Cardena, M M S G; Ribeiro-Dos-Santos, A K; Santos, S E B; Mansur, A J; Bernardez-Pereira, S; Santos, P C J L; Pereira, A C; Fridman, C
There is a high prevalence of heart failure (HF) in the general population, but it is more common in black people. We evaluated the association between genomic ancestry and mitochondrial haplogroups (mt-haplogroups) with HF etiology in 503 Brazilian patients. We elicited Mt-haplogroups by analyzing the control region of mitochondrial DNA, and genomic ancestry, by using 48 autosomal insertion-deletion ancestry informative markers. Hypertensive (28.6%, n=144) and ischemic (28.4%, n=143) etiologies of HF were the most prevalent herein. Our results showed that 233 individuals (46.3%) presented African mitochondrial (mt)-haplogroups, and the major contribution in the genomic ancestry analysis was the European ancestry (57.5% (±22.1%)). African mt-haplogroups were positively associated with a diagnosis of hypertensive cardiomyopathy (odds ratio, OR 1.55, confidence interval, CI 95% 1.04-2.44, P=0.04) when compared with European mt-haplogroups. Regarding the genomic ancestry, the African ancestry variant had higher risks (OR 7.84, 95% CI 2.81-21.91, Pancestry variant had lower risks (OR 0.14, 95% CI 0.04-5.00, Pancestry showed an OR of 4.05 (CI 95% 1.53-10.74, P=0.005), whereas African ancestry showed an OR of 0.17 (CI 95% 0.06-0.48, P=0.001) for developing ischemic etiology. In conclusion, this study supports the importance of using ancestry informative markers and mitochondrial DNA to study the genetics of complex diseases in admixed populations to improve the management, treatment and prevention of these illnesses. Therefore, the ancestry informative markers and mt-haplogroups could provide new biomarkers to be associated with HF etiologies and be used as a premise for more specific management.
Gil, Julio M; Weber, Raimar; Rosales, Claudia B; Rodrigues, Helcio; Sennes, Luiz U; Kalil, Jorge; Chagury, Azis; Miziara, Ivan D
Pemphigus vulgaris is a mucocutaneous blistering autoimmune disease that manifests as painful blisters or erosions on the skin and/or mucosal surfaces. IgG autoantibodies target desmoglein, playing a major role in disease pathogenesis. Genetic predisposal to pemphigus vulgaris, especially the HLA DR and DQ alleles, has been known since the 1980s. The unique constitution of the Brazilian population favors exploratory genetic studies. The study group included 51 patients with a confirmed diagnosis of pemphigus vulgaris from a tertiary hospital in Sao Paulo city, Sao Paulo, southeast Brazil. DNA was extracted from peripheral blood, and HLA A, B, C, DR, and DQ typing was performed. The control group was composed of a database of 297 deceased donors from the city of São Paulo typed with the same method. The statistical significance level was adjusted using the Bonferroni correction depending on the phenotypic frequencies evaluated for HLA A, HLA B, HLA C, HLA DRB1, DQA1, and HLA DQB1. The alleles HLA-B*57, HLA-C*15, HLA-DRB1*04:02, HLA-DRB1*08:04, HLA-DRB1*14:01, DQA1*03:01, DQB1*03:02, and DQB1*05:03 were associated with susceptibility. Alleles HLA DRB1*04:02 and HLA-DRB1*14:01 and their respective haplotypes DRB1*04-DQA1*03:01-DQB1*03:02, and DRB1*14-DQA1*01:01-DQB1*05:03 conferred a risk of the disease. The DRB1*04:02 and DQB1*05:03 alleles are associated with pemphigus vulgaris in our study as well as in various populations. The association with HLA-DRB1*08:04 in our study was confirmed to be specific to this allele and not to linkage disequilibrium to any adjacent gene. The association between HLA-B*57 and pemphigus vulgaris is reported for the first time in the present study. © 2017 The International Society of Dermatology.
Sousa, Maria Fernanda B; Santos, Raquel L; Turró-Garriga, Oriol; Dias, Rachel; Dourado, Marcia C N; Conde-Sala, Josep L
Transcultural studies regarding the comparison of levels of burden in caregivers of patients with Alzheimer's disease (AD) from Europe and Latin America are rare. We designed this study to investigate the differentiating factors associated with burden in Brazilian and Spanish caregivers of patients with AD. This is a cross-sectional study composed by samples of outpatients with AD and their caregivers from Brazil (n = 128) and Spain (n = 146). Caregivers answered the Zarit Burden Interview (ZBI) and a Sociodemographic Questionnaire. Patients were assessed with the Mini-Mental State Examination (MMSE), Functional Activities Questionnaire (FAQ), Disability Assessment for Dementia (DAD), Neuropsychiatric Inventory (NPI), and Clinical Dementia Rating (CDR) Scale. In the multivariate regression analysis, high burden levels were reported in Brazil, when caregivers were female (p = 0.025) and when patients did not attend Day Care Center (p = 0.025). In Spain, high burden levels were associated with living with the patient (p = 0.014), younger caregivers (p = 0.003), and participation of patients at Day Care Center (p = 0.046). Also, different neuropsychiatric symptoms explained high burden levels: in Brazil, depression (p Caregivers' gender, patients who attended Day Care Center and neuropsychiatric symptoms were differentiating factors in the burden of Brazilian and Spanish caregivers.
Morais, Luana Carolina de; Zanuto, Everton Alex Carvalho; Queiroz, Dayane Cristina; Araújo, Monique Yndawe Castanho; Rocha, Ana Paula Rodrigues; Codogno, Jamile Sanches
ABSTRACT Many factors are associated with sleep disorders, causing an increase in health spending. The objective of this study was to analyze the association of sleep disorders and non-communicablechronic diseases in patients over 50 years of age, attended by Basic Health Care Units of Presidente Prudente. In total, 363 patients participated. The history of diseases was self-reported through the use of a questionnaire, the level of physical activity was evaluated by the Baecke questionnaire, ...
Aperecida da Silva, Maria; Cordeiro, Quirino; Louza, Mario; Vallada, Homero
Objective: To investigate a possible association between a 3'UTR VNTR polymorphism of the dopamine transporter gene (SLC6A3) and ADHD in a Brazilian sample of adult patients. Method: Study Case-control with 102 ADHD adult outpatients ("DSM-IV" criteria) and 479 healthy controls. The primers' sequence used were: 3'UTR-Forward: 5' TGT GGT…
Lana, Tamires Prates; da Silva Costa, Sueli Matilde; Ananina, Galina; Hirata, Fábio Endo; Rim, Priscila Hae Hyun; Medina, Flávio MacCord; de Vasconcellos, José Paulo Cabral; de Melo, Mônica Barbosa
Age-related macular degeneration is a multifactorial disease that can lead to vision impairment in older individuals. Although the etiology of age-related macular degeneration remains unknown, risk factors include age, ethnicity, smoking, hypertension, obesity, and genetic factors. Two main loci have been identified through genome-wide association studies, on chromosomes 1 and 10. Among the variants located at the 10q26 region, rs11200638, located at the HTRA1 gene promoter, has been associated with age-related macular degeneration in several populations and is considered the main polymorphism. We conducted a replication case-control study to analyze the frequency and participation of rs11200638 in the etiology of age-related macular degeneration in a sample of patients and controls from the State of São Paulo, Brazil, through polymerase chain reaction and enzymatic digestion. The frequency of the A allele was 57.60% in patients with age-related macular degeneration and 36.45% in controls (p value macular degeneration group compared to the control group (p = 1.21 e-07 and 0.0357, respectively). No statistically significant results were observed after stratification in dry versus wet types or advanced versus non-advanced forms. To our knowledge, this is the first time the association between rs11200638 and overall age-related macular degeneration has been reported in South America.
Marques, T; Patente, T A; Monteiro, M B; Cavaleiro, A M; Queiroz, M S; Nery, M; de Azevedo, M J; Canani, L H; Parisi, M C; Moura-Neto, A; Passarelli, M; Giannella-Neto, D; Machado, U F; Corrêa-Giannella, M L
Mesangial cells subject to high extracellular glucose concentrations, as occur in hyperglycaemic states, are unable to down regulate glucose influx, resulting in intracellular activation of deleterious biochemical pathways. A high expression of GLUT1 participates in the development of diabetic glomerulopathy. Variants in the gene encoding GLUT1 (SLC2A1) have been associated to this diabetic complication. The aim of this study was to test whether polymorphisms in SLC2A1 confer susceptibility to diabetic nephropathy (DN) in Brazilian type 1 diabetes patients. Four polymorphisms (rs3820589, rs1385129, rs841847 and rs841848) were genotyped in a Brazilian cohort comprised of 452 patients. A prospective analysis was performed in 155 patients. Mean duration of follow-up was 5.6 ± 2.4 years and the incidence of renal events was 18.0%. The rs3820589 presented an inverse association with the prevalence of incipient DN (OR: 0.36, 95% CI: 0.16 - 0.80, p=0.01) and with progression to renal events (HR: 0.20; 95% CI: 0.03 - 0.70; p=0.009). AGGT and AGAC haplotypes were associated with the prevalence of incipient DN and the AGAC haplotype was also associated with the prevalence of established/advanced DN. In conclusion, rs3820589 in the SLC2A1 gene modulates the risk to DN in Brazilian patients with inadequate type 1 diabetes control. Copyright © 2015 Elsevier B.V. All rights reserved.
Monica Pinheiro de Almeida Verissimo
Full Text Available In the absence of an iron chelating agent, patients with beta-thalassemia on regular transfusions present complications of transfusion-related iron overload. Without iron chelation therapy, heart disease is the major cause of death; however, hepatic and endocrine complications also occur. Currently there are three iron chelating agents available for continuous use in patients with thalassemia on regular transfusions (desferrioxamine, deferiprone, and deferasirox providing good results in reducing cardiac, hepatic and endocrine toxicity. These practice guidelines, prepared by the Scientific Committee of Associação Brasileira de Thalassemia (ABRASTA, presents a review of the literature regarding iron overload assessment (by imaging and laboratory exams and the role of T2* magnetic resonance imaging (MRI to control iron overload and iron chelation therapy, with evidence-based recommendations for each clinical situation. Based on this review, the authors propose an iron chelation protocol for patients with thalassemia under regular transfusions.
Full Text Available A single-nucleotide polymorphism (SNP upstream of interleukin (IL28B was recently identified as an important predictor of the outcome of chronic hepatitis C patients treated with pegylated interferon plus ribavirin (PEG-IFN/RBV. The aim of this study was to investigate the association between the IL28B gene polymorphism (rs12979860 and virological response in chronic hepatitis C patients. Brazilian patients (n = 263 who were infected with hepatitis C virus (HCV genotype 1 and were receiving PEG-IFN/RBV were genotyped. Early virological response (EVR (12 weeks, end-of-treatment response (EOTR (48 weeks, sustained virological response (SVR (72 weeks and relapse were evaluated using conventional and quantitative polymerase chain reaction (PCR assays. The frequency of the C allele in the population was 39%. Overall, 43% of patients experienced SVR. The IL28B CC genotype was significantly associated with higher treatment response rates and a lower relapse rate compared to the other genotypes [84% vs. 58% EVR, 92% vs. 63% EOTR, 76% vs. 38% SVR and 17% vs. 40% relapse rate in CC vs. other genotypes (CT and TT, respectively]. Thus, the IL28B genotype appears to be a strong predictor of SVR following PEG-IFN/RBV therapy in treatment-naïve Brazilian patients infected with HCV genotype 1. This study, together with similar research examining other SNPs, should help to define adequate protocols for the treatment of patients infected with HCV genotype 1, especially those with a poor prognosis.
Conclusion: Our findings indicate that the MTRR rs326119 variant might be a genetic marker associated with homocysteine and cobalamin concentrations, but not a strong risk factor for CHD or coronary atherosclerosis in the Brazilian population.
Krieger José E
Full Text Available Abstract Background Reactive oxygen species have been implicated in the physiopathogenesis of hypertensive end-organ damage. This study investigated the impact of the C242T polymorphism of the p22-phox gene (CYBA on left ventricular structure in Brazilian hypertensive subjects. Methods We cross-sectionally evaluated 561 patients from 2 independent centers [Campinas (n = 441 and Vitória (n = 120] by clinical history, physical examination, anthropometry, analysis of metabolic and echocardiography parameters as well as p22-phox C242T polymorphism genotyping. In addition, NADPH-oxidase activity was quantified in peripheral mononuclear cells from a subgroup of Campinas sample. Results Genotype frequencies in both samples were consistent with the Hardy- Weinberg equilibrium. Subjects with the T allele presented higher left ventricular mass/height2.7 than those carrying the CC genotype in Campinas (76.8 ± 1.6 vs 70.9 ± 1.4 g/m2.7; p = 0.009, and in Vitória (45.6 ± 1.9 vs 39.9 ± 1.4 g/m2.7; p = 0.023 samples. These results were confirmed by stepwise regression analyses adjusted for age, gender, blood pressure, metabolic variables and use of anti-hypertensive medications. In addition, increased NADPH-oxidase activity was detected in peripheral mononuclear cells from T allele carriers compared with CC genotype carriers (p = 0.03. Conclusions The T allele of the p22-phox C242T polymorphism is associated with higher left ventricular mass/height2.7 and increased NADPH-oxidase activity in Brazilian hypertensive patients. These data suggest that genetic variation within NADPH-oxidase components may modulate left ventricular remodeling in subjects with systemic hypertension.
Boechat, Narjara de Oliveira; Ogusku, Mauricio Morish; Boechat, Antonio Luiz; Sadahiro, Aya
Background Rheumatoid Arthritis (RA) is an autoimmune disease characterized by chronic inflammation of the joints that affects approximately 1% of the population worldwide. The HLA-DRB1 gene locus plays a major role in genetic susceptibility to RA, a condition that has been associated with a high cardiovascular morbidity and mortality in many studies. Methodology/Principal Findings The aim of this work was to investigate which types of HLA class II genes are associated with RA in patients from the Brazilian Amazon and their influence on high cardiovascular risk status in this population. For this purpose, a case-control study was carried out with a total of 350 non-Indian individuals made up of a cohort of 132 consecutive RA sufferers and 218 healthy controls. A χ2 test showed that HLADRB1*04 (p<0.0016; OR = 1.89; 95% CI = 1.29–2.79) and HLADRB1*10 (p = 0.0377; OR = 3.81; 95% CI = 1.16–12.50) are the major HLA genes associated with susceptibility to RA. A logistic regression model also showed that the interaction between HLADRB1*04 (p = 0.027; OR = 6.02; 95% CI = 1.21–29.7), age (p = 0.0001; OR = 1.26; 95% CI = 1.13–1.39) and smoking (p = 0.0001; OR = 23.6; 95% CI = 4.25–32.1) is associated with a probability of a high cardiovascular risk status at an early age. Conclusions/Significance The results of this study show for the first time that HLA class II type is associated with RA in Brazilian Amazon populations and that a specific interaction between the HLA-DRB1*04 gene and smoking is associated with a high cardiovascular risk status, as initially reported in the European population. This study therefore contributes to an understanding of gene-environment interactions in RA patients. PMID:22912672
Luiz Fábio Magno Falcão
Full Text Available The aim of this study was to compare computed tomography (CT scans of chest and lung function among patients with Human T-Lymphotropic Virus Type 1 (HTLV with and without HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP. In this cross-sectional study performed between January 2013 and June 2016, we included 48 patients with HAM/TSP (19 women and 11 men and without HAM/TSP (12 women and 6 men. We compared CT findings and lung functions of these groups. Patients who had HAM/TSP had abnormal CT findings (P = 0.000, including more frequent bronchiectasis (P = 0.049, parenchymal bands (P = 0.007, interlobular septal thickening (P = 0.035, and pleural thickening (P = 0.009. In addition, neither patients with HAM/TSP (9/30; 30% nor the controls (0/18; 0% had obstructive or restrictive lung disease (P = 0.009. HTLV diagnosis should be considered in all patients with abnormal CT findings in whom no other cause is apparent. It is important to remember that lung disease increases the rates of morbidity and mortality in developing countries.
Full Text Available Inosine triphosphatase (ITPA single nucleotide polymorphisms (SNPs are strongly associated with protection against ribavirin (RBV-induced anaemia in European, American and Asian patients; however, there is a paucity of data for Brazilian patients. The aim of this study was to evaluate the ITPA SNP (rs7270101/rs1127354 frequency in healthy and hepatitis C virus (HCV-infected patients from Brazil and the association with the development of severe anaemia during antiviral therapy. ITPA SNPs were determined in 200 HCV infected patients and 100 healthy individuals by sequencing. Biochemical parameters and haemoglobin (Hb levels were analysed in 97 patients who underwent antiviral therapy. A combination of AArs7270101+CCrs1127354 (100% ITPase activity was observed in 236/300 individuals. Anaemia was observed in 87.5% and 86.2% of treated patients with AA (rs7270101 and CC genotypes (rs1127354, respectively. Men with AA (rs7270101 showed a considerable reduction in Hb at week 12 compared to those with AC/CC (p = 0.1475. In women, there was no influence of genotype (p = 0.5295. For rs1127354, men with the CC genotype also showed a sudden reduction in Hb compared to those with AC. Allelic distribution of rs7270101 and rs1127354 shows high rates of the genotypes AA and CC, respectively, suggesting that the study population had a great propensity for developing RBV-induced anaemia. A progressive Hb reduction during treatment was observed; however, this reduction was greater in men at week 12 than in women.
Eugênia Ribeiro Valadares
Results and discussion: Age at diagnosis was between 10 and 32 months and the severity of the disease correlated with the increasing of age at diagnosis. The predominant symptoms were vomiting, weight loss, and hepatomegaly. Severe renal tubular acidosis manifested in one child. All patients had remission of symptoms after dietary modification. The sequencing of the ALDOB gene identified one homozygous patient for the mutation c.524C>A (p.A175D, while the others were compound heterozygous for c.360_363delCAAA (p.N120KfsX32, c.178C>T (p.R60X mutations, c.448G>C (p.A150P and c.524C>A (p.A175D. Clinical improvement of patients after dietary treatment is suggestive of the diagnosis, confirmed by molecular analysis. The prevalence of mutations found in our Brazilian patients is different from those of international literature.
Sippert, Emília Ângela; Silva, Cléverson de Oliveira e; Ayo, Christiane Maria; Marques, Silvia Barbosa Dutra; Visentainer, Jeane Eliete Laguila; Sell, Ana Maria
Human leukocyte antigens (HLA) have a pivotal role in immune response and may be involved in antigen recognition of periodontal pathogens. However, the associations of HLA with chronic periodontitis (CP) have not been previously studied in the Brazilian population. In an attempt to clarify the issue of genetic predisposition to CP, we examined the distribution of HLA alleles, genotypes, and haplotypes in patients from Southern Brazil. One hundred and eight CP patients and 151 healthy and unrelated controls with age-, gender-, and ethnicity-matched were HLA investigated by polymerase chain reaction with sequence specific oligonucleotides. To exclude smoking as a predisposing factor, statistical analyses were performed in the total sample and in nonsmoking individuals. The significant results showed a positive association of the A∗02/HLA-B∗40 haplotype with CP (total samples: 4.2% versus 0%, P c = 0.03; nonsmokers: 4.3% versus 0%, P c = 0.23) and a lower frequency of HLA-B∗15/HLA-DRB1∗11 haplotype in CP compared to controls (total samples: 0.0% versus 4.3%, P c = 0.04; nonsmokers: 0 versus 5.1%, P c = 1.0). In conclusion, the HLA-A∗02/B∗40 haplotype may contribute to the development of CP, while HLA-B∗15/DRB1∗11 haplotype might indicate resistance to disease among Brazilians. PMID:26339134
Emília Ângela Sippert
Full Text Available Human leukocyte antigens (HLA have a pivotal role in immune response and may be involved in antigen recognition of periodontal pathogens. However, the associations of HLA with chronic periodontitis (CP have not been previously studied in the Brazilian population. In an attempt to clarify the issue of genetic predisposition to CP, we examined the distribution of HLA alleles, genotypes, and haplotypes in patients from Southern Brazil. One hundred and eight CP patients and 151 healthy and unrelated controls with age-, gender-, and ethnicity-matched were HLA investigated by polymerase chain reaction with sequence specific oligonucleotides. To exclude smoking as a predisposing factor, statistical analyses were performed in the total sample and in nonsmoking individuals. The significant results showed a positive association of the A∗02/HLA-B∗40 haplotype with CP (total samples: 4.2% versus 0%, Pc = 0.03; nonsmokers: 4.3% versus 0%, Pc = 0.23 and a lower frequency of HLA-B∗15/HLA-DRB1∗11 haplotype in CP compared to controls (total samples: 0.0% versus 4.3%, Pc = 0.04; nonsmokers: 0 versus 5.1%, Pc = 1.0. In conclusion, the HLA-A∗02/B∗40 haplotype may contribute to the development of CP, while HLA-B∗15/DRB1∗11 haplotype might indicate resistance to disease among Brazilians.
Guidelines for maintenance of adult patients with brain death and potential for multiple organ donations: the Task Force of the Brazilian Association of Intensive Medicine the Brazilian Association of Organs Transplantation, and the Transplantation Center of Santa Catarina.
Westphal, G A; Caldeira Filho, M; Fiorelli, A; Vieira, K D; Zaclikevis, V; Bartz, M; Wanzuita, R; Teixeira, C; Franke, C; Machado, F O; Friedman, G; Andrade, J; Matos, J D; Lamgaro, D M; Silva, E; Costa, G; Coelho, M E; Oliveira, M C; Youssef, N C M; Akamine, N; Duarte, P; Lisboa, R; Mazzali, M; Ferraz Neto, B H
The organ shortage for transplantation, the principal factor that increases waiting lists, has become a serious public health problem. In this scenario, the intensivist occupies a prominent position as one of the professionals that first has a chance to identify brain death and to be responsible for the maintenance of the potential deceased donor. This report attempts to establish guidelines for care and maintenance of adult deceased donor organs guiding and standardizing care provided to patients with brain death. These guidelines were composed by intensivists, transplant coordinators, professionals from various transplant teams, and used transplant center. The formulated questions were forwarded to all members and recommendations were constructed after an extensive literature review selecting articles with the highest degree of evidence. Guidelines were developed in the form of questions reflecting frequent experiences in clinical intensive care practices. The main questions were: Is there an optimal interval for keeping organs of deceased donors viable? What actions are considered essential for maintaining deceased donors in this period? What are the limits of body temperature? How should the patient be warmed? Which laboratory tests should be performed? What is the collection interval? What are the limits in the laboratory and the capture scenario? What are the limits of blood pressure? When and how should one use catecholamines? This pioneer project involved a multidisciplinary team working in organ transplantation seeking to provide treatment guidance to increase the number of viable organs from deceased adult donors. Copyright © 2012 Elsevier Inc. All rights reserved.
Jungerman, Ivy; Toyota, Julia; Montoni, Neyller Patriota; Azevedo, Elma Heitmann Mares; Guedes, Renata Ligia Vieira; Damascena, Aline; Lowe, Derek; Vartanian, José Guilherme; Rogers, Simon N; Kowalski, Luiz Paulo
The purpose of this study was to translate, culturally validate and evaluate the Patients Concerns Inventory - Head and Neck (PCI-H&N) in a consecutive series of Brazilian patients. This study included adult patients treated for upper aerodigestive tract (UADT) cancer. The translation and cultural adaptation of the PCI-H&N followed internationally accepted guidelines and included a pretest sample of patients that completed the first Brazilian Portuguese version of the PCI. Use, feasibility and acceptability of the PCI were tested subsequently in a consecutive series of UADT cancer patients that completed the final Brazilian Portuguese version of the PCI and a Brazilian Portuguese version of the University of Washington Quality of Life Questionnaire (UW-QOL). Associations between physical and socio-emotional composite scores from the UW-QOL and the PCI were analyzed. Twenty (20) patients participated in the pretest survey (translation and cultural adaptation process), and 84 patients were analyzed in the cultural validation study. Issues most selected were: fear of cancer returning, dry mouth, chewing/eating, speech/voice/being understood, swallowing, dental health/teeth, anxiety, fatigue/tiredness, taste, and fear of adverse events. The three specialists most selected by the patients for further consultation were speech therapist, dentist and psychologist. Statistically significant relationships between PCI and UW-QOL were found. The translation and cultural adaptation of the PCI into Brazilian Portuguese language was successful, and the results demonstrate its feasibility and usefulness, making this a valuable tool for use among the Brazilian head and neck cancer population.
Association analysis of anti-Epstein-Barr nuclear antigen-1 antibodies, anti-cyclic citrullinated peptide antibodies, the shared epitope and smoking status in Brazilian patients with rheumatoid arthritis
Michel Alexandre Yazbek
Full Text Available INTRODUCTION: Epstein-Barr virus exposure appears to be an environmental trigger for rheumatoid arthritis that interacts with other risk factors. Relationships among anti-cyclic citrullinated peptide antibodies, the shared epitope, and smoking status have been observed in patients with rheumatoid arthritis from different populations. OBJECTIVE: To perform an association analysis of anti-Epstein-Barr nuclear antigen-1 antibodies, anti-cyclic citrullinated peptide antibodies, the shared epitope, and smoking status in Brazilian patients with rheumatoid arthritis. METHODS: In a case-control study, 140 rheumatoid arthritis patients and 143 healthy volunteers who were matched for age, sex, and ethnicity were recruited. Anti-Epstein-Barr nuclear antigen-1 antibodies and anti-cyclic citrullinated peptide antibodies were examined using an enzyme-linked immunosorbent assay, and shared epitope alleles were identified by genotyping. Smoking information was collected from all subjects. A comparative analysis of anti-Epstein-Barr nuclear antigen-1 antibodies, anti-cyclic citrullinated peptide antibodies, the shared epitope, and smoking status was performed in the patient group. Logistic regression analysis models were used to analyze the risk of rheumatoid arthritis. RESULTS: Anti-Epstein-Barr nuclear antigen-1 antibodies were not associated with anti-cyclic citrullinated peptide antibodies, shared epitope alleles, or smoking status. Anti-cyclic citrullinated peptide antibody positivity was significantly higher in smoking patients with shared epitope alleles (OR = 3.82. In a multivariate logistic regression analysis using stepwise selection, only anti-cyclic citrullinated peptide antibodies were found to be independently associated with rheumatoid arthritis (OR = 247.9. CONCLUSION: Anti-Epstein-Barr nuclear antigen-1 antibodies did not increase the risk of rheumatoid arthritis and were not associated with the rheumatoid arthritis risk factors studied. Smoking
Gomide, Laura; Kummer, Arthur; Cardoso, Francisco; Teixeira, Antonio Lucio
Clozapine has been used as an attempt to manage levodopa complications in advanced Parkinson's disease (PD). To investigate the use of clozapine in this context in a Brazilian sample, a retrospective chart review was carried out at the Movement Disorders Clinic from the Federal University of Minas Gerais. This study enrolled 43 PD patients who used or were in use of clozapine. Patients had a mean age of 64 years and a mean UPDRS score of 55. Clozapine was indicated for dyskinesias in 17 patients, for psychosis in 15 and for both reasons in 11. The average maximum dose was 70 mg/day. Twenty six patients used it for a mean of 3.5 years. Twenty nine presented an improvement of their condition, 9 remained clinically stable. Twenty subjects interrupted the use of clozapine, being 9 due to adverse effects. Clozapine may play a role in the management of motor and psychiatric complications in PD, but it is associated with low tolerability.
Bahia, Luciana; Kupfer, Rosane; Momesso, Denise; Cabral, Debora A P; Tschiedel, Balduino; Puñales, Marcia; Lavigne, Suzana; Façanha, Cristina F S; Forti, Adriana C; Mendes, Angela D N; Tura, Bernardo R
Hypoglycemia is a critical and limiting factor of a good metabolic control and can adversely affect the quality of life of diabetic patients. The aim of the study was to evaluate the health-related quality of life and calculate utilities values associated with hypoglycemia in patients with type 1 diabetes mellitus (T1DM). A multicenter, cross-sectional and observational study with T1DM patients from reference centers of the Brazilian public health system was conducted in three cities. Demographic and clinical data were collected, besides details on the frequency and severity of hypoglycemia. Health-related quality of life was assessed using EQ-5D instrument and utility values generated. 221 patients (107 women, 114 men), aged 29.8 ± 11.6 and disease duration of 14.2 ± 9.1 years were included. Most patients (n = 214, 96.8%) reported at least one symptomatic hypoglycemia in the last three months, 68% (n = 150) reported nocturnal episodes and 34.8% (n = 77) reported severe episodes. High frequency (daily or weekly) was observed in 38.6 and 26% of those reporting nocturnal or severe hypoglycemia, respectively. The median visual analog scale was 70 [60-85] for all patients, with differences between those with and without severe hypoglycemia (70 [60-80] vs 80 [61-90]; p = 0.006) and those with high and low frequency (62.5 [50-72.25] vs 70 [60-80]; p = 0.007). The median utility values was 0.801 [0.756-1.000] for all patients, with difference between those with high and low frequency of severe episodes (0.737 [0.628-1.000] vs 0.801 [0.756-1.000]; p = 0.02). This study shows the high frequency of hypoglycemia in a sample of T1DM patients treated in three reference centers of the Brazilian public health system and the impact of severe episodes on health-related quality of life. Utility values were generated and can be used in economic analysis for treatments that could decrease hypoglycemia and consequently improve quality of life.
Full Text Available Patients with chronic renal insufficiency (CRI have reduced hemoglobin levels, mostly as a result of decreased kidney production of erythropoietin, but the relation between renal insufficiency and the magnitude of hemoglobin reduction has not been well defined. Hereditary hemochromatosis is an inherited disorder of iron metabolism. The importance of the association of hemochromatosis with treatment for anemia among patients with CRI has not been well described. We analyzed the frequency of the C282Y and H63D mutations in the HFE gene in 201 Brazilian individuals with CRI undergoing hemodialysis. The analysis of the effects of HFE mutations on iron metabolism and anemia with biochemical parameters was possible in 118 patients of this study (hemoglobin, hematocrit, ferritin levels, transferrin saturation, and serum iron. A C282Y heterozygous mutation was found in 7/201 (3.4% and H63D homozygous and heterozygous mutation were found in 2/201 (1.0% and 46/201 (22.9%, respectively. The allelic frequencies of the HFE mutations (0.017 for C282Y mutation and 0.124 for H63D mutation did not differ between patients with CRI and healthy controls. Regarding the biochemical parameters, no differences were observed between HFE heterozygous and mutation-negative patients, although ferritin levels were not higher among patients with the H63D mutation (P = 0.08. From what we observed in our study, C282Y/H63D HFE gene mutations are not related to degrees of anemia or iron stores in CRI patients receiving intravenous iron supplementation (P > 0.10. Nevertheless, the present data suggest that the H63D mutation may have an important function as a modulating factor of iron overload in these patients.
Barreto, Sandhi Maria; Giatti, Luana; Casado, Leticia; de Moura, Lenildo; Crespo, Claudio; Malta, Deborah
Background Very few studies have examined the role of school, household and family contexts in youth smoking in middle-income countries. Methods This work describes smoking exposure among 59 992 high school students who took part in the Brazilian Survey of School Health and investigates contextual factors associated with regular smoking, defined as smoking cigarettes at least once in the past 30 days. The explaining variables were grouped into: socio-demographic characteristics, school contex...
João Gabriel Silva Souza
Full Text Available Abstract Objective: To describe the prevalence of dental pain in Brazilian preschoolers, as well as its associated factors, considering a representative sample of that population group in Brazil. Methods: Cross-sectional study that used the analytical data from national oral health survey (SB Brazil carried out in 2010. A representative sample of Brazilian preschoolers aged 5 years was considered. Interviews were carried out (answered by parents/tutors, as well as clinical examinations in children. Descriptive, bivariate and mutiple analyzes were performed, described in odds ratios and 95% confidence interval (OR/95%CI. Results: 7280 preschoolers were included. Of these, 1520 (21.1% had dental pain in the last 6 months. The chance of the occurrence of dental pain was higher among those who used dental services (1.51/1.02–2.23, with tooth decay (3.08/2.08–4.56, that self-perceveid the need for dental treatment (3.96/2.48–6.34, whose parents reported dissatisfaction by children with their teeth and mouth (1.47/1.04–2.10 and those who reported impact of oral problems on quality of life (5.76/3.90–8.49. Conclusions: The prevalence of dental pain among Brazilian preschool children was relatively high, being associated with the use of dental services and the normative and subjective oral health status.
Brochado, Maria José Franco; Nascimento, Daniela Francisca; Campos, Wagner; Deghaide, Neifi Hassan Saloum; Donadi, Eduardo Antonio; Roselino, Ana Maria
Genetic factors, particularly those concerning HLA class II, have been associated with the pathogenesis of pemphigus. Taking advantage of an area where pemphigus foliaceus (PF) and pemphigus vulgaris (PV) are prevalent in the northeastern region of the state of São Paulo, Southeastern Brazil, we have studied the HLA class I (A, B and C) and class II (DRB1 and DQA1/DQB1) profiles in 86 and 83 patients with PF and PV, respectively, as compared with 1592 controls from the same region. Among all the HLA alleles described herein, the more prevalent susceptibility alleles for PF were HLA-A*11, 33, -B*14; -DRB1*01:01, *01:02; -DQA1*01:02; and -DQB1*05:01. In PV patients, the HLA-B*38; -C*12; -DRB1*04:02, *08:04, *14:01, *14:04; -DQA1*03:01; and -DQB1*03:02 and *05:03 alleles were associated with susceptibility. The HLA-DRB1*01:02 allele and the HLA-DRB1*01-DQA1*01-DQB1*05 haplotype in PF patients and the HLA-DRB1*04:02 and *14:01 alleles and the HLA-DRB1*14-DQA1*01-DQB1*05 haplotype in PV patients were related with the highest etiologic fraction values. Distinct genetic patterns and not yet described HLA susceptibility/protection alleles/haplotypes profiles have been observed in this series. Our findings corroborate the differential genetic markers in PF and PV in an area where pemphigus is prevalent but not yet reported. Copyright © 2016 Elsevier Ltd. All rights reserved.
Gamba, B F; Vieira, G H; Souza, D H; Monteiro, F F; Lorenzini, J J; Carvalho, D R; Morreti-Ferreira, D
Smith-Magenis syndrome (SMS) is a complex congenital anomaly characterized by craniofacial anomalies, neurological and behavioral disorders. SMS is caused by a deletion in region 17p11.2, which includes the RAI1 gene (90% of cases), or by point mutation in the RAI1 gene (10% of cases). Laboratory diagnosis is through cytogenetic analysis by GTG banding and molecular cytogenetic analysis by FISH. We carried out an active search for patients in Associations of Parents and Friends of Exceptional Children (APAE) of São Paulo and genetic centers in Brazil. Forty-eight patients were screened for mental retardation, craniofacial abnormalities and stereotyped behavior with a diagnosis of SMS. In seven of them, chromosome banding at high resolution demonstrated chromosome 17p11.2 deletions, confirmed by FISH. We also made a meta-analysis of 165 cases reported between 1982 and 2010 to compare with the clinical data of our sample. We demonstrated differences between the frequencies of clinical signs among the cases reported and seven Brazilian cases of this study, such as dental anomalies, strabismus, ear infections, deep hoarse voice, hearing loss, and cardiac defects. Although the gold standard for diagnosis of SMS is FISH, we found that the GTG banding technique developed to evaluate chromosome 17 can be used for the SMS diagnosis in areas where the FISH technique is not available.
Oliveira, Luciano Santos; Lira-Junior, Ronaldo; Figueredo, Carlos Marcelo; Gomes, Marília Brito; Fischer, Ricardo Guimarães
This study aimed to evaluate the possible association between periodontitis and systemic complications in a Brazilian type 1 diabetes population. A multicentre, sectional study was carried out in 28 public clinics located in 20 Brazilian cities. Data from 3,591 patients were obtained (56.0% females, 57.2% Caucasians), with an average age of 21.2 ± 11.7 years and whose mean duration of type 1 diabetes was 9.6 ± 8.1 years. Periodontitis was evaluated through self-report. Odds ratios (OR) and 95% confidence intervals were calculated to evaluate the association between periodontitis and systemic diabetes complications (chronic micro and macrovascular complications and hospitalizations by hyperglycemia and diabetic ketoacidosis). The prevalence of periodontitis was 4.7% (n=170). Periodontitis patients had mean age of 27.4 ± 12.9. This group was older (pperiodontitis. Systolic and diastolic blood pressures were significantly increased in periodontitis patients (pPeriodontitis patients had increased odds of microvascular complications (2.43 [1.74-3.40]) and of hospitalizations related to hyperglycemia (2.76 [1.72-4.42]) and ketoacidosis (2.72 [1.53-4.80]). In conclusion, periodontitis was associated to systemic complications in Brazilian type 1 diabetes patients.
Maria José Franco Brochado
Full Text Available Pemphigus are blistering autoimmune diseases related with genetic and environmental factors. Here we describe HLA genotyping in pemphigus patients. First, we review the HLA class I/II data on pemphigus reported in Brazilian samples and then present the HLA class I (-A, -B, -C and class II (-DRB1, -DQA1, -DQB1 alleles related to susceptibility/resistance to pemphigus by comparing 86 patients with pemphigus foliaceus, 83 patients with pemphigus vulgaris, and 1592 controls from the northeastern region of the state of São Paulo, Southeastern Brazil. The data presented here are related to the manuscript “Differential HLA class I and class II associations in Pemphigus Foliaceus and Pemphigus Vulgaris patients from a prevalent Southeastern Brazilian region” Brochado et al. (2016 .
BIRMAN, Esther G.; SILVEIRA, Fernando R. X.; GODOY, Luzia F.; COSTA, Catalina R.
One hundred and forty-four Brazilian AIDS patients presenting with Kaposi’s sarcoma (KS) were evaluated with respect to the frequency of oral neoplasms and their clinical features. The majority of the patients were young male adults (age range: 21-40 years old), from which 11.1 % presented with oral KS (OKS) exclusively. Oral and skin lesions were associated in 25% of the cases, while only four patients showed association between oral and visceral KS; 49.3% of the cases were exclusively derma...
Honjo, R S; Mello, C B; Pimenta, L S E; Nuñes-Vaca, E C; Benedetto, L M; Khoury, R B F; Befi-Lopes, D M; Kim, C A
Cri du Chat syndrome (CdCS) is a genetic syndrome caused by deletions in the short arm of chromosome 5. Although the main clinical features of CdCS are well known, the neurocognitive and behavioural characteristics of the phenotype are rarely described in detail in the literature. In this study, we analysed the main phenotypic features of CdCS from a parental perspective. A questionnaire was sent to 700 Brazilian families that were registered in the Brazilian Association of CdCS. The questions involved specific domains of CdCS, such as pregnancy and birth conditions, recurrence of the disease in the family, current major health problems, and aspects of cognitive development. In total, 73 questionnaires were completed: 44 females and 29 males, ranging from 9.5 months old to 40 years old (mean = 13.8 years; median = 12 years). Most of the parents noticed the typical cat-like cry at birth (94.4%). The age at diagnosis of CdCS ranged from the time of birth to 180 months (mean = 14 months; median = 6 months), while one case was diagnosed during pregnancy. In all of the cases, the diagnosis of CdCS was made by G-banding karyotype analysis. In 66.2% of the cases, the parents underwent cytogenetic investigation. A total of 52.1% of the parents answered that they did not remember what the recurrence risk of CdCS was in their family. The main health problems that were reported were as follows: swallowing problems (80.3%), feeding problems (80.3%), congenital heart disease (31.5%), spine abnormalities (28.8%), and neurological symptoms (20.5%), including seizures (11%). The behavioural problems that were reported were as follows: aggressive behaviour, stereotypies, anxiety, phobias, and genital manipulation/masturbation. Neurodevelopmental delay was reported in all of the cases. Independent walking was achieved in 72.2% of the patients. Approximately 50% of the patients never presented expressive language, and most of the patients are dependent on others for
Padovan, Lara; Segat, Ludovica; Crovella, Sergio
We investigated the possible association between PRF1 gene polymorphisms and HIV-1 vertical transmission in Brazilian children by analyzing PRF1 gene coding and untranslated regions in 173 perinatally infected children (HIV+), 51 exposed uninfected (HIV-), and 171 HIV-unexposed uninfected children. Seven single nucleotide polymorphisms were identified in our samples. The rs885822 C allele and CC genotype were significantly more frequent in HIV-negative than in HIV-positive patients and associated with a protective effect toward HIV vertical transmission.
Brandão, Danusa S; Venancio, Sonia I; Giugliani, Elsa R J
To estimate the association between the implementation of the Brazilian Breastfeeding Network and prevalence of breastfeeding in a medium-size city in southern Brazil. This was a cross-sectional study involving 405 children under 1 year who participated in the second phase of the multivaccination campaign in 2012. Children's consumption of food on the day before the interview was obtained through interviews with mothers or guardians. The manager and one health professional from every health facility that joined the Network were interviewed in order to investigate the process of implementation of this initiative. The association between prevalence of breastfeeding and exclusive breastfeeding and adherence to the Network implementation process was tested using Poisson regression with robust variance. Multivariate analysis revealed that among the children assisted by health facilities who joined the Network and those attending services that did not adhere to this strategy, the prevalence of breastfeeding (74% and 70.4% among children under 1 year, respectively) and exclusive breastfeeding (43.3% and 38.1% among children under 6 months, respectively) did not differ significantly. Difficulties in implementing the Network, such as high turnover of professionals, not meeting the criteria for accreditation, and insufficient participation of tutors in the process were identified. Contrary to the hypothesis of this study, there was no significant association between the implementation of the Brazilian Breastfeeding Network and prevalence of breastfeeding and exclusive breastfeeding in the studied city. It is possible that the difficulties found in implementing the Network in this city have influenced this result. Copyright © 2014 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.
Breast cancer screening: updated recommendations of the Brazilian College of Radiology and Diagnostic Imaging, Brazilian Breast Disease Society, and Brazilian Federation of Gynecological and Obstetrical Associations
Linei Augusta Brolini Dellê Urban
Full Text Available Abstract Objective: To present the current recommendations for breast cancer screening in Brazil, as devised by the Brazilian College of Radiology and Diagnostic Imaging, the Brazilian Breast Disease Society, and the Brazilian Federation of Gynecological and Obstetrical Associations. Materials and methods: We analyzed scientific studies available in the Medline and Lilacs databases. In the absence of evidence, the recommendations reflected the consensus of a panel of experts. Recommendations: Annual mammography screening is recommended for women 40-74 years of age. Among women ≥ 75 years of age, annual mammography screening should be reserved for those with an expected survival > 7 years. Complementary ultrasound should be considered for women with dense breasts. Complementary magnetic resonance imaging is recommended for women at high risk. When available, an advanced form of mammography known as tomosynthesis can be considered as a means of screening for breast cancer.
Ambiel, Marcela Vendruscolo; Roselino, Ana Maria
BACKGROUND Pemphigus foliaceus and pemphigus vulgaris are endemic in the northeastern region of São Paulo State, Brazil. They are treated mainly with systemic corticosteroids, which may provoke osteoporosis; atherosclerosis, higher blood pressure, insulin resistance, glucose intolerance, hyperlipidemia and abdominal obesity. These side effects of corticoids also constitute criteria for the diagnosis of metabolic syndrome. OBJECTIVE The prevalence of metabolic syndrome and each component of metabolic syndrome in Pemphigus foliaceus and pemphigus vulgaris groups was compared with Brazilian casuistic samples. METHODS Data of 147 patients (pemphigus foliaceus 48.9% and pemphigus vulgaris 51.1%) were compiled from medical records regarding metabolic syndrome and its components, and included in the analysis. RESULTS There was no significant difference regarding the prevalence of metabolic syndrome in pemphigus groups compared with the Brazilian casuistic samples. The analysis of each component of metabolic syndrome showed a higher prevalence of: higher blood pressure in male subjects with pemphigus vulgaris, and in pemphigus foliaceus in both genders; diabetes mellitus in both genders for pemphigus vulgaris and pemphigus foliaceus; obesity in females for pemphigus vulgaris and pemphigus foliaceus, and hypertriglyceridemia in both genders for pemphigus vulgaris and pemphigus foliaceus groups that were statistically significant compared to the Brazilian reports. Furthermore, the study noted a higher incidence of cardiovascular events in both genders in pemphigus foliaceus and pemphigus vulgaris groups than in Brazilian casuistic samples. CONCLUSION The components of metabolic syndrome are more numerous in pemphigus when compared with Brazilian casuistic samples. Future studies are necessary to assure that metabolic syndrome may be associated with pemphigus per se, including a greater casuistic sample of patients who have not taken corticoids. PMID:25184914
Brandão, Ajacio Bandeira de Mello; Mariante-Neto, Guilherme
Patients infected with the human immunodeficiency virus (HIV) have generally been excluded from consideration for liver transplantation. Recent advances in the management and prognosis of these patients suggest that this policy must be reevaluated. To identify the current position of Brazilian transplant centers concerning liver transplantation in asymptomatic HIV-infected patients with end-stage liver disease. A structured questionnaire was submitted by e-mail to Brazilian groups who perform liver transplantation and were active in late 2003, according to the Brazilian Association of Organ Transplantation. Of the 53 active groups, 30 e-mail addresses have been found of professionals working in 41 of these groups. Twenty-one responses (70%) were obtained. Most of the professionals (62%) reported that they do not include HIV-infected patients in waiting lists for transplants, primarily on account of the limited world experience. They also reported, however, that this issue will soon be discussed by the group. Those who accept these patients usually follow the guidelines provided by the literature: patients must fulfill the same inclusion criteria as the other patients with end-stage liver diseases, present low or undetectable HIV viral load, and a CD4 count above 250/mm3. They reported that there are 10 HIV-infected patients in waiting list and that only one patient has received a liver transplant in the country. Most centers do not accept in waiting lists for liver transplantation patients with HIV infection, even asymptomatic ones. However, advances in the management of HIV-infected patients suggest that this policy must be reevaluated. In Brazil, there is practically no experience in liver transplantation in HIV-positive patients.
Rosemeyre França de Paula FIUZA
Full Text Available ABSTRACT Objective To analyze the prevalence and factors associated with breakfast skipping among adolescents. Methods Cross-sectional study, with adolescents aged 10-17 years, evaluated between 2009 and 2011, belonging to a cohort study in the Central-West region of Brazil. Breakfast skipping was considered as not having breakfast every day. Demographic, socioeconomic, and lifestyle factors were evaluated through a questionnaire. Anthropometric assessment included measurement of weight and height, which were used to classify weight status using body mass index. Poisson regression was used to assess the association of breakfast skipping with demographic and socioeconomic variables, lifestyle factors, and weight status. Results Among 1,716 Brazilian adolescents evaluated, 36.2% reported not consuming breakfast every day, with the highest prevalence among girls (p=0.03. After adjusting for age and economic class, breakfast skipping was associated with not consuming breakfast with parents and morning shift at school, in both genders, and with obesity only in boys. Lifestyle factors such as alcohol consumption, physical activity, diet quality, and smoking were not associated with skipping breakfast. Conclusion The omission of breakfast was observed in more than a third of adolescents, being associated with demographic and lifestyle factors. In the public health perspective, the importance of encouraging the consumption of this meal is highlighted, with actions involving the school environment and the family.
Souza-Lima, Rita de Cássia de; Barbosa, Maria das Graças Vale; Coura, José Rodrigues; Arcanjo, Ana Ruth Lima; Nascimento, Adelaide da Silva; Ferreira, João Marcos Bemfica Barbosa; Magalhães, Laylah Kelre; Albuquerque, Bernardino Cláudio de; Araújo, Guilherme Alfredo Novelino; Guerra, Jorge Augusto de Oliveira
Chagas disease is considered as emerging in the Brazilian Amazon, usually occurring in acute outbreaks. We describe 17 cases of acute Chagas disease in Rio Negro, Amazonas. There were 15 males (average age, 31.3 years), all positive for Trypanosoma cruzi in fresh blood smear examination, and 14 positive by xenodiagnosis and PCR. The top clinical manifestations were fever, asthenia, abdominal pain, and palpitations. Electrocardiograms featured low-voltage QRS, anterosuperior divisional block, and right bundle branch block associated with anterosuperior divisional block. All patients had consumed açaí products from Monte Alegre in the rural area around Santa Izabel do Rio Negro, Brazil.
Yára Dadalti Fragoso
Full Text Available OBJECTIVE: To assess the impact of multiple sclerosis (MS on the professional life of Brazilian patients. METHOD: One hundred MS patients were randomly selected from the database of the Brazilian Multiple Sclerosis Association (ABEM. An individual interview was carried out by telephone by a member of ABEM, who collected data on the patients' clinical status, educational level and professional lives. RESULTS: Complete data were obtained from 96 patients (27 males and 69 females aged 55.0±14.1 years, with average disease duration of 4.6±4.0 years. Eighty percent had eleven or more years of schooling. Among the whole group, 66% did not present limitations on walking. The longer the disease duration and the older the patient were, the higher the chances were that the patient was retired or receiving workers' compensation benefits. However, even among patients with MS for less than five years, the rate of non-participation in the workforce was 47.7%. Fatigue, paresthesia, cognitive dysfunction and pain were often cited as the motives for not working. CONCLUSION: MS patients presented high levels of unemployment, retirement and receipt of workers' compensation benefits, despite their high schooling levels. Age, disease duration and disability influenced these results for the whole group. However, even among younger patients with shorter disease duration and low disability, this finding remained.
Lima, Daniela Braga; Damiani, Lucas Petri; Fujimori, Elizabeth
To analyze the variables associated with vitamin A deficiency (VAD) in Brazilian children aged 6 to 59 months, considering a hierarchical model of determination. This is part of the National Survey on Demography and Health of Women and Children, held in 2006. Data analysis included 3,417 children aged from six to 59 months with retinol data. Vitamin A deficiency was defined as serum retinol Poisson regression analysis were performed, with significance level set at 5%, using a hierarchical model of determination that considered three conglomerates of variables: those linked to the structural processes of community (socioeconomic-demographic variables); to the immediate environment of the child (maternal variables, safety and food consumption); and individual features (biological characteristics of the child). Data were expressed in prevalence ratio (PR). After adjustment for confounding variables, the following remained associated with VAD: living in the Southeast [PR=1,59; 95%CI 1,19-2,17] and Northeast [PR=1,56; 95%CI 1,16-2,15]; in urban area [RP=1,31; 95%CI 1,02-1,72]; and mother aged ≥36 years [RP=2,28; 95%CI 1,37-3,98], the consumption of meat at least once in the last seven days was a protective factor [PR=0,24; 95%CI 0,13-0,42]. The main variables associated with VAD in the country are related to structural processes of society and to the immediate, but not individual, environment of the child.
Full Text Available Apolipoprotein E (protein: apo E; gene: APOE plays an important role in the multifactorial etiology of both Alzheimer's disease (AD and lipid level concentrations. The polymerase chain reaction (PCR was used to investigate the APOE gene polymorphism in 446 unrelated Caucasians, among them 23 AD patients, and 100 Afro-Brazilians living in Porto Alegre, Brazil. The frequencies of the APOE*2, APOE*3 and APOE*4 alleles were 0.075, 0.810 and 0.115 in Caucasians and 0.075, 0.700 and 0.225 in Afro-Brazilians, respectively (c2 = 8.72, P = 0.013. A highly significant association was observed between the APOE*4 allele and AD in this population-based sample. The APOE*4 frequency in AD patients (39% was about four times higher than in the general Caucasian population (11.5%. The influence of each of the three common APOE alleles on lipid traits was evaluated by the use of the average excess statistic. The E*2 allele is associated with lower levels of triglycerides and of total and non-HDL cholesterol in both men and women. Conversely, the E*4 allele is associated with higher levels of these traits in women only. The effect of APOE alleles was of greater magnitude in women.
Fernández, María Raquel; Goettems, Marília Leão; Demarco, Flávio Fernando; Corrêa, Marcos Britto
This cross-sectional study aimed to determine the association between dental caries and weight status, and between dental caries and physical activity in Brazilian schoolchildren aged 8 to 12 years. A multi-stage sample of children enrolled in 20 private and public schools in 2010 in Pelotas, Southern Brazil, were invited to participate in the study. Socioeconomic data were collected from parents, and data regarding children characteristics were collected from children using a questionnaire and anthropometric measures. The Body Mass Index was obtained, and children were classified as overweight/obese considering age and sex. Dental examinations were performed to assess the presence of gingival inflammation, dental caries prevalence (DMFT≥1) and dental caries experience (mean DMFT). Multivariate Poisson Regression was used to assess factors associated with dental caries prevalence and experience. A total of 1,210 children were included in the study. Dental caries prevalence was 32.4% (95% CI 29.7-35.2), while the mean DMFT was 0.64 (± SD 1.00). Children who practiced less than 300 minutes per week of physical activity and overweigh/obese children had lower prevalence of dental caries, while children with obesity or overweight presented lower dental caries experience. Obesity/overweight and physical activity level presented an inverse relationship with dental caries. Longitudinal studies investigating the complexity of this relationship are required.
Borges, Camila Aparecida; Marchioni, Dirce Maria Lobo; Levy, Renata Bertazzi; Slater, Betzabeth
The present study aims to identify the dietary patterns of adolescents and associate these patterns with overweight. We analyzed food-consumption data from 6784 adolescents in the age group 10-18 years old collected in the Household Budget Survey 2008-2009. Dietary patterns were assessed through exploratory factor analysis. Logistic regression models were used in order to associate dietary patterns with overweight. Four dietary patterns were recorded: Traditional Brazilian Pattern, Snacks Pattern, Fast Food Pattern, and the Milk, Fruit and Cereal Breakfast Pattern. Results were adjusted according to the sociodemographic variables and showed that the higher the adherence to Snacks (OR: 1.50 fifth quintile vs first (95% CI: 1.13, 1.99) p linear trend patterns (OR: 1.55 fifth quintile vs first (95% CI = 1.12, 2.12) p linear trend patterns to increased overweight among adolescents. In addition, understanding adolescents' eating habits according to their dietary patterns may guide the development of healthy dietary recommendations based on the combination between food and food groups, rather than only on nutrients or nutritional adequacy. Copyright © 2018 Elsevier Ltd. All rights reserved.
European Association of Cardiovascular Imaging/Cardiovascular Imaging Department of the Brazilian Society of Cardiology recommendations for the use of cardiac imaging to assess and follow patients after heart transplantation.
Badano, Luigi P; Miglioranza, Marcelo H; Edvardsen, Thor; Colafranceschi, Alexandre Siciliano; Muraru, Denisa; Bacal, Fernando; Nieman, Koen; Zoppellaro, Giacomo; Marcondes Braga, Fabiana G; Binder, Thomas; Habib, Gilbert; Lancellotti, Patrizio
The cohort of long-term survivors of heart transplant is expanding, and the assessment of these patients requires specific knowledge of the surgical techniques employed to implant the donor heart, the physiology of the transplanted heart, complications of invasive tests routinely performed to detect graft rejection (GR), and the specific pathologies that may affect the transplanted heart. A joint EACVI/Brazilian cardiovascular imaging writing group committee has prepared these recommendations to provide a practical guide to echocardiographers involved in the follow-up of heart transplant patients and a framework for standardized and efficient use of cardiovascular imaging after heart transplant. Since the transplanted heart is smaller than the recipient's dilated heart, the former is usually located more medially in the mediastinum and tends to be rotated clockwise. Therefore, standard views with conventional two-dimensional (2D) echocardiography are often difficult to obtain generating a large variability from patient to patient. Therefore, in echocardiography laboratories equipped with three-dimensional echocardiography (3DE) scanners and specific expertise with the technique, 3DE may be a suitable alternative to conventional 2D echocardiography to assess the size and the function of cardiac chambers. 3DE measurement of left (LV) and right ventricular (RV) size and function are more accurate and reproducible than conventional 2D calculations. However, clinicians should be aware that cardiac chamber volumes obtained with 3DE cannot be compared with those obtained with 2D echocardiography. To assess cardiac chamber morphology and function during follow-up studies, it is recommended to obtain a comprehensive echocardiographic study at 6 months from the cardiac transplantation as a baseline and make a careful quantitation of cardiac chamber size, RV systolic function, both systolic and diastolic parameters of LV function, and pulmonary artery pressure. Subsequent
Godinho, Eliane-Lopes; Farias, Lucyana-Conceição; Aguiar, João-Carlos-Andrade; Martelli-Júnior, Hercílio; Bonan, Paulo-Rogério-Ferreti; Ferreira, Raquel-Conceição; De Paula, Alfredo-Maurício-Batista; Martins, Andréa-Maria-Eleutério de Barros-Lima; Guimarães, André-Luiz-Sena
We attempt to investigate a possible association between periodontal disease (PD) and mental disorders (MD) in a population of Brazilian Police. From a total study population consisting of 803 policemen, 345 police officers were obtained by a sample calculation using the finite population correction who were randomly selected in Montes Claros, Minas Gerais, Brazil. Patients who had been prescribed steroids or those diagnosed with diabetes and cardiovascular diseases were excluded from this study. The General Health Questionnaire (GHQ-12) was used to assess mental disorders. Odds ratios (ORs) for periodontal diseases severity and their respective 95% confidence intervals (CIs) were estimated. The risk of advanced scores in Clinical Attachment Level (CAL) and Community Periodontal Index (CPI) were estimated using Poisson Regression analyses. Only smoking and age were associated with severity in CAL and CPI index. No relation between MD and PD was observed even in different positions within the police department. It was not observed relation between GHQ-12 and the incidence of Periodontal Disease in a Brazilian Police population. Classical factors like age and smoking, however, were associated with CAL and CPI index higher scores in this population.
Full Text Available Schizophrenia is a severe psychotic disorder with recurrent relapse and functional impairment. It results from a poorly understood gene-environment interaction. The Taq1A polymorphism (located in the gene cluster NTAD is a likely candidate for schizophrenia. Its rs1800497 polymorphism was shown to be associated with DRD2 gene expression. Therefore the present work aims to investigate a possible association between schizophrenia and such polymorphism. The compared distribution of the alleles and genotypes of the studied polymorphism was investigated in a Brazilian sample of 235 patients and 834 controls. Genotypic frequencies were in Hardy-Weinberg equilibrium. There was a trend of allelic association between the Taq1A polymorphism (rs1800497 with schizophrenia in the studied sample. However no statistically differences were found between cases and controls when analyzed by gender or schizophrenia subtypes.
Franco, Ana L; Fernandes, Giovana; Gonçalves, Daniela A G; Bonafé, Fernanda S S; Camparis, Cinara M
To verify whether headaches (HAs) are associated with temporomandibular disorders (TMD) in young Brazilian adolescents. From a population sample, 3117 public school children (12 to 14 y) were randomly invited to participate in this study. TMD was assessed according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I, in addition to questions #3, #4, and #14 of Axis II history questionnaire. HAs were investigated with question #18 of RDC/TMD Axis II. Chronic TMD pain was considered as pain that has persisted for 6 months or more, as proposed by the International Association for the Study of Pain. The statistical analysis consisted of χ tests, odds ratio (OR), and logistic regression models, adopting a significance level of 5%. The sample included 1307 individuals (a response rate of 41.93%), and 56.8% (n=742) were girls. Overall, 330 adolescents (25.2%) were diagnosed with painful TMD and 595 (45.5%) presented with HAs. Individuals presenting with HAs were more likely to present painful TMD (OR=4.94; 95% confidence interval [CI], 3.73-6.54, P<0.001), especially combined muscle and joint painful TMD (OR=7.58; 95% CI, 4.77-12.05, P<0.001). HAs also increased the risk to a higher magnitude for chronic TMD pain (OR=6.12; 95% CI, 4.27-8.78, P<0.0001). All estimated ORs remained essentially unchanged after adjusting for sex. HAs were a potential risk factor for TMD in adolescents, and the risk was particularly higher for painful and chronic TMD. When HAs are present in young adolescents, a complete examination is strongly recommended with regard to the presence of painful TMD, and vice versa.
Ascef, Bruna de Oliveira; Haddad, João Paulo Amaral; Álvares, Juliana; Guerra, Augusto Afonso; Costa, Ediná Alves; Acurcio, Francisco de Assis; Guibu, Ione Aquemi; Costa, Karen Sarmento; Karnikowski, Margô Gomes de Oliveira; Soeiro, Orlando Mario; Leite, Silvana Nair; Silveira, Micheline Rosa
To analyze the Health-Related Quality of Life (HRQoL) of patients of the primary health care of the Brazilian Unified Health System (SUS) and its associated factors. This is a cross-sectional study with data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015). Data were collected with a questionnaire that included the EuroQol 5 Dimensions (EQ-5D) instrument. Patients from the five regions of Brazil were interviewed. Multiple linear regression was used to analyze their Health-Related Quality of Life and its associated factors. Of the total of 8,590 patients, the most frequent dimensions were pain/discomfort (50.7%) and anxiety/depression (38.8%). About 10% of the patients reported extreme problems in these dimensions. The following factors were significantly associated with a worse quality of life: being female; having arthritis, osteoarthritis, or rheumatism; cerebrovascular accident; heart disease; depression; health self-assessment as poor or very poor; drinking alcoholic beverages once or more per month; dieting to lose weight, avoiding salt consumption, and reducing fat intake. Significant association was observed between a better quality of life and: living in the North and Southeast regions of Brazil; practicing physical activities; and having a higher educational level. No association was observed with factors related to the health services. The Health-Related Quality of Life of patients was influenced by demographic and socioeconomic factors that were related to health conditions and lifestyle, being useful to guide specific actions for promoting health and the integral care to patients of the Brazilian Unified Health System.
Bruna de Oliveira Ascef
Full Text Available ABSTRACT OBJECTIVE To analyze the Health-Related Quality of Life (HRQoL of patients of the primary health care of the Brazilian Unified Health System (SUS and its associated factors. METHODS This is a cross-sectional study with data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015. Data were collected with a questionnaire that included the EuroQol 5 Dimensions (EQ-5D instrument. Patients from the five regions of Brazil were interviewed. Multiple linear regression was used to analyze their Health-Related Quality of Life and its associated factors. RESULTS Of the total of 8,590 patients, the most frequent dimensions were pain/discomfort (50.7% and anxiety/depression (38.8%. About 10% of the patients reported extreme problems in these dimensions. The following factors were significantly associated with a worse quality of life: being female; having arthritis, osteoarthritis, or rheumatism; cerebrovascular accident; heart disease; depression; health self-assessment as poor or very poor; drinking alcoholic beverages once or more per month; dieting to lose weight, avoiding salt consumption, and reducing fat intake. Significant association was observed between a better quality of life and: living in the North and Southeast regions of Brazil; practicing physical activities; and having a higher educational level. No association was observed with factors related to the health services. CONCLUSIONS The Health-Related Quality of Life of patients was influenced by demographic and socioeconomic factors that were related to health conditions and lifestyle, being useful to guide specific actions for promoting health and the integral care to patients of the Brazilian Unified Health System.
Goes, E.G.; Borges, J.C.; Covas, D.T.; Motta, I.
Transfusion-associated graft-versus-host disease (TA-GVHD) is a usually complication of transfusion of blood component containing T lymphocytes what recently has also involved immunocompetent patient. Gamma irradiation of cellular blood components has been the mainstay against TA-GVHD, nevertheless there is little information in the literature about current transfusion medicine practices regarding gamma irradiation of blood products. This work presents an overview of the Brazilian reality and suggests policies to optimize TA-GVHD prevention. (Author)
Goes, E.G.; Borges, J.C. [EE/COPPE-UFRJ (Brazil); Covas, D.T. [Faculdade deMedicina-USP-RP (Brazil); Motta, I. [Instituto Nacional do Cancer- Rio deJaneiro (Brazil)
Transfusion-associated graft-versus-host disease (TA-GVHD) is a usually complication of transfusion of blood component containing T lymphocytes what recently has also involved immunocompetent patient. Gamma irradiation of cellular blood components has been the mainstay against TA-GVHD, nevertheless there is little information in the literature about current transfusion medicine practices regarding gamma irradiation of blood products. This work presents an overview of the Brazilian reality and suggests policies to optimize TA-GVHD prevention. (Author)
Rita de Cassia de Souza-Lima
Full Text Available Introduction Chagas disease is considered as emerging in the Brazilian Amazon, usually occurring in acute outbreaks. Methods We describe 17 cases of acute Chagas disease in Rio Negro, Amazonas. Results There were 15 males (average age, 31.3 years, all positive for Trypanosoma cruzi in fresh blood smear examination, and 14 positive by xenodiagnosis and PCR. The top clinical manifestations were fever, asthenia, abdominal pain, and palpitations. Electrocardiograms featured low-voltage QRS, anterosuperior divisional block, and right bundle branch block associated with anterosuperior divisional block. Conclusions All patients had consumed açaí products from Monte Alegre in the rural area around Santa Izabel do Rio Negro, Brazil.
Danielle Fernandes Durso
Full Text Available The Brazilian population was formed by extensive admixture of three different ancestral roots: Amerindians, Europeans and Africans. Our previous work has shown that at an individual level, ancestry, as estimated using molecular markers, was a poor predictor of color in Brazilians. We now investigate if SNPs known to be associated with human skin pigmentation can be used to predict color in Brazilians. For that, we studied the association of fifteen SNPs, previously known to be linked with skin color, in 243 unrelated Brazilian individuals self-identified as White, Browns or Blacks from Rio de Janeiro and 212 unrelated Brazilian individuals self-identified as White or Blacks from São Paulo. The significance of association of SNP genotypes with self-assessed color was evaluated using partial regression analysis. After controlling for ancestry estimates as covariates, only four SNPs remained significantly associated with skin pigmentation: rs1426654 and rs2555364 within SLC24A5, rs16891982 at SLC45A2 and rs1042602 at TYR. These loci are known to be involved in melanin synthesis or transport of melanosomes. We found that neither genotypes of these SNPs, nor their combination with biogeographical ancestry in principal component analysis, could predict self-assessed color in Brazilians at an individual level. However, significant correlations did emerge at group level, demonstrating that even though elements other than skin, eye and hair pigmentation do influence self-assessed color in Brazilians, the sociological act of self-classification is still substantially dependent of genotype at these four SNPs.
Mattos, Maria Cláudia Tavares de; Campos, Maria Pontes de Aguiar
This is a contribution for the history of nursing from Sergipe and, as a consequence, for the Brazilian Nursing. It aims at rescuing the Brazilian Nursing Association, Sergipe's Section history and to document the accomplishment of this entity into the scientific, cultural and political scenery. A qualitative research, whose data were collected by means of oral and official history registered on books, journals, and other documents. Data were submitted to content analysis. That history is presented by some characters from this plot, indicating that present may be an answer from the past because it contains the writing of the history founded by its actor's will. It was concluded that rethinking Brazilian Nursing Association, Sergipe's Section history is rethinking our own capability of interaction with the category.
Marco Antonio Araujo Leite
Full Text Available Myocardial scintigraphy with meta-iodo-benzyl-guanidine (123I cMIBG has been studied in Parkinson's disease (PD, especially in Asian countries, but not in Latin America. Most of these studies include individuals with PD associated to a defined dysautonomia. Our goal is to report the cardiac sympathetic neurotransmission in de novo Brazilian patients with sporadic PD, without clinically defined dysautonomia. We evaluated retrospectively a series of 21 consecutive cases with PD without symptoms or signs of dysautonomia assessed by the standard bedside tests. This number was reduced to 14 with the application of exclusion criteria. 123I cMIBG SPECT up-take was low or absent in all of them and the heart/mediastinum ratio was low in 12 of 14. We concluded that 123I cMIBG has been able to identify cardiac sympathetic neurotransmission disorder in Brazilian de novo PD patients without clinically defined dysautonomia.
Octávio Marques Pontes-Neto
Full Text Available ABSTRACT These guidelines are the result of a joint effort from writing groups of the Brazilian Stroke Society, the Scientific Department of Cerebrovascular Diseases of the Brazilian Academy of Neurology, the Brazilian Stroke Network and the Brazilian Society of Diagnostic and Therapeutic Neuroradiology. Members from these groups participated in web-based discussion forums with predefined themes, followed by videoconference meetings in which controversies and position statements were discussed, leading to a consensus. This guidelines focuses on the implications of the recent clinical trials on endovascular therapy for acute ischemic stroke due to proximal arterial occlusions, and the final text aims to guide health care providers, health care managers and public health authorities in managing patients with this condition in Brazil.
da Silva Kotze, Lorete Maria; Nisihara, Renato Mitsunori; da Rosa Utiyama, Shirley Ramos; Piovezan, Gislaine Custodio; Kotze, Luiz Roberto
Patients with celiac disease (CD) can develop a gluten related autoimmune disorder that affects not only the small intestine but other tissues as well. An increased prevalence of autoimmune diseases has been reported, particularly autoimmune thyroiditis. The aim of this study was to characterize thyroid disorders in patients with CD. Fifty-two patients with CD (43 female, 9 male; mean age, 41.1 years) were studied. Nine were on a gluten-free diet (GFD). They were divided into four groups: Group 1, without thyroid involvement (n=30); Groups 2A-C, with thyroid involvement (n=22); Group 2A, subclinical hypothyroidism (n=11); Group 2B, clinical hypothyroidism (n=10); and Group 2C, other thyroid disorders (n=1). CD was confirmed by serologic and histologic criteria. Thyroid involvement was detected by measurement of thyroid stimulating hormone (TSH) and anti-thyroperoxidase antibodies (anti-TPO). Increased levels of TSH and/or anti-TPO levels were detected in Groups 2A (21.1%) and 2B (19.2%). The patients of Group 2B presented clinical symptoms of hypothyroidism before the diagnosis of CD, and 5 of these patients were receiving levothyroxine. One woman (Group 2C; 1.92%) had a medullary carcinoma. There was statistical significance between the age when thyroid disease was diagnosed (current age) and the age of CD diagnosis between Groups 1 and 2B. Patients with thyroid involvement presented associated diseases such as diabetes mellitus (2), Down's syndrome (2), ulcerative colitis (1), and dermatitis herpetiformis (2). Our findings demonstrated an increased prevalence of thyroid disorders (hypothyroidism, 19.2%; and subclinical hypothyroidism, 21.2%), and other associated diseases in celiac patients, even on a GFD, increasing with the age of the patients. Screening for associated diseases is recommended for patients with CD, independent of age at diagnosis or treatment duration.
