Neiva C. J. Valle

Dor lombar crônica em uma população adulta do Sul do Brasil: prevalência e fatores associados

To identify the prevalence of chronic low back pain (CLBP) and examine factors associated with this condition in a Southern Brazilian adult population, a population-based cross-sectional study was conducted, including 3,182 subjects of both sexes, aged 20 years or over, living in the urban area of Pelotas, Rio Grande do Sul State. The questionnaire included socio-demographic, behavioral, and nutritional variables, as well as characterization of exposure to ergonomic factors in daily activities. CLBP prevalence was 4.2%. The variables sex, age, marital status, schooling, smoking, body mass index, working in a lying position, heavy physical work, and repetitive movements were associated with CLBP. Prevalence of CLBP is important as it limits normal activities and increases the use of health care services. There may be differences in the ergonomic risk factors for CLBP and low back pain in general.

Prevalence of Helicobacter pylori infection and associated factors among adults in Southern Brazil: a population-based cross-sectional study

BackgroundHelicobacter pylori (Hp) infection is associated with several upper gastrointestinal disorders. Local data on the epidemiology of the infection are scarce in Brazil. The purpose of this study is to measure the prevalence rate and to explore the associated factors among the adult population living in Pelotas, a southern Brazilin city.MethodsThis was a population-based cross-sectional study. Through a multi-stage sampling method all individuals 20 years and over living at the selected households at the urban area of the city were interviewed regarding past and current socio-economic indicators; demographic characteristics; nutritional and behavioural habits; and history of upper gastrointestinal symptoms.Hp infection was ascertained through the 13C-UBT. Due to the high prevalence, data were analysed through robust Poisson regression. All analyses took into account the family clustering of the data.ResultsAmong 563 eligible individuals, 363 agreed to perform the 13C-UBT (refusal rate of 35.5%). Refusals were associated with female sex, consumption of mate drinking, and presence of upper gastrointestinal symptoms. The prevalence rate of H. pylori infection was 63.4% (95%CI 59.3%–69.3%). In crude analyses, prevalence was associated with increasing age, non-white skin colour, lower current family income, lower education level, higher size of the family, low socio-economic conditions in childhood, higher number of siblings and attendance to day-care centres in childhood, and presence of dyspeptic symptoms. In adjusted analysis the level of education of the father was inversely associated with the infection, whereas number of siblings and attendance to day-care centre in childhood were directly associated with it. Non-white skin colour remained significantly associated with increased prevalence even after allowing for past and current socio-economic characteristics, age and sex. Compared to non-symptomatic individuals, those reporting dyspeptic symptoms presented a higher prevalence of the infection even after allowing for current and past socio-economic conditions, ethnicity, age, and sex.ConclusionHp infection is as common among adults in southern Brazil as it is in other developing countries. Socio-economic conditions in childhood besides ethnicity and presence of dyspeptic symptoms were the factors significantly associated with the infection.

Prevalência e fatores associados à ocorrência de anemia entre menores de seis anos de idade em Pelotas, RS

OBJETIVOS: Determinar a prevalencia e investigar fatores associados a ocorrencia de anemia entre menores de seis anos de idade atendidos pela Pastoral da Crianca em Pelotas, RS. METODOS: Na fase de rastreamento de uma intervencao nutricional, as criancas foram avaliadas atraves de estudo transversal. No domicilio, apos consentimento informado, a mae foi entrevistada, sendo coletadas informacoes sobre caracteristicas demograficas e socioeconomicas da familia, saude da crianca, caracteristicas ao nascer, amamentacao e frequencia semanal de consumo de alimentos. As criancas foram pesadas e medidas. Foi coletada uma amostra de sangue capilar da polpa digital em microcuveta e a leitura da concentracao de hemoglobina foi feita em fotometro portatil (Hemocue). Considerou-se como tendo anemia quando a concentracao de hemoglobina era inferior a 11 g/dl. Por se tratar de desfecho frequente, a associacao com as variaveis independentes foi analisada por regressao de Poisson. A analise obedeceu a modelo hierarquico previamente definido. RESULTADOS: Foram identificadas 362 criancas menores de seis anos, sendo a hemoglobina dosada em 304 (84,0%) delas. A prevalencia de anemia foi de 53,0% (IC95% 47,2% - 58,7%). Os fatores de risco foram a menor idade da crianca, cor nao branca, presenca de familia numerosa e classe social E (em comparacao a D). A disponibilidade de agua encanada dentro de casa e o maior peso ao nascer mostraram-se fatores protetores. CONCLUSOES: os achados deste estudo mostram uma alta prevalencia de anemia entre as criancas alvo da acao da Pastoral da Crianca, bem como a presenca de diversos fatores de risco e poucos fatores de protecao, o que mostra a necessidade de intervencoes preventivas.

