Maria Cristina Falcão Raposo

Fatores socioeconômicos e dietéticos de risco para a anemia em crianças de 6 a 59 meses de idade

OBJECTIVE The objective of this study was to use statistical modeling to identify risk factors for anemia in children aged 6 to 59 months in the state of Pernambuco, covering socioeconomic and dietary aspects. METHODS The sample comprised 746 children aged between 6 and 59 months from the state of Pernambuco. Their hemoglobin was assayed and a 24-hour dietary recall performed. Risk of anemia was analyzed with relation to socioeconomic variables and to dietary intakes, using multivariate analysis models. RESULTS The risk factors for anemia were: a high proportion of calories from cows milk, low density of nonheme iron, low age and low maternal educational level; age was the most prominent factor, with children under 24 months exhibiting 3.61 times greater risk of being anemic than the older children. CONCLUSIONS This study confirms the need for a clear picture of the dietary intake of children in Brazil, in order that associations with anemia can be better understood. Our results revealed that the dietary factors which were most responsible for risk of anemia were a greater proportion of calories from cows milk and lower density of nonheme iron, in addition to age below 24 months and low maternal educational level.OBJECTIVE: The objective of this study was to use statistical modeling to identify risk factors for anemia in children aged 6 to 59 months in the state of Pernambuco, covering socioeconomic and dietary aspects. METHODS: The sample comprised 746 children aged between 6 and 59 months from the state of Pernambuco. Their hemoglobin was assayed and a 24-hour dietary recall performed. Risk of anemia was analyzed with relation to socioeconomic variables and to dietary intakes, using multivariate analysis models. RESULTS: The risk factors for anemia were: a high proportion of calories from cows milk, low density of nonheme iron, low age and low maternal educational level; age was the most prominent factor, with children under 24 months exhibiting 3.61 times greater risk of being anemic than the older children. CONCLUSIONS: This study confirms the need for a clear picture of the dietary intake of children in Brazil, in order that associations with anemia can be better understood. Our results revealed that the dietary factors which were most responsible for risk of anemia were a greater proportion of calories from cows milk and lower density of nonheme iron, in addition to age below 24 months and low maternal educational level.

Concentração de hemoglobina e anemia em crianças no Estado de Pernambuco, Brasil: fatores sócio-econômicos e de consumo alimentar associados

This study aimed to assess hemoglobin level and anemia prevalence and their association with food-consumption and socioeconomic variables. A cross-sectional survey was conducted in the State of Pernambuco, Brazil, in 1997, using three-stage sampling which included 746 6-to-59-month-old children. Hemoglobin testing and a 24-hour food recall interview were performed. The anemia rate was 40.6% and was higher in the rural area and inversely proportional to age, income, and maternal schooling. Most children (88.9%) consumed cows milk. Anemia was associated directly with the proportion of calories from cows milk and indirectly with the iron level. Childs age, geographic area, per capita family income, maternal schooling, iron density (total, heme, and non-heme), and the proportion of calories from cows milk in the diet were determinants for anemia.

