Maurício Gomes Pereira

Prevalência do aleitamento materno nas capitais brasileiras

OBJECTIVE: To estimate the prevalence of breastfeeding and of exclusive breastfeeding in Brazilian capital cities, in the 5 major geographical areas of Brazil and in the whole country, at the ages of 30, 120 and 180 days, as agreed among specialists. METHODS: Restudy of data from the population inquiry about breastfeeding in 25 capital cities and in the Federal District during a mass immunization campaign, on October 16th, 1999, National Day of Vaccination, supervised by one of the authors. The random sample of this study refers to 10,778 children, according to the ages mentioned above. The point and interval estimates (95% CI) were given for the capital cities and then extrapolated to the major geographical areas and to Brazil. The regression analysis was used on the SAS statistical program. RESULTS: The estimated prevalence of breastfeeding in Brazil was 87.3% (CI 95%: 86.8 87.7) at the age of 30 days, 77.5% (77.1 78.0) at the age of 120 days and 68.6% (68.2 69.1) at the age of 180 days. The exclusive breastfeeding prevalence was 47.5% (46.4 48.5), 17.7% (17.2 18.3) and 7.7% (7.2 8.2) at the ages mentioned. At the age of 30 days, variation of the frequency of exclusive breastfeeding was wide, from 73.4% (Fortaleza) to 25.2% (Cuiaba). At the age of 180 days, the prevalence ranged from 16.9% in Belem to 2.8% in Cuiaba. CONCLUSION: There was a moderate reduction of the prevalence of breastfeeding and a steep decline of the prevalence of exclusive breastfeeding from birth to the age of 180 days. Important differences were noted in the frequency of exclusive breastfeeding among the capital cities surveyed.

Prevalence of depression morbidity among Brazilian adults: a systematic review and meta-analysis

OBJECTIVE To estimate the prevalence of depressive symptoms and major depressive disorder, as assessed in population-based cross-sectional studies of Brazilian adults. METHODS We performed a systematic review of the literature. The major databases were searched up through October 2013. Two researchers selected the studies, extracted the data, and assessed their methodological quality. Meta-analyses were performed using random effects. RESULTS Of the 2,971 records retrieved, we selected 27 studies that assessed the prevalence of depression morbidity in 464,734 individuals (66% women). Eleven different screening tools were used to assess depression morbidity. The prevalence of depressive symptoms was 14% (95% confidence interval [95%CI] 13-16; I2 = 99.5%), whereas the 1-year prevalence of major depressive disorder was 8% (95%CI 7-10; I2 = 86.7%), and the lifetime prevalence of major depressive disorder was 17% (95%CI 14-19; I2 = 91.6%). All rates were higher in women than in men. No causes of heterogeneity could be identified. CONCLUSION Depression morbidity was common among Brazilian adults, and affects more women than men. Inconsistencies across studies highlight the need for standardization of future research. Clinicians should routinely investigate for the presence of depression morbidity in this population.

Antioxidants for Preventing Preeclampsia: A Systematic Review

Objective. To investigate the efficacy of antioxidants for preventing preeclampsia and other maternal and fetal complications among pregnant women with low, moderate, or high risk of preeclampsia. Methods. We searched MEDLINE, Embase, CENTRAL, mRCT, and other databases, with no language or publication restrictions. Two independent reviewers selected randomized controlled trials that evaluated the use of antioxidants versus placebo and extracted the relevant data. Relative risks (RRs) and 95% confidence intervals (95% CIs) were calculated. The data were compiled through the random effects model. Main Results. Fifteen studies were included (21,012 women and 21,647 fetuses). No statistically significant difference was found between women who received antioxidant treatment and women who received placebo for preeclampsia (RR  = 0.92; 95% CI: 0.82–1.04), severe preeclampsia (RR  = 1.03; 95% CI: 0.87–1.22), preterm birth (RR  = 1.03; 95% CI: 0.94–1.14), and small for gestational age <10th centile (RR  = 0.92; 95% CI: 0.80–1.05). Side effects were numerically more frequent in the antioxidants group compared to placebo, but without significant statistical difference (RR  = 1.24; 95% CI: 0.85–1.80). Conclusions. The available evidence reviewed does not support the use of antioxidants during pregnancy for the prevention of preeclampsia and other outcomes.