Evaluation of the impact of a nutritional program for undernourished children in Brazil

To assess the effectiveness on child growth and body composition of a supplementary feeding program (Milk Supplement Program), a prospective, controlled study was conducted in Northeast Brazil. When entering the Program, children from 10 municipalities with the highest coverage rates in the Program (intervention group) were compared to non-beneficiary children from 10 municipalities with the lowest coverage rates (control group). A total of 219 children aged 6-18 months were enrolled. At entry, both groups were comparable in terms of age, sex, and nutritional status. There were frequent gaps in delivery of the supplement, no extra milk was provided to siblings less than 5 years of age, intra-household redistribution of milk was high, and maternal compliance with recommendations was low. Adjusted analyses by multilevel modelling showed average changes in weight, length, weight-age and length-age Z-scores, and % body water (deuterium method), at 6 months, of 1.53 kg, 6.34 cm, 0.33, 0.05, and 1.11% respectively among supplemented children as compared to 1.54 kg, 6.5 cm, 0.26, 0.07, and 4.10% among controls, with no statistically significant difference between groups. Thus, the Program failed to compensate for nutritional deficiencies in undernourished children in Northeast Brazil.

Blood glucose control in diabetes patients seen in primary health care centers

OBJECTIVE To identify factors associated to poor glycemic control among diabetic patients seen at primary health care centers. METHODS A cross-sectional study was carried out in a sample of 372 diabetic patients attending 32 primary health care centers in southern Brazil. Data on three hierarchical levels of health unit infrastructure, medical care and patient characteristics were collected. RESULTS The frequency of poor glycemic control was 50.5%. Multivariate analysis (multilevel method) showed that patients with body mass indexes below 27 kg/m2, patients on oral hypoglycemic agents or insulin, and patients diagnosed as diabetic over five years prior to the interview were more likely to present poor glycemic control when compared to their counterparts. CONCLUSIONS Given the hierarchical data structuring, all associations found suggest that factors associated to hyperglycemia are related to patient-level characteristics.

Óbitos evitáveis até 48 meses de idade entre as crianças da Coorte de Nascimentos de Pelotas de 2004

OBJETIVO: Descrever obitos evitaveis de criancas pertencentes a Coorte de Pelotas, RS, de 2004. METODOS: O obito de 92 criancas entre 2004-2008 da Coorte de Pelotas 2004 foi identificado e classificado conforme a Lista de Causas de Mortes Evitaveis por Intervencoes do Sistema Unico de Saude. Os Sistemas de Informacao sobre Mortalidade (SIM) municipal e estadual foram rastreados para localizar mortes ocorridas fora de Pelotas e as causas apos o primeiro ano vida. O obito de menores de um ano foi avaliado e comparado entre um subestudo e o SIM. Foram calculados coeficientes de mortalidade: 1.000 nascidos vivos (NV), mortalidade proporcional por causas evitaveis e conforme tipo de unidade basica de saude (tradicional ou Estrategia Saude da Familia). RESULTADOS: O coeficiente de mortalidade foi de 22,2:1.000 NV, 82 obitos ocorreram no primeiro ano de vida (19,4:1.000 NV), dos quais 37 (45%) na primeira semana. Mais de ¾ dos obitos (70/92) eram evitaveis. No primeiro ano de vida, a maioria (42/82) das mortes seriam evitadas pela adequada atencao a mulher durante a gestacao; de acordo com o SIM, a maioria (n = 32/82), pela adequada atencao ao recem-nascido. Nao houve diferenca entre o tipo de Unidade Basica de Saude quanto a proporcao de obitos evitaveis. CONCLUSOES: E alta a proporcao de obitos infantis que podem ser evitados. Para que os obitos evitaveis possam ser utilizados como indicadores no monitoramento da qualidade da atencao a saude materno-infantil, e necessario aprimorar a qualidade dos os registros das Declaracoes de Obito.

Avaliação da eficácia do aconselhamento nutricional dentro da estratégia do AIDPI (OMS/UNICEF)

Este foi um estudo randomizado, controlado, cego, cujo objetivo foi avaliar o impacto do aconselhamento nutricional, dentro da estrategia da Atencao Integral as Doencas Prevalentes na Infância (OMS/UNICEF), sobre o crescimento infantil. Os 28 postos de saude de Pelotas foram emparelhados conforme indicadores nutricionais. Um posto de cada par foi aleatoriamente selecionado e seus medicos treinados em aconselhamento nutricional. Foram incluidos 33 medicos e de cada um deles selecionados 12-13 pacientes, de 0 a 18 meses de idade. O estudo incluiu avaliacao do conhecimento dos medicos, observacao de consultas e visitas domiciliares aos 8, aos 45 e aos 180 dias apos a consulta inicial. O conhecimento materno, as praticas alimentares e a aderencia as recomendacoes foram avaliadas. Foram tomadas medidas antropometricas das criancas. O consumo de alimentos foi avaliado para um dia inteiro em uma subamostra de criancas. Os medicos do grupo intervencao sabiam mais sobre nutricao infantil e melhoraram seu desempenho em avaliacao da alimentacao e em aconselhamento nutricional. O recordatorio materno, bem como a satisfacao com a consulta, foram maiores no grupo intervencao. O uso referido dos alimentos recomendados foi maior no grupo intervencao. O aporte diario de lipideos, calorias e zinco foi maior no grupo intervencao. As criancas de 12 meses ou mais apresentaram ganhos significativos no peso e diferencas positivas, embora nao significativas, em comprimento. O treinamento em aconselhamento nutricional melhorou o desempenho dos medicos, as praticas maternas, as dietas e o crescimento das criancas. O desenho randomizado com avaliacao cega do desfecho sugere fortemente uma associacao causal.

