenatal care, and family income (p<0.001), being employed during pregnancy (p=0.05), and number of pregnancies (p=0.02). Walking was the most frequent activity. CONCLUSIONS: The prevalence of leisure-time physical activity is low among Brazilian pregnant women. Although physical activity is not perceived as being pregnancy-threatening, and current guidelines recommend it, this population's behavior does not seem to be changing. Active lifestyle for both pregnant women and future mothers should be encouraged.

Anthropometric evaluation and micronutrients intake in patients submitted to laparoscopic Roux-en-Y gastric bypass with a postoperative period of ≥1 year

Backgroung - Bariatric surgery is indicated as the most effective treatment for morbid obesity; the Roux-en-Y gastric bypass (RYGB) is considered the procedure of choice. However, nutritional deficiency may occur in the postoperative period as a result of reduced gastric capacity and change in nutrients absorption in the gastrointestinal tract. The prescription of vitamin and mineral supplementation is a common practice after RYGB; however, it may not be sufficient to prevent micronutrient deficiencies. The aim of this study was to quantify the micronutrient intake in patients undergoing RYGB and verify if the intake of supplementation would be enough to prevent nutritional deficiencies. Methods - The study was conducted on 60 patients submitted to RYGB. Anthropometric, analytical, and nutritional intake data were assessed preoperatively and 1 and 2 years postoperatively. The dietary intake was assessed using 24-h food recall; the values of micronutrients evaluated (vitamin B12, folic acid, iron, and calcium) were compared to the dietary reference intakes (DRI). Results - There were significant differences (p < 0.05) between excess weight loss at the first and second year (69.9 ± 15.3 vs 9.6 ± 62.9 %). In the first and second year after surgery, 93.3 and 94.1 % of the patients, respectively, took the supplements as prescribed. Micronutrient deficiencies were detected in the three evaluation periods. At the first year, there was a significant reduction (p < 0.05) of B12, folic acid, and iron intake. Conclusions - Despite taking vitamin and mineral supplementation, micronutrient deficiencies are common after RYGB. In the second year after surgery, micronutrient intake remains below the DRI.

Fat intake interacts with polymorphisms of Caspase9, FasLigand and PPARgamma apoptotic genes in modulating Crohn's disease activity

Background & aims: Crohn’s disease (CD) is a multifactorial disease where resistance to apoptosis is one major defect. Also, dietary fat intake has been shown to modulate disease activity. We aimed to explore the interaction between four single nucleotide polymorphisms (SNPs) in apoptotic genes and dietary fat intake in modulating disease activity in CD patients. Methods: Polymerase Chain Reaction (PCR) and Restriction Fragment Length Polymorphism (RFLP) techniques were used to analyze Caspase9þ93C/T, FasLigand-843C/T, Peroxisome Proliferator-Activated Receptor gammaþ161C/T and Peroxisome Proliferator-Activated Receptor gamma Pro12Ala SNPs in 99 patients with CD and 116 healthy controls. Interactions between SNPs and fat intake in modulating disease activity were analyzed using regression analysis. Results: None of the polymorphisms analyzed influenced disease susceptibility and/or activity, but a high intake of total, saturated and monounsaturated fats and a higher ratio of n-6/n-3 polyunsaturated fatty acids (PUFA), was associated with a more active phenotype (p < 0.05). We observed that the detrimental effect of a high intake of total and trans fat was more marked in wild type carriers of the Caspase9þ93C/T polymorphism [O.R (95%CI) 4.64 (1.27e16.89) and O.R (95%CI) 4.84 (1.34e17.50)]. In the Peroxisome Proliferator-Activated Receptor gamma Pro12Ala SNP, we also observed that a high intake of saturated and monounsaturated fat was associated to a more active disease in wild type carriers [OR (95%CI) 4.21 (1.33e13.26) and 4.37 (1.52e12.51)]. Finally, a high intake of n-6 PUFA was associated with a more active disease in wild type carriers for the FasLigand-843C/T polymorphism [O.R (95%CI) 5.15 (1.07e24.74)]. Conclusions: To our knowledge, this is the first study to disclose a synergism between fat intake and SNPs in apoptotic genes in modulating disease activity in CD patients.

Risk of colorectal cancer associated with the C677T polymorphism in 5,10-methylenetetrahydrofolate reductase in Portuguese patients depends on the intake of methyl-donor nutrients

Background: Polymorphisms located in genes involved in the metabolism of folate and some methyl-related nutrients are implicated in colorectal cancer (CRC). Objective: We evaluated the association of 3 genetic polymorphisms [C677T MTHFR (methylene tetrahydrofolate reductase), A2756G MTR (methionine synthase), and C1420T SHMT (serine hydroxymethyltransferase)] with the intake of methyl-donor nutrients in CRC risk. Design: Patients withCRC(n 196) and healthy controls (n 200) matched for age and sex were evaluated for intake of methyl-donor nutrients and the 3 polymorphisms. Results: Except for folate intake, which was significantly lower in patients (P 0.02), no differences were observed in the dietary intake of other methyl-donor nutrients between groups. High intake of folate ( 406.7 g/d) was associated with a significantly lower risk of CRC (odds ratio: 0.67; 95% CI: 0.45, 0.99). The A2756G MTR polymorphism was not associated with the risk of developing CRC. In contrast, homozygosity for the C677TMTHFRvariant (TT) presented a 3.0-fold increased risk of CRC (95% CI: 1.3, 6.7). Similarly, homozygosity for the C1420T SHMT polymorphism also had a 2.6-fold increased risk (95% CI: 1.1, 5.9) of developing CRC. When interactions between variables were studied, low intake of all methyl-donor nutrients was associated with an increased risk ofCRC in homozygous participants for the C677T MTHFR polymorphism, but a statistically significant interaction was only observed for folate (odds ratio: 14.0; 95% CI: 1.8, 108.5). No significant associations were seen for MTR or SHMT polymorphisms. Conclusion: These results show an association between the C677T MTHFR variant and different folate intakes on risk of CRC.