Regina Paiva Daumas

Factors associated to breastfeeding in the first hour of life: systematic review

OBJECTIVE To identify independent risk factors for non-breastfeeding within the first hour of life. METHODS A systematic review of Medline, LILACS, Scopus, and Web of Science electronic databases, till August 30, 2013, was performed without restrictions on language or date of publishing. Studies that used regression models and provided adjusted measures of association were included. Studies in which the regression model was not specified or those based on specific populations regarding age or the presence of morbidities were excluded. RESULTS The search resulted in 155 articles, from which 18 met the inclusion criteria. These were conducted in Asia (9), Africa (5), and South America (4), between 1999 and 2013. The prevalence of breastfeeding within the first hour of life ranged from 11.4%, in a province of Saudi Arabia, to 83.3% in Sri Lanka. Cesarean delivery was the most consistent risk factor for non-breastfeeding within the first hour of life. “Low family income”, “maternal age less than 25 years”, “low maternal education”, “no prenatal visit”, “home delivery”, “no prenatal guidance on breastfeeding” and “preterm birth” were reported as risk factors in at least two studies. CONCLUSIONS Besides the hospital routines, indicators for low socioeconomic status and poor access to health services were also identified as independent risk factors for non-breastfeeding within the first hour of life. Policies to promote breastfeeding, appropriate to each context, should aim to reduce inequalities in health.

Clinical and laboratory features that discriminate dengue from other febrile illnesses: a diagnostic accuracy study in Rio de Janeiro, Brazil.

BackgroundDengue is an acute febrile illness caused by an arbovirus that is endemic in more than 100 countries. Early diagnosis and adequate management are critical to reduce mortality. This study aims to identify clinical and hematological features that could be useful to discriminate dengue from other febrile illnesses (OFI) up to the third day of disease.MethodsWe conducted a sectional diagnostic study with patients aged 12 years or older who reported fever lasting up to three days, without any evident focus of infection, attending an outpatient clinic in the city of Rio de Janeiro, Brazil, between the years 2005 and 2008. Logistic regression analysis was used to identify symptoms, physical signs, and hematological features valid for dengue diagnosis. Receiver-operating characteristic (ROC) curve analyses were used to define the best cut-off and to compare the accuracy of generated models with the World Health Organization (WHO) criteria for probable dengue.ResultsBased on serological tests and virus genome detection by polymerase chain reaction (PCR), 69 patients were classified as dengue and 73 as non-dengue. Among clinical features, conjunctival redness and history of rash were independent predictors of dengue infection. A model including clinical and laboratory features (conjunctival redness and leukocyte counts) achieved a sensitivity of 81% and specificity of 71% and showed greater accuracy than the WHO criteria for probable dengue.ConclusionsWe constructed a predictive model for early dengue diagnosis that was moderately accurate and performed better than the current WHO criteria for suspected dengue. Validation of this model in larger samples and in other sites should be attempted before it can be applied in endemic areas.

The Fraction of Cancer Attributable to Ways of Life, Infections, Occupation, and Environmental Agents in Brazil in 2020

Many human cancers develop as a result of exposure to risk factors related to the environment and ways of life. The aim of this study was to estimate attributable fractions of 25 types of cancers resulting from exposure to modifiable risk factors in Brazil. The prevalence of exposure to selected risk factors among adults was obtained from population-based surveys conducted from 2000 to 2008. Risk estimates were based on data drawn from meta-analyses or large, high quality studies. Population-attributable fractions (PAF) for a combination of risk factors, as well as the number of preventable deaths and cancer cases, were calculated for 2020. The known preventable risk factors studied will account for 34% of cancer cases among men and 35% among women in 2020, and for 46% and 39% deaths, respectively. The highest attributable fractions were estimated for tobacco smoking, infections, low consumption of fruits and vegetables, excess weight, reproductive factors, and physical inactivity. This is the first study to systematically estimate the fraction of cancer attributable to potentially modifiable risk factors in Brazil. Strategies for primary prevention of tobacco smoking and control of infection and the promotion of a healthy diet and physical activity should be the main priorities in policies for cancer prevention in the country.

