Denise Pimentel Bergamaschi

Amputações de extremidades inferiores por diabetes mellitus: estudo caso-controle

OBJETIVO: As amputacoes de extremidades inferiores sao cada vez mais frequentes em pessoas com diabetes mellitus, tornando-se importante problema de saude publica, no Brasil e no mundo. O estudo objetivou detectar fatores associados a amputacoes de extremidades inferiores, em pessoas com diabetes mellitus. METODOS: Realizou-se estudo caso controle emparelhado. Foram identificados 117 pessoas com diabetes mellitus e submetidas a amputacoes de extremidades inferiores, na rede de servicos do Municipio de Sao Paulo. Os casos foram comparados com 234 controles, pessoas com diabetes mellitus, mas nao submetidas a amputacoes. As variaveis consideradas no emparelhamento foram sexo, idade e duracao da doenca. Caracteristicas sociodemograficas, de habitos de vida, clinicas e relativas a educacao em saude em diabetes mellitus foram incluidas. Inicialmente, foi realizada analise univariada, verificando a presenca de associacoes entre amputacoes e variaveis exploratorias. Foi utilizado modelo de regressao logistica condicional para a analise multivariada, com adocao do odds ratio como medida de associacao. RESULTADOS: Observou-se existencia de associacao entre amputacao e habito de fumar, ultima glicemia (superior a 200 mg/dl), presenca da polineuropatia simetrica distal e da vasculopatia periferica. O tratamento do diabetes mellitus e o comparecimento as consultas de enfermagem foram importantes fatores associados a prevencao dessas amputacoes. CONCLUSOES: O reconhecimento dos determinantes e dos fatores intervenientes para o acometimento desse agravo levarao a reducao dos custos na area e a melhoria da qualidade da assistencia prestada na rede de servicos de saude publica.

Comparação entre pesquisa larvária e armadilha de oviposição, para detecção de Aedes aegypti

This study compares two techniques for detecting the presence of Aedes aegypti: larval surveys and the oviposition trap. 5,026 households in two areas of the municipality of Salvador, Bahia, Brazil were investigated. Larval surveys and oviposition traps were used simultaneously in these households. Different positivity levels (larvae and/or eggs) were detected between and within the two areas. However, only the use of the oviposition trap detected a significant statistical difference between the areas (z = 9,520, p < 0.001). Comparison of the Breteau, Household and Oviposition Indices reveals greater power of detection of positivity in the oviposition trap. There were prevalence ratios of positivity for ovipositision trap of 3.4 and 2.1 (for areas 1 and 2 respectively) when compared with larval surveys. The oviposition trap proved to be an economical and operationally viable method, and the most effective in the surveillance of this species.This study compares two techniques for detecting the presence of Aedes aegypti: larval surveys and the oviposition trap. In two areas of the municipality of Salvador, Bahia, Brazil were investigated 5,026 households. Larval surveys and oviposition traps were used simultaneously in these households. Different positivity levels (larvae and/or eggs) were detected between and within the two areas. However, only the use of the oviposition trap detected a significant statistical difference between the areas (z = 9,520, p < 0.001). Comparison of the Breteau, Household and Oviposition Indices reveals greater power of detection of positivity in the oviposition trap. There were prevalence ratios of positivity for oviposition trap of 3.4 and 2.1 (for areas 1 and 2 respectively) when compared with larval surveys. The oviposition trap proved to be an economical and operationally viable method, and the most effective in the surveillance of this species.

