Edina Mariko Koga da Silva

Surto de toxoplasmose aguda transmitida através da ingestão de carne crua de gado ovino

The authors present 17 cases of symptomatic acute toxoplasmosis acquired by the ingestion of raw mutton offered during a party in September 1993. The incubation period carried from 6 to 13 days (10.9 ± 7.0). Sixteen (94.5%) patients presented fever, headache, myalgia, arthralgia, and adenopathy (cervical or cervical/axilar). Hepatomegaly was found in 6 patients, splenomegaly in 4 and rash in 2. One patient presented clinical picture of chorioretinitis confirmed by ophthalmological exam. All patients showed increased serum levels of specific antibodies (IgG and IgM) on indirect immunofuorescence assay evidencing acute phase of toxoplasmosis. The patients were treated with specific drugs for toxoplasmosis and presented satisfactory clinical and laboratory response.

Avaliação das práticas e conhecimentos de profissionais da atenção primária à saúde sobre vigilância do desenvolvimento infantil

O objetivo desta pesquisa foi avaliar os conhecimentos e praticas relacionados a vigilância do desenvolvimento da crianca de 160 profissionais que atuam na atencao primaria a saude, no Municipio de Belem, Para. Foram selecionados 40 medicos e 40 enfermeiros de Unidades Municipais de Saude (UMS), e 40 medicos e 40 enfermeiros do Programa da Familia Saudavel (PFS). Na avaliacao dos conhecimentos por meio da aplicacao de teste objetivo, o percentual de acerto foi de 63,7% para medicos das UMSs, 57,3% para medicos do PFS, 62,1% para os enfermeiros do PFS e 54,3% para enfermeiros das UMSs. Na avaliacao das praticas, apenas 21,8% das maes informaram que foram indagadas sobre o desenvolvimento dos seus filhos, 27,6% que o profissional perguntou ou observou o desenvolvimento da sua crianca e 14,4% que receberam orientacao sobre como estimula-las. Concluimos que medicos e enfermeiros da atencao primaria no Municipio de Belem apresentam deficiencias nos conhecimentos sobre desenvolvimento infantil e que a vigilância do desenvolvimento nao e realizada de forma satisfatoria, sendo necessarias sensibilizacao e capacitacao dos profissionais para esta pratica.

Metabolic syndrome among prepubertal Brazilian schoolchildren

This was a two-stage cross-sectional study that assessed metabolic syndrome and associated factors among prepubertal schoolchildren. In the first stage, nutritional status, blood pressure, personal (low birth weight) and family antecedents for cardiovascular disease (CVD) were collected. In the second stage, schoolchildren with at least one of these criteria participated: obesity, personal or family history. Metabolic syndrome (MS) was defined by ATP III and WHO definitions. Among 929 (6–10 year old) schoolchildren, 27.7% presented with overweight/obesity, 12.2% hypertension, and personal (9.4%) and family (35.3%) antecedents. 205 children finished the second stage. The frequencies of MS-ATP and MS-WHO were 9.3% and 1.9%. Among the obese, MS was present in 25.8% (ATP) and 5.2% (WHO). Children with normal weight presented: low HDL (23.6%), hyperglycaemia (3.6%), HOMA-IR (0.9%) and MS-ATP (0.9%). In conclusion, overweight/obesity was associated with metabolic syndrome in schoolchildren. It was found that children with normal weight with personal and/or family antecedents presented with HOMA-IR and MS-ATP.

Living conditions and receptive vocabulary of children aged two to five years

OBJECTIVE To assess the receptive vocabulary of children aged between two years and six months and five years and eleven months who were attending childcare centers and kindergarten schools. METHODS An analytical cross-sectional study was carried out in the municipality of Embu, Southeastern Brazil. The Peabody Picture Vocabulary Test and analysis of factors associated with childrens performance were applied. The sample consisted of 201 children of both genders, aged between two and six years. Statistical analysis was performed using multivariate analysis and logistic regression model. The dependent variable analyzed was test performance and the independent variables were childs age, mothers level of education and family socio-demographic characteristics. RESULTS It was observed that 44.3% of the children had performances in the test that were below what would be expected for their age. The factors associated with the best performances in the test were childs age (OR=2.4; 95% CI: 1.6-3.5) and mothers education level (OR= 3.2; 95% CI: 1.3-7.4). CONCLUSIONS Mothers education level is important for childs language development. Settings such as childcare and kindergarten schools are protective factors for child development in families of low income and education.