Carga de doença no Brasil e suas regiões, 2008

The current study estimated DALY (disability-adjusted life years), an indicator of burden of disease, for Brazil in 2008. The North and Northeast regions showed higher burden of disease. Chronic noncommunicable diseases predominated in all regions of the country, especially cardiovascular diseases, mental disorders (particularly depression), diabetes, and chronic obstructive pulmonary disease. The study also showed a high burden of homicides and traffic accidents. Brazils epidemiological profile appears even more complex when one considers the non-negligible burden of communicable diseases, maternal and perinatal conditions, and nutritional deficiencies. The analyses allowed a more detailed understanding of the Brazilians populations health status, underscoring the need for crosscutting actions beyond specific health sector policies and greater attention to the quality of information on morbidity and mortality.En este estudio, se estimo DALY (anos de vida ajustados por discapacidad), un indicador de estudios de carga de enfermedad, para Brasil durante 2008. Entre los principales resultados se observan la mayor carga de enfermedad en las regiones Norte y Noreste y la preponderancia de las enfermedades cronicas no transmisibles en todas las regiones del pais; en particular, las enfermedades cardiovasculares, los trastornos mentales, destacandose la depresion, la diabetes y la enfermedad pulmonar obstructiva cronica. Llama tambien la atencion la elevada carga de homicidios y accidentes de trafico. El perfil epidemiologico se revela mas complejo cuando se considera la no despreciable carga de enfermedades transmisibles, condiciones maternas, perinatales y deficiencias nutricionales. Los analisis efectuados hicieron posible conocer el status de salud de la poblacion, lo que pone en evidencia la demanda de acciones que van mas alla de politicas especificas para el area de la salud, asi como la necesidad de ampliar la preocupacion con la calidad de las informaciones sobre morbimortalidad en Brasil.

Burden of disease in Brazil and its regions, 2008

The current study estimated DALY (disability-adjusted life years), an indicator of burden of disease, for Brazil in 2008. The North and Northeast regions showed higher burden of disease. Chronic noncommunicable diseases predominated in all regions of the country, especially cardiovascular diseases, mental disorders (particularly depression), diabetes, and chronic obstructive pulmonary disease. The study also showed a high burden of homicides and traffic accidents. Brazils epidemiological profile appears even more complex when one considers the non-negligible burden of communicable diseases, maternal and perinatal conditions, and nutritional deficiencies. The analyses allowed a more detailed understanding of the Brazilians populations health status, underscoring the need for crosscutting actions beyond specific health sector policies and greater attention to the quality of information on morbidity and mortality.En este estudio, se estimo DALY (anos de vida ajustados por discapacidad), un indicador de estudios de carga de enfermedad, para Brasil durante 2008. Entre los principales resultados se observan la mayor carga de enfermedad en las regiones Norte y Noreste y la preponderancia de las enfermedades cronicas no transmisibles en todas las regiones del pais; en particular, las enfermedades cardiovasculares, los trastornos mentales, destacandose la depresion, la diabetes y la enfermedad pulmonar obstructiva cronica. Llama tambien la atencion la elevada carga de homicidios y accidentes de trafico. El perfil epidemiologico se revela mas complejo cuando se considera la no despreciable carga de enfermedades transmisibles, condiciones maternas, perinatales y deficiencias nutricionales. Los analisis efectuados hicieron posible conocer el status de salud de la poblacion, lo que pone en evidencia la demanda de acciones que van mas alla de politicas especificas para el area de la salud, asi como la necesidad de ampliar la preocupacion con la calidad de las informaciones sobre morbimortalidad en Brasil.

Accuracy of Zika virus disease case definition during simultaneous Dengue and Chikungunya epidemics

Background Zika is a new disease in the American continent and its surveillance is of utmost importance, especially because of its ability to cause neurological manifestations as Guillain-Barré syndrome and serious congenital malformations through vertical transmission. The detection of suspected cases by the surveillance system depends on the case definition adopted. As the laboratory diagnosis of Zika infection still relies on the use of expensive and complex molecular techniques with low sensitivity due to a narrow window of detection, most suspected cases are not confirmed by laboratory tests, mainly reserved for pregnant women and newborns. In this context, an accurate definition of a suspected Zika case is crucial in order for the surveillance system to gauge the magnitude of an epidemic. Methodology We evaluated the accuracy of various Zika case definitions in a scenario where Dengue and Chikungunya viruses co-circulate. Signs and symptoms that best discriminated PCR confirmed Zika from other laboratory confirmed febrile or exanthematic diseases were identified to propose and test predictive models for Zika infection based on these clinical features. Results and discussion Our derived score prediction model had the best performance because it demonstrated the highest sensitivity and specificity, 86·6% and 78·3%, respectively. This Zika case definition also had the highest values for auROC (0·903) and R2 (0·417), and the lowest Brier score 0·096. Conclusions In areas where multiple arboviruses circulate, the presence of rash with pruritus or conjunctival hyperemia, without any other general clinical manifestations such as fever, petechia or anorexia is the best Zika case definition.

