Fernando Antonio Basile Colugnati

Secular trends and factors associated with overweight among Brazilian preschool children: PNSN-1989, PNDS-1996, and 2006/07

Objective to describe the secular trends in overweight among preschool children in the years 1989, 1996, and 2006, and to identify risk factors associated with this condition in 2006.OBJECTIVE to describe the secular trends in overweight among preschool children in the years 1989, 1996, and 2006, and to identify risk factors associated with this condition in 2006. METHODS anthropometric data from three surveys (1989, 1996, and 2006) with a representative sample of the population were analyzed. Overweight was defined as the weight-for-height Z-score. The multivariable models of overweight association with risk factors were generated by Poisson regression, and the estimates were shown as prevalence ratios with their respective 95% confidence intervals (PR [95% CI]). RESULTS throughout the 17-year period studied, the relative prevalence of overweight in preschoolers increased by 160% in Brazil, representing an increase of 9.4% per year. Based on data from the National Survey on Demography and Health of Women and Children - 2006/07, four multivariable models were created (macro-environmental, maternal, individual, and final model) assuming hierarchy among the risk factors. In the final model, only the following remained associated with overweight: regions South/Southeast (1.55 [1.17 to 2.06]), middle-class (1.35 [1.02 to 1.77]), maternal obesity (1.66 [1.22 to 2.27]), birth weight ≥ 3.9kg (1.87 [1.31 to 2.67]), and being an only child or having only one sibling (1.81 [1.31 to 2.49]). CONCLUSION the prevalence of overweight among preschool children in Brazil has increased dramatically over the past 17 years, and it was higher in the 1996-2006 period. Future strategies for prevention and control of overweight in public health should focus or intensify actions in communities that are characterized by the presence of the risks identified in the present study.

Transcultural adaptation and initial validation of Brazilian-Portuguese version of the Basel assessment of adherence to immunosuppressive medications scale (BAASIS) in kidney transplants

BackgroundTransplant recipients are expected to adhere to a lifelong immunosuppressant therapeutic regimen. However, nonadherence to treatment is an underestimated problem for which no properly validated measurement tool is available for Portuguese-speaking patients. We aimed to initially validate the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS®) to accurately estimate immunosuppressant nonadherence in Brazilian transplant patients.MethodsThe BAASIS® (English version) was transculturally adapted and its psychometric properties were assessed. The transcultural adaptation was performed using the Guillemin protocol. Psychometric testing included reliability (intraobserver and interobserver reproducibility, agreement, Kappa coefficient, and the Cronbach’s alpha) and validity (content, criterion, and construct validities).ResultsThe final version of the transculturally adapted BAASIS® was pretested, and no difficulties in understanding its content were found. The intraobserver and interobserver reproducibility variances (0.007 and 0.003, respectively), the Cronbach’s alpha (0.7), Kappa coefficient (0.88) and the agreement (95.2%) suggest accuracy, preciseness and reliability. For construct validity, exploratory factorial analysis demonstrated unidimensionality of the first three questions (r = 0.76, r = 0.80, and r = 0.68). For criterion validity, the adapted BAASIS® was correlated with another self-report instrument, the Measure of Adherence to Treatment, and showed good congruence (r = 0.65).ConclusionsThe BAASIS® has adequate psychometric properties and may be employed in advance to measure adherence to posttransplant immunosuppressant treatments. This instrument will be the first one validated to use in this specific transplant population and in the Portuguese language.

The role of exclusive breastfeeding and sugar-sweetened beverage consumption on preschool children's weight gain.

Sugar‐sweetened beverages (SSBs) and breastfeeding practices have been recognized as important factors linked to childrens weight status. However, no other studies have simultaneously investigated the role of each factor on childrens conditional weight gain (CWG).

