Nelson Shozo Uchimura

Anemia e peso ao nascer

OBJECTIVE To verify the influence of Low Birthweight (LBW) on child anemia and malnutrition during the first year of life. METHODS Sample population included all children under one year seen at Health Units of the municipality of Maringá, southern Brazil, in 1998. Total sample size was 587 children. LBW was defined as birthweight below 2 500 g. The analysis of growth for the weigh-for-age and height-for-age indicators was based on National Center for Health Statistics standards. For anemia diagnosis, a biochemical hemoglobin concentration dosage, using HemoCue direct colorimetric method was employed. Children with [Hb] <11,0 g/dL were considered as anemic. RESULTS Fifty-eight percent of the studied population were anemic, and 37 children (6.3%) presented LBW. Anemia was more prevalent during the second semester of life (p=0.0093). Undernutrition, as indicated by the height-for-age indicator, was high especially for children aged 0-3 months with LBW. CONCLUSIONS Although LBW rates among the studied population were similar to those of developed countries, we suggest the implementation of specific antenatal care for high-risk women, aiming at reducing LBW, an event that affects the child, hampering its growth and increasing the risk of anemia and its countless deleterious consequences.

Quality and performance of pap smears in the cervical cancer screening program in a city of southern Brazil

OBJECTIVE To estimate prevalence and analyze quality and performance of colpocytology carried out under the Cervical Cancer Screening Program in Maringá, Paraná, Brazil. METHODS A retrospective study of the SIS-Colo database of the Brazilian Ministry of Health. Variables such as age, colpocytology result and origin were analyzed. Ages were divided into brackets; origin was distributed in five Regional Health Divisions of the city of Maringá; colpocytology was categorized according to the Bethesda System. Colpocytology, coverage was calculated by dividing the number of exams in the population between 25 and 59 years of age by the number of women in that same age group. RESULTS The 17,664 colpocytology exams collected in 2005 by the public health system were distributed among women between 12 and 82 years of age, with 12,961 (73.4%) examinations in women between the ages of 25 and 59, considered at high risk for cancer. A total of 17,458 (98.84%) cytological examinations were negative for malignancy, and atypical results (ASCUS / AGUS, LSIL, HSIL and invasive cancer) totaled 206 (1.16%). The study found a prevalence of 0.85% (151) for ASCUS / AGUS, 1.14% (203/17.664) for atypical cells, and a 2.75 ASCUS / atypical cells ratio (151/55). CONCLUSION The lower than expected prevalence of colpocytological and ASCUS alterations, the high ASCUS / atypical cells ratio and the insufficient population coverage by colpocytology jeopardized the performance of the cervical cancer prevention program. The low-income population requires special attention, and those more privileged should be advised about the frequency of examination and the age bracket with higher risks.

Utilização de métodos contraceptivos entre as usuárias da rede pública de saúde do município de Maringá-PR

PURPOSE: to evaluate the contraceptive methods adopted by the public health system of Maringa County, Parana, regarding the orientations for using them, indications, contraindications and reasons for interrupting these methods, as well as the profile of the female users. METHODS: transversal descriptive study, performed through 284 home interviews with women selected from the 62 groups of the Family Health Program, after their free and informed consent, and after the questionnaire had been approved by the Ethics in Research Committee involving human beings of the State University of Maringa (Universidade Estadual de Maringa - UEM). Before applying the questionnaires, they were pretested, focusing on the following sections: characterization of the interviewee, socioeconomical factors and contraceptive methods. Results were analyzed using the Statistical Package for the Social Sciences software 12.0 version. RESULTS: most women were white, married, between 35 and 49 years old, with high school education, working without salary, and from D and E economical classes. Of them, 22.5% were smokers and 4.9% alcohol users. Contraceptive pills were adopted by 50.3% of the women; condom by 28.1% and tubal ligature by 32%, following, in general, the health professional orientation. Reasons for interrupting the contraceptive methods were the wish to get pregnant, preference for a permanent method, and also because of the side effects of the pill. Smoking was the most prevalent risk factor for pill use. Only 35.9% of the interviewed women started using the pill after a previous medical visit, and almost in the same proportion, 33.6%, without visit before starting to use it. CONCLUSIONS: it was observed that the indications of the contraceptive method to be used, and the orientations accomplished by the health professionals were satisfactory, despite the high levels of tubal ligature and the detection of relative contraindications for pill users with more than 5 years of use.