Helicobacter pylori and anemia: a community-based cross-sectional study among adults in Southern Brazil

To investigate the association between Helicobacter pylori and anemia, a community-based cross-sectional study was conducted among 18-45 year old users of the 31 primary health care units in Pelotas, Southern Brazil. Interviews using a structured questionnaire were carried out in waiting rooms during two work shifts. Anemia (hemoglobin < 11g/dL among pregnant women, < 12g/dL among women and < 13g/dL among men) was diagnosed from capillary blood (HemoCue) and H. pylori by means of a 13C-UBT. Information on socio-demographic, behavioral and biological characteristics was collected. Logistic and linear regression analyses were carried out, taking into account aggregated primary health care units. A total of 1,117 respondents fulfilled the inclusion criteria (losses/refusals: 8.1%). Prevalence of anemia was 20.6% (18.2-23.2%) and of H. pylori, 70.7% (68.0-73.6%). After allowing for age, sex and skin color the odds ratio for anemia among those who were diagnosed H. pylori positive was 0.94 (0.70-1.27). After allowing for sex, skin color, family monthly income, age, and smoking, the reduction in hemoglobin among H. pylori positive respondents was 0.07g/dL (-0.24-0.11; p = 0.4). There is no association between H. pylori and anemia among adults attending primary health care units in Southern Brazil.

Avaliação do impacto do Programa Nacional do Leite em Alagoas, através de métodos isotópicos: aspectos metodológicos e resultados preliminares

OBJETIVOS: Descrever aspectos metodologicos e resultados preliminares de um estudo de intervencao planejado para medir o impacto de um programa de suplementacao alimentar sobre a promocao do crescimento infantil de criancas desnutridas. METODOS: Estudo longitudinal, controlado, desenvolvido no estado de Alagoas, com grupos comparados antes e depois da intervencao. Vinte municipios foram selecionados atraves de um indicador de cobertura do programa de suplementacao alimentar. Essa cobertura foi estimada pela diferenca entre a proporcao de criancas desnutridas e a proporcao de criancas atendidas pelo programa. Os dez municipios com indicador de alta cobertura foram selecionados para o grupo intervencao e aqueles de menor cobertura para o grupo controle. Em cada municipio do grupo intervencao foram selecionadas 15 criancas ingressando no Programa. Em cada municipio do grupo controle foram incluidas 15 criancas elegiveis, mas que nao conseguiram vaga no Programa. RESULTADOS: Foram aplicados 111 e 102 questionarios em criancas dos municipios do grupo intervencao e controle, respectivamente. A comparacao em relacao as caracteristicas de base mostra que a distribuicao das variaveis demograficas e nutricionais foi semelhante entre as criancas dos grupos intervencao e controle. Por outro lado, as criancas do grupo intervencao sao provenientes de familias com menor renda familiar e seus pais apresentaram menor escolaridade quando comparadas as do grupo controle. CONCLUSOES: Os resultados preliminares mostram que os grupos sao comparaveis em relacao as variaveis demograficas e nutricionais e que as diferencas observadas quanto ao nivel socioeconomico deverao ser consideradas na analise ajustada, na segunda fase do estudo.

Avoidable deaths in the first four years of life among children in the 2004 Pelotas (Brazil) birth cohort study

Avoidable deaths have been employed as indicators of health care quality. The aim of this study was to identify factors associated with avoidable deaths from birth to four years of age among children from the 2004 Pelotas (Brazil) birth cohort study. From January 1st, 2004, to December 31st, 2005, deaths were monitored on a daily basis and the causes were investigated and classified according to avoidability. After the first year, deaths were monitored through the Mortality Information System. A total of 94 children died during this period. It was possible to classify 92 deaths, 70 of which were preventable. Low family income, fewer prenatal visits and poor-quality prenatal care, preterm birth, low 5-minute Apgar score, and no breastfeeding in the first 24 hours of life were associated with increased risk of death. Prematurity was present in 39 deaths, but only five of these would have been prevented by measures provided during prenatal care. Although limited, compliance with antenatal care program guidelines is still the most important strategy for preventing avoidable deaths in childhood, particularly among the poorest children.