Luiz Oscar Cardoso Ferreira

Efetividade de três esquemas com sulfato ferroso para tratamento de anemia em gestantes

OBJECTIVE To evaluate the effectiveness of three regimens employing ferrous sulfate to treat pregnant women with anemia. METHODS The study was carried out at the Womens Health Center of the Pernambuco Institute of Maternal and Child Health in the city of Recife, Pernambuco, Brazil, from May 2000 to December 2001. A randomized clinical trial with blinded laboratory analysis was conducted. Iron (60 mg) was administered as 300-mg ferrous sulfate tablets. The women were allocated to three treatment groups, according to the frequency of ingesting the tablets: once a week (48 women), twice a week (53 women), and once a day (49 women). The groups were compared for the values for hemoglobin (Hb) concentration, mean corpuscular volume, and ferritin before and after the treatment. RESULTS Before the intervention, the groups were homogeneous. They had the following mean (+/- standard deviation) concentrations of hemoglobin: 10.2 +/- 0.5 g/dL for the group receiving iron once a week, 10.2 +/- 0.6 g/dL for the group receiving iron twice a week, and 10.1 +/- 0.6 g/dL for the group receiving iron once a day. The means of corpuscular volume were, respectively: 88.5 +/- 5.0 fL, 87.6 +/- 5.9 fL, and 88.7 +/- 5.1 fL. The respective medians for ferritin were 30.2 ng/mL, 37.1 ng/mL, and 52.9 ng/mL. The cure rate (Hb > 11 g/dL) was 27% in the patients treated once a week, 34% in those treated twice a week, and 47% in the women treated daily. Treatment failure (hemoglobin < 10 g/dL) was seen in 41.6%, 13.2%, and 2.0% of the patients in the respective groups. Interruption of treatment due to diarrhea or epigastric pain occurred only among the patients treated daily. CONCLUSION The regimen with iron administered daily is still the best option for treating anemia. However, treatment with ferrous sulfate administered twice a week is an alternative for patients who are unable to adhere to daily treatment.

Adherence and side effects of three ferrous sulfate treatment regimens on anemic pregnant women in clinical trials

The objective of this study was to analyze adherence and side effects of three iron supplement regimens (ferrous sulfate) on anemic pregnant women. The clinical trial involved 150 women between the 16th and 20th gestational weeks, at low obstetric risk and with hemoglobin concentration of between 8.0 and 11.0 g/dL. Treatment was provided by ferrous sulfate with 60 mg of elemental iron during 16 (+/- 1) weeks, in three regimens: single tablet a week (n = 48); single tablet twice a week (n = 53) or single tablet a day (n = 49). The outcomes were adherence, assessed through interviews and by counting tablets, and side effects, according to patient information. The adherence showed a declining trend (92%, 83% and 71%; p = 0.010) and the side effects revealed a growing trend (40%, 45% and 71%; p = 0.002) as the dosage increased. Diarrhea and epigastric pain were significantly associated with the dose administered (p = 0.002). These results suggest that in anemic pregnant women, complaints are directly proportional and the compliance is inversely proportional to the amount of medicinal iron.O objetivo deste estudo foi analisar a adesao e os efeitos colaterais de tres esquemas de suplementacao com sulfato ferroso em gestantes anemicas. O ensaio clinico incluiu 150 mulheres entre a 16a e 20a semanas de gestacao, de baixo risco obstetrico e com concentracao de hemoglobina entre 8,0 e 11,0g/dL. A intervencao foi realizada com 60mg de ferro elementar, durante 16 (±1) semanas, em tres esquemas: uma dragea semanal (n = 48); uma dragea duas vezes por semana (n = 53) ou uma dragea diariamente (n = 49). Os desfechos foram adesao, verificada por entrevista e contagem das drageas, e efeitos colaterais auto-relatados pelas pacientes. A adesao apresentou tendencia declinante (92%, 83% e 71%; p = 0,010) e os efeitos colaterais, ascendente (40%, 45% e 71%; p = 0,002) com o aumento da dose prescrita. Diarreia e dor epigastrica estiveram significativamente associadas a dose administrada (p = 0,002). Os resultados sugerem que em gestantes anemicas as queixas e a adesao ao tratamento com sulfato ferroso sao, respectivamente, direta e inversamente proporcionais a quantidade do ferro medicamentoso.