Molecular Detection of HPV and Chlamydia trachomatis Infections in Brazilian Women with Abnormal Cervical Cytology

The question of whether Chlamydia trachomatis (Ct) is a cofactor for human Papillomavirus (HPV) in cervical carcinogenesis is still controversial. We conducted a molecular detection study of both infections in 622 Brazilian women, including 252 women with different grades of abnormal cervical cytology and cervical cancer (CC; cases) and 370 women with normal cytology (controls). Although Ct infection did not seem related to CC carcinogenicity, women with abnormal cytology had a significant high rate of Ct infection. Therefore, it is important to adopt protocols for diagnosis and treatment of this bacterium in conjunction with screening for CC in this population.

Sensitive Detection of Thirteen Bacterial Vaginosis-Associated Agents Using Multiplex Polymerase Chain Reaction

Bacterial vaginosis (BV) is characterized by a polymicrobial proliferation of anaerobic bacteria and depletion of lactobacilli, which are components of natural vaginal microbiota. Currently, there are limited conventional methods for BV diagnosis, and these methods are time-consuming, expensive, and rarely allow for the detection of more than one agent simultaneously. Therefore, we conceived and validated a multiplex polymerase chain reaction (M-PCR) assay for the simultaneous screening of thirteen bacterial vaginosis-associated agents (BV-AAs) related to symptomatic BV: Gardnerella vaginalis, Mobiluncus curtisii, Mobiluncus mulieris, Bacteroides fragilis, Mycoplasma hominis, Atopobium vaginae, Ureaplasma urealyticum, Megasphaera type I, Clostridia-like bacteria vaginosis-associated bacteria (BVABs) 1, 2, and 3, Sneathia sanguinegens, and Mycoplasma genitalium. The overall validation parameters of M-PCR compared to single PCR (sPCR) were extremely high, including agreement of 99.1% and sensitivity, specificity, and positive predictive values of 100.0%, negative predictive value of 97.0%, accuracy of 99.3%, and agreement with Nugent results of 100.0%. The prevalence of BV-AAs was very high (72.6%), and simultaneous agents were detected in 53.0%, which demonstrates the effectiveness of the M-PCR assay. Therefore, the M-PCR assay has great potential to impact BV diagnostic methods in vaginal samples and diminish associated complications in the near future.

Intervention analysis of introduction of rotavirus vaccine on hospital admissions rates due to acute diarrhea

The aim of this study is to investigate the impact of rotavirus vaccine on hospitalization rates for acute diarrhea in children younger than 5 years old after the introduction of the vaccine in 2006. A descriptive analytical observational study was carried out of the hospitalization rates occurred between 2000 and 2011 in 22 Regional Health Centers of Paraná State, Brazil. The effect of the vaccine was assessed by applying the SARIMA/Box-Jenkins time series methodology of intervention analysis, which allows verifying the slopes of the series are different after the introduction of the vaccine and estimating the magnitude of these effects for children younger than five years of age, by age group, for each region center. It was verified a statistically significant reduction by center/month on hospitalization rates for children 1 year old and younger, with averages of 47% and 58%, respectively, in December 2011.O objetivo desse estudo e investigar o impacto da vacina do rotavirus nas taxas de internacao por diarreia aguda em criancas menores de cinco anos apos a introducao da vacina em 2006. Foi realizado um estudo analitico observacional descritivo das taxas de hospitalizacao ocorridas entre 2000 e 2011, em 22 Centros Regionais de Saude do Estado do Parana, Brasil. O efeito da vacina foi avaliado por series temporais aplicando a metodologia SARIMA/Box-Jenkins com analise da intervencao, a qual permite verificar que os declives das series sao diferentes apos a introducao da vacina, bem como estimar a magnitude desses efeitos para criancas menores de cinco anos de idade, por faixa etaria, para cada regiao. Verificou-se reducao estatisticamente significativa por centro/mes nas taxas de internacao por diarreia aguda para as criancas menores de 1 ano de idade e de 1 ano de idade, com medias de 47% e 58%, respectivamente, em dezembro de 2011.

