Elyne Montenegro Engstrom

Vigilância de fatores de risco para doenças não transmissíveis entre adolescentes: a experiência da cidade do Rio de Janeiro, Brasil

This paper presents the methodology and results of the implementation of a Surveillance System for Non-Communicable Disease Risk Factors in Adolescents. A random sample of 8th-grade students (n = 1,684) enrolled in municipal schools in Rio de Janeiro, Brazil, was studied. Students were asked to complete a confidential questionnaire on food consumption, physical activity, sedentary leisure-time activities, and tobacco consumption. Prevalence estimates of risk factors were calculated for the entire sample and by gender. Non-response rates ranged from 1.1 to 8.9%. The findings included low consumption of fruits (45.8%) and vegetables (20.0% and 16.5% for salads and cooked vegetables, respectively), regular consumption of soft drinks (36.7%) and candies (46.7%), extensive time on TV, computer, and videogames (71.7% spend at least 4h/day at these activities), low frequency of regular physical activity (40%), and 6.4% prevalence of smoking. Girls showed less physical activity and more smoking. The system appeared to be feasible and indicated high prevalence of risk factors for non-communicable diseases.

Crescimento e estado nutricional em amostra probabilística de escolares no Município do Rio de Janeiro, 1999

Growth and nutritional status were assessed in a probabilistic sample of public schoolchildren (1,705 girls and 1,682 boys) in the city of Rio de Janeiro in 1999. Nutritional status of the under-10-year group was assessed by z < -2 (undernutrition) for body mass for height and height for age and by z > +2 for body mass for height (overweight). For children over 10, the 5th and 85th percentiles of body mass index for age were used to assess underweight and overweight, respectively. Prevalence rates of overweight and obesity according to the International Obesity Task Force criteria were also calculated. Prevalence rates for undernutrition were below expected for the reference population. Prevalence of overweight was approximately 18% and 14% for girls and boys, respectively, and obesity was 5% for both sexes. The results of the present study are similar to findings from population-based surveys in Brazil: low prevalence of undernutrition and high prevalence of overnutrition.

Déficit estatural nas crianças brasileiras: relação com condições sócio-ambientais e estado nutricional materno

The relationship between stunting in Brazilian children with their mothers nutritional status and their social-environmental situation was assessed in a probabilistic sample of the Brazilian population in 1989. Data from 12644 mother-son pairs were analyzed. Maternal nutritional status was classified based on the body mass index and stunting was identified in children with stature or length for age Z < or = -2 of the American growth reference curve (NCHS). Stunting was observed in 14.4% of the children (15.9% of boys and 12.9% of girls) There was an inverse relationship between the level of stunting and maternal education, income and house living conditions. Children of illiterate mothers showed more stunting (OR = 17.2) than children whose mothers had had at least 9 years of formal education. Stunting was more frequently observed in children whose mothers were underweight (OR = 2.5), and who were from the first quartile of family income in comparison to the fourth quartile (OR = 11.0) and lived in the poorest living conditions (OR = 7.6). These results suggest a positive association between stunted children and underweight mothers.

Health-related and socio-demographic factors associated with frailty in the elderly: a systematic literature review

Frailty is a syndrome that leads to practical harm in the lives of elders, since it is related to increased risk of dependency, falls, hospitalization, institutionalization, and death. The objective of this systematic review was to identify the socio-demographic, psycho-behavioral, health-related, nutritional, and lifestyle factors associated with frailty in the elderly. A total of 4,183 studies published from 2001 to 2013 were detected in the databases, and 182 complete articles were selected. After a comprehensive reading and application of selection criteria, 35 eligible articles remained for analysis. The main factors associated with frailty were: age, female gender, black race/color, schooling, income, cardiovascular diseases, number of comorbidities/diseases, functional incapacity, poor self-rated health, depressive symptoms, cognitive function, body mass index, smoking, and alcohol use. Knowledge of the complexity of determinants of frailty can assist the formulation of measures for prevention and early intervention, thereby contributing to better quality of life for the elderly.A fragilidade e uma sindrome que gera prejuizos praticos a vida do idoso, pois esta relacionada a maior risco de dependencia, quedas, hospitalizacao, institucionalizacao e morte. O objetivo desta revisao sistematica foi identificar os fatores sociodemograficos, psicocomportamentais, de condicoes de saude, estado nutricional e estilo de vida associados a fragilidade em idosos. Quatro mil cento e oitenta e tres trabalhos publicados entre 2001 e 2013 foram detectados nas bases bibliograficas e selecionados 182 artigos completos. Apos a leitura integral e aplicacao dos criterios de selecao, restaram 35 artigos elegiveis para analise. Os principais fatores associados foram: idade, sexo feminino, raca/cor da pele preta, escolaridade, renda, doencas cardiovasculares, numero de comorbidades/doencas, incapacidade funcional, autoavaliacao de saude ruim, sintomas depressivos, funcao cognitiva, indice de massa corporal, tabagismo e uso de alcool. O conhecimento da complexidade dos determinantes da fragilidade auxilia na formulacao de acoes de prevencao e intervencao precoce, garantindo maior qualidade de vida.

