Marcel de Toledo Vieira

Prevalência de quedas e fatores associados em idosos

OBJECTIVE To estimate the prevalence of falls in elderly individuals and to analyze associated factors. METHODS Cross-sectional study with 420 elderly subjects (aged 60 years or older) living in the city of Juiz de Fora (Southeastern Brazil) in 2010. A household survey was conducted and the occurrence of falls in the 12 previous months was described. For the analysis of factors associated with the outcome, a theoretical determination model with three hierarchical blocks was built. The variables were adjusted among each other within each block; those with level of significance < 0.20 were included in the Poisson regression model and adjusted to the immediately higher level, with 5% significance level. RESULTS The prevalence of falls among the elderly was 32.1% (95%CI: 27.7; 36.9). Among those who experienced falls, 53% had a single fall and 19% had fractures as a consequence. Most of the falls (59%) occurred at the elderly persons home. The occurrence of falls was associated with old age, female sex, need of help for locomotion and self-reported diagnosis of osteoporosis. CONCLUSIONS Falls are frequent among the elderly. Knowledge of the factors associated with the occurrence of this event can aid the development of prevention strategies and adequate health services.OBJETIVO: Estimar la prevalencia de caidas en ancianos y analizar factores asociados. METODOS: Estudio transversal con 420 ancianos (60 anos o mas) residentes en Juiz de Fora, Sureste de Brasil, en 2010. Se realizo pesquisa domiciliaria y se describio la ocurrencia de caida en los ultimos 12 meses. Para analisis de los factores asociados al resultado, se construyo un modelo teorico de determinacion con tres bloques jerarquizados. Las variables fueron ajustadas entre si dentro de cada bloque; las que presentaron nivel de significancia < 0,20 fueron incluidas en el modelo de regresion de Poisson y ajustadas al nivel superior al de cada una, con el nivel de 5% de significancia. RESULTADOS: La prevalencia de caidas entre los ancianos fue de 32,1% (IC95% 27,7;36,9). Entre aquellos que sufrieron caida, 53% tuvieron una unica caida y 19% tuvieron fractura como consecuencia. La mayor parte de las caidas (59%) ocurrio en el domicilio del anciano. La ocurrencia de caidas se asocio con edad avanzada, sexo femenino, necesidad de auxilio para locomocion y diagnostico auto-referido de osteoporosis. CONCLUSIONES: Las caidas son frecuentes entre ancianos. El conocimiento de los factores asociados a la ocurrencia de este evento puede auxiliar en la elaboracion de estrategias de prevencion y servicios de salud adecuados.

Prevalence of falls and associated factors in elderly individuals

OBJECTIVE To estimate the prevalence of falls in elderly individuals and to analyze associated factors. METHODS Cross-sectional study with 420 elderly subjects (aged 60 years or older) living in the city of Juiz de Fora (Southeastern Brazil) in 2010. A household survey was conducted and the occurrence of falls in the 12 previous months was described. For the analysis of factors associated with the outcome, a theoretical determination model with three hierarchical blocks was built. The variables were adjusted among each other within each block; those with level of significance < 0.20 were included in the Poisson regression model and adjusted to the immediately higher level, with 5% significance level. RESULTS The prevalence of falls among the elderly was 32.1% (95%CI: 27.7; 36.9). Among those who experienced falls, 53% had a single fall and 19% had fractures as a consequence. Most of the falls (59%) occurred at the elderly persons home. The occurrence of falls was associated with old age, female sex, need of help for locomotion and self-reported diagnosis of osteoporosis. CONCLUSIONS Falls are frequent among the elderly. Knowledge of the factors associated with the occurrence of this event can aid the development of prevention strategies and adequate health services.OBJETIVO: Estimar la prevalencia de caidas en ancianos y analizar factores asociados. METODOS: Estudio transversal con 420 ancianos (60 anos o mas) residentes en Juiz de Fora, Sureste de Brasil, en 2010. Se realizo pesquisa domiciliaria y se describio la ocurrencia de caida en los ultimos 12 meses. Para analisis de los factores asociados al resultado, se construyo un modelo teorico de determinacion con tres bloques jerarquizados. Las variables fueron ajustadas entre si dentro de cada bloque; las que presentaron nivel de significancia < 0,20 fueron incluidas en el modelo de regresion de Poisson y ajustadas al nivel superior al de cada una, con el nivel de 5% de significancia. RESULTADOS: La prevalencia de caidas entre los ancianos fue de 32,1% (IC95% 27,7;36,9). Entre aquellos que sufrieron caida, 53% tuvieron una unica caida y 19% tuvieron fractura como consecuencia. La mayor parte de las caidas (59%) ocurrio en el domicilio del anciano. La ocurrencia de caidas se asocio con edad avanzada, sexo femenino, necesidad de auxilio para locomocion y diagnostico auto-referido de osteoporosis. CONCLUSIONES: Las caidas son frecuentes entre ancianos. El conocimiento de los factores asociados a la ocurrencia de este evento puede auxiliar en la elaboracion de estrategias de prevencion y servicios de salud adecuados.

