Hermano Alexandre Lima Rocha

Prevalência e determinantes de obesidade e sobrepeso em mulheres em idade reprodutiva residentes na região semiárida do Brasil

O estudo estimou a prevalencia e identificou fatores determinantes do sobrepeso e obesidade em mulheres em idade fertil na regiao semiarida do Brasil. Na amostra por conglomerados de oito mil domicilios do estado do Ceara, foram pesquisadas 6.845 mulheres. Sobrepeso e obesidade foram medidos pelo Indice de Massa Corporal, utilizando-se a analise multivariada para a identificacao dos fatores determinantes. As prevalencias de sobrepeso e obesidade foram de 32,6% e 16,1%, respectivamente. Na analise ajustada, a obesidade esteve positivamente associada a: idade >30 anos (RP=1,55), estado civil casada (RP=1,36), escolaridade fundamental (RP=1,40), idade na menarca 1 filho (RP=1,65), uso de contraceptivos (RP=1,31). Os fatores relacionados a saude e a nutricao, referentes a obesidade morbida, foram: hipertensao arterial (RP=3,11), diabetes (RP=2,08), insatisfacao com a imagem corporal (RP=4,26) e procedimentos para perder peso (RP=2,73). Sobrepeso e obesidade sao altamente prevalentes na regiao semiarida. A educacao foi o unico fator socioeconomico passivel de ser modificado. Os fatores reprodutivos identificados apontam para a necessidade de mobilizacao dos servicos de pre-natal, pos-parto e planejamento familiar na prevencao e no controle da obesidade.

Prevalence and determinants of child undernutrition and stunting in semiarid region of Brazil

OBJETIVO : Analisar tendencias na prevalencia e determinantes da desnutricao em criancas na regiao semiarida do Brasil. METODOS : Foram analisados dados de duas pesquisas transversais domiciliares de base populacional que utilizaram a mesma metodologia. A amostragem por conglomerados foi utilizada para coletar os dados de 8.000 familias, do estado do Ceara, Nordeste do Brasil, para os anos de 1987 e 2007. A desnutricao aguda foi calculada como peso/idade < -2 desvios padrao; nanismo como altura/idade < -2 desvios padrao; e emaciacao como peso/altura < -2 desvios padrao. Os dados sobre os determinantes biologicos e sociodemograficos foram analisados por meio de analises multivariadas com base em um modelo teorico hierarquizado. RESULTADOS : Amostras de 4.513 e 1.533 criancas menores de tres anos de idade, em 1987 e 2007, respectivamente, foram incluidas nas analises. A prevalencia de desnutricao aguda foi reduzida em 60,0%, passando de 12,6% em 1987, para 4,7% em 2007, enquanto a prevalencia de nanismo foi reduzida em 50,0%, passando de 27,0% em 1987 para 13,0% em 2007. A prevalencia de emaciacao teve pouca alteracao no periodo. Em 1987, as caracteristicas socioeconomicas e biologicas (renda familiar, escolaridade da mae, disponibilidade de latrina e agua potavel, consulta medica e hospitalizacao da crianca, idade, sexo e peso ao nascer) foram fatores significativamente associados a desnutricao, ao nanismo e a emaciacao. Em 2007, os determinantes da desnutricao ficaram restritos as caracteristicas biologicas (idade, sexo e peso ao nascer). Apenas uma caracteristica socioeconomica, a disponibilidade de latrina, permaneceu significantemente associada ao nanismo. CONCLUSOES : O desenvolvimento socioeconomico, alem de intervencoes de saude, parecem ter efetivamente contribuido para a melhoria do estado nutricional das criancas. Peso ao nascer, especialmente o peso extremamente baixo (< 1.500 g), aparece como o fator de risco mais importante para a desnutricao na primeira infância.OBJECTIVE To analyze the evolution in the prevalence and determinants of malnutrition in children in the semiarid region of Brazil. METHODS Data were collected from two cross-sectional population-based household surveys that used the same methodology. Clustering sampling was used to collect data from 8,000 families in Ceará, Northeastern Brazil, for the years 1987 and 2007. Acute undernutrition was calculated as weight/age < -2 standard deviation (SD); stunting as height/age < -2 SD; wasting as weight/height < -2 SD. Data on biological and sociodemographic determinants were analyzed using hierarchical multivariate analyses based on a theoretical model. RESULTS A sample of 4,513 and 1,533 children under three years of age, in 1987 and 2007, respectively, were included in the analyses. The prevalence of acute malnutrition was reduced by 60.0%, from 12.6% in 1987 to 4.7% in 2007, while prevalence of stunting was reduced by 50.0%, from 27.0% in 1987 to 13.0% in 2007. Prevalence of wasting changed little in the period. In 1987, socioeconomic and biological characteristics (family income, mother’s education, toilet and tap water availability, children’s medical consultation and hospitalization, age, sex and birth weight) were significantly associated with undernutrition, stunting and wasting. In 2007, the determinants of malnutrition were restricted to biological characteristics (age, sex and birth weight). Only one socioeconomic characteristic, toilet availability, remained associated with stunting. CONCLUSIONS Socioeconomic development, along with health interventions, may have contributed to improvements in children’s nutritional status. Birth weight, especially extremely low weight (< 1,500 g), appears as the most important risk factor for early childhood malnutrition.