Prevalência de deficiência de vitamina A e fatores associados em pré-escolares de Teresina, Piauí, Brasil

A deficiencia de vitamina A constitui um problema de saude publica no Nordeste brasileiro. O objetivo deste estudo foi determinar a prevalencia da deficiencia de vitamina A e os fatores associados em pre-escolares de Teresina, Piaui, Brasil. Os niveis de retinol serico foram determinados por HPLC, e foram investigadas as caracteristicas socio-economicas e demograficas de 631 criancas com idade de 36 a 83 meses. Investigou-se a associacao entre os niveis de retinol e as variaveis de interesse por analise de regressao linear uni e multivariada. O nivel medio de retinol foi de 1,21mmol/L (IC95%: 1,17-1,25µmol/L), independente do sexo (p = 0,259). A hipovitaminose A (retinol < 0,69µmol/L) foi observada em 15,4% das criancas (IC95%: 12,7-18,4), com tendencia a diminuicao com o avanco da idade; 29% das criancas (IC95%: 25,2-32,4) tinham valores aceitaveis de retinol, mas nao adequados (0,70 a 1,04µmol/L). Encontrou-se associacao positiva entre niveis de retinol e idade, renda per capita, suplementacao previa com vitamina A e escolaridade materna. A prevalencia de hipovitaminose A representa um problema moderado de saude publica, ressaltando a importância das estrategias de combate a essa carencia na regiao.

Infestation of Aedes aegypti estimated by oviposition traps in Brazil

OBJECTIVE To assess infestation levels of Aedes aegypti using the oviposition trap (ovitrap) method and to compare these results with data obtained with the use of indices traditionally applied in public programs aimed at fighting this vector. METHODS Nine sentinel areas in Northeastern, Brazil, were assessed and infestation levels were measured for a nine-month period. Egg density and container indices were estimated and compared with previous results found using the house index and Breteau index. RESULTS The results indicated that the area studied was infested with this vector during the entire study period and that the infestation was widespread in all areas. Different results were found with the different indices studied. There were areas in which the house index and the Breteau index were negative or close to zero, whereas the container index for the same area was 11% and the egg density index was 8.3%. CONCLUSIONS The container and egg density indices allow better assessment of infestation rates in a city than the conventionally used indices (house index and Breteau index). At lower operational costs and easier standardization, these indices can be applied as a measurement tool for assessing infestation rates during entomological surveillance in programs to fight Aedes aegypti.

The possible role of selenium status in adverse pregnancy outcomes.

The present study reviews the possible role of Se status during pregnancy regarding adverse pregnancy outcomes, with emphasis on those related to diminished antioxidant activity and increased oxidative stress. Studies have reported that Se could play an important role in adverse outcomes such as miscarriages, neural tube defects, diaphragmatic hernia, premature birth, low birth weight, pre-eclampsia, glucose intolerance and gestational diabetes. Also, low Se status has been associated with adverse outcomes among HIV-infected pregnant women and their offspring. Nevertheless, the function of Se in the aetiology of pregnancy complications is yet to be elucidated. Available evidence presents the following limitations: most study designs do not allow conclusions about causal relationships; study populations, selection of subjects, research setting, procedures for defining sample size and analytical methods are often poorly described; many studies fail to adjust for important confounding variables. In addition, population studies assessing the relationship between Se intake during pregnancy and health outcomes are scarce. Further research is still needed to clarify the role of Se status in adverse pregnancy outcomes, especially those related to augmented oxidative stress.

Concentrações de retinol e de beta-caroteno séricos e perfil nutricional de crianças em Teresina, Piauí, Brasil

