Neusa Nunes da Silva e Gonçalves

Exposição humana ao mercúrio na Amazônia brasileira: uma perspectiva histórica

The objective of the present article was to present the most important data generated by a multicentric study carried out by Brazilian researchers who, with the support of national and international institutions, worked during the 1990s to describe human exposure to mercury in gold mining areas in the Brazilian Amazon. Three sets of procedures were followed with residents of the Tocantins and Xingu river basins: (1) clinical examination, based on a standardized protocol and performed by a single researcher, in order to identify five basic levels of contamination; (2) determination of mercury levels in blood, hair, and urine, using atomic absorption spectrophotometry (Xingu Project); and (3) investigation of genotoxicity by using four cytogenetic indicators. During the first stage, 41 individuals were studied. Mercury was found in miners and their family members. Contamination was significantly associated with occupation and showed a differential correlation with genotoxicity indicators. After that, the Xingu project, which encompassed 625 individuals, focused on 417 Kayapo natives from the Gorotire and Djudjetiktire villages; 142 miners; and 66 riverine individuals (ribeirinhos). The highest levels of methylmercury in hair and total mercury in blood and urine were found among the Indian population. Contamination with inorganic forms of mercury was also observed in the blood, hair, and urine of Indians. Following a specific recommendation from the World Health Organization, special attention was given to pregnant Gorotire and Djudjetiktire women, who, although not directly exposed to mercury vapors, showed considerable levels of mercury intoxication. Despite this worrisome scenario, a number of social achievements in the 1990s point to new standards of dignity in health care and of social ethics in Brazil that could benefit everyone, including the victims of environmental injury.

Determinantes da evolução do peso e altura em crianças de 3 meses a 6 anos assistidas em creche: análise por modelo linear não hierarquizado em ensaio quase-experimental

Objetivo. Avaliar os determinantes do crescimento em criancas de 3 meses a 6 anos assistidas em creche usando como grupo de comparacao criancas de caracteristicas semelhantes mas que nao frequentavam creche. Metodos. Foi planejado um estudo quase experimental com observacao de 444 criancas entre 3 e 72 meses de idade, residentes em area periferica de Sorocaba, Estado de Sao Paulo, Brasil, constituindo dois grupos: o grupo de intervencao (164 criancas matriculadas em creche) e o grupo de nao intervencao (280 que nao frequentavam creche). Ambos os grupos foram acompanhados por 16 meses, mediante quatro observacoes. Foram medidos o peso e a altura e coletadas informacoes sobre antecedentes socio-demograficos e de morbidade da mae, caracteristicas das criancas ao nascimento, morbidade nos ultimos 15 dias antes de cada observacao e hospitalizacoes. Resultados. Os lactentes e pre-escolares dos dois grupos eram de familias de baixo poder aquisitivo, 65% com renda media mensal inferior a 100 dolares. Oitenta por cento das maes tinham ensino fundamental (8 anos) ou menor. A regressao linear multivariada mostrou que na primeira observacao -- portanto, antes da entrada na creche -- o peso ao nascer foi a unica condicao a explicar as variacoes nutricionais dos grupos. Modelagens subsequentes revelaram que a frequencia ou nao a creche e condicao determinante do crescimento, especialmente quando se analisa a adequacao do peso para idade, tendo sido controlados os efeitos do peso ao nascer, sexo, idade ao inicio do estudo e doencas nos 15 dias anteriores as entrevistas. O impacto nutricional da frequencia a creche ja era significativo nos primeiros 3 meses de observacao. Conclusoes. O beneficio nutricional da assistencia prestada nas creches supera os efeitos negativos da maior morbidade observada entre criancas que frequentam creche.

Evolução da relação entre peso e altura e peso e idade em crianças de 3 meses a 6 anos assistidas em creche, Sorocaba (SP), Brasil