Mourão, Aline Mansueto; Gomez, Rodrigo Santiago; Barbosa, Luiz Sergio Mageste; Freitas, Denise da Silva; Comini-Frota, Elizabeth Regina; Kummer, Arthur; Lemos, Stella Maris Aguiar; Teixeira, Antonio Lucio
The aims of the current study were 1) to evaluate the reliability and validity of the Brazilian version of the 15-item Myasthenia Gravis Quality of Life Scale and 2) to investigate the quality of life of Brazilian patients with myasthenia gravis and its determinants. This cross-sectional study included 69 patients with myasthenia gravis who underwent neurological evaluation and completed questionnaires regarding quality of life (the 36-item Short Form of the Medical Outcomes Study and the 15-item Myasthenia Gravis Quality of Life Scale), anxiety and depressive symptoms. The Brazilian version of the 15-item Myasthenia Gravis Quality of Life Scale showed high internal consistency and good concurrent validity with the 36-item Short Form of the Medical Outcomes Study and its subscales. Determinants of quality of life in Brazilian patients with myasthenia gravis included the current status of myasthenia gravis as assessed by the Myasthenia Gravis Composite, the current prednisone dose and the levels of anxiety and depression. The Brazilian version of the 15-item Myasthenia Gravis Quality of Life Scale is a valid instrument. Symptom severity, prednisone dosage and anxiety and depression levels impact the quality of life of patients with myasthenia gravis.
Szuster, Daniele Araújo Campos; Caiaffa, Waleska Teixeira; Andrade, Eli Iola Gurgel; Acurcio, Francisco de Assis; Cherchiglia, Mariangela Leal
The aim of this study was to analyze the survival of patients who initiated renal replacement therapy (RRT) with hemodialysis or peritoneal dialysis in the Brazilian Unified National Health System from 2002 to 2004. This was an observational, prospective, non-concurrent study. The study used the National Database for Renal Replacement Therapies resulting from probabilistic matching of Authorization of High-Complexity Procedures/Outpatient Information System and the Mortality Information System. The study included patients admitted in 2002 and 2003, with 3 months of treatment, and 18 years or older. Of the 31,298 patients, the majority: began RRT with hemodialysis, were male, with mean age 54 years, and living in the Southeast region and in municipalities with a mean HDI of 0.78. Increased risk of death was associated with: female gender, age greater than 55 years, diagnosis of diabetes mellitus, peritoneal dialysis, and not residing in the Southeast region. Residing in cities with higher HDI was associated with lower risk. Adjusted risk was HR = 1.17 in favor of hemodialysis. The results suggest shorter survival for peritoneal dialysis and older patients. It is thus necessary to support policies to better evaluate the RRT modality with studies that further elucidate the findings.
Andrade, Luiz Eduardo Lima; Lopes, Johnnatas Mikael; Souza, Marlon César Melo; Vieira, Romero Fonseca; Farias, Luiz Paulo Costa; Santos, Carla Caroline Medeiros Dos; Gama, Zenewton André da Silva
The scope of the study was to evaluate patient safety culture and associated factors in Brazilian hospitals with different types of management, namely federal, state and private hospitals. The design was cross-sectional and observational. A survey of 1576 professionals at three hospitals of Rio Grande do Norte state was performed using the Hospital Survey on Patient Safety Culture adapted for Brazil, which measures 12 dimensions of safety culture. Perceptions are described by attributing a general result (Range 0-10) and the percentage of positive responses to estimate their strengths and weaknesses. The response rate was 13.6% (n= 215). The patient safety coefficient was between 7 and 10 for 78.1% of the respondents, whereby the highest average grade was attributed to the private hospital (8.32). It has been estimated that the type of hospital management, unit service, position and number of adverse event notifications are associated with the overall patient safety grade (p <0.001). Only the private hospital had strengths in the dimensions analyzed, while the weaknesses appeared in all the hospitals.
Full Text Available Abstract: INTRODUCTION Recent studies have shown a high incidence and prevalence of latent tuberculosis infection (LTBI in indigenous populations around the World. We aimed to estimate the prevalence and annual risk of infection (ARI as well as to identify factors associated with LTBI in an indigenous population from the Brazilian Amazon. METHODS We conducted a cross-sectional study in 2011. We performed tuberculin skin tests (TSTs, smears and cultures of sputum samples, and chest radiographs for individuals who reported cough for two or more weeks. Associations between LTBI (TST ≥5mm and socio-demographic, clinical, and epidemiological characteristics were investigated using Poisson regression with robust variance. Prevalence ratio (PR was used as the measure of association. RESULTS We examined 263 individuals. The prevalence of LTBI was 40.3%, and the ARI was 2.4%. Age ≥15 years [PR=5.5; 95% confidence interval (CI: 3.5-8.6], contact with tuberculosis (TB patients (PR=3.8; 95% CI: 1.2-11.9, previous TB history (PR=1.4; 95% CI: 1.2-1.7, and presence of Bacillus Calmette-Guérin (BCG scar (PR=1.9, 95% CI: 1.2-2.9 were associated with LTBI. CONCLUSIONS Although some adults may have been infected years prior, the high prevalence of infection and its strong association with age ≥15 years, history of TB, and recent contact with TB patients suggest that the TB transmission risk is high in the study area.
Zhao, Liting; Pu, Lingling; Wei, Jingyu; Li, Jinghua; Wu, Jianquan; Xin, Zhonghao; Gao, Weina; Guo, Changjiang
Propolis contains a variety of bioactive components and possesses many biological properties. This study was designed to evaluate potential effects of Brazilian green propolis on glucose metabolism and antioxidant function in patients with type 2 diabetes mellitus (T2DM). In the 18-week randomized controlled study, enrolled patients with T2DM were randomly assigned to Brazilian green propolis group (900 mg/day) (n = 32) and control group (n = 33). At the end of the study, no significant difference was found in serum glucose, glycosylated hemoglobin, insulin, aldose reductase or adiponectin between the two groups. However, serum GSH and total polyphenols were significantly increased, and serum carbonyls and lactate dehydrogenase activity were significantly reduced in the Brazilian green propolis group. Serum TNF-α was significantly decreased, whereas serum IL-1β and IL-6 were significantly increased in the Brazilian green propolis group. It is concluded that Brazilian green propolis is effective in improving antioxidant function in T2DM patients.
Paulo Lisboa Bittencourt
Full Text Available ABSTRACT Survival rates of critically ill patients with liver disease has sharply increased in recent years due to several improvements in the management of decompensated cirrhosis and acute liver failure. This is ascribed to the incorporation of evidence-based strategies from clinical trials aiming to reduce mortality. In order to discuss the cutting-edge evidence regarding critical care of patients with liver disease, a joint single topic conference was recently sponsored by the Brazilian Society of Hepatology in cooperation with the Brazilian Society of Intensive Care Medicine and the Brazilian Association for Organ Transplantation. This paper summarizes the proceedings of the aforementioned meeting and it is intended to guide intensive care physicians, gastroenterologists and hepatologists in the care management of patients with liver disease.
Rodrigues, Dalva N; Siqueira, Lucia H; Galizoni, Andréa M; Arruda, Valder R; Annichino-Bizzacchi, Joyce M
The prevalence of factor VII (FVII) deficiency in 267 Brazilian patients was estimated to be 4.1%, including one patient with significant bleeding, five with minor bleeding and five patients asymptomatic. Only one novel mutation 8926G F7 polymorphisms and FVII activity were found in these patients, as those with higher levels of FVII activity presented the genotype described in the literature as related to reduced FVII activity. As the R304Q mutation was the most frequent in these patients, and may be associated with an asymptomatic form of the disease, particularly in Blacks, we examined this mutation and FVII activity in 49 Blacks and 49 Caucasian blood donors with no clinical bleeding. None of the individuals showed the R304Q mutation, and FVII activity was normal in all of them, thus indicating that FVII deficiency is not common in normal individuals of these two ethnic groups in Brazil. This is the first study in South America to examine the prevalence and molecular basis of FVII deficiency, including the description of a novel mutation.
Guerra, Jorge Augusto O.; Coelho, Leíla I. R. C.; Pereira, Flávio R.; Siqueira, André M.; Ribeiro, Rogério L.; Almeida, Thiago Miranda L.; Lacerda, Marcus Vinícius G.; Barbosa, Maria das Graças V.; Talhari, Sinésio
American tegumentary leishmaniasis (ATL) and human immunodeficiency virus (HIV) are both common infectious diseases in the Brazilian Amazon with overlapping expansion areas, which leads to the occurrence of Leishmania/HIV coinfection. Most ATL/HIV–acquired immunodeficiency syndrome (AIDS) association cases have been reported from areas where Leishmania (Viannia) braziliensis is the main pathogen; this finding is in contrast with the Amazon region, where L. (V.) guyanensis is the most implicated agent, implying distinct clinical and therapeutic aspects. We describe 15 cases of ATL/HIV coinfection treated in a tertiary care center in the Brazilian Amazon between 1999 and 2008. Thirteen patients presented with diverse clinical manifestations of cutaneous leishmaniasis, and four of them had disseminated forms; two patients presented with mucosal leishmaniasis (ML). Seven patients required more than one course of treatment. The particularities of ATL/HIV-AIDS association in L. (V.) guyanensis-endemic areas require efforts for an increased understanding of its burden and subsequent improvements in case management. PMID:21896816
Mendes, Aline; Pereira, Jaqueline Lopes; Fisberg, Regina Mara; Marchioni, Dirce Maria Lobo
Cross-sectional and longitudinal studies present association of low dietary energy density with higher intake of vitamins, minerals and dietary fiber, lower intake of fat, and better balance of macronutrients. The objective of this study was to verify the relationship between dietary energy density and diet quality measured by an index of diet quality. This study used data from 496 adults and 445 older adults of cross-sectional population-based survey from São Paulo conducted in 2008-2009, Brazil. Dietary intake data was assessed by two 24-h dietary recalls. Dietary energy density values were calculated based on foods only method. Dietary energy density and revised Brazilian Health Eating Index and its components, were estimated by usual intake using Multiple Source Method. The relationship between dietary energy density and the total revised Brazilian Health Eating Index and its components were assessed by Gaussian family log-link model for each age group. The analyses showed an inverse association between dietary energy density and total revised Brazilian Health Eating Index in adults (T2:β = 0.96, p energy density and nine of twelve revised Brazilian Health Eating Index components in adult and/or older adults groups. Dietary energy density was associated with diet quality in Brazilian adults and older adults regardless of sex, per capita household income, body mass index, physical activity level, current smoking habits status, alcohol beverage drinking status and usual energy intake (kilocalories) from beverages. Copyright © 2015 Elsevier Ltd. All rights reserved.
Michelle Nigri Levitan
Full Text Available Objective: To present the most relevant findings regarding the Brazilian Medical Association guidelines for the diagnosis and differential diagnosis of panic disorder. Methods: We used the methodology proposed by the Brazilian Medical Association for the Diretrizes Project. The MEDLINE (PubMed, Scopus, Web of Science, and LILACS online databases were queried for articles published from 1980 to 2012. Searchable questions were structured using the PICO format (acronym for “patient” [or population], “intervention” [or exposure], “comparison” [or control], and “outcome”. Results: We present data on clinical manifestations and implications of panic disorder and its association with depression, drug abuse, dependence and anxiety disorders. In addition, discussions were held on the main psychiatric and clinical differential diagnoses. Conclusions: The guidelines are proposed to serve as a reference for the general practitioner and specialist to assist in and facilitate the diagnosis of panic disorder.
Silvia Marinho Ferolla
Full Text Available OBJECTIVE: Recent evidence suggests that non-alcoholic fatty liver disease is associated with diet. Our aim was to investigate the dietary patterns of a Brazilian population with this condition and compare them with the recommended diet. METHODS: A cross-sectional study was conducted on 96 non-alcoholic fatty liver disease patients before any dietetic counseling. All patients underwent abdominal ultrasound, biochemical tests, dietary evaluations, and anthropometric evaluations. Their food intake was assessed by a semi-quantitative food-frequency questionnaire and 24-hour food recall. RESULTS: The median patient age was 53 years, and 77% of the individuals were women. Most (67.7% participants were obese, and a large waist circumference was observed in 80.2% subjects. Almost 70% of the participants had metabolic syndrome, and 62.3% presented evidence of either insulin resistance or overt diabetes. Most patients (51.5, 58.5, and 61.7%, respectively exceeded the recommendations for energy intake, as well as total and saturated fat. All patients consumed less than the amount of recommended monounsaturated fatty acids, and 52.1 and 76.6% of them consumed less polyunsaturated fatty acids and fiber, respectively, than recommended. In most patients, the calcium, sodium, potassium, pyridoxine, and vitamin C intake did not meet the recommendations, and in 10.5-15.5% of individuals, the tolerable upper limit intake for sodium was exceeded. The patients presented a significantly high intake of meats, fats, sugars, legumes (beans, and vegetables and a low consumption of cereals, fruits, and dairy products compared with the recommendations. CONCLUSIONS: Although patients with non-alcoholic fatty liver disease exhibited high energy and lipid consumption, most of them had inadequate intake of some micronutrients. The possible role of nutrient-deficient intake in the development of non-alcoholic fatty liver disease warrants investigation.
Barbosa, Flávia Regina; Matsuda, Josie Budag; Mazucato, Mendelson; de Castro França, Suzelei; Zingaretti, Sônia Marli; da Silva, Lucienir Maria; Martinez-Rossi, Nilce Maria; Júnior, Milton Faria; Marins, Mozart; Fachin, Ana Lúcia
Fibromyalgia syndrome (FS) is a rheumatic syndrome affecting to 2-3% of individuals of productive age, mainly women. Neuroendocrine and genetic factors may play a significant role in development of the disease which is characterized by diffuse chronic pain and presence of tender points. Several studies have suggested an association between FS, especially pain sensitivity, and polymorphism of the catechol-O-methyltransferase (COMT) gene. The aim of the present study was to characterize the SNPs rs4680 and rs4818 of the COMT gene and assess its influence in pain sensitivity of patients with fibromyalgia screened by the Fibromyalgia Impact Questionnaire (FIQ). DNA was extracted from peripheral blood of 112 patients with fibromyalgia and 110 healthy individuals and was used as template in PCR for amplification of a 185-bp fragment of the COMT gene. The amplified fragment was sequenced for analyses of the SNPs rs4680 and rs4818. The frequency of mutant genotype AA of SNP rs6860 was 77.67% in patients with FS and 28.18% for the control group. For the SNP rs4818, the frequency of mutant genotype CC was 73.21 and 39.09% for patients with FS and controls, respectively. Moreover, the FIQ score was higher in patients with the homozygous mutant genotype for SNPs rs4680 (87.92 points) and rs4818 (86.14 points). These results suggest that SNPs rs4680 and rs4818 of the COMT gene may be associated with fibromyalgia and pain sensitivity in FS Brazilian patients.
Sauer Liberato, Ana Carolina; Cunha Matheus Rodrigues, Roberta; Kim, MyoungJin; Mallory, Caroline
This study examined the reliability and validity of the Brazilian Portuguese version of the Treatment Satisfaction Questionnaire for Medication (version 1.4) among patients with hypertension. Understanding the patient experience with treatment satisfaction will contribute to improved medication adherence and control of hypertension. Hypertension is a serious problem in Brazil that is associated with chronic illness controlled, in part, by consistent adherence to medications. Patient satisfaction with medication treatment is associated with adherence to medication. The Treatment Satisfaction Questionnaire for Medication (version 1.4) is a promising instrument for measuring medication; however, to date there has been no report of the reliability and validity of the instrument with Portuguese-speaking adults with hypertension in Brazil. Cross-sectional descriptive exploratory study. A convenience sample of 300 patients with hypertension in an outpatient setting in the southeast region of São Paulo state in Brazil completed the Treatment Satisfaction Questionnaire for Medication (version 1.4). The instrument, comprised of four subscales, was evaluated for reliability using correlation analyses and internal consistency. Confirmatory factor analysis was used to determine factorial validity. Correlational analyses, internal consistency (Cronbach's alpha) and hierarchical confirmatory factor analysis demonstrate adequate support for the four-factor dimensionality, reliability and factorial validity of the Treatment Satisfaction Questionnaire for Medication (version 1.4). This study provides modest evidence for internal consistency and factorial validity of the Treatment Satisfaction Questionnaire for Medication (version 1.4) in Portuguese-speaking adult Brazilians with hypertension. Future testing should focus on extending reliability testing, discriminant validity and potential translation and literacy issues in this population. Within known limitations, clinicians will
Tiago Ricardo Moreira
Full Text Available ABSTRACT OBJECTIVE To examine whether the level of complexity of the services structure and sociodemographic and clinical characteristics of patients in hemodialysis are associated with the prevalence of poor health self-assessment. METHODS In this cross-sectional study, we evaluated 1,621 patients with chronic terminal kidney disease on hemodialysis accompanied in 81 dialysis services in the Brazilian Unified Health System in 2007. Sampling was performed by conglomerate in two stages and a structured questionnaire was applied to participants. Multilevel multiple logistic regression was used for data analysis. RESULTS The prevalence of poor health self-assessment was of 54.5%, and in multivariable analysis it was associated with the following variables: increasing age (OR = 1.02; 95%CI 1.01–1.02, separated or divorced marital status (OR = 0.62; 95%CI 0.34–0.88, having 12 years or more of study (OR = 0.51; 95%CI 0.37–0.71, spending more than 60 minutes in commuting between home and the dialysis service (OR = 1.80; 95%CI 1.29–2.51, having three or more self-referred diseases (OR = 2.20; 95%CI 1.33–3.62, and reporting some (OR = 2.17; 95%CI 1.66–2.84 or a lot of (OR = 2.74; 95%CI 2.04–3.68 trouble falling asleep. Individuals in treatment in dialysis services with the highest level of complexity in the structure presented less chance of performing a self-assessment of their health as bad (OR = 0.59; 95%CI 0.42–0.84. CONCLUSIONS We showed poor health self-assessment is associated with age, years of formal education, marital status, home commuting time to the dialysis service, number of self-referred diseases, report of trouble sleeping, and also with the level of complexity of the structure of health services. Acknowledging these factors can contribute to the development of strategies to improve the health of patients in hemodialysis in the Brazilian Unified Health System.
Moreira, Tiago Ricardo; Giatti, Luana; Cesar, Cibele Comini; Andrade, Eli Iola Gurgel; Acurcio, Francisco de Assis; Cherchiglia, Mariângela Leal
ABSTRACT OBJECTIVE To examine whether the level of complexity of the services structure and sociodemographic and clinical characteristics of patients in hemodialysis are associated with the prevalence of poor health self-assessment. METHODS In this cross-sectional study, we evaluated 1,621 patients with chronic terminal kidney disease on hemodialysis accompanied in 81 dialysis services in the Brazilian Unified Health System in 2007. Sampling was performed by conglomerate in two stages and a structured questionnaire was applied to participants. Multilevel multiple logistic regression was used for data analysis. RESULTS The prevalence of poor health self-assessment was of 54.5%, and in multivariable analysis it was associated with the following variables: increasing age (OR = 1.02; 95%CI 1.01–1.02), separated or divorced marital status (OR = 0.62; 95%CI 0.34–0.88), having 12 years or more of study (OR = 0.51; 95%CI 0.37–0.71), spending more than 60 minutes in commuting between home and the dialysis service (OR = 1.80; 95%CI 1.29–2.51), having three or more self-referred diseases (OR = 2.20; 95%CI 1.33–3.62), and reporting some (OR = 2.17; 95%CI 1.66–2.84) or a lot of (OR = 2.74; 95%CI 2.04–3.68) trouble falling asleep. Individuals in treatment in dialysis services with the highest level of complexity in the structure presented less chance of performing a self-assessment of their health as bad (OR = 0.59; 95%CI 0.42–0.84). CONCLUSIONS We showed poor health self-assessment is associated with age, years of formal education, marital status, home commuting time to the dialysis service, number of self-referred diseases, report of trouble sleeping, and also with the level of complexity of the structure of health services. Acknowledging these factors can contribute to the development of strategies to improve the health of patients in hemodialysis in the Brazilian Unified Health System. PMID:27143610
Paula Bruna Araujo
Full Text Available Aryl hydrocarbon receptor-interacting protein (AIP gene mutations (AIPmut are the most frequent germline mutations found in apparently sporadic pituitary adenomas (SPA. Our aim was to evaluate the frequency of AIPmut among young Brazilian patients with SPA. We performed an observational cohort study between 2013 and 2016 in a single referral center. AIPmut screening was carried out in 132 SPA patients with macroadenomas diagnosed up to 40 years or in adenomas of any size diagnosed until 18 years of age. Twelve tumor samples were also analyzed. Leukocyte DNA and tumor tissue DNA were sequenced for the entire AIP-coding region for evaluation of mutations. Eleven (8.3% of the 132 patients had AIPmut, comprising 9/74 (12% somatotropinomas, 1/38 (2.6% prolactinoma, 1/10 (10% corticotropinoma and no non-functioning adenomas. In pediatric patients (≤18 years, AIPmut frequency was 13.3% (2/15. Out of the 5 patients with gigantism, two had AIPmut, both truncating mutations. The Y268* mutation was described in Brazilian patients and the K273Rfs*30 mutation is a novel mutation in our patient. No somatic AIP mutations were found in the 12 tumor samples. A tumor sample from an acromegaly patient harboring the A299V AIPmut showed loss of heterozygosity. In conclusion, AIPmut frequency in SPA Brazilian patients is similar to other populations. Our study identified two mutations exclusively found in Brazilians and also shows, for the first time, loss of heterozygosity in tumor DNA from an acromegaly patient harboring the A299V AIPmut. Our findings corroborate previous observations that AIPmut screening should be performed in young patients with SPA.
Full Text Available Apolipoprotein E (apoE - e2, e3, e4 alleles plays a role in the regulation of lipid metabolism, with the e4 considered to be a risk factor for coronary artery disease (CAD. We aimed to evaluate the apoE polymorphisms in Brazilians with CAD and their influence on the lipid profile and other risk factors (hypertension, diabetes mellitus, smoking. Two hundred individuals were examined: 100 patients with atherosclerosis confirmed by coronary angiography and 100 controls. Blood samples were drawn to determine apoE polymorphisms and lipid profile. As expected, the e3 allele was prevalent in the CAD (0.87 and non-CAD groups (0.81; P = 0.099, followed by the e4 allele (0.09 and 0.14, respectively; P = 0.158. The e3/3 (76 and 78% and e3/4 (16 and 23% were the most common genotypes for patients and controls, respectively. The lipid profile was altered in patients compared to controls (P < 0.05, independently of the e4 allele. However, in the controls this allele was prevalent in individuals with elevated LDL-cholesterol levels only (odds ratio = 2.531; 95% CI = 1.028-6.232. The frequency of risk factors was higher in the CAD group (P < 0.05, but their association with the lipid profile was not demonstrable in e4 carriers. In conclusion, the e4 allele is not associated with CAD or lipid profile in patients with atherosclerosis. However, its frequency in the non-CAD group is associated with increased levels of LDL-cholesterol, suggesting an independent effect of the e4 allele on lipid profile when the low frequency of other risk factors in this group is taken into account.
Natalia Pereira Machado
Full Text Available ABSTRACT Objectives: Innate immunity is involved in the physiopathology of ankylosing spondylitis (AS, with the participation of Gram-negative bacteria, modulation of human leukocyte antigen (HLA B27 and the involvement of pattern recognition receptors, such as Toll-like receptors (TLRs. The aim of this study was to investigate the clinical characteristics and frequency of TLR4 polymorphisms (Asp299Gly and Thr 399Ile in a cohort of Brazilian patients with AS. Methods: A cross-sectional study was carried out involving 200 patients with a diagnosis of AS and a healthy control group of 200 individuals. Disease activity, severity and functional capacity were measured. The study of TLR4 polymorphisms was performed using the restriction fragment length polymorphism method. HLA-B27 was analyzed by conventional polymerase chain reaction. The IBM SPSS Statistics 20 program was used for the statistical analysis, with p-values less than 0.05 considered significant. Results: Mean age and disease duration were 43.1 ± 12.7 and 16.6 ± 9.2 years, respectively. The sample was predominantly male (71% and non-Caucasian (52%. A total of 66% of the group of patients were positive for HLA-B27. The sample of patients was characterized by moderate functional impairment and a high degree of disease activity. No significant association was found between the two TLR4 polymorphisms and susceptibility to AS. Conclusions: TLR4 polymorphisms 399 and 299 were not more frequent in patients with AS in comparison to the health controls and none of the clinical variables were associated with these polymorphisms.
Igor Suzano Machado
Full Text Available This study aims to analyze the performance of a specific group among the legitimate to mobilize the judicial review: the class associations. In addition to belong to civil society, the professional associations also show themselves interesting as they involve groups with potentially opposing interests, as entrepreneurs and workers. Then, the intention is to study their performance regarding the use of ADPFs - Pleas of violation of constitutional fundamental statements - that are a mean of judicial review against laws which violate the Constitution in what such associations regard as its most important dictates.
Ribas, Marcelo Romanovitch; Oliveira Netto, Zair Candido; Salgueirosa, Fabiano; Fernandes, Priscila; Matos, Oslei de; Bassan, Julio Cesar
ABSTRACT Introduction: By associating genetics and sport, it is possible to identify subjects with greater capacity to adapt to training, and lower chances of injury. Objective: The investigation evaluated the genotypic and allelic distribution of ACTN3 R577X and ACE I/D polymorphisms in Brazilian high-performance athletes in wrestling and percussion combat sports. Methods: The study included 37 male athletes ranked from first to third place in world scenarios, divided into two groups: wrestl...
Reis Alessandra Diehl
Full Text Available OBJECTIVE: Although there is a considerable amount of data in the literature regarding the association between alcohol consumption and injuries treated in emergency rooms, little is known about the relationship between such injury and the use of other substances. The objective of this study was to estimate the prevalence of substance use in patients admitted to the emergency room for non-fatal injuries. METHOD: A prospective cross-sectional study assessing all patients admitted to the emergency room within 6 hours after a non-fatal injury was conducted over a three-month period. The following were used as measures of alcohol and drug use: a standardized World Health Organization questionnaire; a self-administered questionnaire related to drug consumption within the 24 hours preceding contact; the Drug Abuse Screening Test; urine screens for cannabis, cocaine and benzodiazepines; and determination of blood alcohol concentration. Descriptive analyses were performed and the confidence interval used was 95%. RESULTS: A total of 353 patients were included. Cannabis and cocaine screens were conducted for 242 patients and benzodiazepine screens were conducted for 166. Blood alcohol concentrations reached the level of positivity in 11% (n = 39, and 10% (n = 33 presented some degree of intoxication. Among the 242 patients screened, 13.6% (n = 33 tested positive for cannabis, and 3.3% (n = 8 tested positive for cocaine, whereas 4.2% (n = 7 of the 166 patients screened tested positive for benzodiazepines. CONCLUSIONS: Substance use was highly prevalent among these individuals. In this sample, the frequency for the use of cannabis (an illicit drug was comparable to that of alcohol. More studies are needed in order to characterize such use among Brazilians and to develop proper approaches to such cases, with the aim of reducing substance use and its consequences.
da Silva, Daniela Wosiack; de Andrade, Selma Maffei; Soares, Dorotéia Fátima Pelissari de Paula; Mathias, Thais Aidar de Freitas; Matsuo, Tiemi; de Souza, Regina Kazue Tanno
The objective of the study was to identify factors associated with reports of road accidents, among motorcycle couriers in two medium-sized municipalities in southern Brazil. A self-administered questionnaire was answered by motorcycle couriers that had worked for at least 12 months in this profession. The outcomes analyzed were reports on accidents and serious accidents over the 12 months prior to the survey. Bivariate and multivariate analyses by means of logistic regression were carried out to investigate factors that were independently associated with the outcomes. Seven hundred and fifty motorcycle couriers, of mean age 29.5 years (standard deviation = 8.1 ), were included in the study. Young age (18 to 24 years compared to ≥ 25 years, odds ratio [OR] = 1.77) speeding (OR = 1.48), and use of cell phones while driving (OR = 1.43) were factors independently associated with reports of accidents. For serious accidents, there was an association with alternation of work shifts (OR = 1.91) and speeding (OR = 1.67). The characteristics associated with accidents-personal (young age), behavioral (use of cell phones while driving and speeding), and professional (speeding and alternation of work shifts)-reveal the need to adopt wide-ranging strategies to reduce these accidents, including better work conditions for these motorcyclists.
Fuly, Patrícia Dos Santos Claro; Leite, Joséte Luzia; Lima, Suzinara Beatriz Soares
This study is a research that has as objective analyze the bibliographical production about the Systematization of Nursing Care in order to discuss concepts associated to the subject. Were analyzed books and national articles published in the database of the Virtual Library in Health, Medline, Lilacs and Scielo, in the period of January of 2000 to January of 2008. Were analyzed 11 articles, having been identified three distinct kind of thought to define concepts associated to Systematization of Nursing Care. Such fact aims for the difficulty of theoretical and pratical articulation, evidenced by the conflicts existing in the literature.
Metsavaht, Leonardo; Leporace, Gustavo; Riberto, Marcelo; Sposito, Maria Matilde M; Del Castillo, Letícia N C; Oliveira, Liszt P; Batista, Luiz Alberto
Clinical measurement. To translate and culturally adapt the Lower Extremity Functional Scale (LEFS) into a Brazilian Portuguese version, and to test the construct and content validity and reliability of this version in patients with knee injuries. There is no Brazilian Portuguese version of an instrument to assess the function of the lower extremity after orthopaedic injury. The translation of the original English version of the LEFS into a Brazilian Portuguese version was accomplished using standard guidelines and tested in 31 patients with knee injuries. Subsequently, 87 patients with a variety of knee disorders completed the Brazilian Portuguese LEFS, the Medical Outcomes Study 36-Item Short-Form Health Survey, the Western Ontario and McMaster Universities Osteoarthritis Index, and the International Knee Documentation Committee Subjective Knee Evaluation Form and a visual analog scale for pain. All patients were retested within 2 days to determine reliability of these measures. Validation was assessed by determining the level of association between the Brazilian Portuguese LEFS and the other outcome measures. Reliability was documented by calculating internal consistency, test-retest reliability, and standard error of measurement. The Brazilian Portuguese LEFS had a high level of association with the physical component of the Medical Outcomes Study 36-Item Short-Form Health Survey (r = 0.82), the Western Ontario and McMaster Universities Osteoarthritis Index (r = 0.87), the International Knee Documentation Committee Subjective Knee Evaluation Form (r = 0.82), and the pain visual analog scale (r = -0.60) (all, PPortuguese LEFS had a low level of association with the mental component of the Medical Outcomes Study 36-Item Short-Form Health Survey (r = 0.38, PPortuguese version of the LEFS were high. The standard error of measurement was low (3.6) and the agreement was considered high, demonstrated by the small differences between test and retest and the narrow
Cardoso, C.R.L.; Salles, G.F.
Increased proteinuria is recognized as a risk predictor for all-cause and cardiovascular mortality in diabetic patients; however, no study has evaluated these relationships in Brazilian patients. The aim of this study was to investigate the prognostic value of gross proteinuria for all-cause and cardiovascular mortalities and for cardiovascular morbidity in a cohort study of 471 type 2 diabetic individuals followed for up to 7 years. Several clinical, laboratory and electrocardiographic varia...
Azevedo-Santos, Isabela Freire; Alves, Iura Gonzalez Nogueira; Cerqueira Neto, Manoel Luiz de; Badauê-Passos, Daniel; Santana-Filho, Valter Joviniano; Santana, Josimari Melo de
The Behavioral Pain Scale is a pain assessment tool for uncommunicative and sedated Intensive Care Unit patients. The lack of a Brazilian scale for pain assessment in adults mechanically ventilated justifies the relevance of this study that aimed to validate the Brazilian version of Behavioral Pain Scale as well as to correlate its scores with the records of physiological parameters, sedation level and severity of disease. Twenty-five Intensive Care Unit adult patients were included in this study. The Brazilian Behavioral Pain Scale version (previously translated and culturally adapted) and the recording of physiological parameters were performed by two investigators simultaneously during rest, during eye cleaning (non-painful stimulus) and during endotracheal suctioning (painful stimulus). High values of responsiveness coefficient (coefficient=3.22) were observed. The Cronbach's alpha of total Behavioral Pain Scale score at eye cleaning and endotracheal suctioning was 0.8. The intraclass correlation coefficient of total Behavioral Pain Scale score was ≥ 0.8 at eye cleaning and endotracheal suctioning. There was a significant highest Behavioral Pain Scale score during application of painful procedure when compared with rest period (p≤0.0001). However, no correlations were observed between pain and hemodynamic parameters, sedation level, and severity of disease. This pioneer validation study of Brazilian Behavioral Pain Scale exhibits satisfactory index of internal consistency, interrater reliability, responsiveness and validity. Therefore, the Brazilian Behavioral Pain Scale version was considered a valid instrument for being used in adult sedated and mechanically ventilated patients in Brazil. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.
Mauro Henrique N. G. Abreu
Full Text Available The present paper examines the relationship between hydrochemical characteristics and endemic dental fluorosis, controlling for variables with information on an individual level. An epidemiological survey was carried out in seven rural communities in two municipalities in the state of Minas Gerais, Brazil. The Thystrup & Fejerskov index was employed by a single examiner for the diagnosis of dental fluorosis. A sampling campaign of deep groundwater in the rural communities of interest was carried out concomitantly to the epidemiological survey for the determination of physiochemical parameters. Multilevel modeling of 276 individuals from seven rural communities was achieved using the non-linear logit link function. Parameters were estimated using the restricted maximum likelihood method. Analysis was carried out considering two response variables: presence (TF 1 to 9 or absence (TF = 0 of any degree of dental fluorosis; and presence (TF ≥ 5—with loss of enamel structure or absence of severe dental fluorosis (TF ≤ 4—with no loss of enamel structure. Hydrogeological analyses revealed that dental fluorosis is influenced by the concentration of fluoride (OR = 2.59 CI95% 1.07–6.27; p = 0.073 and bicarbonate (OR = 1.02 CI95% 1.01–1.03; p = 0.060 in the water of deep wells. No other variable was associated with this prevalence (p > 0.05. More severe dental fluorosis (TF ≥ 5 was only associated with age group (p < 0.05. No other variable was associated to the severe dental fluorosis (p > 0.05. Dental fluorosis was found to be highly prevalent and severe. A chemical element besides fluoride was found to be associated (p > 0.05 to the prevalence of dental fluorosis, although this last finding should be interpreted with caution due to its p value.
da Silva, Daniela Wosiack; Andrade, Selma Maffei de; Soares, Dorotéia Fátima Pelissari de Paula; Mathias, Thais Aidar de Freitas; Matsuo, Tiemi; de Souza, Regina Kazue Tanno
The objective of the study was to identify factors associated with reports of road accidents, among motorcycle couriers in two medium-sized municipalities in southern Brazil. A self-administered questionnaire was answered by motorcycle couriers that had worked for at least 12 months in this profession. The outcomes analyzed were reports on accidents and serious accidents over the 12 months prior to the survey. Bivariate and multivariate analyses by means of logistic regression were carried ou...
Carlucci, Marcelo T O; Braz, José R C; do Nascimento, Paulo; de Carvalho, Lidia R; Castiglia, Yara M M; Braz, Leandro G
Little information on the factors influencing intraoperative cardiac arrest and its outcomes in trauma patients is available. This survey evaluated the associated factors and outcomes of intraoperative cardiac arrest in trauma patients in a Brazilian teaching hospital between 1996 and 2009. Cardiac arrest during anesthesia in trauma patients was identified from an anesthesia database. The data collected included patient demographics, ASA physical status classification, anesthesia provider information, type of surgery, surgical areas and outcome. All intraoperative cardiac arrests and deaths in trauma patients were reviewed and grouped by associated factors and also analyzed as totally anesthesia-related, partially anesthesia-related, totally surgery-related or totally trauma patient condition-related. Fifty-one cardiac arrests and 42 deaths occurred during anesthesia in trauma patients. They were associated with male patients (Pundergoing gastroenterological or multiclinical surgeries (Ptrauma (Ptrauma patient condition. Intraoperative cardiac arrest and mortality incidence was highest in male trauma patients at a younger age with poor clinical condition, mainly related to uncontrolled hemorrhage and head injury, resulted from motor vehicle accidents and violence.
Dos Santos, Beatriz Ferraz; Madathil, Sreenath; Zuanon, Angela Cristina Cilense; Bedos, Christophe; Nicolau, Belinda
The aims of this study were to investigate dental students' attitudes toward people living in poverty and the extent to which their perceptions were associated with their willingness to treat those patients in their future practice. All 910 dental students enrolled in three Brazilian public universities in 2010 were invited to take part in a cross-sectional survey. A total of 766 students (83.7% response rate) completed the self-administered questionnaire on their perceptions of and attitudes about poverty and their intention to provide dental care to poor people. The responding students showed slightly positive attitudes about people living in poverty; however, a high percentage (35%) reported thinking they were different from the rest of the population. Nevertheless, most of these students expressed willingness to provide care to underserved populations in their future practice; this willingness was found to be associated with their beliefs about poverty (OR 1.65; 95% CI=1.41-1.94). Overall, the study found that these dental students had altruistic views toward people living in poverty. However, they seemed to lack a deep understanding of poverty that may prevent them from acting on their good intentions.
Carod-Artal, Francisco Javier; Casanova Lanchipa, Jardiel Omar; Cruz Ramírez, Luis Miguel; Pérez, Noelia Sánchez; Siacara Aguayo, Fátima M; Moreno, Isabel Gómez; Romero, Lourdes Gómez; Coral, Luciene Ferreira; Trizotto, Daniele Stieven; Moreira, Clarissa Menezes
With the increase in life expectancy worldwide, changes in stroke subtypes and burden of stroke population are expected in both developing and developed countries. Prevalence of stroke subtypes and comorbidity in ischemic stroke patients was assessed in Brasilia, Brazil, and Cuenca, Spain. This was an international (Brazilian-Spanish) cross-sectional study. Stroke subtypes were assessed by means of Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification. Modified Rankin scale was used to measure functional recovery and the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) was used to assess comorbidity. A total of 500 patients (mean age 66.2 ± 16.4 years; 48% female; 48.2% Spanish) were included in the study. Spanish patients were significantly older than Brazilian ones (76.4 ± 11.2 versus 56.7 ± 14.6 years; P < .0001). Prevalence of ischemic cardiopathy (20.3% versus 6.2%) and atrial fibrillation (25.7% versus 6.6%) was significantly higher in Spanish stroke patients, whereas they less frequently used tobacco (28.3% versus 52.9%); P less than .0001. Prevalence of stroke subtypes in Spanish and Brazilian stroke patients was: stroke of undetermined etiology (58.1% versus 32.4%), cardioembolism (24.5% versus 11.6%), lacunar infarct (11.6% versus 25.5%), atherothrombotic (3.7% versus 19.7%), and other causes (2.1% versus 10.8%); P less than .0001. The Spanish sample had a significantly higher frequency of comorbidities. The CIRS-G total score and CIRS-G mean number of affected organs significantly increased with age, and correlated with the level of functional dependence as measured by Rankin scale (rS = 0.50; P = .0005). Spanish stroke people had a higher frequency of comorbid conditions, atrial fibrillation, and cardioembolism and these facts were associated with age. Atherothrombotic and lacunar strokes were more common in the younger Brazilian stroke population. Copyright © 2014 National Stroke Association. Published by Elsevier
Polymorphism in the methylenetetrahydrofolate reductase (C677T) gene and homocysteine levels: a comparison in Brazilian patients with coronary arterial disease, ischemic stroke and peripheral arterial obstructive disease.
Sabino, Adriano; Fernandes, Ana Paula; Lima, Luciana Moreira; Ribeiro, Daniel Dias; Sousa, Marinez Oliveira; de Castro Santos, Maria Elizabeth Rennó; Mota, Ana Paula Lucas; Dusse, Luci Maria Sant'Ana; das Graças Carvalho, Maria
This study aimed to compare plasma levels of total homocysteine (tHcy) in different arterial events as well as to investigate an association between homocysteine levels and C677T polymorphism in Brazilian patients. A total of 145 subjects were enrolled in this study including 43 patients with coronary arterial disease (CAD), 21 with ischemic stroke (IS), 44 with peripheral arterial obstructive disease (PAOD) and 37 control subjects. A preliminary analysis showed significant difference for tHcy plasma levels between patients with CAD (P = 0.003) or PAOD (P = 0.03) compared to controls. However, after adjustment for sex, age, total cholesterol, LDL, diabetes, tabagism or C677T polymorphism, no significant differences were detected in tHcy levels among patients groups and controls. No significant correlation was demonstrated for C677T polymorphism and homocysteine levels. These results indicate that increased Hcy levels may not be considered an independent risk factor for atherothrombotic diseases in Brazilian patients.
Truzzi, Annibal; Ulstein, Ingun; Valente, Letice; Engelhardt, Eliasz; Coutinho, Evandro Silva Freire; Laks, Jerson; Engedal, Knut
Neuropsychiatric symptoms (NPS) affect the majority of patients who have dementia. Neuropsychiatric sub-syndromes with symptoms that occur together and have common neurobiological correlates have been identified. There are scarce data regarding the comparison of the pattern of the neuropsychiatric sub-syndromes in distinct ethnical and cultural populations. We aim at comparing the pattern of the NPS, and the factor analysis of the Neuropsychiatric Inventory (NPI-10) in two samples of outpatients with dementia living in Brazil and Norway. This is a cross-sectional study. The sample consists of 168 Brazilian and 155 Norwegian demented patients from psychogeriatric facilities and community-based educational programs. Brazilian patients were diagnosed with Alzheimer's disease (63.7%), vascular dementia (15.5%), or mixed dementia (20.8%), whereas the diagnoses of Norwegian patients were Alzheimer's disease (97.4%) and mixed dementia (2.6%). Principal component analysis with the Varimax rotation was used for factor analysis of the NPI-10. Apathy (80.4 %), agitation/aggression (45.8%), and aberrant motor behavior (45.8%) were the most common symptoms in the Brazilian sample. Apathy (72.3%), dysphoria (61.9%), and anxiety (52.3%) were the most frequent symptoms in the Norwegian sample. Factor analysis of the NPI-10 revealed three syndromes for the Brazilian (Psychosis, Mood, Psychomotor) and Norwegian (Psychosis, Mood, Frontal) groups. The frequency of individual NPS may differ among distinct populations. However, Psychosis and Depression are common sub-syndromes in diverse ethnical and cultural patients with dementia. Our findings support the syndromic approach for the clinical assessment of the patients with dementia.
Fidalgo, Thiago M; Sanchez, Zila M; Caetano, Sheila C; Andreoni, Solange; Sanudo, Adriana; Chen, Qixuan; Martins, Sílvia S
The effects of exposure to violent events in adolescence have not been sufficiently studied in middle-income countries such as Brazil. The aims of this study are to investigate the prevalence of psychiatric disorders among 12-year-olds in two neighborhoods with different socioeconomic status (SES) levels in São Paulo and to examine the influence of previous violent events and SES on the prevalence of psychiatric disorders. Students from nine public schools in two neighborhoods of São Paulo were recruited. Students and parents answered questions about demographic characteristics, SES, urbanicity and violent experiences. All participants completed the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) to obtain DSM-IV diagnoses. The data were analyzed using weighted logistic regression with neighborhood stratification after adjusting for neighborhood characteristics, gender, SES and previous traumatic events. The sample included 180 individuals, of whom 61.3% were from low SES and 39.3% had experienced a traumatic event. The weighted prevalence of psychiatric disorders was 21.7%. Having experienced a traumatic event and having low SES were associated with having an internalizing (adjusted OR = 5.46; 2.17-13.74) or externalizing disorder (adjusted OR = 4.33; 1.85-10.15). Investment in reducing SES inequalities and preventing violent events during childhood may improve the mental health of youths from low SES backgrounds.
Thiago M. Fidalgo
Full Text Available Objective: The effects of exposure to violent events in adolescence have not been sufficiently studied in middle-income countries such as Brazil. The aims of this study are to investigate the prevalence of psychiatric disorders among 12-year-olds in two neighborhoods with different socioeconomic status (SES levels in São Paulo and to examine the influence of previous violent events and SES on the prevalence of psychiatric disorders. Methods: Students from nine public schools in two neighborhoods of São Paulo were recruited. Students and parents answered questions about demographic characteristics, SES, urbanicity and violent experiences. All participants completed the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS to obtain DSM-IV diagnoses. The data were analyzed using weighted logistic regression with neighborhood stratification after adjusting for neighborhood characteristics, gender, SES and previous traumatic events. Results: The sample included 180 individuals, of whom 61.3% were from low SES and 39.3% had experienced a traumatic event. The weighted prevalence of psychiatric disorders was 21.7%. Having experienced a traumatic event and having low SES were associated with having an internalizing (adjusted OR = 5.46; 2.17-13.74 or externalizing disorder (adjusted OR = 4.33; 1.85-10.15. Conclusions: Investment in reducing SES inequalities and preventing violent events during childhood may improve the mental health of youths from low SES backgrounds.
Carolinie Batista Nobre da Cruz
Full Text Available Shigellosis is a global human health problem and the incidence is highest among children. In the present work, main Shigella virulence genes was examined by PCR and compared to symptoms of pediatric shigellosis. Thirty Shigella isolates were identified from an etiologic study at which 1,339 children ranging 0–10 years old were enrolled. S. flexneri was the most frequent species reaching 60.0% of isolates, 22.2% were S. sonnei, and 6.6% were both S. dysenteriae and S. boydii. All Shigella infected children had diarrhea, but not all were accompanied by others symptoms of bacillary dysentery. Among major virulence genes, the PCR typing revealed ipaBCD was present in all isolates, followed by IpaH7.8, set-1A, set-1B, sen/ospD3, virF, and invE. The pathogenic potential of the ShET-1B subunit was observed in relation to dehydration (P<0.001 and ShET-2 related to the intestinal injury (P=0.033 evidenced by the presence of bloody diarrhea. Our results show associations among symptoms of shigellosis and virulence genes of clinical isolates of Shigella spp.
Vieira, M J; Faro, C M
This work outlines the facts that contributed for the creation of the Brazilian Association of Nursing in Sergipe. It reports the trajectory, contributions and main accomplishments of ABEN in that state, pointing out its participation in the foundation and organization of services and institutions. The study also mentions the difficulties faced by ABEn-Sergipe, but mainly, it emphasizes the struggle of the association for maintaining its principles, its role in the social and cultural organization of the syndicate, and the availability of the nursing service for the community.
Priscila Ferreira de Sousa Moreira
Full Text Available Grass pollen, in particular from Lolium multiflorum is a major allergen source in temperate climate zones of Southern Brazil. The IgE sensitization profile of Brazilian grass pollen allergic patients to individual allergen molecules has not been analyzed yet.To analyze the IgE sensitization profile of a Brazilian grass pollen allergic population using individual allergen molecules.We analyzed sera from 78 grass pollen allergic patients for the presence of IgE antibodies specific for 103 purified micro-arrayed natural and recombinant allergens by chip technology. IgE-ELISA inhibition experiments with Lolium multiflorum, Phleum pratense extracts and a recombinant fusion protein consisting of Phl p 1, Phl p 2, Phl p 5 and Phl p 6 were performed to investigate cross-reactivities.Within the Brazilian grass pollen allergic patients, the most frequently recognized allergens were Phl p 1 (95%, Phl p 5 (82%, Phl p 2 (76% followed by Phl p 4 (64%, Phl p 6 (45%, Phl p 11 (18% and Phl p 12 (18%. Most patients were sensitized only to grass pollen allergens but not to allergens from other sources. A high degree of IgE cross-reactivity between Phleum pratense, Lolium multiflorum and the recombinant timothy grass fusion protein was found.Component-resolved analysis of sera from Brazilian grass pollen allergic patients reveals an IgE recognition profile compatible with a typical Pooideae sensitization. The high degree of cross-reactivity between Phleum pratense and Lolium multiflorum allergens suggests that diagnosis and immunotherapy can be achieved with timothy grass pollen allergens in the studied population.
Vinholes, Daniele B; Melo, Ione M F; Machado, Carlos Alberto; de Castro Chaves, Hilton; Fuchs, Flavio D; Fuchs, Sandra C
Dietary pattern plays a causative role in the rising of noncommunicable diseases. The SESI (Serviço Social da Indústria) study was designed to evaluate risk factors for noncommunicable diseases. We aimed to describe food items consumed by Brazilian workers and to assess their association with socioeconomic status. Cross-sectional study was carried out among Brazilian industrial workers, selected by multistage sampling, from 157 companies. Interviews were conducted at the work place using standardized forms. 4818 workers were interviewed, aged 35.4 ± 10.7 years, 76.5% were men. The workers had an average of 8.7 ± 4.1 years of schooling and 25.4 ± 4.1 kg/m² of BMI. Men and individuals with less than high school education were less likely to consume dairy products, fruits, and vegetables daily, even after control for confounding factors. Men consumed rice and beans daily more often than women. In comparison to workers aged 50-76 years, those under 30 years old consumed less fruits and green leafy vegetables daily. The food items consumed by Brazilian workers show that there are insufficient consumption according to the guidelines of healthy foods, particularly of dairy products, vegetables, and fruits.
Daniele B. Vinholes
Full Text Available Background. Dietary pattern plays a causative role in the rising of noncommunicable diseases. The SESI (Serviço Social da Indústria study was designed to evaluate risk factors for noncommunicable diseases. We aimed to describe food items consumed by Brazilian workers and to assess their association with socioeconomic status. Methods. Cross-sectional study was carried out among Brazilian industrial workers, selected by multistage sampling, from 157 companies. Interviews were conducted at the work place using standardized forms. Results. 4818 workers were interviewed, aged 35.4±10.7 years, 76.5% were men. The workers had an average of 8.7±4.1 years of schooling and 25.4±4.1 kg/m2 of BMI. Men and individuals with less than high school education were less likely to consume dairy products, fruits, and vegetables daily, even after control for confounding factors. Men consumed rice and beans daily more often than women. In comparison to workers aged 50–76 years, those under 30 years old consumed less fruits and green leafy vegetables daily. Conclusion. The food items consumed by Brazilian workers show that there are insufficient consumption according to the guidelines of healthy foods, particularly of dairy products, vegetables, and fruits.
Vinholes, Daniele B.; Melo, Ione M. F.; Machado, Carlos Alberto; de Castro Chaves, Hilton; Fuchs, Flavio D.; Fuchs, Sandra C.
Background. Dietary pattern plays a causative role in the rising of noncommunicable diseases. The SESI (Serviço Social da Indústria) study was designed to evaluate risk factors for noncommunicable diseases. We aimed to describe food items consumed by Brazilian workers and to assess their association with socioeconomic status. Methods. Cross-sectional study was carried out among Brazilian industrial workers, selected by multistage sampling, from 157 companies. Interviews were conducted at the work place using standardized forms. Results. 4818 workers were interviewed, aged 35.4 ± 10.7 years, 76.5% were men. The workers had an average of 8.7 ± 4.1 years of schooling and 25.4 ± 4.1 kg/m2 of BMI. Men and individuals with less than high school education were less likely to consume dairy products, fruits, and vegetables daily, even after control for confounding factors. Men consumed rice and beans daily more often than women. In comparison to workers aged 50–76 years, those under 30 years old consumed less fruits and green leafy vegetables daily. Conclusion. The food items consumed by Brazilian workers show that there are insufficient consumption according to the guidelines of healthy foods, particularly of dairy products, vegetables, and fruits. PMID:22701097
Baccaro, Luiz Francisco; de Souza Santos Machado, Vanessa; Costa-Paiva, Lúcia; Sousa, Maria Helena; Osis, Maria José; Pinto-Neto, Aarão Mendes
The aging of Brazilian population has been well-documented. A longer time since menopause, poor self-perception of health, and having arthrosis and balance problems are factors associated with postmenopausal osteoporosis. Poor self-perception of health, menopausal treatment with natural remedies, smoking, and decreased functional capacity are associated with early onset of the disease. This study aims to evaluate the prevalence of osteoporosis and its associated factors in Brazilian women over 50 years of age and to obtain information on factors related to the early onset of the disease. A cross-sectional study with 622 women over 50 years of age residing in Campinas/Brazil was conducted between May 10 and October 31, 2011 in the form of a population survey. A questionnaire was applied by trained interviewers. Osteoporosis was classified either as self-reported or as osteoporosis diagnosed by bone densitometry. Statistical analysis was carried out by chi-square test, Poisson regression analysis, and Cox multiple regression model. The mean age of the women was 64.1 years. The prevalence of self-reported osteoporosis was 21.3 %. A longer time since menopause (prevalence ratios (PR), 1.04; 95 % CI, 1.03-1.05; p osteoporosis. The variables associated with early onset of the disease were: self-perception of health as fair/poor/very poor (coefficient, 0.77; p menopausal treatment with natural remedies (coefficient, 1.01; p 20 cigarettes/day (coefficient, 1.02; p = 0.003), and problems in running/lifting something heavy/practicing sports/doing heavy work (coefficient, 0.60; p = 0.029). The results of this study have improved understanding of the factors associated with osteoporosis in the Brazilian population and may help identify those women who should undergo bone densitometry.
Avila, Lazslo A; de Araujo Filho, Gerardo M; Guimarães, Estefano F U; Gonçalves, Lauro C S; Paschoalin, Paola N; Aleixo, Fabia B
Fibromyalgia (FM) is a complex syndrome that is characterized by lasting and diffuse chronic musculoskeletal pain, derived from non-inflammatory causes and classically associated with the presence of specific tender points. However, studies have highlighted other important symptoms associated with a lower quality of life (QOL) in FM, such as sleep disturbances and alexithymia. This study aimed to investigate the pain, sleep and alexithymia patterns of FM patients treated in a Brazilian tertiary center. 20 patients with FM who were followed-up in the Rheumatology outpatient clinic of a Brazilian tertiary center (Faculdade de Medicina de São José do Rio Preto - FAMERP, São Paulo, Brazil) and 20 patients without FM from other outpatient services of the FAMERP completed a clinical and socio-demographic questionnaire, the Fibromyalgia Impact Questionnaire (FIQ), the Pittsburgh Sleep Quality Index (PSQI), the Toronto Alexithymia Scale (TAS-20) and the SF-36 (WHOQOL). The patients with FM presented worse performances in all QOL dimensions of the SF-36 and higher scores on the PSQI (p=0.01), and the TAS-20 (p=0.02). Patients with FM also scored significantly higher in all specific domains of PSQI and TAS-20. The present data were in accordance with literature, disclosing a worse performance of patients with FM on pain impact, sleep complains and more presence of alexithymia. Studies have disclosed the presence of important and frequently underdiagnosed symptoms beyond pain complaints in FM, such as sleep complaints and alexithymia, and a better knowledge of such disturbances might improve FM patients' approach and treatment. Copyright © 2014 Elsevier Editora Ltda. All rights reserved.
Andrade, Luiz Eduardo Lima de; Melo, Laiza Oliveira Mendes de; Silva, Ivanise Gomes da; Souza, Roselma Marinho de; Lima, André Luiz Barbosa de; Freitas, Marise Reis de; Batista, Almária Mariz; Gama, Zenewton André da Silva
to adapt the Hospital Survey on Patient Safety Culture (HSOPSC) to the Brazilian context and validate a computer program that facilitates the collection and analysis of data in hospitals with different types of management. methodological study developed in six hospitals in Natal-RN, Brazil; a software which allows data collection via e-mail, cloud storage and automatic data report was developed; validity was verified through confirmatory factor analysis and reliability, through consistency analysis with Cronbach's alpha. 863 professionals participated in the study; the adapted version presented total Cronbach's alpha of 0.92 and median of 0.69 in the 12 dimensions (90% confidence interval: 0.53;0.87); the model was fitted and showed good indexes in the confirmatory factor analysis. the results confirmed the validity and reliability of the instrument with adequate psychometric properties for the assessment of patient's safety culture in Brazilian hospitals.
Fontes, Amanda Nogueira Brum; Sakamuri, Rama Murthy; Baptista, Ida Maria Foschiani Dias; Ura, Somei; Moraes, Milton Ozório; Martínez, Alejandra Nóbrega; Sarno, Euzenir Nunes; Brennan, Patrick J; Vissa, Varalakshmi D; Suffys, Philip Noel
Leprosy is a chronic disease caused by infection with Mycobacterium leprae, an obligate intracellular parasite. A problem in studying the transmission of leprosy is the small amount of variation in bacterial genomic DNA. The discovery of variable number of tandem repeats (VNTRs) allowed the detection of strain variation in areas with a high prevalence of leprosy. Four genotypes of M. leprae based on three single-nucleotide polymorphism (SNPs) were also discovered to be useful for analysis of the global spread of leprosy. In this present study, we examined the allelic diversity of M. leprae at 16 select VNTR and three SNP loci using 89 clinical isolates obtained from patients mainly from the neighbouring states of São Paulo and Rio de Janeiro Brazil. By use of a PCR-RFLP-based procedure that allows the recognition of SNP types 3 and 4 without the need for the more expensive DNA sequencing steps, characterisation of the main M. leprae genotypes was easy. When applied on the study population, it was found that the SNP type 3 is most frequent in these two states of Brazil, and that VNTRs provided further discrimination of the isolates. Two Short Tandem Repeats (STRs) were monomorphic, with the remaining 14 STRs represented by two to 18 alleles. Epidemiological associations with township or state were not evident in this random collection and require further investigations. In phylogenetic trees, branches formed by all 16 STRs clearly separated SNP type 3 organisms from the other types while the allelic patterns of two minisatellite loci 27-5 and 12-5 were highly correlated with SNP type 3. This strain typing study provide the basis for comparison of M. leprae strain types within Brazil and with those from other countries, and informed selection of genomic markers and methods for future studies.
e Silva, M R M A; Moreira, P R; da Costa, G C; Saraiva, A M; de Souza, P E A; Amormino, S A F; da Costa, J E; Gollob, K J; Dutra, W O
Susceptibility to and severity of periodontal disease is influenced by gene polymorphisms related to the immune response. Co-stimulatory molecules, such as CD28 and CTLA-4, are critical in the development of such responses. Our hypothesis is that polymorphisms in genes that code for these molecules may be associated with periodontitis. The aim of the study was to investigate the association between +17 (T/C) CD28 and +49 (A/G) CTLA-4 gene polymorphisms and periodontitis in Brazilians. Genomic DNA was obtained from oral swabs of 424 individuals categorized into three groups (control group, aggressive, and chronic periodontitis) considering clinical parameters such as probing depth and clinical attachment loss. The genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism. There was an association between the T(-) genotype of the CD28 polymorphism and aggressive periodontitis (P = 0.04). Moreover, the A(+) genotype for CTLA-4 was associated with greater clinical attachment loss in non-smokers with aggressive periodontitis (P = 0.006, OR = 16.25, CI = 2.25-117.11). These findings show that T(-) in CD28 + 17 (T/C) and the A(+) in CTLA-4 +49 (A/G) genotypes are associated with susceptibility to aggressive periodontal disease. Thus, our study highlights these polymorphisms as potential genetic susceptibility markers of periodontitis in Brazilians. © 2012 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Janaína P. Jaeger
Full Text Available The CB1 cannabinoid receptor and its endogenous ligands, the endocannabinoids, are involved in energy balance control, stimulating appetite and increasing body weight in wasting syndromes. Different studies have investigated the relationship between polymorphisms of the cannabinoid receptor 1 (CNR1 gene and obesity with conflicting results. In the present study, we investigated the 1359G/A (rs1049353, 3813A/G (rs12720071 and 4895A/G (rs806368 polymorphisms in the CNR1 gene in a Brazilian population of European descent. To verify the association between these variants and obesity-related traits in this population, 756 individuals were genotyped by PCR-RFLP methods. The 4895G allele was associated with waist to hip ratio (WHR (P = 0.014; P = 0.042 after Bonferroni correction. An additive effect with the GAA haplotype was associated with WHR (P = 0.028, although this statistical significance disappeared after Bonferroni correction (P = 0.084. No significant association was observed between the genotypes of the 1359G/A and 3813A/G polymorphisms and any of the quantitative variables investigated. Our findings suggest that CNR1 gene polymorphism is associated with central obesity in this Brazilian population of European ancestry.
Garofolo, Luciana; Ferreira, Sandra Roberta G.; Miranda, Fausto Junior
Cardiovascular diseases are the major cause of morbidity and mortality in developed and emerging countries. Their main etiology, atherosclerosis, is a disseminated disease that affects the coronary, cerebral and peripheral territories. The peripheral arterial disease (PAD), as well as its consequences, indicates the involvement of the coronary territory. Therefore, its better understanding enables proper treatment, delaying local and long-term complications, reducing the cost to the health system. This study estimates the percentage of PAD in Japanese-Brazilians from Bauru (SP), recognized by the high prevalence of metabolic disorders such as hypertension (43%), diabetes mellitus (33%) and hypercholesterolemia (60%), and examines the association with risk biomarkers. This cross-sectional population study evaluated 1,330 Japanese-Brazilians of both genders aged ≥ 30 who underwent a complete physical examination, anthropometric measurements, laboratory tests and ankle-brachial index (ABI). Participants with ABI ≤ 0.90 were diagnosed as having PAD. After applying the exclusion criteria, 1,038 individuals were part of the analysis. We used Poisson regression to analyze associations with PAD. The mean age was 56.8 years and the percentage of PAD was 21.1%, equal among the genders. PAD was associated with smoking (PR 2.16 [1.33 to 3.48]) and hypertension (PR 1.56 [1.12-2.22]). The percentage of PAD in Japanese-Brazilians was similar to other populations of adverse cardiometabolic profile (US PARTNERS and POPADAD). The independent association of PAD with smoking and hypertension, but not with other classical risk factors, may depend on the very high frequencies of metabolic disorders in this population
Garofolo, Luciana, E-mail: email@example.com [Universidade Federal de São Paulo (Unifesp), São Paulo, SP (Brazil); Ferreira, Sandra Roberta G. [Faculdade de Saúde Pública - Universidade de São Paulo (USP), São Paulo, SP (Brazil); Miranda, Fausto Junior [Departamento de Cirurgia - Universidade Federal de São Paulo (Unifesp), São Paulo, SP (Brazil)
Cardiovascular diseases are the major cause of morbidity and mortality in developed and emerging countries. Their main etiology, atherosclerosis, is a disseminated disease that affects the coronary, cerebral and peripheral territories. The peripheral arterial disease (PAD), as well as its consequences, indicates the involvement of the coronary territory. Therefore, its better understanding enables proper treatment, delaying local and long-term complications, reducing the cost to the health system. This study estimates the percentage of PAD in Japanese-Brazilians from Bauru (SP), recognized by the high prevalence of metabolic disorders such as hypertension (43%), diabetes mellitus (33%) and hypercholesterolemia (60%), and examines the association with risk biomarkers. This cross-sectional population study evaluated 1,330 Japanese-Brazilians of both genders aged ≥ 30 who underwent a complete physical examination, anthropometric measurements, laboratory tests and ankle-brachial index (ABI). Participants with ABI ≤ 0.90 were diagnosed as having PAD. After applying the exclusion criteria, 1,038 individuals were part of the analysis. We used Poisson regression to analyze associations with PAD. The mean age was 56.8 years and the percentage of PAD was 21.1%, equal among the genders. PAD was associated with smoking (PR 2.16 [1.33 to 3.48]) and hypertension (PR 1.56 [1.12-2.22]). The percentage of PAD in Japanese-Brazilians was similar to other populations of adverse cardiometabolic profile (US PARTNERS and POPADAD). The independent association of PAD with smoking and hypertension, but not with other classical risk factors, may depend on the very high frequencies of metabolic disorders in this population.
Sarmento, Roberta Aguiar; Riboldi, Bárbara Pelicioli; da Costa Rodrigues, Ticiana; de Azevedo, Mirela Jobim; de Almeida, Jussara Carnevale
To investigate the association between dietary components and development of chronic diabetic complications, the dietary evaluation should include a long period, months or years. The present manuscript aims to develop a quantitative food frequency questionnaire (FFQ) and a portfolio with food photos to assess the usual intake pattern of Brazilian patients with type 2 diabetes to be used in future studies. Dietary data using 3-day weighed diet records (WDR) from 188 outpatients with type 2 diabetes were used to construct the list of usually consumed foods. Foods were initially clustered into eight groups: "cereals, tubers, roots, and derivatives"; "vegetables and legumes"; "fruits"; "beans"; "meat and eggs"; "milk and dairy products"; "oils and fats", and "sugars and sweets". The frequency of food intake and the relative contribution of each food item to the total energy and nutrient intakes were calculated. Portion sizes were determined according to the 25th, 50th, 75th, and 95th percentiles of intake for each food item. A total of 62 food items were selected based on the 3-day WDR and another 27 foods or how they are prepared and nine beverages were included after the expert examination. Also, a portfolio with food photos of each included food item and portion sizes was made to assist the patients in identifying the consumed portion. We developed a practical quantitative FFQ and portfolio with photos of 98 food items covering those most commonly consumed in the past 12 months, to assess the usual diet pattern of patients with type 2 diabetes in Southern Brazil.
Coelho, Rafael Corrêa; Reinert, Tomás; Campos, Franz; Peixoto, Fábio Affonso; de Andrade, Carlos Augusto; Castro, Thalita; Herchenhorn, Daniel
The aim of this study was to assess the impact of sunitinib treatment in a non-screened group of patients with metastatic renal cell cancer (mRCC) treated by the Brazilian Unified Health System (SUS) at a single reference institution. Retrospective cohort study, which evaluated patients with mRCC who received sunitinib between May 2010 and December 2013. Fifty-eight patients were eligible. Most patients were male 41 (71%), with a median age of 58 years. Nephrectomy was performed in 41 (71%) patients with a median interval of 16 months between the surgery and initiation of sunitinib. The most prevalent histological subtype was clear cell carcinoma, present in 52 (91.2%) patients. In 50 patients (86%), sunitinib was the first line of systemic treatment. The main adverse effects were fatigue (57%), hypothyroidism (43%), mucositis (33%) and diarrhea (29%). Grade 3 and 4 adverse effects were infrequent: fatigue (12%), hypertension (12%), thrombocytopenia (7%), neutropenia (5%) and hand-foot syndrome (5%). Forty percent of patients achieved a partial response and 35% stable disease, with a disease control rate of 75%. Median progression free survival was 7.6 months and median overall survival was 14.1 months. Sunitinib treatment was active in the majority of patients, especially those with low and intermediate risk by MSKCC score, with manageable toxicity. Survival rates were inferior in this non-screened population with mRCC treated in the SUS. Copyright© by the International Brazilian Journal of Urology.
Full Text Available OBJECTIVE: To evaluate the effectiveness of the Brazilian Cardioprotective Diet Program in reducing blood pressures, fasting glucose levels and body mass indices in patients with established atherothrombotic disease. METHOD: This randomized controlled pilot trial included outpatients who were over 45 years of age with atherothrombotic cardiovascular disease. Group A, who received the Brazilian Cardioprotective Diet Program, had weekly sessions with dietitians. Groups B and C received the usual dietary therapy that is given to patients with cardiovascular diseases as proposed by the Brazilian guidelines. This diet had the same nutrient profile as that given to Group A, but it was customized by the integration of typical Mediterranean foods. The difference between Groups B and C was the number of sessions with the dietitian. Group B received weekly sessions, while group C only had monthly sessions. ClinicalTrials.gov: NCT 01453166. RESULTS: There was a greater reduction in systolic (7.8% and diastolic (10.8% blood pressures in Group A compared with Group B (2.3% and 7.3%, and Group C (3.9% and 4.9%, respectively. Fasting glucose decreased by 5.3% and 2% in Groups A and B, respectively. Fasting glucose increased by 3.7% in Group C. The BMIs decreased by 3.5% and 3.3% in Groups A and B, respectively. Group C did not present with any changes in BMI. However, none of these data showed statistical differences between the groups, which is methodologically acceptable in pilot trials. CONCLUSIONS: The Brazilian Cardioprotective Diet Program seems to be more effective in reducing blood pressures, fasting glucose levels, weights and BMIs in patients with previous cardiovascular disease compared with the diet that has been proposed by the Brazilian guidelines.
Sanches, S B; Osório, F L; Louzada-Junior, P; Moraes, D; Crippa, J A S; Martín-Santos, R
Anxiety disorders may be associated with several non-psychiatric disorders. Current literature has been investigating the association between anxiety and joint hypermobility (JHM), with special interest in non-articular symptoms that may be related to autonomic dysfunction. This study investigated the association between anxiety and JHM in a sample of Brazilian university students. Data were cross-sectionally collected in two Brazilian universities (N=2600). Participants completed three validated self-rating anxiety scales: Beck Anxiety Inventory (BAI), Social Phobia Inventory (SPIN) and the brief-version of SPIN (Mini-SPIN). They also answered the self-rating screening questionnaire for JHM: the Five-part Questionnaire for Identifying Hypermobility. Hypermobile women showed significantly higher scores in all the anxiety scales, when compared with men: BAI total score (t=3.77; panxiety and JHM in women, showing specific gender-related features in this field. It also directs attention to non-articular symptoms that may be enrolled in this association. Copyright © 2014 Elsevier Inc. All rights reserved.
Costa, Ana Lucia Siqueira; Heitkemper, Margaret M; Alencar, Gizelton Pereira; Damiani, Lucas Petri; Silva, Rodrigo Marques da; Jarrett, Monica E
The well-being of patients undergoing chemotherapy treatment for colorectal cancer (CRC) is affected by psychological effects associated with cancer treatment. However, little is known about the impact of these psychological factors in Brazilian patients with CRC. The aim of this study was to determine whether perceived stress, social support, and resilience are associated with quality of life in urban Brazilian patients receiving chemotherapy treatment for CRC. This was a cross-sectional study conducted with 144 Brazilian CRC patients in an ambulatory oncology clinic. The participants completed 5 questionnaires: Demographics, Perceived Stress Scale 14, Social Support Satisfaction Scale, Resilience Scale, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaires (C30 and CR29). Confirmatory factor analysis modeling and Cronbach's α were used to examine construct validity and internal consistency. We used the MPlus 3.0 to construct and validate the structural model. There was a moderate and positive effect of resilience on the physical, social, and emotional aspects of quality of life. Social support had a strong and positive direct effect on quality of life (ie, social, physical, social, and emotional). Social support had a negative effect on stress perception. Resilience was also negatively related to stress perception. Family support and professional social support are important factors for Brazilian CRC patients. Resilience is an important ally for patients. It is important for nurses to consider this when developing educational and psychological interventional strategies to reduce stress and ultimately improve quality of life in this population. Psychological factors that improve quality of life should be evaluated in patients undergoing treatment for cancer.
Fernando Aguilar Lopes
Full Text Available Abstract We aimed to detect DNA of Borrelia burgdorferi in whole blood and serum samples of patients with clinical symptoms and epidemiology compatible with Brazilian Lyme-like disease. Four patients with positive epidemiological histories were recruited for the study. Blood samples were collected, screened by serologic testing by ELISA and Western blotting and molecular identification of B. burgdorferi by amplifying a fragment of the conserved gene that synthesizes the hook flagellar flgE. The results showed positive serology and for the first time, the presence of B. burgdorferi sensu lato in humans in the Midwest region of Brazil. The resulting sequences were similar to GenBank corresponding sequences of B. burgdorferi flgE gene. By neighbor-joining the phylogenetic analysis, the flgE sequence of the Brazilian strain clustered in a monophyletic group with the sequence of B. burgdorferi sensu lato under 100% bootstrap support. This study opens up promising perspectives and reinforces the need for additional studies to determine the epidemiological characteristics of the disease, as well as the impact of the prevalence of Brazilian borreliosis in Mato Grosso do Sul State, Brazil.