Oportunidades do ambiente domiciliar para o desenvolvimento motor

OBJETIVO: Avaliar as oportunidades presentes no ambiente domiciliar para o desenvolvimento motor de lactentes. METODOS: Estudo epidemiologico de base populacional, transversal, realizado com 239 lactentes com idade entre tres e 18 meses, residentes no municipio de Juiz de Fora, MG, em 2010. Os participantes foram selecionados por amostragem aleatoria estratificada, conglomerada, em multiplos estagios. Para avaliar a qualidade e quantidade de estimulo motor no ambiente domiciliar foi utilizado o instrumento Affordance in the Home Environment for Motor Development - Infant Scale. Procedeu-se a analise bivariada com aplicacao do teste qui-quadrado, seguida de regressao logistica multinomial para verificar a associacao entre as oportunidades presentes no domicilio e fatores biologicos, comportamentais, demograficos e socioeconomicos. RESULTADOS: As oportunidades de estimulacao ambiental foram relativamente baixas. Na analise bivariada, para a faixa etaria de tres a nove meses, foi encontrada associacao com os fatores: ordem de nascimento (p = 0,06), classificacao socioeconomica (p = 0,08), renda mensal (p = 0,06) e renda per capita (p = 0,03). No modelo de regressao, prevaleceu a classificacao socioeconomica (RC = 7,46; p = 0,03). Para a faixa etaria de dez a 18 meses, os fatores associados, na analise bivariada, foram: estado civil materno (p < 0,01), convivio da crianca com o pai (p = 0,08), chefe da familia (p = 0,04), numero de pessoas no domicilio (p = 0,05), escolaridade materna (p < 0,01) e paterna (p < 0,01), classificacao socioeconomica (p < 0,01) e renda per capita (p = 0,03). No modelo de regressao, o estado civil materno (RC = 4,83; p = 0,02), escolaridade materna (RC = 0,29; p = 0,03) e paterna (RC = 0,33; p = 0,04) permaneceram associados as oportunidades de estimulacao ambiental. CONCLUSOES: A uniao estavel dos pais, maior escolaridade materna e paterna e maior nivel economico foram os fatores associados as melhores oportunidades de estimulacao motora no lar.

Detection of Group B Streptococcus in Brazilian pregnant women and antimicrobial susceptibility patterns

Group B Streptococcus (GBS) is still not routinely screened during pregnancy in Brazil, being prophylaxis and empirical treatment based on identification of risk groups. This study aimed to investigate GBS prevalence in Brazilian pregnant women by culture or polymerase chain reaction (PCR) associated to the enrichment culture, and to determine the antimicrobial susceptibility patterns of isolated bacteria, so as to support public health policies and empirical prophylaxis. After an epidemiological survey, vaginal and anorectal specimens were collected from 221 consenting laboring women. Each sample was submitted to enrichment culture and sheep blood agar was used to isolate suggestive GBS. Alternatively, specific PCR was performed from enrichment cultures. Antimicrobial susceptibility patterns were determined for isolated bacteria by agar diffusion method. No risk groups were identified. Considering the culture-based methodology, GBS was detected in 9.5% of the donors. Twenty five bacterial strains were isolated and identified. Through the culture-PCR methodology, GBS was detected in 32.6% specimens. Bacterial resistance was not detected against ampicillin, cephazolin, vancomycin and ciprofloxacin, whereas 22.7% were resistant to erythromycin and 50% were resistant to clindamycin. GBS detection may be improved by the association of PCR and enrichment culture. Considering that colony selection in agar plates may be laboring and technician-dependent, it may not reflect the real prevalence of streptococci. As in Brazil prevention strategies to reduce the GBS associated diseases have not been adopted, prospective studies are needed to anchor public health policies especially considering the regional GBS antimicrobial susceptibility patterns.