Prevalência e influência do sexo, idade e tipo de operação na dor pós-operatória

BACKGROUND AND OBJECTIVES Postoperative pain is frequent despite of the therapeutic armamentarium available. Its development is related with factors inherent to the surgery and patient. The objective of this study was to evaluate the prevalence of postoperative pain in hospitalized patients and its association with gender and type of surgery. METHODS This is a transversal study in which interviews were done with 187 patients undergoing surgeries. The incidence of pain in the first 24 hours and its severity according to a numeric rating scale: mild (1 to 3), moderate (4 to 6), and severe (7 to 10), were evaluated. RESULTS Three of 190 patients interviewed were excluded due to difficulties understanding the method used to evaluate the level of pain. In the study population, 66.8% (n = 125) were females; mean age 45.83 +/- 16.17 years, but 25.1% (n = 47) were 60 years old or more. In the first 24 hours, 46% (n = 85) of the patients reported pain. Among male patients, 48.4% (n = 30) complained of pain, while 66.8% (n = 55) of the females did so. The prevalence of pain showed no differences regarding gender (p = 0.536) and age (p = 0.465). As for pain severity, 29.4% of the patients referred mild pain, it was moderate in 43.5%, and severe in 27.1%. A significant association between the incidence of postoperative pain and type of surgery was observed (p = 0.003). CONCLUSIONS This study demonstrated that an elevated number of patients experience pain in the first 24 hours after the surgery. The incidence of pain was higher in patients undergoing general surgery.JUSTIFICATIVA Y OBJETIVOS: El dolor en el postoperatorio es un evento frecuente, a pesar del arsenal terapeutico existente. Su aparecimiento esta relacionado con los factores inherentes al procedimiento quirurgico y al paciente. El estudio tuvo como objetivo, evaluar la prevalencia del dolor en el postoperatorio en pacientes ingresados y su asociacion con el sexo y el tipo de operacion. METODO: Estudio del tipo corte transversal, realizado por entrevista a 187 pacientes sometidos a la operacion. Se evaluo el aparecimiento del dolor en las primeras 24 horas, y su intensidad a traves de la escala numerica: leve (1 a 3), moderada (4 a 6) y fuerte (7 a 10). RESULTADOS:De los 190 pacientes entrevistados, tres de ellos quedaron excluidos por dificultad de entender el metodo utilizado para evaluar el dolor. En la muestra, un 66,8% (n = 125) eran mujeres. El promedio de edad fue de 45,83 ± 16,17 anos, siendo 25,1% (n = 47) con 60 anos o mas. En las primeras 24 horas, 46% (n = 85) de los pacientes relataron dolor. Entre los hombres, un 48,4% (n=30) relataron dolor y entre las mujeres, 66,8% (n = 55). No hubo diferencia significativa entre la prevalencia de dolor por sexo (p = 0,536) y edad (p = 0,465). En cuanto a la intensidad, el dolor se considero leve en un 29,4%, moderado en 43,5% y fuerte en 27,1% de los pacientes. Hubo una asociacion significativa entre el aparecimiento del dolor postoperatorio y el tipo de operacion (p = 0,003). CONCLUSIONES: El estudio muestra, que un elevado numero de pacientes todavia siente dolor en las primeras 24 horas del postoperatorio. Las pacientes sometidas a la Cirugia General, sintieron mas dolor en el postoperatorio que en los demas tipos de operaciones.

Prevalência de obesidade e fatores associados em mulheres idosas

OBJECTIVE: To analyze the prevalence of obesity in elderly women and its association with socio-demographic, biochemical and hypertension variables. MATERIAL AND METHODS: By means of a cross sectional study, 188 outpatient women, 60 to 89 years-old were assessed. Obesity was defined by a BMI > 30Kg/m2 (WHO, 1998). The parameters examined were age, education, marital status, fasting glycemia, total cholesterol, high and low density cholesterol lipoproteins, triglycerides and presence or absence of blood hypertension. Data analysis was performed by Pearsons Chi-square or Exact Test of Fisher and Multivariate Analysis of Logistic Regression, estimating the probability of obesity. RESULTS/CONCLUSIONS: Among eldery women, 25.6% were obese. Obesity was present in the age ranges of 60 to 69 and 70 to 79 years, and positively associated (p= 0.050) to fasting glycemia > 126mg/dL, with increased risk (Odds= 1.76) for elder diabetic, compared to non-diabetics women. The highest probability for obesity, around 18%, was observed in women younger than 70 years-old, triglycerides > 200gm/dL, diabetic and hypertensive, emphasizing the role of associated morbidity.

Concurrent validity of the pressure biofeedback unit and surface electromyography in measuring transversus abdominis muscle activity in patients with chronic nonspecific low back pain

