Enrico A. Colosimo

Prevalência de sobrepeso e obesidade em crianças e adolescentes das regiões Sudeste e Nordeste

Objective: to study the prevalence of obesity and overweight among children and adolescents from Northeast and Southeast regions of Brazil. Methods: data was collected form Life Pattern Research conducted by the Brazilian Institute of Geography and Statistics (IBGE) in 1997. A sample of 3,317 children and 3,943 adolescents was studied according age groups. Overweight (adolescents) and obesity (adolescents and children) were defined according to World Health Organization recommendations. Z-test was used to compare prevalence among age groups, sex and geographic region. The cut-off point for statistical significance was 0.05. Results: overweight prevalence in adolescents was 1.7% in Northeast and 4.2% in Southeast. Obesity prevalence in adolescents was 6.6% and 8.4% in children and 8.2% and 11.9% in Northeast and Southeast, respectively. Considering both regions prevalence of obese female children was 10.3%, the rate of obese adolescents was 9.3% and overweight adolescents represented 3.0%. Among males prevalence was 9.2%, 7.3% and 2.6%, respectively. Conclusions: obesity prevalence is lower in Northeast than Southeast among children with age from 2 to 17 years old. Overweight prevalence among adolescents was also lower in Northeast than in Southeast. The prevalence of obesity among younger than 2 and older than 18 years old was the same. Obesity prevalence is higher among breast-fed females. Among other age groups prevalence of obesity and overweight was the same for males and females. It is difficult to compare these results with other studies, since there are few populational studies and the criteria used to define overweight and obesity in children and adolescents varies in each study.

Prevalência de sobrepeso e obesidade nas regiões Nordeste e Sudeste do Brasil

OBJECTIVE: to evaluate the prevalence of overweight and obesity in children, adolescents, adults and elderlies from Northeast and Southeast regions of Brazil. METHODS: anthropometric evaluation of 17.184 people, studied in Life Pattern Research conducted by Brazilian Institute of Geographic and Statistics in 1996/97, by body mass index. Overweight and obesity definitions according to body mass index values proposed by Cole et al. which are related to adult definition. RESULTS: It was studied a little more females in this study (53.1%). Average age was 29 years and five months (± 20 years), median was 25 years and six months. Overweight prevalence was 10.8% in children, 9.9% in adolescents and 28.3% among adults and obesity was 7.3%, 1.8% and 9.7% respectively. It was noticed a gradual increase in overweight or obesity prevalence since infancy through adult age with decrease among the elderly. CONCLUSION: Prevalence of overweight and obesity joined is higher among females. More than half of the women among 50 and 69 years old, from Northeast and Southeast regions of Brazil have overweight or obesity. There are few studies of overweight and obesity among children and adolescents and a lot of definition for obesity in children which makes more difficult the comparison of studies of prevalence among children.

Association between socioeconomic factors and infant deaths due to diarrhea, pneumonia, and malnutrition in a metropolitan area of Southeast Brazil: a case-control study

A population-based case-control study was carried out to identify determinant factors for post-neonatal infant deaths due to diarrhea, pneumonia, and malnutrition in Greater Metropolitan Belo Horizonte, Southeast Brazil. From May 1, 1991, to April 30, 1992, 511 post-neonatal deaths due to diarrhea, pneumonia, and malnutrition were selected after investigation of medical records to validate cause of death. Of this total, 396 deaths were compared to a neighborhood control group, matched for age. The study was carried out in a low-income area with a high proportion of families living in shantytowns. The article discusses the methodology and selected socioeconomic factors. Logistic regression analysis indicated that number of household appliances, mothers and fathers education, and mothers marital and work status were significantly associated with risk of infant death, i.e., they were determinants of infant deaths due to avoidable causes.