RIFLE and Acute Kidney Injury Network classifications predict mortality in leptospirosis-associated acute kidney injury.

Aim:  Acute kidney injury (AKI) is a common complication in leptospirosis. The aim of this study is to investigate the association between RIFLE and AKIN classifications with mortality in leptospirosis‐associated AKI.

Factors associated with non-vaccination against measles in northeastern Brazil: Clues about causes of the 2015 outbreak

Measles is a highly contagious disease that can be effectively prevented through vaccination. The recent increase in vaccination coverage was successful in reducing the mortality globally of the disease by 74%. As a whole, the Americas have been considered a disease-free zone. However, it is known that if an immunization programs fails, there will be an accumulation of susceptible people that can lead to disease outbreaks. Recently, both the United States and Brazil faced outbreaks of measles. The present study aims to identify the determining factors of non-vaccination in Brazil in two different vaccination coverage moments, to provide clues as to the causes of current outbreaks. Data were drawn from five population-based cross-sectional studies that surveyed a representative sample of preschool children from 1987 to 2007 (9585 children in total). To assess childrens vaccination status, two different information sources were used: information provided by mothers and information from childrens health cards. Multivariate analyses with logistic binary regression models were conducted. After adjustment for confounding factors, it was observed that in 1987, with 48.2% vaccination coverage, socioeconomic, maternal, nutritional factors and access to health facilities were important, while in 2007 (96.7% coverage), nutritional and maternal factors were important. Distinct patterns of determinants of non-vaccination were also found. In addition, the low coverage in 1987 resulted in a current pool of adults who were not immunized as children; this may have contributed to the beginning of the current Brazilian outbreak. Globally, there are two standards of vaccination coverage (low and high). Therefore, discussion of the determinants of non-vaccination is important. Our findings suggest vulnerable groups should receive special attention to ensure they are protected. It is also important to consider the possible impact of pools of adults not immunized.

Different Patterns in a Cohort of Patients with Severe Leptospirosis (Weil Syndrome): Effects of an Educational Program in an Endemic Area

The aim of this study is to investigate the changes in clinical pattern and therapeutic measures in leptospirosis-associated acute kidney injury; a retrospective study with 318 patients in Brazil. Patients were divided according to the time of admission: 1985-1996 (group I) and 1997-2010 (group II). Patients were younger in group I (36 ± 13 versus 41 ± 16 years, P = 0.005) and the numbers of oliguria increased (21% versus 41% in group II, P = 0.014). Higher frequency of lung manifestations was observed in group II (P < 0.0001). Although increased severity, there was a significant reduction in mortality (20% in group I versus 12% in group II, P = 0.03). Mortality was associated with advanced age, low diastolic blood pressure, oliguria, arrhythmia, and peritoneal dialysis, besides a trend to better mortality with penicillin administration. Leptospirosis is occurring in an older population, with a higher number of oliguria and lung manifestations. However, mortality is decreasing and can be the result of changes in treatment.

Metodologia das Pesquisas Populacionais de Saúde Materno-Infantil: uma série transversal realizada no Estado do Ceará de 1987 a 2007

Objective: to describe the methods used in mother-child health studies (PESMIC), over a period of 20 years in Ceara. Methods: a series of studies carried out over a twenty-year period were examined with regard to the following aspects: a) population-based cross-sectional series studies, with a representative sample of 8000 families; b) questionnaires and anthropo-metric measurements were used, studying the levels and causes of infant mortality, the prevalence of mother and child malnutrition, the duration of breastfeeding, vaccination coverage, the prevalence and management of diarrhea and access to mother-child health services; c) the results obtained were outcome variables (mainly infant mortality) and various determining factors relating to the child and the mother and social and economic conditions. Results: the response rate was nearly 100% for the five studies (1986-2007) and there were important changes in socio-demographic and health indicators, an 81% reduction in the infant mortality rate, a 43% increase in breastfeeding an immunization rate of 95%. There was also a 243% increase in overweight. In total the five studies covered 177,132 residents, 47,508 women and 13,049 children. Conclusion: it is recommended that these studies should be continued using the same methodology, making it possible to analyze variations over time.

