Olga Akiko Takano

Desenvolvimento de pré-escolares na educação infantil em Cuiabá, Mato Grosso, Brasil

O objetivo foi avaliar o desenvolvimento neuropsicomotor de pre-escolares na educacao infantil. Estudo de corte transversal, utilizando 38 itens do teste de Denver II. Foram avaliados todos os pre-escolares com idade entre quatro e seis anos incompletos matriculados na Rede Publica Municipal de Ensino de Cuiaba, Mato Grosso, Brasil, no periodo de agosto 2002 a novembro 2003. Nesse periodo havia 960 pre-escolares matriculados em 27 creches e duas escolas publicas. Para a analise estatistica foi aplicado o teste C2 com intervalo de 95% de confianca e ± = 5%. Para calcular os percentis da idade em que os pre-escolares passaram em cada prova foi realizada uma regressao logistica. Dos 960 pre-escolares avaliados, 67% apresentaram desempenho normal, 30,2% questionavel e 2,8% anormal. Em 27/38 itens avaliados, o percentual de acertos ultrapassou 90%. O desempenho alterado predominou no sexo masculino, no grupo de cinco a seis anos. O desempenho dessa populacao foi muito semelhante ao dos pre-escolares norte-americanos de Denver, Colorado. O melhor resultado segundo o genero ocorreu no sexo feminino e segundo a idade no grupo de quatro anos.

Risk factors, clinical and laboratory aspects of asthma in children

OBJETIVO: avaliar os aspectos clinicos, laboratoriais, e os fatores de risco associados a asma em criancas atendidas no Ambulatorio de Pediatria, do Hospital Universitario Julio Muller. Metodo: estudo de caso-controle, incluindo 59 criancas asmaticas (casos) e 104 nao-asmaticas (controles). Os seguintes fatores foram considerados para analise de risco: escolaridade dos pais, exposicao aos alergenos domiciliares, tabagismo passivo, aleitamento materno, renda e antecedentes familiares alergicos. Foram coletadas amostras de sangue para hemograma e dosagem de IgE total e especifica para alergenos. Realizou-se teste cutâneo de hipersensibilidade imediata pelo metodo de puntura para os seguintes alergenos: acaros, animais, fungos e baratas com controles positivo (histamina) e negativo (solucao fisiologica).Um modelo de regressao logistica foi usado para calcular odds ratio (OR) e intervalo de confianca (IC) 95% ajustado para outros fatores de risco e confundidores. RESULTADOS: dentre os fatores de risco estudados, sexo, baixa escolaridade, baixa renda, tempo de aleitamento materno e tabagismo passivo nao estiveram associados a ocorrencia de asma. A exposicao aos alergenos foi semelhante nos dois grupos, a nao ser pela maior frequencia de animais nos domicilios dos controles (c2=16,9; P < 0,05). Rinite paterna foi o unico antecedente familiar associado a asma (OR=3,33; IC 95%:1,03-11,17; P < 0,05). As criancas asmaticas apresentaram maior frequencia de positividade do teste cutâneo que os controles, principalmente para acaros: Dermatophagoides pteronyssinus (69,5%), Dermatophagoides farinae (59,3%) e Blomia tropicalis (59,3%); baratas: Periplaneta americana (59,3%) e gato: Felis domesticus (37,3%); com OR variando de 11,2-21,0; p < 0,05. Eosinofilia e niveis sericos de IgE total foram mais elevados no grupo de asmaticos (p < 0,05). A positividade do teste de IgE especifica para Dermatophagoides pteronyssinus e Blomia tropicalis foi maior nos casos em relacao aos controles (P < 0,05). A analise multivariada mostrou que sensibilizacao as baratas (OR=9,26, 95%IC:2,59-33,4), animais (OR=3,93, 95%IC:1,05-14,67) e acaros (OR=3,74, 95%IC:1,18-11,8) foram os mais importantes fatores de risco para asma. CONCLUSOES: a sensibilizacao aos alergenos domiciliares, principalmente acaros, barata e animais mostrou uma forte associacao com asma neste estudo.

Surveillance for adverse events after DTwP/Hib vaccination in Brazil: sensitivity and factors associated with reporting.

We estimated the sensitivity, i.e., the proportion of all cases of adverse events following immunization (AEFIs) reported to the Brazilian passive surveillance for adverse events following immunization (PSAEFI) with the diphtheria-tetanus-whole-cell pertussis-Haemophilus influenzae type b (DTwP/Hib) vaccine, as well as investigating factors associated with AEFIs reporting. During 2003-2004, 8303 AEFIs associated with DTwP-Hib were reported; hypotonic-hyporesponsive episodes (HHEs), fever and convulsions being the most common. Cure without sequel was achieved in 98.4% of the cases. The mean sensitivity of the PSAEFI was 22.3% and 31.6%, respectively, for HHE and convulsions, varying widely among states. Reporting rates correlated positively with the Human Development Index and coverage of adequate prenatal care, correlating negatively with infant mortality rates. Quality of life indicators and the degree of organization of health services are associated with greater PSAEFI sensitivity. In addition to consistently describing the principal AEFIs, PSAEFI showed the DTwP/Hib vaccine to be safe and allayed public fears related to its use.