Comparison of antibody isotype responses to Schistosoma mansoni antigens by infected and putative resistant individuals living in an endemic area

The isotypic patterns of antibodies against Schistosoma mansoni antigenic preparations from eggs (SEA), adult worms (SWAP) andcercariae (CERC) have been studied in sera from two groups of individuals living in an area endemic for S. mansoni. One of the groups was comprised of individuals diagnosed as having S. mansoni infections based on their patency, i.e. those passing eggs in their faeces (patent infections, PI). The other group has been consider ‘putatively resistant’ due to their residence in an endemic area, their documented exposure to positive transmission sites, and their repeated negativity upon stool examinations (endemic normals, EN). There are strong specific responses oflgGl, IgG4 and IgM, particularly to SEA and CERC, by both groups. The reactivities of all isotypes were lower to SWAP. The responses of IgG4, IgM and IgE anti‐CERC in EN and PI are higher than those found in normal individuals from outside endemic areas. In general, EN individuals express a relative higher level of anti‐STEG IgE as compared to IgG4. On the other hand the pool of sera from PI showed the opposite pattern of higher IgG4 as compared to IgE. Several correlations are seen between isotypic responses to SEA, SWAP and CERC based on comparisons to the anti‐SWAP IgE responses of the individuals in the two groups. These comparisons indicate the presence of distinct immunologic differences between individuals in the PI and the EN groups.,

Triagem auditiva em hospital público de Belo Horizonte, Minas Gerais, Brasil: deficiência auditiva e seus fatores de risco em neonatos e lactentes

The objective of this study was to estimate the prevalence of hearing impairment in children in a public hospital in Belo Horizonte, Minas Gerais, Brazil, and to investigate the association with risk factors described in the literature. This study was cross-sectional and retrospective and analyzed 798 newborns and infants evaluated in the Universal Neonatal Hearing Screening Program from June 2002 to December 2003. The risk factors established by the Joint Committee on Infant Hearing in 1994 and Azevedo in 1996 were studied, besides prematurity. Prevalence of hearing impairment was 1.8% (15 cases). A multivariate logistic regression analysis was used to verify associations between risk factors and hearing impairment, showing a significant statistical association (p < 0.05) between hearing loss and suspicion of hearing loss by relatives, hyperbilirubinemia (serum level requiring exchange transfusion), ototoxic drugs, and low birth weight. A significant prevalence of hearing impairment in neonates and infants was confirmed. Attention should thus be focused on risk factors for hearing impairment, using hearing programs that ensure prevention, early detection, and intervention.

Prognostic factors in fetal hydronephrosis : a multivariate analysis

Abstract With the increasing use of obstetric echography fetal hydronephrosis has been reported more frequently. The purpose of this study was to identify prognostic factors associated with adverse outcome, such as renal failure and death, in fetal hydronephrosis. One hundred and forty-eight children with fetal hydronephrosis were admitted, submitted to a systematic protocol, and prospectively followed. Prognostic factors associated with fetal echography and clinical and laboratory findings on admission were studied. The median follow-up was 39 months. The analysis was conducted in two steps. In a univariate analysis, variables associated with adverse outcome were identified by the Kaplan-Meier method. The variables that were significantly associated with adverse outcome were then included in a multivariate analysis. This analysis, using the multivariate Cox’s model, was performed to identify variables that were independently associated with a worse prognosis. Only variables that remained independently associated with adverse outcome were included in the final model. After final adjustment by Cox’s multivariate model, three variables were identified as independent predictors of adverse outcome: oligohydramnios, prematurity, and glomerular filtration rate lower than 20 ml/min. Thus, in the presence of oligohydramnios, prematurity, and abnormal renal function, the medical team must plan appropriate follow-up for infants at health centers prepared to investigate and treat uropathies in newborns.