Preliminary Study on Tubuloglomerular Dysfunction and Evidence of Renal Inflammation in Patients with Visceral Leishmaniasis

Visceral leishmaniasis (VL) is a re-emerging zoonosis of worldwide distribution. Monocyte chemotactic protein-1 (MCP-1) and malondialdehyde (MDA) are inflammation biomarkers that have never been investigated in VL. The aim of this study is to investigate the association between renal abnormalities and inflammation biomarkers in VL. This study is a preliminary prospective study with 16 VL adult patients evaluated before treatment compared with a group of 13 healthy volunteers and 5 VL patients evaluated after treatment. Urinary concentration and acidification tests were performed. MCP-1 and MDA were quantified in urine. Urinary concentration deficit was found in all VL patients before (100%) and four VL patients after (80%) treatment. Urinary acidification deficit was found in nine cases before (56.2%) and two cases after (40%) treatment. Urinary MCP-1 (374 ± 359 versus 42 ± 29 pg/mg creatinine, P = 0.002) as well as urinary MDA (5.4 ± 2.6 versus 2.0 ± 0.8 μmol/mL) showed significant differences between VL patients and controls. These data show that VL patients present urinary concentration and acidification deficit, which can persist even after specific treatment. Urinary MCP-1 and MDA are elevated in patients with VL, which suggests renal inflammation and incipient renal damage.

Changing patterns in leptospirosis: a three-decade study in Brazil

BACKGROUND This study was conducted to investigate changes in the clinical pattern of leptospirosis over time, analyzing its clinical and laboratory presentations in a metropolitan city of Brazil. METHOD This was a retrospective study including all patients with leptospirosis admitted to tertiary care hospitals in Fortaleza in the northeast of Brazil, between 1985 and 2015. Patients were divided into three groups according to the year of hospital admission: group I for the years 1985-1995, group II for 1996-2005, and group III for 2006-2015. Demographic, clinical, and laboratory data were compared between the groups. RESULTS A total of 507 patients were included. Their mean age was 37.3±15.9years and 82.4% were male. The mean time between symptom onset and admission was 7±4 days. There was a linear decrease in the levels of serum urea (190.1±92.7, 135±79.5, and 95.6±73.3mg/dl, respectively, p <0.0001) and creatinine (5.8±2.9, 3.8±2.6, and 3.0±2.5mg/dl, respectively, p <0.0001) in each decade, while levels of hemoglobin (10.31±1.9, 10.8±2.0, and 11.5±2.1g/dl, respectively, p <0.0001) and platelets (57.900±52.650, 80.130±68.836, and 107.101±99.699×109/l, respectively, p<0.0001) increased. There was a tendency towards a linear decrease in mortality (22%, 14%, and 11.6%, respectively, p=0.060). CONCLUSIONS Leptospirosis showed significant changes over time in this region. The main changes point to a decrease in disease severity and complications, such as acute kidney injury. Mortality has decreased, being close to 11%.