Risk factors associated with wheezing in infants

OBJECTIVE to identify possible risk factors associated with wheezing in infants (12-15 months-old) in the state of Mato Grosso, Brazil. METHODS this was a cross-sectional study performed by applying a standardized written questionnaire from the international study on wheezing in infants (Estudio Internacional de Sibilancia en Lactantes - EISL), phase 3. Parents and/or guardians of infants were interviewed at primary health care clinics or at home from August of 2009 to November of 2010. Factors associated to wheezing were studied using bivariate and multivariate analysis (using the Statistical Package for Social Sciences [SPSS] v.18.0), and expressed as odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS the written questionnaire was answered by 1,060 parents and/or guardians. The risk factors for wheezing were: history of asthma in the family [mother (OR = 1.62; 95% CI = 1.07-2.43); father (OR = 1.98; 95% CI = 1.22-3.23); siblings (OR = 2.13; 95% CI = 1.18-3.87)]; history of previous pneumonia (OR = 10.80; 95% CI = 4.52-25.77); having had more than six upper respiratory tract infections (URTIs) (OR = 2.95; 95% CI = 2.11-4.14); having had first URTI before the third month of life (OR = 1.50; 95% CI = 1.04-2.17); living in a moderately polluted area (OR = 1.59; 95% CI = 1.08-2.33); paracetamol use for URTI (OR = 2.13; 95% CI = 1.54-2.95); and antibiotic use for skin infection (OR = 2.29; 95% CI = 1.18-4.46). CONCLUSIONS the study of risk factors for wheezing in the first year of life is important to help physicians identify young children at high risk of developing asthma and to improve public health prevention strategies in order to reduce the morbidity of wheezing in childhood.

Prevalência e fatores de risco para asma em adolescentes de 13 a 14 anos do Município de Cuiabá, Mato Grosso, Brasil

The objective of this study was to estimate the prevalence of active asthma and identify associated risk factors in adolescents 13 to 14 years of age in Cuiabá, Mato Grosso State, Brazil. A cross-sectional population-based and a subsequently a nested case-control study was conducted in 2008 using the protocol of the International Study of Asthma and Allergies in Childhood (ISAAC). Risk factor analysis used the chi-square test, Fishers exact test, and binary logistic regression. Variables with p < 0.20 in the bivariate analysis entered the logistic regression model, with six variables remaining in the final model (p < 0.05). Prevalence of active asthma was 19.1%. Risk factors for active asthma (p = 0.01) were: smoking during pregnancy, exclusive breastfeeding < 6 months, family income < 3 minimum wages, female gender, pets currently in the home, and absence of fish in the diet. Prevalence of active asthma was high, but with a significant reduction compared to 1998.

Avaliação do sistema brasileiro de vigilância de eventos adversos pós-vacinação

OBJETIVOS: Descrever e avaliar o Sistema brasileiro de vigilância passiva de eventos adversos pos-vacinacao (SPVEAPV). METODOS: A descricao e avaliacao do SPVEAPV fundamentaram-se nas notificacoes de eventos adversos pos-vacina Tetravalente ou DTwP/Hib - vacina adsorvida difteria, tetano, pertussis e Haemophilus influenzae b (conjugada) - (EAPV-T), durante o periodo de 2002 a 2005. Empregou-se a metodologia proposta pelo Centers for Disease Control and Prevention. RESULTADOS: O SPVEAPV apresenta abrangencia nacional, tem por objetivos identificar e padronizar condutas frente a casos de eventos adversos pos-vacinacao (EAPV) e identificar lotes reatogenicos. A vigilância e util, simples e flexivel, sua sensibilidade e baixa, superestima os eventos mais graves, mas descreve de forma consistente os EAPV-T, identificando a convulsao, a febre e o episodio hipotonico-hiporresponsivo como os mais frequentes, apontando a maior proporcao de EAPV na primeira dose (49,7%) e nas primeiras seis horas apos a vacinacao (72,8%); e util ao subsidiar decisoes e investigacoes complementares; 46,1% das notificacoes sao feitas ate 10 dias apos a vacinacao; sua completude varia de 70% a 90%, conforme o item. CONCLUSOES: O SPVEAPV mostra-se util no monitoramento da seguranca da vacina DTwP/Hib, sendo, porem, recomendavel a incorporacao de novas metodologias como a de municipios e/ou hospitais sentinelas e a de sistemas informatizados de registros de imunizacao com a finalidade de elevar sua sensibilidade.

