Eliana Zandonade

Aspectos epidemiológicos da depressão pós-parto em amostra brasileira

Introduction: Psychiatric symptoms are frequent in the postpartum period, a moment marked by hormonal alterations and changes in social character, family organization and women’s identity. The Edinburgh Postnatal Depression Scale (EPDS) is a selfreporting instrument to track depression after pregnancy, unfortunately not always properly supported by health care professionals. This study aimed at verifying the prevalence of postpartum depression in women receiving care at basic health units. Methods: Cross-sectional study including 292 women in the postpartum period (from day 31 to 180) who answered the EPDS questionnaire. Cut-off point < 12 for EPDS depression was used. Results: A total of 115 women (39.4%) had scores < 12 in EPDS, classified as depressive; 177 (60.6%) had scores < 12 and were not considered depressive. Women with lower education, higher number of pregnancies, higher parity, higher number of live children and shortest relationship time had more depression. Conclusion: High frequency of postpartum depression is associated with social factors, which shows the importance of health care professionals in early detection of depression, with the aid of instruments such as EPDS, due to its efficacy and practicability.INTRODUCTION: Psychiatric symptoms are frequent in the postpartum period, a moment marked by hormonal alterations and changes in social character, family organization and womens identity. The Edinburgh Postnatal Depression Scale (EPDS) is a self-reporting instrument to track depression after pregnancy, unfortunately not always properly supported by health care professionals. This study aimed at verifying the prevalence of postpartum depression in women receiving care at basic health units. METHODS: Cross-sectional study including 292 women in the postpartum period (from day 31 to 180) who answered the EPDS questionnaire. Cut-off point < 12 for EPDS depression was used. RESULTS: A total of 115 women (39.4%) had scores < 12 in EPDS, classified as depressive; 177 (60.6%) had scores < 12 and were not considered depressive. Women with lower education, higher number of pregnancies, higher parity, higher number of live children and shortest relationship time had more depression. CONCLUSION: High frequency of postpartum depression is associated with social factors, which shows the importance of health care professionals in early detection of depression, with the aid of instruments such as EPDS, due to its efficacy and practicability.

Associação entre tabagismo e paracoccidioidomicose: um estudo de caso-controle no Estado do Espírito Santo, Brasil

A paracoccidioidomicose e a principal micose sistemica em nosso meio, que exige tratamento prolongado, de alto custo, e que deixa sequelas graves nos pulmoes, orgaos mais frequentemente acometidos e sujeitos ainda as agressoes de fatores de risco externos, como o tabaco. Investigou-se, por meio de um estudo caso-controle, a influencia do tabagismo e do alcoolismo no desenvolvimento da forma cronica da paracoccidioidomicose. Dados sobre a ocupacao, moradia e habitos de vida foram obtidos de 70 doentes e 180 controles. Os doentes fumavam e bebiam mais que os controles. A chance de adoecer foi 14 vezes maior entre os fumantes e 3,6 vezes maior entre os que bebiam acima de 50g/dia de alcool. Na regressao logistica, foram significativas as variaveis consumo de tabaco por mais de 20 anos (OR = 10,1), consumo de cigarros industrializados (OR = 4,8) e consumo de alcool acima de 50g/dia (OR = 2,9). Os doentes que fumavam 20 ou mais cigarros/dia adoeceram em media oito anos antes que os demais (p = 0,002). O consumo de alcool acima de 50g/dia nao influenciou na idade de adoecimento (p = 0,78). Conclui-se que o tabagismo constitui fator de risco para o desenvolvimento da paracoccidioidomicose; o alcoolismo atuaria como um co-fator, associado ao tabagismo.

Distribuição de metais pesados em sedimentos do sistema estuarino da Ilha de Vitória-ES

Heavy-metal concentration in sediment is an important parameter for identifying pollution sources and assessing pollution levels in aquatic ecosystems. In this context, the present study aimed at determining concentrations of heavy metals in sediments from the Vitoria estuarine system, Brazil. Twenty nine stations were surveyed to assess the spatial distribution of heavy metals. The metals for silt-clay fractions (<63 µm) were analyzed through atomic absorption spectrometry. A discriminant analysis segregated the stations in four groups representing four areas within the estuarine system. The Espirito Santo Bay showed the lowest metal concentrations, while the Vitoria harbor canal showed the highest. We concluded that concentrations of heavy metals reflect natural conditions and the contribution of human activities from sewage and industrial effluents. It was not possible to directly associate metal concentrations to specific pollution sources.