Exclusive breastfeeding duration and determinants among Brazilian children under two years of age

OBJECTIVE: The present study described the duration and identified the determinants of exclusive breastfeeding. METHODS: The study used data from the Pesquisa Nacional de Demografia e Saude da Crianca e da Mulher 2006 (National Demographic and Health Survey on Women and Children 2006). Data were collected using questionnaires administered by trained professionals and refer to a subsample of 1,704 children aged less than 24 months. The estimated durations of exclusive breastfeeding are presented according to socioeconomic, demographic and epidemiological variables. Kaplan Meier estimator curves were used to produce valid estimates of breastfeeding duration and the Coxs proportional hazards model was fitted to identify risks. RESULTS: The median estimated duration of exclusive breastfeeding was 60 days. The final Cox model consisted of mothers age <20 years (hazard ratio=1.53, 95% confidence interval=1.11-1.48), use of pacifier (hazard ratio=1.53, 95% confidence interval=1.37-1.71), not residing in the countrys southeast region (hazard ratio=1.22, 95% confidence interval=1.07-1.40) and socioeconomic status (hazard ratio=1.28, 95% confidence interval=1.06-1.55). CONCLUSION: The Kaplan Meier estimator corrected the underestimated duration of breastfeeding in the country when calculated by the current status methodology. Despite the national efforts done in the last decades to promote breastfeeding, the results indicate that the duration of exclusive breastfeeding is still half of that recommended for this dietary practice to promote health. Ways to revert this situation would be ongoing educational activities involving the educational and health systems, associated with advertising campaigns on television and radio mainly targeting young mothers with low education level and low income, identified as those at high risk of weaning their children early.

Association between socioeconomic and biological factors and infant weight gain: Brazilian Demographic and Health Survey – PNDS-2006/07

OBJECTIVE To examine the associations between socioeconomic and biological factors and infant weight gain. METHODS All infants (0-23 months of age) with available birth and postnatal weight data (n = 1763) were selected from the last nationally representative survey with complex probability sampling conducted in Brazil (2006/07). The outcome variable was conditional weight gain (CWG), which represents how much an individual has deviated from his/her expected weight gain, given the birth weight. Associations were estimated using simple and hierarchical multiple linear regression, considering the survey sampling design, and presented in standard deviations of CWG with their respective 95% of confidence intervals. Hierarchical models were designed considering the UNICEF Conceptual Framework for Malnutrition (basic, underlying and immediate causes). RESULTS The poorest Brazilian regions (-0.14 [-0.25; -0.04]) and rural areas (-0.14 [-0.26;-0.02]) were inversely associated with CWG in the basic causes model. However, this association disappeared after adjusting for maternal and household characteristics. In the final hierarchical model, lower economic status (-0.09 [-0.15; -0.03]), human capital outcomes (maternal education < 4th grade (-0.14[-0.29; 0.01]), higher maternal height (0.02[0.01; 0.03])), and fever in the past 2 weeks (-0.13[-0.26; -0.01]) were associated with postnatal weight gain. CONCLUSION The results showed that poverty and lower human capital are still key factors associated with poor postnatal weight gain. The approach used in these analyses was sensitive to characterize inequalities among different socioeconomic contexts and to identify factors associated with CWG in different levels of determination.

Avaliação do risco cardiovascular em hipertensos

Objetivo: evaluar el riesgo cardiovascular utilizando el puntaje de Framingham tradicional y el modificado por la incorporacion de factores de riesgo emergentes como historia familiar de infarto agudo del miocardio, sindrome metabolico y enfermedad renal cronica. Metodo: participaron 50 hipertensos que hacen tratamiento en ambulatorio. Los datos clinicos fueron obtenidos por medio de entrevista semiestructurada y los de laboratorio fueron obtenidos de fichas. Resultados: se verifico que el puntaje de Framingham tradicional fue predominantemente bajo (74%), 14% presento riesgo medio y 12% riesgo alto. Tras la inclusion de factores de riesgo emergentes, la probabilidad de ocurrir un evento coronario fue baja en 22% de los casos, media en 56% y alta en 22% de los casos. Conclusiones: la comparacion entre el puntaje de riesgo de Framingham tradicional y el modificado demostro diferencia significativa entre la clasificacion del riesgo cardiovascular, cuya correlacion muestra discreta concordancia entre las dos escalas. Los elementos relacionados al estilo de vida parecen ser determinantes en el aumento del riesgo cardiovascular.