Livia L. Correa
Full Text Available Introduction Published data suggest that patients with acromegaly have an increased prevalence of prostate disorders. Objective To evaluate prostatic disorders in acromegalic patients comparing these results after one year of treatment of acromegaly and with a group of healthy men. Materials and Methods This study was composed of two parts: sectional study comparing patients with healthy controls (baseline and prospective, longitudinal study (at baseline and after one year of treatment. Forty acromegalic patients were enrolled and evaluated at baseline and after one year with the application of international prostatic symptoms score (IPSS, digital rectal examination, measurements of growth hormone (GH, insulin-like growth factor-I (IGF-I, insulin-like growth factor-binding protein-3 (IGFBP-3, sex hormone-binding globulin (SHBG, prolactin, luteinizing hormone (LH, follicle-stimulating hormone (FSH, total testosterone, total and free prostate-specific antigen (PSA levels and prostate ultrasonography (US. Thirty healthy men were selected as control group. Results We stratified patients and controls according to age, considering 40 years-old as cut off. Healthy controls under 40 had IPSS values lower than acromegalic patients. When considering only older patients and controls prostate hyperplasia and structural abnormalities were more frequent in acromegalics. After one year of treatment there was significant decrease in GH, IGF-I and prostate volume in acromegalics over 40 years-old. Conclusions Acromegalics under 40 have more urinary symptoms according to IPSS and above 40 years-old higher frequency of structural changes and increased prostate volume than healthy men. Significant reduction of GH and IGF-I levels during treatment of acromegaly leads to decrease in the prostate volume.
Goudouris, Ekaterini Simões; Silva, Almerinda Maria do Rego; Ouricuri, Aluce Loureiro; Grumach, Anete Sevciovic; Condino, Antonio; Costa-Carvalho, Beatriz Tavares; Prando, Carolina Cardoso de Mello; Kokron, Cristina Maria; Vasconcelos, Dewton de Moraes; Tavares, Fabíola Scancetti; Segundo, Gesmar Rodrigues Silva; Barreto, Irma Cecília Douglas Paes; Dorna, Mayra de Barros; Barros, Myrthes Anna Maragna Toledo; Forte, Wilma Carvalho Neves
ABSTRACT In the last few years, new primary immunodeficiencies and genetic defects have been described. Recently, immunoglobulin products with improved compositions and for subcutaneous use have become available in Brazil. In order to guide physicians on the use of human immunoglobulin to treat primary immunodeficiencies, based on a narrative literature review and their professional experience, the members of the Primary Immunodeficiency Group of the Brazilian Society of Allergy and Immunology prepared an updated document of the 1st Brazilian Consensus, published in 2010. The document presents new knowledge about the indications and efficacy of immunoglobulin therapy in primary immunodeficiencies, relevant production-related aspects, mode of use (routes of administration, pharmacokinetics, doses and intervals), adverse events (major, prevention, treatment and reporting), patient monitoring, presentations available and how to have access to this therapeutic resource in Brazil. PMID:28444082
Luciano Grüdtner Buratto
Full Text Available The emotional content of words can affect both true and false memory performance. One hypothesis suggests that the effects of emotion on memory stem from the semantic cohesion of these words. Emotional words are better remembered because they are more inter-related than neutral words (semantic cohesion hypothesis. Although support for this assumption has been found in tasks that measure true memory, less is known about how the structure of lexical knowledge affects emotional false memories. This is partially due to the scarcity of norms that capture the pre-existing knowledge structure of verbal materials commonly used to investigate emotional false memories, such as the Deese/Roediger-McDermott word lists. In this study, we present inter-item association norms for the 44 lists of the Brazilian version of the DRM paradigm. Free-association responses were collected from a sample of 1,042 undergraduates and were used to estimate the level of connectivity among the words present in the DRM lists. Connectivity measures were then used to test the semantic cohesion hypothesis. No significant correlations were found between the emotional measures (valence and arousal and the connectivity measures. The results do not give support to the semantic cohesion hypothesis and suggest that, for the Brazilian version of DRM lists, inter-item association and emotionality can be independently manipulated.
Marcelo Romanovitch Ribas
Full Text Available ABSTRACT Introduction: By associating genetics and sport, it is possible to identify subjects with greater capacity to adapt to training, and lower chances of injury. Objective: The investigation evaluated the genotypic and allelic distribution of ACTN3 R577X and ACE I/D polymorphisms in Brazilian high-performance athletes in wrestling and percussion combat sports. Methods: The study included 37 male athletes ranked from first to third place in world scenarios, divided into two groups: wrestling (23 wrestlers, being 11 of Judo, 4 of Greco-Roman style, 8 of Brazilian Jiu Jitsu, with mean age of 27.3 ± 6.9 years and percussion combat sports (14 athletes with a mean age of 25.7±4.4 years, being 6 of Karate, 3 of Muay Thai, 4 of Taekwondo, 1 Boxing. Genotyping of ACTN3 and ACE I/D polymorphisms was performed by polymerase chain reaction (PCR from the genomic DNA. Genotypic and allelic distributions were compared with control populations and athletes by Chi-square test and Fisher’s exact test; all analyzes considered p ≤ 0.05. Results: The genotypic distributions and allelic frequencies of ACTN3 RR=46%, RX=38% and XX=16%; R=65% and X=35%, and ACE I/D DD=47.7%, ID=34.3% and II=20%; D=62.9% and I=37.1% did not differ from the control population; however, when compared with wrestling athletes a significant difference was observed. Conclusion: These results suggest an association of ACTN3 R577X and ACE I/D genes with Brazilian high-performance wrestling athletes.
Passos Gregorio, Sheila; Gattaz, Wagner F; Tavares, Hildeberto
the association of the NUMBL variant, our most promising finding, in an unrelated set of 684 Danish patients and controls. When the Brazilian and Danish cohorts were merged, a total of 1084 subjects, we found the allele 18 CAG of NUMBL (p=0.003, x2=8.88, OR=1.30, 95% CI 1.09-1.56) as well as the 18/18 CAG...... genotype (p=0.002, x2=9.46, OR=1.46, 95% CI 1.15-1.87) to be associated with schizophrenia. The consistency of this finding in two independent and unrelated populations reinforces the veracity of this association....
Andrade, L A; Ferraz, H B
Dystonia may be classified by age of onset (childhood, adolescence, adult onset), body distribution of the abnormal movements (focal, segmental, unilateral, multifocal and generalized) and etiology (idiopathic and symptomatic). We studied 76 patients with idiopathic dystonia among 122 cases of dystonic syndrome (62.3% of the total). There were 48 female and 28 male patients. Adult-onset focal dystonia was the most frequent feature (37 patients). The onset of generalized dystonia was more frequently seen under the age of 20, whereas focal and segmental dystonia usually started over this age. Postural tremor of the hands was observed in 19.7% of the patients. Spasmodic torticollis was the most prevalent form of dystonia overall. Except for writer's cramp, which occurred more frequently in males, and generalized dystonia, which was equally divided between sexes, all other forms were more frequent in females. Our data suggest that differences in racial origin, social and economical status and environmental factors do not account for a different manifestation in dystonia pattern.
Luiz A. F. Andrade
Full Text Available Dystonia may be classified by age of onset (childhood, adolescence, adult onset, body distribution of the abnormal movements (focal, segmental, unilateral, multifocal and generalized and etiology (idiopathic and symptomatic. We studied 76 patients with idiopathic dystonia among 122; cases of dystonic syndrome (62.3% of the total. There were 48 female and 28 male patients. Adult-onset focal dystonia was the most frequent feature (37 patients. The onset of generalized dystonia was more frequently seen under the age of 20, whereas focal and segmental dystonia usually started over this age. Postural tremor of the hands was observed in 19.7% of the patients. Spasmodic torticollis was the most prevalent form of dystonia overall. Except for writer's cramp, which occurred more frequently in males, and generalized dystonia, which was equally divided between sexes, all other forms were more frequent in females. Our data suggest that differences in racial origin, social and economical status and environmental factors do not account for a different manifestation in dystonia pattern.
Trindade, Aline Heloísa; Meira, Henrique Côrtes; Pereira, Igor Figueiredo; de Lacerda, Julio César Tanos; de Mesquita, Ricardo Alves; Santos, Vagner Rodrigues
Paracoccidioidomycosis (PCM) is a rare fungal infection in the world, but endemic and acquired exclusively in Latin America, with the highest prevalence in South America and Brazil, particularly. Changes in oral cavity are common and constitute the first clinical manifestation in many patients. The aim of this study was to describe the prevalence of oral PCM and analyse the profile of the disease and patients. Retrospective research, consisting of information present in the medical records in the period 1998-2015, whose histopathological diagnosis was oral PCM. Fifty-five oral PCM cases were confirmed. Of these patients, 90.9% were males and 9.1% were females. The average age was 49.66 years and the most reported occupation was rural workers. The painful symptomatology was present in 61.82% of patients. Erythematous lesions were predominant in 73% of them. In single lesions (22 cases), the most common locations were jugal mucosa and tongue. In multiple involvement (30 cases), the most affected regions were lips, jugal mucosa and alveolar ridge. Epidemiology of PCM, was similar to several other studies, especially in Brazil. This is the most important fungal infection in Latin America and the recognition of oral lesions is extremely important, as is often the first and in many cases the only manifestation of the disease. © 2017 Blackwell Verlag GmbH.
Siegel, Pamela; da Motta, Pedro Mourão Roxo; da Silva, Luis G; Stephan, Celso; Lima, Carmen Silvia Passos; de Barros, Nelson Filice
The purpose of this pilot study was to explore whether individualized Reiki given to cancer patients at a Brazilian hospital improved symptoms and well-being. Data from 36 patients who received 5 Reiki sessions were collected using the MYMOP and were compared before and after their treatment and also with 14 patients who did not receive Reiki and who acted as a comparison group. Twenty-one patients reported feeling better, 12 felt worse, and 3 reported no change. Of the comparison group, 6 patients reported feeling better and 8 felt worse. The Reiki practice delivered as part of the integrative care in oncology did produce clinically significant effects, although not statistically significant results, for more than half of the patients undergoing cancer treatment.
Marcelo T O Carlucci
Full Text Available BACKGROUND: Little information on the factors influencing intraoperative cardiac arrest and its outcomes in trauma patients is available. This survey evaluated the associated factors and outcomes of intraoperative cardiac arrest in trauma patients in a Brazilian teaching hospital between 1996 and 2009. METHODS: Cardiac arrest during anesthesia in trauma patients was identified from an anesthesia database. The data collected included patient demographics, ASA physical status classification, anesthesia provider information, type of surgery, surgical areas and outcome. All intraoperative cardiac arrests and deaths in trauma patients were reviewed and grouped by associated factors and also analyzed as totally anesthesia-related, partially anesthesia-related, totally surgery-related or totally trauma patient condition-related. FINDINGS: Fifty-one cardiac arrests and 42 deaths occurred during anesthesia in trauma patients. They were associated with male patients (P<0.001 and young adults (18-35 years (P=0.04 with ASA physical status IV or V (P<0.001 undergoing gastroenterological or multiclinical surgeries (P<0.001. Motor vehicle crashes and violence were the main causes of trauma (P<0.001. Uncontrolled hemorrhage or head injury were the most significant associated factors of intraoperative cardiac arrest and mortality (P<0.001. All cardiac arrests and deaths reported were totally related to trauma patient condition. CONCLUSIONS: Intraoperative cardiac arrest and mortality incidence was highest in male trauma patients at a younger age with poor clinical condition, mainly related to uncontrolled hemorrhage and head injury, resulted from motor vehicle accidents and violence.
Marques, Leandro S; Pordeus, Isabela A; Ramos-Jorge, Maria L; Filogônio, Cid A; Filogônio, Cintia B; Pereira, Luciano J; Paiva, Saul M
In the period of adolescence physical appearance takes on significant importance in the construction of personal identity, including one's relationship with one's own body. A variety of social, cultural, psychological and personal factors influences the self-perception of dental appearance and the decision to undergo orthodontic treatment. Adolescents who seek orthodontic treatment are concerned with improving their appearance and social acceptance. The aim of the present study was to determine factors associated to the desire for orthodontic treatment among Brazilian adolescents and their parents. The sample consisted of 403 subjects aged 14 to 18 years, selected randomly from a population of 182,291 schoolchildren in the same age group. The outcome variable "desire for orthodontic treatment" was assessed through a questionnaire. Self-perception of dental aesthetics was assessed using the Oral Aesthetic Subjective Impact Scale (OASIS) and the Dental Aesthetic Index (DAI) was used for clinical assessment. Statistical analysis involved the chi-square test as well as both simple and multiple logistic regression analyses. The majority (78%) of the Brazilian adolescents desired orthodontic treatment and 69% of the parents reported that their children were not in orthodontic treatment due to the high costs involved. There was significant association (p or = 2 mm and parents' perception of their child's need for treatment.
Gisele Ferreira Paris
Full Text Available Abstract OBJECTIVE To verify the association between complicated grief and sociodemographic, reproductive, mental, marital satisfaction, and professional support characteristics in women after stillbirth. METHOD Cross-sectional study with 26 women who had stillbirth in 2013, living in the city of Maringá, Brazil, and eight women who attended the Centre d'Études et de Rechercheen Intervention Familiale at the University of Quebec en Outaouais, in Canada. The instrument was administered as an interview to a small number of mothers of infants up to three months (n=50, who did not participate in the validation study. RESULTS By applying the short version of the Perinatal Grief Scale, the prevalence of complicated grief in Brazilian women was found to be higher (35% in relation to Canadian women (12%.Characteristics of the Brazilian women associated with the grief period included the presence of previous pregnancy with live birth, absence of previous perinatal loss, postpartum depression, and lack of marital satisfaction. For the Canadians it was observed that 80% of the women presenting no grief made use of the professional support group. In both populations the occurrence of complicated grief presented a higher prevalence in women with duration of pregnancy higher than 28 weeks. CONCLUSION The women that must be further investigated during the grief period are those living in Brazil, making no use of a professional support group, presenting little to no marital satisfaction, having no religion, and of a low educational level.
Cascaes, Andreia Morales; Peres, Karen Glazer; Peres, Marco Aurélio
The aim of this study was to investigate the association between periodontal disease and self-rated oral health among Brazilian adults. Data on 11,874 adults in 250 cities from all the Brazilian regions were analysed. The outcome investigated was self-rated oral health (dichotomized into "Good" and "Poor") and the main exposure was periodontal disease defined as the combination of periodontal pocket depth >or=4 mm and clinical attachment loss >or=4 mm. Demographic characteristics, socioeconomic conditions, clinical oral health conditions (dental caries, dental and gingival pain, tooth loss and use of prosthesis) and use of dental services were the other explanatory variables. Simple and multivariate Poisson regression was performed allowing the estimation of prevalence ratios (PRs). All analyses were adjusted for the cluster sampling design. The prevalence of periodontal disease was 8.9% ((95%)CI 7.6-10.3) and poor self-rated oral health was 23.6% ((95%)CI 21.9-25.2) which was significantly higher among those who presented periodontal disease (PR 1.4; (95%)CI 1.2-1.5), after the adjustment for possible confounders. Periodontal disease was associated with poor self-rated oral health. The results of this study should be considered by population health planners in order to assess and plan periodontal services.
Clarissa L.C Campêlo
Full Text Available Genetic susceptibility contributes to the etiology of sporadic Parkinson’s Disease (PD and worldwide studies have found positive associations of polymorphisms in the alpha-synuclein gene (SNCA with the risk for PD. However, little is known about the influence of variants of SNCA in individual traits or phenotypical aspects of PD. Further, there is a lack of studies with Latin-American samples. We evaluated the association between SNCA single nucleotide polymorphisms (single nucleotide polymorphisms, SNPs – rs2583988, rs356219, rs2736990, and rs11931074 and PD risk in a Brazilians sample. In addition, we investigated their potential interactions with environmental factors and specific clinical outcomes (motor and cognitive impairments, depression, and anxiety. A total of 105 PD patients and 101 controls participated in the study. Single locus analysis showed that the risk allele of all SNPs were more frequent in PD patients (p < 0.05, and the associations of SNPs rs2583988, rs356219, and rs2736990 with increased PD risk were confirmed. Further, the G-rs356219 and C-rs2736990 alleles were associated with early onset PD. T-rs2583988, G-rs356219 and C-2736990 alleles were significantly more frequent in PD patients with cognitive impairments than controls in this condition. In addition, in a logistic regression model, we found an association of cognitive impairment with PD, and the practice of cognitive activity and smoking habits had a protective effect. This study shows for the first time an association of SNCA polymorphism and PD in a South-American sample. In addition, we found an interaction between SNP rs356219 and a specific clinical outcome, i.e., the increased risk for cognitive impairment in PD patients.
Lima, Francisca Sueli da Silva; Merchán-Hamann, Edgar; Urdaneta, Margarita; Damacena, Giseli Nogueira; Szwarcwald, Célia Landmann
Few studies in Brazil have focused on violence against female sex workers, a theme that has attracted researchers' attention worldwide, especially due to possible associations with HIV. The current study aims to estimate the prevalence of violence against female sex workers according to type and perpetrator and to identify associated factors. A cross-sectional study was conducted with data on 2,523 female sex workers from ten Brazilian cities, and with the respondent-driven sampling (RDS). Prevalence of verbal violence was 59.5%, physical violence 38.1%, sexual violence 37.8%, intimate partner physical violence 25.2%, and violence by clients 11.7%. Factors associated with physical violence were age violence. The identification of vulnerability factors is essential for interventions to safeguard human rights and control HIV.
Edson Zangiacomi Martinez
Full Text Available OBJECTIVE: The aim of this study was to examine the association between religiousness and blood donation among postgraduate students.METHODS: The Portuguese-language version of the Duke University Religion Index was administered to a sample of 226 Brazilian students with ages ranging from 22 to 55 years. All study participants had completed undergraduate courses in health-related areas.RESULTS: In the present study, 23.5% of the students were regular donors. Organizational religiousness was found to be associated with attitudes related to blood donation. This study also shows evidence that regular blood donors have a higher intrinsic religiousness than subjects who donate only once and do not return.CONCLUSION: This study shows that the attitudes concerning blood donation may have some association with religiosity.
Silva, Vladimir Schuindt da; Souza, Israel; Silva, Diego Augusto Santos; Barbosa, Aline Rodrigues; Fonseca, Maria de Jesus Mendes da
This study aimed to describe BMI's short-term trends and analyze the association between the Body Mass Index (BMI) and the sociodemographic variables and variables of family perception of the sufficiency and type of food consumed by Brazilian elderly of both sexes. The authors used data from the Household Budget Surveys (HBS) collected by the Brazilian Institute of Geography and Statistics (IBGE) in 2002/03 and 2008/09. The prevalence of overweight and obesity increased, whereas normal and low weight decreased. Multinomial regression models were used for 2008/09 to analyze the association between BMI and sociodemographic variables and variables of family perception of the sufficiency and type of food intake. Income and age were more associated with BMI. We suggest that health and nutrition prevention and monitoring measures be implemented through public policies, considering multifactorial overweight in the Brazilian elderly.
Pilonetto, Daniela V; Pereira, Noemi F; Bonfim, Carmem M S; Ribeiro, Lisandro L; Bitencourt, Marco A; Kerkhoven, Lianne; Floor, Karijn; Ameziane, Najim; Joenje, Hans; Gille, Johan J P; Pasquini, Ricardo
Fanconi anemia (FA) is a predominantly autosomal recessive disease with wide genetic heterogeneity resulting from mutations in several DNA repair pathway genes. To date, 21 genetic subtypes have been identified. We aimed to identify the FA genetic subtypes in the Brazilian population and to develop a strategy for molecular diagnosis applicable to routine clinical use. We screened 255 patients from Hospital de Clínicas, Universidade Federal do Paraná for 11 common FA gene mutations. Further analysis by multiplex ligation-dependent probe amplification (MLPA) for FANCA and Sanger sequencing of all coding exons of FANCA , -C , and - G was performed in cases who harbored a single gene mutation. We identified biallelic mutations in 128/255 patients (50.2%): 89, 11, and 28 carried FANCA , FANCC , and FANCG mutations, respectively. Of these, 71 harbored homozygous mutations, whereas 57 had compound heterozygous mutations. In 4/57 heterozygous patients, both mutations were identified by the initial screening, in 51/57 additional analyses was required for classification, and in 2/57 the second mutation remained unidentified. We found 52 different mutations of which 22 were novel. The proposed method allowed genetic subtyping of 126/255 (49.4%) patients at a significantly reduced time and cost, which makes molecular diagnosis of FA Brazilian patients feasible.
Vanessa Fernanda Goes
Full Text Available Alzheimer’s disease (AD is characterized by disorders that can impair the nutrition of the patient and lead to weight loss and nutritional deficits during the course of the disease. The aim of this study was to assess the nutritional status and food intake of Brazilian patients with Alzheimer’s disease at 3 different stages of the disease. The sample consisted of 30 subjects of both genders, mean age 77 years, with probable AD. Subjects were assessed by collecting anthropometric data, the Mini Nutritional Assessment (MNA, serum albumin content, Mini Mental State Examination and 24-hour records of food and drink. Although a steady decrease in average weight was observed as the disease progressed (CDR1: 70.8±15.9 kg; CDR2: 61.4±15.7 kg; CDR3: 56.1± 8.4 kg, the differences were not significant. MNA and serum albumin both fell during the progression of the disease (p = 0.042; p = 0.047, respectively and, at the severe stage, half the patients were found to be undernourished and the other half at risk of undernutrition. According to their body mass index, 23.3% of patients were overweight. The nutritional value of the food consumed was similar across the stages of AD. In conclusion, the majority of Brazilian patients with AD in this study exhibited cognitive decline and malnutrition. However, food intake was similar among the stages of the disease, thus having no direct association with the progression of AD.
Melo, B; Rezende, L; Machado, P; Gouveia, N; Levy, R
Although both consumption of ultra-processed products and asthma are common during adolescence, the epidemiological evidence in regarding their association is unclear. We investigated the associations of ultra-processed products consumption with asthma and wheezing in a representative sample of Brazilian adolescents. We used data from a representative sample of 109,104 Brazilian adolescents enrolled in the National Survey of School Health, 2012. The consumption of ultra-processed products was based on the weekly consumption (0-2, 3-4, ≥5 days/week) of sweet biscuits, salty biscuits, ultra-processed meats, sweets/candies, soft drinks, and packaged snacks over the previous seven days. We also calculated an ultra-processed consumption score by adding partial scores corresponding to weekly frequency intake of each ultra-processed product. The ultra-processed consumption score ranged from 0 to 42, the higher score, the higher the intake of these products. Presence of wheezing in the previous 12 months and asthma at any time in the past were self-reported. The adjusted odds ratios of asthma comparing the extreme categories ranged from 1.08 (95% CI 1.03-1.13) for sweets/candies to 1.30 (1.21-1.40) for ultra-processed meats. Similar magnitude of associations was found for wheezing outcome. The ultra-processed consumption score was positively associated with presence of asthma and wheezing in a dose-response manner. The adjusted OR of asthma and wheezing comparing highest to lowest quintile of ultra-processed consumption score were 1.27 (95% CI 1.15-1.41) and 1.42 (1.35-1.50), respectively. The consumption of ultra-processed products was positively associated with the presence of asthma and wheezing in adolescents. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Priscila Lucelia Moreira
Full Text Available Objective: dietary pattern evaluation is often used in order to determine wheter a diet is healthy, as well as to predict the onset of diseases. This study aimed to identify dietary patterns, and to examine their associations with general (body mass index and central (waist circumference and waist-to-hip ratio obesity in community-living elderly in a Brazilian city. Methods: this cross-sectional study included 126 elderly subjects aged 60 or older (57.1% females and mean age 74.2 ± 6.46 years. Anthropometric variables, weight, height, waist (WC and hip (HC circumferences, were measured. Body mass index (BMI and waist-to-hip ratio (WHR were calculated. Answers to a Food Frequency Questionnaire were interpreted by Principal Component Analysis in order to identify dietary patterns. Results: five dietary patterns were identified and named as prudent (fruit, vegetables and meat, sweets and fats (pastries, sugary foods, fatty foods, whole milk, typical Brazilian (fried eggs, cooked beans, beef, candy, string beans, fried cassava, Mediterranean (fruit, vegetables, olive oil and nuts and traditional meal (rice and beans. Moderate and high adherences to the Mediterranean pattern were protective factors to general and central obesity (WHR. High adherence to prudent was also protective to central obesity (WC. Conclusion: adherences to the dietary patterns prudent and Mediterranean were protective factors to general and central obesity in elderly.
Alencar, João Carlos Nascimento de; Leocadio-Miguel, Mario André; Duarte, Leandro Lourenção; Louzada, Fernando; Fontenele Araujo, John; Pedrazzoli, Mario
Daylight Saving Time (DST) annually moves clocks 1 hour forward, when daytime is longer than night. Previous studies from medium and high latitude locations have pointed to a disruptive effect of DST on human circadian rhythms. Since Brazil is an equatorial country implementing DST, a different relationship between photic and social synchronisers may interfere with DST effects. To explore the prevalence and duration of self-reported discomfort related to DST among Brazilian residents (latitude 12-33° S, longditude 39-57° W). It was hypothesised that an elevated prevalence of self-reported discomfort would be found in Brazil, due to the pronounced uncoupling between social and geophysical synchronisers. In total, 12 467 volunteers completed a web-based, Brazilian version of Horne-Östberg Morningness-Eveningness Questionnaire, provided demographic information, and answered questions related to DST complaints (discomfort, duration of discomfort). Of the total sample, 45.43% reported no discomfort related to DST, with meaningful proportions for all chronotypes. However, eveningness was most associated with discomfort. About one fourth of the total sample reported discomfort over the whole DST period. Gender interaction is largely supported by these results. DST at low latitude locations may be disruptive for circadian rhythms, since seasonality of sunrise near the equator is negligible or very mild.
Full Text Available ABSTRACT Background International studies have demonstrated an increase in the prevalence of boys and a decrease of patients’ age at the beginning of outpatient treatment for eating disorders (ED. Objective To evaluate if these changes are also present in the Brazilian population participating in the PROTAD, a Brazilian ED program, and to discuss its clinical implication for treatment. Methods Cross-sectional study. We evaluated 150 medical records of patients under 18 years diagnosed with ED (DSM IV-TR. Patients were divided into two groups: G1 (2001-2007 (n = 77 and G2 (2008-2014 (n = 73. The girl/boy proportion and the mean age of patients were compared. Results In G1, six boys (7.8% were admitted (girl/boy proportion: 11.8:1, while in G2, 16 (22% boys were admitted (girl/boy proportion: 3.5:1 (p 0.05. Discussion The increase in the number of boys treated for EDs reported in international studies was also found at the PROTAD. Contrary to what has been reported in international studies, the mean age of patients at the PROTAD did not decrease significantly. Gender and sexual orientation issues, clinical presentation, prior overweight history and culture/media impact on boys should be addressed by the healthcare team to increase the therapeutic efficacy.
Priscilla de Laet Sant'Ana
Full Text Available Oropharyngeal candidiasis continues to be considered the most common opportunistic disease in Aids patients. This study was designed to investigate species distribution, serotype and antifungal susceptibility profile among Candida spp. isolated from the oral cavity of Aids patients recruited from six Brazilian university centers. Oral swabs from 130 Aids patients were plated onto CHROMagar Candida medium and 142 isolates were recovered. Yeast isolates were identified by classical methods and serotyped using the Candida Check® system-Iatron. Antifungal susceptibility testing was performed according to the NCCLS microbroth assay. C. albicans was the most frequently isolated species (91%, and 70% of the isolates belonged to serotype A. We detected 12 episodes of co-infection (9%, including co-infection with both serotypes of C. albicans. Non-albicans species were isolated from 12 episodes, 50% of them exhibited DDS or resistance to azoles. Otherwise, only 8 out 130 isolates of C. albicans exhibited DDS or resistance to azoles. Brazilian Aids patients are infected mainly by C. albicans serotype A, most of them susceptible to all antifungal drugs.
Ada Ávila Assunção
Full Text Available ABSTRACT OBJECTIVE To describe the prevalence of work-related musculoskeletal disorder (WMSD and analyze the factors associated with this outcome in the Brazilian population. METHODS In this cross-sectional, population-based study, we use data from the National Survey on Health (PNS of 2013. The sample was composed of 60,202 Brazilians aged 18 years or older. The outcome variable was the occurrence of self-reported WMSD. Sociodemographic and occupational characteristics, personal resources, and health conditions were investigated as explanatory variables. Analyses were performed with the software Stata 12.0 and considered the weighting imposed by the sampling design of the study. Then, univariate and multivariate binary logistic models were carried out, considering a significance level of 5%. RESULTS The results obtained indicated that the prevalence of WMSD in the Brazilian population was of 2.5%, ranging from 0.2% (Acre to 4.2% (Santa Catarina. The factors associated with a greater chance of occurrence of WMSD were: female sex (OR = 2.33; 95%CI 1.72–3.15; be temporarily away from work (OR = 2.44; 95%CI 1.41–4.23; be exposed to noise at the workplace (OR = 2.16; 95%CI 1.68–2.77; seniority equal to or greater than 4.5 years at the current job (OR = 1.37; 95%CI 1.09–1.72; participate in volunteer work (OR = 1.65; 95%CI 1.25–2.17; report medical diagnosis of arthritis or rheumatism (OR = 2.40; 95%CI 1.68–3.44; and depression (OR = 2.48; 95%CI 1.86–3.31. On the other hand, factors associated with less chance of WMSD were: not having a partner (OR = 0.73; 95%CI 0.37–0.71 and working in an open environment (OR = 0.51; 95%CI 0.37–0.71. CONCLUSIONS The associated factors and the prevalence found indicate regional and gender differences. Special attention to comorbidities and environmental noise monitoring would benefit the health of workers in the Country.
Background In the period of adolescence physical appearance takes on significant importance in the construction of personal identity, including one's relationship with one's own body. A variety of social, cultural, psychological and personal factors influences the self-perception of dental appearance and the decision to undergo orthodontic treatment. Adolescents who seek orthodontic treatment are concerned with improving their appearance and social acceptance. The aim of the present study was to determine factors associated to the desire for orthodontic treatment among Brazilian adolescents and their parents. Methods The sample consisted of 403 subjects aged 14 to 18 years, selected randomly from a population of 182,291 schoolchildren in the same age group. The outcome variable "desire for orthodontic treatment" was assessed through a questionnaire. Self-perception of dental aesthetics was assessed using the Oral Aesthetic Subjective Impact Scale (OASIS) and the Dental Aesthetic Index (DAI) was used for clinical assessment. Statistical analysis involved the chi-square test as well as both simple and multiple logistic regression analyses. Results The majority (78%) of the Brazilian adolescents desired orthodontic treatment and 69% of the parents reported that their children were not in orthodontic treatment due to the high costs involved. There was significant association (p ≤ 0.05) between the desire for orthodontic treatment and most types of malocclusion. However, there was no significant association between the desire for orthodontic treatment and the variables gender and age. Conclusions The following were considered factors associated to the desire for treatment: upper anterior crowding ≥ 2 mm and parents' perception of their child's need for treatment. PMID:20021649
Carla Thais Rosada PERUCHI
Full Text Available Abstract The aim of this study was to investigate the association between oral health status and central obesity (CO in Brazilian independent-living elderly. A cross-sectional study was carried out in a sample of 489 elderly, who were participants of the Study on Aging and Longevity, in Londrina, state of Parana. The number of natural teeth and use of prostheses were evaluated according to the World Health Organization criteria. The presence of CO was assessed using measures of waist circumference (WC and waist-hip ratio (WHR. Information concerning sociodemographic profile and some systemic conditions was also collected. Data were analyzed using stepwise logistic regression, α=5%. According to WC and WHR measures, the prevalence of central obesity was 79.3% and 76.1%, respectively. CO according to WC was not associated with oral status. Considering the WHR measure, the following oral conditions were associated to CO: having fewer natural teeth (OR = 2.61; 95%CI = 1.17–5.80, being edentulous and wearing both upper and lower complete dentures (OR = 2.34; 95%CI = 1.11–4.93, and being edentulous wearing only the upper complete denture (OR = 2.64; 95%CI = 1.01–6.95. Traditional risk factors for CO such as gender, dyslipidemia, hypertension and diabetes were associated with both measures. A poor oral health due to extensive tooth loss, whether partial or complete, even if rehabilitated by removable prostheses, may be considered a good predictor of CO in Brazilian independent-living elderly.
Filogônio Cintia B
Full Text Available Abstract Background In the period of adolescence physical appearance takes on significant importance in the construction of personal identity, including one's relationship with one's own body. A variety of social, cultural, psychological and personal factors influences the self-perception of dental appearance and the decision to undergo orthodontic treatment. Adolescents who seek orthodontic treatment are concerned with improving their appearance and social acceptance. The aim of the present study was to determine factors associated to the desire for orthodontic treatment among Brazilian adolescents and their parents. Methods The sample consisted of 403 subjects aged 14 to 18 years, selected randomly from a population of 182,291 schoolchildren in the same age group. The outcome variable "desire for orthodontic treatment" was assessed through a questionnaire. Self-perception of dental aesthetics was assessed using the Oral Aesthetic Subjective Impact Scale (OASIS and the Dental Aesthetic Index (DAI was used for clinical assessment. Statistical analysis involved the chi-square test as well as both simple and multiple logistic regression analyses. Results The majority (78% of the Brazilian adolescents desired orthodontic treatment and 69% of the parents reported that their children were not in orthodontic treatment due to the high costs involved. There was significant association (p ≤ 0.05 between the desire for orthodontic treatment and most types of malocclusion. However, there was no significant association between the desire for orthodontic treatment and the variables gender and age. Conclusions The following were considered factors associated to the desire for treatment: upper anterior crowding ≥ 2 mm and parents' perception of their child's need for treatment.
Zander Neves, Camila; Devicari Bueno, Claudine; Pires Felden, Giovana; Costa Irigaray, Mariane; Rivadeneira, María Fernanda; Oenning, Nágila Soares Xavier; Goulart, Bárbara N G
To study the association between aspects of mental health and the family context with tobacco experimentation and consumption among Brazilian schoolchildren. A cross-sectional study using data from the National Survey of Schoolchildren's Health in Brazil conducted on 109,104 schoolchildren from the ninth year of elementary school, day scholars in public and private schools in all Brazilian state capitals and the Federal District. Descriptive analysis of variables, bivariate and multivariate analyses were performed with logistic regression estimates, adjusted for socioeconomic variables, obtaining the odds ratio (OR) and 95% confidence interval (95%CI). Among the participants, 52.2% were female. Twenty point nine percent of the students reported having experimented with cigarettes at least once. Adolescents who experienced more often feelings of loneliness (OR: 2.07; 95%CI: 1.98-2.16), difficulty sleeping (OR: 2.37; 95%CI: 2.52-2.48) and lower social interaction (OR: 1.27; 95%CI: 1.26-1.32), were more likely to smoke, regardless of socioeconomic status. The schoolchildren of parents or caregivers (OR: 2.39; 95%CI: 2.29-2.49) who did not know what their children did in their free time (OR: 1.52; 95%CI: 1.46-1.59) were associated with more frequent cigarette smoking. An association was seen between aspects of mental health and the family context with the experimentation and consumption of tobacco in adolescents enrolled in the study in Brazil. These associations are independent of school type, sex and skin colour. It is important that programmes for the prevention of tobacco use in adolescence emphasise these findings. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.
de Almeida Santana, Carla Caroliny; Farah, Breno Quintella; de Azevedo, Liane Beretta; Hill, James O; Gunnarsdottir, Thrudur; Botero, João Paulo; do Prado, Edna Cristina; do Prado, Wagner Luiz
Obesity has been associated with poor academic achievement, while cardiorespiratory fitness (CRF) has been linked to academic success. To investigate whether CRF is associated with academic performance in Brazilian students, independently of body mass index (BMI), fatness and socioeconomic status (SES). 392 5th and 6th grade students (193 girls) (12.11 ± 0.75 years old) were evaluated in 2012. Skinfold thickness measures were performed, and students were classified according to BMI-percentile. CRF was estimated by a 20-meter shuttle run test, and academic achievement by standardized math and Portuguese tests. Multiple linear regression analyses were conducted to explore the association between academic performance and CRF, adjusted for SES, skinfold thickness or BMI-percentile. Among girls CRF was associated with higher academic achievement in math (β = 0.146;p = .003) and Portuguese (β = 0.129;p = .004) in crude and adjusted analyses. No significant association was found among boys. BMI was not associated with overall academic performance. There was a weak negative association between skinfold thickness and performance in mathematics in boys (β =- 0.030;p = .04), but not in girls. The results highlight the importance of maintaining high fitness levels in girls throughout adolescence a period commonly associated with reductions in physical activity levels and CRF.
Paulo Roberto Lima Carreiro
Full Text Available OBJECTIVE: Show the steps of a Trauma Registry (TR implementation in a Brazilian public hospital and evaluate the initial data from the database.METHODS: Descriptive study of the a TR implementation in João XXIII Hospital (Hospital Foundation of the state of Minas Gerais and analysis of the initial results of the first 1,000 patients.RESULTS: The project was initiated in 2011 and from January 2013 we began collecting data for the TR. In January 2014 the registration of the first 1000 patients was completed. The greatest difficulties in the TR implementation were obtaining funds to finance the project and the lack of information within the medical records. The variables with the lowest completion percentage on the physiological conditions were: pulse, blood pressure, respiratory rate and Glasgow coma scale. Consequently, the Revised Trauma Score (RTS could be calculated in only 31% of cases and the TRISS methodology applied to 30.3% of patients. The main epidemiological characteristics showed a predominance of young male victims (84.7% and the importance of aggression as a cause of injuries in our environment (47.5%, surpassing traffic accidents. The average length of stay was 6 days, and mortality 13.7%.CONCLUSION: Trauma registries are invaluable tools in improving the care of trauma victims. It is necessary to improve the quality of data recorded in medical records. The involvement of public authorities is critical for the successful implementation and maintenance of trauma registries in Brazilian hospitals.
Carreiro, Paulo Roberto Lima; Drumond, Domingos André Fernandes; Starling, Sizenando Vieira; Moritz, Mônica; Ladeira, Roberto Marini
Show the steps of a Trauma Registry (TR) implementation in a Brazilian public hospital and evaluate the initial data from the database. Descriptive study of the a TR implementation in João XXIII Hospital (Hospital Foundation of the state of Minas Gerais) and analysis of the initial results of the first 1,000 patients. The project was initiated in 2011 and from January 2013 we began collecting data for the TR. In January 2014 the registration of the first 1000 patients was completed. The greatest difficulties in the TR implementation were obtaining funds to finance the project and the lack of information within the medical records. The variables with the lowest completion percentage on the physiological conditions were: pulse, blood pressure, respiratory rate and Glasgow coma scale. Consequently, the Revised Trauma Score (RTS) could be calculated in only 31% of cases and the TRISS methodology applied to 30.3% of patients. The main epidemiological characteristics showed a predominance of young male victims (84.7%) and the importance of aggression as a cause of injuries in our environment (47.5%), surpassing traffic accidents. The average length of stay was 6 days, and mortality 13.7%. Trauma registries are invaluable tools in improving the care of trauma victims. It is necessary to improve the quality of data recorded in medical records. The involvement of public authorities is critical for the successful implementation and maintenance of trauma registries in Brazilian hospitals.
Full Text Available The hypothesis of the role of iron overload associated with HFE gene mutations in the pathogenesis of nonalcoholic steatohepatitis (NASH has been raised in recent years. In the present study, biochemical and histopathological evidence of iron overload and HFE mutations was investigated in NASH patients. Thirty-two NASH patients, 19 females (59%, average 49.2 years, 72% Caucasians, 12% Mulattoes and 12% Asians, were submitted to serum aminotransferase and iron profile determinations. Liver biopsies were analyzed for necroinflammatory activity, architectural damage and iron deposition. In 31 of the patients, C282Y and H63D mutations were tested by PCR-RFLP. Alanine aminotransferase levels were increased in 30 patients, 2.42 ± 1.12 times the upper normal limit on average. Serum iron concentration, transferrin saturation and ferritin averages were 99.4 ± 31.3 g/dl, 33.1 ± 12.7% and 219.8 ± 163.8 µg/dl, respectively, corresponding to normal values in 93.5, 68.7 and 78.1% of the patients. Hepatic siderosis was observed in three patients and was not associated with architectural damage (P = 0.53 or with necroinflammatory activity (P = 0.27. The allelic frequencies (N = 31 found were 1.6 and 14.1% for C282Y and H63D, respectively, which were compatible with those described for the local population. In conclusion, no evidence of an association of hepatic iron overload and HFE mutations with NASH was found. Brazilian NASH patients comprise a heterogeneous group with many associated conditions such as hyperinsulinism, environmental hepatotoxin exposure and drugs, but not hepatic iron overload, and their disease susceptibility could be related to genetic and environmental features other than HFE mutations.
[Evaluation of performance of BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) in a Brazilian cohort of 1,492 patients with spondyloarthritis: data from the Brazilian Registry of Spondyloarthritides (RBE)].
da Costa, Izaias Pereira; Bortoluzzo, Adriana B; Gonçalves, Célio R; da Silva, José Antonio Braga; Ximenes, Antonio Carlos; Bértolo, Manoel B; Ribeiro, Sandra L E; Keiserman, Mauro; Menin, Rita; Skare, Thelma L; Carneiro, Sueli; Azevedo, Valderílio F; Vieira, Walber P; Albuquerque, Elisa N; Bianchi, Washington A; Bonfiglioli, Rubens; Campanholo, Cristiano; Carvalho, Hellen M S; Duarte, Angela L B Pinto; Kohem, Charles L; Leite, Nocy H; Lima, Sonia A L; Meirelles, Eduardo S; Pereira, Ivânio A; Pinheiro, Marcelo M; Polito, Elizandra; Resende, Gustavo G; Rocha, Francisco Airton C; Santiago, Mittermayer B; Sauma, Maria de Fátima L C; Valim, Valéria; Sampaio-Barros, Percival D
To analyze the results of the application of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in a large series of Brazilian patients with the diagnosis of SpA and establish its correlations with specific variables into the group. A common protocol of investigation was prospectively applied to 1492 Brazilian patients classified as SpA according to the European Spondyoarthropathies Study Group (ESSG), attended at 29 referral centers of Rheumatology in Brazil. Clinical and demographic variables, and disease indices (BASDAI, Basfi, Basri, Mases, ASQol) were applicated. The total values of BASDAI were compared to the presence of the different variables. The mean score of BASDAI was 4.20 ± 2.38. The mean scores of BASDAI were higher in patients with the combined (axial + peripheral + entheseal) (4.54 ± 2.38) clinical presentation, compared to the pure axial (3.78 ± 2.27) or pure peripheral (4.00 ± 2.38) clinical presentations (p<0.001). BASDAI also presented higher scores associated with the female gender (p<0.001) and patients who did not practice exercises (p < 0.001). Regarding the axial component, higher values of BASDAI were significantly associated with inflammatory low back pain (p<0.049), alternating buttock pain (p<0.001), cervical pain (p<0.001) and hip involvement (p<0.001). There was also statistical association between BASDAI scores and the peripheral involvement, related to the lower (p=0.004) and upper limbs (p=0.025). The presence of enthesitis was also associated to higher scores of BASDAI (p=0.040). Positive HLA-B27 and the presence of cutaneous psoriasis, inflammatory bowel disease, uveitis and urethritis were not correlated with the mean scores of BASDAI. Lower scores of BASDAI were associated with the use of biologic agents (p<0.001). In this heterogeneous Brazilian series of SpA patients, BASDAI was able to demonstrate "disease activity" in patients with axial as well as peripheral disease. Copyright © 2014 Elsevier Editora Ltda
Full Text Available Fanconi anemia is a rare hereditary disease showing genetic heterogeneity due to a variety of mutations in genes involved in DNA repair pathways, which may lead to different clinical manifestations. Phenotypic variability makes diagnosis difficult based only on clinical manifestations, therefore laboratory tests are necessary. New advances in molecular pathogenesis of this disease led researchers to develop a diagnostic test based on Western blot for FANCD2. The objective of the present study was to determine the efficacy of this method for the diagnosis of 84 Brazilian patients with Fanconi anemia, all of whom tested positive for the diepoxybutane test, and 98 healthy controls. The FANCD2 monoubiquitinated isoform (FANCDS+/FANCD2L- was not detected in 77 patients (91.7%. In 2 patients (2.4%, there was an absence of both the monoubiquitinated and the non-ubiquitinated proteins (FANCD2S-/FANCD2L- and 5 patients (5.9% had both isoforms (FANCD2S+/FANCD2L+. This last phenotype suggests downstream subtypes or mosaicism. All controls were diepoxybutane negative and were also negative on the FANCD2 Western blot. The Western blot for FANCD2 presented a sensitivity of 94% (79/84 and specificity of 100% (98/98. This method was confirmed as an efficient approach to screen Brazilian patients with deleterious mutations on FANCD2 (FANCD2S-/FANCD2L- or other upstream genes of the FA/BRCA pathway (FANCDS+/FANCD2L-, to confirm the chromosome breakage test and to classify patients according to the level of FA/BRCA pathway defects. However, patients showing both FANCD2 isoforms (FANCD2S+/FANCD2L+ require additional studies to confirm mutations on downstream Fanconi anemia genes or the presence of mosaicism.
Moraes, Augusto César Ferreira de; Falcão, Mário Cícero
Lifestyle variables have a key role in the development of abdominal obesity (AO). The objective of this study was to identify lifestyle factors and socioeconomic variables associated with AO in adolescents. This study carried out a school-based survey in the Brazilian city of Maringá in Paraná. The representative sample was of 991 adolescents (54.5% girls) from both public and private high schools selected through multi-stage random sampling. AO was classified according to waist circumference value. The independent variables studied were: gender, age, socioeconomic level, parental and household characteristics, smoking, alcohol use, physical inactivity, sedentary behaviour and nutrition-related habits. Poisson regression was used with robust variance adjustment to analyse the associations. The analysis was stratified by sexes. The prevalence of AO was 32.7% (girls = 36.3%, boys = 28.4%). In girls, excessive intake of fried foods was inversely associated with AO and excessive consumption of soda was positively associated. In boys, the results demonstrated a negative association with excessive consumption of sweets and soda. It is concluded that the prevalence of AO among adolescents was higher in both sexes. AO is associated with different eating habits in females and males and these relationships are mediated by familial contexts.
Schellini, Silvana; Ferraz, Fabio; Opromolla, Paula; Oliveira, Laryssa; Padovani, Carlos
To determine the main visual symptoms in a Brazilian population sample, associated to refractive errors (REs) and spectacle need to suggest priorities in preventive programs. A cross-sectional study was conducted in nine counties of the southeast region of Brazil, using a systematic sampling of households, between March 2004 and July 2005. The population was defined as individuals aged between 1 and 96y, inhabitants of 3600 residences to be evaluated and 3012 households were included, corresponding to 8010 subjects considered for participation in the survey, of whom 7654 underwent ophthalmic examinations. The individuals were evaluated according their demographic data, eye complaints and eye examination including the RE and the need to prescribe spectacles according to age. Statistical analysis was performed using SPSS software package and descriptive analysis using 95% confidence intervals (PBrazilian population.
Augusto, Rosangela Aparecida; Cobayashi, Fernanda; Cardoso, Marly Augusto
We examined associations between the frequency of fruit and vegetable (F&V) consumption and nutritional deficiencies among Brazilian schoolchildren. A cross-sectional, population-based study was performed. A short FFQ was used to assess consumption of fruits and vegetables (F&V) over the past month. The prevalence ratios (PR) and 95 % confidence intervals for stunting, obesity, anaemia, vitamin A and folate deficiencies, vitamin E and vitamin D insufficiencies were estimated for low F&V consumption frequency (vegetables ≤ 3 times/month and fruits ≤ 3 times/week) and compared with children with usual F&V consumption frequency (vegetables ≥ 1 time/week and fruits ≥ 4 times/week). Acrelândia, Western Brazilian Amazon. A total of 702 children aged 4-10 years. Only 5 % of children consumed F&V ≥ 5 times/d. Prevalence of deficiency was 31 %, 15 %, 9 % and 2 % for vitamins D, A, E and folate, respectively. Overall, 6.3% of children were anaemic, 3.3% were stunted, 2.7% were obese and 33 % had multiple nutritional deficiencies. Low frequency of F&V consumption was associated with lower plasma concentrations of carotenoids and vitamin E. Nutritional deficiencies were higher among non-consumers of F&V when compared with usual consumers: anaemia (PR=1.9; 95 % CI 1.0, 3.7), vitamin E insufficiency (PR=2.5; 95% CI 1.5, 4.2), vitamin D insufficiency (PR=1.5; 95% CI 1.1, 1.9) and stunting (PR=2.6; 95% CI 1.1, 6.1). In our study, the occurrence of nutritional deficiencies in children with low F&V consumption was twice as high as in children with usual F&V consumption, reinforcing the importance of effective actions to promote the consumption of F&V.
Gustavo Goncalves Arliani
Full Text Available OBJECTIVE: This study aims to establish a national methodological model for epidemiological studies on professional soccer player injuries and to describe the numerous relevant studies previously published on this topic. INTRODUCTION: The risk of injury in professional soccer is high. However, previous studies of injury risk in Brazil and other countries have been characterized by large variations in study design and data collection methods as well as definitions of injury, standardized diagnostic criteria, and recovery times. METHODS: A system developed by the Union of European Football for epidemiological studies on professional soccer players is being used as a starting point to create a methodological model for the Brazilian Football Association. To describe the existing studies on professional soccer player injuries, we developed a search strategy to identify relevant epidemiological studies. We included the Latin American and Caribbean Center on Health Sciences and Medline databases in our study. RESULTS: We considered 60 studies from Medline and 16 studies from the Latin American and Caribbean Center on Health Sciences in the final analysis. Twelve studies were selected for final inclusion in this review: seven from the Latin American and Caribbean Center on Health Sciences and five from Medline. We identified a lack of uniformity in the study design, data collection methods, injury definitions, standardized diagnostic criteria, and the definition of recovery time. Based on the information contained within these articles, we developed a model for epidemiological studies for the Brazilian Football Association. CONCLUSIONS: There is no uniform model for epidemiological studies of professional soccer injuries. Here, we propose a novel model to be applied for epidemiological studies of professional soccer player injuries in Brazil and throughout the world.
Arliani, Gustavo Gonçalves; Belangero, Paulo Santoro; Runco, Jose Luiz; Cohen, Moisés
This study aims to establish a national methodological model for epidemiological studies on professional soccer player injuries and to describe the numerous relevant studies previously published on this topic. The risk of injury in professional soccer is high. However, previous studies of injury risk in Brazil and other countries have been characterized by large variations in study design and data collection methods as well as definitions of injury, standardized diagnostic criteria, and recovery times. A system developed by the Union of European Football for epidemiological studies on professional soccer players is being used as a starting point to create a methodological model for the Brazilian Football Association. To describe the existing studies on professional soccer player injuries, we developed a search strategy to identify relevant epidemiological studies. We included the Latin American and Caribbean Center on Health Sciences and Medline databases in our study. We considered 60 studies from Medline and 16 studies from the Latin American and Caribbean Center on Health Sciences in the final analysis. Twelve studies were selected for final inclusion in this review: seven from the Latin American and Caribbean Center on Health Sciences and five from Medline. We identified a lack of uniformity in the study design, data collection methods, injury definitions, standardized diagnostic criteria, and the definition of recovery time. Based on the information contained within these articles, we developed a model for epidemiological studies for the Brazilian Football Association. There is no uniform model for epidemiological studies of professional soccer injuries. Here, we propose a novel model to be applied for epidemiological studies of professional soccer player injuries in Brazil and throughout the world.
Silva Vilma A da
Full Text Available OBJECTIVES: To investigate developmental and environmental factors associated to substance misuse in adolescents seen at a university day-hospital in Brazil and to verify the correlations between those factors and adherence to treatment. To compare factors associated to substance misuse in adolescents with the available scientific literature and to suggest specific preventive interventions for a national policy in Brazil. METHODS: Eighty-six adolescent's guardians were evaluated at admission to the service by using a semistructured interview including sociodemographic data, family relationship, perinatal and pregnancy histories, psychomotor and educational development, social relations, history of previous illnesses and family diseases, including drug abuse. RESULTS: The sample was predominantly male (90%. Adolescents referred from the criminal justice were older than those originating from other sources (16.4 x 15.4 years old p=.00. Forty-four percent of adolescents reported school failure, a level which is two times higher than Brazilian statistics. Forty percent of the sample had criminal involvement, mainly drug dealing. Cannabis was the most prevalent reported drug. Living with both parents was protective, delaying the age of initiation by one year. Domestic violence was more frequent among parents with illicit drugs abuse (38.1% x 12.5%, p<.05. Alcoholism and drug addiction in parents and relatives were about four times higher than those reported for the Brazilian population. No correlation was found between the investigated factors and adherence to treatment. CONCLUSION: Our results indicate that the programs must include treatment of adults and education of parents and parents to be. Withdrawal of treatment occurs in the first month, and seems to be related to factors extrinsic to the adolescent.
Sandra Maria Sampaio Enes
Full Text Available Abstract OBJECTIVE To identify the presence of phlebitis and the factors that influence the development of this complication in adult patients admitted to hospital in the western Brazilian Amazon. METHOD Exploratory study with a sample of 122 peripheral intravenous catheters inserted in 122 patients in a medical unit. Variables related to the patient and intravenous therapy were analyzed. For the analysis, we used chi-square tests of Pearson and Fisher exact test, with 5% significance level. RESULTS Complication was the main reason for catheter removal (67.2%, phlebitis was the most frequent complication (31.1%. The mean duration of intravenous therapy use was 8.81 days in continuous and intermittent infusion (61.5%, in 20G catheter (39.3%, inserted in the dorsal hand vein arc (36.9 %, with mean time of usage of 68.4 hours. The type of infusion (p=0.044 and the presence of chronic disease (p=0.005 and infection (p=0.007 affected the development of phlebitis. CONCLUSION There was a high frequency of phlebitis in the sample, being influenced by concomitant use of continuous and intermittent infusion of drugs and solutions, and more frequent in patients with chronic diseases and infection.
Joao Luiz Bastos
Full Text Available Although research on discrimination and health has progressed significantly, it has tended to focus on racial discrimination and US populations. This study explored different types of discrimination, their interactions and associations with common mental disorders among Brazilian university students, in Rio de Janeiro in 2010. Associations between discrimination and common mental disorders were examined using multiple logistic regression models, adjusted for confounders. Interactions between discrimination and socio-demographics were tested. Discrimination attributed to age, class and skin color/race were the most frequently reported. In a fully adjusted model, discrimination attributed to skin color/race and class were both independently associated with increased odds of common mental disorders. The simultaneous reporting of skin color/race, class and age discrimination was associated with the highest odds ratio. No significant interactions were found. Skin color/race and class discrimination were important, but their simultaneous reporting, in conjunction with age discrimination, were associated with the highest occurrence of common mental disorders.
Drehmer, Michele; Pereira, Mark A; Schmidt, Maria Inês; Del Carmen B Molina, Maria; Alvim, Sheila; Lotufo, Paulo A; Duncan, Bruce B
Inverse associations between dairy intake and the risk of type 2 diabetes have been shown, but more studies are needed, especially from low- and middle-income countries. The objective was to describe the association between dairy products and direct measures of glycemic status in adults without known diabetes. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) includes 15,105 adults, aged 35-74 y, enrolled from universities and research institutions in 6 Brazilian capital cities. We excluded participants with a known diabetes diagnosis, cardiovascular diseases, and cancer. Dairy consumption was assessed by a food-frequency questionnaire, and we computed servings per day for total and subgroups of dairy. Associations with fasting blood glucose (FG) and fasting insulin, 2-h postload glucose (PG), 2-h postload insulin (PI), glycated hemoglobin (Hb A1c), and homeostasis model assessment of insulin resistance (HOMA-IR) were assessed through multivariable linear regression analysis with adjustment for demographic characteristics, behavioral risk factors, other dietary factors, and anthropometric measurements. The sample size after exclusions was 10,010. The intake of total dairy was inversely associated with FG (linear β for dairy servings/d = -0.46 ± 0.2 mg/dL), PG (-1.25 ± 0.5 mg/dL), PI (-1.52 ± 0.6 mg/dL), Hb A1c (-0.02 ± 0.0%), and HOMA-IR (-0.04 ± 0.0) after adjustment for all covariates (P obesity status, and dairy fat amount (reduced-fat vs. full-fat dairy). Fermented dairy products showed particularly strong inverse associations with the outcomes, with adjusted differences for a 1-serving/d increment of -0.24 (95% CI: -0.46, -0.02) mg/dL for FG, -0.86 (-1.42, -0.30) mg/dL for PG, and -0.01% (-0.02%, 0.00%) for Hb A1c. Myristic acid was the only nutrient that appeared to mediate the association between dairy intake and glycemia. Dairy intake, especially fermented dairy, was inversely associated with measures of glycemia and insulinemia in
Rafael Corrêa Coelho
Full Text Available ABSTRACT Purpose: The aim of this study was to assess the impact of sunitinib treatment in a non-screened group of patients with metastatic renal cell cancer (mRCC treated by the Brazilian Unified Health System (SUS at a single reference institution. Material and Methods: Retrospective cohort study, which evaluated patients with mRCC who received sunitinib between May 2010 and December 2013. Results: Fifty-eight patients were eligible. Most patients were male 41 (71%, with a median age of 58 years. Nephrectomy was performed in 41 (71% patients with a median interval of 16 months between the surgery and initiation of sunitinib. The most prevalent histological subtype was clear cell carcinoma, present in 52 (91.2% patients. In 50 patients (86%, sunitinib was the first line of systemic treatment. The main adverse effects were fatigue (57%, hypothyroidism (43%, mucositis (33% and diarrhea (29%. Grade 3 and 4 adverse effects were infrequent: fatigue (12%, hypertension (12%, thrombocytopenia (7%, neutropenia (5% and hand-foot syndrome (5%. Forty percent of patients achieved a partial response and 35% stable disease, with a disease control rate of 75%. Median progression free survival was 7.6 months and median overall survival was 14.1 months. Conclusion: Sunitinib treatment was active in the majority of patients, especially those with low and intermediate risk by MSKCC score, with manageable toxicity. Survival rates were inferior in this non-screened population with mRCC treated in the SUS.
Sanchez, Zila M; Locatelli, Danilo P; Noto, Ana R; Martins, Silvia S
Socioeconomic status (SES) may be directly associated with binge drinking (BD) and country inequality. The aims of this study were to describe the characteristics of BD among high school students in Brazil and the association of BD with students' socioeconomic status in the five different Brazilian macro-regions. A national cross sectional survey was carried out using a multistage probabilistic sample of 17,297 high school students aged 14-18 years drawn from 789 public and private schools in each of the 27 Brazilian state capitals. Self-report data about BD behaviors and SES were analyzed via weighted logistic regressions and a funnel plot. Almost 32% of the students engaged in BD in the past-year. Being in the highest SES stratum doubled the risk of BD among students in all five Brazilian macro-regions. There was a gradient in the association between past-year BD and socioeconomic status: as SES increased; the chance of having recently engaged in BD also increased. In Brazilian capitals as a whole, being a boy versus being a girl (adjusted odds ratio - aOR=1.40 [95%CI 1.26; 1.58]), being older (aOR=1.47 [95%CI 1.40; 1.55]) and attending private versus public schools (aOR=1.39 [95%CI 1.18; 1.62]) were associated with greater risk for BD. Contrary to what is observed in developed countries, students living in Brazilian capitals may be at an increased risk of BD when they belong to the highest socioeconomic status. There might be similar associations between high SES and BD among adolescents growing up in other emerging economies. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
Azevedo, Valderilio Feijó; Rossetto, Chayanne N; Lorencetti, Pedro G; Tramontin, Mariana Y; Fornazari, Bruna; Araújo, Denizar V
Patients with ankylosing spondylitis require a team approach from multiple professionals, various treatment modalities for continuous periods of time, and can lead to the loss of labour capacity in a young population. So, it is necessary to measure its socio-economic impact. To describe the use of public resources to treat AS in a tertiary hospital after the use of biological medications was approved for treating spondyloarthritis in the Health Public System, establishing approximate values for the direct and indirect costs of treating this illness in Brazil. 93 patients selected from the ambulatory spondyloarthritis clinic at the Hospital de Clínicas of the Federal University of Paraná between September 2011 and September 2012 had their direct costs indirect treatment costs estimation. 70 patients (75.28%) were male and 23 (24.72%) female. The mean age was 43.95 years. The disease duration was calculated based on the age of diagnosis and the mean was 8.92 years (standard deviation: 7.32); 63.44% were using anti-tumour necrotic factor drugs. Comparing male and female patients the mean Bath Ankylosing Spondylitis Disease Activity Index was 4.64 and 5.49 while the mean Bath Ankylosing Spondylitis Functional Index was 5.03 and 6.35 respectively. The Brazilian public health system's spending related to ankylosing spondylitis has increased in recent years. An important part of these costs is due to the introduction of new, more expensive health technologies, as in the case of nuclear magnetic resonance and, mainly, the incorporation of anti-tumour necrotic factor therapy into the therapeutic arsenal. The mean annual direct and indirect cost to the Brazilian public health system to treat a patient with ankylosing spondylitis, according to our findings, is US$ 23,183.56. Copyright © 2015 Elsevier Editora Ltda. All rights reserved.
Andréa Lúcia de Almeida Carvalho
Full Text Available This study aimed to assess the prevalence of bruxism and emotional stress in Brazilian police officers, due to exposure to stressful situations, and to assess the relationship between the type of work done by a police officer and the presence of bruxism and emotional stress. A cross-sectional study was conducted at the Military Police of the State of São Paulo, Campinas, SP, Brazil. The final sample included 394 male police officers (mean age = 35.5 years. Bruxism was diagnosed by the presence of aligned dental wear facets associated with the presence of one of the following signs or symptoms: self-report of tooth-grinding, painful sensitivity of the masseter and temporal muscles, discomfort in the jaw musculature upon waking. The Stress Symptoms Inventory (SSI was applied to evaluate emotional stress. The type of work done by the police was classified as organizational or operational, the latter being assumed as the more stressful since it exposes the police officer to life risk. The results showed a prevalence of bruxism of 50.2% and a prevalence of emotional stress of 45.7%. The Chi-square test indicated an association between stress and bruxism (P < .05. No significant association was found between emotional stress and type of work (P = .382 or between bruxism and work activity (P = .611. It could be concluded that emotional stress was associated with bruxism, independently of the type of work done by police officers.
Santos, Eliane Barbosa; Lucio, Paulo Sérgio; Santos e Silva, Cláudio Moisés
The objective of this study is to characterize the atmospheric patterns associated with the occurrence of intense precipitation events (IPE) in different sub-regions of the Brazilian Amazon. Intense rainfall cases over six sub-regions were selected from a precipitation data set for the period from 1983 to 2012. The composition technique was used to characterize the prevailing atmospheric patterns for the occurrence of IPE. In the south of the Amazon, the composition fields showed a favorable configuration for the formation of the South Atlantic Convergence Zone (SACZ). Along the coast, the intense precipitation events must be associated with mesoscale systems, such as squall lines. In the northwest, they are apparently associated with the Intertropical Convergence Zone (ITCZ) and/or local convection. The results reveal the complexity of the synoptic environment associated with the formation and development of weather systems that produce heavy rainfall in the Amazon Basin. Several factors can interfere as conditions in large-scale, local conditions and thermodynamic factors.
Hercílio Paulino ANDRÉ
Full Text Available ABSTRACT Objective To evaluate factors associated with the iron nutritional status of Brazilian children aged 4 to 7 years in the city of Viçosa, Minas Gerais state, Brazil. Methods This is a cross-sectional study of 357 children aged 4-7 years who had been followed-up up for during their first six months of life by the Breastfeeding Support Program. Socioeconomic and demographic characteristics, feeding practices, nutritional status (height-for-age and body mass index-for-age, and serum ferritin and hemoglobin concentrations were evaluated. Multiple linear regression analysis was carried out to evaluate factors independently associated with iron nutritional status (hemoglobin and ferritin, considering α=0.05 as the significance level. Results The prevalence of anemia and iron deficiency was (34 9.52% and (11 11.00%, respectively. The factors independently associated with anemia were younger child age, low maternal education, low height-for-age Z-scores, and children of single and separated mothers or widows. Iron deficiency was associated with child younger age and consumption of chocolates and chocolate flavored milk. Conclusion The results obtained allow us to conclude that anemia among children 4-7 years of age is a public health problem in the city of Viçosa, Minas Gerais. Therefore, there is a need for intervention measures targeting children in this age group. These measures can be implemented through food and nutritional education by encouraging the consumption of iron-rich foods.
Fernanda D.B. Abadio Finco
Full Text Available The purpose of this study was to investigate the nutritional situation of rural adults in the Brazilian Amazon. Anthropometric measurements (height, weight and waist circumference were taken from all participants. BMI was calculated. Dietary intake was assessed by 24 h recall and food patterns were assessed by food frequency questionnaires (FFQ. Energy expenditure was calculated from the resting metabolic rate multiplied by an activity factor based on physical activity. Linear regression was applied to assess variables associated to BMI. Participants of the study comprised 58 men and 50 women. The mean (±standard deviation age of the study population was 44.0 ± 12 years for women and 47.0 ± 15.0 year for men. The BMI for normal weight men was 22.16 ± 1.57 whereas for the overweight group was 28.33 ± 2.58 kg. Overweight and obese adults together comprise 60.2% of the study sample and therefore were considered as one group. Normal weight individuals had higher values of PAL (physical activity level than overweight persons for both sex. There was no statistical difference between the groups concerning the intake of protein, kilocalories from protein and percentage of energy from protein. The physical activity level of participants describes a sedentary profile for women in the rural communities for both groups. The food pattern of surveyed people is based on rice, beans and meat as daily food. The prevalence of overweight and obesity altogether is comparable to that reported by other studies for Brazilian rural areas. The dietetic assessment revealed that energy expenditure was significantly different between normal weight and overweight women. Physical activity was shown to be a relevant factor for overweight in the two rural communities. The food pattern of the two communities expresses a monotonous diet.
Full Text Available Morquio A Syndrome (mucopolysaccharidosis IVA - MPS IVA, OMIM# 253000 is an autosomal recessive inborn error of metabolism caused by the deficiency of N-acetylgalactosamine-6-sulfate sulfatase (GALNS. We investigated five unrelated Brazilian MPS IVA families for mutations in exons 4, 5, 9 and 10 of the GALNS gene. Six out of the 10 mutant alleles were identified. Taken together with a previous study, which included six unrelated families, common mutations among Brazilian patients were p.N164T, p.G116S and p.G301C. Among one hundred control subjects three novel silent mutations were found (p.A107A; GCC -> GCT, p.Y108Y; TAC -> TAT, p.P357P; CCG -> CCA. Screening starting with exons 4, 5, 9, 10 and 11 may be a good strategy for genotyping of Brazilian patients since these exons include 73% of all mutations identified in the current and previous studies.
Full Text Available Mutations in Bruton's tyrosine kinase (BTK gene are responsible for X-linked agammaglobulinemia (XLA, which is characterized by recurrent bacterial infections, profound hypogammaglobulinemia, and decreased numbers of mature B cells in peripheral blood. We evaluated 5 male Brazilian patients, ranging from 3 to 10 years of age, from unrelated families, whose diagnosis was based on recurrent infections, markedly reduced levels of IgM, IgG and IgA, and circulating B cell numbers <2%. BTK gene analysis was carried out using PCR-SSCP followed by sequencing. We detected three novel (Ala347fsX55, I355T, and Thr324fsX24 and two previously reported mutations (Q196X and E441X. Flow cytometry revealed a reduced expression of BTK protein in patients and a mosaic pattern of BTK expression was obtained from mothers, indicating that they were XLA carriers.
Ramalho, V D; Oliveira Júnior, E B; Tani, S M; Roxo Júnior, P; Vilela, M M S
Mutations in Bruton's tyrosine kinase (BTK) gene are responsible for X-linked agammaglobulinemia (XLA), which is characterized by recurrent bacterial infections, profound hypogammaglobulinemia, and decreased numbers of mature B cells in peripheral blood. We evaluated 5 male Brazilian patients, ranging from 3 to 10 years of age, from unrelated families, whose diagnosis was based on recurrent infections, markedly reduced levels of IgM, IgG and IgA, and circulating B cell numbers <2%. BTK gene analysis was carried out using PCR-SSCP followed by sequencing. We detected three novel (Ala347fsX55, I355T, and Thr324fsX24) and two previously reported mutations (Q196X and E441X). Flow cytometry revealed a reduced expression of BTK protein in patients and a mosaic pattern of BTK expression was obtained from mothers, indicating that they were XLA carriers.
Hahn, Eriza Cristina; Zambra, Francis Maria Báo; Kamada, Anselmo Jiro; Delongui, Francieli; Grion, Cíntia Magalhães Carvalho; Reiche, Edna Maria Vissoci; Chies, José Artur Bogo
The human leukocyte antigen G (HLA-G) is a molecule involved in immune system modulation, acting in the maintenance of a state of immune tolerance. Some polymorphisms in the HLA-G gene 3' untranslated region (3'UTR) were associated to distinct levels of HLA-G expression and to sepsis development. In the present study, haplotypes and polymorphisms of the HLA-G 3'UTR were analyzed in Brazilian septic patients. The HLA-G 3'UTR was amplified by PCR, sequenced and eight polymorphisms were genotyped (the 14bp insertion/deletion, +3003T/C, +3010C/G, +3027A/C, +3035C/T, +3142G/C, +3187A/G and+3196C/G) in DNA samples from septic patients (with severe sepsis or septic shock) and controls. The haplotypes were inferred and association tests were performed through Chi square test and binary logistic regression. The+3027AC genotype was associated asa risk factor to sepsis development (OR 3.17, P Bonferroni 0.048). Further, the presence of the UTR-7 haplotype (OR 2.97, P Bonferroni 0.018), and of 14bp-Ins_+3142G_+3187A haplotype (OR 2.39, P Bonferroni 0.045) were associated with sepsis, conferring susceptibility. Our data confirm an important role of HLA-G 3'UTR polymorphisms in the development of severe forms of sepsis (severe sepsis and septic shock). The genotyping of HLA-G genetic variants and haplotypes could be useful as a prediction tool of increased risk to severe sepsis. Copyright © 2017 American Society for Histocompatibility and Immunogenetics. Published by Elsevier Inc. All rights reserved.