BACKGROUND The Pressure biofeedback unit (PBU) is an assessment tool used in clinical practice and research aimed to indirectly analyze the transversus abdominis (TrA) muscle activity. The concurrent validity of the PBU in a clinically relevant sample is still unclear. OBJECTIVE The purpose of this study was to evaluate the concurrent validity and diagnostic accuracy of the PBU in measuring TrA muscle activity in patients with chronic nonspecific low back pain. METHOD This study was performed using a validation, cross-sectional design. Fifty patients with chronic nonspecific low back pain were recruited for this study. To test the concurrent validity both PBU measures (index test) and superficial electromyographic measures (reference-standard test) were compared and collected by a physical therapist in a series of voluntary contraction maneuvers of TrA muscle. RESULTS Participants were on average 22 years old, weighed 63.7 kilos, 1.70 meters height and mean low back pain duration was 1.9 years. It was observed a weak and non-significant Phi coefficient (r=0.2, p<0.20). With regards to diagnostic accuracy tests, our results suggest a low sensitivity (60%) and specificity (60%) of the PBU. The positive predictive value was high (0.8) and negative predictive value was low (0.2). CONCLUSIONS Concurrent validity of the PBU in measuring TrA muscle activity in patients with chronic nonspecific low back pain is poor given the low correlation and diagnostic accuracy with superficial EMG.

Reproducibility of the pressure biofeedback unit in measuring transversus abdominis muscle activity in patients with chronic nonspecific low back pain

The Pressure Biofeedback Unit (PBU) is often used by clinicians and researchers to indirectly evaluate transversus abdominis (TrA) muscle activity. The purpose of this study was to evaluate the inter and intra-examiner reproducibility of the PBU in measuring TrA muscle activity in fifty patients with chronic nonspecific low back pain. This study was performed using a test-retest design with a seven day interval. An Intraclass Correlation Coefficient (ICC(2,1)) of 0.74 (95% CI 0.54 to 0.85) and 0.76 (95% CI 0.58 to 0.86) was observed for the intra and inter-examiner reproducibility, respectively. The intra-examiner agreement (Limits of Agreement - LOA = 2.1 to -1.8 mmHg) and the inter-examiner agreement (LOA = 2.0 to -1.9 mmHg) were within the limits of agreement on 95% of occasions. The reproducibility of PBU in measuring TrA muscle activity in patients with chronic nonspecific low back pain ranged from satisfactory to excellent.

Programa de saúde da família: proposta para identificação de fatores de risco para o desenvolvimento neuropsicomotor

OBJECTIVES: To investigate the occurrence of delayed neuropsychological and motor development in a community assisted through the Family Health Program and to evaluate its association with possible biological, environmental and socioeconomic risk factors. METHODS: The sample consisted of 31 five-year-old children who were evaluated using the Neurological Development Test, following guidelines proposed by Coelho (1999)*. The study was carried out at the Family Health Program (FHP) center in the Brasilit area of Recife, PE, Brazil. Data were collected using a questionnaire that sought information on the child, its mother/guardian, the familys socioeconomic status and residence. Fishers exact test was used for the statistical analysis of the results, with a significance level of 5%. RESULTS: Appendicular coordination was the parameter with the highest frequency of deficits (90%) and static balance was the item least compromised (12.9%). The frequency of static balance deficits was higher among children who did not attend day care centers (p=0.0163) and among those who spent less time with their mother (p=0.0278). Motor persistence deficits were statistically associated with age of entry into day care (p=0.0415) and father-child time (p=0.0436). CONCLUSIONS: The FHP was not only a valuable setting for developing studies of this nature but also an appropriate setting for child development follow-up.

Relations between epileptic seizures and headaches.

PURPOSE To describe headaches in patients with epilepsy and try to identify relations between epileptic seizures and headaches. METHODS Cross-sectional study, with 304 patients from the epilepsy out-patient section of University Hospital of Federal University of Alagoas (Brazil) between February 2007 and February 2008. The presence of headaches and their relationships with the epileptic seizures were analyzed. RESULTS Frequent seizures were associated with a greater tendency of occurrence of headaches (odds ratio=1.6 times, p=0.077). Headaches occurred in 66.1% of the cases. The highest occurrence was of migraine (32.9% of the patients), followed by tension-type headaches (9.2%). Two syndromes with a continuum epilepsy-migraine in the same seizure are worth mentioning: migralepsy in 6.6% and epilepgraine in 10.2% of the patients with epilepsy. CONCLUSIONS A high prevalence of headaches in patients with epilepsy was observed, with emphasis on hybrid crises of epilepsy and migraine.