Avaliação da conduta conservadora na lesão intraepitelial cervical de alto grau

OBJECTIVE To assess the association between conservative management of high-grade cervical squamous intraepithelial lesions and recurrence rates and age groups. METHODS Cross-sectional, retrospective, analytical observational study of 509 women (aged 15 to 76) with abnormal Pap smears attending a public reference center in the city of Maringá, southern Brazil, from 1996 to 2006. Data was collected from medical records, and the variables definitive diagnosis, type of treatment provided, occurrence of high-grade cervical squamous intraepithelial lesions and recurrence were studied. Pearsons chi-square test and Fishers exact test were used in the statistical analyses. RESULTS There were 168 cases of cervical high-grade cervical squamous intraepithelial lesions, of these, 31 were treated with cold-knife conization, 104 loop electrosurgical excision procedure, 9 hysterectomy and 24 conservative treatment (i.e., clinical and cytological follow-up or cervical electrocoagulation). A total of 8 (33.3%) women receiving conservative and 10 (6.9%) receiving non-conservative management had recurrent disease and this difference was statistically significant (p=0.0009), PR = 4.8 (95%CI 2.11;10.93). Three (30.0%) women among those undergoing clinical and cytological follow-up and five 5 (35.7%) among those submitted to cervical electrocoagulation had recurrent disease within three years, but the difference was not significant (p=0.5611). Recurrent rates in those younger and older than 30 were 13.8% (7 women) and 12.2% (11 women) (p = 0.9955). CONCLUSIONS Age is not a predictor of disease recurrence. Conservative treatment is only recommended in exceptional situations due to its high recurrence rates. Careful cytological and colposcopic follow-up is required for three years when most recurrences occur.OBJETIVO: Analisar a associacao entre a conduta conservadora em lesao intraepitelial cervical de alto grau com o indice de recidiva da neoplasia e faixa etaria. METODOS: Estudo transversal e retrospectivo realizado com 509 mulheres (15-76 anos) atendidas no periodo de 1996 a 2006, com colpocitologia oncotica alterada, em um servico publico de referencia em Maringa, PR. Os dados foram coletados dos prontuarios medicos e estudadas as variaveis diagnostico definitivo, tipos de tratamento, ocorrencia da lesao e recidivas, analisados por meio de testes de associacao de qui-quadrado de Pearson e teste exato de Fisher. RESULTADOS: A lesao intraepitelial cervical de alto grau ocorreu em 168 casos; destes, 31 mulheres foram submetidas a amputacao conica, 104 a cirurgias de alta frequencia, nove histerectomizadas e 24 receberam conduta conservadora. Dentre as mulheres com lesao de alto grau e tratadas de forma conservadora, oito (33,3%) recidivaram, enquanto dentre as submetidas a conduta nao conservadora dez (6,9%) recidivaram, sendo essa diferenca estatisticamente significante (p = 0,0009), RP = 4,8 (IC95% 2,11;10,93). Para aquelas que fizeram o seguimento clinico-citologico, tres (30,0%) e, dentre as cauterizadas, cinco (35,7%) recidivaram no prazo de tres anos, sem diferenca significante (p = 0,5611). A recidiva abaixo e acima de 30 anos ocorreu, respectivamente, em sete (13,8%) e 11 (12,2%) mulheres (p = 0,9955). CONCLUSOES: A idade da mulher nao influencia o prognostico de recidiva. O tratamento conservador deve ser indicado como conduta de excecao, dada a alta taxa de recidiva, e o seguimento deve ser rigoroso, com acompanhamento citologico e colposcopico de ate tres anos, periodo em que ocorre a maioria das recidivas.

Evaluation of conservative management of high-grade cervical squamous intraepithelial lesion