Amanda Vansan Marangon
Full Text Available The genetic variability of the host contributes to the risk of human papillomavirus (HPV-related cervical disease. Immune response genes to HPV must be investigated to define patients with the highest risk of developing malignant disease. The aim of this study was to investigate the association of polymorphic immune response genes, namely KIR, HLA class I and II, and single-nucleotide polymorphisms (SNPs of cytokines with HPV-related cervical disease. We selected 79 non-related, admixed Brazilian women from the state of Paraná, southern region of Brazil, who were infected with high carcinogenic risk HPV and present cervical intraepithelial neoplasia grade 3 (CIN3, and 150 HPV-negative women from the same region matched for ethnicity. KIR genes were genotyped using an in-house PCR-SSP. HLA alleles were typed using a reverse sequence-specific oligonucleotide technique. SNPs of TNF −308G>A, IL6 −174G>C, IFNG +874T>A, TGFB1 +869T>C +915G>C, and IL10 −592C>A −819C>T −1082G>A were evaluated using PCR-SSP. The KIR genes were not associated with HPV, although some pairs of i(inhibitoryKIR-ligands occurred more frequently in patients, supporting a role for NK in detrimental chronic inflammatory and carcinogenesis. Some HLA haplotypes were associated with HPV. The associations of INFG and IL10 SNPs potentially reflect impaired or invalid responses in advanced lesions.
Gomes, Walter J; Moreira, Rita Simone; Zilli, Alexandre Cabral; Bettiati, Luiz Carlos; Figueira, Fernando Augusto Marinho Dos Santos; D' Azevedo, Stephanie Steremberg Pires; Soares, Marcelo José Ferreira; Fernandes, Marcio Pimentel; Ardito, Roberto Vito; Bogdan, Renata Andrea Barberio; Campagnucci, Valquíria Pelisser; Nakasako, Diana; Kalil, Renato Abdala Karam; Rodrigues, Clarissa Garcia; Rodrigues, Anilton Bezerra; Cascudo, Marcelo Matos; Atik, Fernando Antibas; Lima, Elson Borges; Nina, Vinicius José da Silva; Heluy, Renato Albuquerque; Azeredo, Lisandro Gonçalves; Henrique, Odilon Silva; Mendonça, José Teles de; Silva, Katharina Kelly de Oliveira Gama; Pandolfo, Marcelo; Lima, José Dantas de; Faria, Renato Max; Santos, Jonas Pereira Dos; Paez, Rodrigo Pereira; Coelho, Guilherme Henrique Biachi; Pereira, Sergio Nunes; Senger, Roberta; Buffolo, Enio; Caputi, Guido Marco; Santo, José Amalth do Espírito; Oliveira, Juliana Aparecida Borges de; Berwanger, Otavio; Cavalcanti, Alexandre Biasi; Jatene, Fabio B
To report the early results of the BYPASS project - the Brazilian registrY of adult Patient undergoing cArdiovaScular Surgery - a national, observational, prospective, and longitudinal follow-up registry, aiming to chart a profile of patients undergoing cardiovascular surgery in Brazil, assessing the data harvested from the initial 1,722 patients. Data collection involved institutions throughout the whole country, comprising 17 centers in 4 regions: Southeast (8), Northeast (5), South (3), and Center-West (1). The study population consists of patients over 18 years of age, and the types of operations recorded were: coronary artery bypass graft (CABG), mitral valve, aortic valve (either conventional or transcatheter), surgical correction of atrial fibrillation, cardiac transplantation, mechanical circulatory support and congenital heart diseases in adults. 83.1% of patients came from the public health system (SUS), 9.6% from the supplemental (private insurance) healthcare systems; and 7.3% from private (out-of -pocket) clinic. Male patients comprised 66%, 30% were diabetics, 46% had dyslipidemia, 28% previously sustained a myocardial infarction, and 9.4% underwent prior cardiovascular surgery. Patients underwent coronary artery bypass surgery were 54.1% and 31.5% to valve surgery, either isolated or combined. The overall postoperative mortality up to the 7th postoperative day was 4%; for CABG was 2.6%, and for valve operations, 4.4%. This first report outlines the consecution of the Brazilian surgical cardiac database, intended to serve primarily as a tool for providing information for clinical improvement and patient safety and constitute a basis for production of research protocols.
Almeida Lopes, Ana Carolina Bertin de; Silbergeld, Ellen Kovner; Navas-Acien, Ana; Zamoiski, Rachel; Martins, Airton da Cunha; Camargo, Alissana Ester Iakmiu; Urbano, Mariana Ragassi; Mesas, Arthur Eumann; Paoliello, Monica Maria Bastos
Environmental lead exposure among adults may increase blood pressure and elevate the risk of hypertension. The availability of data on blood lead levels (BLL) in adult Brazilian population is scarce and population-based studies are important for screening the population exposure and also to evaluate associations with adverse health effects. The goal of this study was to examine the association of BLL with blood pressure and hypertension in a population-based study in a city in Southern Brazil. A total of 948 adults, aged 40 years or older, were randomly selected. Information on socioeconomic, dietary, lifestyle and occupational background was obtained by orally administered household interviews. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured according to the guidelines VI Brazilian Guidelines on Hypertension. BLL were measured by inductively coupled plasma mass spectrometry technique. Multiple linear and logistic regression models were performed to evaluate associations of BLL with SBP and DBP, and with the chance of hypertension and of elevated SBP and DBP. The geometric mean of BLL was 1.97 μg/dL (95%CI:1.90-2.04 μg/dL). After multivariable adjustment, participants in the quartile 4 of blood lead presented 0.06 mm/Hg (95%CI, 0.04-0.09) average difference in DBP comparing with those in quartile 1. Participants in the 90th percentile of blood lead distribution had 0.07 mmHg (95% CI, 0.03 to 0.11) higher DBP compared with those participants in the 10th percentile of blood lead. The adjusted OR for hypertension was 2.54 (95% CI, 1.17-5.53), comparing the highest to the lowest blood lead quartiles. Compared with participants in the 10th percentile of blood lead, participants in the 90th percentile presented higher OR for hypertension (OR: 2.77; 95% CI, 1.41 to 5.46). At low concentrations, BLL were positively associated with DBP and with the odds for hypertension in adults aged 40 or older. It is important to enforce lead
Arruda, Soraia Pinheiro Machado; da Silva, Antônio Augusto Moura; Kac, Gilberto; Goldani, Marcelo Zubaran; Bettiol, Heloisa; Barbieri, Marco Antônio
The aim of the present study was to identify the main dietary patterns among young adults and to investigate the association of socioeconomic and demographic factors, and social mobility with dietary patterns. Data from the fourth follow-up of the 1978/79 Ribeirão Preto birth cohort study, Brazil, were used. A total of 2,061 young adults, whose mothers gave sociodemographic information at birth in 1978-79, provided sociodemographic and dietary data through a validated food frequency questionnaire in 2002-2004, when they were aged 23-25 years. Those whose caloric intake was outside of the ±3 standard deviation range were excluded, leaving 2,034 individuals. The dietary patterns were identified by principal component analysis followed by varimax orthogonal rotation. Poisson regression with robust estimation of variance was used to derive prevalence ratios (PR). Four dietary patterns were identified: healthy, traditional Brazilian, energy-dense and bar. In the adjusted analysis, individuals with higher schooling (≥12 years) in adult life (PR = 1.51, 95% CI: 1.07-2.14) showed greater adherence whilst men (PR = 0.79, 95% CI: 0.68-0.93) had lower adherence to the healthy pattern. The highest adherence to the traditional Brazilian pattern was found for men (PR = 2.39, 95% CI: 2.04-2.80), mullatos (PR = 1.41, 95% CI: 1.21-1.64), households with ≥2 members, and for those with children (PR = 1.28, 95% CI: 1.07-1.55) while individuals with higher schooling in adulthood (≥12 years) (PR = 0.47, 95% CI: 0.34-0.65), higher family income in adulthood (≥20 MW) (PR = 0.57, 95% CI: 0.33-0.99) and higher family income at birth (≥6.1 MW) showed lower adherence. The bar pattern was positively associated with male sex (PR = 2.96, 95% CI: 2.47-3.55) and low schooling (≤8 years). The energy-dense pattern was not associated with any of the variables investigated. Social mobility was associated with the traditional Brazilian pattern. Men and
Watanabe Marlívia G.C.
Full Text Available The aim of this study was to measure the caries prevalence in the root surface in a group of Brazilian adults. The prevalence and their intraoral distribution of caries lesions of root surface were assessed in dental patients ranging in age from 35 to 44 and from 50 to 59 years of age of both sexes (n=360. A total of 98.9% had root surfaces with gingival recession and 78.1% had at least one root caries lesion. The prevalence of the disease was analyzed using the Root Caries Index (RCI. The average value was greater for women (18.6% than for men (13.4% (p0.01. The maxillary canines and first premolars and the mandibular molars presented the greatest RCI values. The RCI was greater in the proximal surface of the maxilla and buccal surface of the mandible. We conclude that caries of the root surface are present in the Brazilian population and deserve attention concerning their actual role in the epidemiology of principal oral diseases of the adult population.
Azeredo, Catarina Machado; Levy, Renata Bertazzi; Araya, Ricardo; Menezes, Paulo Rossi
Few studies have been carried out in low- middle-income countries assessing contextual characteristics associated with bullying. This study aimed to assess the relative importance of contextual (school and city) and individual-level factors to explain the variance in verbal bullying among a nationally representative sample of Brazilian adolescents. 59,348 students from 1,453 schools and 26 state capitals and the Federal District participated in the National Survey of School Health among 9th Grade Students (PeNSE, 2009). We performed multilevel logistic regression in a three level model (individual, school and city). The 30-day prevalence of verbal bullying among these students was 14.2%. We found that 1.8% and 0.3% of the total variance in bullying occurred at school-level and city-level, respectively, and 97.9% at individual-level. At city-level, all factors included failed to demonstrate a significant association with bullying (p school-level, private schools presented more bullying than public schools (OR = 1.17, CI 1.04-1.31). At individual-level, male gender, younger age, not living with both parents, exposed to domestic violence, under or overweight were all associated with bullying. All socioeconomic indicators assessed contributed little to explain the variance in bullying at individual, school or city-level. Population subgroups at risk identified according to their individual profile could be targeted in future interventions in Brazil.
Rafael Aiello Bomfim
Full Text Available ABSTRACT Purpose: to analyze possible associations between a Fantastic lifestyle and self-perception of oral health, binge drinking, and socio-demographic variables among public college students. Methods: questionnaires validated for use in Brazil were applied to 672 students in randomly selected courses. It was the first questionnaire to assess a Fantastic lifestyle, the second to measure oral health-related quality of life (OHIP-14, and the third to include socio-demographic information. Multilevel linear regression was used for the analyses. Results: among the participants, 64.21% were full-time students, 52.82% were females, 50.85% had a family income between 4 and 8 minimum wages, 16.75% were binge drinkers, and 22.22% used to drive after drinking. Socio-demographic variables such as income (p = 0.001, religion (p = 0.02, marital status (p = 0.021, binge drinking (p <0.001, and OHIP-14 (p <0.001 were associated with a Fantastic lifestyle. Conclusions: fantastic lifestyle of the Brazilian college students was associated with income, oral health-related quality of life, marital status, religion, and alcohol consumption (binge drinking.
Baptista, Deise Regina; Thieme, Rubia Daniela; Reis, Walleri Christini Torelli; Pontarolo, Roberto; Correr, Cassyano Januário
Diabetes and its complications are substantial causes of morbidity and mortality, and caused approximately 5.1 million deaths worldwide in 2013. Early detection and treatment of diabetes complications can prevent their progression. This study compared the proportions of patients with type 1 and 2 diabetes mellitus (T1DM and T2DM, respectively) who achieved the goals of good clinical control. Adults and elderly patients with T1DM and T2DM at a public outpatient endocrinology service in Brazil were retrospectively evaluated between 2012 and 2013. Clinical and socio demographic data were obtained from medical records and evaluated in accordance with the Brazilian Diabetes Society Guidelines. Care process measures, outcomes indicators, and supporting process measures were evaluated. A total of 1031 records were analyzed: 29 and 71 % of patients had T1DM and T2DM, respectively. T2DM patients had significantly higher BMI than T1DM patients (overweight and obesity in 85.1 vs. 47.5 %, p achieved all targets, and 1.1 % did not achieve any. The achievement of goals of good clinical practice varies among the parameters evaluated. Almost no patients achieved all targets. Many patients are overweight and do not achieve targets for HbA1c, lipid profile, or blood pressure control.
Deise C Friedrich
Full Text Available Adult-type hypolactasia is a common phenotype caused by the lactase enzyme deficiency. The -13910 C>T polymorphism, located 14 Kb upstream of the lactase gene (LCT in the MCM6 gene was associated with lactase persistence (LP in Europeans. This polymorphism is rare in Africa but several other variants associated with lactase persistence were observed in Africans. The aims of this study were to identify polymorphisms in the MCM6 region associated with the lactase persistence phenotype and to determine the distribution of LCT gene haplotypes in 981 individuals from North, Northeast and South Brazil. These polymorphisms were genotyped by PCR based methods and sequencing. The -13779*C,-13910*T, -13937*A, -14010*C, -14011*T LP alleles previously described in the MCM6 gene region that acts as an enhancer for the LCT gene were identified in Brazilians. The most common LP allele was -13910*T. Its frequency was highly correlated with European ancestry in the Brazilian populations investigated. The -13910*T was higher (0.295 in southern Brazilians of European ancestry and lower (0.175 in the Northern admixed population. LCT haplotypes were derived from the 10 LCT SNPs genotyped. Overall twenty six haplotypes previously described were identified in the four Brazilian populations studied. The Multidimensional Scaling analysis showed that Belém, in the north, was closer to Amerindians. Northeastern and southern Afro-descendants were more related with Bantu-speaking South Africans whereas the Southern population with European ancestry grouped with Southern and Northern Europeans. This study shows a high variability considering the number of LCT haplotypes observed. Due to the highly admixed nature of the Brazilian populations, the diagnosis of hypolactasia in Brazil, based only in the investigation of the -13910*T allele is an oversimplification.
Sanchez, Zila M; Locatelli, Danilo P; Noto, Ana R; Martins, Silvia S
Aims 1) To describe the characteristics of binge drinking (BD) among high school students in Brazil and 2) the association of BD with students' socioeconomic status (SES) in the five different Brazilian macroregions. Design A national multistage probabilistic sample of high school students. Setting Students were drawn from 789 public and private schools in each of the 27 Brazilian state capitals. Participants 17,297 high school students, aged 14 to 18 years. Measurement Self-report data about BD practices and SES were analyzed via weighted logistic regressions and a funnel plot. Findings Almost 32% of the students engaged in BD in the past-year. Being in the highest SES stratum doubled the risk of BD among students in all five Brazilian macroregions. There was a gradient in the association between past-year BD and socioeconomic status: as SES increased; the chance of having recently engaged in BD also increased. In the Brazilian capitals as a whole, boys versus girls (aOR = 1.40 [95% CI 1.26 to 1.58]), being older (aOR = 1.47 [95% CI 1.40 to 1.55] per each additional year of age) and those attending private schools versus public schools (aOR = 1.39 [95% CI 1.18 to 1.62]), were at greater risk for BD. Conclusions Contrary to what is observed in developed countries, students living in Brazilian capitals may be at an increased risk of BD when they belong to the highest socioeconomic status. Adolescents growing up in other emerging economies might have the same association between high SES and BD. PMID:22771006
Forero, Carlos García; Caltran, Marina Paes; Alonso, Jordi; Dantas, Rosana A. Spadoti; Piccolo, Monica Sarto; Farina, Jayme Adriano; Lawrence, John W.; Rossi, Lidia A.
Currently, there is no questionnaire to assess perceived stigmatization among people with visible differences in Brazil. The Perceived Stigmatization Questionnaire (PSQ), developed in the United States, is a valid instrument to assess the perception of stigmatizing behaviours among burn survivors. The objective of this cross-sectional and multicentre study was to assess the factor structure, reliability and validity of the Brazilian Portuguese version of the PSQ in burn patients. A Brazilian version of the 21-item PSQ was answered by 240 adult burn patients, undergoing rehabilitation in two burns units in Brazil. We tested its construct validity by correlating PSQ scores with depression (Beck Depression Index-BDI) and self-esteem (Rosenberg Self-Esteem Scale-RSE), as well as with two domains of the Revised Burn Specific Health Scale—BSHS-R: affect and body image, and interpersonal relationships. We used Confirmatory Item Factor Analysis (CIFA) to test whether the data fit a measurement model involving a three-factor structure (absence of friendly behaviour; confusing/staring behaviour; and hostile behaviour). We conducted Exploratory Factor Analyses (EFA) of the subscale in a 50% random sample of individuals (training split), treating items as ordinal categorical using unweighted least squares estimation. To assess discriminant validity of the Brazilian version of the PSQ we correlated PSQ scores with known groups (sex, total body surface area burned, and visibility of the scars) and assessed its reliability by means of Cronbach's alpha and using test-retest. Goodness-of-fit indices for confirmatory factor analysis were satisfactory for the PSQ, but not for the hostile behaviour subscale, which was modified to improve fit by eliminating 3 items. Cronbach’s alphas for the PSQ refined version (PSQ-R) ranged from 0.65 to 0.88, with test-retest reliability 0.87 for the total score. The PSQ-R scores correlated strongly with depression (0.63; p self-esteem (-0.57; p
da Silva Gasparotto, Guilherme; Pereira da Silva, Michael; Miranda Medeiros Cruz, Raphael; de Campos, Wagner
inadequate food intake can compromise the cardiovascular health, which increases the chances of developing a number of diseases. The relation of inadequate intake of food and certain cardiovascular risk factors in young adult populations are not clear. the objective of this study was to investigate the association between eating habits of college students, excess body weight, high blood pressure and regular physical activity. cross sectional study was conducted with students from a Brazilian federal university. Were evaluated 1 599 students between 18 and 25 years old. An interview was conducted and included sociodemographic variables and the International Physical Activity Questionnaire (IPAQ). Was evaluated body composition (weight, height, calculate the BMI, and waist circumference (WC)). Eating habits and cardiovascular risk behaviors were evaluated by YRBSS -C (Youth Risk Behavior Surveillance). using the chi-square test was identified association between binge drink, consumption of fruits and consumption of salads / vegetables with regular physical activity. There was also an association between consumption of sweet and savory foods, with BMI and waist circumference high. The Logistic regression showed association between sweets intake (odds = 1.34) and savory foods (odds = 1.39) with high BMI. The analysis also showed an association between candy consumption (odds = 1.33), and savory consumption (odds = 1.74) with waist circumference. There was a relationship between MVPA and the binge drink (odds = 1.23), fruits consumption (1.46), and consumption of salads / vegetables (odds = 1.49). Thus, there was an association between the eating habits of college students with excess body weight as well as with regular physical activity. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.
Héber Salvador de Castro Ribeiro
Full Text Available CONTEXT: Liver metastases are a common event in the clinical outcome of patients with colorectal cancer and account for 2/3 of deaths from this disease. There is considerable controversy among the data in the literature regarding the results of surgical treatment and prognostic factors of survival, and no analysis have been done in a large cohort of patients in Brazil. OBJECTIVES: To characterize the results of surgical treatment of patients with colorectal liver metastases, and to establish prognostic factors of survival in a Brazilian population. METHOD: This was a retrospective study of patients undergoing liver resection for colorectal metastases in a tertiary cancer hospital from 1998 to 2009. We analyzed epidemiologic variables and the clinical characteristics of primary tumors, metastatic disease and its treatment, surgical procedures and follow-up, and survival results. Survival analyzes were done by the Kaplan-Meier method and the log-rank test was applied to determine the influence of variables on overall and disease-free survival. All variables associated with survival with P<0.20 in univariate analysis, were included in multivariate analysis using a Cox proportional hazard regression model. RESULTS: During the period analyzed, 209 procedures were performed on 170 patients. Postope-rative mortality in 90 days was 2.9% and 5-year overall survival was 64.9%. Its independent prognostic factors were the presence of extrahepatic disease at diagnosis of liver metastases, bilateral nodules and the occurrence of major complications after liver surgery. The estimated 5-year disease-free survival was 39.1% and its prognostic factors included R1 resection, extrahepatic disease, bilateral nodules, lymph node involvement in the primary tumor and primary tumors located in the rectum. CONCLUSION: Liver resection for colorectal metastases is safe and effective and the analysis of prognostic factors of survival in a large cohort of Brazilian patients
Guilherme Riccioppo Rodrigues
Full Text Available Huntington's disease (HD is a neurodegenerative disorder characterized by chorea, behavioral disturbances and dementia, caused by a pathological expansion of the CAG trinucleotide in the HTT gene. Several patients have been recognized with the typical HD phenotype without the expected mutation. The objective of this study was to assess the occurrence of diseases such as Huntington's disease-like 2 (HDL2, spinocerebellar ataxia (SCA 1, SCA2, SCA3, SCA7, dentatorubral-pallidoluysian atrophy (DRPLA and chorea-acanthocytosis (ChAc among 29 Brazilian patients with a HD-like phenotype. In the group analyzed, we found 3 patients with HDL2 and 2 patients with ChAc. The diagnosis was not reached in 79.3% of the patients. HDL2 was the main cause of the HD-like phenotype in the group analyzed, and is attributable to the African ancestry of this population. However, the etiology of the disease remains undetermined in the majority of the HD negative patients with HD-like phenotype.
Wakamatsu, Tais H; Ueta, Mayumi; Tokunaga, Katsushi; Okada, Yukinori; Loureiro, Renata R; Costa, Karita A; Sallum, Juliana Maria F; Milhomens, José Arthur; Inoue, Chikara; Sotozono, Chie; Gomes, José Álvaro P; Kinoshita, Shigeru
Describing the association with human leukocyte antigen (HLA) alleles could facilitate the understanding of increased risk factors for development of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in patients with severe ocular complications (SOCs). To investigate the association between HLA class I genes and cold medicine (CM)-associated SJS/TEN with SOCs. This case-control study was conducted between February 8, 2013, and August 29, 2014. Thirty-nine Brazilian patients with CM-SJS/TEN of 74 patients with SJS/TEN with SOCs and 133 healthy Brazilian volunteers were enrolled. Human leukocyte antigen class I genes (HLA-A, HLA-B, and HLA-C) were examined to determine whether there was a genetic predisposition for CM-SJS/TEN with SOC. Patients were interviewed to identify possible etiologic factors. Data analysis was performed from April 14, 2013, to August 29, 2014. Genetic predisposition for CM-SJS/TEN with SOCs by analysis of HLA class I genes. Of 74 patients included in the analysis, 32 (43%) were male; mean (SD) age was 36.01 [15.42] years. HLA-A*66:01 (odds ratio [OR], 24.0; 95% CI, 2.79-206.0; P < .001), HLA-B*44:03 (OR, 2.71; 95% CI, 1.11-6.65; P = .04), and HLA-C*12:03 (OR, 5.6; 95% CI, 1.67-18.80; P = .006) were associated with Brazilian CM-SJS/TEN with SOCs, and HLA-A*11:01 (OR, 0.074; 95% CI, 0.004-1.26; P = .008), HLA-B*08:01 (OR, 0.15; 95% CI, 0.02-1.15; P = .048), and HLA-B*51:01 (OR, 0.23; 95% CI, 0.05-1.03; P = .045) were inversely associated with Brazilian CM-SJS/TEN with SOCs (39 cases: 19 Pardo and 16 European ancestry; 14 males and 25 females; age, 35.2 [14.4] years; and 133 controls: 66 Pardo and 61 European ancestry; 55 males and 78 females; age, 41.2 [12.9] years). When multiple test correction within the HLA locus, HLA-A*66:01 and HLA-C*12:03 demonstrated associations. When participants were segregated into Pardo and locus is considered, HLA-A*66:01 was associated with CM-SJS/TEN with SOC among
Souza, Jonas Gordilho; Apolinario, Daniel; Farfel, José Marcelo; Jaluul, Omar; Magaldi, Regina Miksian; Busse, Alexandre Leopold; Campora, Flávia; Jacob-Filho, Wilson
To translate, adapt and evaluate the properties of a Brazilian Portuguese version of the Spoken Knowledge in Low Literacy Patients with Diabetes, which is a questionnaire that evaluate diabetes knowledge. A cross-sectional study with type 2 diabetes patients aged ≥60 years, seen at a public healthcare organization in the city of Sao Paulo (SP). After the development of the Portuguese version, we evaluated the psychometrics properties and the association with sociodemographic and clinical variables. The regression models were adjusted for sociodemographic data, functional health literacy, duration of disease, use of insulin, and glycemic control. We evaluated 129 type 2 diabetic patients, with mean age of 75.9 (±6.2) years, mean scholling of 5.2 (±4.4) years, mean glycosylated hemoglobin of 7.2% (±1.4), and mean score on Spoken Knowledge in Low Literacy Patients with Diabetes of 42.1% (±25.8). In the regression model, the variables independently associated to Spoken Knowledge in Low Literacy Patients with Diabetes were schooling (B=0.193; p=0.003), use of insulin (B=1.326; p=0.004), duration of diabetes (B=0.053; p=0.022) and health literacy (B=0.108; p=0.021). The determination coefficient was 0.273. The Cronbach a was 0.75, demonstrating appropriate internal consistency. This translated version of the Spoken Knowledge in Low Literacy Patients with Diabetes showed to be adequate to evaluate diabetes knowledge in elderly patients with low schooling levels. It presented normal distribution, adequate internal consistency, with no ceiling or floor effect. The tool is easy to be used, can be quickly applied and does not depend on reading skills. Traduzir, adaptar e avaliar as propriedades de uma versão, em português do Brasil, do Spoken Knowledge in Low Literacy Patients with Diabetes, um questionário que avalia conhecimento em diabetes. Estudo transversal, em diabéticos tipo 2, com idade ≥60 anos de uma instituição pública de saúde, em São Paulo (SP
Galli, Rosangela; Moriguchi, Emílio Hideyuki; Bruscato, Neide Maria; Horta, Rogerio Lessa; Pattussi, Marcos Pascoal
Active aging is the process of optimizing opportunities for health, participation and security, aiming to improve quality of life as people age. A series of studies had demonstrated that a lower prevalence of depression is found among more active elderly. To evaluate the association between indicators of active aging and depressive symptoms among the elderly (aged 60 years or more). A population-based cross-sectional study was conducted with 1,006 elderly people (aged 60 years or over) from a small-sized Brazilian municipality. Depressive symptoms were assessed using the Geriatric Depression Scale - 15, with cutoff point ≥ 6 symptoms. Active aging was evaluated using indicators such as: active occupational situation, manual work, reading and physical activities. Data analyses used modified Poisson regression to obtain crude and adjusted prevalence ratios (PR). Most of the elderly people were: white, women and aged between 60 and 74 years. All the indicators of active aging were associated with the outcome. After controlling for socioeconomic, demographic and health variables, elderly people who worked, participated in groups, did manual work and maintained interests such as reading and talking to friends had lower prevalence of depressive symptoms compared to those not doing these activities. Active aging approaches may serve as a valuable mental health promotion strategy aimed at the elderly.
Pinto, Rafaela da Silveira; Matos, Divane Leite; de Loyola Filho, Antônio Ignácio
The scope of this study was to investigate the factors related to the use of dental services by Brazilian adults. Data were collected from 13,356 adults (35 to 44 years of age), participating in a nationwide epidemiological survey of oral health (SB-BRASIL 2003 Project). Data analysis was based on Poisson regression, which produced estimates of Prevalence Ratios as a measure of association. Data analysis showed that the use of dental services by adults was associated with: female gender, low education and income, living in the Northeastern and Southern regions and in small cities, complaints of toothache or gum pain, need for partial/total prosthesis, a greater amount of permanent teeth requiring treatment, demand for service due to some dental problems and evaluation of dental care received on a regular basis. These results showed that the population attended by the public service was socio-economically less privileged and had greater need for treatment. This situation reflects an historical abandonment of the adult population by the dental healthcare system in Brazil and poses a major challenge to the Unified Health Service, in light of its intended role to reduce inequalities and provide universal access to comprehensive care.
Bezerra, M R
The present work is a study of social-historical nature. It has as its objective understanding the participation of Sister Mathilde Nina, as a representative of the Companhia das Filhas da Caridade (Daughters of Charity Company), in the history of the Brazilian Association of Nursing (ABEn). It discusses the association of this sister to ABEn as a way of spreading the catholic ideology. The study covers a period of time between 1939 and 1950. The primary data was collected through written documents and reports of people who were close to Mathilde Nina. The dialectic method was adopted and the discussion of the findings is based on Pierre Bourdieu's thoughts. As a consequence of the edict 20.109/31, the Sisters of Charity made their insertion in the formal education in Brazil. As the first representative of the Company to graduate, sister Nina could perform in different instances of the nursing profession. Her participation in ABEn was a way of spreading the catholic ideology in nursing.
Emília Araújo Vilela
Full Text Available We investigated the association between poor self-rated oral appearance and the need for dental prostheses among elderly Brazilians. National data from an epidemiological survey on oral health in Brazil conducted from 2002 to 2003 by the Ministry of Health (SB, Brazil with a multistage random sample of 4,839 individuals aged 65–74 years in 250 towns were analyzed. The dependent variable was self-rated oral appearance, dichotomized into “poor” (poor∕very poor and “good” (fair∕good∕very good. The main independent variable was the need for an upper or lower dental prosthesis. Other variables included sociodemographic characteristics, approach to dental care, oral health conditions, and self-reported oral disadvantage. Data were analyzed using the chi-square test and Poisson regression models at a 95% significance level. The prevalence of poor self-rated oral appearance was 20.6% and was higher in the elderly who needed a partial or complete upper or lower prosthesis, independent of other variables. This prevalence was associated with age, the use of dental services, access to information about oral disease prevention, number of decayed teeth, self-perception of the need for treatment, dental pain, chewing ability, and the perception that oral health affects relationships with other people. The elderly who needed dental prostheses had a higher prevalence of poor self-rated oral appearance than those who did not need any.
KOTZE Lorete Maria da Silva
Full Text Available Background - Literature data have shown high specificity of antiendomysial antibodies (EmA IgA in celiac disease. The scarcity of Brazilian reports concerning this subject motivated the present study. Objectives - To determine the sensitivity and specificity of antiendomysial IgA antibodies in Brazilian celiac patients at diagnosis and after treatment, to confirm patient adherence to a gluten-free diet and to screen first-degree relatives. Methods - An extensive clinical and serological study was performed by investigating the presence of these antibodies in 392 individuals from Southern Brazil. Indirect immunofluorescence using human umbilical cord as substrate was employed and the total levels of IgA were determined by turbidimetry in all groups. The study was conducted on 57 celiac patients (18 at diagnosis, 24 who adhered to a gluten-free diet and 15 with marked or slight transgression of the diet, 115 relatives of celiac patients (39 families, 94 patients with other gastrointestinal diseases, and 126 healthy individuals from the general population. Results - The results demonstrated 100% positivity for the recently diagnosed patients and for those consuming gluten, in contrast to the patients who complied with the diet (0%. In the control group one individual was positive, but refused to undergo a biopsy. In the group of other gastrointestinal diseases, one positive patient presented ulcerative colitis, Down's syndrome and epilepsy, and the intestinal biopsy was diagnostic for celiac disease. These data showed 99.3% specificity for the test. Eighteen relatives were positive for antiendomysial antibodies IgA (15.65%, and comparison with the healthy population revealed a significant difference. An intestinal biopsy was obtained from seven subjects (one with total villous atrophy and six withouth alterations in the mucosal architecture, but all with a high number of intra-epithelial lymphocytes. Conclusions - The method revealed 100
Janmille Valdivino da Silva
Full Text Available ABSTRACT OBJECTIVE To analyze how individual characteristics and the social context, together, are associated with self-perception of the oral health. METHODS A multilevel cross-sectional study with data from the Brazilian National Health Survey 2013, the United Nations Development Program, and the National Registry of Health Establishments. The explanatory variables for the “oral health perception” outcome were grouped, according to the study framework, into biological characteristics (sex, color, age, proximal social determinants (literacy, household crowding, and socioeconomic stratification, and distal (years of schooling expectancy at age 18, GINI, Human Development Index, and per capita income. The described analysis was performed, along with bivariate Poisson analysis and multilevel Poisson analysis for the construction of the explanatory model of oral health perception. All analyzes considered the sample weights. RESULTS Both the biological characteristics and the proximal and distal social determinants were associated with the perception of oral health in the bivariate analysis. A higher prevalence of bad oral health was associated to lower years of schooling expectancy (PR = 1.31, lower per capita income (PR = 1.45, higher income concentration (PR = 1.41, and worse human development (PR = 1.45. Inversely, oral health services in both primary and secondary care were negatively associated with oral health perception. All the biological and individual social characteristics, except reading and writing, made up the final explanatory model along with the distal social determinants of the Human Development Index and coverage of basic care in the multilevel analysis. CONCLUSIONS Biological factors, individual and contextual social determinants were associate synergistically with the population’s perception of oral health. It is necessary to improve individual living conditions and the implementation of public social policies to improve
Freitas, Noélle de Oliveira; Forero, Carlos García; Caltran, Marina Paes; Alonso, Jordi; Dantas, Rosana A Spadoti; Piccolo, Monica Sarto; Farina, Jayme Adriano; Lawrence, John W; Rossi, Lidia A
Currently, there is no questionnaire to assess perceived stigmatization among people with visible differences in Brazil. The Perceived Stigmatization Questionnaire (PSQ), developed in the United States, is a valid instrument to assess the perception of stigmatizing behaviours among burn survivors. The objective of this cross-sectional and multicentre study was to assess the factor structure, reliability and validity of the Brazilian Portuguese version of the PSQ in burn patients. A Brazilian version of the 21-item PSQ was answered by 240 adult burn patients, undergoing rehabilitation in two burns units in Brazil. We tested its construct validity by correlating PSQ scores with depression (Beck Depression Index-BDI) and self-esteem (Rosenberg Self-Esteem Scale-RSE), as well as with two domains of the Revised Burn Specific Health Scale-BSHS-R: affect and body image, and interpersonal relationships. We used Confirmatory Item Factor Analysis (CIFA) to test whether the data fit a measurement model involving a three-factor structure (absence of friendly behaviour; confusing/staring behaviour; and hostile behaviour). We conducted Exploratory Factor Analyses (EFA) of the subscale in a 50% random sample of individuals (training split), treating items as ordinal categorical using unweighted least squares estimation. To assess discriminant validity of the Brazilian version of the PSQ we correlated PSQ scores with known groups (sex, total body surface area burned, and visibility of the scars) and assessed its reliability by means of Cronbach's alpha and using test-retest. Goodness-of-fit indices for confirmatory factor analysis were satisfactory for the PSQ, but not for the hostile behaviour subscale, which was modified to improve fit by eliminating 3 items. Cronbach's alphas for the PSQ refined version (PSQ-R) ranged from 0.65 to 0.88, with test-retest reliability 0.87 for the total score. The PSQ-R scores correlated strongly with depression (0.63; p validity comparable to the
ROCCO Iray Maria
Full Text Available Dengue outbreaks have occurred in several Brazilian States since 1986 involving serotypes 1 (DEN-1 and 2 (DEN-2. In view of the few cases of double infection documented in the literature, we report here a case of simultaneous infection with DEN-1 and DEN-2 in a patient residing in the municipality of Miranda, State of Mato Grosso do Sul, Western region of Brazil. DEN-1 was introduced in this State in 1989 and DEN-2 in 1996, both of them circulating in some municipalities. This double infection was identified by virus isolation and by indirect immunofluorescence using monoclonal antibodies and confirmed by the polymerase chain reaction (PCR. This is the first documented case of simultaneous infection with serotypes DEN-1 and DEN-2 in Brazil.
Paulo José Lorenzoni
Full Text Available The aim of the study was to analyze a series of Brazilian patients with Niemann-Pick disease type C (NP-C. Method Correlations between clinical findings, laboratory data, molecular findings and treatment response are presented. Result The sample consisted of 5 patients aged 8 to 26 years. Vertical supranuclear gaze palsy, cerebellar ataxia, dementia, dystonia and dysarthria were present in all cases. Filipin staining showed the “classical” pattern in two patients and a “variant” pattern in three patients. Molecular analysis found mutations in the NPC1 gene in all alleles. Miglustat treatment was administered to 4 patients. Conclusion Although filipin staining should be used to confirm the diagnosis, bone marrow sea-blue histiocytes often help to diagnosis of NP-C. The p.P1007A mutation seems to be correlated with the “variant” pattern in filipin staining. Miglustat treatment response seems to be correlated with the age at disease onset and disability scale score at diagnosis.
Moreira, D C F; de Sá, J S M; Cerqueira, I B; Oliveira, A P F; Morgano, M A; Amaya-Farfan, J; Quintaes, K D
While enteral diets for hospitalized patients normally follow nutrient composition guidelines, more than 90% of hospitalized patients receive oral diets with unknown mineral composition. To evaluate the mineral contents and adequacy of three types of oral diets (regular, blend and soft) and complementary snacks offered to patients of a Brazilian hospital. The amount of minerals was determined in two non-consecutive days in duplicate samples of breakfast, collation, lunch, snack, dinner, supper and a complementary snack meal. Dietary Reference Intakes (DRIs) were used to determine the adequacy of the daily amounts served to patients. The regular diet met the RDA (Recommended Dietary Allowances) requirements only for Mn, P and Se, while the blend diet was deficient in Ca, K and Mg, and the soft diet met RDA requirements only for P and Zn. Iron was below the RDA requirement in all diets for women in fertile age, and Na was above the safe limit of intake (UL) in all the diets. The use of complementary snack was effective in meeting RDA requirements for Cu in the regular diet, and Mn and Se in the soft diet, but promoted overconsumption of Na. Evident nutritional imbalances have been detected at a key interphase between nutrition and public health services, but a solution does not appear to be insurmountable. A permanent nutritional evaluation of hospital oral diets should be an integral part of routine health care in order to speed the recovery of the hospitalized patient and dispel eventual risks due to critical mineral imbalances.
Paulo S. Young
Full Text Available Basead on extensive collections of cnidarians from Brazilian shallow-water marine environments, new occurrences of four species of associated barnacles are cited, the first three being redescribed; Tne archaeobalanid Conopea galeata, asssociated with the gorgonians Muriceopsis sulphurea, Lophogorgia punicea and Heterogorgia sp from the States of Paraíba, Bahia, Rio de Janeiro and São Paulo; the balanid Megabalanus stultus, associated with the hydrozoans Millepora spp from Paraíba to Alagoas and from the south of Bahia to Rio de Janeiro; the pyrgomatids Megatrema madreporarum, associated with the scleractinian corals Agaricia spp from Paraíba to Alagoas and the south of Bahia, and Ceratoconcha floridanum, associated with the seleractinian coral Mussismilia hispida from Atol das Rodas and Rio de Janeiro.Com base em extensas coleções de cnidários de ambientes marinhos rasos do Brasil, novas ocorrências de quatro espécies da cracas a eles associadas são citadas, e destas três são redescritas: o arqueobalanídeo Conopea galeata, associado às gorgônias Muriceopsis sulphurea, Lophogorgia punicea e Heterogorgia sp , dos Estados da Paraíba, Bahia, Rio de Janeiro e São Paulo; o balanídeo Megabalanus stltus, associado aos hidrozoários Millepora spp, da Paraíba e Alagoas e ao sul da Bahia até o Rio de Janeiro; os pirgomatídeos Megatrema madreporarum, associado aos corais escleractíneos Agaricia sp , da Paraíba e Alagoas e sul da Bahia, e Ce atoconcha floridanum, associado ao coral escleractíneo Mussismilia hispida, do Atol das Rocas e Rio de Janeiro
Eduardo F. Da Silva
Full Text Available Coffee has been associated with reductions in the risk of non-communicable chronic diseases (NCCD, including diabetes mellitus. Because differences in food habits are recognizable modifying factors in the epidemiology of diabetes, we studied the association of coffee consumption with type-2 diabetes in a sample of the adult population of the Federal District, Brazil. This cross-sectional study was conducted by telephone interview (n = 1,440. A multivariate analysis was run controlling for socio-behavioural variables, obesity and family antecedents of NCCD. A hierarchical linear regression model and a Poisson regression were used to verify association of type-2 diabetes and coffee intake. The independent variables which remained in the final model, following the hierarchical inclusion levels, were: first level—age and marital status; second level—diabetes and dyslipidaemias in antecedents; third level—cigarette smoking, supplement intake, body mass index; and fourth level—coffee intake (£100 mL/d, 101 to 400 mL/day, and >400 mL/day. After adjusting hierarchically for the confounding variables, consumers of 100 to 400 mL of coffee/day had a 2.7% higher (p = 0.04 prevalence of not having diabetes than those who drank less than 100 mL of coffee/day. Compared to coffee intake of £100 mL/day, adults consuming >400 mL of coffee/day showed no statistically significant difference in the prevalence of diabetes. Thus, moderate coffee intake is favourably associated with self-reported type-2 diabetes in the studied population. This is the first study to show a relationship between coffee drinking and diabetes in a Brazilian population.
Full Text Available Information on costs associated with malaria in pregnancy (MiP in low transmission areas where Plasmodium vivax predominates is so far missing. This study estimates health system and patient costs of MiP in the Brazilian Amazon.Between January 2011 and March 2012 patient costs for the treatment of MiP were collected through an exit survey at a tertiary referral hospital and at a primary health care centre in the Manaus metropolitan area, Amazonas state. Pregnant and post-partum women diagnosed with malaria were interviewed after an outpatient consultation or at discharge after admission. Seventy-three interviews were included in the analysis. Ninety-six percent of episodes were due to P. vivax and 4% to Plasmodium falciparum. In 2010, the total median costs from the patient perspective were estimated at US $45.91 and US $216.29 for an outpatient consultation and an admission, respectively. When multiple P. vivax infections during the same pregnancy were considered, patient costs increased up to US $335.85, representing the costs of an admission plus an outpatient consultation. Provider direct and overhead cost data were obtained from several sources. The provider cost associated with an outpatient case, which includes several consultations at the tertiary hospital was US $103.51 for a P. vivax malaria episode and US $83.59 for a P. falciparum malaria episode. The cost of an inpatient day and average admission of 3 days was US $118.51 and US $355.53, respectively. Total provider costs for the diagnosis and treatment of all malaria cases reported in pregnant women in Manaus in 2010 (N = 364 were US $17,038.50, of which 92.4% (US$ 15,741.14 due to P. vivax infection.Despite being an area of low risk malaria transmission, MiP is responsible for a significant economic burden in Manaus. Especially when multiple infections are considered, costs associated with P. vivax are higher than costs associated with P. falciparum. The information generated may
Bôtto-Menezes, Camila; Bardají, Azucena; dos Santos Campos, Giselane; Fernandes, Silke; Hanson, Kara; Martínez-Espinosa, Flor Ernestina; Menéndez, Clara; Sicuri, Elisa
Background Information on costs associated with malaria in pregnancy (MiP) in low transmission areas where Plasmodium vivax predominates is so far missing. This study estimates health system and patient costs of MiP in the Brazilian Amazon. Methods/Principal Findings Between January 2011 and March 2012 patient costs for the treatment of MiP were collected through an exit survey at a tertiary referral hospital and at a primary health care centre in the Manaus metropolitan area, Amazonas state. Pregnant and post-partum women diagnosed with malaria were interviewed after an outpatient consultation or at discharge after admission. Seventy-three interviews were included in the analysis. Ninety-six percent of episodes were due to P. vivax and 4% to Plasmodium falciparum. In 2010, the total median costs from the patient perspective were estimated at US $45.91 and US $216.29 for an outpatient consultation and an admission, respectively. When multiple P. vivax infections during the same pregnancy were considered, patient costs increased up to US $335.85, representing the costs of an admission plus an outpatient consultation. Provider direct and overhead cost data were obtained from several sources. The provider cost associated with an outpatient case, which includes several consultations at the tertiary hospital was US $103.51 for a P. vivax malaria episode and US $83.59 for a P. falciparum malaria episode. The cost of an inpatient day and average admission of 3 days was US $118.51 and US $355.53, respectively. Total provider costs for the diagnosis and treatment of all malaria cases reported in pregnant women in Manaus in 2010 (N = 364) were US $17,038.50, of which 92.4% (US$ 15,741.14) due to P. vivax infection. Conclusion Despite being an area of low risk malaria transmission, MiP is responsible for a significant economic burden in Manaus. Especially when multiple infections are considered, costs associated with P. vivax are higher than costs associated with P
Gonçalves, Luiz Ricardo; Favacho, Alexsandra Rodrigues de Mendonça; Roque, André Luiz Rodrigues; Mendes, Natalia Serra; Fidelis Junior, Otávio Luiz; Benevenute, Jyan Lucas; Herrera, Heitor Miraglia; D'Andrea, Paulo Sérgio; de Lemos, Elba Regina Sampaio; Machado, Rosangela Zacarias; André, Marcos Rogério
Bartonella spp. comprise an ecologically successful group of microorganisms that infect erythrocytes and have adapted to different hosts, which include a wide range of mammals, besides humans. Rodents are reservoirs of about two-thirds of Bartonella spp. described to date; and some of them have been implicated as causative agents of human diseases. In our study, we performed molecular and phylogenetic analyses of Bartonella spp. infecting wild rodents from five different Brazilian biomes. In order to characterize the genetic diversity of Bartonella spp., we performed a robust analysis based on three target genes, followed by sequencing, Bayesian inference, and maximum likelihood analysis. Bartonella spp. were detected in 25.6% (117/457) of rodent spleen samples analyzed, and this occurrence varied among different biomes. The diversity analysis of gltA sequences showed the presence of 15 different haplotypes. Analysis of the phylogenetic relationship of gltA sequences performed by Bayesian inference and maximum likelihood showed that the Bartonella species detected in rodents from Brazil was closely related to the phylogenetic group A detected in other cricetid rodents from North America, probably constituting only one species. Last, the Bartonella species genogroup identified in the present study formed a monophyletic group that included Bartonella samples from seven different rodent species distributed in three distinct biomes. In conclusion, our study showed that the occurrence of Bartonella bacteria in rodents is much more frequent and widespread than previously recognized. In the present study, we reported the occurrence of Bartonella spp. in some sites in Brazil. The identification and understanding of the distribution of this important group of bacteria may allow the Brazilian authorities to recognize potential regions with the risk of transmission of these pathogens among wild and domestic animals and humans. In addition, our study accessed important gaps in
Sonati Maria de Fátima
Full Text Available We report on an eight-year-old Brazilian girl with S-b+ thalassemia. The patient had a steady 10.1 g/dl hemoglobin with 57% HbS. Direct sequence analysis of b-globin gene showed her to be heterozygous for the IVS-I-6 (T®C mutation. This b+ thalassemia mutation, sometimes referred to as the Portuguese type, was found to be associated with the C®T polymorphism at codon 2. In combination with the bS gene, this mutation results in very mild sickle cell disease symptoms.
Freitas, Adriana R; Aznar, Fábio D C; Tinós, Adriana M F G; Yamashita, Joselene M; Sales-Peres, Arsenio; Sales-Peres, Silvia H C
The impact of oral conditions on quality of life in overweight/obesity needs to be elucidated. The aim of this study was to evaluate the association between dental caries activity, quality of life and obesity in Brazilian adolescents. This study was conducted at public schools in Brazil, on a sample of 202 adolescents, 12 years of age. For anthropometric evaluation, the body mass index (BMI)-for-age was used. In oral examinations, the Decayed, Missing, Filled teeth (DMFT), significant caries (SiC) and dental caries activity (DCA) indices were used (κ > 0.94). The Child-Oral Impacts on Daily Performance (Child-OIDP) index was applied. The sample was divided into two groups: O (overweight/obese; n = 101) and N (normal weight; n = 101). For data analysis, chi-square, odds ratio (OR), Wilcoxon and Pearson correlation tests were used (P Obesity, dental caries and quality of life were not correlated. Adolescents with normal weight presented a low perception of the impact of oral conditions on quality of life; however, it seemed to affect psychological aspects in their daily performances. Providing adolescents with nutritional assistance may prevent obesity and dental caries, and improve their quality of life. © 2014 FDI World Dental Federation.
Figueiredo, Daniela de Rossi; Bastos, João Luiz; Peres, Karen Glazer
This study aimed to explore the relations between adverse oral outcomes and socioeconomic, demographic, and self-rated oral health variables and to describe their distribution. Principal component analysis was conducted on data from adolescents in the Brazilian National Oral Health Survey (N = 5,445). Higher loadings were found for crowding (0.6), maxillary and mandibular irregularities (0.5), and count of communitary periodontal index (CPI) sextants with bleeding and dental calculus (0.5). The mean rates for periodontal and occlusal disorders were at least two times higher in adolescents from lower income families and those reporting the need for dental prostheses, as well as those dissatisfied with their dental and overall oral health. Increased mean rates of occlusal disorders were associated with schooling delay and history of toothache in the previous six months. The mean scores suggested accumulation of at least one of the negative oral health indicators in the lower income strata, among adolescents with schooling delay, and in those reporting dental needs. The results suggest priorities for planning and monitoring as a function of oral health requirements.
Daniela de Rossi Figueiredo
Full Text Available Abstract: This study aimed to explore the relations between adverse oral outcomes and socioeconomic, demographic, and self-rated oral health variables and to describe their distribution. Principal component analysis was conducted on data from adolescents in the Brazilian National Oral Health Survey (N = 5,445. Higher loadings were found for crowding (0.6, maxillary and mandibular irregularities (0.5, and count of communitary periodontal index (CPI sextants with bleeding and dental calculus (0.5. The mean rates for periodontal and occlusal disorders were at least two times higher in adolescents from lower income families and those reporting the need for dental prostheses, as well as those dissatisfied with their dental and overall oral health. Increased mean rates of occlusal disorders were associated with schooling delay and history of toothache in the previous six months. The mean scores suggested accumulation of at least one of the negative oral health indicators in the lower income strata, among adolescents with schooling delay, and in those reporting dental needs. The results suggest priorities for planning and monitoring as a function of oral health requirements.
Dias da Silva, João Carlos; Ramos, Sérgio Paula; Luz Luz, Ernani; Melo de Oliveira, Evaldo; Requião, Dagoberto Hungria; Martinez Campana, Angelo Americo
The Brazilian Association for the Study of Alcohol and other Drugs [Associação Brazileira de Estudos do Alcool e outras Drogas (ABEAD)] is a non-profit entity with the purpose of encouraging discussions and exchanges on advances in the prevention, treatment and research of addition. It currently brings together 840 professionals from different areas, such as Psychiatry, Social Assistance, Nursing, Psychology, Sociology, Law, in addition to community leaders, thus having an innovative and dynamic character. It organises annual national congresses and regional meetings hosting foreign guests. The society has a style that is innovative and dynamic. After more than 20 years of work, ABEAD exerts significant national influence and its members have been invited to participate in the main decisions regarding issues linked to drug abuse in Brazil. Among other achievements, it has contributed to the proposals on prevention and treatment policies and the standardization of the different levels of assistance provided by public health-care. In addition, its members have worked closely with the initiatives made by the government and medical entities in the search for a consensus on the treatment of the different types of dependence, including alcohol dependence and smoking. ABEAD's goal for the future is to broaden its participation in the national drug policy arena and to intensify the work with other medical organizations and with the community.
Tardelli-Coelho, F.; Pimenta, A. A.; Tardelli, A.; Abalde, J. R.; Venkatesh, K.
In this paper we present a case of plasma blobs associated with plasma bubbles which were observed by emission of OI 630.0 nm airglow, using ground-based (all-sky images) and DMSP-F15 satellite data on 23 February 2007, over a low latitude station São José dos Campos (SJC) (23.21°S, 45.86°W; dip latitude 18.3°S) in the Brazilian sector. We calculated the zonal drift velocities of the plasma bubble and plasma blobs, and the longitudinal drift of the blobs that occurred that night using the linearization method presented by Pimenta et al. (2001). The north/south and east/west extensions of plasma blobs have also been estimated. The mean velocity of the plasma bubble is found to be 74 ± 8 m/s and the plasma blob zonal drift is 61 ± 6 m/s. The average velocity of the longitudinal drift of the plasma blob was 85 ± 13 m/s and the analyzed blobs had the mean north/south extension of 591 km and east/west extension of 328 and 263 km.
Silva, Diego Augusto Santos; Quadros, Teresa Maria Bianchini de; Gordia, Alex Pinheiro; Petroski, Edio Luiz
To investigate the association of overweight with socio-demographic variables and lifestyle among freshmen of a Brazilian public university. A total of 685 students were evaluated in April 2008. Overweight was determined based on body mass index. Lifestyle and socio-demographic variables were established using a self-administered questionnaire. Overweight was observed in 16% of the students and lifestyle was inadequate in 5.1%. The incidence of overweight was higher among male students (OR=2.69; 95%CI: 1.64-4.42), students aged ≥ 20 years (OR=2.01; 95%CI: 1.25-3.25), married students (OR=2.44; 95%CI: 1.11-5.40), and students who reported being more than 2 kg above healthy weight (OR=17.05; 95%CI: 7.73-37.63) and ingesting caffeine-containing beverages more than twice a day (OR= 1.66; 95%CI: 1.00-2.75). This study demonstrates the need for guidance of university students regarding a healthy lifestyle and for physical activity programs on the campus aimed at reducing excess weight, with special attention to male, older and married students.
Full Text Available The genetic basis for dementias is complex. A common polymorphism in the apolipoprotein E (APOE gene is considered to be the major risk factor in families with sporadic and late-onset Alzheimer's disease as well as in the general population. The distribution of alleles and genotypes of the APOE gene in late-onset Alzheimer's disease (N = 68, other late-life dementias (N = 39, and in cognitively normal controls (N = 58 was determined, as also was the risk for Alzheimer's disease associated with the epsilon4 allele. Peripheral blood samples were obtained from a total of 165 individuals living in Brazil aged 65-82 years. Genomic DNA was amplified by the polymerase chain reaction and the products were digested with HhaI restriction enzyme. APOE epsilon2 frequency was considerably lower in the Alzheimer's disease group (1%, and the epsilon3 allele and epsilon3/epsilon3 genotype frequencies were higher in the controls (84 and 72%, respectively as were the epsilon4 allele and epsilon3/epsilon4 genotype frequencies in Alzheimer's disease (25 and 41%, respectively. The higher frequency of the epsilon4 allele in Alzheimer's disease confirmed its role as a risk factor, while epsilon2 provided a weak protection against development of the disease. However, in view of the unexpectedly low frequency of the epsilon4 allele, additional analyses in a more varied Brazilian sample are needed to clarify the real contribution of apolipoprotein E to the development of Alzheimer's disease in this population.
Arap, Marco A; Reis, Rodolfo Borges dos; Torricelli, Fábio César Miranda; Masson, André L S; Saad, Everardo D
Scientific research originating from Brazil appears to be rising in several medical fields. Research results are often presented at scientific meetings before publication in peer-reviewed journals. We investigated the publication rate of Brazilian studies presented in American Urological Association (AUA) meetings and compared with the rate of publication of Brazilian oncological studies presented at the American Society of Clinical Oncology (ASCO) meetings. a hand search of 12,454 abstracts presented at aua meetings 2001-2007 was conducted. abstracts for which at least two-thirds of institutions were from brazil were considered as brazilian. final publication was searched in pubmed and lilacs databases. oncological abstracts were also hand searched in the asco meetings proceedings in the same years. There was no significant temporal trend in the proportion of AUA studies originating from Brazil along those 7 years. A total of 195 abstracts (1.57%) were from Brazil. One hundred (51.3%) abstracts were published in full, and the estimated 5-year publication rate was 48.2%. There was a progressive increase in publication rates for studies categorized as video, poster, and podium presentations. Considering abstracts presented in years 2001-2005, urologic publication rate was significantly higher than for abstracts presented at the ASCO meeting. Our results suggest that the Brazilian contribution to AUA meetings is at a plateau and that the Brazilian literature contribution is greater in urology than in oncology. Efforts must be invested towards raising this plateau and understanding qualitative aspects of the urology scientific output from Brazil.
Full Text Available Genomic DNA from 23 patients with isolated growth hormone (GH deficiency (12 males and 11 females: heights -4.9 ± 1.4 SDS was screened for GH gene deletions by restriction endonuclease analysis of polymerase chain reaction amplification products. Three unrelated patients had typical features of severe GH deficiency and deletions (6.7 kb in two and 7.6 kb in one of the GH gene. The two patients with 6.7-kb deletions developed growth-attenuating anti-GH antibodies whereas the patient with the 7.6-kb deletion continued to grow with GH replacement therapy. Our finding that 3/23 (~13% Brazilian subjects had GH gene deletions agrees with previous studies of severe isolated GH deficiency subjects in other populations. Two of three subjects (67% with deletions developed blocking antibodies despite administration of exogenous GH at low doses. Interestingly, only 1/10 of cases with affected relatives or parental consanguinity had GH-1 gene deletions
Full Text Available Alexandre Faisal-Cury,1 Karen M Tabb,2 Guilherme Niciunovas,3 Carrie Cunningham,4 Paulo R Menezes,1 Hsiang Huang4,5 1Department of Preventive Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil; 2School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL, USA; 3School of Medicine, Federal University of São Paulo, São Paulo, Brazil; 4Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA; 5Department of Psychiatry, Laboratory of Psychopathology and Psychiatric Therapeutics (LIM-23, Faculty of Medicine, University of São Paulo, São Paulo, Brazil Abstract: Adolescent pregnancy has social, economic, and educational consequences and is also linked to adverse perinatal outcomes. However, studies show a positive relationship between pregnancy and increased social status among low-income adolescents. This study aims to assess the association between planned pregnancy and years of schooling among low-income Brazilian adolescents. This is a secondary analysis of a cohort study conducted from May 2005 to March 2007 in public primary care clinics in São Paulo, Brazil. Participants (n=168 completed a detailed structured questionnaire. Logistic regression was used to examine the association between years of schooling and planned pregnancy. After adjusting for the covariates income, wealth score, crowding, age, marital status, and race, planned pregnancy was independently associated with lower years of education (odds ratio: 1.82; 95% confidence interval: 1.02–3.23. Although this finding may be related to these adolescents having less access to information and health services, another possible explanation is that they have a greater desire to have children during adolescence. Keywords: adolescent pregnancy, planned pregnancy, Brazil, low-income population, women
Barbosa Porcellis da Silva, Rafael; Marques, Alexandre Carriconde; Reichert, Felipe Fossati
Low level of physical activity is a serious health issue in individuals with visual impairment. Few studies have objectively measured physical activity in this population group, particularly outside high-income countries. The aim of this study was to describe physical activity measured by accelerometry and its associated factors in Brazilian adults with visual impairment. In a cross-sectional design, 90 adults (18-95 years old) answered a questionnaire and wore an accelerometer for at least 3 days (including one weekend day) to measure physical activity (min/day). Sixty percent of the individuals practiced at least 30 min/day of moderate-to-vigorous physical activity. Individuals who were blind were less active, spent more time in sedentary activities and spent less time in moderate and vigorous activities than those with low vision. Individuals who walked mainly without any assistance were more active, spent less time in sedentary activities and spent more time in light and moderate activities than those who walked with a long cane or sighted guide. Our data highlight factors associated with lower levels of physical activity in people with visual impairment. These factors, such as being blind and walking without assistance should be tackled in interventions to increase physical activity levels among visual impairment individuals. Implications for Rehabilitation Physical inactivity worldwide is a serious health issue in people with visual impairments and specialized institutions and public policies must work to increase physical activity level of this population. Those with lower visual acuity and walking with any aid are at a higher risk of having low levels of physical activity. The association between visual response profile, living for less than 11 years with visual impairment and PA levels deserves further investigations Findings of the present study provide reliable data to support rehabilitation programs, observing the need of taking special attention to
Maria De Jesus
Full Text Available Mental health providers are increasingly coming into contact with large and growing multi-racial/ethnic and immigrant patient populations in the United States. Knowledge of patient perspectives on what constitutes quality mental health care is necessary for these providers. The aim of this study was to identify indicators of quality of mental health care that matter most to two underrepresented immigrant patient groups of Portuguese background: Brazilians and Cape Verdeans. A qualitative design was adopted using focus group discussions. Six focus groups of patients (n=24 Brazilians; n=24 Cape Verdeans who received outpatient mental health treatment through public safety net clinics in the northeast region of the United States were conducted. The Consensual Qualitative Research analytic method allowed us to identify three quality of care domains: provider performance, aspects of mental health care environment, and effectiveness of mental health care treatment. Provider performance was associated with five categories: relational, communication, linguistic, cultural, and technical competencies. Aspects of mental health care environment were linked to two categories: psychosocial and physical environment. Effectiveness of mental health care treatment was related to two categories: therapeutic relationship and treatment outcomes. Study findings provide useful data for the development of more culturally appropriate and effective patient-centered models and policies in mental health care.
De Jesus, Maria; Earl, Tara R.
Mental health providers are increasingly coming into contact with large and growing multi-racial/ethnic and immigrant patient populations in the United States. Knowledge of patient perspectives on what constitutes quality mental health care is necessary for these providers. The aim of this study was to identify indicators of quality of mental health care that matter most to two underrepresented immigrant patient groups of Portuguese background: Brazilians and Cape Verdeans. A qualitative design was adopted using focus group discussions. Six focus groups of patients (n=24 Brazilians; n=24 Cape Verdeans) who received outpatient mental health treatment through public safety net clinics in the northeast region of the United States were conducted. The Consensual Qualitative Research analytic method allowed us to identify three quality of care domains: provider performance, aspects of mental health care environment, and effectiveness of mental health care treatment. Provider performance was associated with five categories: relational, communication, linguistic, cultural, and technical competencies. Aspects of mental health care environment were linked to two categories: psychosocial and physical environment. Effectiveness of mental health care treatment was related to two categories: therapeutic relationship and treatment outcomes. Study findings provide useful data for the development of more culturally appropriate and effective patient-centered models and policies in mental health care. PMID:24461570
Mais, Laís Amaral; Warkentin, Sarah; Latorre, Maria do Rosário Dias de Oliveira; Carnell, Susan; Taddei, José Augusto Aguiar de Carrazedo
Children's eating behavior, food intake, and weight status are highly influenced by parents, who shape their food environment via parental feeding practices. The aim of this study was to investigate associations between sociodemographic, anthropometric, and behavioral/attitudinal characteristics of parents and their 5- to 9-year-old children and a range of positive ("healthy eating guidance," "monitoring") and potentially negative ("restriction for weight control," "restriction for health," "emotion regulation/food as reward," and "pressure") parental feeding practices. Parents completed a questionnaire assessing parental and child characteristics. Parental feeding practices were measured using a Brazilian adaptation of the Comprehensive Feeding Practices Questionnaire. To test associations between parent and child characteristics and parental feeding practices, we ran bivariate logistic regression models with parent and child characteristics as independent variables and high (above median) scores on individual parental feeding practices as outcome variables. We then conducted multivariate logistic regression models containing all parent and child characteristics, controlling for child age and maternal education. Lower parental perceived responsibility for child feeding, higher child use of screen devices, and higher child ultra-processed food intake were associated with lower scores on "healthy eating guidance" and "monitoring." Higher parental perceived responsibility for child feeding and concern about child overweight were associated with higher scores on "restriction for weight control" and "restriction for health." Parental perceptions of low weight and concern about child underweight, and higher perceived responsibility for child feeding, were associated with higher scores on "pressure." Greater intake of ultra-processed foods and lower maternal age were associated with higher scores on "emotion regulation/food as reward." Parental concerns and perceptions
Fabris, Annalisa; Catamo, Eulalia; Segat, Ludovica; Morgutti, Marcello; Arraes, Luiz Claudio; de Lima-Filho, José L; Crovella, Sergio
The aim of our study was to verify the possible association between an HLA-G 14-bp deletion/insertion polymorphism and perinatal HIV transmission in Brazilian children. We analyzed the 14-bp deletion/insertion polymorphisms in seronegative (i.e., exposed uninfected, N = 71) and seropositive (exposed infected, N = 175) Brazilian children born from HIV-positive mothers and in healthy controls (n = 175). HLA-G 14-bp deletion/insertion polymorphism (rs16375) was detected by PCR amplification of the target sequence followed by agarose gel electrophoresis. All the samples were also analyzed by direct sequencing in order to validate the genotyping results. HIV-exposed uninfected children showed significant differences in their allele and genotype frequencies of the HLA-G 14-bp polymorphism when compared to both seropositive children and healthy controls. The 14-bp-deleted (D) allele was more frequent in exposed uninfected children (79%) than in healthy controls (60%) and HIV-positive children (58%); the higher percentage of the D allele found in the exposed uninfected children with respect to HIV-positive individuals was significantly associated with a reduced risk of vertical transmission. This effect was ascribable to the presence of the D/D homozygous genotype. Our findings support the possible role for the HLA-G 14-bp deletion/insertion polymorphism in the HIV vertical transmission in Brazilian children. The presence of the D allele and D/D genotype is associated with a protective effect toward HIV perinatal infection.
de Castro, Luciano Alberto; de Castro, Joao Gabriel Leite; da Cruz, Alexandre Duarte Lopes; Barbosa, Bruno Henrique de Sousa; de Spindula-Filho, Jose Vieira; Costa, Mauricio Barcelos
Focal epithelial hyperplasia (FEH), or Heck's disease, is a rare disease of the oral mucosa associated with infection by some subtypes of human papilloma virus, especially subtypes 13 or 32. The disease is predominantly found in children and adolescents with indigenous heritage, but other ethnic groups can be affected worldwide. To the best of the authors' knowledge, it has not been reported in Brazil's elderly population. This article describes a case of FEH in a 57-year-old Brazilian patient presenting since childhood, with multiple lesions in the lips, buccal mucosa and tongue. The solitary tongue lesion underwent excisional biopsy and the histopathological analysis showed parakeratosis, acanthosis, rete pegs with a club-shaped appearance, koilocytosis and the presence of mitosoid cells. These microscopic findings in conjunction with clinical presentation were sufficient to establish the accurate diagnosis of FEH. Polymerase chain reaction (PCR) was performed, but no one human papillomavirus (HPV) subtype could be identified. Clinicians must be aware of this rare oral disease, which can even affect elderly patients, as we described here. Treatment may be indicated in selected cases due to esthetic and/or functional problems.
Gomes, Marília B; Cobas, Roberta A; Matheus, Alessandra S; Tannus, Lucianne R; Negrato, Carlos Antonio; Rodacki, Melanie; Braga, Neuza; Cordeiro, Marilena M; Luescher, Jorge L; Berardo, Renata S; Nery, Marcia; Arruda-Marques, Maria do Carmo A; Calliari, Luiz E; Noronha, Renata M; Manna, Thais D; Zajdenverg, Lenita; Salvodelli, Roberta; Penha, Fernanda G; Foss, Milton C; Foss-Freitas, Maria C; Pires, Antonio C; Robles, Fernando C; Guedes, Mariadefátimas; Dib, Sergio A; Dualib, Patricia; Silva, Saulo C; Sepulvida, Janice; Almeida, Henriqueta G; Sampaio, Emerson; Rea, Rosangela; Faria, Ana Cristina R; Tschiedel, Balduino; Lavigne, Suzana; Cardozo, Gustavo A; Azevedo, Mirela J; Canani, Luis Henrique; Zucatti, Alessandra T; Coral, Marisa Helena C; Pereira, Daniela Aline; Araujo, Luiz Antonio; Tolentino, Monica; Pedrosa, Hermelinda C; Prado, Flaviane A; Rassi, Nelson; Araujo, Leticia B; Fonseca, Reine Marie C; Guedes, Alexis D; Matos, Odelissa S; Faria, Manuel; Azulay, Rossana; Forti, Adriana C; Façanha, Cristina; Montenegro, Ana Paula; Montenegro, Renan; Melo, Naira H; Rezende, Karla F; Ramos, Alberto; Felicio, João Sooares; Santos, Flavia M; Jezini, Deborah L; Cordeiro, Marilena M
To determine the characteristics of clinical care offered to type 1 diabetic patients across the four distinct regions of Brazil, with geographic and contrasting socioeconomic differences. Glycemic control, prevalence of cardiovascular risk factors, screening for chronic complications and the frequency that the recommended treatment goals were met using the American Diabetes Association guidelines were evaluated. This was a cross-sectional, multicenter study conducted from December 2008 to December 2010 in 28 secondary and tertiary care public clinics in 20 Brazilian cities in north/northeast, mid-west, southeast and south regions. The data were obtained from 3,591 patients (56.0% females and 57.1% Caucasians) aged 21.2 ± 11.7 years with a disease duration of 9.6 ± 8.1 years (region. Hypertension was more frequent in the mid-west (32%) and north/northeast (25%) than in the southeast (19%) and south (17%) regions (psoutheast region achieved LDL cholesterol goals and were treated with statins (pregions were screened for retinopathy and nephropathy, compared with patients from the south and southeast. Patients from the south/southeast regions had more intensive insulin regimens than patients from the north/northeast and mid-west regions (pregion (pregion (pregion were younger, non-Caucasian, from lower economic status, used less continuous subcutaneous insulin infusion, performed less SBGM and were less overweight/obese (pregions, did not meet metabolic control goals and were not screened for diabetes-related chronic complications. These results should guide governmental health policy decisions, specific to each geographic region, to improve diabetes care and decrease the negative impact diabetes has on the public health system.