Desempenho nas habilidades da linguagem em crianças nascidas prematuras e com baixo peso e fatores associados

Purpose: To examine the language development at chronological age 2 to 3 years of children born preterm with low birth weight and its associated risk factors. Methods In this cross-sectional study, children were assessed using the Denver Developmental Screening Test (Denver II test) and Early Language Milestone Scale (ELM scale). The chi-square test was used and all variables with p<0.20 were entered in a binary logistic regression model; statistical significance was set at p<0.05. Results Among the 77 children studied, 36.4% had abnormal Denver II test performance in its four sectors and 37.6% had cautions and delays in the area of language specifically. On assessment of language ability by the ELM scale, 32.5% of the children showed altered responses. The abnormal performance of the four sectors of the Denver II and language in the ELM scale, after logistic regression, remained associated with suspected developmental abnormalities by parents (Denver II and ELM), weight less than 1500 g and caesarean section (Denver II only), and intracranial hemorrhage and family per capita income less than half the minimum wage (ELM only). Conclusion Children born preterm with low birth weight showed delayed language development, with greater impairment in the expressive auditory function associated with socioeconomic risk factors and child’s history.

Infant mortality rate in Cuiabá, Mato Grosso State, Brazil, 2005: a comparison between direct calculation and linkage between the live birth and infant mortality databases

This study aimed to analyze the infant mortality rate (IMR) by linking the Live Birth Information System (SINASC) and the Mortality Information System (SIM) and comparing the result to direct calculation using crude data provided by the same databases. The systems used were SINASC, containing 9,590 certificates of live birth from January 1 to December 31, 2005, and SIM, containing 156 death certificates from the reference population (2005). Of the 156 deaths in the year 2005, 126 (80.8%) were paired by the direct method and 11 (7%) by manual search, totaling 137 deaths (87.8%). The rates found with the linkage method allowed calculating the real IMR (14.2 deaths/1,000 live births) and its components. The IMR using linkage was 17.3% lower than as calculated using crude SIM data. The early neonatal component (7.2 deaths/1,000 live births) accounted for half of the deaths in the first year of life (50.4%).

Doctors' awareness concerning primary immunodeficiencies in Brazil

BACKGROUND PIDs are a heterogeneous group of genetic illnesses, and delay in their diagnosis is thought to be caused by a lack of awareness among physicians concerning PIDs. The latter is what we aimed to evaluate in Brazil. METHODS Physicians working at general hospitals all over the country were asked to complete a 14-item questionnaire. One of the questions described 25 clinical situations that could be associated with PIDs and a score was created based on percentages of appropriate answers. RESULTS A total of 4026 physicians participated in the study: 1628 paediatricians (40.4%), 1436 clinicians (35.7%), and 962 surgeons (23.9%). About 67% of the physicians had learned about PIDs in medical school or residency training, 84.6% evaluated patients who frequently took antibiotics, but only 40.3% of them participated in the immunological evaluation of these patients. Seventy-seven percent of the participating physicians were not familiar with the warning signs for PIDs. The mean score of correct answers for the 25 clinical situations was 48.08% (±16.06). Only 18.3% of the paediatricians, 7.4% of the clinicians, and 5.8% of the surgeons answered at least 2/3 of these situations appropriately. CONCLUSIONS There is a lack of medical awareness concerning PIDs, even among paediatricians, who have been targeted with PID educational programmes in recent years in Brazil. An increase in awareness with regard to these disorders within the medical community is an important step towards improving recognition and treatment of PIDs.

Prevalence and clinical characteristics of wheezing in children in the first year of life, living in Cuiabá, Mato Grosso, Brazil

Objective: To evaluate the prevalence and the clinical characteristics of wheezing in 12-15 months old infants in the city of Cuiaba, Mato Grosso State, Midw...OBJECTIVE: To evaluate the prevalence and the clinical characteristics of wheezing in infants aged 12 to 15 months in the city of Cuiabá, Mato Grosso State, Midwest Brazil. METHODS: Parents and/or guardians of infants were interviewed and completed a written standardized questionnaire of the Estudio Internacional de Sibilancia en Lactantes (EISL) - phase 3 at primary healthcare clinics at the same day of children vaccination or at home, from August of 2009 to November of 2010. RESULTS: 1,060 parents and/or guardians completed the questionnaire, and 514 (48.5%) infants were male. Among the studied infants, 294 (27.7%) had at least one episode of wheezing during the first year of life, beggining at 5.8±3.0 months of age, with a predominance of male patients. The prevalence of occasional wheezing (<3 episodes of wheezing) was 15.0% and recurrent wheezing (≥3 episodes) was 12.7%. Among the infants with recurrent wheezing, the use of inhaled β2-agonist, oral corticosteroid, leukotriene receptor antagonist, as well as night symptoms, respiratory distress, and hospitalization due to severe episodes were significantly more frequent. Physician-diagnosed asthma was observed in 28 (9.5%) of the wheezing infants. Among the wheezing infants, 80 (27.7%) were diagnosed with pneumonia, of whom 33 (11.2%) required hospitalization; neverthless, no differences between occasional and recurrent wheezing infants were found. CONCLUSIONS: The prevalence of recurrent wheezing and physician-diagnosed asthma in infants were lower compared with those observed in other Brazilian studies. Recurrent wheezing had early onset and high morbity.