Preditores socioeconômicos da qualidade da alimentação de crianças

OBJECTIVE To develop a diet quality index and to analyze socioeconomic factors associated with low child diet quality. METHODS A cross-sectional study was performed with a representative sample of 1,282 children aged between seven and ten years, living in the city of Vitória, Southeastern Brazil, in 2007. Children were randomly selected from 26 public schools and six private schools. Data on socioeconomic characteristics and life habits of children were obtained from a structured questionnaire, sent to homes and preferably completed by mothers. A food frequency questionnaire was created from studies performed with Brazilian children and tested in a public school. An index entitled Indice de Alimentação do Escolar (ALES School Child Diet Index) was designed to assess diet quality, taking in consideration the nutritional recommendations for the Brazilian population and the habit of having breakfast. The association between diet quality and socioeconomic factors was analyzed using multinomial logistic regression. Adjusted odds ratios and 95% confidence intervals were estimated for the variables that remained in the model. RESULTS According to the ALES index, approximately 41% of the children studied had low diet quality (boys= 37.7%, girls= 42.7%, p= 0.179). There were no significant differences between sex, age, maternal employment status and living with the mother and diet quality. The variables that remained associated with low diet quality were low maternal level of education (OR= 3.93; 95% CI: 2.58;5.99), father not present in the household (OR= 2.03; 95% CI: 1.68;2.99) and not having lunch at the table (OR= 1.47; 95% CI: 1.12;1.93). CONCLUSIONS Low maternal level of education increased the probability of a child not consuming a good quality diet, whether due to lack of access to healthy foods and adequate information or poorer ability to discern what is healthy.OBJETIVO: Desarrollar indice de calidad de la alimentacion y analizar factores socioeconomicos asociados con la baja calidad de la alimentacion entre ninos. METODOS: Estudio transversal realizado con muestra representativa de 1.282 ninos de siete a diez anos de edad residentes en Vitoria, sureste de Brasil, en 2007. Los ninos fueron sorteados en 26 escuelas publicas y seis privadas. Datos socioeconomicos y de habitos de vida de los ninos fueron obtenidos a partir de cuestionario estructurado enviado al domicilio y llenado preferiblemente por sus madres. Un cuestionario de frecuencia alimentaria fue construido a partir de estudios realizados con ninos brasileras y evaluado en escuela publica. Para evaluacion de la calidad de la alimentacion fue desarrollado un indice, denominado Alimentacion del Escolar (Indice ALES), llevando en consideracion las recomendaciones nutricionales para la poblacion brasilera y el habito de realizar el desayuno. La asociacion entre la calidad de la alimentacion y factores socioeconomicos fue investigada utilizando la regresion logistica multinomial. Se estimaron odds ratio ajustados y los intervalos con 95% de confianza para las variables que permanecieron en el modelo. RESULTADOS: Segun el Indice ALES, aproximadamente 41% de los ninos estudiados poseian alimentacion de baja calidad (ninos=37,7%, ninas= 42,7%, p=0,179). No fueron encontradas diferencias significativas entre sexo, edad, condicion de empleo materno y vivir con la madre y calidad de la alimentacion. Las variables que permanecieron asociadas con la baja calidad de la alimentacion fueron baja escolaridad materna (OR=3,93; IC 95%: 2,58;5,99), ausencia del padre en el domicilio (OR= 2,03; IC 95%: 1,68;2,99) y no almorzar en la mesa (OR= 1,47; IC 95%: 1,12;1,93). CONCLUSIONES: La baja escolaridad materna aumento la probabilidad del nino no consumir una alimentacion de buena calidad, sea por la falta de acceso a alimentos saludables e informaciones adecuadas y o por la menor capacidad de discernir lo que es saludable.