Celiac disease in Brazilian patients: associations, complications and causes of death. Forty years of clinical experience Doença celíaca em pacientes brasileiros: associações, complicações e causas de morte. Quarenta anos de experiência clínica
Lorete Maria da Silva Kotze
Full Text Available CONTEXT: Celiac disease is a multisystem auto-immune disorder and may start at any age in genetically predisposed individuals. OBJECTIVE: To identify associations, complications, and cause of death in Brazilian patients. METHODS: One hundred and fifty-seven patients were studied: 23 adolescents and 134 adults, 79.6% females, 20.4% males, 75.8% at the time of diagnosis and 24.2% on a gluten-free diet, follow-up between 1 and 40 years. The diagnosis of celiac disease was based on histologic findings and the presence of serologic auto-antibodies markers for celiac disease. Specific tests were done according to clinical suspicion of associations. Bone mineral density was determined by dual energy x-rays in 53 patients upon diagnosis. The data regarding associations, complications, and causes of death were obtained by interviews and from the patient's charts. RESULTS: Associations: atopy (22.3%, depression (17.2%, thyroid disorder (15.9%, dermatitis herpetiformis (11.5%, diabetes mellitus types 1 and 2 (4.5% and tumors (4.5%. COMPLICATIONS: Anemia and osteopenia/osteoporosis in all groups; increased number of spontaneous abortion. Four patients (4.5% died (one from lymphoma, one with diabetes type 1, one from acute meningitis and one due to suicide. Conclusions - This experience is similar to those described in the world literature. Celiac disease presents the same characteristics independently of the geographic region. We recommend periodic evaluations, from childhood, independent of the duration of the diet. The key is to establish an interval between evaluations.CONTEXTO: A doença celíaca é uma enfermidade multissistêmica e autoimune que pode se manifestar em qualquer idade, em indivíduos geneticamente predispostos. OBJETIVO: Identificação das associações, complicações e causas de morte em pacientes brasileiros após longo período de acompanhamento. MÉTODOS: Foram estudados retrospectivamente 157 pacientes, 23 adolescentes e 134
Ellen Fátima Caetano Lança
Full Text Available BACKGROUND: Plasmodium vivax is responsible for a significant proportion of malaria cases worldwide and is increasingly reported as a cause of severe disease. The objective of this study was to characterize severe vivax disease among children hospitalized in intensive care units (ICUs in the Western Brazilian Amazon, and to identify risk factors associated with disease severity. METHODS AND FINDINGS: In this retrospective study, clinical records of 34 children, 0-14 years of age hospitalized in the 11 public pediatric and neonatal ICUs of the Manaus area, were reviewed. P. falciparum monoinfection or P. falciparum/P. vivax mixed infection was diagnosed by microscopy in 10 cases, while P. vivax monoinfection was confirmed in the remaining 24 cases. Two of the 24 patients with P. vivax monoinfection died. Respiratory distress, shock and severe anemia were the most frequent complications associated with P. vivax infection. Ninety-one children hospitalized with P. vivax monoinfections but not requiring ICU were consecutively recruited in a tertiary care hospital for infectious diseases to serve as a reference population (comparators. Male sex (p = 0.039, age less than five years (p = 0.028, parasitemia greater than 500/mm(3 (p = 0.018, and the presence of any acute (p = 0.023 or chronic (p = 0.017 co-morbidity were independently associated with ICU admission. At least one of the WHO severity criteria for malaria (formerly validated for P. falciparum was present in 23/24 (95.8% of the patients admitted to the ICU and in 17/91 (18.7% of controls, making these criteria a good predictor of ICU admission (p = 0.001. The only investigated criterion not associated with ICU admission was hyperbilirubinemia (p = 0.513]. CONCLUSIONS: Our study points to the importance of P. vivax-associated severe disease in children, causing 72.5% of the malaria admissions to pediatric ICUs. WHO severity criteria demonstrated good sensitivity in
Reis, Cláudia Tartaglia; Laguardia, Josué; Vasconcelos, Ana Glória Godoi; Martins, Mônica
The evaluation of the culture of patient safety in hospitals is nowadays considered as a management too, since it helps to identify problem areas and provide valuable information for planning improvements. This study explored the reliability and validity of the Brazilian version of the Hospital Survey on Patient Safety Culture, an instrument that evaluates characteristics of patient safety culture among hospital staff. The reliability of the instrument was evaluated by analyzing the internal consistency of each dimension. The validity of the tool was carried out by means of exploratory and confirmatory factor analysis. The sample was made up of 322 questionnaires that were collected in two Brazilian hospitals in 2012. Cronbach's alpha ranged from 0.52 to 0.91 for the different dimensions, with the exception of two, for which it was much lower. After excluding four items, the exploratory factor analysis presented adjusted indices that were appropriate for a 10 factor model.
Carlos Alberto Pires Pereira
Full Text Available BACKGROUND: Nosocomial bloodstream infections (nBSIs are an important cause of morbidity and mortality and are the most frequent type of nosocomial infection in pediatric patients. METHODS: We identified the predominant pathogens and antimicrobial susceptibilities of nosocomial bloodstream isolates in pediatric patients (≤16 years of age in the Brazilian Prospective Surveillance for nBSIs at 16 hospitals from 12 June 2007 to 31 March 2010 (Br SCOPE project. RESULTS: In our study a total of 2,563 cases of nBSI were reported by hospitals participating in the Br SCOPE project. Among these, 342 clinically significant episodes of BSI were identified in pediatric patients (≤16 years of age. Ninety-six percent of BSIs were monomicrobial. Gram-negative organisms caused 49.0% of these BSIs, Gram-positive organisms caused 42.6%, and fungi caused 8.4%. The most common pathogens were Coagulase-negative staphylococci (CoNS (21.3%, Klebsiella spp. (15.7%, Staphylococcus aureus (10.6%, and Acinetobacter spp. (9.2%. The crude mortality was 21.6% (74 of 342. Forty-five percent of nBSIs occurred in a pediatric or neonatal intensive-care unit (ICU. The most frequent underlying conditions were malignancy, in 95 patients (27.8%. Among the potential factors predisposing patients to BSI, central venous catheters were the most frequent (66.4%. Methicillin resistance was detected in 37 S. aureus isolates (27.1%. Of the Klebsiella spp. isolates, 43.2% were resistant to ceftriaxone. Of the Acinetobacter spp. and Pseudomonas aeruginosa isolates, 42.9% and 21.4%, respectively, were resistant to imipenem. CONCLUSIONS: In our multicenter study, we found a high mortality and a large proportion of gram-negative bacilli with elevated levels of resistance in pediatric patients.
Full Text Available INTRODUCTION: Unsafe abortion accounts for about 12% of maternal deaths in Brazil, although many of these women could meet the requirements for legal abortion in this country. Physicians' inappropriate knowledge of the law may be playing a role in this situation. OBJECTIVE: To evaluate which factors are associated with the level of information and the opinion of the Brazilian gynecologists-obstetricians concerning abortion laws. METHODS: Questionnaires (14.320 were sent to all physicians affiliated to the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO, and 30.2% were returned completed. RESULTS: Most of respondents showed a good knowledge of the situations in which abortion is allowed but not about the documents required to carry out a legal abortion. However, most of them knew about the need for a judicial order in case of abortion of malformed fetus. Knowledge was associated with age, number of children and years of practice. DISCUSSION AND CONCLUSIONS: Poor knowledge on the requirements to carry out an abortion within the law may be a main factor responsible for the lack of access to legal abortion in Brazil.INTRODUÇÃO: Estima-se que 12% dos casos de mortalidade materna no Brasil sejam conseqüência de aborto clandestino. Muitas dessas mulheres cumpririam as condições para interrupção legal da gestação; entretanto, a prática do aborto previsto em lei em hospitais públicos é exceção, provavelmente por desconhecimento dos médicos a respeito da legislação brasileira referente ao aborto. OBJETIVO: Avaliar o conhecimento e a opinião dos ginecologistas e obstetras filiados à Federação Brasileira das Associações de Ginecologia e Obstetrícia (FEBRASGO sobre a legislação brasileira referente ao aborto, e sua correlação com algumas características sociodemográficas dos entrevistados. MÉTODOS: Foram enviados 14.320 questionários para serem respondidos por todos os membros da FEBRASGO, com taxa de
Larissa Rodrigues Gomes
Full Text Available Anti-glycosylphosphatidylinositol (GPI antibodies (Abs may reflect and mediate, at least partially, anti-disease immunity in malaria by neutralising the toxic effect of parasitic GPI. Thus, we assessed the anti-GPI Ab response in asymptomatic individuals living in an area of the Brazilian Amazon that has a high level of malaria transmission. For comparative purposes, we also investigated the Ab response to a crude extract prepared from Plasmodium falciparum, the merozoite surface protein (MSP3 antigen of P. falciparum and the MSP 1 antigen of Plasmodium vivax (PvMSP1-19 in these individuals and in Angolan patients with acute malaria. Our data suggest that the Ab response against P. falciparum GPI is not associated with P. falciparum asymptomatic infection in individuals who have been chronically exposed to malaria in the Brazilian Amazon. However, this Ab response could be related to ongoing parasitaemia (as was previously shown in the Angolan patients. In addition, our data show that PvMSP1-19may be a good marker antigen to reflect previous exposure to Plasmodium in areas that have a high transmission rate of P. vivax.
Full Text Available The human beta defensin 1 (hBD-1 antimicrobial peptide is a member of the innate immune system known to act in the first line of defence against microorganisms, including viruses such as human papillomavirus (HPV. In this study, five functional polymorphisms (namely g-52G>A, g-44C>G and g-20G>A in the 5’UTR and c.*5G>A and c.*87A>G in the 3’UTR in the DEFB1 gene encoding for hBD-1 were analysed to investigate the possible involvement of these genetic variants in susceptibility to HPV infection and in the development of HPV-associated lesions in a population of Brazilian women. The DEFB1 g-52G>A and c.*5G>A single-nucleotide polymorphisms (SNPs and the GCAAA haplotype showed associations with HPV-negative status; in particular, the c.*5G>A SNP was significantly associated after multiple test corrections. These findings suggest a possible role for the constitutively expressed beta defensin-1 peptide as a natural defence against HPV in the genital tract mucosa.
das Graças, Dayana; Nakamura, Letícia; Barbosa, Fernando Sérgio Silva; Martinez, Paula Felippe; Reis, Filipe Abdalla; Oliveira-Junior, Silvio Assis de
Brazilian jiu-jitsu is characterized by musculoskeletal disorders and high occurrence of sports injuries. The present study was aimed to analyze some internal factors, as well as to describe occurrence and characteristics of retrospective musculoskeletal injuries in different age groups of Brazilian jiu-jitsu practitioners. One hundred ninety-three Brazilian jiu-jitsu practitioners, which were divided into three age groups: Adolescent, Adult, and Master. Besides anthropometric characterization, standard clinical tests were conducted to analyze the global and segmental joint flexibility, lumbar spine range of motion, and handgrip strength. Sports injury occurrence and total physical activity were obtained from an adapted morbidity survey and International Physical Activity Questionnaire - Short Form (IPAQ-SF), respectively. A total of 247 cases of retrospective injuries was registered (1.27 injury/ participant). Occurrence of rectus femoral muscle retraction in the right leg was increased within Master. Adult and Master have exhibited higher occurrence of sports injuries than Adolescent group ( p jiu-jitsu practitioners. While female gender and exposure time constituted the most predictive variables for sports injury occurrence in Adolescent, graduation level was more associated with sports injuries occurrence in Adult. Joint injuries derived from combat demands were the main sports injury in all age categories of Brazilian jiu-jitsu. Master subjects presented a higher occurrence of clinical changes and retrospective musculoskeletal injuries in relation to other age groups. Female gender and exposure time constituted the main predictive factors in adolescent subjects, while graduation category was more directly associated with retrospective injury onset in the Adult group.
Machado Arruda, Soraia Pinheiro; da Silva, Antônio Augusto Moura; Kac, Gilberto; Vilela, Ana Amélia Freitas; Goldani, Marcelo; Bettiol, Heloisa; Barbieri, Marco Antônio
The objective of the present study was to investigate whether dietary patterns are associated with excess weight and abdominal obesity among young adults (23-25 years). A cross-sectional study was conducted on 2061 participants of a birth cohort from Ribeirão Preto, Brazil, started in 1978-1979. Twenty-seven subjects with caloric intake outside ±3 standard deviation range were excluded, leaving 2034 individuals. Excess weight was defined as body mass index (BMI ≥ 25 kg/m(2)), abdominal obesity as waist circumference (WC > 80 cm for women; >90 cm for men) and waist/hip ratio (WHR > 0.85 for women; >0.90 for men). Poisson regression with robust variance adjustment was used to estimate the prevalence ratio (PR) adjusted for socio-demographic and lifestyle variables. Four dietary patterns were identified by principal component analysis: healthy, traditional Brazilian, bar and energy dense. In the adjusted analysis, the bar pattern was associated with a higher prevalence of excess weight (PR 1.46; 95 % CI 1.23-1.73) and abdominal obesity based on WHR (PR 2.19; 95 % CI 1.59-3.01). The energy-dense pattern was associated with a lower prevalence of excess weight (PR 0.73; 95 % CI 0.61-0.88). Men with greater adherence to the traditional Brazilian pattern showed a lower prevalence of excess weight (PR 0.65; 95 % CI 0.51-0.82), but no association was found for women. There was no association between the healthy pattern and excess weight/abdominal obesity. In this sample, the bar pattern was associated with higher prevalences of excess weight and abdominal obesity, while the energy-dense (for both genders) and traditional Brazilian (only for men) patterns were associated with lower prevalences of excess weight.
Malta, Deborah Carvalho; Bernal, Regina Tomie Ivata; Andrade, Silvânia Suely Caribé de Araújo; Silva, Marta Maria Alves da; Velasquez-Melendez, Gustavo
To analyze factors associated with self-reported high blood pressure among adults in Brazilian state capitals. The study uses data from Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel - Surveillance System of Risk and Protection Factors of Noncommunicable Diseases by Telephone Survey) collected in 2013. Prevalence rates and their respective 95% confidence intervals by gender were estimated according to sociodemographic variables, lifestyle, reported noncommunicable diseases and self-rated health status. Multivariate logistic regression modeling was used to identify variables associated with self-reported high blood pressure with α high blood pressure among adults living in Brazilian state capitals and the Federal District was 24.1%. The following variables were associated with self-reported high blood pressure: age group, taking 18-24 as reference (all age groups presented increased risk - from 25-34 years [OR = 2.6; 95%CI 2.0-3.4] up to 65 years or more [OR = 28.1; 95%CI 21.7-36.4]); low education level (9 to 11 years of study [OR = 0.8; 95%CI 0.7-0.9] and 12 years or more [OR = 0.6; 95%CI 0.6-0.7]); Black race or skin color (OR = 1.3; 95%CI 1.1-1.5); being a former smoker (OR = 1.2; 95%CI 1.1-1.3); obesity (OR = 2.7; 95%CI 2.4-3.0); diabetes (OR = 2.9; 95%CI 2.5-3.5%), and high cholesterol (OR = 1.9; 95%CI 1.8-2.2). Approximately one quarter of the adult population living in Brazilian state capitals reported having high blood pressure. Information from Vigitel is useful to monitor high blood pressure and identity its associated factors, supporting public policies for health promotion, surveillance and care. Analisar os fatores associados à hipertensão arterial autorreferida entre adultos nas capitais brasileiras. Estudo com os dados do Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel) coletados no ano de 2013. Foram estimadas
Palhares, Daniel M F; Marcolino, Milena S; Santos, Thales M M; da Silva, José L P; Gomes, Paulo R; Ribeiro, Leonardo B; Macfarlane, Peter W; Ribeiro, Antonio L P
Knowledge of the normal limits of the electrocardiogram (ECG) is mandatory for establishing which patients have abnormal ECGs. No studies have assessed the reference standards for a Latin American population. Our aim was to establish the normal ranges of the ECG for pediatric and adult Brazilian primary care patients. This retrospective observational study assessed all the consecutive 12-lead digital electrocardiograms of primary care patients at least 1 year old in Minas Gerais state, Brazil, recorded between 2010 and 2015. ECGs were excluded if there were technical problems, selected abnormalities were present or patients with selected self-declared comorbidities or on drug therapy. Only the first ECG from patients with multiple ECGs was accepted. The University of Glasgow ECG analysis program was used to automatically interpret the ECGs. For each variable, the 1st, 2nd, 50th, 98th and 99th percentiles were determined and results were compared to selected studies. A total of 1,493,905 ECGs were recorded. 1,007,891 were excluded and 486.014 were analyzed. This large study provided normal values for heart rate, P, QRS and T frontal axis, P and QRS overall duration, PR and QT overall intervals and QTc corrected by Hodges, Bazett, Fridericia and Framingham formulae. Overall, the results were similar to those from other studies performed in different populations but there were differences in extreme ages and specific measurements. This study has provided reference values for Latinos of both sexes older than 1 year. Our results are comparable to studies performed in different populations.
Vieira, E; Maia, H S; Monteiro, C B; Carvalho, L M; Tonon, T; Vanz, A P; Schwartz, I V D; Ribeiro, M G
Early dietary treatment of phenylketonuria (PKU), an inborn error of phenylalanine (Phe) metabolism, results in normal cognitive development. Although health-related quality of life (HRQoL) of PKU patients has been reported as unaffected in high-income countries, there are scarce data concerning HRQoL and adherence to treatment of PKU children and adolescents from Brazil. The present study compared HRQoL scores in core dimensions of Brazilian early-treated PKU pediatric patients with those of a reference population, and explored possible relationships between adherence to treatment and HRQoL. Early-treated PKU pediatric patient HRQoL was evaluated by self- and parent-proxy reports of the Pediatric Quality of Life Inventory (PedsQL) core scales. Adherence to treatment was evaluated by median Phe levels and percentage of results within the therapeutic target range in two periods. Means for total and core scales scores of PedsQL self- and parent proxy-reports of PKU patients were significantly lower than their respective means for controls. Adequacy of median Phe concentrations and the mean percentage of values in the target range fell substantially from the first year of life to the last year of this study. There was no significant difference in mean total and core scale scores for self- and parent proxy-reports between patients with adequate and those with inadequate median Phe concentrations. The harmful consequences for intellectual capacity caused by poor adherence to dietary treatment could explain the observed decrease in all HRQoL scales, especially in school functioning. Healthcare system and financial difficulties may also have influenced negatively all HRQoL dimensions.
E. Vieira Neto
Full Text Available Early dietary treatment of phenylketonuria (PKU, an inborn error of phenylalanine (Phe metabolism, results in normal cognitive development. Although health-related quality of life (HRQoL of PKU patients has been reported as unaffected in high-income countries, there are scarce data concerning HRQoL and adherence to treatment of PKU children and adolescents from Brazil. The present study compared HRQoL scores in core dimensions of Brazilian early-treated PKU pediatric patients with those of a reference population, and explored possible relationships between adherence to treatment and HRQoL. Early-treated PKU pediatric patient HRQoL was evaluated by self- and parent-proxy reports of the Pediatric Quality of Life Inventory (PedsQL core scales. Adherence to treatment was evaluated by median Phe levels and percentage of results within the therapeutic target range in two periods. Means for total and core scales scores of PedsQL self- and parent proxy-reports of PKU patients were significantly lower than their respective means for controls. Adequacy of median Phe concentrations and the mean percentage of values in the target range fell substantially from the first year of life to the last year of this study. There was no significant difference in mean total and core scale scores for self- and parent proxy-reports between patients with adequate and those with inadequate median Phe concentrations. The harmful consequences for intellectual capacity caused by poor adherence to dietary treatment could explain the observed decrease in all HRQoL scales, especially in school functioning. Healthcare system and financial difficulties may also have influenced negatively all HRQoL dimensions.
Borges, Ana Luiza Vilela; Santos, Osmara Alves Dos; Nascimento, Natália de Castro; Chofakian, Christiane Borges do Nascimento; Gomes-Sponholz, Flávia Azevedo
The objective of this study is to assess preconception health behaviors among Brazilian women, and analyze the effect of pregnancy planning status in carrying out preconception measures. This is a cross-sectional quantitative study conducted with 807 women, of whom 649 had a planned or ambivalent pregnancy. Preconception health behaviors were assessed by the Brazilian version of the London Measure of Unplanned Pregnancy. Preconception health behaviors were performed by only 15.9% of women. Among those who planned their pregnancy, less than half completed a health measure (47.0%); the most common was seeking medical assistance and improving the diet. Multiple logistic regression analysis showed a strong association between the preconception health behaviors and a planned pregnancy (adjusted OR = 16.77; 95% CI: 9.47-29.81). Age over 30 years, paid work, and the time interval between menarche and first sexual intercourse were also associated with completing preconception measures. The low frequency of preconception health measures, even among women who planned their pregnancy, indicates the urgency of including preconception care on the agenda of public health policies in Brazil. Mensurar a realização do preparo pré-concepcional, descrever as medidas adotadas como preparo pré-concepcional e analisar o efeito do planejamento da gravidez na realização do preparo pré-concepcional. Estudo quantitativo, do tipo transversal, conduzido com 807 mulheres, das quais 649 tinham gravidez planejada ou ambivalente. O preparo pré-concepcional foi mensurado a partir do London Measure of Unplanned Pregnancy , versão Brasil. O preparo pré-concepcional foi realizado por apenas 15,9% das mulheres. Dentre as que planejaram a gravidez, menos da metade realizou algum preparo (47,0%), sendo os mais frequentes ter procurado assistência médica e mudanças na alimentação. Análise de regressão logística múltipla mostrou forte associação entre a realização do preparo pr
Paris, Gisele Ferreira; Montigny, Francine de; Pelloso, Sandra Marisa
To verify the association between complicated grief and sociodemographic, reproductive, mental, marital satisfaction, and professional support characteristics in women after stillbirth. Cross-sectional study with 26 women who had stillbirth in 2013, living in the city of Maringá, Brazil, and eight women who attended the Centre d'Études et de Rechercheen Intervention Familiale at the University of Quebec en Outaouais, in Canada. The instrument was administered as an interview to a small number of mothers of infants up to three months (n=50), who did not participate in the validation study. By applying the short version of the Perinatal Grief Scale, the prevalence of complicated grief in Brazilian women was found to be higher (35%) in relation to Canadian women (12%).Characteristics of the Brazilian women associated with the grief period included the presence of previous pregnancy with live birth, absence of previous perinatal loss, postpartum depression, and lack of marital satisfaction. For the Canadians it was observed that 80% of the women presenting no grief made use of the professional support group. In both populations the occurrence of complicated grief presented a higher prevalence in women with duration of pregnancy higher than 28 weeks. The women that must be further investigated during the grief period are those living in Brazil, making no use of a professional support group, presenting little to no marital satisfaction, having no religion, and of a low educational level. Verificar aassociação entre o luto complicado e as características sociodemográficas, reprodutivas, mentais, de satisfação conjugal e apoio profissional em mulheres após óbito fetal. Estudo transversal com 26 mulheres que tiveram óbito fetal no ano de 2013 residentes no município de Maringá, Brasil, e 18 mulheres participantes do Centre d'Études et de Rechercheen Intervention Familiale, na Universidade do Quebec em Outaouais, no Canadá. Por meio da aplicação da vers
Velasquez-Melendez, Gustavo; Molina, Maria Del Carmen B; Benseñor, Isabela M; Cardoso, Leticia O; Fonseca, Maria de Jesus M; Moreira, Alexandra D; Pereira, Taísa Sabrina S; Barreto, Sandhi M
To estimate the association between regular consumption of sweetened soft drinks, natural fruit juice, and coconut water with metabolic syndrome (MetS). This was a cross-sectional study including men and women aged 35-74 years from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) Study, excluding patients with type 2 diabetes. The main explanatory variables were beverage consumption and the outcome variable was metabolic syndrome (Adult Treatment Panel III). After adjustments, a daily intake of 250 ml of soft drink increased the chance of metabolic syndrome (odds ratio [OR] = 1.95; 95% confidence interval [CI], 1.60-2.38). There was no association between coconut water and MetS. Moderate consumption of fruit juices has low odds of MetS compared to no consumption. Our results add evidence to potential negative effects of sweetened soft drinks on cluster metabolic abnormalities in middle-income countries.
Reis, Claudia Tartaglia; Laguardia, Josué; Martins, Mônica
Patient safety culture assessment allows hospitals to identify and prospectively manage safety issues in work routines. This article aimed to describe the cross-cultural adaptation of the Hospital Survey on Patient Safety Culture (HSOPSC) into Brazilian Portuguese. A universalist approach was adopted to assess conceptual, item, and semantic equivalence. The methodology involved the following stages: (1) translation of the questionnaire into Portuguese; (2) back-translation into English; (3) an expert panel to prepare a draft version; and (4) assessment of verbal understanding of the draft by a sample of the target population. The questionnaire was translated into Portuguese, and the scale's final version included 42 items. The target population sample assessed all the items as easy to understand. The questionnaire has been translated into Portuguese and adapted to the Brazilian hospital context, but it is necessary to assess its measurement equivalence, external validity, and reproducibility.
Lucas M. Mantovani
Full Text Available The UCSD Performance-based Skills Assessment (UPSA is a measure of Functional Capacity and assesses skills involved in community tasks. It has good psychometrics properties, and is currently recommended as a co-primary assessment of cognition in the MATRICS Project. To our knowledge so far, there are no studies in western developing countries concerning Functional Capacity in Schizophrenia. The aims of this study were to translate, culturally adapt and validate the UPSA to assess Functional Capacity in community-dwelling patients with Schizophrenia living in Brazil. Eighty-two subjects (52 patients, 30 controls were evaluated using: the Brazilian version of the UPSA (UPSA-1-BR, PANSS, Personal and Social Performance (PSP and Global Assessment of Functioning (GAF. In the reliability test, UPSA-1-BR showed good Internal Consistency (Cronbach’s alpha of 0.88 and strong correlation between test and retest (4-month gap; r = 0.91; p < 0.01. Spearman’s rho values showed a moderate correlation between UPSA-1-BR and both PSP (0.50; p < 0.01 and GAF (0.46; p < 0.01 scores. UPSA-1-BR is capable of differentiating people with and without Schizophrenia. Patients scored lower than controls (58.9 versus 79.1, with an AUC of 0.79 (95%IC: 0.69–0.89. Sensitivity and specificity values of 0.71 and 0.70, respectively, were found in the cut-off point of 73.5, for separation of patients and controls, with predictive values of 80% (positive and 58% (negative. UPSA-B-BR was also evaluated. UPSA-1-BR and its brief version presented adequate psychometric properties and proved to be valid and reliable instruments in the assessment of Functional Capacity in subjects with Schizophrenia.
Ramírez-Castrillón, Mauricio; Mendes, Sandra Denise Camargo; Valente, Patricia
A comprehensive understanding of the presence and role of yeasts in bottled wines helps to know and control the organoleptic quality of the final product. The South Region of Brazil is an important wine producer, and the state of "Rio Grande do Sul" (RS) accounts for 90% of Brazilian wines. The state of "Santa Catarina" (SC) started the production in 1975, and is currently the fifth Brazilian producer. As there is little information about yeasts present in Brazilian wines, our main objective was to assess the composition of culturable yeasts associated to bottled wines produced in RS and SC, South of Brazil. We sampled 20 RS and 29 SC bottled wines produced between 2003 and 2011, and we isolated culturable yeasts in non-selective agar plates. We identified all isolates by sequencing of the D1/D2 domain of LSU rDNA or ITS1-5.8 S-ITS2 region, and comparison with type strain sequences deposited in GenBank database. Six yeast species were shared in the final product in both regions. We obtained two spoilage yeast profiles: RS with Zygosaccharomyces bailii and Pichia membranifaciens (Dekkera bruxellensis was found only in specific table wines); and SC with Dekkera bruxellensis and Pichia manshurica. Knowledge concerning the different spoilage profiles is important for winemaking practices in both regions.
Eshriqui, Ilana; Vilela, Ana Amélia Freitas; Rebelo, Fernanda; Farias, Dayana Rodrigues; Castro, Maria Beatriz Trindade; Kac, Gilberto
To identify gestational dietary patterns and evaluate the association between these patterns and the blood pressure (BP) rate of change during pregnancy and the postpartum. Prospective cohort study composed of 191 healthy pregnant women. Systolic BP (SBP) and diastolic BP (DBP) were obtained at the 5th-13th, 20th-26th, 30th-36th gestational weeks, and with 30-45 days postpartum. A food frequency questionnaire administered at the 30th-36th gestational week was used to measure dietary intake during pregnancy. Principal component analysis was performed to identify the dietary patterns. A longitudinal linear mixed-effects regression model was used to evaluate the association between the dietary patterns and BP (adjusted for time elapsed after conception and the women's age, education, parity, body mass index and total energy intake). Three gestational dietary patterns were identified: healthy, common-Brazilian and processed. SBP/DBP mean values (SD) were 110.1 (9.0)/66.9 (7.5), 108.7 (9.0)/64.9 (6.7), 111.3 (9.2)/67.0 (6.9) and 115.0 (10.7)/73.7 (8.6) mmHg at the first, second and third gestational trimesters and postpartum, respectively. Women with higher/lower adherence to the processed pattern presented SBP of 117.9 and 113.0 mmHg (P = 0.037), respectively, during postpartum. No association was found between any of the three dietary patterns and SBP in the multiple longitudinal linear regression models, whereas 1 SD increase in the common-Brazilian pattern was associated with a small change of DBP (β = 0.0006; 95% CI 4.66e-06, 0.001; P = 0.048). The three dietary patterns identified revealed no association with changes of SBP and DBP levels during pregnancy and at early postpartum in this sample of healthy Brazilian women.
Breder, Raphael; Leite, Marco Antonio Araujo; Pinto, Jony Arrais; Cavalcante, Igor Pinto; Pessoa, Bruno Lima; Neves, Marco Antônio Orsini
Recent publications have highlighted the low sensitivity of the Mini-Mental State Examination (MMSE) for the cognitive assessment of patients with Parkinson disease (PD). The Montreal Cognitive Assessment (MoCA), otherwise, has shown greater sensitivity when compared to the MMSE. Based on this, we have searched for the cognitive impairment measurable by the MoCA and the functional performance on activities of daily living in a sample of Brazilian patients with PD and normal MMSE. We hypothesized that the low sensitivity of the MMSE, already shown by other authors, could be replicated in a low-income country. To describe the performance on the MoCA and the dependence on third parties for activities of daily living in a sample of Brazilian patients with PD and normal MMSE. We evaluated 43 volunteers with PD and normal MMSE considering the Brazilian cutoffs. Cognitive performance was assessed through the MoCA and functional performance through a modified version of the Disability Assessment for Dementia Scale. Despite normal score on the MMSE, considering the Brazilian cutoffs, 62.7% of the volunteers performed below the literature cutoff for the MoCA (26 points). Furthermore, 30.2% had dependence on third party for activities of daily living. By using a strict cutoff for the MMSE (26 points), 56.7% performed below the MoCA cutoff and 24.3% had dependence for activities of daily living. Our findings confirm the limitations of the MMSE for the cognitive screening of patients with PD in a low-income country.
BRASIL, Patrícia; DE PAIVA, Daurita D.; DE LIMA, Dirce B.; DA SILVA, Edson Jurado; PERALTA, José Mauro; DA SILVA, Alexandre J.; SODRÉ, Fernando C.; VILLELA, Érika Veríssimo; MOURA, Hércules
Enterocytozoon bieneusi is the most prevalent microsporidian parasite that causes gastrointestinal infection in persons with AIDS. Microsporidia are increasingly recognized as important opportunistic pathogens all over the world but in Brazil only few cases have been reported due either to the non awareness of the clinical presentation of the disease or to difficulties in the laboratory diagnosis. We report a 3-year follow-up of a Brazilian HIV-positive patient in whom microsporidial spores w...
Zaverucha-do-Valle, Camila; Monteiro, Sérgio P; El-Jaick, Kênia B; Rosadas, Leonardo A; Costa, Marli J M; Quintana, Marcel S B; de Castro, Liane
Tuberculosis (TB) is still a major health concern and side-effects related to the treatment, especially drug-induced hepatotoxicity (DIH), should be better investigated. In the present study, a possible association between anti-TB DIH and cigarette smoking, N-acetyltransferase 2 (NAT2), Cytochrome P450 2E1 (CYP2E1) and Cytochrome P450 3A4 (CYP3A4) genotypes was studied in 131 TB Brazilian patients. The NAT2 and CYP3A4 genetic polymorphisms were determined using a polymerase chain reaction (PCR) direct sequencing approach and genetic polymorphisms of CYP2E1 gene were determined by restriction fragment length polymorphism (RFLP). The risk of anti-TB DIH was lower in rapid/intermediate acetylators when compared to slow acetylators (OR: 0.34, CI 95: 0.16-0.71; p < 0.01). A decreased risk of developing anti-TB DIH was also observed in active smokers when compared to non-smokers (OR: 0.28, 95 CI: 0.11-0.64; p < 0.01). Significant association between CYP3A4 genotypes and hepatotoxicity was not observed, as well as between CYP2E1 genotype and hepatotoxicity, whose frequency of patients with wild homozygous was more prevalent. The anti-TB drugs interactions with smoking on hepatotoxicity, as well as the NAT2 phenotype, may require to adjust therapeutic regimen dosages or alarm in case of adverse event developments. Copyright © 2014 Elsevier Ltd. All rights reserved.
Álvares, Juliana; Guerra, Augusto Afonso; Araújo, Vânia Eloisa de; Almeida, Alessandra Maciel; Dias, Carolina Zampirolli; Ascef, Bruna de Oliveira; Costa, Ediná Alves; Guibu, Ione Aquemi; Soeiro, Orlando Mario; Leite, Silvana Nair; Karnikowski, Margô Gomes de Oliveira; Costa, Karen Sarmento; Acurcio, Francisco de Assis
To evaluate the access to medicines in primary health care of the Brazilian Unified Health System (SUS), from the patients' perspective. This is a cross-sectional study that used data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Services, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines), conducted by interviews with 8,591 patients in cities of the five regions of Brazil. Evaluation of access to medicines used concepts proposed by Penshansky and Thomas (1981), according to the dimensions: availability, accessibility, accommodation, acceptability, and affordability. Each dimension was evaluated by its own indicators. For the "availability" dimension, 59.8% of patients reported having full access to medicines, without significant difference between regions. For "accessibility," 60% of patients declared that the basic health unit (UBS) was not far from their house, 83% said it was very easy/easy to get to the UBS, and most patients reported that they go walking (64.5%). For "accommodation," UBS was evaluated as very good/good for the items "comfort" (74.2%) and "cleanliness" (90.9%), and 70.8% of patients reported that they do not wait to receive their medicines, although the average waiting time was 32.9 minutes. For "acceptability," 93.1% of patients reported to be served with respect and courtesy by the staff of the dispensing units and 90.5% declared that the units' service was very good/good. For "affordability," 13% of patients reported not being able to buy something important to cover expenses with health problems, and 41.8% of participants pointed out the expense with medicines. Results show 70%-90% compliance, which is compatible with developed countries. However, access to medicines remains a challenge, because it is still heavily compromised by the low availability of essential medicines in public health units, showing that it does not occur universally, equally
Full Text Available INTRODUCTION: The objective of this study was to identify the patterns of dental variables of adolescent Japanese-Brazilian descents with normal occlusion, and also to compare them with a similar Caucasian and Mongoloid sample. METHODS: Lateral cephalometric radiographs were used to compare the groups: Caucasian (n = 40, Japanese-Brazilian (n = 32 and Mongoloid (n = 33. The statistical tests used were one-way ANOVA and ANCOVA. The cephalometric measurements used followed the analyses of Steiner, Tweed and McNamara Jr. RESULTS: Statistical differences (P < 0.05 indicated a smaller interincisal angle and overbite for the Japanese-Brazilian sample, when compared to the Caucasian sample, although with similar values to the Mongoloid group. CONCLUSION: The dental patterns found for the Japanese-Brazilian descents were, in general, more similar to those of the Mongoloid sample.
Sathler, Renata; Pinzan, Arnaldo; Fernandes, Thais Maria Freire; de Almeida, Renato Rodrigues; Henriques, José Fernando Castanha
Introduction The objective of this study was to identify the patterns of dental variables of adolescent Japanese-Brazilian descents with normal occlusion, and also to compare them with a similar Caucasian and Mongoloid sample. Methods Lateral cephalometric radiographs were used to compare the groups: Caucasian (n = 40), Japanese-Brazilian (n = 32) and Mongoloid (n = 33). The statistical tests used were one-way ANOVA and ANCOVA. The cephalometric measurements used followed the analyses of Steiner, Tweed and McNamara Jr. Results Statistical differences (P overbite for the Japanese-Brazilian sample, when compared to the Caucasian sample, although with similar values to the Mongoloid group. Conclusion The dental patterns found for the Japanese-Brazilian descents were, in general, more similar to those of the Mongoloid sample. PMID:25279521
Goudouris, Ekaterini Simões; Rego Silva, Almerinda Maria do; Ouricuri, Aluce Loureiro; Grumach, Anete Sevciovic; Condino-Neto, Antonio; Costa-Carvalho, Beatriz Tavares; Prando, Carolina Cardoso; Kokron, Cristina Maria; Vasconcelos, Dewton de Moraes; Tavares, Fabíola Scancetti; Silva Segundo, Gesmar Rodrigues; Barreto, Irma Cecília; Dorna, Mayra de Barros; Barros, Myrthes Anna; Forte, Wilma Carvalho Neves
In the last few years, new primary immunodeficiencies and genetic defects have been described. Recently, immunoglobulin products with improved compositions and for subcutaneous use have become available in Brazil. In order to guide physicians on the use of human immunoglobulin to treat primary immunodeficiencies, based on a narrative literature review and their professional experience, the members of the Primary Immunodeficiency Group of the Brazilian Society of Allergy and Immunology prepared an updated document of the 1st Brazilian Consensus, published in 2010. The document presents new knowledge about the indications and efficacy of immunoglobulin therapy in primary immunodeficiencies, relevant production-related aspects, mode of use (routes of administration, pharmacokinetics, doses and intervals), adverse events (major, prevention, treatment and reporting), patient monitoring, presentations available and how to have access to this therapeutic resource in Brazil. RESUMO Nos últimos anos, novas imunodeficiências primárias e defeitos genéticos têm sido descritos. Recentemente, produtos de imunoglobulina, com aprimoramento em sua composição e para uso por via subcutânea, tornaram-se disponíveis em nosso meio. Com o objetivo de orientar o médico no uso da imunoglobulina humana para o tratamento das imunodeficiências primárias, os membros do Grupo de Assessoria em Imunodeficiências da Associação Brasileira de Alergia e Imunologia produziram um documento que teve por base uma revisão narrativa da literatura e sua experiência profissional, atualizando o I Consenso Brasileiro publicado em 2010. Apresentam-se novos conhecimentos sobre indicações e eficácia do tratamento com imunoglobulina nas imunodeficiências primárias, aspectos relevantes sobre a produção, forma de utilização (vias de administração, farmacocinética, doses e intervalos), efeitos adversos (principais efeitos, prevenção, tratamento e notificação), monitorização do
Destaques das diretrizes de doenças pulmonares intersticiais da Sociedade Brasileira de Pneumologia e Tisiologia Highlights of the Brazilian Thoracic Association guidelines for interstitial lung diseases
Bruno Guedes Baldi
Full Text Available As doenças pulmonares intersticiais (DPIs são afecções heterogêneas, envolvendo um elevado número de condições, cuja abordagem ainda é um grande desafio para o pneumologista. As Diretrizes de DPIs da Sociedade Brasileira de Pneumologia e Tisiologia, publicadas em 2012, foram estabelecidas com o intuito de fornecer aos pneumologistas brasileiros um instrumento que possa facilitar a abordagem dos pacientes com DPIs, padronizando-se os critérios utilizados para a definição diagnóstica das diferentes condições, além de orientar sobre o melhor tratamento nas diferentes situações. Esse artigo teve como objetivo descrever resumidamente os principais destaques dessas diretrizes.Interstitial lung diseases (ILDs are heterogeneous disorders, involving a large number of conditions, the approach to which continues to pose an enormous challenge for pulmonologists. The 2012 Brazilian Thoracic Association ILD Guidelines were established in order to provide Brazilian pulmonologists with an instrument that can facilitate the management of patients with ILDs, standardizing the criteria used for the diagnosis of different conditions and offering guidance on the best treatment in various situations. The objective of this article was to briefly describe the highlights of those guidelines.
Full Text Available Background: Recent studies have highlighted associations between use of antidepressant medications and coronary heart disease (CHD. Tricyclic antidepressants are not recommended in patients with CHD as they may increase morbidity and mortality. However, this class of antidepressants are freely prescribed in public health pharmacies, while access to other classes of antidepressants is restricted in Brazil. Here we examine the associations between antidepressant use and prevalent CHD in a large cohort from Brazil. Methods: Participants included 14,994 civil servants aged 35 to 74 from the baseline assessment of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil. CHD (n=710 included stable angina, myocardial infarction and coronary revascularization. Univariate (unadjusted and multivariate (adjusted logistic regression analyses were conducted to estimate odds ratios and confidence intervals. Results: After full adjustment for covariates, tricyclic antidepressants (TCA use (n=156 was associated with a 2-fold increase in prevalent CHD, relative to non-use (n=14,076. Additional sensitivity analysis revealed a three-fold association for myocardial infarction (OR: 2.962, 95% CI: 1.413-6.210 and coronary revascularization (OR: 2.915, 95% CI: 1.275-6.662. There were no significant associations between antidepressant use and stable angina pectoris. Conclusions: Findings highlight a strong association between TCA use and prevalent CHD. While the cross-sectional design is an important limitation of the present study, findings have important implications for the treatment of cardiac patients in Brazil.
Leite, Paula Mendonça; de Freitas, Aline A; Mourão, Aline de O Magalhães; Martins, Maria A P; Castilho, Rachel O
The aim of this study was to analyze factors associated with the consumption of medicinal plants by patients being treated with warfarin in a Brazilian anticoagulation clinic and to study the safety of medicinal plant use in patients on warfarin therapy. The study was performed as an observational cross-sectional analysis. Study participants were outpatients on long-term warfarin therapy for at least 2 months for atrial fibrillation or prosthetic cardiac valves. Interviews were carried out concerning information about the habits of medicinal herb consumption, and logistic regression analysis was performed to identify factors associated with the consumption of herbs. The scientific names of the medicinal plants were identified to search for information on the effects on the hemostasis of the interactions between the medicinal herbs reported and warfarin. The mean age of the 273 patients included was 60.8 years; 58.7% were women. Medicinal plants were used by 67% of the participants. No association between demographic and clinical data and the use of medicinal plants was identified. Patients reported a total of 64 different plants, primarily consumed in the form of tea. The plants were mainly used to treat respiratory tract and central nervous system disorders. About 40% of the plants cited have been reported to potentially interfere with the anticoagulation therapy, principally by potentiating the effects of warfarin, which could, increase the risk of bleeding. The use of medicinal plants was highly common and widespread in patients receiving warfarin as an anticoagulation therapy. Univariate analysis of variables associated with the consumption of herbs showed no statistically significant difference in the consumption of medicinal plants for any of the sociodemographic and clinical data. The medicinal plants that were reportedly consumed by the patients could affect hemostasis. This study reinforces the need for further studies evaluating the habits of patients
Haliton Alves de Oliveira Junior
Full Text Available The aim of this study was to describe the baseline demographic and clinical characteristics as well as the functional status of a prospective cohort of patients with rheumatic diseases assisted by the Brazilian Public Health System (SUS. Data for 302 patients receiving tumor necrosis factor α inhibitors (anti-TNF agents was collected through a standard form. Among patients, 229 (75.8% were female and 155 (51.3% were Caucasian; the mean age was 50.3 ± 12.8 years, and the mean disease duration was 9.9 ± 8.7 years. Among them 214 patients (70.9% received adalimumab, 72 (23.8% etanercept, and 16 (5.3% infliximab. Mean Health Assessment Questionnaire-Disability Index (HAQ-DI was 1.37 ± 0.67 for all participants. Poor functional response was associated with female gender, married patients and with a score of < 0.6 on the EuroQoL-5 dimensions (EQ-5D. Significant correlation was found between the HAQ-DI values, disease activity and quality of life (QOL. The results obtained in this study contribute to a better understanding of the clinical and demographic characteristics of patients with rheumatic diseases at the beginning of anti-TNF-agent treatment by SUS. Furthermore, our findings are consistent with another Brazilian and foreign cross-sectional investigations. This knowledge can be of great importance for further studies evaluating the effectiveness of biological agents, as well as, to contribute to improve the well-being of the patients with rheumatic diseases.
had an influence on the RVR rate (odds ratio [OR] =0.011; 95% confidence interval [CI]: 0.001–0.119; P<0.001/OR =13.004; 95% CI: 1.522–111.115; P=0.019, respectively.Conclusion: In this longitudinal multicenter cohort study conducted from the Brazilian perspective, differences were found in the RVR rates, favoring telaprevir over boceprevir for genotype 1 HCV-infected patients. In addition, the baseline viral load was associated with RVR achievement in both evaluated groups. As RVR is also reported in the literature as a predictor of the sustained virological response (SVR, further analyses of RVR as predictor of SVR outcomes should be further evaluated in Brazil. Keywords: hepatitis C, rapid virological response, protease inhibitors, telaprevir, boceprevir, multicenter
Vieira, Mariana L A; Johann, Susana; Hughes, Frederic M; Rosa, Carlos A; Rosa, Luiz H
The fungal endophyte community associated with Baccharis trimera, a Brazilian medicinal plant, was characterized and screened for its ability to present antimicrobial activity. By using molecular methods, we identified and classified the endophytic fungi obtained into 25 different taxa from the phyla Ascomycota and Basidiomycota. The most abundant species were closely related to Diaporthe phaseolorum, Pestalotiopsis sp. 1, and Preussia pseudominima. The differences observed in endophytic assemblages from different B. trimera specimens might be associated with their crude extract activities. Plants that had higher α-biodiversity were also those that contributed more to the regional (γ) diversity. All fungal isolates were cultured and their crude extracts screened to examine the antimicrobial activities. Twenty-three extracts (12.8%) displayed antimicrobial activities against at least one target microorganism. Among these extracts, those obtained from Epicoccum sp., Pestalotiopsis sp. 1, Cochliobolus lunatus, and Nigrospora sp. presented the best minimum inhibitory concentration values. Our results show that the endophytic fungal community associated with the medicinal plant B. trimera included few dominant bioactive taxa, which may represent sources of compounds with antifungal activity. Additionally, the discovery of these bioactive fungi in association with B. trimera suggests that Brazilian plants used as folk medicine may shelter a rich fungal diversity as well as taxa able to produce bioactive metabolites with antimicrobial activities.
Machado, Silmara Rodrigues; Parise, Edison Roberto; Carvalho, Luciana de
The potential role of coffee as a hepatoprotective substance for chronic liver diseases has been widely discussed. Our main aim was to evaluate the effect of coffee intake regarding clinical, biochemical tests and liver biopsy data in treatment naïve patients with chronic hepatitis C. One hundred and thirty-six patients with chronic hepatitis C, diagnosed through liver biopsy, or by means of clinical, ultrasound or endoscopic signs of cirrhosis, were assessed by determination of biochemical tests, metabolic and morphological alterations. Food frequency was scrutinized by using a structured questionnaire. Coffee intake represented more than 90% of the total daily caffeine, and the 75th percentile was 4-Brazilian coffee-cup/day (≥ 255 mL/day or ≥ 123 mg caffeine/day). According to caffeine intake, patients were divided into two groups (caffeine/day). Patients with higher ingestion of caffeine had lower serum levels of aspartate aminotransferase (× upper limit of normal) (1.8 ± 1.5 vs 2.3 ± 1.5, p=0.04), lower frequencies of advanced (F3, F4) fibrosis (23.5% vs 54.5%, pcaffeine intake (OR- 0.16; 95%CI - 0.03-0.80; p=0.026), γ-glutamil transferase serum levels and morphological activity. But only fibrosis was associated with histological activity. In conclusion caffeine consumption greater than 123 mg/day was associated with reduced hepatic fibrosis. In addition, this study supports the assumption that coffee intake has hepatoprotective benefits for Brazilian patients with chronic hepatitis C, even in lower doses than that of American and European population intake. Copyright © 2013. Published by Elsevier Editora Ltda.
Maria de Lourdes Lopes Ferrari Chauffaille
Full Text Available Background: Chronic myeloid leukemia is a myeloproliferative disorder characterized by the Philadelphia chromosome or t(9;22(q34.1;q11.2, resulting in the break-point cluster regionAbelson tyrosine kinase fusion gene, which encodes a constitutively active tyrosine kinase protein. The Philadelphia chromosome is detected by karyotyping in around 90% of chronic myeloid leukemia patients, but 5-10% may have variant types. Variant Philadelphia chromosomes are characterized by the involvement of another chromosome in addition to chromosome 9 or 22. It can be a simple type of variant when one other chromosome is involved, or complex, in which two or more chromosomes take part in the translocation. Few studies have reported the incidence of variant Philadelphia chromosomes or the breakpoints involved among Brazilian chronic myeloid leukemia patients. Objective: The aim of this report is to describe the diversity of the variant Philadelphia chromosomes found and highlight some interesting breakpoint candidates for further studies. Methods: the Cytogenetics Section Database was searched for all cases with diagnoses of chronic myeloid leukemia during a 12-year period and all the variant Philadelphia chromosomes were listed. Results: Fifty (5.17% cases out of 1071 Philadelphia-positive chronic myeloid leukemia were variants. The most frequently involved chromosome was 17, followed by chromosomes: 1, 20, 6, 11, 2, 10, 12 and 15. Conclusion: Among all the breakpoints seen in this survey, six had previously been described: 11p15, 14q32, 15q11.2, 16p13.1, 17p13 and 17q21. The fact that some regions get more fre- quently involved in such rare rearrangements calls attention to possible predisposition that should be further studied. Nevertheless, the pathological implication of these variants remains unclear.
Costa, Clarisse Melo Franco Neves; Silveira, Micheline Rosa; Acurcio, Francisco de Assis; Guerra, Augusto Afonso; Guibu, Ione Aquemi; Costa, Karen Sarmento; Karnikowski, Margô Gomes de Oliveira; Soeiro, Orlando Mario; Leite, Silvana Nair; Costa, Ediná Alves; Nascimento, Renata Cristina Rezende Macedo do; Araújo, Vânia Eloísa de; Álvares, Juliana
To characterize the use of medicines by patients of the primary health care of the Brazilian Unified Health System (SUS). This is a cross-sectional, exploratory, and descriptive study, part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015). Interviews were carried out with patients present in the services by semi-structured questionnaires. Sociodemographic, clinical, and use of medicines variables were assessed and the use of medicines in the 30 days prior to the interview was also verified. The population was stratified into three age groups: 18 to 44, 45 to 64, and 65 years or more. The differences between the age groups were verified using the Student's t-test for continuous variables and chi-square test for the categorical ones. The complex samples analysis plan was employed. The medicines were classified according to the Anatomical Therapeutic Chemical Classification System. Of the 8,803 patients interviewed, 6,511 (76.2%) reported to have used medicines in the 30 days prior to the interview. On average, each patient used 2.32 medicines, without difference between the sexes. Among medicine users, 18.2% were aged 65 years or more. Compared to the other age groups, older adults presented more comorbidities, used more medicines, and self-reported worse health conditions. They were also less educated, reported worse economic situation, and lived alone. The medicines that were mostly used were "other analgesics and antipyretics" (3rd ATC level) and Losartan (5th ATC level). Most medicine users had lower education level and presented comorbidities. The most used medicines were the antihypertensive ones. Self-medication was higher among young people. Most patients reported to use generic medicines. The average number of medicines and the prevalence of use increased with age. Due to the characteristics
Oliveira, Maria José Couto; Motta, Fernando do Couto; Siqueira, Marilda M; Resende, Paola Cristina; Born, Priscilla da Silva; Souza, Thiago Moreno L; Mesquita, Milene; Oliveira, Maria de Lourdes Aguiar; Carney, Sharon; Mello, Wyller Alencar de; Magalhães, Vera
After the World Health Organization officially declared the end of the first pandemic of the XXI century in August 2010, the influenza A(H1N1)pdm09 virus has been disseminated in the human population. In spite of its sustained circulation, very little on phylogenetic data or oseltamivir (OST) resistance is available for the virus in equatorial regions of South America. In order to shed more light on this topic, we analysed the haemagglutinin (HA) and neuraminidase (NA) genes of influenza A(H1N1)pdm09 positive samples collected during the pandemic period in the Pernambuco (PE), a northeastern Brazilian state. Complete HA sequences were compared and amino acid changes were related to clinical outcome. In addition, the H275Y substitution in NA, associated with OST resistance, was investigated by pyrosequencing. Samples from PE were grouped in phylogenetic clades 6 and 7, being clustered together with sequences from South and Southeast Brazil. The D222N/G HA gene mutation, associated with severity, was found in one deceased patient that was pregnant. Additionally, the HA mutation K308E, which appeared in Brazil in 2010 and was only detected worldwide the following year, was identified in samples from hospitalised cases. The resistance marker H275Y was not identified in samples tested. However, broader studies are needed to establish the real frequency of resistance in this Brazilian region.
Oliveira, Maria José Couto; Motta, Fernando do Couto; Siqueira, Marilda M; Resende, Paola Cristina; Born, Priscilla da Silva; Souza, Thiago Moreno L; Mesquita, Milene; Oliveira, Maria de Lourdes Aguiar; Carney, Sharon; de Mello, Wyller Alencar; Magalhães, Vera
After the World Health Organization officially declared the end of the first pandemic of the XXI century in August 2010, the influenza A(H1N1)pdm09 virus has been disseminated in the human population. In spite of its sustained circulation, very little on phylogenetic data or oseltamivir (OST) resistance is available for the virus in equatorial regions of South America. In order to shed more light on this topic, we analysed the haemagglutinin (HA) and neuraminidase (NA) genes of influenza A(H1N1)pdm09 positive samples collected during the pandemic period in the Pernambuco (PE), a northeastern Brazilian state. Complete HA sequences were compared and amino acid changes were related to clinical outcome. In addition, the H275Y substitution in NA, associated with OST resistance, was investigated by pyrosequencing. Samples from PE were grouped in phylogenetic clades 6 and 7, being clustered together with sequences from South and Southeast Brazil. The D222N/G HA gene mutation, associated with severity, was found in one deceased patient that was pregnant. Additionally, the HA mutation K308E, which appeared in Brazil in 2010 and was only detected worldwide the following year, was identified in samples from hospitalised cases. The resistance marker H275Y was not identified in samples tested. However, broader studies are needed to establish the real frequency of resistance in this Brazilian region. PMID:25410995
Maria José Couto Oliveira
Full Text Available After the World Health Organization officially declared the end of the first pandemic of the XXI century in August 2010, the influenza A(H1N1pdm09 virus has been disseminated in the human population. In spite of its sustained circulation, very little on phylogenetic data or oseltamivir (OST resistance is available for the virus in equatorial regions of South America. In order to shed more light on this topic, we analysed the haemagglutinin (HA and neuraminidase (NA genes of influenza A(H1N1pdm09 positive samples collected during the pandemic period in the Pernambuco (PE, a northeastern Brazilian state. Complete HA sequences were compared and amino acid changes were related to clinical outcome. In addition, the H275Y substitution in NA, associated with OST resistance, was investigated by pyrosequencing. Samples from PE were grouped in phylogenetic clades 6 and 7, being clustered together with sequences from South and Southeast Brazil. The D222N/G HA gene mutation, associated with severity, was found in one deceased patient that was pregnant. Additionally, the HA mutation K308E, which appeared in Brazil in 2010 and was only detected worldwide the following year, was identified in samples from hospitalised cases. The resistance marker H275Y was not identified in samples tested. However, broader studies are needed to establish the real frequency of resistance in this Brazilian region.
Rodrigues, Poliany C.O.; Ignotti, Eliane; Hacon, Sandra S.
Abstract Objective: To analyze the seasonality of blood parameters related to iron homeostasis, inflammation, and allergy in two riverine populations from the Brazilian Amazon. Methods: This was a cross-sectional study of 120 children and adolescents of school age, living in riverine communities of Porto Velho, Rondonia, Brazil, describing the hematocrit, hemoglobin, ferritin, serum iron, total white blood cell count, lymphocytes, eosinophils, C-reactive protein, and immunoglobulin E levels...
Carvalho, Ellaine; Honjo, Rachel; Magalhães, Monize; Yamamoto, Guilherme; Rocha, Katia; Naslavsky, Michel; Zatz, Mayana; Passos-Bueno, Maria Rita; Kim, Chong; Bertola, Debora
Schinzel-Giedion syndrome is a rare autosomal dominant disorder comprising postnatal growth failure, profound developmental delay, seizures, facial dysmorphisms, genitourinary, skeletal, neurological, and cardiac defects. It was recently revealed that Schinzel-Giedion syndrome is caused by de novo mutations in SETBP1, but there are few reports of this syndrome with molecular confirmation. We describe two unrelated Brazilian patients with Schinzel-Giedion syndrome, one of them carrying a novel mutation. We also present a review of clinical manifestations of the syndrome, comparing our cases to patients reported in literature emphasizing the importance of the facial gestalt associated with neurological involvement for diagnostic suspicion of this syndrome. © 2015 Wiley Periodicals, Inc.
Silva Joyce MK
Full Text Available Abstract Background Adult-type hypolactasia, the physiological decline of lactase some time after weaning, was previously associated with the LCT -13910C>T polymorphism worldwide except in Africa. Lactase non-persistence is the most common phenotype in humans, except in northwestern Europe with its long history of pastoralism and milking. We had previously shown association of LCT -13910C>T polymorphism with adult-type hypolactasia in Brazilians; thus, we assessed its frequency among different Brazilian ethnic groups. Methods We investigated the ethnicity-related frequency of this polymorphism in 567 Brazilians [mean age, 42.1 ± 16.8 years; 157 (27.7% men]; 399 (70.4% White, 50 (8.8% Black, 65 (11.5% Brown, and 53 (9.3% Japanese-Brazilian. DNA was extracted from leukocytes; LCT -13910C>T polymorphism was analyzed by PCR-restriction fragment length polymorphism. Results Prevalence of the CC genotype associated with hypolactasia was similar (57% among White and Brown groups; however, prevalence was higher among Blacks (80% and those of Japanese descent (100%. Only 2 (4% Blacks had TT genotype, and 8 (16% had the CT genotype. Assuming an association between CC genotype and hypolactasia, and CT and TT genotypes with lactase persistence, 356 (62.8% individuals had hypolactasia and 211 (37.2% had lactase persistence. The White and Brown groups had the same hypolactasia prevalence (~57%; nevertheless, was 80% among Black individuals and 100% among Japanese-Brazilians (P Conclusion The lactase persistence allele, LCT -13910T, was found in about 43% of both White and Brown and 20% of the Black Brazilians, but was absent among all Japanese Brazilians studied.
Luciana Burim Scomparini
Full Text Available OBJECTIVES: The objective of this study was to evaluate the association between different types of child maltreatment and the presence of psychiatric disorders in highly vulnerable children and adolescents served by a multidisciplinary program. METHODS: In total, 351 patients with a mean age of 12.47, of whom 68.7% were male and 82.1% lived in shelters, underwent psychiatric evaluations based on the Kiddie-Sads-Present and Lifetime Version. Two different methods were used to evaluate maltreatment: medical records were reviewed to identify previous diagnoses related to socioeconomic and psychosocial circumstances, and the Childhood Trauma Questionnaire was used to obtain a structured history of trauma. Bivariate associations were evaluated between psychiatric disorders and evidence of each type and the frequency of abuse. RESULTS: The most frequent psychiatric diagnoses were substance use disorders, affective disorders and specific disorders of early childhood, whereas 13.67% of the sample had no psychiatric diagnosis. All patients suffered neglect, and 58.4% experienced physical or sexual abuse. The presence of a history of multiple traumas was only associated with a diagnosis of substance use disorder. Mental retardation showed a strong positive association with reported physical abuse and emotional neglect. However, a negative correlation was found when we analyzed the presence of a history of multiple traumas and mental retardation. CONCLUSION: All children living in adverse conditions deserve careful assistance, but we found that physical abuse and emotional neglect were most strongly associated with mental retardation and multiple traumas with substance abuse.
de Lima-Stein, Mariana Leão; Alkmim, Wagner Tadeu; Bizinoto, Maria Clara de Souza; Lopez, Luis Fernandez; Burattini, Marcelo Nascimento; Maricato, Juliana Terzi; Giron, Leila; Sucupira, Maria Cecília Araripe; Diaz, Ricardo Sobhie; Janini, Luiz Mario
Hypermutation alludes to an excessive number of specific guanine-to-adenine (G- >A) substitutions in proviral DNA and this phenomenon is attributed to the catalytic activity of cellular APOBECs. Population studies relating hypermutation and the progression of infection by human immunodeficiency virus type 1 (HIV-1) have been performed to elucidate the effect of hypermutation on the natural course of HIV-1 infection. However, the many different approaches employed to assess hypermutation in nucleotide sequences render the comparison of results difficult. This study selected 157 treatment-naive patients and sought to correlate the hypermutation level of the proviral sequences in clinical samples with demographic variables, HIV-1 RNA viral load, and the level of CD4(+) T cells. Nested touchdown polymerase chain reaction (PCR) was performed with specific primers to detect hypermutation in the region of HIV-1 integrase, and the amplified sequences were run in agarose gels with HA-Yellow. The analysis of gel migration patterns using the k-means clustering method was validated by its agreement with the results obtained with the software Hypermut. Hypermutation was found in 31.2% of the investigated samples, and a correlation was observed between higher hypermutation levels and higher viral load levels. These findings suggest a high frequency of hypermutation detection in a Brazilian cohort, which can reflect a particular characteristic of this population, but also can result from the method approach by aiming at hypermutation-sensitive sites. Furthermore, we found that hypermutation events are pervasive during HIV-1 infection as a consequence of high viral replication, reflecting its role during disease progression.
Leonardo Rios Diniz
Full Text Available Abstract Objective: To assess the prevalence of fatigue in a Brazilian population with early rheumatoid arthritis using multiple instruments, and the predictors of these instruments by differents independent variables. Methods: Cross-sectional study with direct interview and medical records review. Fatigue, dependent variable, was assessed using eight instruments: Profile of Mood States (POMS, Multidimensional Assessment of Fatigue scale (MAF, Fatigue Severity Scale (FSS, Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ, Numerical Rating Scales (BRAF-NRS, Short-form Survey 36 (SF-36, Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT-F and Visual Analogic Scale for Fatigue (VASf. Independent variables: sociodemographic, clinical and serological, were measured using medical records and direct interview. Disability and disease activity were assessed using the Health Assessment Questionnaire (HAQ and disease activity assessed using the Disease Activity Score 28 joints (DAS28. The scores of scales demonstrated the level of fatigue and multiple linear regression method used in statistical analysis to demonstrate prediction models. Results: A total of 80 patients was assessed, and 57 reported clinically relevant fatigue (VASf > 2, representing 71.25% prevalence point (51 women [89.5%], mean age 48.35 ± 15 years, and mean disease duration of 4.92 ± 3.8 years. Eight predictive models showed statistical significance, one for each fatigue instrument. The highest coefficient of determination (R 2 was 56% for SF-36 and the lowest (R 2 = 21% for FSS. The HAQ was the only independent variable to predict fatigue on all instruments. Conclusion: Clinically relevant fatigue is a highly prevalent symptom and is mostly predicted by disability and age in the population assessed.
Diniz, Leonardo Rios; Balsamo, Sandor; Souza, Talita Yokoy de; Muniz, Luciana Feitosa; Martins, Wagner Rodrigues; Mota, Licia Maria Henrique da
To assess the prevalence of fatigue in a Brazilian population with early rheumatoid arthritis using multiple instruments, and the predictors of these instruments by differents independent variables. Cross-sectional study with direct interview and medical records review. Fatigue, dependent variable, was assessed using eight instruments: Profile of Mood States (POMS), Multidimensional Assessment of Fatigue scale (MAF), Fatigue Severity Scale (FSS), Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ), Numerical Rating Scales (BRAF-NRS), Short-form Survey 36 (SF-36), Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT-F) and Visual Analogic Scale for Fatigue (VASf). sociodemographic, clinical and serological, were measured using medical records and direct interview. Disability and disease activity were assessed using the Health Assessment Questionnaire (HAQ) and disease activity assessed using the Disease Activity Score 28 joints (DAS28). The scores of scales demonstrated the level of fatigue and multiple linear regression method used in statistical analysis to demonstrate prediction models. A total of 80 patients was assessed, and 57 reported clinically relevant fatigue (VASf>2), representing 71.25% prevalence point (51 women [89.5%], mean age 48.35±15 years, and mean disease duration of 4.92±3.8 years). Eight predictive models showed statistical significance, one for each fatigue instrument. The highest coefficient of determination (R 2 ) was 56% for SF-36 and the lowest (R 2 =21%) for FSS. The HAQ was the only independent variable to predict fatigue on all instruments. Clinically relevant fatigue is a highly prevalent symptom and is mostly predicted by disability and age in the population assessed. Copyright © 2017 Elsevier Editora Ltda. All rights reserved.
de Oliveira Francisco, Daniela; de Paula Andres, Marina; Gueuvoghlanian-Silva, Bárbara Yasmim; Podgaec, Sergio; Fridman, Cintia
Based on the assumption that genetic factors are involved in the etiology of endometriosis, this study aimed to investigate the possibility of rs498679 (TLR4 gene), rs1799964 (TNF-α gene), rs3024496 (IL-10 gene), and rs2294021 (CCDC22 gene) polymorphisms being associated with the occurrence of this disease in a sample of Brazilian women. We conducted a case-control study with 100 women with histological confirmation of endometriosis (endometriosis group) and 100 women submitted to laparoscopy for benign disorders, in which the absence of endometriosis was confirmed (control group). All samples were genotyped by real-time PCR technique for rs498679, rs1799964, rs3024496, and rs2294021 polymorphisms. No significant difference was observed in genotypic or allelic frequencies between control and endometriosis groups for rs498679 (TLR4 gene), rs1799964 (TNF-α gene), rs3024496 (IL-10 gene), neither when comparing endometriosis subgroups (I-II versus III-IV). On the other hand, significant difference between stages I-II and III-IV of the disease was found in genotypic and allelic frequencies for the rs2294021 (CCDC22 gene) SNP (p = 0.048 and p = 0.017, respectively). Our results suggest that the rs2294021 (CCDC22 gene) polymorphism could be associated with increased susceptibility to endometriosis in Brazilian women when the allele C is present. In order to clarify this result, further studies should be conducted on a larger population.
de Castro, Alinne Pereira; Araújo, Samuel Dias; Reis, Alessandra M. M.; Pompeu, Maira; Hatay, Mark; de Moura, Rodrigo Leão; Francini-Filho, Ronaldo B.; Thompson, Fabiano L.; Krüger, Ricardo H.
The diversity of bacterial communities associated with three Brazilian endemic reef corals from genus Mussismilia (M. hispida, M. braziliensis, and M. harttii) at a single site was assessed using 16S rRNA clone libraries. The study site, Pedra do Leste, is a coastal reef within the largest and richest South Atlantic coralline reef complex (Abrolhos Bank) and is subject to high fishing pressure, high sedimentation loads, and other land-based stressors. The three coral species are Neogene relicts with unique biological and morphological traits that enable them to survive relatively high sedimentation levels. Our results show that sequences affiliated with γ-Proteobacteria predominated, accounting for more than 60% of the examined sequences. Indeed, the most frequent species were related to Alteromonas, Marinomonas, Neptuniibacter, and Vibrio, which are copiotrophic microorganisms common in environments highly affected by anthropogenic stress. Principal component analysis revealed that bacterial communities of M. braziliensis and M. hispida were more similar to each other than to M. harttii-associated bacteria. Such pattern is likely related to distinct morphological properties of M. harttii, such as the existence of phaceloid colonies, in which polyps are not connected by soft tissue. This is the first investigation assessing the bacterial communities of the three Brazilian endemic Mussismilia species at the same location.
Soares, Márcio; Lobo, Suzana Margarete Ajeje; Torelly, André Peretti; Mello, Patricia Veiga de Carvalho; Silva, Ulisses; Teles, José Mário Meira; Silva, Eliézer; Caruso, Pedro; Friedman, Gilberto; Souza, Paulo César Pereira de; Réa-Neto, Alvaro; Vianna, Arthur Oswaldo; Azevedo, José Raimundo; Vale, Erico; Rezegue, Leila; Godoy, Michele; Maia, Marcelo Oliveira; Salluh, Jorge Ibrain Figueira
Critically ill cancer patients are at increased risk for acute kidney injury, but studies on these patients are scarce and were all single centered conducted in specialized intensive care units. The objective was to evaluate the characteristics and outcomes in a prospective cohort of cancer patients admitted to several intensive care units with acute kidney injury. Prospective multicenter cohort study conducted in intensive care units from 28 hospitals in Brazil over a two-month period. Univariate and multivariate logistic regression were used to identify factors associated with hospital mortality. Out of all 717 intensive care unit admissions, 87 (12%) had acute kidney injury and 36% of them received renal replacement therapy. Kidney injury developed more frequently in patients with hematological malignancies than in patients with solid tumors (26% vs. 11%, P=0.003). Ischemia/shock (76%) and sepsis (67%) were the main contributing factor for and kidney injury was multifactorial in 79% of the patients. Hospital mortality was 71%. General and renal-specific severity-of-illness scores were inaccurate in predicting outcomes for these patients. In a multivariate analysis, length of hospital stay prior to intensive care unit, acute organ dysfunctions, need for mechanical ventilation and a poor performance status were associated with increased mortality. Moreover, cancer-related characteristics were not associated with outcomes. The present study demonstrates that intensive care units admission and advanced life-support should be considered in selected critically ill cancer patients with kidney injury.
Villar, Rodrigo; Gillis, Jason; Santana, Givanildo; Pinheiro, Daniel S; Almeida, André L R A
Villar, R, Gillis, J, Santana, G, Pinheiro, DS, and Almeida, ALRA. Association between anaerobic metabolic demands during simulated Brazilian jiu-jitsu combat and specific jiu-jitsu anaerobic performance test. J Strength Cond Res 32(2): 432-440, 2018-The aims of this study were to design a specific Jiu-Jitsu anaerobic performance test (JJAPT) and investigate the relationship between blood lactate ([La]), heart rate (HR), and rating of perceived exertion (RPE) during simulated Brazilian Jiu-Jitsu combat (SBJJC) and JJAPT. Nine male elite Brazilian medium heavy weight athletes performed a 10-minute SBJJC and JJAPT that required performance of a common BJJ technique for 5 consecutive bouts of 1-minute with 45-second rest between bouts. [La] was measured by a lactate analyzer, HR by an HR monitor, and RPE using Borg's scale, and the number of repetitions of butterfly lifts (NBL) was recorded. During JJAPT, NBL decreased in the fourth and fifth bouts (p ≤ 0.05) with increases in [La], HR, and RPE (p ≤ 0.05), indicating that the JJAPT measured anaerobic performance. [La] during SBJJC was not different than [La] at the third and fourth bouts, but was significantly different than the fifth bout (p ≤ 0.05). [La] showed strong correlation between SBJJC and JJAPT for the third (r = 0.80, p ≤ 0.05), fourth (r = 0.83, p ≤ 0.05), and fifth (r = 0.82, p ≤ 0.05) bouts, but not between the HR and RPE. The JJAPT with 4 bouts presented the best combination of stimulus and highest correlation with SBJJC, supporting its use to assess anaerobic performance of BJJ athletes. These data will aid coaches and athletes to better understand the demands of their sport and may help to monitor adaptation in sport-specific performance across periodized training plans.
Martins, Andréa Maria Eleutério de Barros Lima; Jardim, Lorena Amaral; Souza, João Gabriel Silva; Rodrigues, Carlos Alberto Quintão; Ferreira, Raquel Conceição; Pordeus, Isabela Almeida
This study aimed at identifying the prevalence of the negative evaluation of dental services among elderly Brazilians and at investigating whether the prevalence was higher among those using public or philanthropic provider services than among those paying privately or using private health plans. Additionally, factors associated with this negative assessment were identified. Interview and survey data were collected in the residences of participants by trained and calibrated examiners as part of a national epidemiological survey of oral health conditions of the Brazilian population in 2002/2003. The dependent variable was obtained in response to questions regarding whether the participant had ever used dental services, the frequency of use, and the quality of this service. Potential responses to the questions regarding the quality of service were very poor or poor, fair, and good or very good. The main independent variable was the system of health care used with potential responses being health plan or private, public, and philanthropic services. We conducted univariate (linear tendency χ2 test) and multiple descriptive analyses, and the partial proportional Odds model for ordinal logistic regression. Among the elderly, 196 (3.7%) evaluated the provided services negatively (very poor or poor). Participants with the following responses were more likely to evaluate the services negatively: those who had used public or philanthropic services, men, those with higher education, the ones who had not received information about preventing dental problems, those who perceived pain in their teeth and gums in the last six months, and those who self-reported their oral health and speech was poor. In conclusion, elderly Brazilian users of public and philanthropic services were more likely than users of private or insurance-based plans to evaluate their dental services negatively, regardless of the other investigated variables.