Environmental sanitation conditions and health impact: a case-control study

This epidemiological investigation examines the impact of several environmental sanitation conditions and hygiene practices on diarrhea occurrence among children under five years of age living in an urban area. The case-control design was employed; 997 cases and 999 controls were included in the investigation. Cases were defined as children with diarrhea and controls were randomly selected among children under five years of age. After logistic regression adjustment, the following variables were found to be significantly associated with diarrhea: washing and purifying fruit and vegetables; presence of wastewater in the street; refuse storage, collection and disposal; domestic water reservoir conditions; feces disposal from swaddles; presence of vectors in the house and flooding in the lot. The estimates of the relative risks reached values up to 2.87. The present study revealed the feasibility of developing and implementing an adequate model to establish intervention priorities in the field of environmental sanitation.

Using degradation data to assess reliability: a case study on train wheel degradation

Degradation experiments are usually used to assess the lifetime distribution of highly reliable products, which are not likely to fail under the traditional life tests or accelerated life tests. In such cases, if there exist product characteristics whose degradation over time can be related to reliability, then collecting ‘degradation data’ can provide information about product reliability. In general, the degradation data are modeled by a nonlinear regression model with random coefficients. If we can obtain the estimates of parameters under the model, then the failure-time distribution can be estimated. In order to estimate those parameters, three basic methods are available, namely, the analytical, numerical and the approximate. They are chosen according to the complexity of the degradation path model used in the analysis. In this paper, the numerical and the approximate methods are compared in a simulation study, assuming a simple linear degradation path model. A comparison with traditional failure-time analysis is also performed. The mean-squared error of the estimated 100pth percentile of the lifetime distribution is evaluated for each one of the approaches. The approaches are applied to a real degradation data set. Copyright

Qualidade do preenchimento da Caderneta de Saúde da Criança e fatores associados

The Child Health Record (CHR) is an essential document for childrens health care activities. A cross-sectional study was performed with simple random sampling, aimed at analyzing factors related to quality of data completion on the CHR. Interviews and direct verification of 365 CHRs from 9 health districts in Belo Horizonte, Minas Gerais State, Brazil, were performed. A scoring system was created to classify the CHRs in terms of quality of data completion and to relate them to explanatory variables. Odds ratios were calculated by logistic regression. Completion of the 20 scoring items varied from 3.1% (use of iron supplements) to 99.7% (date of birth). Factors associated with worse scores were: children > 12 months old (OR = 1.77), mothers with < or = 6 years of schooling (OR = 1.97), children not treated by general practitioners (OR = 3.18), and mothers who had not received explanations on the CHR while in the maternity ward (OR = 1.77). The results show poor use of the CHR and emphasize the need for on-going efforts to train health professionals and prepare health services for their important role in the promotion of childrens health.

Prevalence and impact of chronic otitis media in school age children in Brazil. First epidemiologic study concerning chronic otitis media in Latin America

OBJECTIVE The first epidemiological study carried out in Latin America to investigate the prevalence of otological disease and its impact in a representative random sample of the school children population. METHODS A cross sectional epidemiological survey to investigate the epidemiology of otitis in a representative random sample of 1119 children and adolescents from a total of 486166 elementary and high-school students, aged 6-18 years, regularly registered in one of the 521 public and private schools of the city of Belo Horizonte, in the state of Minas Gerais, southern Brazil. The interviews were conducted individually, in the school, by an otolaryngologist or a pediatrician. The interview included all of the personal data and also detailed questions regarding otological disorders and hearing. The otological examination was carried out with Mini-Heine otoscopes and the audiometric evaluation with the AudioScope 3 with 25dB intensity. The questionnaire and basic procedures for medical examination had been previously tested through a pilot test in two schools. RESULTS The prevalence of chronic otitis media was 0.94%. Impacted wax was found in 12.3% of the students. The prevalence of abnormalities (excluding wax) in the otoscopy examination was 10.5%. It was found that 8.3% of students had a past history of otitis and 7.7% had a past history of otorrhea. These two special groups presented statistically significant associations with chronic otitis media, hearing loss and otolaryngological surgeries (when compared with the other school children). Parents and school children seemed significantly able to identify a special group of children with past history of otitis during childhood.