Claudio Torres de Miranda

Depression in hemodialysis patients: the role of dialysis shift

OBJECTIVE: Depression is the most important neuropsychiatric complication in chronic kidney disease because it reduces quality of life and increases mortality. Evidence demonstrating the association between dialysis shift and depression is lacking; thus, obtaining such evidence was the main objective of this study. METHOD: This cross-sectional study included patients attending a hemodialysis program. Depression was diagnosed using Becks Depression Inventory. Excessive daytime sleepiness was evaluated using the Epworth Sleepiness Scale. RESULTS: A total of 96 patients were enrolled (55 males, age 48±14 years). Depression and excessive daytime sleepiness were observed in 42.7% and 49% of the patients, respectively. When comparing variables among the three dialysis shifts, there were no differences in age, dialysis vintage, employment status, excessive daytime sleepiness, hemoglobin, phosphorus levels, or albumin levels. Patients in the morning shift were more likely to live in rural areas (p<0.0001), although patients in rural areas did not have a higher prevalence of depression (pu200a=u200a0.30). Patients with depression were more likely to be dialyzed during the morning shift (pu200a=u200a0.008). Independent risk factors for depression were age (p<0.03), lower levels of hemoglobin (p<0.01) and phosphorus (p<0.01), and dialysis during the morning shift (pu200a=u200a0.0009). The hospitalization risk of depressive patients was 4.5 times higher than that of nondepressive patients (p<0.008). CONCLUSION: These data suggest that depression is associated with dialysis shift, higher levels of phosphorus, and lower levels of hemoglobin. The results highlight the need for randomized trials to determine whether this association occurs by chance or whether circadian rhythm disorders may play a role.

Prevalence of common mental disorders in mothers in the semiarid region of Alagoas and its relationship with nutritional status

CONTEXT AND OBJECTIVEnCompromised maternal mental health (MMH) is considered to be a risk factor for child malnutrition in low income areas. Psychosocial variables associated with MMH are potentially different between urban and rural environments. The aim here was to investigate whether associations existed between MMH and selected sociodemographic risk factors and whether specific to urban or rural settings.nnnDESIGN AND SETTINGnCross-sectional study on a representative population sample of mothers from the semiarid region of Alagoas.nnnMETHODSnMultistage sampling was used. The subjects were mothers of children aged up to 60 months. MMH was evaluated through the Self-Reporting Questionnaire-20. Mothers nutritional status was assessed using the body mass index and waist circumference. Univariate analysis used odds ratios (OR) and chi-square. Logistic regression was performed separately for urban and rural subsamples using MMH as the dependent variable.nnnRESULTSnThe sample comprised 288 mothers. The prevalences of common mental disorders (CMD) in rural and urban areas were 56.2% and 43.8%, respectively (OR = 1.03; 95% CI: 0.64-1.63). In univariate analysis and logistic regression, the variable of education remained associated with MMH (OR = 2.2; 95% CI: 1.03-4.6) in urban areas. In rural areas, the variable of lack of partner remained associated (OR = 2.6; 95% CI: 1.01-6.7).nnnCONCLUSIONSnThe prevalence of CMD is high among mothers of children aged up to two years in the semiarid region of Alagoas. This seems to be associated with lower educational level in urban settings and lack of partner in rural settings.

Fatores associados ao desenvolvimento neuropsicomotor em crianças de 6-18 meses de vida inseridas em creches públicas do Município de João Pessoa, Paraíba, Brasil