Full Text Available Individuals with Down syndrome (DS present decreased homocysteine (Hcy concentration, reflecting a functional folate deficiency secondary to overexpression of the cystathionine ß-synthase gene. Since plasma Hcy may be influenced by genetic polymorphisms, we evaluated the influence of C677T and A1298C polymorphisms in the methylenetetrahydrofolate reductase gene (MTHFR, of A2756G polymorphism in the methionine synthase gene (MTR, and of A80G polymorphism in the reduced folate carrier 1 gene on Hcy concentrations in Brazilian DS patients. Fifty-six individuals with free trisomy 21 were included in the study. Plasma Hcy concentrations were measured by liquid chromatography_tandem mass spectrometry with linear regression coefficient r² = 0.9996, average recovery between 92.3 to 108.3% and quantification limits of 1.0 µmol/L. Hcy concentrations >15 µmol/L were considered to characterize hyperhomocystinemia. Genotyping for the polymorphisms was carried out by polymerase chain reaction followed by enzyme digestion and allele-specific polymerase chain reaction. The mean Hcy concentration was 5.2 ± 3.3 µmol/L. There was no correlation between Hcy concentrations and age, gender or MTHFR C677T, A1298C and reduced folate carrier 1 A80G genotype. However, Hcy concentrations were significantly increased in the MTR 2756AG heterozygous genotype compared to the MTR 2756AA wild-type genotype. The present results suggest that the heterozygous genotype MTR 2756AG is associated with the increase in plasma Hcy concentrations in this group of Brazilian patients with DS.
Reis Rodrigo S
Full Text Available Abstract Background The aim of this study was analyze associations between the practice of walking and environmental perception among elderly Brazilians in a region of low socioeconomic level. Methods A cross-sectional study was conducted among 385 elderly people aged 60 years and over. To evaluate walking, the International Physical Activity Questionnaire (IPAQ, long version (leisure and transport modules was used. The environment was evaluated by means of the Neighborhood Environmental Walkability Scale (NEWS (adapted Brazilian version. For the statistical analysis, multiple logistic regression models were created separately for men and women. The practice of at least 150 minutes a week of walking was the dependent variable, and the variables of environmental perception were the independent variables. All the models were controlled for schooling level and age. Results The proportion of elderly people active in walking was 56.9% for the men and 26.4% for the women. The perception of the presence of soccer fields (OR = 4.12 and their proximity, within ten minutes' walk from home (OR = 3.43, were associated with the practice of walking among the men. The perception of the presence of public squares (OR = 4.70 and the proximity of primary healthcare units, within ten minutes' walk from home (OR = 3.71, were associated with the practice of walking among the women. An association with adequate perception of vehicle traffic remained at the threshold of significance for the women. Conclusion Accessibility of leisure structures such as football fields and public squares and of health services such as primary healthcare units were important environmental variables associated with the practice of walking among elderly people living in a region of low socioeconomic level in Brazil. These variables need to be taken into consideration when aiming to promote the practice of walking among elderly people living in similar regions.
Azeredo, Catarina Machado; de Rezende, Leandro Fórnias Machado; Canella, Daniela Silva; Claro, Rafael Moreira; Peres, Maria Fernanda Tourinho; Luiz, Olinda do Carmo; França-Junior, Ivan; Kinra, Sanjay; Hawkesworth, Sophie; Levy, Renata Bertazzi
Evidence of the influence of the school food environment on adolescent diet is still little explored in low- and middle-income countries. We aimed to evaluate the association between food environment in schools and the immediate vicinity and the regular consumption of unhealthy food among adolescents. We used cross-sectional data collected by the Brazilian National Survey of School Health (PeNSE) from a representative sample of adolescents attending 9th grade public and private schools in Brazil, in 2012. We estimated students' regular consumption (>5days/week) of unhealthy food (soft drinks, bagged salty snacks, deep fried salty snacks and sweets) and school availability, in the cafeteria or an alternative outlet, of the same food plus some healthy options (fruit and natural fruit juice). We performed multilevel logistic regression models. Having a cafeteria inside school selling soft drinks (private schools OR=1.23; 95% CI=1.14-1.33; public schools OR=1.13; 95% CI=1.06-1.20) and deep fried salty snacks (private schools OR=1.41 95% CI=1.26-1.57; public schools OR=1.16 95% CI=1.08-1.24) was associated with a higher consumption of these unhealthy foods of among students. In private schools, cafeteria selling fruit and natural fruit juice was associated with lower student consumption of bagged salty snacks (OR=0.86; 95% CI 0.77-0.96) and soft drinks (OR=0.85; 95% CI=0.76-0.94). In addition, eating meals from the Brazilian School Food Program in public schools was associated with a lower consumption of unhealthy foods. Foods available in the school food environment are associated with the consumption of unhealthy food among adolescents in Brazil. Copyright © 2016. Published by Elsevier Inc.
Jaime Natan Eisig
Full Text Available CONTEXT: The curative treatment of peptic ulcer is made available nowadays through the eradication of the bacterium Helicobacter pylori, which is associated with it, but the best therapeutic regimen is yet to be determined. OBJECTIVE: To assess the efficacy of a therapeutic regimen with 400 mg ranitidine bismuth citrate associated with 500 mg clarithromycin given twice a day for seven days in a cohort of Brazilian patients with peptic ulcer. TYPE OF STUDY: Cross-sectional study. SETTING: Tertiary-care hospital. PATIENTS: One hundred and twenty nine outpatients, with active or healed peptic ulcers infected by Helicobacter pylori, diagnosed via endoscopy with confirmation via the urease test and histological examination, who had never undergone a regimen for the eradication of the bacterium. PROCEDURE: Administration of 400 mg ranitidine-bismuth and 500 mg clarithromycin twice a day, for seven days. MAIN MEASUREMENTS: Efficacy of the treatment, with a check on the cure done via another endoscopy eight weeks after drug administration. The eradication of the bacterium was determined via the urease test and histological examination. Patients who were negative for both were considered to be cured. RESULTS: Eight patients failed to complete the study. The eradication rate according to intention to treat was 81% (104/129 and per protocol was 86% (104/121. CONCLUSION: The bismuth ranitidine compound associated with clarithromycin used for one week was shown to be a simple, effective and well-tolerated therapeutic regimen for the eradication of Helicobacter pylori.
Gondim, Anne Isabelley; Dias, Thelma Lúcia Pereira; Christoffersen, Martin Lindsey; Stöhr, Sabine
We redescribe Hemieuryale pustulata on the basis of 325 specimens obtained from the continental shelf off northeastern and southeastern Brazil. This is the first record of the species for Brazil. We illustrate for the first time details of the dental plate, oral plate, and vertebrae. Few morphological variations were observed in our extensive material. All specimens were associated with the gorgonian Nicella guadalupensis, suggesting an obligatory association in the Brazilian littoral. H. pustulata did not reveal a particular pattern of distribution on its host gorgonian, but larger gorgonians tend to support a larger number of ophiuroids. In addition to expanding the knowledge on morphology and ecology, we extend the known bathymetric distribution of the species, which is now known from 18 to 330 m.
Natascha Giovannetti de Menezes
Full Text Available This study evaluated the frequency of the tumor necrosis factor-alpha (TNF-α -308 G/A polymorphism in Brazilians with periodontal health (PH = 51, chronic periodontitis (CP = 74 and generalized aggressive periodontitis (GAgP = 38. Human DNA was obtained from mouthwash samples and TNF-α genotyping was performed by PCR and RFLP analyses. Differences in clinical and genetic parameters among groups were sought by Kruskal-Wallis, χ² and Fisher's exact tests. The allele -308G was detected in 91.7%, whereas the allele -308A was found in 35.4% of all subjects. No significant differences were observed in the frequency of these alleles (χ² = 2.610, p > 0.05 and the genotypes G/G, G/A, and A/A (χ² = 2.547, p = 0.636 among groups. The data suggest that the TNF-α -308 G/A polymorphism is not associated with periodontitis in this Brazilian population.
Peixoto, Henry M; Brito, Marcelo A M; Romero, Gustavo A S; Monteiro, Wuelton M; de Lacerda, Marcus V G; de Oliveira, Maria R F
The use of primaquine (PQ) for radical treatment of Plasmodium vivax in carriers of G6PD deficiency (G6PDd) constitutes the main factor associated with severe haemolysis in G6PDd. The current study aimed to estimate the incremental cost-effectiveness ratio of using a rapid diagnostic test (RDT) to detect G6PDd in male patients with P. vivax malaria in the Brazilian Amazon, in comparison with the routine indicated by the Programme for Malaria Control, which does not include this evaluation. A cost-effectiveness analysis of estimated RDT use was carried out for the Brazilian Amazon for the year 2013, considering the perspective of the Brazilian Public Health System. Using decision trees, estimates were compared for two different RDT strategies for G6PDd in male individuals infected with P. vivax before being prescribed PQ, with the routine indicated in Brazil, which does not include prior diagnosis of G6PDd. The first strategy considered the combined use of RDT BinaxNOW(®) G6PD (BX-G6PD) in municipalities with more than 100,000 inhabitants and the routine programme (RP) for the other municipalities. Operational limitations related to the required temperature control and venous blood collection currently restrict the use of RDT BX-G6PD in small municipalities. The second strategy considered the use of the RDT CareStart™ G6PD (CS-G6PD) in 100 % of the municipalities. The analysis was carried out for the outcomes: "adequately diagnosed case" and "hospitalization avoided". For the outcome "adequately diagnosed case", comparing the RDT strategies based on RDT with the routine control programme (RP), the CS-G6PD strategy was the most cost-effective, with BX-G6PD extendedly dominating (the ICER of BX-G6PD compared with RP was higher than the ICER of CS-G6PD compared with RP). CS-G6PD dominated the other strategies for the "hospitalization avoided" outcome. The CS-G6PD strategy is cost-effective for adequately diagnosing cases and avoiding hospitalization. This
da Rocha, Ivete M; Gasparotto, Aline S; Lazzaretti, Rosmeri K; Notti, Regina K; Sprinz, Eduardo; Mattevi, Vanessa S
This study evaluated the impact of seven single nucleotide polymorphisms in five candidate genes (ABCB1, ABCC2, ABCC4, SLC22A6, and SLC22A11) in relation to nephrotoxicity associated with highly active antiretroviral therapy (HAART) in HIV-infected individuals. The following single nucleotide polymorphisms were genotyped by real-time PCR: ABCB1 rs1045642, ABCC2 rs717620 and rs2273697, ABCC4 rs1751034 and rs3742106, SLC22A6 rs11568626, and SLC22A11 rs11231809 in 507 HIV-infected patients from the city of Porto Alegre, Southern Brazil, receiving HAART for, at least, 1 year. From the 507 HIV-infected patients recruited, 19.1% presented a reduction in estimated glomerular filtration rate (eGFR). A total of 16 (3.2%) patients fulfilled the criteria for chronic kidney disease (defined as eGFRT (rs717620) presented lower eGFR than C/C homozygotes (104 ± 22 vs. 108 ± 22 ml/min/1.73 m, independent-samples t-test, P=0.040). In multivariate analysis, the predictors associated with decreased eGFR were time of treatment, tenofovir use, atazanavir/ritonavir use, and carrying one T allele of ABCC2 -24 C>T. Our data support the importance of genetic factors in the etiology of nephrotoxicity in patients treated with HAART. Studies to verify treatment implications of genotyping before HAART initiation may be advisable to guide the selection of an appropriate antiretroviral therapy regimen.
Yara Dadalti Fragoso
Full Text Available Objective Natalizumab is a new and efficient treatment for multiple sclerosis (MS. The risk of developing progressive multifocal leukoencephalopathy (PML during the use of this drug has created the need for better comprehension of JC virus (JCV infection. The objective of the present study was to assess the prevalence of JCV-DNA in Brazilian patients using natalizumab. Method Qualitative detection of the JCV in the serum was performed with real-time polymerase chain reaction (PCR. Results In a group of 168 patients with MS who were undergoing treatment with natalizumab, JCV-DNA was detectable in 86 (51.2% patients. Discussion Data on JCV-DNA in Brazil add to the worldwide assessment of the prevalence of the JCV in MS patients requiring treatment with natalizumab.
Araujo, Marina Campos; Verly Junior, Eliseu; Junger, Washington Leite; Sichieri, Rosely
To verify associations of income and education with nutrient intakes in Brazilian adults. Data from the population-based National Dietary Survey conducted in 2008-2009. Family per capita income and education levels were categorized into quartiles. Prevalences of inadequate nutrient intakes and excessive intakes of saturated fat and Na were calculated by using the method prescribed by the National Cancer Institute. The Estimated Average Requirement was used as a reference for micronutrient intake. Linear regression models for both the independent and the mutually adjusted associations of education and income with nutrient intakes were tested. Interaction between education and income was tested. Households (n 13 569) selected using a two-stage cluster sampling design. Food records for two non-consecutive days were obtained for 21 003 Brazilian adults (aged 20-59 years). For most of eleven nutrients, the prevalence of inadequate intake declined with increasing income and education levels; however, it remained high across all income and education quartiles. Excessive intake of saturated fat and low fibre intake increased with both variables. Most nutrients were independently associated with income and education in both sexes. Fe, vitamin B12 and Na intakes among women were associated only with education. There was an interaction between income and education for Na intake in men, P intake in women and Ca intake in both sexes. Education is one important step to improve nutrient intakes in Brazil. Emphasis should be laid on enhancing dietary knowledge and formulating economic strategies that would allow lower-income individuals to adopt a healthy diet.
Werneck, André O; Cyrino, Edilson S; Collings, Paul J; Ronque, Enio R V; Szwarcwald, Célia L; Sardinha, Luís B; Silva, Danilo R
This study describes the levels and patterns of television (TV) viewing in Brazilian adults and investigates associations of TV viewing with hypertension, type 2 diabetes, and heart disease. Data from the Brazilian Health Survey, a nationally representative survey that was conducted in 2013 (N = 60,202 men and women aged ≥18 y), were used. Information regarding TV viewing, physician diagnoses of type 2 diabetes, hypertension, and heart disease was collected via interview-administered questionnaire. Data on covariables (including chronological age, educational status, skin color, sodium consumption, sugar consumption, tobacco smoking, alcohol consumption, and leisure-time physical activity) were also self-reported. Logistic regression models and population attributable fractions were used for the etiological analyses. The prevalence (95% confidence interval) of >4 hours per day of TV viewing was 12.7% (12.0-13.4) in men and 17.5% (16.8-18.3) in women. Men and women being younger or older, moderately educated, living alone, smoking tobacco, and drinking alcohol were associated with higher reported TV viewing time. Odds ratios (95% confidence interval) revealed that >4 hours per day of TV viewing was associated with type 2 diabetes [male: 1.64 (1.23-2.17) and female: 1.33 (1.09-1.63)], hypertension [male: 1.36 (1.14-1.63) and female: 1.20 (1.05-1.37)], and heart disease [male: 1.96 (1.43-2.69) and female: 1.30 (1.00-1.68)]. Exceeding 4 hours per day of TV viewing was responsible for 6.8% of type 2 diabetes, 3.7% of hypertension, and 7.5% of heart disease cases. Independent of covariates, >4 hours per day of TV viewing was associated with type 2 diabetes, hypertension, and heart disease. High volumes of TV viewing are prevalent and appear to contribute to chronic disease burden.
Turi, B C; Monteiro, H L; Lemes, Í R; Codogno, J S; Lynch, K R; Asahi Mesquita, C A; Fernandes, R A
The purpose of this study was to investigate the association between television (TV) viewing and all-cause mortality among Brazilian adults after 6 years of follow-up. This longitudinal study started in 2010 in the city of Bauru, SP, Brazil, and involved 970 adults aged ≥50 years. Mortality was reported by relatives and confirmed in medical records of the Brazilian National Health System. Physical activity (PA) and TV viewing were assessed by the Baecke questionnaire. Health status, sociodemographic and behavioral covariates were considered as potential confounders. After 6 years of follow-up, 89 deaths were registered (9.2% [95% CI=7.4%-11%]). Type 2 diabetes mellitus was associated with higher risk of mortality (P-value=.012). Deaths correlated significantly with age (ρ=.188; P-value=.001), overall PA score (ρ=-.128; P-value=.001) and TV viewing (ρ=.086; P-value=.007). Lower percentage of participants reported TV viewing time as often (16%) and very often (5.7%), but there was an association between higher TV viewing time ("often" and "very often" grouped together) and increased mortality after 6 years of follow-up (P-value=.006). The higher TV viewing time was associated with a 44.7% increase in all-cause mortality (HR=1.447 [1.019-2.055]), independently of other potential confounders. In conclusion, the findings from this cohort study identified increased risk of mortality among adults with higher TV viewing time, independently of PA and other variables. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Machado, Renato Assis; Messetti, Ana Camila; de Aquino, Sibele Nascimento; Martelli-Júnior, Hercílio; Swerts, Mário Sérgio Oliveira; de Almeida Reis, Silvia Regina; Moreira, Helenara Salvati Bertolossi; Persuhn, Darlene Camati; Coletta, Ricardo D
To determine the association of single-nucleotide polymorphisms (SNPs) in genes related to craniofacial development, which were previously identified as susceptibility signals for nonsyndromic oral clefts, in Brazilians with nonsyndromic cleft lip and/or palate (NSCL/P). The SNPs rs748044 (TNP1), rs1106514 (MSX1), rs28372960, rs15251 and rs2569062 (TCOF1), rs7829058 (FGFR1), rs1793949 (COL2A1), rs11653738 (WNT3), and rs242082 (TIMP3) were assessed in a family-based transmission disequilibrium test (TDT) and a structured case-control analysis based on the individual ancestry proportions. The SNPs were initially analyzed by TDT, and polymorphisms showing a trend toward excess transmission were subsequently studied in an independent case-control sample. The study sample consisted of 189 case-parent trios of nonsyndromic cleft lip with or without cleft palate (NSCL±P), 107 case-parent trios of nonsyndromic cleft palate (NSCP), 318 isolated samples of NSCL±P, 189 isolated samples of NSCP, and 599 healthy controls. Association of alleles with NSCL/P pathogenesis. Preferential transmission of SNPs rs28372960 and rs7829058 in NSCL±P trios and rs11653738 in NSCP trios (P = .04) were observed, although the structured case-control analysis did not confirm these associations. The haplotype T-C-C formed by TCOF1 SNPs rs28372960, rs15251, and rs2569062 was more frequently transmitted from healthy parents to NSCL±P offspring, but the P value (P = .01) did not withstand Bonferroni correction for multiple tests. With the modest associations, our results do not support the hypothesis that TNP1, MSX1, TCOF1, FGFR1, COL2A1, WNT3, and TIMP3 variants are risk factors for nonsyndromic oral clefts in the Brazilian population.
Carmen R. Vargas
Full Text Available Adrenoleukodystrophy (X-ALD is an X-linked recessively inherited peroxisomal disorder, phenotypically heterogeneous, characterized by progressive white-matter demyelination of the central nervous system and adrenocortical insufficiency. We investigated 15 male X-ALD patients varying in age from 7 to 39, diagnosed among 108 suspected patients referred for investigation. Plasma levels of very long chain fatty acids (VLCFA were measured at our laboratory using gas chromatography (GC. Eleven cases of childhood X-ALD and four cases of adrenomyeloneuropathy (AMN were diagnosed. Adrenal leukodystrophy insufficiency and limb weakness were the most frequent symptoms, appearing in 12, 8 and 6 of the patients, respectively. Physician awareness of X-ALD seems inadequate to judge by age at diagnosis and lengthy interval between the start of symptoms and diagnosis. This is the first published series of Brazilian patients with X-ALD. We determined signs and symptoms relevant for diagnosis, as early identification seems important for treatment outcome. In addition, diagnosis identifies carriers, who could benefit from genetic counselling and prenatal diagnosis.Adrenoleucodistrofia (X-ALD é uma desordem peroxissomal com padrão de herança ligada ao X, fenotipicamente heterogênea, caracterizada por uma progressiva desmielinização da substância branca do sistema nervoso central e por insuficiência adrenal. Foram investigados por nós 15 pacientes do sexo masculino com sinais clínicos sugestivos de X-ALD, com idade entre 7 e 39 anos, diagnosticados entre 108 pacientes encaminhados para investigação por suspeita clínica. Os níveis plasmáticos dos ácidos graxos de cadeia muito longa (VLCFA foram dosados em nosso laboratório através de cromatografia gasosa (GC. Onze (73% casos da forma infantil de X-ALD (ALD e 4 (27% casos de adrenomieloneuropatia (AMN foram diagnosticados. Insuficiência leucodistrofia adrenal e fraqueza muscular foram os sinais mais
Villar, Livia M; de Melo, Maria M M; Calado, Izabelle A; de Almeida, Adilson J; Lampe, Elisabeth; Gaspar, Ana M C
Hepatitis A virus (HAV) superinfection is associated with a high risk of liver failure and death in patients with hepatitis C virus (HCV) infection. The aim of this study was to investigate the presence of serological and molecular HAV markers in a population of HCV-infected patients in order to determine a cost-effective strategy to vaccinate against HAV. The presence of total and immunoglobulin (Ig)M anti-HAV antibodies was investigated in 399 patients (median age, 50 years; range, 4-81) referred to the Public Health Central Laboratory of Pernambuco State who tested positive for anti-HCV antibodies and HCV RNA. HAV RNA was investigated by reverse transcription-nested polymerase chain reaction in these patients. Three hundred and eighty-four (96%) patients were positive for anti-HAV total and negative for IgM anti-HAV antibodies (immune patients). Three patients had IgM (and total) anti-HAV antibodies, showing an acute infection, and two of them had HAV RNA detected in serum samples. HAV RNA was also found in another patient in the absence of detectable anti-HAV antibodies. By nucleotide sequencing, it was demonstrated that the HAV isolates infecting these patients belonged to subgenotype 1B. This study provides valuable new data on anti-HAV prevalence among HCV carriers in Brazil. In the present study, we found a high proportion of patients with anti-HAV positivity, indicating that anti-HAV testing of HCV-infected patients is a cost-effective strategy and should be carried out before vaccination against HAV in these patients, particularly in regions such as our geographical area with high total anti-HAV prevalence.
Curado, J. F.; Added, N.; Rizzutto, M. A.
X-Radiography technique has been used effectively for decades to evaluate and identify differences in homogeneities in samples. It is a simple, fast and non-destructive technique that provides a view of internal structure helping investigating manufacturing details of archaeological ceramics. Characteristics of the paste used in the matrix composition can be derived using PIXE technique through the determination of the major elemental composition allowing the calculation of its expected density. Combining this information with x-ray images is possible to check for differences in the average density of material indicating the presence of homogeneously distributed porosity or temper. The present work evaluates the porosity in a set of native Brazilian pottery sherds that were collected in the Aldeia Lalima archaeological site, located at Mato Grosso do Sul State.
Sousa, Carlos Augusto Moreira de; Bahia, Camila Alves; Constantino, Patrícia
Brazil has the sixth largest bicycles fleet in the world and bicycle is the most used individual transport vehicle in the country. Few studies address the issue of cyclists' accidents and factors that contribute to or prevent this event. VIVA is a cross-sectional survey and is part of the Violence and Accidents Surveillance System, Brazilian Ministry of Health. We used complex sampling and subsequent data review through multivariate logistic regression and calculation of the respective odds ratios. Odds ratios showed greater likelihood of cyclists' accidents in males, people with less schooling and living in urban and periurban areas. People who were not using the bike to go to work were more likely to suffer an accident. The profile found in this study corroborates findings of other studies. They claim that the coexistence of cyclists and other means of transportation in the same urban space increases the likelihood of accidents. The construction of bicycle-exclusive spaces and educational campaigns are required.
Schwingel, Paulo Adriano; Cotrim, Helma Pinchemel; Santos, Crimério Ribeiro dos; Santos, Adriano Oliveira dos; Andrade, Antônio Ricardo Cardia Ferraz de; Carruego, Marcos Vinicius Vilas Boas; Zoppi, Cláudio Cesar
The recreational use of anabolic-androgenic steroids (AAS) has reached alarming levels among healthy people. However, several complications have been related to consumption of these drugs, including liver disorders. To evaluate the prevalence of liver injuries in young Brazilian recreational AAS users. Between February/2007 and May/2012 asymptomatic bodybuilders who were ≥18 years old and reported AAS use for ≥6 months were enrolled. All had clinical evaluations, abdominal ultrasound (AUS), and blood tests. 182 individuals were included in the study. The median age (interquartile range) was 26.0 years (22.0-30.0) and all were male. Elevated liver enzyme levels were observed in 38.5% (n = 70) of AAS users, and creatine phosphokinase was normal in 27.1% (n = 19) of them. Hepatic steatosis was observed by AUS in 12.1% of the sample. One individual had focal nodular hyperplasia and another had hepatocellular adenoma. One case each of hepatitis B and C virus infection was found. A diagnosis of toxic liver injury was suggested in 23 (12.6%) AAS users without a history of alcohol or other medications/drugs consumption, or evidence of other liver diseases. Young Brazilian recreational AAS users presented a wide spectrum of liver injuries that included hepatotoxicity, fatty liver, and liver neoplasm. They also presented risk factors for liver diseases such as alcohol consumption and hepatitis B and C virus infection. The results suggest that the risk of AAS use for the liver may be greater than the esthetic benefits, and demonstrate the importance of screening AAS users for liver injuries.
Full Text Available Spinal muscular atrophy (SMA, the second most common lethal autosomal recessive disorder, has an incidence of 1:10,000 newborns. SMA is divided into acute (Werdnig-Hoffmann disease, type I, intermediate (type II and juvenile forms (Kugelberg-Welander disease, type III. The gene of all three forms of SMA maps to chromosome 5q 11.2-13.3. Two candidate genes, the survival motor neuron (SMN gene and the neuronal apoptosis inhibitory protein (NAIP gene, have been identified; SMN is deleted in most SMA patients. We studied both genes in 87 Brazilian SMA patients (20 type I, 14 type II and 53 type III from 74 unrelated families, by using PCR and single strand conformation polymorphism (SSCP. Deletions of exons 7 and/or 8 of the SMN gene were found in 69% of the families: 16/20 in type I, 9/12 in type II and 26/42 in type III. Among 51 families with deletions, 44 had both exons deleted while seven had deletions only of exon 7. Deletions of exon 5 of the NAIP gene were found in 7/20 of type I, 2/12 of type II and 1/42 of type III patients. No deletion of SMN and NAIP genes was found in 112 parents, 26 unaffected sibs and 104 normal controls. No correlation between deletions of one or both genes and phenotype severity was found.As amiotrofias espinhais progressivas (SMAs constituem as doenças degenerativas de origem genética letais mais comuns do sistema nervoso central e mais freqüentes dentre as doenças autossômicas recessivas após a mucoviscidose. A incidência estimada das SMAs é de aproximadamente 1:10.000 nativivos. Clinicamente, as SMAs são classificadas em mais grave (doença de Werdnig-Hoffmann, tipo I, intermediária (tipo II e tardia e benigna (doença de Kugelberg-Welander, tipo III. O gene para os três tipos de SMAs foi mapeado no cromossomo 5 q11.2-13.3. Foram identificados dois genes candidatos na mesma região: SMN (sobrevida do neurônio motor e NAIP (proteína inibidora de apoptose neuronal. Estudamos ambos genes em 87 pacientes
da Cruz, Jane Lilliane Gonçalves; Marques, Isaac Rosa
The journal Annaes de Enfermagem was created to publish ideas, concepts, results of scientific production, reflections and, mainly to expose the Political Professional Project of the Associagao Nacional de Enfermeiras Diplomadas Brasileiras (Brazilian Graduate Nurses National Association). This study aimed at describing and characterizing that elements as they were present in the referred journal in the periodo from 1932 up to 1941. This is a qualitative study based on the historical method. Main elements of the political project comprehends the desired attributes for the nurse as altruism, abnegation, patriotism, humantary sense, professional progress linked to education, art, ideal, ethics and components of Christian religion. These elements made part of a political project that aimed at integrating nursing in the health national context by that time.
Campos, Antonio Hugo Jose Froes Marques; Moreira, Adriana; Ribeiro, Karina Braga; Paes, Roberto Pinto; Zerbini, Maria Claudia; Aldred, Vera; de Souza, Carmino Antonio; Neto, Cristovam Scapulatempo; Soares, Fernando Augusto; Vassallo, Jose
The epidemiology of classical Hodgkin lymphoma varies significantly in populations with different socioeconomic conditions. Among other changes, improvement in such conditions leads to a reduction in the association with EBV infection and predominance of the nodular sclerosis subtype. This study provides an overview of the epidemiology of 817 cases of classical Hodgkin lymphoma diagnosed in five reference hospitals of the State of Sao Paulo, Brazil, over 54 years (1954-2008). The cases were distributed in 3 periods (1954-1979; 1980-1999; and 2000-2008). EBV-positive cases decreased from 87% to 46%. In children and adolescents (45 years), the decrease in EBV infection was not significant. Nodular Sclerosis was the most common subtype in all periods. These results support the hypothesis that, in the Brazilian State of Sao Paulo, classical Hodgkin lymphoma has changed and now shows characteristics consistent with Pattern III observed in populations that experienced a similar socioeconomic transition.
Maria Letícia Santos Cruz
Full Text Available Challenges to the adherence to combination antiretroviral therapy among the pediatric population should be understood in the context of the trajectories of families, their interaction with healthcare services, and their access to material and symbolic goods. The present study analyzed individual, institutional and social factors that might be associated with the caregivers’ role in the treatment adherence of children and adolescents living with HIV (CALHIV. Based on semi-structured interviews and questionnaires applied to 69 caregivers seen at pediatric AIDS services of five Brazilian macro-regions, we observed that adherent caregivers had better acceptance of diagnosis and treatment, were less likely to face discrimination and social isolation secondary to AIDS-related stigma and tended to believe in the efficacy of treatment, and to be more optimistic about life perspectives of CALHIV. Interventions aiming to improve adherence and to promote the health of CALHIV should take in consideration the interplay of such different factors.
Cruz, Maria Letícia Santos; Cardoso, Claudete A Araújo; Darmont, Mariana Q; Dickstein, Paulo; Bastos, Francisco I; Souza, Edvaldo; Andrade, Solange D; Fabbro, Marcia D'All; Fonseca, Rosana; Monteiro, Simone
Challenges to the adherence to combination antiretroviral therapy among the pediatric population should be understood in the context of the trajectories of families, their interaction with healthcare services, and their access to material and symbolic goods. The present study analyzed individual, institutional and social factors that might be associated with the caregivers' role in the treatment adherence of children and adolescents living with HIV (CALHIV). Based on semi-structured interviews and questionnaires applied to 69 caregivers seen at pediatric AIDS services of five Brazilian macro-regions, we observed that adherent caregivers had better acceptance of diagnosis and treatment, were less likely to face discrimination and social isolation secondary to AIDS-related stigma and tended to believe in the efficacy of treatment, and to be more optimistic about life perspectives of CALHIV. Interventions aiming to improve adherence and to promote the health of CALHIV should take in consideration the interplay of such different factors.
Alex Magno Coelho Horimoto
Full Text Available ABSTRACT Introduction: Systemic sclerosis (SSc is a connective tissue disease of unknown etiology, characterized by a triad of vascular injury, autoimmunity and tissue fibrosis. It is known that a positive family history is the greatest risk factor already identified for the development of SSc in a given individual. Preliminary observation of a high prevalence of polyautoimmunity and of familial autoimmunity in SSc patients support the idea that different autoimmune phenotypes may share common susceptibility variants. Objectives: To describe the frequency of familial autoimmunity and polyautoimmunity in 60 SSc patients in the Midwest region of Brazil, as well as to report the main autoimmune diseases observed in this association of comorbidities. Methods: A cross-sectional study with recruitment of 60 consecutive patients selected at the Rheumatology Department, University Hospital, Medicine School, Federal University of Mato Grosso do Sul (FMUFMS, as well as interviews of their relatives during the period from February 2013 to March 2014. Results: A frequency of 43.3% of polyautoimmunity and of 51.7% of familial autoimmunity in SSc patients was found. Patients with the presence of polyautoimmunity and familial autoimmunity presented primarily the diffuse form of SSc, but this indicator did not reach statistical significance. The autoimmune diseases most frequently observed in polyautoimmunity patients were: Hashimoto's thyroiditis (53.8%, Sjögren's syndrome (38.5%, and inflammatory myopathy (11.5%. The main autoimmune diseases observed in SSc patients' relatives were: Hashimoto's thyroiditis (32.3%, rheumatoid arthritis (22.6%, and SLE (22.6%. The presence of more than one autoimmune disease in SSc patients did not correlate with disease severity or activity. Conclusions: From the high prevalence of coexisting autoimmune diseases found in SSc patients, we stress the importance of the concept of shared autoimmunity, in order to promote a
Jamile Sanches Codogno
Full Text Available DOI: http://dx.doi.org/10.5007/1980-0037.2013v15n1p82 The relationship between physical activity and the use of medicines is not clear. The purpose of this study was to investigate this relationship between the level of physical activity and the use of medications by type 2 diabetic patients who were attended in the Brazilian public healthcare system. The sample was composed of 121 Brazilian diabetic patients, of both genders, attended by the public healthcare system. Body fat (estimated by anthropometry and bioelectrical impedance, physical activity (measured by Baecke’s questionnaire, and the participant’s use of medicines (during the 15 days before evaluation were assessed. There was a relationship between the use of medicines and: gender (r = 0.18; p = 0.045, body mass index (BMI (r = 0.22; p = 0.012, waist circumference (r = 0.19; p = 0.029, body fat percentage (r = 0.21; p = 0.016, age (r = 0.23; p = 0.009, and level of physical activity (r = -0.22; p = 0.012. Linear regression included in the multivariate model only age (β = 0.718; p = 0.057, BMI (β= 0.057; p = 0.022, and level of physical activity (β = -0.176; p = 0.044. In conclusion, physical activity decreases medicinal use independent of age or obesity.
Karla Cristina Vasconcelos Moura
Full Text Available Parkinson's disease is the second most frequent neurodegenerative disorder in the world, affecting 1-2% of individuals over the age of 65. The etiology of Parkinson's disease is complex, with the involvement of gene-environment interactions. Although it is considered a disease of late manifestation, early-onset forms of parkinsonism contribute to 5–10% of all cases. In the present study, we screened mutations in coding regions of PARK2 and PINK1 genes in 136 unrelated Brazilian patients with early-onset Parkinson's disease through automatic sequencing. We identified six missense variants in PARK2 gene: one known pathogenic mutation, two variants of uncertain role, and three nonpathogenic changes. No pathogenic mutation was identified in PINK1 gene, only benign polymorphisms. All putative pathogenic variants found in this study were in heterozygous state. Our data show that PARK2 point mutations are more common in Brazilian early-onset Parkinson's disease patients (2.9% than PINK1 missense variants (0%, corroborating other studies worldwide.
Ilana de França Azevedo
Full Text Available Objective: This study investigated the occurrence of the p190 and p210 break point clusterregion-Abelson (BCR-ABL rearrangements in adults with acute lymphoblastic leukemia and possible associations with clinical and laboratory characteristics and survival. Methods: Forty-one over 18-year-old patients with acute lymphoblastic leukemia of both genders followed-up between January 2008 and May 2012 were included in this study. Clinical and laboratory data were obtained from the medical charts of the patients. Reverse transcription polymerase chain reaction (RT-PCR using specific primers was employed to identify molecular rearrangements. Results: At diagnosis, the median age was 33 years, and there was a predominance of males (61%. The most common immunophenotype was B lineage (76%. BCR-ABL rearrangements was detected in 14 (34% patients with the following distribution: p190 (28%, p210 (50% and double positive (22%. Overall survival of patients with a mean/median of 331/246 days of follow up was 39%, respectively, negative BCR-ABL (44% and positive BCR-ABL (28%. Conclusion: These results confirm the high frequency of BCR-ABL rearrangements and the low survival rate of adult Brazilian patients with acute lymphoblastic leukemia.
de Souza Buriol, Viviane Costa; Hirakata, Vânia; Goldani, Marcelo Zubaran; da Silva, Clécio Homrich
To analyze the trend of low birth weight (LBW) and its determinants in Brazilian state capitals between 1996 and 2011. We intended to determine which variables are associated with LBW during the period studied. This is a cross-sectional study that used data from the National Information System of Live Births from 26 state capitals and Brasilia (the federal capital), divided into five geographical regions. The Average Annual Percentage of Change (AAPC) was used to assess the possible time trend in the low birth weight rates for considering all regions together and each region separately, according to each variable, and the Poisson regression was calculated in order to demonstrate time trends in low birth weight and the impact of variables (age and educational maternal level, antenatal visits, type of delivery, and gestational age) during the period. All variables were analyzed together using the Poisson regression as well. From the total of 11,200,255 live births used in this study, there was a significant reduction in the number of live births, especially in the more developed regions. The low birth weight rate was 8 %, and it was stable during the period. Considering regional trends, the rate was higher in the Southeast and South regions, and significantly higher in the North, Northeast, and Central West regions. Improvements in maternal education and antenatal care coverage reduced the risk for low birth weight in all regions. Also, there was an increase in caesarean sections in all regions, with a small impact on low birth weight rates. Improvements in education and health care reduced the risk for low birth weight in all Brazilian regions during the period of study. Trends in low birth weight rates and the associated factors differ from region to region, showing different stages of demographic, epidemiological and developmental transition in Brazil. The present study was approved by the Research Ethics Committee at the Hospital de Clínicas de Porto Alegre
Guerra-Shinohara, Elvira M; Pereira, Perla M; Kubota, Ananka M; Silva, Thaiomara A; Reis, Jucilene L; Miyashita, Gerson S; D'Almeida, Vânia; Allen, Robert H; Stabler, Sally P
The pathophysiology of spontaneous abortion is complex and may involve the interaction of genetic and environmental factors. We evaluated the predictors of spontaneous abortion in Brazilian pregnant women. The effects of age, gestational age, body mass index (BMI), cigarette smoking, alcohol ingestion, use of multivitamins and concentrations of vitamins (folate, cobalamin and vitamin B6) and vitamin-dependent metabolites were analyzed. Study population included 100 healthy women that attended pre-natal care in 2 health centers of Sao Paulo, Brazil, and in whom pregnancy outcome was known. Folate and cobalamin status was measured in blood specimens collected between 4 and 16 weeks. The genotypes for 8 gene polymorphisms were evaluated by PCR-RFLP. Eighty-eight women had normal pregnancy outcome (Group 1), while 12 experienced a miscarriage after blood collection (Group 2). Increased methylmalonic acid (MMA) concentrations were found in Group 2 (median [25th-75th percentile]=274 [149-425] nmol/l) relative to Group 1 (138 [98-185]) (PMMA, cystathionine, body mass index (BMI), cigarette smoking, alcohol ingestion and use of multivitamins the risk of abortion was significantly associated with MMA (OR [95% CI]=3.80 [1.36, 10.62] per quartile increase in MMA), BMI (OR [95% CI]=5.49 [1.29, 23.39] per quartile) and gestational age (OR [95% CI]=0.10 [0.01, 0.77] per increase of interval in gestational age). Increased serum MMA and BMI concentrations are associated with spontaneous abortion in Brazilian women. Copyright 2009 Elsevier B.V. All rights reserved.
The diversity of cultivable endophytic fungal community associated with the rare, ancient and narrowly endemic Neotropical plant Vellozia gigantea present in the Brazilian Rupestrian Grasslands was assessed. Two hundred and eighty-five fungal isolates obtained were identified into 27 genera and 87 t...
Paula Cristina Trevilatto
Full Text Available Objective: Tumor necrosis factor-alpha (TNF-α is a major mediator of the immune-inflammatory response and may play an important role in the pathogenesis and progression of chronic periodontitis. Polymorphisms in the promoter of the TNFA gene have been associated with some types of inflammatory diseases. The present study investigated the association between a single-nucleotide polymorphism (SNP of the TNFA (G-308A gene and chronic periodontitis in Brazilians. Methods: One hundred and thirteen (113 over 25 years were divided according to the severity level of periodontal disease: 44 healthy individuals (control group, 31 subjects with moderate and 38 patients with severe periodontitis. Genomic DNA was obtained from epithelial cells. The samples were analyzed for TNFA (G-308A polymorphism using polymerase chain reaction-restriction fragment length polymorphism techniques. The significance of the differences in the genotype frequencies of the polymorphism was assessed by Chi-square test (p<0.05. Results: No significant differences in the genotype distribution and allele frequency were found between control and groups with periodontitis. Conclusion: It was concluded that TNFA (-308 polymorphism was not associated with chronic periodontitis. Other polymorphisms in this or/and other genes of the host inflammatory response might be involved in determining susceptibility to periodontitis in the study population.
Silmara Rodrigues Machado
Full Text Available The potential role of coffee as a hepatoprotective substance for chronic liver diseases has been widely discussed. Our main aim was to evaluate the effect of coffee intake regarding clinical, biochemical tests and liver biopsy data in treatment naïve patients with chronic hepatitis C. One hundred and thirty-six patients with chronic hepatitis C, diagnosed through liver biopsy, or by means of clinical, ultrasound or endoscopic signs of cirrhosis, were assessed by determination of biochemical tests, metabolic and morphological alterations. Food frequency was scrutinized by using a structured questionnaire. Coffee intake represented more than 90% of the total daily caffeine, and the 75th percentile was 4-Brazilian coffee-cup/day (≥255 mL/day or ≥123 mg caffeine/day. According to caffeine intake, patients were divided into two groups (< or ≥123 mg caffeine/day. Patients with higher ingestion of caffeine had lower serum levels of aspartate aminotransferase (× upper limit of normal (1.8 ± 1.5 vs 2.3 ± 1.5, p = 0.04, lower frequencies of advanced (F3, F4 fibrosis (23.5% vs 54.5%, p < 0.001 and of histological activity grade (A3, A4 observed in liver biopsies (13.8% vs 36.9%, p < 0.001. By multivariate logistic regression, fibrosis was independently associated with caffeine intake (OR– 0.16; 95%CI – 0.03–0.80; p = 0.026, γ-glutamil transferase serum levels and morphological activity. But only fibrosis was associated with histological activity. In conclusion caffeine consumption greater than 123 mg/day was associated with reduced hepatic fibrosis. In addition, this study supports the assumption that coffee intake has hepatoprotective benefits for Brazilian patients with chronic hepatitis C, even in lower doses than that of American and European population intake.
Caniatti, Marcela Caleffi da Costa Lima; Marchioro, Ariella Andrade; Guilherme, Ana Lúcia Falavigna; Tsuneto, Luiza Tamie
Allergic reaction to dust mites is a relatively common condition among children, triggering cutaneous and respiratory responses that have a great impact on the health of this population. Anaphylactic hypersensitivity is characterized by an exacerbated response involving the production of regulatory cytokines responsible for stimulating the production of IgE antibodies. To investigate an association of variants in cytokine genes (IL1A-889, IL1B-511, +3962, IL1R1970, IL1RA11100, IL4RA+1902, IL12-1188, IFNG+874, TGFB1 codon 10, codon 25, TNFA-308, -238, IL2-330, +166, IL4-1098, -590, -33, IL6-174, nt565, and IL10-1082, -819, -592) between patients sensitive to dust mites and a control group. A total of 254 patients were grouped as atopic and non-atopic according to sensitivity as evaluated by the Prick Test and to cytokine genotyping by the polymerase chain reaction-sequence specific primers (PCR-SSP) method using the Cytokine Genotyping Kit. A comparison between individuals allergic to Dermatophagoides farinae, Dermatophagoides pteronyssinus, and Blomia tropicalis and a non-atopic control group showed significant differences between allele and genotype frequencies in the regulatory regions of cytokine genes, with important evidence for IL4-590 in T/C (10.2% vs. 43.1%, odd ratio [OR] = 0.15, p = 5.2 10-8, pc = 0.0000011, and 95% confidence interval [95%CI] = 0.07-0.32) and T/T genotypes (42.9% vs. 13.8%, OR = 4.69, p = 2.5 10-6, pc = 0.000055, and 95%CI = 2.42-9.09). Other associations were observed in the pro-inflammatory cytokines IL1A-889 (T/T, C, and T) and IL2-330 (G/T and T/T) and the anti-inflammatory cytokines IL4RA+1902 (A and G), IL4-590 (T/C, T/T, C, and T), and IL10-592 (A/A, C/A, A, and C). Our results suggest a possible association between single nucleotide polymorphisms (SNPs) in cytokine genes and hypersensitivity to dust mites.
Full Text Available Huntington disease (HD is associated with expansions of a CAG trinucleotide repeat in the HD gene. Accurate measurement of a specific CAG repeat sequence in the HD gene in 92 Brazilian controls without HD, 44 Brazilian subjects with clinical findings suggestive of HD and 40 individuals from 6 putative HD families, showed a range from 7 to 33 repeats in normal subjects and 39 to 88 repeats in affected subjects. A trend between early age at onset of first symptoms and increasing number of repeats was seen. Major increase of repeat size through paternal inheritance than through maternal inheritance was observed. Data generated from this study may have significant implications for the etiology, knowledge of the incidence, diagnosis, prognosis, genetic counseling and treatment of HD Brazilian patients.
Crispim, S.M.; Nascimento, A.M.A.; Costa, P.S.; Moreira, J.L.S.; Nunes, A.C.; Nicoli, J.R.; Lima, F.L.; Mota, V.T.; Nardi, R.M.D.
Puba or carimã is a Brazilian staple food obtained by spontaneous submerged fermentation of cassava roots. A total of 116 lactobacilli and three cocci isolates from 20 commercial puba samples were recovered on de Man, Rogosa and Sharpe agar (MRS); they were characterized for their antagonistic activity against foodborne pathogens and identified taxonomically by classical and molecular methods. In all samples, lactic acid bacteria were recovered as the dominant microbiota (7.86 ± 0.41 log10 CFU/g). 16S–23S rRNA ARDRA pattern assigned 116 isolates to the Lactobacillus genus, represented by the species Lactobacillus fermentum (59 isolates), Lactobacillus delbrueckii (18 isolates), Lactobacillus casei (9 isolates), Lactobacillus reuteri (6 isolates), Lactobacillus brevis (3 isolates), Lactobacillus gasseri (2 isolates), Lactobacillus nagelii (1 isolate), and Lactobacillus plantarum group (18 isolates). recA gene-multiplex PCR analysis revealed that L. plantarum group isolates belonged to Lactobacillus plantarum (15 isolates) and Lactobacillus paraplantarum (3 isolates). Genomic diversity was investigated by molecular typing with rep (repetitive sequence)-based PCR using the primer ERIC2 (enterobacterial repetitive intergenic consensus). The Lactobacillus isolates exhibited genetic heterogeneity and species-specific fingerprint patterns. All the isolates showed antagonistic activity against the foodborne pathogenic bacteria tested. This antibacterial effect was attributed to acid production, except in the cases of three isolates that apparently produced bacteriocin-like inhibitory substances. This study provides the first insight into the genetic diversity of Lactobacillus spp. of puba. PMID:24159278
Full Text Available Puba or carimã is a Brazilian staple food obtained by spontaneous submerged fermentation of cassava roots. A total of 116 lactobacilli and three cocci isolates from 20 commercial puba samples were recovered on de Man, Rogosa and Sharpe agar (MRS; they were characterized for their antagonistic activity against foodborne pathogens and identified taxonomically by classical and molecular methods. In all samples, lactic acid bacteria were recovered as the dominant microbiota (7.86 ± 0.41 log10 CFU/g. 16S-23S rRNA ARDRA pattern assigned 116 isolates to the Lactobacillus genus, represented by the species Lactobacillus fermentum (59 isolates, Lactobacillus delbrueckii (18 isolates, Lactobacillus casei (9 isolates, Lactobacillus reuteri (6 isolates, Lactobacillus brevis (3 isolates, Lactobacillus gasseri (2 isolates, Lactobacillus nagelii (1 isolate, and Lactobacillus plantarum group (18 isolates. recA gene-multiplex PCR analysis revealed that L. plantarum group isolates belonged to Lactobacillus plantarum (15 isolates and Lactobacillus paraplantarum (3 isolates. Genomic diversity was investigated by molecular typing with rep (repetitive sequence-based PCR using the primer ERIC2 (enterobacterial repetitive intergenic consensus. The Lactobacillus isolates exhibited genetic heterogeneity and species-specific fingerprint patterns. All the isolates showed antagonistic activity against the foodborne pathogenic bacteria tested. This antibacterial effect was attributed to acid production, except in the cases of three isolates that apparently produced bacteriocin-like inhibitory substances. This study provides the first insight into the genetic diversity of Lactobacillus spp. of puba.
Full Text Available Abstract Objectives: to summarize Brazilian studies that analyzed the risk factors for Exclusive Breastfeeding (EBF interruption before the child's six months of life. Methods: systematic review and meta-analysis indexed articles from Bireme, Scielo and Pubmed databases published in the period of January 2000 to December 2015. Results: 22 articles were included in the meta-analysis. The factors related to newborns were observed, such as birth weight (OR= 1.17; CI 95%: 1.05-1.29, female gender (OR= 1,09; CI 95%: 1.04-1.13 and the use of pacifier (OR= 2.29; CI 95%: 1.68-2.91 were the main factors responsible for the increase in the occurrence of EBF interruption. The factors were related to the mother, maternal age below twenty years old (OR= 1.22; CI 95%: 1.12-1.33 low schooling level (OR=1.28; CI 95%: 1.11-1.45, primiparity (OR= 1.17; CI 95%: 1.02-1.32 maternal employment during the postpartum period (OR= 1.26; CI 95%: 1.11-1.41, and low family income (OR= 1.22; CI 95%: 1.08-1.37 contributed significantly to the EBF interruption . Conclusions: the meta-analysis of Brazilian epidemiological studies demonstrated evidences to conclude that below the age of twenty, low schooling, primiparity, maternal employment in the postpartum period and low family income are associated to the interruption of exclusive breastfeeding until 6 months of age. Children with low birth weight, female gender and used a pacifier had greater vulnerability to not be exclusively breastfed. In conclusion, most of these factors can be modified through appropriate public policies throughout the adequate prenatal period to promote exclusive breastfeeding.
Full Text Available Introduction Few Latin American studies have assessed the prevalence of hepatitis C virus (HCV infection in elderly individuals, in whom the highest rates are expected. We aimed to investigate the prevalence of and factors associated with HCV infection in elderly residents in the municipality of Tubarão, Santa Catarina. Methods This cross-sectional study included 820 individuals (aged ≥ 60 years who were selected by simple random sampling. The presence of anti-HCV antibodies was tested by chemiluminescence, and HCV RNA detection was performed for the anti-HCV-reactive subjects. Those individuals who were anti-HCV reactive but had undetectable HCV RNA levels were tested using a third-generation recombinant immunoblot assay. The variables were compared using the chi-squared test or Fisher's exact test, and those variables with p < 0.05 were included in the logistic regression model. Results The mean patient age was 68.6 years (SD 7.0 years; 39% were men, and 92% were Caucasian. Eighteen subjects were anti-HCV positive. Among these individuals, 4 were characterized as false-positives, leaving 14 (1.7% individuals with confirmed infections for analysis. HCV infection was associated with an age older than 65 years, households with 3 or more residents and the previous transfusion of blood products. In the logistic regression analysis, the following variables were independently associated with HCV infection: households with 3 or more residents (OR 7.9, 95% CI 1.7–35.9, p = 0.008 and previous blood transfusion (OR 6.2, 95% CI 2.1–18.6, p = 0.001. Conclusions The HCV prevalence in the elderly population in the municipality of Tubarão was higher than that found in previous studies of blood donors in the same region. Although exposure to contaminated blood products remained important, other transmission routes, such as household transmission, could play a role in HCV infection.
Souza, João Gabriel Silva; Jones, Kimberly Marie; Fonseca, Adelia Dayane Guimarães; de Barros Lima Martins, Andréa Maria Eleutério
To estimate the prevalence of the consumption of beer and distilled beverages and associated factors among Brazilian older adults residing in a highly populated city in Brazil, highlighting the factors associated with frequent consumption and differences in consumption between men and women. It was a cross-sectional, analytic study carried out by means of probability samples of conglomerates of older adults (aged 65-74 years). Descriptive analysis, univariate analysis and estimates of multivariate models through logistic regression (OR, 95% CI) were realized. 500 of the 736 evaluated seniors were included in the present analysis. 128 (27.3%), 103 (21.3%) and 167 (34.9%) of the seniors indicate past or current use of beer, distilled beverages and frequent use of alcohol, respectively. The consumption of beer was associated with use of tobacco between women; and with marital status and schooling between men. The consumption of distilled beverages was associated with schooling and use of tobacco between women; and age and use of tobacco in men. Daily or weekly use was associated with schooling and use of tobacco between women; age and the use of tobacco between men. In the elderly population studied, a noteworthy prevalence of the consumption of beer and distilled beverages was identified, and this use was associated with personal and behavioral determinants. Similar associations related to frequent (daily or weekly) consumption were also identified. Significant differences in the profile of consumption were identified between men and women, with more abusive use among men. Geriatr Gerontol Int 2016; 16: 810-820. © 2015 Japan Geriatrics Society.
Jonas Augusto C. Silveira
Full Text Available OBJECTIVE: To examine the associations between socioeconomic and biological factors and infant weight gain. METHODS: All infants (0-23 months of age with available birth and postnatal weight data (n = 1763 were selected from the last nationally representative survey with complex probability sampling conducted in Brazil (2006/07. The outcome variable was conditional weight gain (CWG, which represents how much an individual has deviated from his/her expected weight gain, given the birth weight. Associations were estimated using simple and hierarchical multiple linear regression, considering the survey sampling design, and presented in standard deviations of CWG with their respective 95% of confidence intervals. Hierarchical models were designed considering the UNICEF Conceptual Framework for Malnutrition (basic, underlying and immediate causes. RESULTS: The poorest Brazilian regions (-0.14 [-0.25; -0.04] and rural areas (-0.14 [-0.26;-0.02] were inversely associated with CWG in the basic causes model. However, this association disappeared after adjusting for maternal and household characteristics. In the final hierarchical model, lower economic status (-0.09 [-0.15; -0.03], human capital outcomes (maternal education < 4th grade (-0.14[-0.29; 0.01], higher maternal height (0.02[0.01; 0.03], and fever in the past 2 weeks (-0.13[-0.26; -0.01] were associated with postnatal weight gain. CONCLUSION: The results showed that poverty and lower human capital are still key factors associated with poor postnatal weight gain. The approach used in these analyses was sensitive to characterize inequalities among different socioeconomic contexts and to identify factors associated with CWG in different levels of determination.
Egan, Kieren J; Campos Santos, Hadassa; Beijamini, Felipe; Duarte, Núbia E; Horimoto, Andréa R V R; Taporoski, Tâmara P; Vallada, Homero; Negrão, André B; Krieger, José E; Pedrazzoli, Mário; Knutson, Kristen L; Pereira, Alexandre C; von Schantz, Malcolm
Significant questions remain unanswered regarding the genetic versus environmental contributions to racial/ethnic differences in sleep and circadian rhythms. We addressed this question by investigating the association between diurnal preference, using the morningness-eveningness questionnaire (MEQ), and genetic ancestry within the Baependi Heart Study cohort, a highly admixed Brazilian population based in a rural town. Analysis was performed using measures of ancestry, using the Admixture program, and MEQ from 1,453 individuals. We found an association between the degree of Amerindian (but not European of African) ancestry and morningness, equating to 0.16 units for each additional percent of Amerindian ancestry, after adjustment for age, sex, education, and residential zone. To our knowledge, this is the first published report identifying an association between genetic ancestry and MEQ, and above all, the first one based on ancestral contributions within individuals living in the same community. This previously unknown ancestral dimension of diurnal preference suggests a stratification between racial/ethnic groups in an as yet unknown number of genetic polymorphisms.
Neitzke-Montinelli, Vanessa; Urmenyi, Turan P; Rondinelli, Edson; Cabello, Pedro Hernan; Silva, Rosane; Moura-Neto, Rodrigo S
We describe an association of two SNPs, rs3212345:C>T and rs3212346:G>A, located approximately 2.5 kb upstream of the melanocortin-1 receptor (MC1R) translation initiation codon, with pigmentation phenotype variation in a Southeast Brazilian miscegenated population. One hundred thirty-eight genetically unrelated subjects, with multicolor phenotype, were selected from the southeast region of Brazil. Skin, hair and eye color, and tanning ability were rated. Genotypes for each SNP (rs3212345:C>T and rs3212346:G>A) were determined. A logistic regression analysis was performed with the additive model to determine which of the polymorphisms contributed to a specific phenotype. We found that the rs3212345:C>T is associated with light skin, red hair, and poor tanning ability, while the rs3212346:G>A is associated with dark skin, black hair, and strong tanning ability. The presence of rs3212345-C and rs3212346-A alleles in human, chimpanzee, gorilla, orangutan, and marmoset genomes suggests that they are the ancestral alleles. These data suggest that the rs3212345-T and rs3212346-G alleles may have contributed to lighter pigmentation phenotypes in modern humans. Genotyping for these SNPs may prove useful to the fields of molecular anthropology and forensic genetics. Copyright © 2012 Wiley Periodicals, Inc.
Corrêa, Flavia Regina Sobreira; Schanuel, Fernanda Seabra; Moura-Nunes, Nathalia; Monte-Alto-Costa, Andréa; Daleprane, Julio Beltrame
The use of natural products in wound healing has been extensively studied in the context of complementary and alternative medicine. Propolis, a natural product, is a polyphenol-rich resin used for this purpose. This study aimed to investigate the effect of Brazilian Red Propolis Extract (BRPE) on inflammation and wound healing in mice, using a tissue repair model. The BRPE polyphenol content was analyzed by liquid chromatography coupled to mass spectrometry (LC/MS). A full-thickness excision lesion was created, and mice were treated orally with daily doses of vehicle solution (water-alcohol solution containing 2% of ethanol, control group) or 100mg/kg of BRPE (P100 group) during nine consecutive days. BRPE chemical composition analysis showed that this complex matrix contains several phenolic compounds such as phenolic acids, phenolic terpenes and flavonoids (especially catechins, flavonols, chalcones, isoflavones, isoflavans, pterocarpans and bioflavonoids). After BRPE administration, it was observed that, when compared to the control group, P100 group presented faster wound closure (p<0.001); less neutrophils per mm 2 (p<0.05) and macrophages (p<0.01) in tissue analyses, down regulation of the inflammatory transcription factor pNF-κB protein expression, and reduced production of inflammatory cytokine, such as TGF-β, TNF-α (p<0.0001), and IL-6 (p<0.001). These findings suggest a positive role of BRPE oral administration in the wound healing process via suppressing the inflammatory response during tissue repair. Copyright © 2016 Elsevier Masson SAS. All rights reserved.
Poliany C.O. Rodrigues
Full Text Available Abstract Objective: To analyze the seasonality of blood parameters related to iron homeostasis, inflammation, and allergy in two riverine populations from the Brazilian Amazon. Methods: This was a cross-sectional study of 120 children and adolescents of school age, living in riverine communities of Porto Velho, Rondonia, Brazil, describing the hematocrit, hemoglobin, ferritin, serum iron, total white blood cell count, lymphocytes, eosinophils, C-reactive protein, and immunoglobulin E levels in the dry and rainy seasons. The chi-squared test and the prevalence ratio were used for the comparison of proportions and mean analysis using paired Student's t-test. Results: Hemoglobin (13.3 g/dL and hematocrit (40.9% showed higher average values in the dry season. Anemia prevalence was approximately 4% and 12% in the dry and rainy seasons, respectively. Serum iron was lower in the dry season, with a mean of 68.7 mcg/dL. The prevalence of iron deficiency was 25.8% in the dry season and 9.2% in the rainy season. Serum ferritin did not show abnormal values in both seasons; however, the mean values were higher in the dry season (48.5 ng/mL. The parameters of eosinophils, lymphocytes, global leukocyte count, C-reactive protein and immunoglobulin E showed no seasonal differences. C-reactive protein and immunoglobulin E showed abnormal values in approximately 7% and 60% of the examinations, respectively. Conclusion: Hematological parameters of the red cell series and blood iron homeostasis had seasonal variation, which coincided with the dry season in the region, in which an increase in atmospheric pollutants derived from fires is observed.
Full Text Available The aim of this study was to determine risk factors for adverse events (AE-related treatment discontinuation and severe anemia among patients with chronic hepatitis C virus (HCV genotype 1 infection, treated with first-generation protease inhibitor (PI-based therapy. We included all patients who initiated treatment with PI-based therapy at a Brazilian university hospital between November 2013 and December 2014. We prospectively collected data from medical records using standardized questionnaires and used Epi Info 6.0 for analysis. Severe anemia was defined as hemoglobin ≤8.5 mg/dL. We included 203 patients: 132 treated with telaprevir (TVR and 71 treated with boceprevir (BOC. AE-related treatment discontinuation rate was 19.2% and anemia was the main reason (38.5%. Risk factors for treatment discontinuation were higher comorbidity index (OR=1.85, CI=1.05-3.25 for BOC, and higher bilirubin count (OR=1.02, CI=1.01-1.04 and lower BMI (OR=0.98, CI=0.96-0.99 for TVR. Severe anemia occurred in 35 (17.2% patients. Risk factors for this outcome were lower estimated glomerular filtration rate (eGFR; OR=0.95, CI=0.91-0.98 for patients treated with TVR, and higher comorbidity index (OR=2.21, CI=1.04-4.67 and ribavirin dosage (OR=0.84, CI=0.72-0.99 for those treated with BOC. Fifty-five (57.3% patients treated with TVR and 15 (27.3% patients treated with BOC achieved sustained virological response (SVR. Among patients who received TVR and interrupted treatment due to AE (n=19, only 26.3% (n=5 achieved SVR (P=0.003. Higher number of comorbidities, lower eGFR and advanced liver disease are associated with severe anemia and early treatment cessation, which may compromise SVR achievement.
Maruo, Ivan Toshio
The orthodontic treatment of patients with chief complaint of temporomandibular disorders (TMD) presents doubtful prognosis, due to the poor correlation between malocclusions and TMDs. The present case report describes the treatment of an adult patient with Angle Class II Division 2 subdivision left malocclusion associated with anterior deep overbite and TMD. This case was presented to the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO), as part of the requirements to obtain the title of BBO Diplomate.
del Giglio, Auro; Ito, Cristina
Patients with metastatic non-small cell lung cancer are deemed incurable, but they may derive some benefit from systemic palliative chemotherapy. Recently, with the introduction of epidermal growth factor receptor (EGFR) antagonists such as gefitinib (Iressa), an effective and less toxic option is now available for the treatment of such patients. To assess the activity and toxicity of gefitinib in a group of Brazilian patients. Prospective, open label, non-randomized and non-controlled. Clínica de Oncologia e Hematologia (CLIOH), São Paulo, Brazil. From June 2002 to April 2003 we treated five patients with metastatic previously-treated non-small cell lung cancer (median of two previous chemotherapy regimens), using gefitinib at a dose of 250 mg orally on a daily basis, within a compassionate protocol sponsored by AstraZeneca. The patients' median age was 65 years and two of them were male. Three had a performance status of 1, one of 2 and one of 3, on the ECOG (Eastern Cooperative Oncology Group) scale. We observed skin rash in two patients, diarrhea in three and arthralgia in two. One patient had a partial response and another had stabilization of her disease, as measured via imaging studies (which have lasted for more than 11 and 4 months, respectively), which were accompanied by significant decrease in tumor markers, whereas three patients worsened during treatment. New options of chemotherapy agents with favorable toxicity profiles are urgently needed for the treatment of metastatic non-small lung cancer patients who usually have short life expectancies. In our small series of five patients, we observed stabilization of the disease in two of them and the skin and gastrointestinal reactions often described in the literature in all of them. Two had arthralgia, not reported before. We concluded that gefitinib is an important addition to the therapeutic armamentarium for patients with metastatic non-small cell lung cancer.
Pordeus Isabela A
Full Text Available Abstract Background Traumatic dental injury (TDI could have physical and psychosocial consequences for children. Thus, it is important to measure the impact of TDI on the quality of life of children (QoL. The aim of the present study was to investigate the association between treated/untreated TDI and the impact on the quality of life of 11-to-14-year-old Brazilian schoolchildren. Methods A cross-sectional study was carried out involving 1612 male and female schoolchildren aged 11 to 14 years attending public and private elementary schools in the city of Belo Horizonte, Brazil. A multi-stage sampling technique was adopted to select the children. Three calibrated examiners used the Andreasen classification for the diagnosis of TDI. Oral health-related quality of life was assessed using the Brazilian version of the Child Perceptions Questionnaire (CPQ11-14 - Impact Short Form (ISF:16, composed of 16 items and self-administered by all children. Other oral conditions (dental caries and malocclusion and the Social Vulnerability Index were determined and used as controlling variables. Results Two hundred nineteen children were diagnosed with untreated TDI and 64 were diagnosed with treated TDI. There were no statistically significant associations between untreated or treated TDI and overall CPQ11-14 (Fisher = 0.368 and Fisher = 0.610, respectively. Children with an untreated TDI were 1.4-fold (95% CI = 1.1-2.1 more likely to report impact on the item "avoided smiling/laughing" than those without TDI, whereas children with a treated TDI were twofold (95% CI = 1.1-3.5 more likely to report impact on the item "other children asked questions" than those without TDI. Conclusions Neither treated nor untreated TDI was associated with oral symptoms, functional limitations or emotional wellbeing. However, children with a TDI in the anterior teeth experienced a negative impact on social wellbeing, mainly with regard to avoiding smiling or laughing and being
Full Text Available In Mycobacterium tuberculosis (MTB infection, the complex interaction of host immune system and the mycobacteria is associated with levels of cytokines production that play a major role in determining the outcome of the disease. Several single-nucleotide polymorphisms (SNPs in cytokine genes have been associated with tuberculosis (TB outcome. The aim of this study was to evaluate the association between previously reported SNPs IL2-330 T>G (rs2069762; IL4-590 C>T (rs2243250; IL6-174 G>C (rs1800795; IL10-592 A>C (rs1800872; IL10-1082 G>A (rs1800896; IL17A -692 C>T (rs8193036; IL17A -197 G>A (rs2275913; TNF -238 G>A (rs361525; TNF -308 G>A (rs1800629 and IFNG +874 T>A (rs2430561 and pulmonary TB (PTB susceptibility. We conducted a case-control study in individuals from Southern Brazil who were recruited between February 2012 and October 2013 in a high incidence TB city. We performed a multiplex genotyping assay in 191 patients with PTB and 175 healthy subjects. Our results suggest a decreased risk for PTB development associated with the IL17A -197A allele (OR = 0.29; p = 0.04, AA genotype (OR = 0.12; p = 0.04 and A carrier (AG/AA (OR = 0.29; p = 0.004 and IL6 -174C carrier (CC/CG (OR = 0.46; p = 0.04. We could not properly analyze IL17A -692 C>T (rs8193036 and IFNG +874T>A due to genotypic inconsistencies and found no evidence of association for the IL2, IL4, IL10 and TNF polymorphisms and PTB. In conclusion, our results show a protective effect of IL17 and IL6 polymorphisms on PTB outcome in Southern Brazilian population.
José Fernando Vila Nova de Moraes
Full Text Available DOI: http://dx.doi.org/10.5007/1980-0037.2016v18n3p259 Obesity is considered a disease with multiple etiologies. Recent advances in technology have pointed candidate genes that are related to weight gain in several populations. However, in countries with ethnic miscegenation, such as Brazil, studies of this nature with students are still scarce. The aim of the present study was to compare anthropometric variables of Brazilian male students according to the genotypes of the rs9939609 of the FTO gene. In order to do so, 205 participants underwent body mass, height, waist circumference and skinfold thickness measurements. Body mass index (BMI, waist-to-height ratio and body fat percentage were calculated. Volunteers were characterized as overweight according to the BMI-for-age z-score. Participants were genotyped according to the single nucleotide polymorphism rs9939609 of the FTO gene (AA, AT and TT. ANOVA one-way with Bonferroni’s post hoc was performed to compare genotypes and anthropometric variables. Odds Ratio was calculated to reveal increased chances of presenting higher body mass index z-score, waist-to-height ratio and body fat percentage. Participants homozygous for the A allele presented significantly higher values of BMI-for-age z-score (0.38±1.01 vs. -0.29±1.15, waist circumference (77.15±6.51 vs. 72.85±7.36 cm and waist-to-height ratio (0.44±0.04 vs. 0.42±0.04 when compared to individuals with the TT genotype. The A allele of the rs9939609 of the FTO gene seems to influence in the adiposity of male students.
Miranda, Angelica Espinosa; Ribeiro, Denis; Rezende, Erika Fazito; Pereira, Gerson Fernando Mendes; Pinto, Valdir Monteiro; Saraceni, Valeria
The scope of this study was to describe knowledge of military conscripts about STD in relation to level of schooling upon enlistment in the Brazilian Army. A self-administered questionnaire with demographic and clinical aspects, forms of transmission, sexual behavior and access to STD information was applied in a national sample in 2007. Variables associated with low schooling were: being 19-20 years old [OR=1.2(95%CI:1.18-1.32)]; saying that STD can be transmitted by: eating contaminated food [OR=2.2(95%CI:1,96-2.55)]; bathing in rivers/beaches [OR=1.5(95%CI:1.27-1.88)]; mosquito bites [OR=1.5(95%CI:1.38-1.65)]; sexual intercourse STD can be transmitted by: sharing syringes/needles [OR=0.7(95%CI: 0.62-0.78)]; mother-to-child transmission [OR=0.6(95%CI:0.58-0.69)]; having used a condom in the last sexual intercourse [OR=0.8(95%CI:0.71-0.85)]; being MSM [OR=0.7(95% CI: 0.60-0.92)]; knowing that sex without condoms increases risk of transmission [OR=0.4 (95%CI:0,37-0,51)]. Given the association of low schooling with less knowledge about STD, educational policies geared to this population are needed because they are more vulnerable.