OBJETIVO: Avaliar as concentracoes sericas de retinol e beta-caroteno de pre-escolares em Teresina, Piaui, com caracterizacao do perfil antropometrico e do consumo alimentar. MATERIAL E METODOS: Estudo transversal envolvendo 135 criancas em creche municipal, com avaliacao do estado nutricional pelos metodos: bioquimico (concentracao serica de retinol e beta-caroteno), antropometrico (indices de peso para estatura - P/E e estatura para idade - E/I) e dietetico (frequencia de consumo alimentar). RESULTADOS: Observou-se prevalencia de deficiencia de vitamina A (DVA) de 8,9% (IC95%: 4,7 - 15,0%) e existencia de associacao entre suplementacao anterior e concentracoes de retinol, com maior proporcao de criancas com niveis normais de retinol entre as suplementadas (p = 0,025). As concentracoes de retinol e de beta-caroteno mostraram-se correlacionadas, porem com forca leve a moderada (p < 0,021). Os percentuais de criancas com baixo P/E e de baixa E/I foram de 1,9% (IC95%: 0,2 - 6,8%) e 9,7% (IC95%: 4,8 - 17,1%), respectivamente. Na avaliacao dietetica verificou-se baixo consumo de alimentos ricos em vitamina A. CONCLUSOES: A elevada prevalencia de DVA nas criancas, combinada com a alta percentagem de criancas com valores aceitaveis de retinol, os baixos valores medianos de beta-caroteno, a alta percentagem de deficit estatural e a inadequacao do consumo de alimentos ricos em vitamina A, indicam a necessidade de se aprimorar as estrategias de educacao em saude e nutricao da populacao, incentivando o consumo de alimentos fontes de vitamina A, como medidas auto-sustentaveis importantes no combate ao problema. Alem disso, deve ser considerado o incentivo a fortificacao dos alimentos e ao fortalecimento de Programas de suplementacao.

Comparative study between larval surveys and ovitraps to monitor populations of Aedes aegypti

This study compares two techniques for detecting the presence of Aedes aegypti: larval surveys and the oviposition trap. 5,026 households in two areas of the municipality of Salvador, Bahia, Brazil were investigated. Larval surveys and oviposition traps were used simultaneously in these households. Different positivity levels (larvae and/or eggs) were detected between and within the two areas. However, only the use of the oviposition trap detected a significant statistical difference between the areas (z = 9,520, p < 0.001). Comparison of the Breteau, Household and Oviposition Indices reveals greater power of detection of positivity in the oviposition trap. There were prevalence ratios of positivity for ovipositision trap of 3.4 and 2.1 (for areas 1 and 2 respectively) when compared with larval surveys. The oviposition trap proved to be an economical and operationally viable method, and the most effective in the surveillance of this species.This study compares two techniques for detecting the presence of Aedes aegypti: larval surveys and the oviposition trap. In two areas of the municipality of Salvador, Bahia, Brazil were investigated 5,026 households. Larval surveys and oviposition traps were used simultaneously in these households. Different positivity levels (larvae and/or eggs) were detected between and within the two areas. However, only the use of the oviposition trap detected a significant statistical difference between the areas (z = 9,520, p < 0.001). Comparison of the Breteau, Household and Oviposition Indices reveals greater power of detection of positivity in the oviposition trap. There were prevalence ratios of positivity for oviposition trap of 3.4 and 2.1 (for areas 1 and 2 respectively) when compared with larval surveys. The oviposition trap proved to be an economical and operationally viable method, and the most effective in the surveillance of this species.

Comparison of methods to measure body fat in 7-to-10-year-old children: a systematic review

OBJECTIVE To investigate methodological aspects in body fat (BF) measurements in 7-to-10-year-old children. STUDY DESIGN Systematic review of the literature. METHODS The studies were chosen from the PubMed and Scielo databases according to a protocol that defined: inclusion criteria; a search and quality-assessment strategy; and information extraction. RESULTS 27 studies published from 2004 to 2014 were included. The literature describes skinfold measurements and dual energy X-ray absorptiometry (DEXA) as being the reference methods most widely used in the assessment of the ability of methods to identify BF. The most commonly-used statistical analyses were the Pearson correlation coefficient, and sensitivity and specificity performance analyses. The comparison between the tested methods and the references showed that body mass index (BMI) and waist circumference (WC) are strongly correlated to BF as calculated by bioelectrical impedance or skinfolds, and that there is a moderate positive correlation with percent body fat as calculated by DEXA, air-displacement plethysmography (ADP) or isotope dilution. There was a moderate positive correlation between waist-to-height ratio (WHtR) and BF, as estimated by ADP and skinfolds. Performance studies suggest that BMI and WC are very specific but less sensitive methods. CONCLUSIONS The results of this systematic review show favourable evidence for the use of anthropometric indicators - above all BMI and WC- in the measurement of BF, when more accurate techniques such as DEXA and ADP are not feasible. They also demonstrate features that make them advantageous for epidemiological studies in a child population, since they are easy and safe to obtain and well tolerated by the children.