An experimental study was conducted to evaluate the nutritional impact of the municipal preschool nutritional assistance program in the city of Sorocaba Sao Paulo Brazil. Over the course of a year (1995) quarterly measurements of weight and height were done on 444 children with an age range of 3 months to 6 years using a structured questionnaire. In this population 164 children were assisted by the preschool nutritional program (intervention group = IG) and 280 children were not (nonintervention group = NG). The z score groupings were established at the beginning of the study for three different age groups: younger than 24 months 24-36 months and older than 36 months. Only 8% of children in the IG were in the proper weight-for-height category while 5% of the IG and 3% of NG were in the proper weight-for-age group. 32% of children in the IG experienced an increase in the z score values for weight-for-height vs. 13% of controls in the NG. The percentage increases for weight-for-age for all three age groups were 10% 14% and 22% in the IG vs. 8% 6% and 18% in the NG. More of the mothers of children in the intervention group had jobs outside the home; the children in the intervention group were significantly older; nutritional status was worse in the intervention group; and prevalence of hospital admittance was higher in the intervention group. After the first three months of the study 32% of the children in the intervention group had moved to a higher nutritional stratum whereas only 13% of children in the nonintervention group showed improved nutritional status.As condicoes nutricionais da populacao brasileira melhoraram nas ultimas 3 decadas. Mesmo assim, e pouco conhecido o papel da assistencia oferecida por instituicoes publicas ou filantropicas que atendem criancas pre-escolares de baixa renda e de maior risco nutricional. Visando avaliar o impacto nutricional do programa municipal de assistencia alimentar em creches do municipio de Sorocaba, Estado de Sao Paulo, Brasil, realizou-se um estudo quase-experimental. Durante 1 ano, em quatro observacoes trimestrais, acompanhou-se a evolucao no peso e altura de 444 criancas de 3 meses a 6 anos completos: 164 assistidas em uma creche (grupo de intervencao) e 280 nao assistidas (grupo de nao intervencao), residentes na area adstrita a creche porem nao frequentes a mesma, e identificadas em censo especifico. Depois de colhidos termos de assentimento e executado um pre-teste, profissionais e alunos universitarios entrevistaram as maes das criancas participantes no estudo, segundo tecnicas e condicoes padronizadas. A antropometria foi realizada por dupla de investigadores, um deles sempre fixo na equipe, com equipamentos aferidos pela agencia tecnica regional. Avaliou-se a concordância entre a primeira observacao e as observacoes subsequentes, com estratificacao da populacao em tres grupos de escores z de peso para idade e peso por altura (tendo como referencia as curvas do National Center for Health Statistics) verificados ao inicio do estudo e em tres faixas etarias (menores de 24 meses, de 24 a 36 e maiores de 36 meses). Os grupos de intervencao e nao intervencao foram semelhantes quanto as condicoes socio-demograficas, exceto trabalho materno (as maes no grupo de intervencao trabalhavam fora com maior frequencia); foram significativamente distintos quanto a idade (mais velhas no grupo de intervencao), condicoes nutricionais (piores no grupo de intervencao) e prevalencia de internacao hospitalar anterior (maior no grupo de intervencao). Ja nos primeiros 3 meses, 32% das criancas no grupo de intervencao migraram para estrato de status nutricional superior, enquanto no grupo de nao intervencao apenas 13% apresentaram melhora. A diferenca favorecendo o grupo de intervencao aumentou com a duracao da intervencao e foi maior entre criancas mais velhas, permitindo concluir que a assistencia na creche melhorou a nutricao das criancas atendidas.The nutritional status of Brazilians has improved over the last three decades. Still, little is known about the role played by nutritional assistance programs that public institutions and philanthropic organizations provide for low-income preschool children, who face greater nutritional risk. Therefore, we carried out a quasi-experimental study to evaluate the nutritional impact of the municipal preschool nutritional assistance program in the city of Sorocaba, São Paulo, Brazil. Over the course of a year, we performed quarterly measurements of weight and height on 444 children, whose ages ranged from 3 months to 6 years. In this population, 164 children were assisted by the preschool nutritional program (intervention group), and 280 children were not (nonintervention group). The children in the nonintervention group were identified by a special census for that purpose; they did not attend the preschool but lived nearby. After obtaining informed consent and carrying out a pretest, professionals and university students interviewed the mothers of the participating children, following standard techniques and conditions. Anthropometric measurements were done by teams of two interviewers, one of whom was a permanent member of the team, using equipment calibrated by the appropriate regional technical organization. The correspondence between the first measurement and subsequent measurements was evaluated by stratifying the population into three groups by z scores for weight-for-age and for weight-for-height, using U.S. National Center for Health Statistics reference curves. The z score groupings were established at the beginning of the study for three different age groups: younger than 24 months, 24-36 months, and older than 36 months. The two study groups (intervention and nonintervention) were similar sociodemographically, with the following exceptions: maternal employment (more of the mothers of children in the intervention group had jobs outside the home); age (children in the intervention group were significantly older); nutritional status (it was worse in the intervention group); and prevalence of hospital admittance (it was higher in the intervention group). After just the first three months of the study, 32% of the children in the intervention group had moved to a higher nutritional stratum, whereas only 13% of children in the nonintervention group had shown improved nutritional status. The difference in favor of the intervention group increased with the length of the intervention and was higher among older children. These results show that the preschool nutritional assistance program helped to improve the assisted childrens nutritional status.

Evolução e determinantes de incremento de peso (por altura e idade) em crianças de dois a 72 meses em Sorocaba, São Paulo: evidências a partir de estudo quase-experimental seriado.

OBJECTIVES: to review the main aspects of a project conducted by the authors during the last decade with the aim of presenting elements of nutritional supplement in childhood in relation to public policies. METHODS: the growth and development indicators had been accompanied every three months during one year in a population of two to 72 month old children in the outskirts of Sorocaba, Sao Paulo, Brazil. After completing a child census in two regions of the city, children who had received nutrional assistance (in number of 164) were compared to 280 who had not. A quantitative analysis was performed by Kappas and Goodmans tests, and by multivariate models. Bias and confounding were investigated and controlled. RESULTS: the main information obtained refers to the characteristics of the assisted group: 1) higher average age; 2) lower rates of natural milk feeding; 3) lower values of weight/height at admission and greater gains during evolution; 4) this improvement grew with the length of exposure and was greater in the oldest children. CONCLUSIONS: emphasize that today in our country assistance to preschool children should be a mandatory social policy.Objectives: to review the main aspects of a project conducted by the authors during the last decade with the aim of presenting elements of nutritional supplement in childhood in relation to public policies. Methods: the growth and development indicators had been accompanied every three months during one year in a population of two to 72 month old children in the outskirts of Sorocaba, São Paulo, Brazil. After completing a child census in two regions of the city, children who had received nutrional assistance (in number of 164) were compared to 280 who had not. A quantitative analysis was performed by Kappas and Goodmans tests, and by multivariate models. Bias and confounding were investigated and controlled. Results: the main information obtained refers to the characteristics of the assisted group: 1) higher average age; 2) lower rates of natural milk feeding; 3) lower values of weight/height at admission and greater gains during evolution; 4) this improvement grew with the length of exposure and was greater in the oldest children. Conclusions: emphasize that today in our country assistance to preschool children should be a mandatory social policy.