Eqüidade na atenção pré-natal e ao parto em área da Região Metropolitana de São Paulo, 1996

A cross-sectional study was conducted to evaluate prenatal and childbirth care interviewing mothers of infants in the municipality of Embu (Greater Metropolitan Sao Paulo) in 1996, according to four socioeconomic strata. A door-to-door survey included a probabilistic sample consisting of 483 infants. In all strata more than 90% of the mothers had received prenatal care, but with late access in stratum 4 (residents of favelas, or slums). Breast examination during prenatal care, reported by only 60.8% of the mothers, was the worst single indicator of quality of prenatal care in the municipality. The outcome indicator - first prenatal consultation after the first trimester and total number of consultations less than six - was associated with maternal age (less than 20 years), low per capita family income (less than one minimum wage), and lack of private health plan. As for deliveries, 97.7% occurred in hospital, of which 32.5% by cesarean section, with the latter more frequent in private health care facilities (63.2%). No population segments were identified as being excluded from the health care system, but some indicators suggest greater deficiencies in socioeconomic stratum 4. These results have supported local health system managers in redefining health measures for the municipality.

Risk factors associated with developmental abnormalities among high-risk children attended at a multidisciplinary clinic

CONTEXT AND OBJECTIVE Knowledge of risk factors associated with child development disorders is essential for delivering high-quality childcare. The objective here was to evaluate the relationships between risk factors and occurrences of developmental abnormalities among children attended at a reference clinic for children at risk of developmental abnormalities. DESIGN AND SETTING Retrospective study at a multidisciplinary reference center, Embu, São Paulo. METHODS All cases followed up for more than three months between 1995 and 2003 were reviewed. The risk factors assessed were low birth weight, gestational age, length of stay in neonatal ward, perinatal asphyxia, mothers age < 18 years, congenital infections, malformations and low mothers education level. Developmental abnormalities were defined according to developmental tests and assessments by the clinics professionals. The statistical analysis consisted of the chi-squared test for comparing categorical variables and a logistic regression model for multivariate analysis. RESULTS 211 children were followed up for more than three months. Developmental abnormalities occurred in 111 (52.6%). Univariate analysis showed significant relationships between developmental abnormality and low birth weight, perinatal asphyxia, length of stay > 5 days, prematurity and mothers age 18 years and older. Low birth weight, history of perinatal asphyxia and mothers age continued to be significant in multivariate analysis. CONCLUSIONS Special attention must be paid to the development of low birth weight infants and/or infants with histories of neonatal complications. Low birth weight is easily assessed and should be considered to be an important marker when defining guidelines for following up child development.

Prevalência e fatores associados à deficiência de ferro em lactentes atendidos em um centro de saúde-escola em Belém, Pará, Brasil

Determinar a prevalencia de deficiencia de ferro e fatores associados em lactentes. Neste estudo transversal, foram estudados 365 lactentes atendidos em um centro de saude-escola, em Belem, Para, Brasil. Anemia ferropriva (hemoglobina 11g/dl e ferritina 11g/dl e ferritina > 12µg/l), em 18,1%. Em 12,5% dos lactentes, nao incluidos na avaliacao dos fatores associados com a deficiencia de ferro, encontraram-se hemoglobina 12µg/l. Os resultados do modelo de regressao logistica mostraram associacao entre deficiencia de ferro (ferritina < 12µg/l) e: faixa etaria entre 6 e 12 meses, OR = 3,67 e IC95%: 1,93-7,04; nao utilizacao de formula fortificada com ferro como primeiro leite no desmame, OR = 1,93 e IC95%: 1,04-3,60; e renda per capita ¾ 1 salario minimo, OR = 2,69 e IC95%: 1,30-5,59. A prevalencia de deficiencia de ferro foi elevada, evidenciando a necessidade de implementacao de acoes efetivas para a prevencao desse importante problema de saude publica.