Atividade antropofílica de Aedes aegypti e Aedes albopictus em área sob controle e vigilância

OBJETIVO: Descrever a atividade de hematofagia de Aedes aegypti e Aedes albopictus em area submetida ao controle e a vigilância entomologica. METODOS: O estudo foi realizado de abril de 1993 a setembro de 1994, na cidade de Cosmopolis, Estado de Sao Paulo. Utilizou-se isca humana para coleta dos exemplares. Calculou-se o numero medio mensal de femeas capturadas por domicilio segundo as areas central e periferica do municipio e os locais intra e peridomiciliar. Apresenta-se o indice pluviometrico mensal sem ajuste de modelo. RESULTADOS: Observou-se a presenca de femeas das especies em 83% (Ae. albopictus) e 61% (Ae. aegypti) do periodo estudado. Os meses de janeiro, fevereiro e marco apresentaram maior atividade de femeas para as duas especies, com maior presenca de Ae. albopictus do que de Ae. aegypti. Os exemplares foram capturados na area central e periferica da cidade, nos periodos matutino, das 9:00 as 12:00 e crepuscular vespertino, das 16:00 as 19:00. Com utilizacao de modelo de regressao de Poisson, observou-se que femeas de Ae. albopictus foram mais capturadas no peridomicilio, independente se area central ou periferica. CONCLUSOES: Foi detectada diferenca no perfil de atividade da hematofagia somente para o Ae. albopictus, sendo de relevância o peridomicilio.

Elevated risk for HIV-1 infection in adolescents and young adults in Sao Paulo, Brazil.

Background Recent studies have sought to describe HIV infection and transmission characteristics around the world. Identification of early HIV-1 infection is essential to proper surveillance and description of regional transmission trends. In this study we compare people recently infected (RI) with HIV-1, as defined by Serologic Testing Algorithm for Recent HIV Seroconversion (STARHS), to those with chronic infection. Methodology/Principal Findings Subjects were identified from 2002–2004 at four testing sites in São Paulo. Of 485 HIV-1-positive subjects, 57 (12%) were defined as RI. Of the participants, 165 (34.0%) were aware of their serostatus at the time of HIV-1 testing. This proportion was statistically larger (p<0.001) among the individuals without recent infection (n = 158, 95.8%) compared to 7 individuals (4.2%) with recently acquired HIV-1 infection. In the univariate analysis, RI was more frequent in <25 and >59 years-old age strata (p<0.001). The majority of study participants were male (78.4%), 25 to 45 years-old (65.8%), white (63.2%), single (61.7%), with family income of four or more times the minimum wage (41.0%), but with an equally distributed educational level. Of those individuals infected with HIV-1, the predominant route of infection was sexual contact (89.4%), with both hetero (47.5%) and homosexual (34.5%) exposure. Regarding sexual activity in these individuals, 43.9% reported possible HIV-1 exposure through a seropositive partner, and 49.4% reported multiple partners, with 47% having 2 to 10 partners and 37.4% 11 or more; 53.4% of infected individuals reported condom use sometimes; 34.2% reported non-injecting, recreational drug use and 23.6% were reactive for syphilis by VDRL. Subjects younger than 25 years of age were most vulnerable according to the multivariate analysis. Conclusions/Significance In this study, we evaluated RI individuals and discovered that HIV-1 has been spreading among younger individuals in São Paulo and preventive approaches should, therefore, target this age stratum.