Pubertal timing in girls and depression: A systematic review

BACKGROUND Because the incidence of depression increases after puberty, it is possible that pubertal timing in girls influences the onset of depression. Our objective was to assess the effect of early and late puberty in girls on the incidence of depression. METHODS We systematically searched relevant databases for controlled studies that assessed the impact of pubertal timing in girls on the incidence of depression or depressive symptoms. The last search was completed in August 2013. Two authors selected the studies, extracted the data, and assessed the quality of the evidence. Meta-analyses of the adjusted and unadjusted results were calculated using random effects. RESULTS Four cohort studies were included (n=8055 participants). Early puberty significantly increased the risk of new cases of depression in the unadjusted meta-analysis (RR=1.33; CI 95%: 1.02, 1.73) but not in the adjusted estimate of two of the included studies (RR=1.48; CI 95%: 0.69, 2.28). For late puberty, no significant associations were found (unadjusted RR=1.28; CI 95%: 0.87, 1.88). Two studies assessed the effect of early puberty on depressive symptoms and found positive associations. The quality of the available evidence was rated as very low. LIMITATIONS The polled results had wide confidence intervals, and the available evidence was of very low quality. CONCLUSIONS The available evidence supports little confidence regarding the impact of pubertal timing on the onset of depression in girls but suggests that early puberty in girls may increase the risk of depression. Further higher quality studies are needed to clarify the association between pubertal timing and the incidence of depression in girls and women.

Avaliação das estruturas de concordância e discordância nos estudos de confiabilidade

OBJECTIVE: To complement the data of a previous research concerning the evaluation of the lifetime risk of radiation-induced cancer due to the ingestion of 226Ra, 228Ra and 222Rn in mineral spring waters from a natural highly radioactive region of Brazil. The study was performed to evaluate the lifetime risk of radiation-induced cancer due to the ingestion of 238U and 234 U in the same spring waters. METHOD: It is assumed that the risk coefficient for natural U isotopes is the same as for the 226Ra-induced bone sarcomas and that the equilibrium for skeletal content is 25 times the daily ingestion of 226Ra, but 11 times the daily ingestion of long-lived uranium isotopes. Waters samples were collected seasonally over a period of one year at all the spring sites used by the local population of Aguas da Prata, S. Paulo State (Brazil). RESULTS: Concentrations ranging from 2.0 to 28.4 mBq/L and from 4.7 to 143 mBq/L were observed for 238U and 234U, respectively. Based upon the measured concentrations the lifetime risk due to the ingestion of uranium isotopes was estimated. A total of 0.3 uranium-induced cancers per 106 exposed persons was predicted, suggesting that chronic ingestion of uranium at the levels observed at these springs will result in an incremental increase of fatal cancers of 0.1 %. CONCLUSIONS: By taking into account the uncertainties in evaluating the carcinogenic effects, it can be concluded that virtually no cancer would be expected from the ingestion of uranium in the mineral spring waters analyzed.

Indicadores de saúde para idosos: comparação entre o Brasil e os Estados Unidos

OBJETIVO: Identificar no Brasil indicadores equivalentes aos utilizados nos Estados Unidos para avaliar a populacao com idade de 65 anos ou mais no ano de 2000 e comparar a situacao nos dois paises. METODO: Este e um estudo descritivo e transversal, baseado em dados secundarios. A partir de uma lista de indicadores de bem-estar empregada nos Estados Unidos, equivalentes brasileiros foram pesquisados nos sites de instituicoes publicas de saude ou de planejamento. Tambem foram utilizados dados de pesquisas nacionais e, se necessario, foram feitas reanalises de bases de dados. RESULTADOS: Dos 31 indicadores que compoem a lista norte-americana, somente para tres nao foi encontrado um equivalente brasileiro: comprometimento de memoria, atividade social e crimes violentos. Nos Estados Unidos, o numero de idosos foi maior e a escolaridade desse grupo foi mais alta. Os dois paises foram semelhantes em termos de condicao de saude e expectativa de vida aos 65 anos. Maiores taxas de obito por doenca cerebrovascular e diabetes foram registradas no Brasil e por neoplasias malignas nos Estados Unidos. A morbidade auto-referida por artrite e por depressao foi mais frequente nos Estados Unidos, assim como as incapacidades. A autopercepcao de bom estado de saude foi superior no Brasil, ao passo que os indicadores de habitos de vida e os fatores de risco revelaram uma melhor situacao nos Estados Unidos. CONCLUSOES: Se o poder discriminatorio dos indicadores utilizados for de fato adequado, as condicoes de saude dos idosos no ano de 2000 eram proximas nos dois paises.

Safety of Benzathine Penicillin for Preventing Congenital Syphilis: A Systematic Review