Cardiovascular risk assessment in hypertensive patients.

Objetivo: evaluar el riesgo cardiovascular utilizando el puntaje de Framingham tradicional y el modificado por la incorporacion de factores de riesgo emergentes como historia familiar de infarto agudo del miocardio, sindrome metabolico y enfermedad renal cronica. Metodo: participaron 50 hipertensos que hacen tratamiento en ambulatorio. Los datos clinicos fueron obtenidos por medio de entrevista semiestructurada y los de laboratorio fueron obtenidos de fichas. Resultados: se verifico que el puntaje de Framingham tradicional fue predominantemente bajo (74%), 14% presento riesgo medio y 12% riesgo alto. Tras la inclusion de factores de riesgo emergentes, la probabilidad de ocurrir un evento coronario fue baja en 22% de los casos, media en 56% y alta en 22% de los casos. Conclusiones: la comparacion entre el puntaje de riesgo de Framingham tradicional y el modificado demostro diferencia significativa entre la clasificacion del riesgo cardiovascular, cuya correlacion muestra discreta concordancia entre las dos escalas. Los elementos relacionados al estilo de vida parecen ser determinantes en el aumento del riesgo cardiovascular.

Avaliação de serviços em saúde mental no Brasil: revisão sistemática da literatura

Assessment in the mental health area is a mechanism able to generate information that positively helps decision-making. Therefore, it is necessary to appropriate on the existing discussions, reasoning the challenges and possibilities linked to knowledge production within this scientific filed. A systematic review of publications about the Brazilian scientific production on mental health service assessment was performed, identifying and discussing methods, assessment perspectives and results. The search for articles was done in IBECS, Lilacs and Scielo databases, considering the publication of Federal Law 10.216. Thirty-five articles were selected based on the used terms and on the inclusion and exclusion criteria. Scientific production in this field is concentrated in the South and Southwest regions and holds different scopes and participants. Such wide range of possibilities is adopted as a way to help improving services and decision-making processes in mental health care. Advances in humanized, participative and community care are highlighted, but requiring more investments, professional qualification and organizational improvements. It is postulated greater integration among research, with evaluations going beyond structural aspects and the comparison with hospitalocentric models.Assessment in the mental health area is a mechanism able to generate information that positively helps decision-making. Therefore, it is necessary to appropriate on the existing discussions, reasoning the challenges and possibilities linked to knowledge production within this scientific filed. A systematic review of publications about the Brazilian scientific production on mental health service assessment was performed, identifying and discussing methods, assessment perspectives and results. The search for articles was done in IBECS, Lilacs and Scielo databases, considering the publication of Federal Law 10.216. Thirty-five articles were selected based on the used terms and on the inclusion and exclusion criteria. Scientific production in this field is concentrated in the South and Southwest regions and holds different scopes and participants. Such wide range of possibilities is adopted as a way to help improving services and decision-making processes in mental health care. Advances in humanized, participative and community care are highlighted, but requiring more investments, professional qualification and organizational improvements. It is postulated greater integration among research, with evaluations going beyond structural aspects and the comparison with hospitalocentric models.

Serum levels of vitamin D and chronic periodontitis in patients with chronic kidney disease