Prevalência e determinantes da desnutrição infantil no semiárido do Brasil

OBJETIVO : Analisar tendencias na prevalencia e determinantes da desnutricao em criancas na regiao semiarida do Brasil. METODOS : Foram analisados dados de duas pesquisas transversais domiciliares de base populacional que utilizaram a mesma metodologia. A amostragem por conglomerados foi utilizada para coletar os dados de 8.000 familias, do estado do Ceara, Nordeste do Brasil, para os anos de 1987 e 2007. A desnutricao aguda foi calculada como peso/idade < -2 desvios padrao; nanismo como altura/idade < -2 desvios padrao; e emaciacao como peso/altura < -2 desvios padrao. Os dados sobre os determinantes biologicos e sociodemograficos foram analisados por meio de analises multivariadas com base em um modelo teorico hierarquizado. RESULTADOS : Amostras de 4.513 e 1.533 criancas menores de tres anos de idade, em 1987 e 2007, respectivamente, foram incluidas nas analises. A prevalencia de desnutricao aguda foi reduzida em 60,0%, passando de 12,6% em 1987, para 4,7% em 2007, enquanto a prevalencia de nanismo foi reduzida em 50,0%, passando de 27,0% em 1987 para 13,0% em 2007. A prevalencia de emaciacao teve pouca alteracao no periodo. Em 1987, as caracteristicas socioeconomicas e biologicas (renda familiar, escolaridade da mae, disponibilidade de latrina e agua potavel, consulta medica e hospitalizacao da crianca, idade, sexo e peso ao nascer) foram fatores significativamente associados a desnutricao, ao nanismo e a emaciacao. Em 2007, os determinantes da desnutricao ficaram restritos as caracteristicas biologicas (idade, sexo e peso ao nascer). Apenas uma caracteristica socioeconomica, a disponibilidade de latrina, permaneceu significantemente associada ao nanismo. CONCLUSOES : O desenvolvimento socioeconomico, alem de intervencoes de saude, parecem ter efetivamente contribuido para a melhoria do estado nutricional das criancas. Peso ao nascer, especialmente o peso extremamente baixo (< 1.500 g), aparece como o fator de risco mais importante para a desnutricao na primeira infância.OBJECTIVE To analyze the evolution in the prevalence and determinants of malnutrition in children in the semiarid region of Brazil. METHODS Data were collected from two cross-sectional population-based household surveys that used the same methodology. Clustering sampling was used to collect data from 8,000 families in Ceará, Northeastern Brazil, for the years 1987 and 2007. Acute undernutrition was calculated as weight/age < -2 standard deviation (SD); stunting as height/age < -2 SD; wasting as weight/height < -2 SD. Data on biological and sociodemographic determinants were analyzed using hierarchical multivariate analyses based on a theoretical model. RESULTS A sample of 4,513 and 1,533 children under three years of age, in 1987 and 2007, respectively, were included in the analyses. The prevalence of acute malnutrition was reduced by 60.0%, from 12.6% in 1987 to 4.7% in 2007, while prevalence of stunting was reduced by 50.0%, from 27.0% in 1987 to 13.0% in 2007. Prevalence of wasting changed little in the period. In 1987, socioeconomic and biological characteristics (family income, mother’s education, toilet and tap water availability, children’s medical consultation and hospitalization, age, sex and birth weight) were significantly associated with undernutrition, stunting and wasting. In 2007, the determinants of malnutrition were restricted to biological characteristics (age, sex and birth weight). Only one socioeconomic characteristic, toilet availability, remained associated with stunting. CONCLUSIONS Socioeconomic development, along with health interventions, may have contributed to improvements in children’s nutritional status. Birth weight, especially extremely low weight (< 1,500 g), appears as the most important risk factor for early childhood malnutrition.

Kidney dysfunction and beta S-haplotypes in patients with sickle cell disease.

Objetive To investigate the association between kidney dysfunction and haplotypes in sickle cell disease. Methods A cohort of 84 sickle cell disease patients, treated in a public health service in Fortaleza, Brazil, was studied. Hemoglobin S haplotypes were obtained from 57 patients as they had recently received blood transfusions with 18 of them agreeing to undertake urinary concentrating ability and acidification tests. The glomerular filtration rate was estimated using the Modification of Diet in Renal Disease Study equation. Urinary concentration was evaluated utilizing the urinary and serum osmolality ratio (U/Posm) after 12 hours of water deprivation. Urinary acidification was evaluated by measuring the urinary pH before and after the administration of oral CaCl2. The analysis of the haplotypes of the beta S gene cluster was carried out by polymerase chain reaction-restriction fragment length polymorphism. The analysis of variance (ANOVA) test was used for multiple comparisons of means and the Newman-Keuls test was used to identify which groups were significantly different. Results The mean age of the patients was 33 ± 13 years with 64.2% being females. The glomerular filtration rate was normal in 25 cases (30%) and a rate > 120 mL/min was seen in 52 cases (62%). Urinary concentration deficit was found in all patients who underwent the test and urinary acidification in 22%. There was no significant difference when comparing patients with the Bantu/Bantu and Benin/Benin haplotypes. On comparing patients with the Central African Republic-haplotype however, a higher number had glomerular filtration rates between 60 and 120 mL/min. Conclusion There was no significant difference among sickle cell disease patients regarding the haplotypes and kidney dysfunction.