Declining prevalence of hepatitis A virus antibodies among children from low socioeconomic groups reinforces the need for the implementation of hepatitis A vaccination in Brazil

Age-related seroprevalence studies that have been conducted in Brazil have indicated a transition from a high to a medium endemicity of hepatitis A virus (HAV) infection in the population. However, most of these studies have focused on urban populations that experience lower incidence rates of HAV infection. In the current study, the prevalence of anti-HAV antibodies was investigated in children with a low socioeconomic status (SES) that live on the periphery of three capital cities in Brazil. A total of 1,162 dried blood spot samples were collected from individuals whose ages ranged from one-18 years and tested for anti-HAV antibodies. A large number of children under five years old (74.1-90%) were identified to be susceptible to HAV infection. The anti-HAV antibody prevalence reached ≥ 50% among those that were 10-14 years of age or older. The anti-HAV prevalence rates observed were characteristics of regions with intermediate level of hepatitis A endemicity. These data indicated that a large proportion of children with a low SES that live at the periphery of urban cities might be at risk of contracting an HAV infection. The hepatitis A vaccine that is currently offered in Brazil is only available for high-risk groups or at private clinics and is unaffordable for individuals with a lower SES. The results from this study suggest that the hepatitis A vaccine should be included in the Brazilian National Program for Immunisation.

Tendência temporal da amamentação na cidade do Rio de Janeiro: 1996-2006

OBJETIVO: Analisar a tendencia temporal da pratica de aleitamento materno (AM) e de aleitamento materno exclusivo (AME). METODOS: Foram analisados dados de sistema de monitoramento baseado em inqueritos realizados nos anos de 1996, 1998, 2000, 2003 e 2006 durante a Campanha Nacional de Imunizacao na cidade do Rio de Janeiro, RJ. A populacao de estudo foi constituida de 19.044 criancas menores de um ano de idade que compareceram aos postos de vacinacao. Para cada ano foi estudada uma amostra probabilistica por conglomerado (postos de vacinacao), auto-ponderada representativa da populacao de criancas menores de 12 meses ( 6 e em AME<6 foram observadas em todas as categorias de todas as variaveis sociodemograficas maternas. Para AME<6, a desvantagem observada em 1996 entre mulheres de menor escolaridade e em 1998 entre mulheres que trabalhavam nao foi completamente superada ate 2006. CONCLUSOES: O AM e o AME aumentaram no periodo estudado independentemente da faixa etaria da crianca e das caracteristicas sociodemograficas maternas. Nao foram totalmente superadas diferencas observadas entre mulheres em diferentes situacoes sociodemograficas.OBJECTIVE To analyze time trend in breast-feeding (BF) and exclusive breast-feeding (EBF). METHODS Data from a monitoring system, based on surveys conducted during the National Immunization Campaign in the city of Rio de Janeiro, Southeastern Brazil, in 1996, 1998, 2000, 2003 and 2006, were analyzed. Study population was comprised of 19,044 children younger than one year of age, who were present in vaccination stations. A probability cluster sample (vaccination stations), self-weighted and representative of the population of children younger than 12 months of age (<12), was studied for each year. A structured questionnaire with closed questions about the childs diet at the moment of the study and maternal sociodemographic characteristics was applied. The BF and EBF indicators proposed by the World Health Organization were adopted. RESULTS BF<12 increased from 61.3% to 73.4% between 1996 and 2006. Similar trend was observed in all age groups analyzed. EBF in children <4 and <6 months of age (EBF<6) increased from 18.8% to 42.4% and from 13.8% to 33.3%, respectively. Improvements in BF>6 and EBF<6 were found in all categories of all maternal sociodemographic variables. For EBF<6, the disadvantage observed in women with a lower level of education in 1996 and in women who worked in 1998 was not completely overcome by 2006. CONCLUSIONS BF and EBF increased in the period studied, independently from child age group and maternal socio-demographic characteristics. The differences found among women in distinct sociodemographic situations were not completely overcome.