Prevalência de parasitoses intestinais em comunidade quilombola no Município de Bias Fortes, Estado de Minas Gerais, Brasil, 2008

Summary Objective: the study aims to investigate prevalence and factors associated to intestinal parasitic diseases in the population of Colonia do Paiol, a quilombola community in the municipality of Bias Fortes, located in the Zona da Mata region of the State of Minas Gerais, Brazil. Methodology: cross-sectional census study was conducted, and 391 (92%) of the 425 inhabitants were interviewed through a questionnaire and evaluated by means of a coproparasitologic test. Results: the test positivity rate for at least one parasite specie was of 63.8%, and the pathogenic species more often found were Ascaris lumbricoides (22.4%) and Trichuris trichiura (17.9%); multiparasitism was diagnosed in 36.5% of those who took part in the study; prevalence was higher for females compared to males, also for school children aged from 6 to 14 years old. Conclusion: a significant association was observed between the presence of intestine parasites and a number of environment conditions such as sewage collection and disposal, access to basic health services, use of easily administered medicines for treatment of enteroparasitosis, and education policies on basic health knowledge among population members.

Leitura contextual e processamento metalingüístico no português do Brasil: um estudo longitudinal

Metalinguistic skill is the ability to reflect upon language as an object of thought. Amongst metalinguistic skills, two seem to be associated with reading and spelling: morphological awareness and phonological awareness. Phonological awareness is the ability of reflecting upon the phonemes that compose words, and morphological awareness is the ability of reflecting upon the morphemes that compose the words. The latter seems to be particularly important for reading comprehension and contextual reading, as beyond phonological information, syntactic and semantic information are required. This study is set to investigate - with a longitudinal design - the relation between those abilities and contextual reading measured by the Cloze test. The first part of the study explores the relationship between morphological awareness tasks and Cloze scores through simple correlations and, in the second part, the specificity of such relationship was inquired using multiple regressions. The results give some support to the hypothesis that morphological awareness offers an independent contribution regarding phonological awareness to contextual reading in Brazilian Portuguese.

Frequência e distribuição de Helicobacter spp. na mucosa gástrica de cães

Frequency and distribution of Helicobacter spp. in gastric mucosa of dogs The association of the helicobacter bacteria with gastric diseases in human beings and in some domestic pets and wild animals suggests these bacteria as a possible factor in the pathogenesis of gastritis in pet dogs. In this study we investigate the presence of Helicobacter spp. in the gastric mucosa of dogs and evaluate its association with some macro and microscopic findings, considering the age of the animals. Samples from cardia, fundus, body , and pylorus regions were collected from the stomach of 60 dogs for histopathologic examination, using hematoxilin-eosina (HE) and carbol-fucsina (CF) staining. The examinations detected Helicobacter spp. in 96.7% of the animals, revealing inflammatory infiltrate, predominantly mononuclear (100%), lymphoid nodules hyperplasia (98.3%), erosions/ulcerations (6.7%), hemorrhage (5%) and hyperemia (95%) in the samples stained with HE. There was no correlation between Helicobacter spp. infection and age of the animal, as well as between inflammatory changes and age in the presence of bacteria. Samples of the body and pylorus region showed increased presence of bacteria in the histopathologic