Objective To estimate the risk of serious adverse reactions to benzathine penicillin in pregnant women for preventing congenital syphilis. Methods We searched for clinical trials or cohorts that assessed the incidence of serious adverse reactions to benzathine penicillin in pregnant women and the general population (indirect evidence). MEDLINE, EMBASE, Scopus and other databases were searched up to December 2012. The GRADE approach was used to assess quality of evidence. Absolute risks of each study were calculated along with their 95% confidence intervals (95% CI). We employed the DerSimonian and Laird random effects model in the meta-analyses. Results From 2,765 retrieved studies we included 13, representing 3,466,780 patients. The studies that included pregnant women were conducted to demonstrate the effectiveness of benzathine penicillin: no serious adverse reactions were reported among the 1,244 pregnant women included. In the general population, among 2,028,982 patients treated, 4 died from an adverse reaction. The pooled risk of death was virtually zero. Fifty-four cases of anaphylaxis were reported (pooled absolute risk = 0.002%; 95% CI: 0%–0.003% I2 = 12%). From that estimate, penicillin treatment would be expected to result in an incidence of 0 to 3 cases of anaphylaxis per 100,000 treated. Any adverse reactions were reported in 6,377 patients among 3,465,322 treated with penicillin (pooled absolute risk = 0.169%; 95% CI: 0.073%–0.265% I2 = 97%). The quality of evidence was very low. Conclusion Studies that assessed the risk of serious adverse events due to benzathine penicillin treatment in pregnant women were scarce, but no reports of adverse reactions were found. The incidence of severe adverse outcomes was very low in the general population. The risk of treating pregnant women with benzathine penicillin to prevent congenital syphilis appears very low and does not outweigh its benefits. Further research is needed to improve the quality of evidence.

Prevalence of dementia among elderly Brazilians: a systematic review

CONTEXT AND OBJECTIVE The rapid growth of the elderly population in Brazil has implied a significant rise in the number of individuals with dementia. The real prevalence of this disease needs to be ascertained in order to establish appropriate measures for improving the quality of life of those affected. The aim of this study was to estimate the prevalence of dementia among elderly Brazilians (≥ 60 years) through a systematic review of high-quality, population-based, double-blind studies published between 1990 and 2010. DESIGN AND SETTING Systematic review of prevalence studies. The manuscript was produced in the School of Medicine, Universidade de Brasília. METHODS Database searches for articles were conducted in Medline (Medical Literature Analysis and Retrieval System Online), Embase (Excerpta Medica database), Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde), SciELO (Scientific Electronic Library Online) and theses and dissertations, using specific keywords. Quality was assessed according to eight criteria for sampling and measurement of findings. RESULTS Out of 112 articles identified, eleven were included in the qualitative synthesis. In five higher-quality studies from São Paulo, the prevalence rates ranged from 5.1 to 19.0%. No meta-analysis was presented because of heterogeneity among the studies. Poor, illiterate, female and very elderly individuals were the groups most affected. CONCLUSION The findings from this review did not reflect the reality of the whole country. Although the results brought some information on the prevalence and distribution of dementia in Brazil, cross-sectional studies with consistent methodology are needed.

Revisões sistemáticas da literatura: passos para sua elaboração

Ao estudar um tema, frequentemente nos deparamos com resultados contraditorios. Um caminho coerente para tentar esclarecer controversias e apoiar-se apenas nos estudos de melhor qualidade sobre o assunto. Partindo desse principio, surgiu um novo delineamento de pesquisa: a revisao sistematica da literatura. Trata-se de um tipo de investigacao focada em questao bem definida, que visa identificar, selecionar, avaliar e sintetizar as evidencias relevantes disponiveis.A atividade de compilar dados cientificos sobre um tema e praticada na area da saude ha muito tempo. Uma das primeiras revisoes de que se tem registro data de 1753, e foi feita por Sir James Lind sobre a prevencao e o tratamento do escorbuto.

Identifying and quantifying misclassified and under-reported AIDS deaths in Brazil: a retrospective analysis from 1985 to 2009

Background A retrospective analysis of deaths registered in the Brazilian Mortality System was conducted to quantify the under-reporting of HIV/AIDS deaths and those misclassified to AIDS-related conditions in the 15–49 years old population in Brazil. Methods Death rates for AIDS-related diseases were calculated by age and sex for 1985–2009. Changes in the age-sex-specific death rates over time were used to identify conditions likely to be misclassified AIDS deaths and to quantify the corresponding number of misclassified deaths. Deaths due to ill-defined causes were redistributed across all other natural causes of death. The resulting total number of AIDS deaths was further adjusted for incompleteness of the mortality reporting system. Results Out of the 28 potential causes of death investigated, five increased in the same distinct age pattern as AIDS: pneumonia, Kaposis sarcoma, other immunodeficiencies, other septicaemia and toxoplasmosis. 18 490 deaths due to these five causes were recoded to HIV/AIDS from 1985 to 2009. 38 145 deaths due to ill-defined causes were redistributed to AIDS and 15 485 were added to the number of AIDS deaths to correct for completeness of the mortality system in Brazil. Altogether, 72 120 deaths were recoded to AIDS between 1985 and 2009 and added to the reported 194 445 AIDS related deaths in the country, representing 27% misclassification of AIDS deaths in Brazil. Conclusions This study demonstrated that AIDS mortality is underestimated by the official mortality information system in Brazil. Efforts need to be made to reduce misclassification of causes of death in the future and identify ways in which the confidentiality of information regarding cause of death can be maintained.