Fatores de risco para a mortalidade perinatal no Recife, Pernambuco, Brasil, 2003

The aim of this study was to identify and analyze risk factors for perinatal mortality in Recife, Pernambuco State, Brazil, in 2003, using a multilevel hierarchical model. In this case-control study, cases consisted of all perinatal deaths in 2003 in singleton infants with birth weight > 500g and without congenital malformations. The controls were live births from December 26, 2002, to December 31, 2003, with the same characteristics as the study group, but who survived > 6 days. By using record linkage techniques, 403 cases and 1,612 controls were obtained. All variables, when submitted jointly to multiple logistic regression, showed statistical significance in decreasing order of risk, as follows: prematurity (OR = 18.23), low birth weight (OR = 4.90), maternal age > 35 (OR = 1.97), delivery in public hospitals (OR = 1.93), and maternal schooling < 4 years (OR = 1.78).

Perfil epidemiológico da tuberculose no Município de Teresina-PI, no período de 1999 a 2005

Summary This work describes the epidemiological features of tuberculosis in the city of Teresina, Piaui State, Brazil, from 1999 to 2005. This is a descriptive epidemiologic study of historical series on newly reported tuberculosis cases among residents of Teresina, State of Piaui, by analyzing their demographic, socioeconomic and clinical characteristics. Data were collected from the Information System for Notifiable Diseases (Sinan) and from the Information System on Mortality in Teresina. The median incidence rate of new cases was 50.1/100,000 population and the mean mortality coefficient was 3.3/100,000 population. The disease has affected mostly males (64.0%), those who had less than 7 ye ars of formal education (70.33%) and in young adults (58.8%), although the highest incidence rate was found in the age group of 50 and over. Pulmonary tuberculosis was found in 80.23% of all cases. As for the course of the disease, 71.07% of patients were cured and 17.15% were transferred from one health service to another. This study has helped understand the characteristics of the population studied and the difficulties of the Tuberculosis Control Program in the city of Teresina as far as Sinan is concerned.

Prevenção e tratamento da anemia nutricional ferropriva: novos enfoques e perspectivas

The authors briefly describe the epidemiology of anemia, the goals established by the United Nations to combat the problem worldwide, and the difficulties encountered in applying proven effective strategies in public health services to prevent and cure anemia in pregnant women and children, both of which are prime high-risk groups. They analyze recent research aimed at four objectives related to prevention and cure: improving treatment efficacy; increasing effectiveness; reducing costs; and decreasing unwanted side effects. The study indicates that ongoing research could improve prospects for treatment through public health services.

Eficácia da suplementação de ferro associado ou não à vitamina A no controle da anemia em escolares

This study aimed to evaluate the efficacy of weekly iron supplementation with or without vitamin A in the treatment of iron deficiency anemia, using an experimental, randomized, non-placebo-controlled design in 1999. 267 schoolchildren 6 to 14 years of age were randomized to two treatment groups: one group (144) received 200mg iron sulfate alone, with 40 mg of elemental iron, while the other (123) received the same iron supplementation dose plus 10,000 IU of vitamin A (both groups for 30 weeks). Final anemia prevalence was reduced from 48.4% to 17.7% (p < 0.001) in the group receiving iron supplementation alone and 58.1% to 14.3% (p < 0.001) in the group receiving iron plus vitamin A. There was no significant difference between the groups at the end of the study according to mean Hb (p = 0.355) and anemia (p = 0.479). There was a significant correction for iron deficiency anemia with weekly iron-alone supplementation, but with no additional advantage of vitamin A. New studies on the synergism between these two micronutrients are recommended.

Estudo descritivo da homofobia e vulnerabilidade ao HIV/Aids das travestis da Região Metropolitana do Recife, Brasil