Efetividade da suplementação diária ou semanal com ferro na prevenção da anemia em lactentes

OBJETIVO: Evaluar la efectividad del suplemento universal profilactico con sulfato ferroso, en administracion diaria o semanal, en la prevencion de la anemia en lactantes. METODOS: Se realizo un ensayo de campo aleatorio con ninos de seis a 12 meses de edad, atendidos en unidades basicas de salud del municipio de Rio de Janeiro (Sureste de Brasil), en 2004-2005. Se formaron tres cohortes coincidentes con suplemento universal con sulfato ferroso con grupos: diario (n=150; 12,5mgFe/dia), semanal (n=147; 25mgFe/semana) y control (n=94). La intervencion duro 24 semanas y fue acompanada por acciones educativas promotoras de adhesion. La concentracion de hemoglobina serica fue analizada de acuerdo a su distribucion, promedio y prevalencia de anemia (Hb<110,0g/L) a los 12 meses de edad. La evaluacion de la efectividad fue realizada con base a la intencion de tratar y adhesion al protocolo, utilizandose analisis de regresion multiple (lineal y de Poisson). RESULTADOS: Los grupos se mostraron homogeneos con relacion a las variables de caracterizacion. La intervencion fue operacionalizada con exito, con elevada adhesion al protocolo en ambos grupos expuestos, sin diferencia estadistica entre ellos. Luego de un ajuste, solamente el esquema diario presento efecto protector. En el analisis por adhesion, el esquema diario presento evidente efecto dosis-respuesta para el promedio de hemoglobina serica y prevalencia de anemia, sin observarse efecto protector del esquema semanal. CONCLUSIONES: Solo el esquema diario de suplemento universal con sulfato ferroso de los seis a los 12 meses de edad fue efectivo para aumentar la concentracion de hemoglobina serica y reducir el riesgo de anemia.OBJECTIVE To evaluate the effectiveness of universal prophylactic targeting with iron sulfate on daily or weekly basis in the prevention of anemia in infants. METHODS Randomized clinical field trial with children between ages six and 12 months seen at primary health care units in the municipality of Rio de Janeiro, Brazil, between 2004 and 2005. Three concurrent cohorts were compared: daily group (n=150; 12.5mg Fe/day); weekly group (n=147; 25mg Fe/week) and control group. The intervention consisted of universal supplementation with iron sulfate for 24 weeks, combined with educational adherence-promoting measures. OUTCOME mean serum hemoglobin concentration, distribution and prevalence of anemia (Hb<110.0 g/l) at age 12 months. Effectiveness was evaluated considering both intent to treat and adherence to protocol, using multiple regression analysis (linear and Poisson). RESULTS Groups were homogeneous in terms of descriptive variables. The intervention was implemented successfully, with high adhesion to protocol in both groups, and no statistical difference between them. After adjustment, only the daily regimen showed a protective effect. Adherence analysis demonstrated an evident dose-response effect on mean Hb and prevalence of anemia only for the daily regimen. No protective effect was detected for the weekly regimen. CONCLUSIONS Universal supplementation with iron sulfate from six to 12 months of age was effective in increasing serum Hb and decreasing risk of anemia only when administered on a daily basis.

Effectiveness of daily and weekly iron supplementation in the prevention of anemia in infants

OBJETIVO: Evaluar la efectividad del suplemento universal profilactico con sulfato ferroso, en administracion diaria o semanal, en la prevencion de la anemia en lactantes. METODOS: Se realizo un ensayo de campo aleatorio con ninos de seis a 12 meses de edad, atendidos en unidades basicas de salud del municipio de Rio de Janeiro (Sureste de Brasil), en 2004-2005. Se formaron tres cohortes coincidentes con suplemento universal con sulfato ferroso con grupos: diario (n=150; 12,5mgFe/dia), semanal (n=147; 25mgFe/semana) y control (n=94). La intervencion duro 24 semanas y fue acompanada por acciones educativas promotoras de adhesion. La concentracion de hemoglobina serica fue analizada de acuerdo a su distribucion, promedio y prevalencia de anemia (Hb<110,0g/L) a los 12 meses de edad. La evaluacion de la efectividad fue realizada con base a la intencion de tratar y adhesion al protocolo, utilizandose analisis de regresion multiple (lineal y de Poisson). RESULTADOS: Los grupos se mostraron homogeneos con relacion a las variables de caracterizacion. La intervencion fue operacionalizada con exito, con elevada adhesion al protocolo en ambos grupos expuestos, sin diferencia estadistica entre ellos. Luego de un ajuste, solamente el esquema diario presento efecto protector. En el analisis por adhesion, el esquema diario presento evidente efecto dosis-respuesta para el promedio de hemoglobina serica y prevalencia de anemia, sin observarse efecto protector del esquema semanal. CONCLUSIONES: Solo el esquema diario de suplemento universal con sulfato ferroso de los seis a los 12 meses de edad fue efectivo para aumentar la concentracion de hemoglobina serica y reducir el riesgo de anemia.OBJECTIVE To evaluate the effectiveness of universal prophylactic targeting with iron sulfate on daily or weekly basis in the prevention of anemia in infants. METHODS Randomized clinical field trial with children between ages six and 12 months seen at primary health care units in the municipality of Rio de Janeiro, Brazil, between 2004 and 2005. Three concurrent cohorts were compared: daily group (n=150; 12.5mg Fe/day); weekly group (n=147; 25mg Fe/week) and control group. The intervention consisted of universal supplementation with iron sulfate for 24 weeks, combined with educational adherence-promoting measures. OUTCOME mean serum hemoglobin concentration, distribution and prevalence of anemia (Hb<110.0 g/l) at age 12 months. Effectiveness was evaluated considering both intent to treat and adherence to protocol, using multiple regression analysis (linear and Poisson). RESULTS Groups were homogeneous in terms of descriptive variables. The intervention was implemented successfully, with high adhesion to protocol in both groups, and no statistical difference between them. After adjustment, only the daily regimen showed a protective effect. Adherence analysis demonstrated an evident dose-response effect on mean Hb and prevalence of anemia only for the daily regimen. No protective effect was detected for the weekly regimen. CONCLUSIONS Universal supplementation with iron sulfate from six to 12 months of age was effective in increasing serum Hb and decreasing risk of anemia only when administered on a daily basis.