Cirurgia bariátrica cura síndrome metabólica

OBJECTIVES: To evaluate the impact of bariatric surgery on the metabolic syndrome (MS) and what are the criteria that contribute the most for its exclusion after surgery. The progress of leucometry was also analyzed. METHODS AND PROCEDURES: 47 obese women with MS were evaluated. All patients were operated with the Roux-en-Y vertical gastric bypass technique, with the insertion of a contention ring on the gastro-jejune anastomosis (Fobi-Capella). Patients were evaluated before and on the first year post-surgery. RESULTS: Fasting glucose presented a relevant decrease at 3 months after surgery. After 12 months, all 20 patients who had DM2 or altered fasting glucose presented normal levels of fasting glucose and glicated hemoglobin, and none of them was using any anti-diabetic drug. Triglycerides levels were reduced by 49.2%, whereas HDL-cholesterol increased by 27.2%. Systolic and diastolic blood pressures were reduced by an average of 28.7 and 20.8 mmHg, respectively. Leucocytes counting fell from 7671/µL to 6156/µL. Fasting glucose, triglycerides, DBP, SBP and HDL-cholesterol were the variables that contributed most for the reduction of MS. At the end of the first year, elimination of MS occurred in 80.9% of the patients. DISCUSSION: Bariatric surgery reduces resistance to insulin and consequently the cardiovascular risk factors.

Proposição, validação e análise dos modelos que correlacionam estrutura química e atividade biológica

The present paper aims to bring under discussion some theoretical and practical aspects about the proposition, validation and analysis of QSAR models based on multiple linear regression. A comprehensive approach for the derivation of extrathermodynamic equations is reviewed. Some examples of QSAR models published in the literature are analyzed and criticized.

Risco cardiovascular em vegetarianos e onívoros: um estudo comparativo

BACKGROUND: Clinical and epidemiological studies have demonstrated a strong association between eating habits and chronic diseases, particularly cardiovascular events, although not all the mechanisms of action are understood. OBJECTIVE: To describe and analyze the cardiovascular risk (CVR) in vegetarians and omnivores residing in Greater Vitoria, State of Espirito Santo, Brazil, in the age range from 35 to 64 years. METHODS: To evaluate CVR in the groups, a historical cohort study with 201 individuals was conducted. Sixty seven individuals who had been following a vegetarian diet for at least five years, and who were from Greater Vitoria, as well as 134 omnivores participating in the MONICA Project/Vitoria matched for socioeconomic class, gender, age and race were included. Biochemical and hemodynamic measurements were obtained in the Cardiovascular Investigation Clinic of UFES. For comparison of proportions, the c2 test was used, and the Prevalence Ratio was calculated. The CVR was calculated using the Framingham algorithm for the group as a whole, and for separate genders. RESULTS: The mean age of the group was 47±8 years and the mean duration of vegetarianism was 19±10 years; the lacto-ovo vegetarian diet was followed by 73% of the vegetarians. Blood pressure, fasting plasma glucose, total cholesterol, LDL-c, and triglycerides were lower among vegetarians (p<0.001). HDL-c levels were not different between the groups. According to the Framingham algorithm, vegetarians had a lower CVR (p<0.001). CONCLUSION: Unbalanced omnivorous diet with excess animal protein and fat may be implicated, to a great extent, in the development of noncommunicable diseases and conditions, especially in the CVR.

Smoking and 2-month culture conversion during anti-tuberculosis treatment.

OBJECTIVE To investigate risk factors for delayed sputum culture conversion to negative during anti-tuberculosis treatment, with an emphasis on smoking. DESIGN Nested case-control study of adults with non-cavitary, culture-confirmed pulmonary tuberculosis (TB) participating in an anti-tuberculosis treatment trial in Brazil. A case of delayed culture conversion was a patient who remained culture-positive after 2 months of treatment. Odds ratios with 95% confidence intervals were calculated. RESULTS Fifty-three cases and 240 control patients were analyzed. Smokers had three-fold greater odds of remaining culture-positive after 2 months of treatment (P = 0.007) than non-smokers, while smokers and ex-smokers who smoked >20 cigarettes a day had two-fold greater odds of remaining culture-positive after 2 months of treatment (P = 0.045). CONCLUSION Cigarette smoking adversely affects culture conversion during anti-tuberculosis treatment. Support for smoking cessation should be considered to improve outcomes in TB control programs.