O estudo objetivou verificar a prevalencia de alteracao no desenvolvimento neuropsicomotor em lactentes inseridos nas creches publicas de Joao Pessoa, Paraiba, Brasil, e analisar fatores associados ao desenvolvimento infantil. Realizou-se um estudo seccional com o censo de criancas entre 6 e 18 meses de vida inseridas nas creches. O desenvolvimento infantil foi avaliado pelo Teste de Triagem de Denver II. Variaveis de natureza biologica, materna, social, demografica e relativas a creche foram investigadas atraves de questionario e formulario. As associacoes foram ajustadas por regressao logistica. A prevalencia de alteracao no desenvolvimento foi 52,7%. Associou-se a alteracao no desenvolvimento a crianca ter mais que 12 meses de idade (RC = 4,3), o parto vaginal (RC = 4,4), a fototerapia (RC = 7,9) e a creche nao ter apoio da Estrategia Saude da Familia (RC = 2,9). Os achados sugerem que o desenvolvimento infantil e o reflexo das condicoes familiares, bem como da assistencia recebida pelos servicos de educacao e saude.This study aimed to determine the prevalence of altered neurodevelopment in children in public daycare centers in João Pessoa, Paraíba State, Brazil, and to analyze factors associated with child development. A cross-sectional study was conducted in a sample of children 6 to 18 months of age enrolled in daycare. Child development was assessed by the Denver II Screening Test. Biological, riables were studied with a questionnaire and form. Associations were adjusted using logistic regression. Altered development was present in 52.7% of the children and was associated with age > 12 months (OR = 4.3), vaginal delivery (OR = 4.4), neonatal phototherapy (OR = 7.9), and daycare centers not supported by the Family Health Strategy (OR = 2.9). The findings suggest that child development reflects the familys conditions and the care received from educational and healthcare services.

Qualidade da Atenção à Saúde da Criança na Estratégia Saúde da Família

Objective: to verify the quality of child health care in the Family Health Strategy (FHS) in a state capital of Northeastern Brazil. Methods: a descriptive study using a quantitative approach was carried out in 2010 with 66 primary care (PC) teams represented by their doctors and nurses. The survey used part of the Evaluation for Quality Improvement of the Family Health Strategy2 (AMQ), a self-rating instrument of the Brazilian Ministry of Health which evaluates the FHS actions and services and classifies them by the following quality-based standards of care: Elementary, undergoing development, Consolidated, Good or Advanced. Results: 84.1% of the FHS-teams rated themselves as providing “Elementary” actions and services, and 47.7% of them considered that they provided “Advanced” ones. The health teams with less than four years of implementation rated themselves better. Conclusion: these findings suggest that most of the FHC-teams are providing care with an elementary standard of quality, and indicate that better quality child care is apparently delivered with by teams with less time of implementation.

Association between child malnutrition and maternal common mental disorders: the potential role of disability

In 1996 one of the authors (CTM) was the leading author of a clinically based case–control study conducted in Brazil, which investigated the association between child stunting and maternal common mental disorders (MCMD).1 A positive association (OR 2.8; 95% CI 1.2 to 6.9) was found in that case. Similar methods and results have been reported in another study conducted in Pakistan (OR 3.9; 95% CI 1.95 to7.86).2nnHarpham et al 3 were the first to test this association through population surveys in a multicentre study. They found significant positive associations between child stunting and MCMD in two out of four countries, namely India (OR 1.4; 95% CI 1.2 to 1.6) and Vietnam (OR 1.4; 95% CI 1.1 to 1.8). In Peru and Ethiopia, there was no significant association. There was congruence in the results of clinical and population-based studies.nnWe conducted a …

Disability due to maternal common mental disorders (CMDs) as a risk factor for chronic childhood malnutrition: cross-sectional study

CONTEXT AND OBJECTIVEnThe disability associated with maternal common mental disorders (CMDs) is among the possible explanations for the association between chronic childhood malnutrition and CMDs. CMDs may impair the mothers ability to perform her role, particularly in deprived environments. The present study aimed to evaluate whether disability relating to CMDs could be part of the pathway of the association between childhood malnutrition and maternal CMDs.nnnDESIGN AND SETTINGnCross-sectional study conducted in two institutions: one for malnourished children and another for eutrophic children living in a low-income community in the state of Alagoas, Brazil.nnnMETHODnThe cases consisted of 55 malnourished children aged from 12 to 60 months who were attending a nutritional rehabilitation center, with height-for-age z-scores < 2. The controls were 70 eutrophic children of the same age who were attending a day care center in the same area as the cases. The Self-Report Questionnaire made it possible to identify likely cases of maternal CMD. The Sheehan Disability Scale enabled evaluation of the associated disability.nnnRESULTSnChronic childhood malnutrition was significantly associated with maternal disability relating to CMDs (OR = 2.28; 95% CI: 1.02-5.1). The best logistic regression model using chronic childhood malnutrition as the dependent variable included the following independent variables: higher number of people living in the household; absence of the biological father from the household; and maternal disability relating to CMDs.nnnCONCLUSIONSnIf confirmed, the association between chronic childhood malnutrition and maternal disability relating to CMDs may be useful in helping to identify the causal chain between childhood malnutrition and maternal CMDs and to indicate environmental risk factors associated with chronic childhood malnutrition.