Horta, Bernardo Lessa; Schaan, Beatriz D; Bielemann, Renata Moraes; Vianna, Carolina Ávila; Gigante, Denise Petrucci; Barros, Fernando C; Ekelund, Ulf; Hallal, Pedro Curi
To examine the associations between objectively measured physical activity and sedentary time with pulse wave velocity (PWV) in Brazilian young adults. Cross-sectional analysis with participants of the 1982 Pelotas (Brazil) Birth Cohort who were followed-up from birth to 30 years of age. Overall physical activity (PA) assessed as the average acceleration (mg), time spent in moderate-to-vigorous physical activity (MVPA - min/day) and sedentary time (min/day) were calculated from acceleration data. Carotid-femoral PWV (m/s) was assessed using a portable ultrasound. Systolic and diastolic blood pressure (SBP/DBP), waist circumference (WC) and body mass index (BMI) were analyzed as possible mediators. Multiple linear regression and g-computation formula were used in the analyses. Complete data were available for 1241 individuals. PWV was significantly lower in the two highest quartiles of overall PA (0.26 m/s) compared with the lowest quartile. Participants in the highest quartile of sedentary time had 0.39 m/s higher PWV (95%CI: 0.20; 0.57) than those in the lowest quartile. Individuals achieving ≥30 min/day in MVPA had lower PWV (β = -0.35; 95%CI: -0.56; -0.14). Mutually adjusted analyses between MVPA and sedentary time and PWV changed the coefficients, although results from sedentary time remained more consistent. WC captured 44% of the association between MVPA and PWV. DBP explained 46% of the association between acceleration and PWV. Physical activity was inversely related to PWV in young adults, whereas sedentary time was positively associated. Such associations were only partially mediated by WC and DBP. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.
Erick Nelo Pedreira
Full Text Available The purposes of this study were to investigate radiographically the dental and maxillomandibular in patients with neuropsychomotor disorders and determine the role of panoramic radiographs for quantitative and qualitative analyses of dental alterations. A total of 322 panoramic radiographs from 190 males and 132 females aged 4 to 57 years were obtained from the files of the Center for Care to Patients with Special Needs (CAPE; Dental School, University of São Paulo and subdivided into syndromes, special needs, neurological, neuromuscular or cerebral disorders, and sequels of diseases. 32% of dental alterations were in tooth position, with 69% of this group associated with tooth rotation. The mandible accounted for 54.62% of alterations. The male gender (55.85% and the permanent dentition (78.7% were most affected. Panoramic radiographs were proved to be well suited for quantitative evaluation of dental anomalies of epidemiological nature. Panoramic radiographs are important diagnostic resources when applied to patients with special needs because of the difficulty to place intraoral films and held them correctly positioned during the radiographic technique.
Renan Cardoso Soares
Full Text Available Malassezia yeasts are part of the resident cutaneous microbiota, and are also associated with skin diseases such as seborrheic dermatitis (SD. The role these fungi play in skin diseases and why they are pathogenic for only some individuals remain unclear. This study aimed to characterize Malassezia microbiota from different body sites in healthy and SD subjects from Brazil. Scalp and forehead samples from healthy, mild SD and severe SD subjects were collected. Non-scalp lesions from severe SD patients were also sampled. 5.8S rDNA/ITS2 amplicons from Malassezia sp. were analyzed by RFLP and sequencing. Results indicate that Malassezia microbiota did not group according to health condition or body area. Phylogenetic analysis revealed that three groups of sequences did not cluster together with any formally described species, suggesting that they might belong to potential new species. One of them was found in high proportions in scalp samples. A large variety of Malassezia subtypes were detected, indicating intra-specific diversity. Higher M. globosa proportions were found in non-scalp lesions from severe SD subjects compared with other areas, suggesting closer association of this species with SD lesions from areas other than scalp. Our results show the first panorama of Malassezia microbiota in Brazilian subjects using molecular techniques and provide new perspectives for further studies to elucidate the association between Malassezia microbiota and skin diseases.
Soares, Renan Cardoso; Zani, Marcelo Bergamin; Arruda, Ana Carolina Belini Bazán; Arruda, Lucia Helena Fávaro de; Paulino, Luciana Campos
Malassezia yeasts are part of the resident cutaneous microbiota, and are also associated with skin diseases such as seborrheic dermatitis (SD). The role these fungi play in skin diseases and why they are pathogenic for only some individuals remain unclear. This study aimed to characterize Malassezia microbiota from different body sites in healthy and SD subjects from Brazil. Scalp and forehead samples from healthy, mild SD and severe SD subjects were collected. Non-scalp lesions from severe SD patients were also sampled. 5.8S rDNA/ITS2 amplicons from Malassezia sp. were analyzed by RFLP and sequencing. Results indicate that Malassezia microbiota did not group according to health condition or body area. Phylogenetic analysis revealed that three groups of sequences did not cluster together with any formally described species, suggesting that they might belong to potential new species. One of them was found in high proportions in scalp samples. A large variety of Malassezia subtypes were detected, indicating intra-specific diversity. Higher M. globosa proportions were found in non-scalp lesions from severe SD subjects compared with other areas, suggesting closer association of this species with SD lesions from areas other than scalp. Our results show the first panorama of Malassezia microbiota in Brazilian subjects using molecular techniques and provide new perspectives for further studies to elucidate the association between Malassezia microbiota and skin diseases.
Márcia L. Chaves
Full Text Available Introduction. This study evaluates the progression of dementia and identifies prognostic risk factors for dementia. Methods. A group of 80 Brazilian community residents with dementia (34 with Alzheimer's disease and 46 with vascular dementia was assessed over the course of 2 years. Data were analyzed with Cox regression survival analysis. Results. The data showed that education predicted cognitive decline (HR=1.2; P<.05 when analyzed without controlling for vascular risk factors. After the inclusion of vascular risk factors, education (HR=1.32; P<.05 and hypertension were predictive for cognitive decline (HR=38; P<.05, and Alzheimer's disease diagnosis was borderline predictive (P=.055. Conclusion. Vascular risk factors interacted with the diagnosis of vascular dementia. Education was a strong predictor of decline.
Wanessa Cardoso da Silva
Full Text Available This article presents data related to our another article entitled, Genotyping and differential expression analysis of inflammasome genes in sporadic malignant melanoma reveal novel contribution of CARD8, IL1B and IL18 in melanoma susceptibility and progression (W.C. Silva, T.M. Oshiro, D.C. Sá, D.D.G.S. Franco, C. Festa Neto, A. Pontillo, 2016 . Data presented here refers to the distribution of selected inflammasome SNPs in a Brazilian case/control cohort. We have identified 4 inflammasome related Single Nucleotide Polymorphisms (SNPs for CARD8 (rs6509365; IL1B (rs1143643 and IL18 (rs5744256 and rs1834481 related to melanoma susceptibility/protection. This data can serve as a potential prognostic marker in sporadic malignant melanoma.
Silva Fernando Marcuz
Full Text Available OBJECTIVES: To determine the efficacy of a simple, short-term and low-cost eradication treatment for Helicobacter pylori (H. pylori using omeprazole, tetracycline, and furazolidone in a Brazilian peptic ulcer population, divided into 2 subgroups: untreated and previously treated for the infection. PATIENTS AND METHODS: Patients with peptic ulcer disease diagnosed by endoscopic examination and infected by H. pylori diagnosed by the rapid urease test (RUT and histological examination, untreated and previously unsuccessfully treated by macrolides and nitroimidazole, were medicated with omeprazole 20 mg daily dose and tetracycline 500 mg and furazolidone 200 mg given 3 times a day for 7 days. Another endoscopy or a breath test was performed 12 weeks after the end of treatment. Patients were considered cured of the infection if a RUT and histologic examination proved negative or a breath test was negative for the bacterium. RESULTS: Sixty-four patients were included in the study. The women were the predominant sex (58%; the mean age was 46 years. Thirty-three percent of the patients were tobacco users, and duodenal ulcer was identified in 80% of patients. For the 59 patients that underwent follow-up examinations, eradication was verified in 44 (75%. The eradication rate for the intention-to-treat group was 69%. The incidence of severe adverse effects was 15%. CONCLUSION: The treatment provides good efficacy for H. pylori eradication in patients who were previously treated without success, but it causes severe adverse effects that prevented adequate use of the medications in 15% of the patients.
Gonçalves, R O; Fraga, L R; Santos, W V B; Carvalho, A F L; Veloso Cerqueira, B A V; Sarno, M; Toralles, M B P; Vieira, M J; Dutra, C G; Schüler-Faccini, L; Sanseverino, M T V; Gonçalves, M S; Vianna, F S L; Costa, O L N
Some cases of recurrent first trimester miscarriage have a thrombotic etiology. The aim of this study was to investigate the prevalence of the most common thrombophilic mutations - factor V (FV) Leiden G1691A (FVL), prothrombin (FII) G20210A, and methylenetetrahydrofolate reductase (MTHFR) C677T - in women with recurrent miscarriages. In this case-control study, we included 137 women with two or more consecutive first-trimester miscarriages (£12 weeks of gestation) and 100 healthy women with no history of pregnancy loss, and with at least one living child. DNA was extracted from the patient samples, and the relevant genes (FVL, FII, and MTHFR) were amplified by PCR, followed by restriction fragment length polymorphism, to assess the polymorphisms in these genes. The allelic frequencies of polymorphisms were not significantly different between the case and control groups. Polymorphisms in the MTHFR, FVL, and FII genes were not associated with recurrent miscarriage during the first trimester of pregnancy in Brazilian women (P = 0.479; P = 0.491 and P = 0.107, respectively). However, the etiologic identification of genetic factors is important for genetic counseling.
Full Text Available In June 2008, the Brazilian Interdisciplinary AIDS Association (ABIA and the Indian NGO SAHARA submitted a joint pre-grant opposition to the patent application of Tenofovir Disoproxil Fumarate in India. This joint action provides a pertinent case model of the potential effects of South-South cooperation between civil society groups. In this study, the aim sought to determine the practicality of the methodology and propositions developed in Resources, Knowledge and Influence: the Organizational Effects of Interorganizational Collaboration (Hardy et al., 2003 in predicting the types of collaboration effects that would result from the degree of “involvement” and “embeddedness” of a collaboration. Data collection came from archival research, participant observation research and interviews. Research tasks included an investigation on South-South Cooperation in the area of IP rights and AIDS, compiling an SLR on knowledge management and collaboration theories, creating a chronology of the collaboration and application of aforementioned methodology. Application included (1 implementation of codification methodology based on “involvement” and “embeddedness” and (2 identification of types of effects in collaboration - strategic, knowledge creation or political. During data analysis, these effects were compared with the aims of collaboration. Results were then tested against propositions (Hardy et al., 2003 of the relationship between involvement and embeddedness and the collaborative effects. Findings support three propositions: (1 Collaborations with high levels of involvement will be positively associated with the acquisition of distinctive resources, (2 Collaborations with high levels of involvement and high levels of embeddedness will be positively associated with the creation of knowledge, (3 Collaborations that are highly embedded will be positively associated with an increase of influence.
A. C. G. César
Full Text Available Exposure to nitrogen oxides (NOx emitted by burning fossil fuels has been associated with respiratory diseases. We aimed to estimate the effects of NOx exposure on mortality owing to respiratory diseases in residents of Taubaté, São Paulo, Brazil, of all ages and both sexes. This time-series ecological study from August 1, 2011 to July 31, 2012 used information on deaths caused by respiratory diseases obtained from the Health Department of Taubaté. Estimated daily levels of pollutants (NOx, particulate matter, ozone, carbon monoxide were obtained from the Centro de Previsão de Tempo e Estudos Climáticos Coupled Aerosol and Tracer Transport model to the Brazilian developments on the Regional Atmospheric Modeling System. These environmental variables were used to adjust the multipollutant model for apparent temperature. To estimate association between hospitalizations owing to asthma and air pollutants, generalized additive Poisson regression models were developed, with lags as much as 5 days. There were 385 deaths with a daily mean (±SD of 1.05±1.03 (range: 0-5. Exposure to NOx was significantly associated with mortality owing to respiratory diseases: relative risk (RR=1.035 (95% confidence interval [CI]: 1.008-1.063 for lag 2, RR=1.064 (95%CI: 1.017-1.112 lag 3, RR=1.055 (95%CI: 1.025-1.085 lag 4, and RR=1.042 (95%CI: 1.010-1.076 lag 5. A 3 µg/m3 reduction in NOx concentration resulted in a decrease of 10-18 percentage points in risk of death caused by respiratory diseases. Even at NOx concentrations below the acceptable standard, there is association with deaths caused by respiratory diseases.
César, A C G; Carvalho, J A; Nascimento, L F C
Exposure to nitrogen oxides (NOx) emitted by burning fossil fuels has been associated with respiratory diseases. We aimed to estimate the effects of NOx exposure on mortality owing to respiratory diseases in residents of Taubaté, São Paulo, Brazil, of all ages and both sexes. This time-series ecological study from August 1, 2011 to July 31, 2012 used information on deaths caused by respiratory diseases obtained from the Health Department of Taubaté. Estimated daily levels of pollutants (NOx, particulate matter, ozone, carbon monoxide) were obtained from the Centro de Previsão de Tempo e Estudos Climáticos Coupled Aerosol and Tracer Transport model to the Brazilian developments on the Regional Atmospheric Modeling System. These environmental variables were used to adjust the multipollutant model for apparent temperature. To estimate association between hospitalizations owing to asthma and air pollutants, generalized additive Poisson regression models were developed, with lags as much as 5 days. There were 385 deaths with a daily mean (±SD) of 1.05±1.03 (range: 0-5). Exposure to NOx was significantly associated with mortality owing to respiratory diseases: relative risk (RR)=1.035 (95% confidence interval [CI]: 1.008-1.063) for lag 2, RR=1.064 (95%CI: 1.017-1.112) lag 3, RR=1.055 (95%CI: 1.025-1.085) lag 4, and RR=1.042 (95%CI: 1.010-1.076) lag 5. A 3 µg/m3 reduction in NOx concentration resulted in a decrease of 10-18 percentage points in risk of death caused by respiratory diseases. Even at NOx concentrations below the acceptable standard, there is association with deaths caused by respiratory diseases.
Kianoush, Sina; Yakoob, Mohammad Yawar; Al-Rifai, Mahmoud; DeFilippis, Andrew P; Bittencourt, Marcio S; Duncan, Bruce B; Bensenor, Isabela M; Bhatnagar, Aruni; Lotufo, Paulo A; Blaha, Michael J
There is a need to identify sensitive biomarkers of early tobacco-related cardiovascular disease. We examined the association of smoking status, burden, time since quitting, and intensity, with markers of inflammation and subclinical atherosclerosis. We studied 14 103 participants without clinical cardiovascular disease in ELSA-Brasil (Brazilian Longitudinal Study of Adult Health). We evaluated baseline cross-sectional associations between smoking parameters and inflammation (high-sensitivity C-reactive protein [hsCRP]) and measures of subclinical atherosclerosis (carotid intima-media thickness, ankle-brachial index, and coronary artery calcium [CAC]). The cohort included 1844 current smokers, 4121 former smokers, and 8138 never smokers. Mean age was 51.7±8.9 years; 44.8% were male. After multivariable adjustment, compared with never smokers, current smokers had significantly higher levels of hsCRP (β=0.24, 0.19-0.29 mg/L; P 0 (odds ratio: 1.83; 95% confidence interval, 1.46-2.30; P 0 were lower with increasing time since quitting ( P 0 ( P =0.03) after adjusting for duration of smoking. Strong associations were observed between smoking status, burden, and intensity with inflammation (hsCRP) and subclinical atherosclerosis (carotid intima-media thickness, ankle-brachial index, CAC). These markers of early cardiovascular disease injury may be used for the further study and regulation of traditional and novel tobacco products. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
Rosa, Regis Goulart; Moraes, Rafael Barberena; Lisboa, Thiago Costa; Schunemann, Daniel Pretto; Teixeira, Cassiano
We compared the discriminatory capacity of the sequential organ failure assessment (SOFA) versus the systemic inflammatory response syndrome (SIRS) score for predicting ICU mortality, need for and length of mechanical ventilation, ICU stay, and hospitalization in patients with suspected infection admitted to a mixed Brazilian ICU. We performed a retrospective analysis of a longitudinal ICU database from a tertiary hospital in Southern Brazil. Patients were categorized according to whether they met the criteria for sepsis according to SOFA (variation ≥2 points over the baseline clinical condition) and SIRS (SIRS score ≥2 points). From January 2008 to December 2014, 1487 patients were admitted to the ICU due to suspected infection. SOFA ≥2 identified more septic patients than SIRS ≥2 (79.0% [n=1175] vs. 68.5% [n=1020], pSIRS ≥2 in predicting need for mechanical ventilation (AUROC=0.64 vs. 0.62, p=0.001), ICU stay>7 days (AUROC=0.65 vs. 0.63, p=0.004), and length of hospitalization >10 days (AUROC=0.61 vs. 0.59, p7 days. Copyright © 2017 Sociedade Brasileira de Infectologia. Published by Elsevier Editora Ltda. All rights reserved.
Regis Goulart Rosa
Full Text Available We compared the discriminatory capacity of the sequential organ failure assessment (SOFA versus the systemic inflammatory response syndrome (SIRS score for predicting ICU mortality, need for and length of mechanical ventilation, ICU stay, and hospitalization in patients with suspected infection admitted to a mixed Brazilian ICU. We performed a retrospective analysis of a longitudinal ICU database from a tertiary hospital in Southern Brazil. Patients were categorized according to whether they met the criteria for sepsis according to SOFA (variation ≥2 points over the baseline clinical condition and SIRS (SIRS score ≥2 points. From January 2008 to December 2014, 1487 patients were admitted to the ICU due to suspected infection. SOFA ≥2 identified more septic patients than SIRS ≥2 (79.0% [n = 1175] vs. 68.5% [n = 1020], p 7 days (AUROC = 0.65 vs. 0.63, p = 0.004, and length of hospitalization >10 days (AUROC = 0.61 vs. 0.59, p 7 days.
Full Text Available In most mammals, male development is triggered by the transient expression of the SRY gene, which initiates a cascade of gene interactions ultimately leading to the formation of a testis from the indifferent fetal gonad. Mutation studies have identified several genes essential for early gonadal development. We report here a molecular study of the SRY, DAX1, SF1 and WNT4 genes, mainly involved in sexual determination, in Brazilian 46,XX and 46,XY sex-reversed patients. The group of 46,XX sex-reversed patients consisted of thirteen 46,XX true hermaphrodites and four 46,XX males, and was examined for the presence of the SRY gene and for the loss of function (inactivating mutations and deletions of DAX1 and WNT4 genes. In the second group consisting of thirty-three 46,XY sex-reversed patients we investigated the presence of inactivating mutations in the SRY and SF1 genes as well as the overexpression (duplication of the DAX1 and WNT4 genes. The SRY gene was present in two 46,XX male patients and in none of the true hermaphrodites. Only one mutation, located outside homeobox domain of the 5' region of the HMG box of SRY (S18N, was identified in a patient with 46,XY sex reversal. A novel 8-bp microdeletion of the SF1 gene was identified in a 46,XY sex-reversed patient without adrenal insufficiency. The dosage of DAX1 and WNT4 was normal in the sex-reversed patients studied. We conclude that these genes are rarely involved in the etiology of male gonadal development in sex-reversed patients, a fact suggesting the presence of other genes in the sex determination cascade.
Ferraroni, N R; Segat, L; Guimarães, R L; Brandão, L A C; Crovella, S; Constantino-Silva, R N; Loja, C; da Silva Duarte, A J; Grumach, A S
Mannose-binding lectin (MBL) is a protein able to bind to carbohydrate patterns on pathogen membranes; upon MBL binding, its' associated serine protease MBL-associated serine protease type 2 (MASP2) is autoactivated, promoting the activation of complement via the lectin pathway. For both MBL2 and MASP2 genes, the frequencies of polymorphisms are extremely variable between different ethnicities, and this aspect has to be carefully considered when performing genetic studies. While polymorphisms in the MBL-encoding gene (MBL2) have been associated, depending upon ethnicity, with several diseases in different populations, little is known about the distribution of MASP2 gene polymorphisms in human populations. The aim of our study was thus to determine the frequencies of MBL2 (exon 1 and promoter) and MASP2 (p.D371Y) polymorphisms in a Brazilian population from Rio de Janeiro. A total of 294 blood donor samples were genotyped for 27 polymorphisms in the MBL2 gene by direct sequencing of a region spanning from the promoter polymorphism H/L rs11003125 to the rs1800451 polymorphism (at codon 57 in the first exon of the gene). Genotyping for MASP2 p.D371Y was carried out using fluorogenic probes. To our knowledge, this is the first study reporting the prevalence of the MASP2 p.D371Y polymorphism in a Brazilian population. The C allele frequency 39% is something intermediate between the reported 14% in Europeans and 90% in Sub-Saharan Africans. MBL2 polymorphisms frequencies were quite comparable to those previously reported for admixed Brazilians. Both MBL2 and MASP2 polymorphisms frequencies reported in our study for the admixed Brazilian population are somehow intermediate between those reported in Europeans and Africans, reflecting the ethnic composition of the southern Brazilian population, estimated to derive from an admixture of Caucasian (31%), African (34%) and Native American (33%) populations. In conclusion, our population genetic study describes the frequencies
Oliveira, Simone Gomes Dias; de Moura, Flávio Renato Reis; Demarco, Flávio Fernando; Nascente, Patrícia da Silva; Pino, Francisco Augusto Burkert Del; Lund, Rafael Guerra
In this study, an ethnomedicinal survey was conducted in the city of Pelotas, Brazil, with professionals and patients in the Unified Health System (SUS). With the approval of the National Policy on Medicinal Plants and Herbal Medicines, and with the adoption of a National Policy on Integrative and Complementary Practices in the SUS in Brazil, there is growing concern regarding Brazilian medicinal plants and their proper use in medicine. The expansion of the therapeutic options offered to the users of the SUS includes access to medicinal plants and herbal drugs, as well as related services, such as phytotherapy. For improving health and for the social inclusion of phytotherapies, safety, efficacy, and quality are important strategies. Interviews of both professionals and patients were conducted at five Basic Care Units, and a sample size of 393 was obtained. Of the patients attending the Basic Care Units, 91.6% had experienced the use of medicinal plants at least once to treat certain diseases. Of the professionals, 65% had used medicinal plants but only 10% prescribed phytotherapeutics to their patients. Generally, the users were homemakers (26%) of the female gender (71.5%) who were older than 60 years (26%) and had a family income between 1 and 2 Brazilian minimal salaries. The professionals were predominantly female (80%), and a high proportion (80%) believed in the positive effects of phytotherapy (80%), even though these professionals had not been taught phytotherapy as undergraduate students (75%) and had not discussed the topic with their teachers (85%). Patients (81.5%) and professionals (45%) reported that their knowledge of medicinal plants came from their parents or grandparents. From a total of 66 different herbs used by the subjects, mauve (24%) was the most commonly used, often to treat toothaches (24.2%). It is concluded that a high proportion of users and professionals made use of medicinal plants, and of the large number of plants mentioned in the
Egydio-Brandão, Anary Priscila Monteiro; Furlan, Claudia Maria; Dos Santos, Déborah Yara Alves Cursino
Annona crassiflora Mart. is a native tree from Brazilian savanna. Isoquinoline alkaloids are characteristic of species of Annonaceae. This work aimed to assess the magnitude of genetic diversity among different populations of A. crassiflora using AFLP markers, and verify the existence of any correlation between the AFLP data and previous reported alkaloid composition. A. crassiflora from eight populations in the states of São Paulo, Goiás, Minas Gerais, and Distrito Federal were analyzed. The data suggest a low, moderate, and high level of genetic diversity from different populations of A. crassiflora. Concentration of alkaloids was significantly correlated with AFLP data, suggesting interaction between chemical and molecular markers in A. crassiflora. The data of association between the chemical and genetic differentiation of A. crassiflora may be useful to establish cultivation areas allowing the definition of strategies to preserve their genetic diversity with an interest in specific chemotypes for genetic improvement programs focused on sustainable utilization of this specie. © 2016 Wiley-VHCA AG, Zürich.
Yêska Paola Costa Aguiar
Full Text Available Dental erosion is a pathological condition resulting from the irreversible dissolution of the mineralized portion of the teeth, being recognized in modern society as an important cause of loss of tooth structure. The aim of this study was to assess the prevalence and its association with diet in Brazilian adolescents of Campina Grande, PB, Brazil. A population-based study was conducted on a stratified sample of 675 adolescents aged from 15 to 19 of both sexes using the index proposed by O'Sullivan. Dental examinations were performed by two calibrated dentists (kappa = 0.82. The significance level adopted was 5%. The prevalence of dental erosion was 21%, and the upper central incisors and lateral incisors were the most affected elements, with 50.5% and 40.2%, respectively. The buccal surface showed greater impairment (51.4% and 67.8% of teeth with dental erosion had more than half of the surface of affected area. Most damage was on the enamel (93.5%. There were no statistically significant differences between the occurrence of dental erosion and gender, age, socioeconomic status, self-reported ethnicity, and diet. There was high prevalence of dental erosion in its early stages among adolescents and there were no significant differences in the frequency of the consumption of foods and beverages and the presence of dental erosion.
Zerbeto, Amanda B; Cortelo, Fernando M; C Filho, Élio B
To review the literature that addresses the relationship between prematurity, birth weight, and development of language in Brazilian children. A systematic review of studies published between 2003 and 2012 in English and Portuguese and indexed in PubMed, LILACS, and SciELO. The following key words were used in the searches: Prematuro, Prematuridade, Linguagem, Prematurity, Language, Speech-Language Pathology. Fifty-seven articles were retrieved, 13 of which were included in the systematic review. The results showed an association between prematurity, low birth weight, and language development. In studies that made comparisons between preterm and term infants, there was evidence that preterm infants had poorer performance on indicators of language. It was also observed that children born with lower birth weight had a poorer performance on measures of language when compared to children with higher weight and closer to 37 weeks of gestational age. Regarding the type of language assessed, expression proved to be more impaired than reception. Higher parental education and family income were indicated as protective factors for the development of language. Conversely, lower birth weight and higher degree of prematurity emerged as risk factors. Preterm birth and low birth weight poses risks for the language development of children, especially in the first years of life. Therefore, it is essential that pediatricians are aware of the language development of these children to ensure proper treatment. Copyright © 2015 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.
Full Text Available Abstract Introduction The guidelines on allergic rhinitis aim to update knowledge about the disease and care for affected patients. The initiative called "Allergic Rhinitis and its Impact on Asthma", initially published in 2001 and updated in 2008 and 2010, has been very successful in disseminating information and evidence, as well as providing a classification of severity and proposing a systemized treatment protocol. In order to include the participation of other medical professionals in the treatment of allergic rhinitis, it is important to develop algorithms that accurately indicate what should and can be done regionally. Objective To update the III Brazilian Consensus on Rhinitis - 2012, with the creation of an algorithm for allergic rhinitis management. Methods We invited 24 experts nominated by the Brazilian Association of Allergy and Immunology, Brazilian Association of Otorhinolaryngology and Head and Neck Surgery and Brazilian Society of Pediatrics to update the 2012 document. Results The update of the last Brazilian Consensus on Rhinitis incorporated and adapted the relevant information published in all "Allergic Rhinitis and its Impact on Asthma" Initiative documents to the Brazilian scenario, bringing new concepts such as local allergic rhinitis, new drugs and treatment evaluation methods. Conclusion A flowchart for allergic rhinitis treatment has been proposed.
Sakano, Eulalia; Sarinho, Emanuel S C; Cruz, Alvaro A; Pastorino, Antonio C; Tamashiro, Edwin; Kuschnir, Fábio; Castro, Fábio F M; Romano, Fabrizio R; Wandalsen, Gustavo F; Chong-Neto, Herberto J; Mello, João F de; Silva, Luciana R; Rizzo, Maria Cândida; Miyake, Mônica A M; Rosário Filho, Nelson A; Rubini, Norma de Paula M; Mion, Olavo; Camargos, Paulo A; Roithmann, Renato; Godinho, Ricardo N; Pignatari, Shirley Shizue N; Sih, Tania; Anselmo-Lima, Wilma T; Solé, Dirceu
The guidelines on allergic rhinitis aim to update knowledge about the disease and care for affected patients. The initiative called "Allergic Rhinitis and its Impact on Asthma", initially published in 2001 and updated in 2008 and 2010, has been very successful in disseminating information and evidence, as well as providing a classification of severity and proposing a systemized treatment protocol. In order to include the participation of other medical professionals in the treatment of allergic rhinitis, it is important to develop algorithms that accurately indicate what should and can be done regionally. To update the III Brazilian Consensus on Rhinitis - 2012, with the creation of an algorithm for allergic rhinitis management. We invited 24 experts nominated by the Brazilian Association of Allergy and Immunology, Brazilian Association of Otorhinolaryngology and Head and Neck Surgery and Brazilian Society of Pediatrics to update the 2012 document. The update of the last Brazilian Consensus on Rhinitis incorporated and adapted the relevant information published in all "Allergic Rhinitis and its Impact on Asthma" Initiative documents to the Brazilian scenario, bringing new concepts such as local allergic rhinitis, new drugs and treatment evaluation methods. A flowchart for allergic rhinitis treatment has been proposed. Copyright © 2017. Published by Elsevier Editora Ltda.
de Camargo, Kenneth R; Guedes, Carla R; Caetano, Rosângela; Menezes, Alexandre; Trajman, Anete
This article presents the qualitative component linked to a larger study of implementation of the Xpert™ MTB/Rif technology in two Brazilian cities. Despite intrinsic advantages of new health technologies, its introduction can be disruptive to existing routines, and it is thus important to understand how these innovations are perceived by the different groups involved in its regular use. This study was based on semi-structured interviews with patients, lab technicians, health care workers and managers involved with diagnosis and care of Tuberculosis (TB). The interviews had their content analyzed in order to abstract the different perspectives for the various actors. For patients the changes were not perceived as significant, since their greatest concerns were related to treatment and the stigma associated with TB. The professionals in general welcomed the new technique, which dramatically decreases the workload, time and reliability of diagnosis, in their view. However, we noted difficulties with the concomitant implementation of new IT technology for recording and reporting test results, which negatively impacted the time necessary to get lab diagnosis to physicians. Through this analysis we detected some bottlenecks in the surrounding environment, not necessarily linked to the technology itself but which could hamper considerably its advantages.
de Lucena, Gildásio Lucas; dos Santos Gomes, Cristiano; Guerra, Ricardo Oliveira
Osgood-Schlatter (OS) syndrome is a disease of the musculoskeletal system often observed during the bone growth phase in adolescents. HYPOTHESIS/ PURPOSE: Demographic and anthropometric factors and those linked to the practice of sports may be related to the prevalence of OS. The aim of the present study was to describe the epidemiologic profile and associated factors of individuals with OS syndrome in a population-based sample of Brazilian adolescents. Cross-sectional study; Level of evidence, 3. A cross-sectional study was conducted with 956 adolescent students (474 boys, 482 girls) from 2008 to 2009 enrolled in the school system of Natal, Brazil. The age ranged between 12 and 15 years (13.7 ± 1.04 years). Tests were performed to assess the anthropometric and clinical aspects related to OS. To confirm the diagnosis of OS syndrome, the participant had to fulfill all the following clinical criteria: pain with direct pressure on the tibial apophysis; aforementioned pain before, during, and after physical activities; enlargement or prominence of the tibial apophysis; pain with resisted knee extension; and pain from jumping. The prevalence of OS in the sample was 9.8% (11.0% of boys and 8.3% of girls; boys, 13.5 ± 1.07 years; girls, 13.6 ± 1.01 years). The results showed that 74.6% of the students suffered from muscle shortening. Multivariate analysis using logistic regression showed that the factors associated with the presence of OS were the regular practice of sport activity (odds ratio, 1.94; 95% confidence interval, 1.22-3.10) and the shortening of the rectus femoris muscle (odds ratio, 7.15; 95% confidence interval, 2.86-17.86). The regular practice of sports in the pubertal phase and the shortening of the rectus femoris muscle were the main factors associated to the presence of OS syndrome in the students.
Full Text Available Most studies on the prevalence of back pain have evaluated it in developed countries (Human Development Index--HDI > 0.808, and their conclusions may not hold for developing countries. The aim of this study was to identify the prevalence of back pain in representative Brazilian athletes from public high schools. This cross-sectional study was performed during the state phase of the 2015 Jogos dos Institutos Federais (JIF, or Federal Institutes Games, in Brazil (HDI = 0.744, and it enrolled 251 athletes, 173 males and 78 females (14-20 years old. The dependent variable was back pain, and the independent variables were demographic, socioeconomic, psychosocial, hereditary, exercise-level, anthropometric, strength, behavioral, and postural factors. The prevalence ratio (PR was calculated using multivariable analysis according to the Poisson regression model (α = 0.05. The prevalence of back pain in the three months prior to the study was 43.7% (n = 104, and 26% of the athletes reported feeling back pain only once. Multivariable analysis showed that back pain was associated with demographic (sex, psychosocial (loneliness and loss of sleep in the previous year, hereditary (ethnicity, parental back pain, strength (lumbar and hand forces, anthropometric (body mass index, behavioral (sleeping time per night, reading and studying in bed, smoking habits in the previous month, and postural (sitting posture while writing, while on a bench, and while using a computer variables. Participants who recorded higher levels of lumbar and manual forces reported a lower prevalence of back pain (PR 1.30. In conclusion, there is no association between exercise levels and back pain but there is an association between back pain and non-exercise related variables.
Noll, Matias; de Avelar, Ivan Silveira; Lehnen, Georgia Cristina; Vieira, Marcus Fraga
Most studies on the prevalence of back pain have evaluated it in developed countries (Human Development Index--HDI > 0.808), and their conclusions may not hold for developing countries. The aim of this study was to identify the prevalence of back pain in representative Brazilian athletes from public high schools. This cross-sectional study was performed during the state phase of the 2015 Jogos dos Institutos Federais (JIF), or Federal Institutes Games, in Brazil (HDI = 0.744), and it enrolled 251 athletes, 173 males and 78 females (14-20 years old). The dependent variable was back pain, and the independent variables were demographic, socioeconomic, psychosocial, hereditary, exercise-level, anthropometric, strength, behavioral, and postural factors. The prevalence ratio (PR) was calculated using multivariable analysis according to the Poisson regression model (α = 0.05). The prevalence of back pain in the three months prior to the study was 43.7% (n = 104), and 26% of the athletes reported feeling back pain only once. Multivariable analysis showed that back pain was associated with demographic (sex), psychosocial (loneliness and loss of sleep in the previous year), hereditary (ethnicity, parental back pain), strength (lumbar and hand forces), anthropometric (body mass index), behavioral (sleeping time per night, reading and studying in bed, smoking habits in the previous month), and postural (sitting posture while writing, while on a bench, and while using a computer) variables. Participants who recorded higher levels of lumbar and manual forces reported a lower prevalence of back pain (PR 1.30). In conclusion, there is no association between exercise levels and back pain but there is an association between back pain and non-exercise related variables.
Alves, Luana Severo; Susin, Cristiano; Damé-Teixeira, Nailê; Maltz, Marisa
To assess the association between weight status and dental caries among 12-year-old Brazilian schoolchildren. This cross-sectional study was carried out in Porto Alegre using a multistage probability sampling strategy to draw a representative sample of schoolchildren attending public and private schools. Data on demographics, socioeconomic status, oral hygiene habits, anthropometrics, and dental caries were collected. Overweight and obesity were defined according to WHO categories for BMI (body mass index)-for-age Z-scores. Survey Poisson regression models were used to assess the association between weight status and dental caries. Estimates were adjusted for gender, socioeconomic status, and brushing frequency. Prevalence ratios (PR), rate ratios (RR) and 95% confidence intervals (95% CI) were reported. One thousand five hundred and twenty-eight of 1837 eligible schoolchildren were examined. Prevalence of overweight and obesity were 22.15% (95% CI = 20.59-23.72) and 13.61% (95% CI = 11.44-15.78), respectively. Caries experience was observed in 55.23% (95% CI = 45.26-65.19) of children. Schoolchildren presented, on average, 1.39 (95% CI = 1.07-1.71) decayed, missing or filled teeth. No significant differences in caries experience or extent were observed among BMI groups. After adjusting for important cofactors, weight status was not associated with caries prevalence (overweight, PR = 0.99; 95% CI = 0.89-1.10; obese, PR = 1.00; 95% CI = 0.87-1.16) or caries extent (overweight, RR = 0.91; 95% CI = 0.74-1.12; obese, RR = 0.86; 95% CI = 0.72-1.04). Our findings indicate that overweight and obese adolescents should not be regarded as at higher risk of dental caries in this population. © 2012 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Nassar Junior, Antonio Paulo; Azevedo, Luciano César Pontes de
To evaluate job and personal satisfaction rates in physicians who work in adult intensive care units and to identify the factors associated with satisfaction. A cross-sectional study performed with physicians who participated in two intensive medicine online discussion groups. A questionnaire designed to assess the physician's sociodemographic profile and job was available for both groups for 3 months. At the end of the questionnaire, the participants addressed their degrees of job and personal satisfaction using a Likert scale in which 1 represented "very dissatisfied" and 5 represented "very satisfied". The association between sociodemographic and job characteristics with job and personal satisfaction was evaluated. Variables independently associated with satisfaction were identified using a logistic regression model. The questionnaire was answered by 250 physicians, of which 137 (54.8%) declared they were satisfied with their jobs and 34 (13.5%) were very satisfied. None of the evaluated characteristics were independently associated with job satisfaction. Regarding personal satisfaction, 136 (54.4%) physicians reported being satisfied, and 48 (19.9%) reported being very satisfied. Job satisfaction (OR = 7.21; 95%CI 3.21 - 16.20) and working in a university hospital (OR = 3.24; 95%CI 1.29 - 8.15) were factors independently associated with the personal satisfaction of the participants. The participant physicians reported job and personal satisfaction with their work in intensive care. Job satisfaction and working in a university hospital were independently associated with greater personal satisfaction.
Anteghini, M; Fonseca, H; Ireland, M; Blum, R W
To describe the prevalence of health risk behaviors and identify risk and protective factors that are associated with several health risk behaviors (cigarette smoking, drug use, onset of sexual intercourse before age 15, pregnancy, gun-carrying, suicidal ideation, and suicide attempts) among adolescents in Brazil, as well as to explore gender differences. We estimated prevalence rates, evaluated bivariate associations, and explored multivariate analyses using logistic regression on data from a 1997 survey of adolescent health among 2059 eighth- and 10(th)-grade students in Santos, Brazil. Youth in Santos, Brazil report high rates of gun-carrying, suicidal thoughts and attempts, sexual intercourse, and pregnancy. Factors associated with diminished involvement for nearly all health risk behaviors, for both boys and girls, included having good family relationships, and feeling liked by friends and teachers. Factors associated with increases in nearly all health risk behaviors were: gun-carrying and gun availability in the home, drug use, and sexual abuse. Factors that are associated with a wide range of health risk behaviors among adolescents in Brazil appear to parallel those found in industrialized countries: access to guns, substance use, and sexual abuse. Likewise, connectedness to family, school, and peers is consistently the protective factor associated with diminished risky behaviors.
Cabral-Marques, Otavio; Schimke, Lena-Friederike; Pereira, Paulo Vítor Soeiro; Falcai, Angela; de Oliveira, João Bosco; Hackett, Mary J; Errante, Paolo Ruggero; Weber, Cristina Worm; Ferreira, Janaíra Fernandes; Kuntze, Gisele; Rosário-Filho, Nelson Augusto; Ochs, Hans D; Torgerson, Troy R; Carvalho, Beatriz Tavares Costa; Condino-Neto, Antonio
CD40 ligand (CD40L) deficiency or X-linked hyper-IgM syndrome (X-HIGM) is a well-described primary immunodeficiency in which Pneumocystis jiroveci pneumonia is a common clinical feature. We have identified an unusual high incidence of fungal infections and other not yet described infections in a cohort of 11 X-HIGM patients from nine unrelated Brazilian families. Among these, we describe the first case of paracoccidioidomycosis (PCM) in X-HIGM. The molecular genetic analysis of CD40L was performed by gene sequencing and evaluation of CD40L protein expression. Nine of these 11 patients (82%) had fungal infections. These included fungal species common to CD40L deficiency (P. jiroveci and Candida albicans) as well as Paracoccidioides brasiliensis. One patient presented with PCM at age 11 years and is now doing well at 18 years of age. Additionally, one patient presented with a simultaneous infection with Klebsiella and Acinetobacter, and one with condyloma caused by human papilloma virus. Molecular analysis revealed four previously described CD40L mutations, two novel missense mutations (c.433 T > G and c.476 G > C) resulting in the absence of CD40L protein expression by activated CD4(+) cells and one novel insertion (c.484_485insAA) within the TNFH domain leading to a frame shift and premature stop codon. These observations demonstrated that the susceptibility to fungal infections in X-HIGM extends beyond those typically associated with X-HIGM (P. jiroveci and C. albicans) and that these patients need to be monitored for those pathogens.
Williams, M. Lee; Clampitt, Phillip G.
Using data drawn from ten initial physician/patient interviews, an original category system was employed to analyze patterns of physician/patient communication. Static analysis, interaction analysis, and Markov chain analysis were used to discover the underlying communication patterns associated with patient satisfaction. Results revealed that…
Andrade, Silvania Suely Caribé de Araújo; Yokota, Renata Tiene de Carvalho; Sá, Naíza Nayla Bandeira de; Silva, Marta Maria Alves da; Araújo, Wildo Navegantes de; Mascarenhas, Márcio Dênis Medeiros; Malta, Deborah Carvalho
This study aimed to identify the association between alcohol and drug consumption and bullying on the one hand and involvement in situations of physical violence among adolescents 13 to 15 years in public and private schools in State capitals and the Federal District of Brazil. The study analyzed data from the National School Health Survey (PeNSE) for the year 2009. Data analysis used logistic regression. Prevalence of involvement in physical violence was 12.9% more common in boys than girls. Both genders showed associations between physical violence or being a victim of bullying and use of illegal drugs, plus the heightened effect of the combined consumption of alcohol and other drugs. In boys, alcohol consumption showed a significant association with physical violence. Having the father or both parents living at home was inversely associated with physical violence in girls. Knowledge of factors associated with physical violence among adolescents is important for supporting health promotion strategies and a culture of peace, thereby counteracting the idea of taking teenage violence for granted.
de Araujo, Thábyta Silva; Barbosa Filho, Valter Cordeiro; Gubert, Fabiane do Amaral; de Almeida, Paulo César; Martins, Mariana Cavalcante; Carvalho, Queliane Gomes da Silva; Costa, Ana Cristina Pereira de Jesus; Vieira, Neiva Francenely Cunha
This study aimed to evaluate sociodemographic, behavioral, and individual factors associated with body image perception in a sample of adolescents from schools in low Human Development Index areas in Brazil. This cross-sectional study included 609 boys and 573 girls (aged 11-17 years). Body image perception (nine-silhouettes scale) and sociodemographic, behavioral, and individual variables were included. Multinomial logistic regression analysis was used. Most boys (76.9%) and girls (77.5%) were dissatisfied with their body image. Body mass index status and healthy body image evaluation were significantly associated with body image dissatisfaction in both boys and girls ( p < .001), and daily fruit consumption was associated with body image dissatisfaction only in boys ( p = .035). Education and health care focused on body image can pay special attention to young people from vulnerable areas with unhealthy nutritional status and focus on strategies that enable improving the perception of a healthy body and a healthy diet.
Kuhnen, Mirian; Peres, Marco A; Masiero, Anelise V; Peres, Karen G
Abstract Background Toothache is a dental public health problem and one of the predictors of dental attendance and it is strongly associated with the life quality of individuals. In spite of this, there are few population-based epidemiological studies on this theme. Objective: To estimate the prevalence of toothache and associated factors in adults of Lages, Southern Brazil. Methods A cross-sectional population-based study was carried out in a sample of 2,022 adults aged 20 to 59 years living...
Nunes, Benevina Maria Vilar Teixeira; dos Santos, Ana Maria Ribeiro; Moura, Maria Eliete Batista; da Costa e Silva, Maria Enóia Dantas; de Monteiro, Claudete Ferreira Souza; Carvalho, Maria do Livramento
Historical and social study that aimed at obtaining the social representations about associative practice present at the collective memory of the members from ABEn-PI. Its primary source were 94 minutes of ABEn-PI created from 1959 to 1970 and from 1995 to 2005 and analyzed according to a thematic analysis of categorical content. The social representations obtained were about knowledge, positioning and feelings about nursing teaching, religiosity and honoring and political fights of ABEn. The dissemination of these knowledge, positioning and feelings among the members of the association, showed the spread of social representations determining the behavior of these nurses as ABEn-PI members.
David Enrique Aguilar Rodriguez
Full Text Available Fanconi anaemia (FA is a recessive autosomal disease determined by mutations in genes of at least eleven complementation groups, with distinct distributions in different populations. As far as we know, there are no reports regarding the molecular characterisation of the disease in unselected FA patients in Brazil. OBECTIVE: This study aimed to investigate the most prevalent mutations of FANCA and FANCC genes in Brazilian patients with FA. METHODS: Genomic DNA obtained from 22 racially and ethnically diverse unrelated FA patients (mean age ± SD: 14.0 ± 7.8 years; 10 male, 12 female; 14 white, 8 black was analysed by polymerase chain reaction and restriction site assays for identification of FANCA (delta3788-3790 and FANCC (delta322G, IVS4+4A -> T, W22X, L496R, R548X, Q13X, R185X, and L554P gene mutations. RESULTS: Mutations in FANCA and FANCC genes were identified in 6 (27.3% and 14 (63.6% out of 22 patients, respectively. The disease could not be attributed to the tested mutations in the two remaining patients enrolled in the study (9.1%. The registry of the two most prevalent gene abnormalities (delta3788-3790 and IVS4 + 4 -> T revealed that they were present in 18.2% and 15.9% of the FA alleles, respectively. Additional FANCC gene mutations were found in the study, with the following prevalence: delta322G (11.4%, W22X (9.1%, Q13X (2.3%, L554P (2.3%, and R548X (2.3% of total FA alleles. CONCLUSION: These results suggest that mutations of FANCA and FANCC genes are the most prevalent mutations among FA patients in Brazil.
Roberto Eduardo Schneiders
Full Text Available Abstract: Budget Impact Analyses require a set of essential information on health technology innovation, including expected rates of adoption. There is an absence of studies investigating trends, magnitude of budgetary effects and determinants of diffusion rates for health technology innovations worldwide during the last decades. The present study proposes a pilot assessment on main determinants influencing diffusion rates of pharmaceutical innovations within the Brazilian Unified National Health System (SUS. Data from the Brazilian Health Informatics Department (DATASUS was gathered to establish the main determinants of diffusion rates of health technology innovations in Brazil, specifically referring to pharmaceutical innovations incorporated in the Brazilian Program for Specialized Pharmaceutical Services (CEAF at SUS. Information was retrieved on DATASUS relating to patients who had used one of the medicines incorporated into CEAF at least three years prior to the beginning of the study (2015 for treatment of each health condition available. Thus, data from patients adopting 10 different medicines were analyzed in the study. Results from the zero-one inflated beta model showed a higher influence on diffusion rates of pharmaceutical innovations due to: number of pharmaceutical competitors for treatment of the same disease available at CEAF (negative; medicine used in combination with other medication (positive; and innovative medicine within the SUS (positive. Further research on diffusion rates of health technology innovations is required, including wider scope of diseases and medications, potential confusion factors and other variables that may influence rates of adoption in different health systems.
Schneiders, Roberto Eduardo; Ronsoni, Ricardo de March; Sarti, Flávia Mori; Nita, Marcelo Eidi; Bastos, Ediane de Assis; Zimmermann, Ivan Ricardo; Ferreira, Fernando Fagundes
Budget Impact Analyses require a set of essential information on health technology innovation, including expected rates of adoption. There is an absence of studies investigating trends, magnitude of budgetary effects and determinants of diffusion rates for health technology innovations worldwide during the last decades. The present study proposes a pilot assessment on main determinants influencing diffusion rates of pharmaceutical innovations within the Brazilian Unified National Health System (SUS). Data from the Brazilian Health Informatics Department (DATASUS) was gathered to establish the main determinants of diffusion rates of health technology innovations in Brazil, specifically referring to pharmaceutical innovations incorporated in the Brazilian Program for Specialized Pharmaceutical Services (CEAF) at SUS. Information was retrieved on DATASUS relating to patients who had used one of the medicines incorporated into CEAF at least three years prior to the beginning of the study (2015) for treatment of each health condition available. Thus, data from patients adopting 10 different medicines were analyzed in the study. Results from the zero-one inflated beta model showed a higher influence on diffusion rates of pharmaceutical innovations due to: number of pharmaceutical competitors for treatment of the same disease available at CEAF (negative); medicine used in combination with other medication (positive); and innovative medicine within the SUS (positive). Further research on diffusion rates of health technology innovations is required, including wider scope of diseases and medications, potential confusion factors and other variables that may influence rates of adoption in different health systems.
Full Text Available Merozoites of Plasmodium falciparum invade through several pathways using different RBC receptors. Field isolates appear to use a greater variability of these receptors than laboratory isolates. Brazilian field isolates were shown to mostly utilize glycophorin A-independent invasion pathways via glycophorin B (GPB and/or other receptors. The Brazilian population exhibits extensive polymorphism in blood group antigens, however, no studies have been done to relate the prevalence of the antigens that function as receptors for P. falciparum and the ability of the parasite to invade. Our study aimed to establish whether variation in the GYPB*S/s alleles influences susceptibility to infection with P. falciparum in the admixed population of Brazil.Two groups of Brazilian Amazonians from Porto Velho were studied: P. falciparum infected individuals (cases; and uninfected individuals who were born and/or have lived in the same endemic region for over ten years, were exposed to infection but have not had malaria over the study period (controls. The GPB Ss phenotype and GYPB*S/s alleles were determined by standard methods. Sixty two Ancestry Informative Markers were genotyped on each individual to estimate admixture and control its potential effect on the association between frequency of GYPB*S and malaria infection.GYPB*S is associated with host susceptibility to infection with P. falciparum; GYPB*S/GYPB*S and GYPB*S/GYPB*s were significantly more prevalent in the in the P. falciparum infected individuals than in the controls (69.87% vs. 49.75%; P<0.02. Moreover, population genetics tests applied on the GYPB exon sequencing data suggest that natural selection shaped the observed pattern of nucleotide diversity.Epidemiological and evolutionary approaches suggest an important role for the GPB receptor in RBC invasion by P. falciparum in Brazilian Amazons. Moreover, an increased susceptibility to infection by this parasite is associated with the GPB S
Tarazona-Santos, Eduardo; Castilho, Lilian; Amaral, Daphne R T; Costa, Daiane C; Furlani, Natália G; Zuccherato, Luciana W; Machado, Moara; Reid, Marion E; Zalis, Mariano G; Rossit, Andréa R; Santos, Sidney E B; Machado, Ricardo L; Lustigman, Sara
Merozoites of Plasmodium falciparum invade through several pathways using different RBC receptors. Field isolates appear to use a greater variability of these receptors than laboratory isolates. Brazilian field isolates were shown to mostly utilize glycophorin A-independent invasion pathways via glycophorin B (GPB) and/or other receptors. The Brazilian population exhibits extensive polymorphism in blood group antigens, however, no studies have been done to relate the prevalence of the antigens that function as receptors for P. falciparum and the ability of the parasite to invade. Our study aimed to establish whether variation in the GYPB*S/s alleles influences susceptibility to infection with P. falciparum in the admixed population of Brazil. Two groups of Brazilian Amazonians from Porto Velho were studied: P. falciparum infected individuals (cases); and uninfected individuals who were born and/or have lived in the same endemic region for over ten years, were exposed to infection but have not had malaria over the study period (controls). The GPB Ss phenotype and GYPB*S/s alleles were determined by standard methods. Sixty two Ancestry Informative Markers were genotyped on each individual to estimate admixture and control its potential effect on the association between frequency of GYPB*S and malaria infection. GYPB*S is associated with host susceptibility to infection with P. falciparum; GYPB*S/GYPB*S and GYPB*S/GYPB*s were significantly more prevalent in the in the P. falciparum infected individuals than in the controls (69.87% vs. 49.75%; Pselection shaped the observed pattern of nucleotide diversity. Epidemiological and evolutionary approaches suggest an important role for the GPB receptor in RBC invasion by P. falciparum in Brazilian Amazons. Moreover, an increased susceptibility to infection by this parasite is associated with the GPB S+ variant in this population.
Full Text Available We examined the association between Household Food Insecurity (HFI, weight for height z-score (WHZ and Body Mass Index for age z-score (BMI-Z in a representative sample of children 0-60 months of age (n = 3,433 in five Brazilian geographical regions. Data were derived from the 2006-07 Brazilian Demographic and Health Survey. HFI was measured with the Brazilian Food Insecurity Scale. Associations were estimated using multiple linear regression models (β coefficients and 95% CI taking into account the complex sampling design. Interaction terms between HFI and geographical region and HFI and child sex and child age were assessed. The weighted prevalence of any level of HFI was 48.6%. Severe food insecurity was more prevalent among children from the North region (16.8%, born from mothers with <4 years of schooling (15.9% and those from families with ≥3 children (18.8%. The interaction between HFI and geographical region was non-significant for BMI-Z (P = 0.119 and WHZ (P = 0.198. Unadjusted results indicated that HFI was negatively associated with BMI-Z (moderate to severe HFI: β = -0.19, 95% CI: -0.35 - -0.03, P = 0.047, and WHZ (moderate to severe HFI: β = -0.26, 95% CI: -0.42 - -0.09, P = 0.009. Estimates lost significance after adjustments for key confounders such as mothers' skin color, mothers' years of schooling, place of household, household income quartiles, mothers' smoking habit, mothers' marital status, number of children 0-60 months in the household, and birth order. HFI is unrelated to weight outcomes among Brazilian children 0-60 months.
Carmem Cristina Beck
Full Text Available OBJECTIVE: This study analyzes factors associated with serum lipids in adolescents from southern Brazil. METHODS: This is a school-based cross-sectional study with a probabilistic sample composed of 660 adolescents aged 14 to 19 years from the city of Três de Maio, Rio Grande do Sul state, Brazil. The following independent variables were analyzed: body mass index; waist-to-height ratio; moderate to vigorous level of physical activity; sedentary behaviour; lipid, total saturated fatty acid, cholesterol, sodium, and fiber intakes; smoking; and alcohol abuse. Linear regression analysis tested the association between the independent variables and total cholesterol and high density lipoprotein-cholesterol. RESULTS: Body mass index was directly associated with total cholesterol (β=0.96, p=0.001 and reversely associated with high density lipoprotein-cholesterol (β=-0.45, p<0.001. CONCLUSION: High body mass index may have a negative impact on the lipid profile of adolescents. Thus, monitoring nutritional status is important to prevent and control dyslipidemia in adolescents. We suggest multidisciplinary and intersectoral actions that encourage teenagers to acquire a healthy lifestyle, with emphasis on the adoption of an active lifestyle and balanced diet.
Paulino, Gustavo Vasconcelos Bastos; Félix, Ciro Ramon; Broetto, Leonardo; Landell, Melissa Fontes
Some of the main threats to coral reefs come from human actions on marine environment, such as tourism, overfishing and pollution from urban development. While several studies have demonstrated an association between bacteria and corals, demonstrating how these communities react to different anthropogenic stressors, yeast communities associated with corals have received far less attention from researchers. The aim of this work was therefore to describe cultivable yeasts associated with three coral species and to evaluate the influence of sewage discharge on yeasts community. We obtained 130 isolates, mostly belonging to phylum Ascomycota and many of them had previously been isolated from human samples or are considered pathogens. The mycobiota was more similar among corals collected from the same reef, indicating that the composition of reef yeast community is more influenced by environmental conditions than host species. We suggest further studies to elucidate which factors are most influential on the composition of the coral-associated yeast community. Copyright © 2017 Elsevier Ltd. All rights reserved.
Leandro D. Battirola
Full Text Available ABSTRACT This study describes the composition and temporal variation of the spider assemblage (Arachnida: Araneae associated with canopies of Vochysia divergens Pohl. (Vochysiaceae in the northern region of the Brazilian Pantanal. Three V. divergens plants were sampled in 2004, at each seasonal period of the northern Pantanal (high water, receding water, dry season and rising water, using thermonebulization of the canopies with insecticide, totaling 396 m2 of sampled canopies. Analysis of abundance and richness of spider families were based on Non-Metric Multidimensional Scaling (NMDS and Variance Analysis (ANOVA and MANOVA. A total of 7,193 spiders were collected (6,330 immatures; 88.0%; 863 adults, 12.0% distributed in 30 families. Araneidae (1,676 individuals, Anyphaenidae (1,631 individuals, Salticidae (1,542 individuals and Pisauridae (906 individuals, were predominant, representing 80.0% of the sample. Ten different guilds were registered: aerial hunters, orb-weavers, nocturnal aerial runners and diurnal space web weavers dominated, sharing most ecological niches. The spider assemblage is affected by changes in the habitat structure, especially by the seasonal hydrological regime and variations in the phenology of V. divergens . The assemblage is composed of different groups of spiders. The dominant taxa and behavioral guilds differ in the different seasonal periods. Spiders were more abundant during the dry and rising water seasons, most likely reflecting a greater supply of potential prey, associated with new foliage and flowering at the canopy. The displacement of soil dwelling spiders to the trunks and canopies before and during the seasonal floods can change the structure and composition of the canopy assemblages. Oonopidae, Gnaphosidae and Caponiidae, were more frequent during the rising and high water seasons, which indicates that these taxa use the canopies of V. divergens as a refuge during the seasonal flooding in the Pantanal.
Full Text Available Almost all individuals (182 belonging to an Amazonian riverine population (Portuchuelo, RO, Brazil were investigated for ascertaining data on epidemiological aspects of malaria. Thirteen genetic blood polymorphisms were investigated (ABO, MNSs, Rh, Kell, and Duffy systems, haptoglobins, hemoglobins, and the enzymes glucose-6-phosphate dehydrogenase, glyoxalase, phosphoglucomutase, carbonic anhydrase, red cell acid phosphatase, and esterase D. The results indicated that the Duffy system is associated with susceptibility to malaria, as observed in other endemic areas. Moreover, suggestions also arose indicating that the EsD and Rh loci may be significantly associated with resistance to malaria. If statistical type II errors and sample stratification could be ruled out, hypotheses on the existence of a causal mechanism or an unknown closely linked locus involved in susceptibility to malaria infection may explain the present findings.
Iva Carneiro Leão Barros
Full Text Available This study aims to investigate fern flora similarity and fern species relationships in the study areas, in terms of their substrates, habitat types, and life forms. The study was conducted in the Água Azul forest fragment, municipality of Timbaúba, Pernambuco, and the Maria Maior forest fragment, municipality of São José da Laje, Alagoas. The Jaccard similarity index was used for cluster analysis. The 112 species that occur in the two areas were used for numerical analysis. The floristic similarity was great (J=43.75%, principally due to similarities in the two areas vegetational types, as was expected due to their geographic proximity to one another and their similar climatic conditions. Five groups of associated species were determined for the Água Azul fragment and six groups for the Maria Maior fragment. In general, the ecological factors that determined fern species associations were habitat and type of substrate.
Kochem, Frederico B; Silva, Julio G
To investigate the prevalence of playing-related musculoskeletal disorders (PRMD) and associated factors among violinists from the state of Rio de Janeiro, Brazil. This cross-sectional study included 106 violinists from eight cities in the state of Rio de Janeiro. Sociodemographic and musical characteristic data, pain symptoms, and upper-limb functionality were collected using the DASH and the Standardized Nordic Questionnaires. The associations between musculoskeletal complaints and possible predictors were analyzed by binary logistic regression. Of the 106 surveyed violin players, 86.8% reported at least one painful area in the last 12 months and 77.4% in the last week. These symptoms were responsible for the temporary interruption of musical activity in 8.1% of musicians. More than 50% of violinists showed dysfunctional upper limbs according to the DASH optional module. Women were more likely to develop musculoskeletal disorders (OR 4.4, CI 1.9-10.0, p<0.001). In addition, older musicians were more likely to report pain in the last 7 days (OR 3.3, CI 5.1-10.97; p=0.04) and also had higher scores on the DASH (OR 1.8, CI 1.1-3.1; p=0.01). Other factors associated with the development of PRMD were body mass index, practice hours per week, and final DASH score. Violinists living and working in the state of Rio de Janeiro have a high prevalence of PRMD, especially women and older musicians.
Fronza Fernanda Cerveira Abuana Osório
Full Text Available Purpose. Sedentary behavior has been identified as a risk factor for chronic non-communicable diseases. This study identified the prevalence of excessive TV viewing time during the week and weekend and associated factors in adolescents living in a small urban and rural area. Methods. A cross-sectional study involving 283 students (aged 10-19 years from Brazil was conducted in 2010. Data on TV viewing time and sociodemographic information were collected by questionnaires, cardiorespiratory fitness was evaluated by the 20-m shuttle run test, and anthropometric characteristics were obtained by measuring waist circumference and skinfold thickness. Statistical analysis involved binary logistic regression. Results. The prevalence of excessive TV viewing time ( 2 h was 76.7% during on weekdays and 78.4% on the weekend. Adolescents aged 10-12 years (OR = 6.20; 95% CI = 2.91, 13.19; p < 0.001 and 13-15 years (OR = 2.57; 95% CI = 1.28, 5.18; p = 0.008 were more exposed to excessive TV viewing time during the week. No associations were found for excessive TV viewing time on the weekend. Conclusions. Approximately 8 in 10 adolescents presented excessive TV viewing time; excessive TV viewing time during the week was associated with age.
Background Non-nutritive sucking habits (NNSH) are very common during childhood. However, if these habits were maintained for 36 months of age or more, they are considered to be prolonged (PNNSH) and can cause occlusal, physiological and esthetic changes. There is controversy about their prevalence and whether perinatal, social, demographic and health characteristics influence their onset and duration. So, the objectives of this study are to estimate the prevalence of PNNSH and to evaluate perinatal, early life and school age factors associated with their occurrence in children. Methods A sample of 1,463 children aged 7–11 years born in Ribeirão Preto (RP-1994) and São Luís (SL-1997/98), Brazil, was reevaluated at school age in 2004/05. Birth weight, gestational age and perinatal variables were obtained at birth. Type of feeding, occurrence and duration of finger and pacifier sucking were recorded retrospectively at school age. PNNSH were defined when persisted for 36 months of age or more. Crude and adjusted prevalence ratios (PR) were estimated by Poisson regression (alpha = 5%). Results Prevalence of PNNSH was higher in RP (47.6%) than in SL (20.2%) – (p < 0.001). Perinatal variables were not associated to PNNSH, whilst female sex (PR = 1.27 in RP; PR = 1.47 in SL) and bottle feeding for 24 months or more (PR = 2.24 in RP; PR = 2.49 in SL) were risk factors in both locations. Breast feeding for 12 months or more (PR = 0.53 in RP; PR = 0.31 in SL) was associated with lower prevalence of PNNSH in both places. In SL, children whose mothers lived in consensual union (PR = 1.62) and worked outside the home (PR = 1.51) showed higher prevalence of PNNSH compared to their counterparts. Conclusions Prevalence of PNNSH was high especially in RP and was not associated with perinatal variables. In both cities there was an association between female sex, shorter breast-feeding duration, longer bottle feeding duration and higher prevalence of PNNSH. PMID:25053157
Niedzielska, Iwona; Puszczewicz, Zbigniew; Mertas, Anna; Niedzielski, Damian; Różanowski, Bartosz; Baron, Stefan; Konopka, Tomasz; Machorowska-Pieniążek, Agnieszka; Skucha-Nowak, Małgorzata; Tanasiewicz, Marta; Paluch, Jarosław; Markowski, Jarosław; Orzechowska-Wylęgała, Bogusława; Król, Wojciech; Morawiec, Tadeusz
Maintenance of proper oral hygiene by dental plaque elimination is one of the most important factors affecting the healing process in postoperative oral wounds. Propolis is a substance produced by bees. Ethanolic extract of propolis has bactericidal, fungicidal, anti-inflammatory, and antioxidative properties. Moreover, it can scavenge free radicals. The purpose of this paper is to demonstrate the efficacy of a gel containing 3% of ethanolic extract of Brazilian green propolis (EEP-B) when used for maintaining oral hygiene in patients with postoperative oral mucosal wounds. The hygiene was assessed using API, OHI, and SBI followed by microbiological examinations. The patients were divided into two groups. Group 1 consisted of those who used a gel containing EEP-B for oral hygiene, and group 2 consisted of those who used a gel without EEP-B. Although improved oral hygiene was noted in both groups, the improvement was markedly greater in the group using gel containing EEP-B. Summing up the results of microbiological examinations, EEP-B has beneficial effect on mouth microflora in postoperative period. Propolis preparations used for oral hygiene allow eliminating microorganisms of pathogenic character and physiological flora microorganisms considered as being opportunistic, with no harmful influence on physiological microflora in oral ecosystem.
Full Text Available INTRODUCTION: Prospective studies have shown that the course of bipolar disorder (BD is characterized by the persistence of symptoms, predominantly depression, along most of the time. However, to our knowledge, no studies in Latin America have investigated it. OBJECTIVES: To replicate international studies using a Brazilian sample to prospectively analyze treatment outcomes in the first year and to determine potential chronicity factors. METHODS: We followed up 102 patients with BD for 12 months and evaluated the number of months with affective episodes and the intensity of manic and depressive symptoms using the Young Mania Rating Scale (YMRS and the Hamilton Depression Scale (HAM-D17. Sociodemographic and retrospective clinical data were examined to determine possible predictors of outcome. RESULTS: Almost 50% of the patients had symptoms about half of the time, and there was a predominance of depressive episodes. Disease duration and number of depressive episodes were predictors of chronicity. Depressive polarity of the first episode and a higher number of depressive episodes predicted the occurrence of new depressive episodes. CONCLUSION: In general, BD outcome seems to be poor in the first year of monitoring, despite adequate treatment. There is a predominance of depressive symptoms, and previous depressive episodes are a predictor of new depressive episodes and worse outcome.
Full Text Available Maintenance of proper oral hygiene by dental plaque elimination is one of the most important factors affecting the healing process in postoperative oral wounds. Propolis is a substance produced by bees. Ethanolic extract of propolis has bactericidal, fungicidal, anti-inflammatory, and antioxidative properties. Moreover, it can scavenge free radicals. The purpose of this paper is to demonstrate the efficacy of a gel containing 3% of ethanolic extract of Brazilian green propolis (EEP-B when used for maintaining oral hygiene in patients with postoperative oral mucosal wounds. The hygiene was assessed using API, OHI, and SBI followed by microbiological examinations. The patients were divided into two groups. Group 1 consisted of those who used a gel containing EEP-B for oral hygiene, and group 2 consisted of those who used a gel without EEP-B. Although improved oral hygiene was noted in both groups, the improvement was markedly greater in the group using gel containing EEP-B. Summing up the results of microbiological examinations, EEP-B has beneficial effect on mouth microflora in postoperative period. Propolis preparations used for oral hygiene allow eliminating microorganisms of pathogenic character and physiological flora microorganisms considered as being opportunistic, with no harmful influence on physiological microflora in oral ecosystem.
Gonçalves, Priscila Dib; Cunha, Paulo Jannuzzi; Malbergier, André; do Amaral, Ricardo Abrantes; de Oliveira, Lúcio Garcia; Yang, Jasmine J; de Andrade, Arthur Guerra
Although there are a large number of studies focused on binge drinking and traffic risk behaviors (TRB), little is known regarding low levels of alcohol consumption and its association to TRB. The aim of this cross-sectional study is to examine the association of low to moderate alcohol intake pattern and TRB in college students in Brazil. 7037 students from a National representative sample were selected under rigorous inclusion criteria. All study participants voluntarily fulfilled a structured, anonymous, and self-questionnaire regarding alcohol and drug use, social-demographic data, and TRB. Alcohol was assessed according to the average number of alcoholic units consumed on standard occasions over the past 12 months. The associations between alcohol intake and TRB were summarized with odds ratio and their confidence interval obtained from logistic regression. Compared with abstainers students who consumed only one alcohol unit had the risk of being a passenger in a car driven by a drunk driver increased by almost four times, students who reported using five or more units were increased by almost five times the risk of being involved in a car crash. Compared with students who consumed one alcohol unit, the risk of driving under the influence of alcohol increased four times in students using three alcohol units. Age group, use of illicit drugs, employment status, gender, and marital status significantly influenced occurrence of TRB among college students. Our study highlights the potential detrimental effects of low and moderate pattern of alcohol consumption and its relation to riding with an intoxicated driver and other TRB. These data suggest that targeted interventions should be implemented in order to prevent negative consequences due to alcohol use in this population. Copyright © 2012 Elsevier Inc. All rights reserved.
Masiero Anelise V
Full Text Available Abstract Background Toothache is a dental public health problem and one of the predictors of dental attendance and it is strongly associated with the life quality of individuals. In spite of this, there are few population-based epidemiological studies on this theme. Objective: To estimate the prevalence of toothache and associated factors in adults of Lages, Southern Brazil. Methods A cross-sectional population-based study was carried out in a sample of 2,022 adults aged 20 to 59 years living in the urban area of a medium sized city in Southern Brazil. A questionnaire including socioeconomic, demographic, smoking, alcohol, and use of dental service variables was applied at adults household. Toothache occurred six months previous of the interview was considered the outcome. Poisson regression analyses were performed following a theoretical hierarchical framework. All analysis was adjusted by the sample design effect. Results The response rate was 98.6%. The prevalence of toothache was 18.0% (95% CI 16.0; 20.1. The following variables were associated with toothache after adjustment: female (PR = 1.3 95% CI 1.3; 2.0, black skin colour vs. whites (PR = 1.5 95% CI 1.1, 1.9, low per capita income (PR = 1.7 95% CI 1.2, 2.3, smokers (PR = 1.5 95% CI 1.2, 1.9 and those who reported alcohol problems (PR = 1.4 95% CI 1.1; 1.9. To be 40 years of age (PR = 0.5 95% CI 0.4, 0.7 and use dental service in the last year (RR = 0.5 95% CI 0.4, 0.6 were protective factors for toothache. Conclusion The prevalence of toothache in adults of Lages can be considered a major problem of dental public health.
Kuhnen, Mirian; Peres, Marco A; Masiero, Anelise V; Peres, Karen G
Toothache is a dental public health problem and one of the predictors of dental attendance and it is strongly associated with the life quality of individuals. In spite of this, there are few population-based epidemiological studies on this theme. To estimate the prevalence of toothache and associated factors in adults of Lages, Southern Brazil. A cross-sectional population-based study was carried out in a sample of 2,022 adults aged 20 to 59 years living in the urban area of a medium sized city in Southern Brazil. A questionnaire including socioeconomic, demographic, smoking, alcohol, and use of dental service variables was applied at adults household. Toothache occurred six months previous of the interview was considered the outcome. Poisson regression analyses were performed following a theoretical hierarchical framework. All analysis was adjusted by the sample design effect. The response rate was 98.6%. The prevalence of toothache was 18.0% (95% CI 16.0; 20.1). The following variables were associated with toothache after adjustment: female (PR = 1.3 95% CI 1.3; 2.0), black skin colour vs. whites (PR = 1.5 95% CI 1.1, 1.9), low per capita income (PR = 1.7 95% CI 1.2, 2.3), smokers (PR = 1.5 95% CI 1.2, 1.9) and those who reported alcohol problems (PR = 1.4 95% CI 1.1; 1.9). To be 40 years of age (PR = 0.5 95% CI 0.4, 0.7) and use dental service in the last year (RR = 0.5 95% CI 0.4, 0.6) were protective factors for toothache. The prevalence of toothache in adults of Lages can be considered a major problem of dental public health.