Equipe “consultório na rua” de Manguinhos, rio de Janeiro, Brasil: práticas de cuidado e promoção da saúde em um território vulnerável

The structuring of care to the homeless people through Primary Health Care (PHC), standardized in 2012 is a challenge to the Brazilian Health System. This article discuss the practices of a Street Clinic (eCnaR) team for the homeless and alcohol, crack and other drugs users in order to provide comprehensive care implemented according to PHC and health promotion conceptions. A qualitative analysis of an eCnaR of the Municipality of Rio de Janeiro in the period 2011-2013 was performed, considering PHC essential atributes, with the following analytical categories: the territorial approach; open-door reception services; the complexity of care to vulnerable groups and the coordination of the health and intersectoral network. As theoretical framework, we systematized the concepts of care provided for in Brazilian policies/standards, considering health needs, as well as alcohol, crack and drug dependence in the homeless. As a PHC team for vulnerable populations and territories, the eCnaR was powerful in promoting access, building longitudinality, providing comprehensive care from the perspective of harm reduction and extended clinic. There are challenges to achieve effectiveness of care, such as the multi-professional education and composition; logistical and specialized support to address complex cases and also, the fragility of the network.

Fatores sociodemográficos e de saúde associados à fragilidade em idosos: uma revisão sistemática de literatura

Frailty is a syndrome that leads to practical harm in the lives of elders, since it is related to increased risk of dependency, falls, hospitalization, institutionalization, and death. The objective of this systematic review was to identify the socio-demographic, psycho-behavioral, health-related, nutritional, and lifestyle factors associated with frailty in the elderly. A total of 4,183 studies published from 2001 to 2013 were detected in the databases, and 182 complete articles were selected. After a comprehensive reading and application of selection criteria, 35 eligible articles remained for analysis. The main factors associated with frailty were: age, female gender, black race/color, schooling, income, cardiovascular diseases, number of comorbidities/diseases, functional incapacity, poor self-rated health, depressive symptoms, cognitive function, body mass index, smoking, and alcohol use. Knowledge of the complexity of determinants of frailty can assist the formulation of measures for prevention and early intervention, thereby contributing to better quality of life for the elderly.A fragilidade e uma sindrome que gera prejuizos praticos a vida do idoso, pois esta relacionada a maior risco de dependencia, quedas, hospitalizacao, institucionalizacao e morte. O objetivo desta revisao sistematica foi identificar os fatores sociodemograficos, psicocomportamentais, de condicoes de saude, estado nutricional e estilo de vida associados a fragilidade em idosos. Quatro mil cento e oitenta e tres trabalhos publicados entre 2001 e 2013 foram detectados nas bases bibliograficas e selecionados 182 artigos completos. Apos a leitura integral e aplicacao dos criterios de selecao, restaram 35 artigos elegiveis para analise. Os principais fatores associados foram: idade, sexo feminino, raca/cor da pele preta, escolaridade, renda, doencas cardiovasculares, numero de comorbidades/doencas, incapacidade funcional, autoavaliacao de saude ruim, sintomas depressivos, funcao cognitiva, indice de massa corporal, tabagismo e uso de alcool. O conhecimento da complexidade dos determinantes da fragilidade auxilia na formulacao de acoes de prevencao e intervencao precoce, garantindo maior qualidade de vida.