This study sought to ascertain the vulnerabilities to HIV/Aids of transvestites of the Metropolitan Region of Recife. The Respondent-Driven Sampling (RDS) method was selected for data collection. Among the 110 transvestites, high indices of homophobia were found in locations such as: security services, work facilities, family and religious environments, neighborhood, school, stores, leisure spaces, and healthcare services. Among the situations of violence experienced, the predominant cases involved verbal aggression (81.8%) and physical aggression (68.2%). The HIV test carried out at some stage in their lives was reported by 84.4% of the subjects. A high level of knowledge of the forms of HIV prevention and transmission was detected. The majority of the transvestites began their sexual activity before 15 years of age without condom use. It was seen that in the context of the HIV/Aids epidemic, the strategies for health promotion can only be effective if factors for enhancing the understanding of the vulnerability to HIV/Aids, such as homophobia, are considered.Ao longo dos ultimos 30 anos, o Brasil vem experimentando um aumento exponencial de suas taxas de homicidio, problema este impulsionado pelo morticinio de jovens do sexo masculino, nao brancos, pobres, moradores de vilas e favelas. Diante do recrudescimento e da complexificacao do fenomeno dos homicidios no Brasil, o presente artigo tem como objetivo discutir alguns dos principais efeitos que estas tendencias projetam sobre o trabalho policial investigativo. Para tanto, realizou-se, entre os anos de 2009 e 2010, um longo trabalho de pesquisa etnografica em seis Delegacias Especializadas de Homicidios da cidade de Belo Horizonte. Durante este periodo, pesquisadores vivenciaram a rotina diaria destas unidades e realizaram diversas de entrevistas em profundidade com investigadores e delegados da Policia Civil. Dentre os resultados destaca-se o descompasso entre a crescente complexidade do fenomeno criminal e as praticas e os procedimentos legais previstos para a investigacao dos homicidios em BH.

Efetividade da aplicação do sulfato ferroso em doses semanais no Programa Saúde da Família em Caruaru, Pernambuco, Brasil

Descreve-se, neste artigo, a avaliacao da efetividade de um projeto experimental de enfrentamento da anemia em criancas de 6 a 23 meses de idade, utilizando doses semanais de sulfato ferroso, atraves do Programa Saude da Familia em Caruaru, Pernambuco, Brasil. O Ministerio da Saude iniciou, em 1999, um programa de combate a anemia em cerca de 300 mil criancas de 512 municipios do Nordeste. Foram aplicados as criancas 50mg de ferro elementar por semana durante cerca de 24 semanas. Avaliaram-se, nesse estudo, 293 criancas de 6 a 23 meses de idade em zonas rural e urbana do Municipio de Caruaru. Antes do inicio da intervencao, a media da concentracao de hemoglobina (dosada pelo metodo da cianometahemoglobina) era de 10,1 (±0,98) g/dl e existiam 77,5% de criancas anemicas. Apos o tratamento, a media de hemoglobina elevou-se para 11,1 (±0,87) g/dl, enquanto ocorreu uma reducao da anemia para 40,3%. A estrategia representa um instrumento promissor na reducao da prevalencia e no controle das formas graves de anemia em criancas.

Cartografia do retardo estatural em escolares do Estado da Paraíba, Brasil

OBJECTIVE The study is part of a project financed by the United Nations (FAO) and the Ministry of Education of Brazil (Fundação de Assistência ao Escolar) which intends to evaluate the nutritional status of public schools students in order to estimate, giving emphasis to geographical aspects, the magnitude and distribution of statural deficit of this population in the Paraíba State, Northeastern Brazil. METHODS Schoolchildren, aged 6-9 years and enrolled in the first grade inall municipalities of Paraíba state went through a height survey. We consider as statural deficit values below -2 standard deviations according to the anthropometric pattern of National Center of Health Statistics. RESULTS A frequency of 14. 5% of statural deficit was found in the whole state, as well as 18. 7% in the semidesertic region (sertão), 13.8% in Agreste area, 11. 9% in Borborema region and 10.9% in Mata zone. In rural area, the prevalence of statural deficit was higher (17.8%) than for those living in urban area (11.8%). CONCLUSIONS The results reveal a process of inlanding of statural deficit, which contrasts with historical descriptions of the geographical distribution of this problem in the Northeastern region of Brazil

New findings on iron absorption conditioning factors

The authors focus iron intake regulation in the body and the probable mechanisms related to iron absorption. They analyze the impact of iron absorption deficiency resulting in iron deficiency anemia, a public health issue of great impact in the world influencing child and maternal health risk increase. This paper aims at highlighting the problems affecting the uptake or inhibiting processes of iron absorption in an attempt to correlate information on conditioning factors and current findings. This study is a document based descriptive study comprising literature review. In food, iron has different forms, such as the heme and non-heme forms following different absorption pathways with different efficiency rates, depending on conditioning factors, such as diet profile, physiological aspects, iron chemical state, absorption regulation, transportation, storing, excretion and the presence of disease, They also discuss the current difficulties in dealing with iron nutritional deficiency in vulnerable groups, children and pregnant women, and focus data on iron consumption, adhesion to breast feeding and the frequency of prenatal care visits.