Prevalence and Influence of Gender, Age, and Type of Surgery on Postoperative Pain

BACKGROUND AND OBJECTIVES Postoperative pain is frequent despite of the therapeutic armamentarium available. Its development is related with factors inherent to the surgery and patient. The objective of this study was to evaluate the prevalence of postoperative pain in hospitalized patients and its association with gender and type of surgery. METHODS This is a transversal study in which interviews were done with 187 patients undergoing surgeries. The incidence of pain in the first 24 hours and its severity according to a numeric rating scale: mild (1 to 3), moderate (4 to 6), and severe (7 to 10), were evaluated. RESULTS Three of 190 patients interviewed were excluded due to difficulties understanding the method used to evaluate the level of pain. In the study population, 66.8% (n = 125) were females; mean age 45.83 +/- 16.17 years, but 25.1% (n = 47) were 60 years old or more. In the first 24 hours, 46% (n = 85) of the patients reported pain. Among male patients, 48.4% (n = 30) complained of pain, while 66.8% (n = 55) of the females did so. The prevalence of pain showed no differences regarding gender (p = 0.536) and age (p = 0.465). As for pain severity, 29.4% of the patients referred mild pain, it was moderate in 43.5%, and severe in 27.1%. A significant association between the incidence of postoperative pain and type of surgery was observed (p = 0.003). CONCLUSIONS This study demonstrated that an elevated number of patients experience pain in the first 24 hours after the surgery. The incidence of pain was higher in patients undergoing general surgery.JUSTIFICATIVA Y OBJETIVOS: El dolor en el postoperatorio es un evento frecuente, a pesar del arsenal terapeutico existente. Su aparecimiento esta relacionado con los factores inherentes al procedimiento quirurgico y al paciente. El estudio tuvo como objetivo, evaluar la prevalencia del dolor en el postoperatorio en pacientes ingresados y su asociacion con el sexo y el tipo de operacion. METODO: Estudio del tipo corte transversal, realizado por entrevista a 187 pacientes sometidos a la operacion. Se evaluo el aparecimiento del dolor en las primeras 24 horas, y su intensidad a traves de la escala numerica: leve (1 a 3), moderada (4 a 6) y fuerte (7 a 10). RESULTADOS:De los 190 pacientes entrevistados, tres de ellos quedaron excluidos por dificultad de entender el metodo utilizado para evaluar el dolor. En la muestra, un 66,8% (n = 125) eran mujeres. El promedio de edad fue de 45,83 ± 16,17 anos, siendo 25,1% (n = 47) con 60 anos o mas. En las primeras 24 horas, 46% (n = 85) de los pacientes relataron dolor. Entre los hombres, un 48,4% (n=30) relataron dolor y entre las mujeres, 66,8% (n = 55). No hubo diferencia significativa entre la prevalencia de dolor por sexo (p = 0,536) y edad (p = 0,465). En cuanto a la intensidad, el dolor se considero leve en un 29,4%, moderado en 43,5% y fuerte en 27,1% de los pacientes. Hubo una asociacion significativa entre el aparecimiento del dolor postoperatorio y el tipo de operacion (p = 0,003). CONCLUSIONES: El estudio muestra, que un elevado numero de pacientes todavia siente dolor en las primeras 24 horas del postoperatorio. Las pacientes sometidas a la Cirugia General, sintieron mas dolor en el postoperatorio que en los demas tipos de operaciones.

Postural control assessment in students with normal hearing and sensorineural hearing loss

INTRODUCTION Children with sensorineural hearing loss can present with instabilities in postural control, possibly as a consequence of hypoactivity of their vestibular system due to internal ear injury. OBJECTIVE To assess postural control stability in students with normal hearing (i.e., listeners) and with sensorineural hearing loss, and to compare data between groups, considering gender and age. METHODS This cross-sectional study evaluated the postural control of 96 students, 48 listeners and 48 with sensorineural hearing loss, aged between 7 and 18 years, of both genders, through the Balance Error Scoring Systems scale. This tool assesses postural control in two sensory conditions: stable surface and unstable surface. For statistical data analysis between groups, the Wilcoxon test for paired samples was used. RESULTS Students with hearing loss showed more instability in postural control than those with normal hearing, with significant differences between groups (stable surface, unstable surface) (p<0.001). CONCLUSIONS Students with sensorineural hearing loss showed greater instability in the postural control compared to normal hearing students of the same gender and age.