Temporal and Spatial Evolution of Dengue Incidence in Brazil, 2001-2012

Background In Brazil, the incidence of dengue greatly increased in the last two decades and there are several factors impeding the control of the disease. The present study focused on describing the space-time evolution of dengue in Brazil from 2001 to 2012 and analyzing the relationship of the reported cases with socio-demographic and environmental factors. Methods The analytic units used in the preparation of thematic maps were municipalities. Statistical tests and multilevel regression models were used to evaluate the association between dengue incidence and the following factors: climate, diagnostic period, demographic density, percentage of people living in rural areas, Gross Domestic Product, Gini index, percentage of garbage collection and the rate of households with a sewage network. Results The largest accumulation of dengue cases in Brazil was concentrated on the Atlantic coast and in the interior part of São Paulo State. The risk of dengue in subtropical and tropical climates was 1.20–11 times lower than that observed in semi-arid climates. In 2009–2010 and 2011–2012, the risks were ten and six times higher than in 2003–2004, respectively. Conclusion Dengue is a common infection in the Brazilian population, with the largest accumulation of dengue cases concentrated on the Atlantic coast and in the interior area of São Paulo State. The high dengue rates observed in the Brazilian coastal region suggest that the cases imported from neighboring countries contribute to the spread of the disease in the country. Our results suggest that several socio-demographic and environmental factors resulted in the increase of dengue in the country over time. This is likely applicable to the occurrence of other arboviruses like Zika and chikungunya. To reverse the situation, Brazil must implement effective public policies that offer basic services such as garbage collection and sanitation networks as well as reduce vector populations.

Clinical and laboratory signs associated to serious dengue disease in hospitalized children

OBJECTIVE To evaluate the validity of clinical and laboratory signs to serious dengue disease in hospitalized children. METHODS Retrospective cohort of children (<18 years) hospitalized with dengue diagnosis (2007-2008). Serious dengue disease was defined as death or use of advanced life support therapy. Accuracy measures and area under the receiver operating characteristic curve were calculated. RESULTS Of the total (n=145), 53.1% were female, 69% aged 2-11 years, and 15.9% evolved to the worse outcome. Lethargy had the best accuracy (positive likelihood ratio >19 and negative likelihood ratio <0.6). Pleural effusion and abdominal distension had higher sensitivity (82.6%). History of bleeding (epistaxis, gingival or gastrointestinal bleeding) and severe hemorrhage (pulmonary or gastrointestinal bleeding) in physical examination were more frequent in serious dengue disease (p<0.01), but with poor accuracy (positive likelihood ratio=1.89 and 3.89; negative likelihood ratio=0.53 and 0.60, respectively). Serum albumin was lower in serious dengue forms (p<0.01). Despite statistical significance (p<0.05), both groups presented thrombocytopenia. Platelets count, hematocrit, and hemoglobin parameters had area under the curve <0.5. CONCLUSIONS Lethargy, abdominal distension, pleural effusion, and hypoalbuminemia were the best clinical and laboratorial markers of serious dengue disease in hospitalized children, while bleeding, severe hemorrhage, hemoconcentration and thrombocytopenia did not reach adequate diagnostic accuracy. In pediatric referral hospitals, the absence of hemoconcentration does not imply absence of plasma leakage, particularly in children with previous fluid replacement. These findings may contribute to the clinical management of dengue in children at referral hospitals.

Participatory evaluation of the quality of health information on the internet: the case of dengue sites

The world has witnessed a powerful and radical transformation of social, economic and cultural relationships promoted by the Internet. The Internet provides opportunities for access, dissemination and production of information worldwide. Health, for example, stands out as one of the main areas with information of interest to a growing number of users. However, this information is often unsatisfactory, incorrect or incomprehensible. This paper analyzes an experiment of evaluation of information on dengue websites developed in a laboratory of the Oswaldo Cruz Foundation. It counted on the participation of a group of Manguinhos dwellers and Public Health PHC physicians, infectious disease specialists and public health physicians in the development of criteria and the evaluation of websites. This paper shows the main results of this experience, which is innovative because its paper and product differ from those proposed by national and foreign agencies and analysts. This experience supports the establishment of an institutional process that issues a quality seal to websites that comply with the suggested criteria and indicators.

Profile of Brazilian smokers in the National Program for Tobacco Control

OBJECTIVE The treatment of tobacco addiction in Brazil has expanded in recent years; however, we must increase knowledge about the characteristics of individuals who adhere to cessation programs in order to adjust treatments to specific characteristics of the target population that favor success. The aim of this study was to describe the characteristics of smokers who present to Brazilian public health units seeking help to quit smoking based on the experience of a primary health care unit that covers a poor community in the city of Rio de Janeiro. METHODS Data were collected at a Teaching Health Center from January 03 2012 to January 03 2014. RESULTS Mean patient age was 49.32 ± 11.82 years, and 71% were women. About half of the participants successfully quit smoking (n=125, 51%). Higher levels of nicotine dependence were associated with lower levels of smoking cessation. There was a notable decrease in the probability of remaining smoking throughout the first month of treatment. After 3 weeks of treatment, only 19% had not quit smoking. The probability of quitting smoking decreases by 2% for every additional year of age. CONCLUSION There is a need to revise and expand current strategies to make them more effective in preventing smoking since childhood.