OBJECTIVE To assess the association between conservative management of high-grade cervical squamous intraepithelial lesions and recurrence rates and age groups. METHODS Cross-sectional, retrospective, analytical observational study of 509 women (aged 15 to 76) with abnormal Pap smears attending a public reference center in the city of Maringá, southern Brazil, from 1996 to 2006. Data was collected from medical records, and the variables definitive diagnosis, type of treatment provided, occurrence of high-grade cervical squamous intraepithelial lesions and recurrence were studied. Pearsons chi-square test and Fishers exact test were used in the statistical analyses. RESULTS There were 168 cases of cervical high-grade cervical squamous intraepithelial lesions, of these, 31 were treated with cold-knife conization, 104 loop electrosurgical excision procedure, 9 hysterectomy and 24 conservative treatment (i.e., clinical and cytological follow-up or cervical electrocoagulation). A total of 8 (33.3%) women receiving conservative and 10 (6.9%) receiving non-conservative management had recurrent disease and this difference was statistically significant (p=0.0009), PR = 4.8 (95%CI 2.11;10.93). Three (30.0%) women among those undergoing clinical and cytological follow-up and five 5 (35.7%) among those submitted to cervical electrocoagulation had recurrent disease within three years, but the difference was not significant (p=0.5611). Recurrent rates in those younger and older than 30 were 13.8% (7 women) and 12.2% (11 women) (p = 0.9955). CONCLUSIONS Age is not a predictor of disease recurrence. Conservative treatment is only recommended in exceptional situations due to its high recurrence rates. Careful cytological and colposcopic follow-up is required for three years when most recurrences occur.OBJETIVO: Analisar a associacao entre a conduta conservadora em lesao intraepitelial cervical de alto grau com o indice de recidiva da neoplasia e faixa etaria. METODOS: Estudo transversal e retrospectivo realizado com 509 mulheres (15-76 anos) atendidas no periodo de 1996 a 2006, com colpocitologia oncotica alterada, em um servico publico de referencia em Maringa, PR. Os dados foram coletados dos prontuarios medicos e estudadas as variaveis diagnostico definitivo, tipos de tratamento, ocorrencia da lesao e recidivas, analisados por meio de testes de associacao de qui-quadrado de Pearson e teste exato de Fisher. RESULTADOS: A lesao intraepitelial cervical de alto grau ocorreu em 168 casos; destes, 31 mulheres foram submetidas a amputacao conica, 104 a cirurgias de alta frequencia, nove histerectomizadas e 24 receberam conduta conservadora. Dentre as mulheres com lesao de alto grau e tratadas de forma conservadora, oito (33,3%) recidivaram, enquanto dentre as submetidas a conduta nao conservadora dez (6,9%) recidivaram, sendo essa diferenca estatisticamente significante (p = 0,0009), RP = 4,8 (IC95% 2,11;10,93). Para aquelas que fizeram o seguimento clinico-citologico, tres (30,0%) e, dentre as cauterizadas, cinco (35,7%) recidivaram no prazo de tres anos, sem diferenca significante (p = 0,5611). A recidiva abaixo e acima de 30 anos ocorreu, respectivamente, em sete (13,8%) e 11 (12,2%) mulheres (p = 0,9955). CONCLUSOES: A idade da mulher nao influencia o prognostico de recidiva. O tratamento conservador deve ser indicado como conduta de excecao, dada a alta taxa de recidiva, e o seguimento deve ser rigoroso, com acompanhamento citologico e colposcopico de ate tres anos, periodo em que ocorre a maioria das recidivas.

Impacto da vacina oral de rotavírus Humano nas taxas de hospitalizações em crianças

Objective: To evaluate the risk of hospitalization for acute diarrhea in children under five, in the period of ten years before and after the oral rotavirus vaccine. Methods: Eco-descriptive-analyticstudy of the rates of hospitalization for acute diarrhea. We used hospitalization rate and the Relative Variation Rate to quantify the difference between the median in the years pre- andpostvaccination. We used logistic regression, odds ratio and attributablerisk to assess for the proportion of cases that could be avoided if exposure was avoided. Results: During the study period, the hospitalization rate was 117.41 per 10,000 children. In the prevaccination period, the median rate of hospitalization was 124.2/10,000 children. After the introduction of the vaccine, hospitalization rates were lower when compared to the median of the pre-vaccination years. Conclusion: There was a reduction in the hospitalization rates for acute diarrhea, thereby suggesting that the use of the vaccine and other associated factors can reduce the number of cases.

Avaliação da profilaxia no primeiro atendimento pós-exposição ao vírus da raiva

OBJECTIVE: To evaluate primary care prophylactic post-exposure anti-rabies treatment. METHODS: This was a cross-sectional, descriptive and analytical study, with data from the Information System for Notification of Diseases. It analyzed 39,087 visits, excluding 1,091 (2.79%) cases of re-exposure and pre-exposure, resulting in 37,996 post-exposure visits. A logistic regression analysis was performed for adjustment of the treatment. RESULTS: A predominance of Caucasians (83.93%), male (54.58%), primary school educational level (66.13%), ages between 20-59 years (45.0%) , followed by 0 to 12 years (32.88%), and residents in the urban area (91.97%) was observed. Among the visits, 15,500 (41.56%) were considered inadequate, 10,587 (28.11%) were deficient or the patient did not receive the necessary treatment, and 5,013 (13.44%) patients received more than what was necessary for rabies prophylaxis. CONCLUSION: The post-exposure prophylaxis for rabies was considered inadequate and requires a better approach on admission, and attention in completing the notification in the data record.