Clinical and hepatic evaluation in adult dengue patients: a prospective two-month cohort study

INTRODUCTION To analyze the liver dysfunction and evolution of signs and symptoms in adult dengue patients during a two-month follow-up period. METHODS A prospective cohort study was conducted in Campos dos Goytacazes, Rio de Janeiro, Brazil, from January to July, 2008. The evolution of laboratory and clinical manifestations of 90 adult dengue patients was evaluated in five scheduled visits within a two-month follow-up period. Twenty controls were enrolled for the analysis of liver function. Patients with hepatitis B, hepatitis C, those known to be human immunodeficiency virus (HIV) seropositive and pregnant women were excluded from the study. RESULTS At the end of the second month following diagnosis, we observed that symptoms persisted in 33.3% (30/90) of dengue patients. We also observed that, 57.7% (15/26) of the symptoms persisted at the end of the second month. The most persistent symptoms were arthralgia, fatigue, weakness, adynamia, anorexia, taste alteration, and hair loss. Prior dengue virus (DENV) infection did not predispose patients to a longer duration of symptoms. Among hepatic functions, transaminases had the most remarkable elevation and in some cases remained elevated up to the second month after the disease onset. Alanine aminotransferase (ALT) levels overcame aspartate aminotransferase (AST) during the convalescent period. Male patients were more severely affected than females. CONCLUSIONS Dengue fever may present a wide number of symptoms and elevated liver transaminases at the end of the second month.

Avaliação da completude das variáveis epidemiológicas do Sistema de Informação sobre Mortalidade em mulheres com óbitos por câncer de mama na Região Sudeste: Brasil (1998 a 2007)

The study evaluates the data from the Mortality Information System in Espírito Santo, southeastern Brazil in the period from 1998 to 2007. It is a descriptive analytic study based on secondary data. The variables of sex, age, race/color, level of education and marital status in women who died of breast cancer were evaluated. The scores used were excellent (variable shows less than 5% of incomplete coverage), good (5% to 10%), fair (10% to 20%), poor (20% to 50%) and very poor (50% or higher). The linear trend equations were calculated using SPSS, version 15.0 for non-plenitude over time. It is essential to include in the education of health professionals, especially in undergraduate and postgraduate studies in medicine, content that develops skills and competencies for systematic registration of epidemiological data, so they can be included in the health information systems.O estudo avalia a completude dos dados do Sistema de Informacao sobre Mortalidade no Espirito Santo, Regiao Sudeste e Brasil no periodo de 1998 a 2007. Trata-se de um estudo descritivo analitico baseado em dados secundarios. Avaliou-se as variaveis de sexo, idade, raca/cor, escolaridade e estado civil em mulheres com obito por câncer de mama. Utilizou-se os escores excelente (variavel apresenta menos de 5% de preenchimento incompleto), bom (5% a 10%), regular (10% a 20%), ruim (20% a 50%) e muito ruim (50% ou mais). Calculou-se as equacoes de tendencia linear para a nao completude ao longo do tempo. Os resultados para as variaveis sexo e idade foram excelentes para o Espirito Santo, o Sudeste e o Brasil. Enquanto no Sudeste e no Brasil as variaveis raca/cor e escolaridade tem tendencia decrescente para a nao completude, no Espirito Santo se mantem estavel, mas inadequadas. Para a variavel estado civil, a nao completude tem tendencia crescente no Espirito Santo, e inadequada. Conclui-se que, as declaracoes de obito com câncer de mama neste estado apresentam inconsistencias, e sugere-se que na formacao dos profissionais de saude, em especial nos cursos de medicina, sejam desenvolvidas habilidades e competencias no registro de dados epidemiologicos, para poderem fundamentar os sistemas de informacao em saude.