Full Text Available BACKGROUND: Preterm birth rate is increasing and is currently a worldwide concern. The purpose of this study was to estimate the prevalence of preterm birth in a sample of health facilities in Brazil and to identify the main risk factors associated with spontaneous preterm births. METHODS AND FINDINGS: This was a multicentre cross sectional study on preterm births in 20 referral obstetric hospitals with a case-control component to identify factors associated with spontaneous preterm birth. Surveillance was implemented at all centres to identify preterm births. For eligible consenting women, data were collected through a post-delivery questionnaire completed with information from all mother-newborn medical records until death or discharge or at a maximum of 60 days post-delivery, whichever came first. The risk of spontaneous preterm birth was estimated with OR and 95%CI for several predictors. A non-conditional logistic regression analysis was then performed to identify independently associated factors. The overall prevalence of preterm birth was 12.3%. Among them, 64.6% were spontaneous and 35.4% therapeutic. In the case-control component, 2,682 spontaneous preterm births were compared to a sample of 1,146 term births. Multivariate analyses identified the following as risk factors for spontaneous preterm birth among women with at least one previous birth: a previous preterm birth (ORadj = 3.19, 2.30-4.43, multiple pregnancy (ORadj = 29.06, 8.43-100.2, cervical insufficiency (ORadj = 2.93, 1.07-8.05, foetal malformation (ORadj = 2.63, 1.43-4.85, polyhydramnios (ORadj = 2.30, 1.17-4.54, vaginal bleeding (ORadj = 2.16, 1.50-3.11, and previous abortion (ORadj = 1.39, 1.08-1.78. High BMI (ORadj = 0.94, 0.91-0.97 and weight gain during gestation (ORadj = 0.92, 0.89-0.95 were found to be protective factors. CONCLUSIONS: The preterm birth rate in these health facilities in Brazil is high and spontaneous preterm births
Suzuki, Cibele; Lopes da Silva, Nilceia; Kumar, Praveen; Pathak, Purnima; Ong, Siew Hwa
Omalizumab add-on to standard-of-care therapy has proven to be efficacious in severe asthma patients for whom exacerbations cannot be controlled otherwise. Moreover, evidence from different healthcare settings suggests reduced healthcare resource utilization with omalizumab. Based on these findings, this study aimed to assess the cost-effectiveness of the addition of omalizumab to standard-of-care therapy in patients with uncontrolled severe allergic asthma in a Brazilian healthcare setting. A previously published Markov model was adapted using Brazil-specific unit costs to compare the costs and outcomes of the addition of omalizumab to standard-of-care therapy vs standard-of-care therapy alone. Model inputs were largely based on the eXpeRience study. Costs and health outcomes were calculated for lifetime-years and were annually discounted at 5%. Both one-way and probabilistic sensitivity analyses were performed. An additional cost of R$280,400 for 5.20 additional quality-adjusted life-years was estimated with the addition of omalizumab to standard-of-care therapy, resulting in an incremental cost-effectiveness ratio of R$53,890. One-way sensitivity analysis indicated that discount rates, standard-of-care therapy exacerbation rates, and exacerbation-related mortality rates had the largest impact on incremental cost-effectiveness ratios. Assumptions of lifetime treatment adherence and rate of future exacerbations, independent of previous events, might affect the findings. The lack of Brazilian patients in the eXpeRience study may affect the findings, although sample size and baseline characteristics suggest that the modeled population closely resembles Brazilian severe allergic asthma patients. Results indicate that omalizumab as an add-on therapy is more cost-effective than standard-of-care therapy alone for Brazilian patients with uncontrolled severe allergic asthma, based on the World Health Organization's cost-effectiveness threshold of up to 3-times the gross
Doença celíaca: avaliação da obediência à dieta isenta de glúten e do conhecimento da doença pelos pacientes cadastrados na Associação dos Celíacos do Brasil (ACELBRA Celiac disease: evaluation of compliance to a gluten-free diet and knowledge of the disease in celiac patients registered at the Brazilian Celiac Association (BCA
Vera Lucia SDEPANIAN
. Conclusões - Quanto maior o grau de conhecimento da doença e seu tratamento, maior a obediência à dieta isenta de glúten.Background The compliance to a gluten-free diet may prevent the development of both non-malignant and malignant complications. Aim - To evaluate compliance to a gluten-free diet and knowledge of the disease in celiac patients registered at the Brazilian Celiac Association (BCA. Methods - A structured questionnaire was designed to assess compliance to a gluten-free diet as well as knowledge of the celiac disease. It was mailed to 584 members of BCA. Results - Five hundred and twenty nine (90.6% of a total of 534 (91.4% answered questionnaires were analyzed; 69.4% were classified as compliant patients whereas 29.5% were classified as noncompliant. The proportion of patients age 21 or older who consume gluten frequently or without any restriction is larger (17.7% than those who were younger than 21 years (9.9%. Frequency of dietary compliance was higher when the diagnosis had taken less than 5 years to be established; 82% of the patients replied that the small intestine was the part of the body affected by the disease. The most common symptoms of the disease according to the answers were diarrhea (96.6%, weight loss (93.4%, protuberant abdomen (90.4%, anemia (68.1% and vomiting (59.6%. Only 59.0% agreed with the existence of genetic predisposition; 90.4% answered that the disease is permanent and 96.2% stated that the diet should exclude gluten absolutely; 67.1% answered that the gluten is a protein and according to 92.1% questionnaires this protein is present in wheat, rye, barley and oat. Greater compliance was observed when there was an understanding of the disease and diet. The small intestine biopsy was considered necessary for just 67.5% of the patients, and greater compliance was observed in patients who had undergone at least one small intestine biopsy. Conclusion - Our findings indicate that the more the patients know and understand about
Godoy, Fabiana; Rosenblatt, Aronita; Godoy-Bezerra, Juliana
This study aimed to assess the prevalence of temporomandibular disorders (TMD) and associated variables among adolescents from 16 to 18 years of age in their senior year of high school in the city of Recife, Pernambuco, Brazil, in 2005. The studied variables were gender, self-esteem and nervous behavior, type of occlusion, and use of orthodontic appliances. In this cross-sectional study, the nonpatient population comprised 410 adolescents attending private and state schools. The data collection was conducted using 2 questionnaires, the first of which was used to evaluate the prevalence of TMD and the second to assess self-esteem. A clinical examination was conducted for the occlusion aspect of the evaluation. The prevalence of TMD was 16.3% in the study group and there was no statistical difference between occlusions judged as normal or as malocclusions (P = .1148). There was a statistically significant association between students who had previously undergone orthodontic treatment and TMD (P = .0033, odds ratio: 3.08). The students classified in the low self-esteem group showed a significant increase in TMD (P= .0140). The group that classified themselves as nervous also showed an increase (P = .0034), with a higher prevalence also found in females (P = .0021). This study suggests that low self-esteem and gender may be more frequently related than dental factors to TMD in adolescents.
Maia, Deborah B; Nóbrega, Augusta; Marques-Portella, Carla; Mendlowicz, Mauro V; Volchan, Eliane; Coutinho, Evandro S; Figueira, Ivan
Peritraumatic reactions feature prominently among the main predictors for development of posttraumatic stress disorder (PTSD). Peritraumatic tonic immobility (PTI), a less investigated but equally important type of peritraumatic response, has been recently attracting the attention of researchers and clinicians for its close association with traumatic reactions and PTSD. Our objective was to investigate the role of PTI, peritraumatic panic, and dissociation as predictors of PTSD symptoms in a cohort of police recruits (n=132). Participants were asked to complete the following questionnaires during academy training and after the first year of work: Posttraumatic Stress Disorder Checklist - Civilian Version (PCL-C), Physical Reactions Subscale (PRS), Peritraumatic Dissociative Experiences Questionnaire (PDEQ), Tonic Immobility Scale (TIS), and Critical Incident History Questionnaire. Employing a zero-inflated negative binomial regression model, we found that each additional point in the TIS was associated with a 9% increment in PCL-C mean scores (RM = 1.09), whereas for PRS, the increment was 7% (RM = 1.07). As the severity of peritraumatic dissociation increased one point in the PDEQ, the chance of having at least one symptom in the PCL-C increased 22% (OR = 1.22). Our findings highlight the need to expand investigation on the incidence and impact of PTI on the mental health of police officers.
Deborah B. Maia
Full Text Available Objective: Peritraumatic reactions feature prominently among the main predictors for development of posttraumatic stress disorder (PTSD. Peritraumatic tonic immobility (PTI, a less investigated but equally important type of peritraumatic response, has been recently attracting the attention of researchers and clinicians for its close association with traumatic reactions and PTSD. Our objective was to investigate the role of PTI, peritraumatic panic, and dissociation as predictors of PTSD symptoms in a cohort of police recruits (n=132. Methods: Participants were asked to complete the following questionnaires during academy training and after the first year of work: Posttraumatic Stress Disorder Checklist - Civilian Version (PCL-C, Physical Reactions Subscale (PRS, Peritraumatic Dissociative Experiences Questionnaire (PDEQ, Tonic Immobility Scale (TIS, and Critical Incident History Questionnaire. Results: Employing a zero-inflated negative binomial regression model, we found that each additional point in the TIS was associated with a 9% increment in PCL-C mean scores (RM = 1.09, whereas for PRS, the increment was 7% (RM = 1.07. As the severity of peritraumatic dissociation increased one point in the PDEQ, the chance of having at least one symptom in the PCL-C increased 22% (OR = 1.22. Conclusions: Our findings highlight the need to expand investigation on the incidence and impact of PTI on the mental health of police officers.
Full Text Available Abstract Background Many indigenous villages in the Amazon basin still suffer from a high malaria burden. Despite this health situation, there are few studies on the bionomics of anopheline larvae in such areas. This publication aims to identify the main larval habitats of the most abundant anopheline species and to assess their associations with some environmental factors. Methods We conducted a 19-month longitudinal study from January 2013 to July 2014, sampling anopheline larvae in two indigenous Yanomami communities, comprised of four villages each. All natural larval habitats were surveyed every two months with a 350 ml manual dipper, following a standardized larval sampling methodology. In a third study area, we conducted two field expeditions in 2013 followed by four systematic collections during the long dry season of 2014–2015. Results We identified 177 larval habitats in the three study areas, from which 9122 larvae belonging to 13 species were collected. Although species abundance differed between villages, An. oswaldoi (s.l. was overall the most abundant species. Anopheles darlingi, An. oswaldoi (s.l., An. triannulatus (s.s. and An. mattogrossensis were primarily found in larval habitats that were partially or mostly sun-exposed. In contrast, An. costai-like and An. guarao-like mosquitoes were found in more shaded aquatic habitats. Anopheles darlingi was significantly associated with proximity to human habitations and larval habitats associated with river flood pulses and clear water. Conclusions This study of anopheline larvae in the Brazilian Yanomami area detected high heterogeneities at micro-scale levels regarding species occurrence and densities. Sun exposure was a major modulator of anopheline occurrence, particularly for An. darlingi. Lakes associated with the rivers, and particularly oxbow lakes, were the main larval habitats for An. darlingi and other secondary malaria vectors. The results of this study will serve as a
Vinholes, Daniele B; Bassanesi, Sérgio L; Chaves Junior, Hilton de Castro; Machado, Carlos Alberto; Melo, Ione M F; Fuchs, Flavio Danni; Fuchs, Sandra Costa
Exposure to risk factors for hypertension may be influenced by the characteristics of the workplace, where workers spend most of their daily time. To evaluate the association between features of the companies, particularly the presence of facilities to provide meals, and of population characteristics and the prevalence of hypertension, taking into account individual risk factors for hypertension. This multilevel analysis was based on a cross-sectional study with individual and company data from the SESI (Serviço Social da Indústria-Social Service of Industries) study and population-based data from the national census statistics. Workers aged ≥15 years were randomly selected from small (20-99), medium (100-499) and large (≥500 employees) companies per state using multistage sampling. Logistic regression was used to analyse the association between hypertension and individual, workplace and population variables, with odds ratios (ORs; 95% CI) adjusted for three-level variables. 4818 Workers from 157 companies were interviewed and their blood pressure, weight and height were measured. Overall, 77% were men, aged 35.4 ±10.7 years, with 8.7 ±4.1 years of schooling and mostly worked in companies with a staff canteen (66%). Besides individual characteristics-being male, ageing, low schooling, alcohol abuse and higher BMI-a workplace with no staff canteen (OR=1.28; 95% CI 1.08 to 1.52), small companies (OR=1.31; 95% CI 1.07 to 1.60) and living in cities with higher economic inequality (OR=1.47; 95% CI 1.23 to 1.76) were associated with a higher risk for hypertension. Among Brazilian workers, the prevalence of hypertension is associated with individual risk factors, lack of a canteen at the workplace, small companies and higher economic inequalities of cities. These three-level characteristics help to interpret differences in the prevalence of hypertension between regions or countries. © Article author(s) (or their employer(s) unless otherwise stated in the
Dawkins, Karim; Esiobu, Nwadiuto
The potential role of soil fungi in the invasion of the Brazilian pepper tree ( Schinus terebinthifolius -BP) in Florida is not known; although the low biotic resistance of Florida soils is often invoked to explain the prevalence of many invasive species. To gain an initial insight into BP's mycorrhizal associations, this study examined the rhizobiome of BP and two native plants ( Hamelia patens and Bidens alba ) across six locations. Arbuscular mycorrhizal fungi (AMF) associated with the roots of the target plants and bulk soil was characterized by spore morphotyping. Sequence analysis of metagenomic DNA from lateral roots/rhizosphere of BP ( n = 52) and a native shrub H. patens ( n = 37) on the same parcel yielded other fungal associates. Overall, the total population of AMF associated with BP was about two folds greater than that of the two native plants ( p = 0.0001) growing on the same site. The dominant AMF under Schinus were members of the common Glomus and Rhizophagus spp. By contrast, the most prevalent AMF in the bulk soil and rhizosphere of the two Florida native plants, Acaulospora spp (29%) was sharply diminished (9%) under BP rhizosphere. Analysis of the ITS2 sequences also showed that Schinus rhizosphere had a high relative abundance of ectomycorrhizal fungi (76.5%) compared to the native H. patens (2.6%), with the species Lactifluus hygrophoroides (Basidiomycota) being the most prevalent at 61.5% ( p < 0.05). Unlike the native plants where pathogenic fungi like Phyllosticta sp., Phoma sp., and Neofusicoccum andium were present (8.1% for H. patens ), only one potentially pathogenic fungal taxon was detected (3.9%) under BP. The striking disparity in the relative abundance of AMF and other fungal types between BP and the native species is quite significant. Fungal symbionts could aide plant invasion via resource-use efficiency and other poorly defined mechanisms of protection from pathogens in their invaded range. This report exposes a potentially
Nascente, Flávia Miquetichuc Nogueira; Jardim, Thiago Veiga; Peixoto, Maria do Rosário Gondim; Carneiro, Carolina de Souza; Mendonça, Karla Lorena; Póvoa, Thaís Inácio Rolim; Sousa, Ana Luiza Lima; Barroso, Weimar Kunz Sebba; Jardim, Paulo César Brandão Veiga
Adolescence is a transition stage between childhood and adulthood and is an important phase for the acquisition of future lifestyles, including the practice of physical activity (PA). The prevalence of sedentary lifestyle in adolescents is often high, creating the need for studies addressing the practice of PA and its associated factors for a better understanding of the phenomenon and possible interventions that would encourage positive changes. Cross-sectional study of a representative sample of students aged 14-18 years enrolled in both public and private schools of a large Brazilian city to determine the level of physical activity (PA) and its associated factors. Sedentary lifestyle was measured by applying the International Physical Activity Questionnaire. The independent variables were gender, age, race, tobacco use and alcohol consumption in the past 30 days, socioeconomic status, body mass index, waist circumference and blood pressure. The crude prevalence ratio was used as a measure of association and was estimated from a Poisson regression. The sample consisted of 862 adolescents with a mean age of 15.4 ± 1.1 years. Females were predominant (52.8%), and the age between 14 and 15 years was the most frequent (52.2%). The majority of the group reported themselves as Caucasians (51.2%), belonging to socioeconomic class C (52.5%) and were attending to public schools (69.1%). The prevalence of sedentary lifestyle was 66.8% (95% confidence interval [CI]: 63.5-69.9), where values of 65.4% and 69.9% were observed among students from public and private schools, respectively (p = 0.196). Sedentary lifestyle was more frequent in females (78.0% vs 54.3%; p sedentary lifestyle was female gender both in public and private schools and the only independent variable related to sedentarism was also female gender. The prevalence of sedentary lifestyle was extremely high in the population of adolescents studied both in public and private schools. Female sex was
Bhakta, Hemangini C; Marco, Catherine A
Patient satisfaction with emergency care is associated with timeliness of care, empathy, technical competence, and information delivery. Previous studies have demonstrated inconsistent findings regarding the association between pain management and patient satisfaction. This study was undertaken to determine the association between pain management and patient satisfaction among Emergency Department (ED) patients presenting with acute painful conditions. In this survey study, a standardized interview was conducted at the Emergency Department at the University of Toledo Medical Center in May-July 2011. Participants were asked to answer 18 questions pertaining to patient satisfaction. Additional data collected included demographic information, pain scores, and clinical management. Among 328 eligible participants, 289 (88%) participated. The mean triage pain score on the verbal numeric rating scale was 8.2 and the mean discharge score was 6.0. The majority of patients (52%) experienced a reduction in pain of 2 or more points. Participants received one pain medication dose (44%), two medication doses (14%), three medication doses (5%), or four medication doses (2%). Reduction in pain scores of 2 or more points was associated with a higher number of medications administered. Reduction in pain scores was associated with higher satisfaction as scored on questions of patient perceptions of adequate assessment and response to pain, and treatment of pain. There was a significant association between patient satisfaction and a reduction in pain of 2 or more points and number of medications administered. Effective pain management is associated with improved patient satisfaction among ED patients with painful conditions. Copyright © 2014 Elsevier Inc. All rights reserved.
Rauber, F; da Costa Louzada, M L; Feldens, C A; Vitolo, M R
The assessment of the factors that influence children's diets is important for supporting the development of public health policies for the prevention of diet-related diseases. The present study aimed to evaluate the diet quality of preschoolers by using the Healthy Eating Index (HEI) and to identify maternal and family characteristics associated with this score and its components. The present study comprised a cohort study conducted with 345 low socioeconomic status children from São Leopoldo in southern Brazil aged 6 months and 3-4 years old. Dietary data were collected through 24-h recalls and diet quality was evaluated according to the HEI. The mean (SD) total HEI score was 65.7 (11.2). Only 9.6% (n = 33) of the children had a good diet. No significant association was detected between the overall diet quality of children and the characteristics. The prevalence of children who achieved the 75th percentile of the scores for grains [prevalence ratio (PR) = 0.65; 95% confidence interval (CI) = 0.43-0.98] and total fat (PR = 0.80; 95% CI = 0.69-0.93) was lower among children whose families had higher incomes, whereas the prevalence for grains was lower in those whose fathers were employed (PR = 0.53; 95% CI = 0.34-0.81). The prevalence for diet variety (PR = 1.44; 95% CI = 1.01-2.05) and milk (P = 1.18; 95% CI = 1.04-1.35) was higher and for total fat (PR = 0.83; 95% CI = 0.70-0.98) and saturated fat (PR = 0.76; 95% CI = 0.59-0.98) was lower among children whose mothers had higher levels of education. The total HEI score in these children indicates that compliance with dietary guidelines is generally poor. Although the overall diet quality did not show variation across maternal and family characteristics, some components of the diet were affected by these features. © 2012 The Authors Journal of Human Nutrition and Dietetics © 2012 The British Dietetic Association Ltd.
Godinho, Marluce Rodrigues; Greco, Rosangela Maria; Teixeira, Maria Teresa Bustamante; Teixeira, Liliane Reis; Guerra, Maximiliano Ribeiro; Chaoubah, Alfredo
Studies about work ability have grown in importance owing to the worldwide aging of active populations. Research has shown that measuring work ability has a predictive value in cases of long-term sickness absence and early retirement. Our goal was to analyze the work ability and associated factors of civil servants from a higher education institution in Brazil. The participants in this cross-sectional study were 600 technical-administrative workers at a public university. Work ability was measured using the work ability index. The participants were as follows: 51.8% male; mean age of 45 years (SD = ±11); married or in a stable union (61.5%); holding a graduate degree (56.7%); having only one job (83.3%), working 40 h a week or less (78.6%); not working evenings (79.8%); and having direct contact with the public (58.3%). The prevalence of reduced work ability was 13.9%. The following factors were found to be associated with reduced work ability: age 50 years old or above (PR = 2.58; 95% CI 1.25-5.09); female (PR = 2.77; 95% CI 1.25-3.60); education up to secondary school (PR = 2.37; 95% CI 1.13-3.59); overall poor self-assessed health (PR = 2.96; 95% CI 1.32-3.93); signs and symptoms of depression (PR = 4.86; 95% CI 2.23-6.55); sedentariness (PR = 3.00; 95% CI 1.38-4.68) and poor social support at work (PR = 4.01; 95% CI 1.66-4.37). Most of the participants showed good work ability, but some subjects had reduced work ability. This study makes a contribution to expanding the discussion about the factors associated with work ability toward proposing actions for maintaining that ability or helping recovery in the case of diminished ability. Such actions can help reduce work absenteeism and early retirement, both of which have a social and economic impact in Brazil. Studying the determinants of work ability and recommendations to address those determinants will help efforts to improve the quality of life of individuals, both at work and personally, and promote healthy
Karinna Alves Amorim de Sousa
Full Text Available The prison populations is considered vulnerable due heterogeneity of confinement, whose predisposing factors are the lifestyle of individuals and prison conditions. This study aimed to investigate the prevalence of HIV and associated factors reported in studies conducted in prisons in Brazil. An integrative review was carried out, with a search in the databases LILACS, MEDLINE and SCIELO, including articles published from 2000. The final sample that met the inclusion and exclusion criteria totaled 11 articles. prevalences were found ranging from 3.2% to 16%. This review made it possible to find average of 10.6% prevalence. Predominated as risk factors: drug use, piercing material sharing, inappropriate sexual behavior and STDs. There was a need for more comprehensive surveys, which provides a situational diagnosis of HIV in this population, so as to reveal specific aspects of individual, social and programmatic vulnerabilities in each region of Brazil.
Colussi, Paulo Roberto Grafitti; Haas, Alex Nogueira; Oppermann, Rui Vicente; Rösing, Cassiano Kuchenbecker
This cross-sectional study evaluated the consumption of fluoridated dentifrice and associated factors in Passo Fundo, Rio Grande do Sul State, Brazil. A total of 688 households were selected. A structured questionnaire was answered by the mother to obtain demographics, habits, and toothpaste consumption. Household toothpaste consumption was considered low when a tube lasted > 1 month and high when toothpaste consumption. In the multivariate model, mother's age > 50 years (OR = 1.62; 95%CI: 1.02-2.61), mother's brushing frequency (OR = 2.53; 95%CI: 1.53-4.16), number of people brushing (OR = 5.69; 95%CI: 3.68-8.81), and cosmetic features in choice of the dentifrice (OR = 1.64; 95%CI: 1.03-2.61) showed the highest odds of high toothpaste consumption.
Full Text Available ABSTRACT Objective The aim of this study was to evaluate the association of Porphyromonas endodontalis, Filifactor alocis and Dialister pneumosintes with the occurrence of periodontitis. Material and Methods Thirty subjects with chronic periodontitis (ChP and 10 with periodontal health (PH were included in the study. Nine subgingival biofilm samples were collected as follows: i PH group - from the mesial/buccal aspect of each tooth in two randomly chosen contralateral quadrants; ii ChP group - from three sites in each of the following probing depth (PD categories: shallow (≤3 mm, moderate (4-6 mm and deep (≥7 mm. Checkerboard DNA-DNA hybridization was used to analyze the samples. Results We found the three species evaluated in a higher percentage of sites and at higher levels in the group with ChP than in the PH group (p<0.05, Mann-Whitney test. We also observed these differences when the samples from sites with PD≤4 mm or ≥5 mm of subjects with ChP were compared with those from subjects with PH (p<0.05, Mann-Whitney test. In addition, the prevalence and levels of D. pneumosintes, and especially of F. alocis were very low in healthy subjects (0.12x105 and 0.01x105, respectively. Conclusion F. alocis and D. pneumosintes might be associated with the etiology of ChP, and their role in the onset and progression of this infection should be further investigated. The role of P. endodontalis was less evident, since this species was found in relatively high levels and prevalence in the PH group.
Gurgel-Giannetti, Juliana; Oliveira, Guilherme; Brasileiro Filho, Geraldo; Martins, Poliana; Vainzof, Mariz; Hirano, Michio
To review all patients with SCO2 mutations and to describe a Brazilian patient with cardioencephalomyopathy carrying compound heterozygous mutations in SCO2, one being the known pathogenic p.E140K mutation and the other a novel 12-base pair (bp) deletion at nucleotides 1519 through 1530 (c.1519_1530del). Case report and literature review. University hospital. Infant girl presenting with an encephalomyopathy, inspiratory stridor, ventilator failure, progressive hypotonia, and weakness, leading to death. Clinical features, neuroimaging findings, muscle biopsy with histochemical analysis, and genetic studies. This infant girl was the first child of healthy, nonconsanguineous parents. She developed progressive muscular hypotonia and ventilatory failure. At the end of the first month of life, she developed cardiomegaly and signs of cardiac failure. Routine blood tests showed lactic acidosis and mild elevation of the creatine kinase level. Brain magnetic resonance imaging showed increased T2 and fluid-attenuated inversion recovery signals in the putamen bilaterally. Nerve conduction studies showed severe axonal sensorimotor neuropathy. Muscle biopsy revealed a neurogenic pattern with mitochondrial proliferation and total absence of cytochrome- c oxidase histochemical stain. Sequencing of SCO2 showed that the patient had compound heterozygote SCO2 mutations: the previously described c.1541G>A (p.E140K) mutation and a novel 12-bp deletion at nucleotides 1519 through 1530 (c.1519_1530del). The patient died at age 45 days. Our findings and the literature review indicate that it is important to consider the diagnosis of mitochondrial disease in newborns with hypotonia and cardiomyopathy. In our case, the accurate diagnosis of SCO2 mutations is particularly important for genetic counseling.
Bruno, A de Souza; Rodrigues, M H; Alvares, M C B; Nahas-Neto, J; Nahas, E A Petri
To evaluate the prevalence and risk factors of non-alcoholic fatty liver disease (NAFLD) in postmenopausal women. A cross-sectional study was carried involving 188 women (age ≥ 45 years and amenorrhea ≥ 12 months) attending the outpatient unit in south-eastern Brazil. Exclusion criteria were liver disease (hepatitis B and C, cholestatic disease, liver insufficiency), use of drugs that affect liver metabolism; alcoholics; AIDS or cancer history; and morbid obesity. NAFLD was diagnosed by abdominal ultrasound. Clinical, anthropometric (body mass index, waist circumference) and biochemical variables were measured. Of the 188 women, 73 (38.8%) had NAFLD. Blood pressure, waist circumference, body mass index, LDL cholesterol, triglycerides and glucose were significantly higher in NAFLD patients when compared with women without NAFLD (control group) (p NAFLD group (6.1 ± 4.6 vs. 2.4 ± 1.4 in control group, p NAFLD, and 46.1% of the control group (p NAFLD, were: high waist circumference (odds ratio (OR) 1.07, 95% confidence interval (CI) 1.01-1.13), insulin resistance (OR 3.81, 95% CI 2.01-7.13), and presence of metabolic syndrome (OR 8.68, 95% CI 3.3-24.1). NAFLD showed a high prevalence among postmenopausal women. The presence of metabolic syndrome, abdominal obesity and IR were indicators of risk for the development of NAFLD.
Full Text Available The prevalence of obesity, pre-diabetes, and type 2 diabetes (T2D is increasing worldwide, especially in the developing nations of South America. Brazil has experienced an exponential increase in the prevalence of these chronic non-communicable diseases. The rising prevalence is probably due to changing eating patterns, sedentary living, and a progressive aging of the population. These trends and their underlying causes carry untoward consequences for all Brazilians and the future of Brazilian public health and the healthcare system. Lifestyle changes that include healthy eating (nutrition therapy and regular physical activity (structured exercise represent efficient inexpensive measures to prevent and/or treat the aforementioned disorders and are recommended for all afflicted patients. Regrettably, the implementation of lifestyle changes is fraught with clinical and personal challenges in real life. The transcultural Diabetes Nutrition Algorithm (tDNA is a therapeutic tool intended to foster implementation of lifestyle recommendations and to improve disease-related outcomes in common clinical settings. It is evidence-based and amenable to cultural adaptation. The Brazilian Diabetes Association, Society of Cardiology and Ministry of Health guidelines for nutrition therapy and physical exercise were considered for the Brazilian adaptation. The resultant tDNA-Brazil and its underlying recommendations are presented and explained.
Moura, Fabio; Salles, João; Hamdy, Osama; Coutinho, Walmir; Baptista, Deise Regina; Benchimol, Alexander; Marchetti, Albert; Hegazi, Refaat A; Mechanick, Jeffrey I
The prevalence of obesity, pre-diabetes, and type 2 diabetes (T2D) is increasing worldwide, especially in the developing nations of South America. Brazil has experienced an exponential increase in the prevalence of these chronic non-communicable diseases. The rising prevalence is probably due to changing eating patterns, sedentary living, and a progressive aging of the population. These trends and their underlying causes carry untoward consequences for all Brazilians and the future of Brazilian public health and the healthcare system. Lifestyle changes that include healthy eating (nutrition therapy) and regular physical activity (structured exercise) represent efficient inexpensive measures to prevent and/or treat the aforementioned disorders and are recommended for all afflicted patients. Regrettably, the implementation of lifestyle changes is fraught with clinical and personal challenges in real life. The transcultural Diabetes Nutrition Algorithm (tDNA) is a therapeutic tool intended to foster implementation of lifestyle recommendations and to improve disease-related outcomes in common clinical settings. It is evidence-based and amenable to cultural adaptation. The Brazilian Diabetes Association, Society of Cardiology and Ministry of Health guidelines for nutrition therapy and physical exercise were considered for the Brazilian adaptation. The resultant tDNA-Brazil and its underlying recommendations are presented and explained.
Castro, Renata A; Quecine, Maria Carolina; Lacava, Paulo T; Batista, Bruna D; Luvizotto, Danice M; Marcon, Joelma; Ferreira, Anderson; Melo, Itamar S; Azevedo, João L
The mangrove ecosystem is a coastal tropical biome located in the transition zone between land and sea that is characterized by periodic flooding, which confers unique and specific environmental conditions on this biome. In these ecosystems, the vegetation is dominated by a particular group of plant species that provide a unique environment harboring diverse groups of microorganisms, including the endophytic microorganisms that are the focus of this study. Because of their intimate association with plants, endophytic microorganisms could be explored for biotechnologically significant products, such as enzymes, proteins, antibiotics and others. Here, we isolated endophytic microorganisms from two mangrove species, Rhizophora mangle and Avicennia nitida, that are found in streams in two mangrove systems in Bertioga and Cananéia, Brazil. Bacillus was the most frequently isolated genus, comprising 42% of the species isolated from Cananéia and 28% of the species from Bertioga. However, other common endophytic genera such as Pantoea, Curtobacterium and Enterobacter were also found. After identifying the isolates, the bacterial communities were evaluated for enzyme production. Protease activity was observed in 75% of the isolates, while endoglucanase activity occurred in 62% of the isolates. Bacillus showed the highest activity rates for amylase and esterase and endoglucanase. To our knowledge, this is the first reported diversity analysis performed on endophytic bacteria obtained from the branches of mangrove trees and the first overview of the specific enzymes produced by different bacterial genera. This work contributes to our knowledge of the microorganisms and enzymes present in mangrove ecosystems.
Rodrigo Costa da Silva
Full Text Available Leptospirosis is a worldwide anthropozoonosis that infects livestock, including sheep as the carriers to other animals and humans. The present study aimed to determine the prevalence of Leptospira spp. in sheep from two slaughterhouses in the state of São Paulo, Brazil and its association with epidemiological variables. Serum samples from 182 sheep were evaluated for Leptospira spp. antibodies by microscopic agglutination test (MAT. Results indicated 34/182 (18.68%; CI95% 13.70-24.98% positive serum samples, mainly to the serovar Copenhageni (17/34; 50%; CI95% 33.99-66.01%. Bacterial growth in the Fletcher medium was detected for 13/34 (38.24%; CI95% 23.87-55.08% animals, and confirmed by Polymerase Chain Reaction (PCR and sequencing for only two kidney samples from two animals. Thus, treatment and vaccination of sheep, besides rodent control, can be useful to prevent the infection in the studied region since sheep are important Leptospira spp. carriers, and its transmission to slaughterhouse workers is mainly through the manipulation of visceral tissues.
Adriano Queiroz de Mesquita
Full Text Available The identification of dairy cows with greater or lower potential to develop mastits has been pursued for many years among different segments of the milk industry, including governmental organizations. Genomic studies have suggested that Single Nucleotide Polymorphisms (SNPs within the pattern recognition receptors (PRR could lead to different responses to pathogens, and consequently result in mastitis resistance or susceptibility. To investigate whether toll like receptor 4 (TLR4 gene is associated with subclinical mastitis in Holstein cows from a property in the state of Goiás, Brazil, TaqMan allelic discrimination and somatic cell count were performed. One hundred and fifty milk samples were analyzed for SCC and centesimal composition. Twenty percent of those samples with SCC above 200,000 (n=13 were screened for real-time PCR identification of microorganisms and blood samples were genotyped for TLR4 SNPs. There was a higher prevalence of Gram-positive bacteria in the analyzed samples (88.9% and animals that had the combined genotypes AACCCC, GGTCGG and GACCGC presented the lowest somatic cell scores, and consequently those genotypes have the potential to be applied as molecular markers for assisted animal selection to improve milk quality.
Background Binge drinking (BD) seems to be related to health and social complications among adolescents. Considering that knowledge about BD in developing countries is limited and that in Brazil high socioeconomic status is a risk factor for alcohol abuse, this study sheds light about this phenomenon among adolescents from a different cultural background than prior North-American and European studies. Methods Brazilian students (n = 2691) selected through a representative, stratified and clustered sampling method were asked to answer a self-report questionnaire. The questionnaire contained questions about patterns of alcohol consumption, religious beliefs, leisure activities, family structure and relationships. Data were analyzed with basic contingency tables with Chi-square tests followed by a decision tree analysis and weighted logistic regression. Results Almost thirty-five percent of the students reported recent binge drinking. BD in the past month was positively associated with older age (aOR = 1.5[1.2-1.7]), male gender (aOR = 1.5[1.2-2.0]) going out with friends almost every night (aOR = 33.9[14.2-80.7]), not living with mother (aOR = 2.4[1.3-4.7]), believing in God with little conviction (aOR = 1.6[1.2-2.0]) and rarely talking to parents about anything (aOR = 1.7[1.3-2.2]) or always about drugs (aOR = 1.8[1.3-2.5]). Factors inversely associated with BD were: paying lower monthly tuition fees (aOR = 0.5[0.4-0.9]), living with people who do not get drunk (aOR = 0.6[0.4-0.7]) and frequent engagement in worships (aOR = 0.7[0.5-0.9]). Conclusion The habit of BD in adolescents enrolled in private high schools in Brazil is strongly linked to the frequency with which they go out with friends at night. Factors such as religiosity, expressed by trust in God and participation in worship, and being enrolled in a school with cheaper tuition fees were associated with avoidance of BD in this population. PMID:21453510
Sanchez, Zila M; Martins, Silvia S; Opaleye, Emerita S; Moura, Yone G; Locatelli, Danilo P; Noto, Ana R
Binge drinking (BD) seems to be related to health and social complications among adolescents. Considering that knowledge about BD in developing countries is limited and that in Brazil high socioeconomic status is a risk factor for alcohol abuse, this study sheds light about this phenomenon among adolescents from a different cultural background than prior North-American and European studies. Brazilian students (n = 2691) selected through a representative, stratified and clustered sampling method were asked to answer a self-report questionnaire. The questionnaire contained questions about patterns of alcohol consumption, religious beliefs, leisure activities, family structure and relationships. Data were analyzed with basic contingency tables with Chi-square tests followed by a decision tree analysis and weighted logistic regression. Almost thirty-five percent of the students reported recent binge drinking. BD in the past month was positively associated with older age (aOR = 1.5[1.2-1.7]), male gender (aOR = 1.5[1.2-2.0]) going out with friends almost every night (aOR = 33.9[14.2-80.7]), not living with mother (aOR = 2.4[1.3-4.7]), believing in God with little conviction (aOR = 1.6[1.2-2.0]) and rarely talking to parents about anything (aOR = 1.7[1.3-2.2]) or always about drugs (aOR = 1.8[1.3-2.5]). Factors inversely associated with BD were: paying lower monthly tuition fees (aOR = 0.5[0.4-0.9]), living with people who do not get drunk (aOR = 0.6[0.4-0.7]) and frequent engagement in worships (aOR = 0.7[0.5-0.9]). The habit of BD in adolescents enrolled in private high schools in Brazil is strongly linked to the frequency with which they go out with friends at night. Factors such as religiosity, expressed by trust in God and participation in worship, and being enrolled in a school with cheaper tuition fees were associated with avoidance of BD in this population.
Locatelli Danilo P
Full Text Available Abstract Background Binge drinking (BD seems to be related to health and social complications among adolescents. Considering that knowledge about BD in developing countries is limited and that in Brazil high socioeconomic status is a risk factor for alcohol abuse, this study sheds light about this phenomenon among adolescents from a different cultural background than prior North-American and European studies. Methods Brazilian students (n = 2691 selected through a representative, stratified and clustered sampling method were asked to answer a self-report questionnaire. The questionnaire contained questions about patterns of alcohol consumption, religious beliefs, leisure activities, family structure and relationships. Data were analyzed with basic contingency tables with Chi-square tests followed by a decision tree analysis and weighted logistic regression. Results Almost thirty-five percent of the students reported recent binge drinking. BD in the past month was positively associated with older age (aOR = 1.5[1.2-1.7], male gender (aOR = 1.5[1.2-2.0] going out with friends almost every night (aOR = 33.9[14.2-80.7], not living with mother (aOR = 2.4[1.3-4.7], believing in God with little conviction (aOR = 1.6[1.2-2.0] and rarely talking to parents about anything (aOR = 1.7[1.3-2.2] or always about drugs (aOR = 1.8[1.3-2.5]. Factors inversely associated with BD were: paying lower monthly tuition fees (aOR = 0.5[0.4-0.9], living with people who do not get drunk (aOR = 0.6[0.4-0.7] and frequent engagement in worships (aOR = 0.7[0.5-0.9]. Conclusion The habit of BD in adolescents enrolled in private high schools in Brazil is strongly linked to the frequency with which they go out with friends at night. Factors such as religiosity, expressed by trust in God and participation in worship, and being enrolled in a school with cheaper tuition fees were associated with avoidance of BD in this population.
Stoll, C; Alembik, Y; Dott, B; Roth, M P
Patients with congenital anorectal malformations (ARM) often have other associated congenital defects. The reported incidence and the types of associated malformations vary between different studies. The purpose of this investigation was to assess the prevalences at birth of associated malformations in patients of a geographically defined population with ARM which were collected between 1979 and 2003 in 334, 262 consecutive births. Of the 174 patients with ARM during the study period, 49.4% had associated malformations. Patients with associated malformations were further classified into groups with nonsyndromic multiple congenital anomalies; chromosomal abnormalities; nonchromosomal syndromes including Townes-Brocks, Walker-Warburg, Ivemark, Fetal alcohol, Klippel-Feil, Pallister-Hall, Facio-auriculo-vertebral spectrum, deletion 22q11.2; sequences, including OEIS, Pierre Robin and sirenomelia; and associations including VATER and MURCS. Malformations of the urogenital system (81.1%) and of the skeletal system (45.5%) were the most common other congenital anomalies occurring with ARM in multiply malformed patients without recognized entities, followed by malformations of the cardiovascular system, the digestive system, and the central nervous system. Weight, length, and head circumference of children with ARM and multiple associated malformations were lower than in controls, as was the weight of the placenta. Prenatal detection by fetal ultrasonographic examination was rarely made in isolated ARM. However, even in multiple associated malformations, prenatal detection by fetal ultrasonographic examination had a low sensitivity, 36%. In conclusion the overall prevalence of malformations, which was close to 1 in two infants, emphasizes the need for a thorough investigation of patients with ARM. A routine screening for other malformations may be considered in patients with ARM, and genetic counseling seems warranted in most of these complicated cases.
Full Text Available Diabetes mellitus (DM is a highly prevalent complex genetic disorder. There has been a worldwide effort in the identification of susceptibility genes for DM and its complications, and the 5-10-methylenetetrahydrofolate reductase (MTHFR and apolipoprotein-E (APOE genes have been considered good candidate susceptibility genes to this condition. The objectives of the present study were to determine if the 677T MTHFR and epsilon2/epsilon3/epsilon4 APOE alleles are risk factors for DM and for severity of diabetic retinopathy (DR. A total of 248 individuals were studied: 107 healthy individuals and 141 diabetic patients (46 with type 1 diabetes and 95 with type 2 diabetes, who also had DR (81 with non-proliferative DR and 60 with proliferative DR. The polymorphisms were analyzed by PCR followed by digestion with restriction enzyme or the single-nucleotide primer extension method. No evidence of association between the 677TT genotype of MTHFR gene and DM [cases: TT = 10/95 (10.6%; controls: TT = 14/107 (13%] or with severity of DR was observed [cases: TT = 5/60 (8.5%; controls: TT = 9/81 (11.1%; P > 0.05]. We also did not find evidence of an association between APOE alleles and proliferative DR (epsilon2, epsilon3 and epsilon4 in cases: 9, 76, and 15%, and in controls: 5, 88, and 12%, respectively but the carriers of epsilon2 allele were more frequent among patients with type 2 DM and DR than in controls [cases: 15/95 (15.8%; controls: 7/107 (6.5%; P < 0.05]. Therefore, our results suggest that the epsilon2 allele/APOE might be a risk factor for diabetes in the Brazilian population.
Soares, Marcia Fatima; Ferreira, Rachel Conceição; Pazzini, Camila Alessandra; Travassos, Denise Vieira; Paiva, Saul Martins; e Ferreira, Efigênia Ferreira
The empowerment embedded in the health area is defined as a process that can facilitate control over the determinants of health of individuals and population as a way to improve health. The aim of this study was to verify the association between individual and collective empowerment with sociodemographic conditions, lifestyle, health conditions and quality of life. A cross-sectional analytical study was conducted with 1150 individuals (aged 35 to 44 years). The empowerment was determined by questions from the Integrated Questionnaire for the Measurement of Social Capital (IQ-MSC). The quality of life was measured using the WHOQOL (World Health Organization Quality of Life-Bref). Lifestyle and health conditions were obtained by adapted questions from the Fantastic Lifestyle Questionnaire The DMFT Index was incorporated in the health conditions questions. Logistic regression or multinomial regression was performed. The practice of physical activity was related to individual (OR: 2.70) and collective (OR: 1.57) empowerment. Regarding individual empowerment, people with higher education level (5-11 years - OR: 3.46 and ≥12 years - OR: 4.41), who felt more able to deal with stress (OR:3.76), who presented a high score on quality of life (psychological domain) (OR:1.23) and that smoked (OR:1.49) were more likely to feel able to make decisions and participate in community activities. The increase in the DMFT Index represented less chance of individuals to feel more able to make decisions (OR: 0.96). Regarding the collective empowerment, being religious (catholic) (OR: 1.82), do not drink or drink just a little (OR: 1.66 and 2.28, respectively), and increased score of overall quality of life (OR: 1.08) were more likely to report that people cooperate to solve a problem in their community. The two approaches to empowerment, the individual and collective are connected, and the physical activity showed to be a good strategy for the empowerment construction.
Pasquini, T.A.S.; Neder, H.D.; Araújo-Junqueira, L.; De-Souza, D.A.
Protein-energy malnutrition (PEM) is a treatable disease with high prevalence among hospitalized patients. It can cause significant increases in the duration of hospitalization and costs. PEM is especially important for health systems since malnourished patients present higher morbidity and mortality. The objective of the present study was to assess the evolution of nutritional status (NS) and the effect of malnutrition on clinical outcome of patients at a public university hospital of high complexity in Brazil. Patients hospitalized in internal medicine (n = 54), oncology (n = 43), and infectious diseases (n = 12) wards were included. NS was evaluated using subjective global assessment up to 48 h after admission, and thereafter at intervals of 4-6 days. On admission, patients (n = 109) were classified as well-nourished (n = 73), moderately malnourished or at risk of malnutrition (n = 28), and severely malnourished (n = 8). During hospitalization, malnutrition developed or worsened in 11 patients. Malnutrition was included in the clinical diagnosis of only 5/36 records (13.9% of the cases, P = 0.000). Nutritional therapy was administered to only 22/36 of the malnourished patients; however, unexpectedly, 6/73 well-nourished patients also received commercial enteral diets. Complications were diagnosed in 28/36 malnourished and 9/73 well-nourished patients (P = 0.000). Death occurred in 12/36 malnourished and 3/73 well-nourished patients (P = 0.001). A total of 24/36 malnourished patients were discharged regardless of NS. In summary, malnutrition remains a real problem, often unrecognized, unappreciated, and only sporadically treated, even though its effects can be detrimental to the clinical course and prognosis of patients. The amount of public and private funds unnecessarily dispersed because of hospital malnutrition is significant
Pasquini, T.A.S. [Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, MG (Brazil); Neder, H.D. [Instituto de Economia, Universidade Federal de Uberlândia, Uberlândia, MG (Brazil); Araújo-Junqueira, L. [Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, MG (Brazil); De-Souza, D.A. [Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, MG (Brazil); Departamento de Clínica Médica e Curso de Nutrição, Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, MG (Brazil)
Protein-energy malnutrition (PEM) is a treatable disease with high prevalence among hospitalized patients. It can cause significant increases in the duration of hospitalization and costs. PEM is especially important for health systems since malnourished patients present higher morbidity and mortality. The objective of the present study was to assess the evolution of nutritional status (NS) and the effect of malnutrition on clinical outcome of patients at a public university hospital of high complexity in Brazil. Patients hospitalized in internal medicine (n = 54), oncology (n = 43), and infectious diseases (n = 12) wards were included. NS was evaluated using subjective global assessment up to 48 h after admission, and thereafter at intervals of 4-6 days. On admission, patients (n = 109) were classified as well-nourished (n = 73), moderately malnourished or at risk of malnutrition (n = 28), and severely malnourished (n = 8). During hospitalization, malnutrition developed or worsened in 11 patients. Malnutrition was included in the clinical diagnosis of only 5/36 records (13.9% of the cases, P = 0.000). Nutritional therapy was administered to only 22/36 of the malnourished patients; however, unexpectedly, 6/73 well-nourished patients also received commercial enteral diets. Complications were diagnosed in 28/36 malnourished and 9/73 well-nourished patients (P = 0.000). Death occurred in 12/36 malnourished and 3/73 well-nourished patients (P = 0.001). A total of 24/36 malnourished patients were discharged regardless of NS. In summary, malnutrition remains a real problem, often unrecognized, unappreciated, and only sporadically treated, even though its effects can be detrimental to the clinical course and prognosis of patients. The amount of public and private funds unnecessarily dispersed because of hospital malnutrition is significant.
Martins, M D; Russo, M P; Lemos, J B D; Fernandes, K P S; Bussadori, S K; Corrêa, C T; Martins, M A T
The aim of the present study was to clinically evaluate the oral mucosa lesions of leprosy patients during and after multi-drug therapy. Clinical examination, medical and dental history examination was performed in 100 leprosy patients. The results revealed that 71 patients, 50 men and 21 women, exibited oral lesions. The most frequent lesions were: fissured tongue (18 cases), inflammatory papillary hyperplasia (16 cases), chronic atrophic candidiasis (10 cases), fibroma (10 cases), erythematous candidiasis (eight cases), and traumatic ulceration (seven cases). We conclude that leprosy-related lesions are not present in patients undergoing treatment for leprosy, probably due to response to multidrug therapy.
Full Text Available Certain host single nucleotide polymorphisms (SNPs affect the likelihood of a sustained virological response (SVR to treatment in subjects infected with hepatitis C virus (HCV. SNPs in the promoters of interleukin (IL-10 (-1082 A/G, rs1800896, myxovirus resistance protein 1 (-123 C/A, rs17000900 and -88 G/T, rs2071430 and tumour necrosis factor (TNF (-308 G/A, rs1800629 and -238 G/A, rs361525 genes and the outcome of PEGylated α-interferon plus ribavirin therapy were investigated. This analysis was performed in 114 Brazilian, HCV genotype 1-infected patients who had a SVR and in 85 non-responders and 64 relapsers. A significantly increased risk of having a null virological response was observed in patients carrying at least one A allele at positions -308 [odds ratios (OR = 2.58, 95% confidence intervals (CI = 1.44-4.63, p = 0.001] or -238 (OR = 7.33, 95% CI = 3.59-14.93, p < 0.001 in the TNF promoter. The risk of relapsing was also elevated (-308: OR = 2.87, 95% CI = 1.51-5.44, p = 0.001; -238: OR = 4.20, 95% CI = 1.93-9.10, p < 0.001. Multiple logistic regression of TNF diplotypes showed that patients with at least two copies of the A allele had an even higher risk of having a null virological response (OR = 16.43, 95% CI = 5.70-47.34, p < 0.001 or relapsing (OR = 6.71, 95% CI = 2.18-20.66, p = 0.001. No statistically significant association was found between the other SNPs under study and anti-HCV therapy response.
Mathias Roberto Loch
Full Text Available OBJECTIVE To investigate the association between social capital and social capital and self-perception of health based on examining the influence of health-related behaviors as possible mediators of this relationship.METHODS A cross-sectional study was used with 1,081 subjects, which is representative of the population of individuals aged 40 years or more in a medium-sized city in Southern Brazil. The subjects who perceived their health as fine, bad or very bad were considered to have a negative self-perception of their health. The social capital indicators were: number of friends, people from whom they could borrow money from when needed; the extent of trust in community members; whether or not members of the community helped each other; community safety; and extent of participation in community activities. The behaviors were: physical activity during leisure time, fruits and vegetable consumption, tobacco use and alcohol abuse. The odds ratios (OR and confidence intervals (CI 95% were calculated by binary logistic regression. The significance of mediation was verified using the Sobel test.RESULTS Following adjustment for demographic and clinical variables, subjects with fewer friends (OR = 1.39, 95%CI 1.08;1.80, those who perceived less frequently help from people in the neighborhood (OR = 1.30, 95%CI 1.01;1.68, who saw the violent neighborhood (OR = 1.33, 95%CI 1.01;1.74 and who had not participated in any community activity (OR = 1.39, 95%CI 1.07;1.80 had more negative self-perception of their health. Physical activity during leisure time was a significant mediator in the relationship between all social capital indicators (except for the borrowed money variable and self-perceived health. Fruit and vegetable consumption was a significant mediator of the relationship between the extent of participation in community activities and self-perceived health. Tobacco use and alcohol abuse did not seem to have a mediating role in any relationship
Full Text Available Children from developed and developing countries differ in their body size and shape due to marked differences across their life history caused by social, economic and cultural differences which are also linked to their motor performance (MP. We used allometric models to identify size/shape characteristics associated with MP tests between Brazilian and Peruvian schoolchildren. A total of 4,560 subjects, 2,385 girls and 2,175 boys aged 9-15 years were studied. Height and weight were measured; biological maturation was estimated with the maturity offset technique; MP measures included the 12 minute run (12MR, handgrip strength (HG, standing long jump (SLJ and the shuttle run speed (SR tests; physical activity (PA was assessed using the Baecke questionnaire. A multiplicative allometric model was adopted to adjust for body size differences across countries. Reciprocal ponderal index (RPI was found to be the most suitable body shape indicator associated with the 12MR, SLJ, HG and SR performance. A positive maturation offset parameter was also associated with a better performance in SLJ, HG and SR tests. Sex differences were found in all motor tests. Brazilian youth showed better scores in MP than their Peruvian peers, even when controlling for their body size differences The current study identified the key body size associated with four body mass-dependent MP tests. Biological maturation and PA were associated with strength and motor performance. Sex differences were found in all motor tests, as well as across countries favoring Brazilian children even when accounting for their body size/shape differences.
Da Silva, Rozana C.; Lyon, Sandra; Lyon, Ana C.; Grossi, Maria A. F.; Lyon, Silvia H.; Bührer-Sékula, Samira; Antunes, Carlos M. F.
Serological tests can be helpful in classifying leprosy patients as having either the paucibacillary or the multibacillary form. The aim of this study was to evaluate the concordance between two serological assays, i.e. ML Flow and ELISA, in a population of leprosy patients in Brazil. The
Rosales, Ana Carolina de Mesquita Netto; Jorge, Jacks; Almeida, Oslei Paes de; Lopes, Marcio Ajudarte [University of Campinas (UNICAMP), Piracicaba, SP (Brazil). Piracicaba Dental School. Dept. of Oral Diagnosis], e-mail: firstname.lastname@example.org; Esteves, Sergio Carlos Barros [Center of Oncology, Piracicaba, SP (Brazil)
In spite of its recognized benefits in the treatment of malignant tumors, radiation therapy have several side effects in the head and neck region. The evaluation of oral conditions by a dentist is important to prevent or minimize these problems. The aim of this retrospective review was to analyze the dental needs in 357 patients who received radiotherapy in the head and neck region and were treated at Orocentro/FOP/UNICAMP, between January 1990 and December 2004. Review of patient files showed that dental examination before radiotherapy was not performed in 148 patients (41.5%) and was done in 209 patients (58.5%). From the total of examined patients, 94 (45%) did not require dental procedures at the moment of examination, while 115 (55%) presented some sort of dental need. Following the patients after the radiotherapy, it was observed that the group of patients that was evaluated before radiation presented less need of restorations, root canal filling and dental extractions than those who were not evaluated. The results of this study confirm that the evaluation of oral conditions prior to radiotherapy is essential to minimize the dental needs, emphasizing the importance of the dentist in the multidisciplinary team that treats cancer patients. (author)
Gordo, D G M; Baldi, F; Lôbo, R B; Koury Filho, W; Sainz, R D; Albuquerque, L G
The objective of this study was to evaluate the genetic variability of body composition traits measured by ultrasound, growth traits, and visual scores as well as their genetic associations in Nelore cattle. A total of 9,765, 13,285, 13,061, 12,811, 3,484, 3,484, 3,483, and 3,303 records of weight at time of ultrasound measure (W550), 12th-13th rib LM area (LMA), backfat thickness (BF), rump fat thickness (RF), visual scores for body structure (BS), finishing precocity (FP), muscling (MS), and sheath and navel characteristics (SN), respectively, were used. The model included contemporary group (defined as year and season of birth, sex, and management group) as a fixed effect and age of dam at calving and age of the animal (linear and quadratic effects) as covariates. The direct additive genetic effect was included as a random effect. The analyses also included 46,157 observations of BW adjusted to 120 d. The (co)variance components were estimated by the restricted maximum likelihood method using a multitrait animal model. Heritability estimates for W550, LMA, BF, RF, BS, FP, MS, and SN were 0.37 ± 0.030, 0.33 ± 0.03, 0.24 ± 0.02, 0.28 ± 0.03, 0.24 ± 0.04, 0.38 ± 0.05, 0.29 ± 0.05, and 0.38 ± 0.06, respectively. The estimated genetic correlations between visual scores and LMA were moderate and positive, ranging from 0.37 to 0.44. Similar results were obtained for the estimated genetic correlations between FP and MS with fat thickness measures (BF and RF). Low genetic correlations were estimated between SN and BS and between SN and the body composition traits, indicating that selection for body composition traits and BS will not affect sheath and navel size. The estimated genetic correlations between weight adjusted to 120 d of age (W120) and W550 and BS were high (0.87 and 0.91) and moderate with LMA (0.49 and 0.55), FP (0.37 and 0.41), and MS (0.47 and 0.55). The visual scores and ultrasound-measured body composition traits have enough genetic variation for
The Program of Health Section / Brazilian Cnen, which was elaborated to promote the use of ionizing radiations (nuclear and x-ray techniques) in benefit of Brazilian health, with safety assurance of patients, personnels, population and environment, is presented. The Ministry of Health, industries, Medical and Physicist Associations, Universities and Research Centers are participants of this program. The activities involved in the program are: production of isotopes and radiopharmaceuticals; radiation detectors and nuclear instrumentation; radiation protection and dosimetry; education and training of human resources; applied research and new technologies. The guiding and actions that the section will adopt to attend the growing necessities of Brazilian society, considering technological powers, management, available substructure and associated difficulties are defined. (M.C.K.) [pt
José Roberto Mendes Pegler
Full Text Available SUMMARY Objective: To describe the most prominent clinical features of a cohort of patients with oculo-auriculo-vertebral (OAV dysplasia in Brazil. Method: A review of medical records of patients with diagnosis of OAV from 1990 to 2010 was performed in a medical genetics center. Results: 41 patients were included in the study. Their average age at diagnosis was 2y 10mo (34,4±48,8 months and the female proportion was 53.7%. Mean maternal age at patient’s birth was 28.5y (min: 17, max: 46y for mothers and 31.4y (min: 21, max: 51y for fathers. Most patients (97.5% had auricular involvement, with facial manifestation in 90.2%, spinal in 65.9%, ocular in 53.7%, 36.6% with cardiovascular involvement, 29.3% urogenital, and 17% of the cases with central nervous system (CNS involvement. The classic OAV triad was present in only 34%. All patients except one had concomitant problems in other organs or systems. Conclusion: Since the diagnosis of OAV dysplasia relies only on a comprehensive medical evaluation, it is imperative that clinicians be aware of the most common presentation of the syndrome. Once suspected, every patient should undergo a complete medical evaluation of multiple systems including complementary exams. Treatment of these patients is based on surgical correction of malformations and rehabilitation.
Almeida, Fabrício Arantes de; Neves, Fernando Freitas; Mora, Delio Jose; Reis, Tarcisio Albertin Dos; Sotini, Diego Moelas; Ribeiro, Barbara De Melo; Andrade-Silva, Leonardo Eurípedes; Nascentes, Gabriel Nogueira; Ferreira-Paim, Kennio; Silva-Vergara, Mario León
Paracoccidioidomycosis (PCM) is endemic to Latin America, where 10 million people may be infected with Paracoccidioides brasiliensis / Paracoccidioides lutzii and 1,600,000 individuals live with human immunodeficiency virus (HIV) infection. An epidemiological overlapping of these infections occurred early in acquired immunodeficiency syndrome era with nearly 180 published cases. This study presents epidemiological, clinical, and outcome profiles for 31 PCM patients with HIV infection diagnosed in a teaching hospital in Brazil, and includes an update of previously reported cases. Medical records were reviewed and data compared with 64 PCM patients without HIV infection. Of the 31 PCM patients with HIV infection, 23 (74.1%) were male, with a median age of 36.7 years, whereas of the 64 PCM, 45 (70.3%) were male, with a median age of 35.1 years. Both groups presented similar proportions for smoking and alcoholism. PCM patients with HIV infection presented more fever, weight loss, and the acute clinical form than the PCM patients who had more mucosal and respiratory involvement characterizing the chronic form. Most PCM patients with HIV infection exhibited overlapping symptoms from both clinical forms with median symptom duration of 4.5 months compared with 8.3 months for the PCM control. Patients received sulfonamides and/or itraconazole for a median of 15.7 and 16.7 months for PCM/HIV-infected and PCM, respectively. Relapses occurred more in PCM (12 [30%]) than PCM/HIV-infected (4 [14.8%]) patients, whose mortality rate was higher (10 [32.8%]) than PCM patients (8 [20%]). The cases of PCM/HIV infection confirm that HIV can interact with some endemic diseases without increasing their frequency, while changing their natural history, clinical presentation, and outcome. The data presented here are in agreement with those observed in other studies. © The American Society of Tropical Medicine and Hygiene.
Lobo, Clarisse Lopes de Castro; do Nascimento, Emilia Matos; Abelha, Renato; Queiroz, Ana Maria Mach; Connes, Philippe; Cardoso, Gilberto Perez; Ballas, Samir K
This study was a prospective cross-sectional cohort study of 125 patients with sickle cell anemia (SS) between the ages of 16 to 60 years. Enrolled patients were followed-up prospectively for 15 months. Demographic, clinical, hematological and routine biochemical data were obtained on all patients. Six-minute walk test and Doppler Echocardiography were performed on all patients. A tricuspid regurgitant jet velocity (TRJV) 3.0 m/sec, severe. Patients with abnormal TRJV were significantly older and more anemic, had significantly higher lactate dehydrogenase (LDH) levels, reticulocyte count and incidence of death. The logistic multimodal model implemented for the 125 patients indicated that age was the covariate that influenced the outcome of normal or abnormal TRJV with a cutoff age of thirty-two years. The survival rate for the group of patients with creatinine (Cr) > 1.0 mg/dL was lower than the group with Cr ≤ 1 and normal TRJV. A coefficient matrix showed that the LDH values were weakly correlated with the reticulocyte count but strongly correlated with hemoglobin suggesting that the TRJV values were not correlated with the hemolytic rate but with anemia. Ten patients died during the follow-up of whom 7 had TRJV > 2.5 m/sec. Acute chest syndrome was the most common cause of death followed by sepsis. In conclusion, this study shows that patients with SS older than thirty-two years with high LDH, elevated TRJV, severe anemia and Cr > 1 have poor prognosis and may be at risk of having pulmonary hypertension and should undergo RHC.
Clarisse Lopes de Castro Lobo
Full Text Available This study was a prospective cross-sectional cohort study of 125 patients with sickle cell anemia (SS between the ages of 16 to 60 years. Enrolled patients were followed-up prospectively for 15 months. Demographic, clinical, hematological and routine biochemical data were obtained on all patients. Six-minute walk test and Doppler Echocardiography were performed on all patients. A tricuspid regurgitant jet velocity (TRJV 3.0 m/sec, severe. Patients with abnormal TRJV were significantly older and more anemic, had significantly higher lactate dehydrogenase (LDH levels, reticulocyte count and incidence of death. The logistic multimodal model implemented for the 125 patients indicated that age was the covariate that influenced the outcome of normal or abnormal TRJV with a cutoff age of thirty-two years. The survival rate for the group of patients with creatinine (Cr > 1.0 mg/dL was lower than the group with Cr ≤ 1 and normal TRJV. A coefficient matrix showed that the LDH values were weakly correlated with the reticulocyte count but strongly correlated with hemoglobin suggesting that the TRJV values were not correlated with the hemolytic rate but with anemia. Ten patients died during the follow-up of whom 7 had TRJV > 2.5 m/sec. Acute chest syndrome was the most common cause of death followed by sepsis. In conclusion, this study shows that patients with SS older than thirty-two years with high LDH, elevated TRJV, severe anemia and Cr > 1 have poor prognosis and may be at risk of having pulmonary hypertension and should undergo RHC.
Michele Martins Gonçalves
Full Text Available The objective of this ecological study was to investigate the association between caries experience in 5- and 12-year-old Brazilian children in 2010 and household sugar procurement in 2003 and the effects of exposure to water fluoridation and socioeconomic indicators. Sample units were all 27 Brazilian capital cities. Data were obtained from the National Surveys of Oral Health; the National Household Food Budget Survey; and the United Nations Program for Development. Data analysis included correlation coefficients, exploratory factor analysis, and linear regression. There were significant negative associations between caries experience and procurement of confectionery, fluoridated water, HDI, and per capita income. Procurement of confectionery and soft drinks was positively associated with HDI and per capita income. Exploratory factor analysis grouped the independent variables by reducing highly correlated variables into two uncorrelated component variables that explained 86.1% of total variance. The first component included income, HDI, water fluoridation, and procurement of confectionery, while the second included free sugar and procurement of soft drinks. Multiple regression analysis showed that caries is associated with the first component. Caries experience was associated with better socioeconomic indicators of a city and exposure to fluoridated water, which may affect the impact of sugars on the disease.
Estephan, Eduardo de Paula; Sobreira, Cláudia Ferreira da Rosa; Dos Santos, André Clériston José; Tomaselli, Pedro José; Marques, Wilson; Ortega, Roberta Paiva Magalhães; Costa, Marcela Câmara Machado; da Silva, André Macedo Serafim; Mendonça, Rodrigo Holanda; Caldas, Vitor Marques; Zambon, Antonio Alberto; Abath Neto, Osório; Marchiori, Paulo Eurípedes; Heise, Carlos Otto; Reed, Umbertina Conti; Azuma, Yoshiteru; Töpf, Ana; Lochmüller, Hanns; Zanoteli, Edmar
The most common causes of congenital myasthenic syndromes (CMS) are CHRNE mutations, and some pathogenic allelic variants in this gene are especially frequent in certain ethnic groups. In the southern region of Brazil, a study found the c.130dupG CHRNE mutation in up to 33% of families with CMS. Here, we aimed to verify the frequency of this mutation among individuals with CMS in a larger cohort of CMS patients from different areas of Brazil and to characterize clinical features of these patients. Eighty-four patients with CMS, from 72 families, were clinically evaluated and submitted to direct sequencing of the exon 2 of CHRNE. The c.130dupG mutation was found in 32 patients (23 families), with 26 patients (19 families, 26.3%) in homozygosis, confirming its high prevalence in different regions of Brazil. Among the homozygous patients, the following characteristics were frequent: onset of symptoms before 2 years of age (92.3%), little functional restriction (92.3%), fluctuating symptoms (100%), ocular muscle impairment (96.1%), ptosis (100%), limb weakness (88.4%), response to pyridostigmine (100%), facial involvement (77%), and bulbar symptoms (70.8%). The pretest probability of finding at least one allele harbouring the c.130dupG mutation was 38.1%. Selecting only patients with impaired eye movement together with limb weakness and improvement with pyridostigmine, the probability increases to 72.2%. This clinical pre-selection of patients is likely a useful tool for regions where CHRNE mutations have a founder effect. In conclusion, the CHRNE mutation c.130dupG leads to fairly benign natural course of the disease with relative homogeneity.
Kampa, Katia Cristina; Morsoletto, Daphne Benatti Gonçalves; Loures, Marcela Rocha; Pissaia, Alcindo; Nones, Rodrigo Bremer; Ivantes, Cláudia Alexandra Pontes
Crohn's disease and ulcerative colitis are chronic inflammatory bowel diseases. In such pathologies, there is an increased production of alpha tumor necrosis factor (TNF-α). Patients, in whom the conventional immunosuppressant treatment fails, require the use of immunobiological therapy, such as anti-TNF-α, a monoclonal antibody. Infliximab is an anti-TNF-α drug, a chimerical immunoglobulin, with a murine component, which is responsible for the generation of immunogenicity against the drug and formation of anti-TNF-α antibodies. The presence of anti-drug antibodies may be responsible for adverse events and reduction of the drug's effectiveness. Patients with inflammatory bowel diseases undergoing therapy with biological medication, such as infliximab, can relapse overtime and this may not be translated into clinical symptoms. Thus, there is a need for a method to evaluate the efficacy of the drug, through the measurement of serum infliximab levels, as well as antibodies research. This study aimed to measure serum infliximab levels and anti-infliximab antibodies in patients with inflammatory bowel diseases post-induction phase and during maintenance therapy, and describe the therapeutic modifications that took place based on the serum levels results. It was a retrospective study, that included forty-five patients, with a total of 63 samples of infliximab measurement. Twenty-one patients had an adequate infliximab serum level, 31 had subtherapeutic levels and 11 had supratherapeutic levels. Seven patients had their medication suspended due to therapeutic failure or high levels of antibodies to infliximab. In conclusion, only a third of the patients had adequate infliximab levels and 36% presented with subtherapeutic levels at the end of the induction phase. Therapy optimization occurred based in about 46% of the samples results, demonstrating the importance of having this tool to help the clinical handling of patients with inflammatory bowel diseases ongoing
Oliveira, Luiz Carlos Marques de; Comácio, Samantha Martins; Santos, Júlia de Fátima Gonçalves
Patients with chronic liver disease have a higher risk of fulminant hepatitis when infected with hepatitis A virus, and vaccination of these patients against such infection is recommended. In Brazil, mainly in the South and Southeast regions, the epidemiology of hepatitis A (HA) has shifted from high to intermediate endemicity, which would have implication on policy of HA vaccination for these populations. To verify the prevalence of HA immunity in adult patients with liver cirrhosis (LC), in Uberlândia MG, a city of Southeastern Brazil. Between December 2005 and December 2006, 106 patients with LC were consecutively evaluated. In addition, 75 individuals without LC or alcoholism were evaluated (control group - CG). Total anti-HAV (ELISA methods) was positive in 104 (98.1%) patients with LC (82 men, 24 women; mean age, 53.3 ± 11.9 years) and in 74 (98.7%) individuals of the CG (55 men, 20 women; mean age, 47 ± 11.6 years), p > 0.05. For patients with chronic liver disease, in the geographic regions and age groups evaluated, routine vaccination against hepatitis A is not recommended. Moreover, the serum determination of total anti-HAV, used to assess immunity, is five times cheaper than vaccination against hepatitis A and, for this reason, should precede vaccination.
Attar-Lévy, D; Gay, C
Providing information to the patients and their families represents one of today's new conditions in the management of the depressed. It will help their adaptation to the illness and its effects. It will maintain a good therapeutic alliance among patients and practitioners, and will enhance their treatment adherence thus improving their quality of life. Several aspects are essential in the transmission of this information: it must be available to every patient, easily accessible, concise, repeated and revised as necessary, discouraging self-diagnosis and self-prescription. This education must be given personally by the physicians and the pharmacists. Depressed patients may also have an access to complementary sources: books, magazines and more rarely scientific journals. Patients' associations provide another potential source of information, offering a comprehensive approach to the patient and the illness. France-Déxpression is a depressive and manic-depressive patients association. Its goals are to provide information and support to the patients and their families, promoting a better understanding and recognition of depressive and manic-depressive illness.
Full Text Available Mitochondrial mutations are responsible for at least 1% of the cases of hereditary deafness, but the contribution of each mutation has not yet been defined in African-derived or native American genetic backgrounds. A total of 203 unselected hearing-impaired patients were screened for the presence of the mitochondrial mutation A1555G in the 12S rRNA gene and mutations in the tRNA Ser(UCN gene in order to assess their frequency in the ethnically admixed Brazilian population. We found four individuals with A1555G mutation (2%, which is a frequency similar to those reported for European-derived populations in unselected samples. On the other hand, complete sequencing of the tRNA Ser(UCN did not reveal reported pathogenic substitutions, namely A7445G, 7472insC, T7510C, or T7511C. Instead, other rare substitutions were found such as T1291C, A7569G, and G7444A. To evaluate the significance of these findings, 110 "European-