Seroprevalence of Helicobacter pylori infection among children of low socioeconomic level in São Paulo

CONTEXT AND OBJECTIVE Helicobacter pylori infection is mainly acquired during childhood, and is associated with significant morbidity in adults. The aim here was to evaluate the seroprevalence and risk factors of H. pylori infection among children of low socioeconomic level attended at a public hospital in São Paulo, Brazil. DESIGN AND SETTING Cross-sectional study, among patients attended at an outpatient clinic. METHODS 326 children were evaluated (150 boys and 176 girls; mean age 6.82 ± 4.07 years) in a cross-sectional study. Patients with chronic diseases or previous H. pylori treatment, and those whose participation was not permitted by the adult responsible for the child, were excluded. The adults answered a demographic questionnaire and blood samples were collected. The serological test used was Cobas Core II, a second-generation test. Titers > 5 U/ml were considered positive. RESULTS H. pylori infection was diagnosed in 116 children (35.6%). Infected children were older than uninfected children (7.77 ± 4.08 years versus 5.59 ± 3.86 years; p < 0.0001). The seroprevalence increased from 20.8% among children aged two to four years, to 58.3% among those older than 12 years. There were no significant relationships between seropositivity and gender, color, breastfeeding, number of people in the home, number of rooms, bed sharing, living in a shantytown, maternal educational level, family income or nutritional status. In multivariate analysis, the only variable significantly associated with H. pylori seropositivity was age. CONCLUSION Infection had intermediate prevalence in the study population, and age was associated with higher prevalence.

Blood pressure levels in childhood: probing the relative importance of birth weight and current size

Several studies have reported data supporting the idea that an impaired intrauterine environment that deprives the fetus of optimal nutrient delivery results in the predisposition of the fetus to experience cardiovascular and metabolic dysfunction in later life. However, contradictory data still exist. Our purpose was to investigate the effects of both birth weight and weight gain on the risk for high blood pressure levels in 6- to 10-year-old children. This cross-sectional study included 739 children divided into quartiles of birth weight. The mean values of both systolic and diastolic pressure were significantly different between quartiles of birth weight, with increasing blood pressure values as the birth weight decreased (P < 0.001). Covariance analysis adjusting for gender, prematurity, and body mass index (BMI) showed that both systolic and diastolic pressure remained greater in the lowest than in the highest birth weight quartile. Separating those with low and normal birth weight demonstrated that the risk of childhood hypertension was significantly higher among children with low birth weight and current obesity (odds ratio [OR]: 5.0, confidence interval [CI]: 3.3 to 16.1; P = 0.023). The inverse association between birth weight and blood pressure levels appears to be programmed during fetal life, while weight gain during childhood adds to this risk.

Prophylaxis for iron deficiency anemia using ferrous sulfate among infants followed up at a primary healthcare unit in the municipality of Embu-SP (2003/2004)

CONTEXT AND OBJECTIVE Iron deficiency anemia is an important public health problem in Brazil. In the municipality of Embu, a population study in 1996 found anemia prevalence of 68.5% among children aged one to two years. From these data, prescription of prophylactic ferrous sulfate was instituted in 1998 for children under two years old followed up within the childrens healthcare program. After five years of intervention, the prevalence of anemia and associated factors were investigated among children aged 12 to 18 months to whom guidance for prophylactic ferrous sulfate use had been given. DESIGN AND SETTING Cross-sectional study covering October 2003 to June 2004 at a primary healthcare unit in Embu. METHODS A randomized sample of children aged 12 to 18 months to whom guidance for prophylactic ferrous sulfate use had been given was obtained. Hemoglobin was measured in capillary blood, using HemoCue apparatus. Hemoglobin < 11 g/100 dl was taken to indicate anemia. RESULTS The sample comprised 118 children and anemia was found in 41.5%. There was no statistically significant association between anemia presence and the variables of sex, birth weight, neonatal intercurrences, chronic diseases, breastfeeding or iron supplementation use. There was a statistically significant association (p = 0.03) between anemia presence and per capita income, such that the higher the income was, the lower the prevalence of anemia was. CONCLUSION The prophylaxis program against iron deficiency anemia did not achieve the expected results. New strategies must be considered in the light of the magnitude of the problem.