Opportunities in the home environment for motor development

OBJETIVO: Avaliar as oportunidades presentes no ambiente domiciliar para o desenvolvimento motor de lactentes. METODOS: Estudo epidemiologico de base populacional, transversal, realizado com 239 lactentes com idade entre tres e 18 meses, residentes no municipio de Juiz de Fora, MG, em 2010. Os participantes foram selecionados por amostragem aleatoria estratificada, conglomerada, em multiplos estagios. Para avaliar a qualidade e quantidade de estimulo motor no ambiente domiciliar foi utilizado o instrumento Affordance in the Home Environment for Motor Development - Infant Scale. Procedeu-se a analise bivariada com aplicacao do teste qui-quadrado, seguida de regressao logistica multinomial para verificar a associacao entre as oportunidades presentes no domicilio e fatores biologicos, comportamentais, demograficos e socioeconomicos. RESULTADOS: As oportunidades de estimulacao ambiental foram relativamente baixas. Na analise bivariada, para a faixa etaria de tres a nove meses, foi encontrada associacao com os fatores: ordem de nascimento (p = 0,06), classificacao socioeconomica (p = 0,08), renda mensal (p = 0,06) e renda per capita (p = 0,03). No modelo de regressao, prevaleceu a classificacao socioeconomica (RC = 7,46; p = 0,03). Para a faixa etaria de dez a 18 meses, os fatores associados, na analise bivariada, foram: estado civil materno (p < 0,01), convivio da crianca com o pai (p = 0,08), chefe da familia (p = 0,04), numero de pessoas no domicilio (p = 0,05), escolaridade materna (p < 0,01) e paterna (p < 0,01), classificacao socioeconomica (p < 0,01) e renda per capita (p = 0,03). No modelo de regressao, o estado civil materno (RC = 4,83; p = 0,02), escolaridade materna (RC = 0,29; p = 0,03) e paterna (RC = 0,33; p = 0,04) permaneceram associados as oportunidades de estimulacao ambiental. CONCLUSOES: A uniao estavel dos pais, maior escolaridade materna e paterna e maior nivel economico foram os fatores associados as melhores oportunidades de estimulacao motora no lar.

Prevalence of and factors associated with benzodiazepine use in community-resident elderly persons

Objetivo: avaliar a prevalencia e os fatores associados ao uso de benzodiazepinicos em idosos da comunidade. Metodo: Estudo transversal, realizado por meio de inquerito domiciliar, com 423 idosos de Juiz de Fora, MG, Brasil. Para analise dos fatores associados ao desfecho, foi utilizado o modelo de regressao de Poisson, baseado no modelo teorico de determinacao com blocos hierarquizados. As variaveis foram ajustadas dentro de cada bloco, permanecendo no modelo final aquelas com nivel de significância de 5%. Resultado: A prevalencia de uso de benzodiazepinicos foi de 18,3% (IC95% 15,2-21,6). A maioria dos benzodiazepinicos utilizados possui meia vida de eliminacao longa (59,2%) e o tempo de uso foi considerado prolongado em 85,5% dos usuarios. Dentre os usuarios de benzodiazepinicos, 38,4% tambem utilizavam antidepressivos. O uso de desses farmacos se mostrou associado a presenca de transtornos mentais e comportamentais autorrelatados, polifarmacia e realizacao de consulta medica nos ultimos tres meses. Conclusao: O uso de benzodiazepinicos foi considerado elevado entre idosos. A reducao da prescricao deve ser avaliada de forma individualizada, considerando as alteracoes fisiologicas dos idosos e os efeitos adversos dos medicamentos, a fim de minimizar prescricoes inadequadas.

Não adesão às diretrizes para rastreamento do câncer do colo do útero entre mulheres que frequentaram o pré-natal

PURPOSE: To estimate the prevalence and identify the factors associated with delayed pap smear test of the cervix (carried out more than three years ago) among mothers with sons under two years of age, who attended the prenatal care. METHODS: Cross-sectional, population-based household survey. Women with sons under two years old, living in the northern area of the city of Juiz de Fora (MG), Brazil, were interviewed. Stratification and clustering were used in a complex sampling procedure. We applied a survey questionnaire to capture womens demographic and socioeconomic characteristics of women and information about prenatal and practices for preventing cancer of the cervix. For statistical analysis of the possible bivariate association of factors, we used χ2 test and a logistic regression model with the explanatory variables that had a significance less than or equal to 0.05 in the bivariate analysis. RESULTS: We found a delayed test prevalence of 26.6% (95%CI 21.3 - 32.6), including women who were never submitted to the exam. The variables associated with the non-adherence to the examination within the stipulated time were: to be married (OR 0.5; 95%CI 0.2 - 0.9), and divorced/widowed (OR 0.1; 95%CI 0.02 - 0,8), having performed gynecological examination in prenatal care (OR 0.3; 95%CI 0.1 - 0.6) and number of prenatal visits (OR 0.09; 95%CI 0.03 - 0.25 for more than 11 visits), being all protection factors. CONCLUSIONS: The prevalence of adherence to Pap smear guidelines is slightly lower than the percentage recommended by the World Health Organization. Apart from that, the fact that the woman was submitted to the prenatal care did not guarantee the adherence to Pap smear frequency guidelines.