INTRODUCTION Concomitance of chronic periodontitis (CP) in patients with chronic kidney disease (CKD) have been associated with adverse outcomes. Vitamin D (25(OH)D) deficiency my play a role in CP and inadequate vitamin D status is common among patients with CKD. OBJECTIVE To examine the relationship between vitamin 25(OH)D and CP in patients with CKD not yet on dialysis. METHOD A case-control study was conducted. Cases and controls were defined as patients with CKD with and without CP, respectively. The demographic, clinical and laboratory data were obtained when the patient was attended in the outpatient clinic. CKD was defined and staged according to the NKF QDOKI TM. Serum 25(OH) D levels were measured by chemiluminescence when assessing the CP, which was definined according to the American Academy of Periodontoly (1999). Serum 25(OH)D levels were stratified into deficient (< 14 ηg/mL), insufficient (15-29 ηg/mL) and sufficiency (> 30 ηg/ mL). RESULTS A total of 15 cases were compared with 14 controls. Cases had lower median 25(OH)D levels than controls (22.6 versus 28.6 ηg/mL, p < 0.01) and were more likely to be categorized as vitamin D insufficiency/deficiency (93,3% versus 57,1%, p < 0,004). On the other hand, the percentage of controls with vitamin D sufficiency was higher then cases (42,9% versus 6,7%, p < 0,004). CONCLUSION In patients with CKD not yet on dialysis, vitamin D deficiency is associated with CP.INTRODUCAO A concomitância de periodontite cronica (PC) em pacientes com doenca renal cronica (DRC) tem sido associada a desfechos adversos. A deficiencia de vitamina D (25(OH)D) parece desempenhar papel importante na PC e niveis inadequados de vitamina D tem sido descritos em pacientes com DRC. OBJETIVO: Examinar a relacao entre niveis sericos de vitamina D e PC em pacientes com DRC pre-dialitica. METODO: Estudo de caso-controle, definidos, respectivamente, como pacientes com DRC e PC e DRC sem PC. Os dados demograficos, de exame fisico e laboratoriais foram obtidos no dia da consulta. A DRC foi definida e estagiada segundo a NKF QDOKITM. Os niveis sericos de 25(OH) D foram dosados por quimioluminescencia quando da avaliacao da PC, a qual foi caracterizada segundo os criterios de Academia Americana de Periodontologia (1999). Os resultados de 25(OH)D foram estratificados em deficiencia ( 30 ηg/mL). RESULTADOS: Um total de 29 pacientes foram estudados, 15 no grupo caso e 14 no grupo controle. Os pacientes casos apresentaram mediana de 25(OH) D inferior a dos pacientes controles (22,6 vs. 28,6 ηg/mL; p < 0,01). A frequencia de pacientes casos com insuficiencia/deficiencia de vitamina D foi maior do que entre os pacientes controles (93,3% vs. 57,1%, p < 0,004). Por outro lado, o percentual de pacientes com suficiencia de vitamina D foi maior entre os controles se comparados aos integrantes do grupo casos (42,9% vs. 6,7%, p < 0,004). CONCLUSAO: Em pacientes com DRC, a deficiencia de vitamina D se associa com PC.

Geographical distribution of medical graduates from a public university

Objective: To evaluate the geographic distribution and career trajectory of medical graduates and the factors associated with their choice of practice location. Method: A cross-sectional study involving graduates from December 2001 to December 2010 was conducted. A self-administered questionnaire collected demographics and geographic information (place of birth, place of residence at the time of medical school admission, place of residency training and practice location), and reason for choosing the current location. Statistical analyses assessed trends in geographic distribution of graduates, and identified factors associated with location choice (through the population density of the location chosen for professional practice). Results: A total of 563 graduates completed the questionnaire. Of those, 4.3% (n=24) reported family medicine as their medical specialty, 19.9% (n=112) reported other primary care specialties (internal medicine, pediatrics, surgery and obstetrics-gynecology) and the others chose subspecialties. Larger cities were more likely to be chosen for practice, particularly for newly-graduated doctors. Job invitations received during medical residency training increased the likelihood of choosing high-populated cities. In contrast, job invitations received during medical school increased the likelihood of choosing cities less populated. Amongst those in cities with lower population density, proximity to family members was an additional influencing factor; those who chose more densely populated cities did so because of better infrastructure and recreational options. Conclusion: Most of the physicians included in this study pursue subspecialties training and were practicing medicine in large cities. Knowing the multiple factors that influenced the choice of practice location can assist in planning future strategies to reduce physician workforce misdistribution.