Factors associated with neurodevelopment in children 6-18 months of age in public daycare centers in João Pessoa, Paraíba State, Brazil

O estudo objetivou verificar a prevalencia de alteracao no desenvolvimento neuropsicomotor em lactentes inseridos nas creches publicas de Joao Pessoa, Paraiba, Brasil, e analisar fatores associados ao desenvolvimento infantil. Realizou-se um estudo seccional com o censo de criancas entre 6 e 18 meses de vida inseridas nas creches. O desenvolvimento infantil foi avaliado pelo Teste de Triagem de Denver II. Variaveis de natureza biologica, materna, social, demografica e relativas a creche foram investigadas atraves de questionario e formulario. As associacoes foram ajustadas por regressao logistica. A prevalencia de alteracao no desenvolvimento foi 52,7%. Associou-se a alteracao no desenvolvimento a crianca ter mais que 12 meses de idade (RC = 4,3), o parto vaginal (RC = 4,4), a fototerapia (RC = 7,9) e a creche nao ter apoio da Estrategia Saude da Familia (RC = 2,9). Os achados sugerem que o desenvolvimento infantil e o reflexo das condicoes familiares, bem como da assistencia recebida pelos servicos de educacao e saude.This study aimed to determine the prevalence of altered neurodevelopment in children in public daycare centers in João Pessoa, Paraíba State, Brazil, and to analyze factors associated with child development. A cross-sectional study was conducted in a sample of children 6 to 18 months of age enrolled in daycare. Child development was assessed by the Denver II Screening Test. Biological, riables were studied with a questionnaire and form. Associations were adjusted using logistic regression. Altered development was present in 52.7% of the children and was associated with age > 12 months (OR = 4.3), vaginal delivery (OR = 4.4), neonatal phototherapy (OR = 7.9), and daycare centers not supported by the Family Health Strategy (OR = 2.9). The findings suggest that child development reflects the familys conditions and the care received from educational and healthcare services.

Los factores asociados con el desarrollo neurológico en los niños de 6-18 meses presentes en guarderías públicas de la ciudad de João Pessoa, Paraíba, Brasil

O estudo objetivou verificar a prevalencia de alteracao no desenvolvimento neuropsicomotor em lactentes inseridos nas creches publicas de Joao Pessoa, Paraiba, Brasil, e analisar fatores associados ao desenvolvimento infantil. Realizou-se um estudo seccional com o censo de criancas entre 6 e 18 meses de vida inseridas nas creches. O desenvolvimento infantil foi avaliado pelo Teste de Triagem de Denver II. Variaveis de natureza biologica, materna, social, demografica e relativas a creche foram investigadas atraves de questionario e formulario. As associacoes foram ajustadas por regressao logistica. A prevalencia de alteracao no desenvolvimento foi 52,7%. Associou-se a alteracao no desenvolvimento a crianca ter mais que 12 meses de idade (RC = 4,3), o parto vaginal (RC = 4,4), a fototerapia (RC = 7,9) e a creche nao ter apoio da Estrategia Saude da Familia (RC = 2,9). Os achados sugerem que o desenvolvimento infantil e o reflexo das condicoes familiares, bem como da assistencia recebida pelos servicos de educacao e saude.This study aimed to determine the prevalence of altered neurodevelopment in children in public daycare centers in João Pessoa, Paraíba State, Brazil, and to analyze factors associated with child development. A cross-sectional study was conducted in a sample of children 6 to 18 months of age enrolled in daycare. Child development was assessed by the Denver II Screening Test. Biological, riables were studied with a questionnaire and form. Associations were adjusted using logistic regression. Altered development was present in 52.7% of the children and was associated with age > 12 months (OR = 4.3), vaginal delivery (OR = 4.4), neonatal phototherapy (OR = 7.9), and daycare centers not supported by the Family Health Strategy (OR = 2.9). The findings suggest that child development reflects the familys conditions and the care received from educational and healthcare services.