Sandra Costa Fonseca

Relationship between ultra-processed foods and metabolic syndrome in adolescents from a Brazilian Family Doctor Program

OBJECTIVE To estimate the association between food intake and metabolic syndrome (MetS). DESIGN Cross-sectional design conducted from July 2006 to December 2007. SETTING Adolescents assisted by the Family Doctor Program (FDP) in Niterói, a metropolitan area in Rio de Janeiro State, Brazil. SUBJECTS Survey of 210 adolescents. Individuals with three or more of the following components of MetS were classified as having this syndrome: TAG ≥ 110 mg/dl; HDL cholesterol < 50 mg/dl for girls aged 12-19 years and boys aged 12-14 years or <45 mg/dl for boys aged 15-19 years; waist circumference ≥75th percentile; serum glucose >100 mg/dl; and blood pressure ≥90th percentile. A semi-quantitative FFQ was used, and foods were grouped as: unprocessed or minimally processed foods (Group 1), processed culinary and food industry ingredients (Group 2) and ultra-processed foods (Group 3). The associations between food consumption and MetS were adjusted for sociodemographic, behavioural and family history covariates and were estimated using generalized estimation equations with the Poisson regression model. RESULTS MetS was diagnosed in 6·7 % of the adolescents; the most frequent diagnostic criteria included the reduction of HDL cholesterol (46·7 %), elevated serum glucose (17·1 %) and the elevation of waist circumference (16·7 %). Crude analysis showed higher average daily intakes of energy, carbohydrates and ultra-processed foods among adolescents with MetS. After statistical adjustment, the intake of ultra-processed foods (≥3rd quartile) remained associated with MetS (prevalence ratio = 2·5; P = 0·012). CONCLUSIONS High consumption of ultra-processed foods was associated with the prevalence of MetS in this adolescents group.

Trajetória das mulheres na definição pelo parto cesáreo: estudo de caso em duas unidades do sistema de saúde suplementar do estado do Rio de Janeiro

Cesarean section rates are very high in Brazil mainly in private hospitals, probably due to socioeconomic and cultural factors. The objective of this study was to describe socioeconomic, demographic, cultural and reproductive characteristics of women in the postpartum period and the factors that had determined their decision for caesarean section in two units of the supplementary health care system of the State of Rio de Janeiro. The study population was composed of 437 women that had vaginal or caesarean childbirths in the two selected units. Data were collected by means of interviews with mothers and consultation of hospital records. The factors associated with the decision for cesarean section as mode of delivery were evaluated using non-conditional logistic regression analysis and following the hierarchic models established at three definite moments. Although 70% of the women had no initial preference for cesarean section, 90% of them had this mode of birth. It was verified that, despite their initial desire, the interaction with the health services resulted in cesarean section as mode of birth. Educative actions directed to pregnant women and to the public at large as well as changes in the childbirth care model can be promising strategies for reverting this picture.

Pesquisa sobre mortalidade perinatal no Brasil: revisão da metodologia e dos resultados

The perinatal mortality rate remains a public health problem, demanding epidemiological studies to describe its magnitude and time trends, identify risk factors, and define adequate interventions. There are still methodological controversies, resulting in heterogeneous studies and possible biases. In Brazil, there has been a growing scientific output on this theme, mainly in the South and Southeast of the country. Twenty-four articles from 1996 to 2003 were reviewed, focusing on definitions and classifications, data sources, study designs, measurement of variables, statistical analysis, and results. The review showed an increasing utilization of data bases (mainly SINASC and SIM), few studies on stillbirth, the incorporation of classification schemes, and disagreement concerning risk factors.

Morbidade Materna Grave e Near Misses em Hospital de Referência Regional

OBJECTIVE: To investigate severe maternal morbidity/near misses in a tertiary public maternity in the state of Rio de Janeiro, using different identification criteria. METHODS: This is a cross-sectional study, performed in a regional reference hospital between June and October 2009, on severe maternal morbidity/near miss cases identified from the log books of the maternity hospital and review of medical records. This study focused on women who, during pregnancy, delivery, or the postpartum period, showed no clinical symptoms compatible with the defining criteria for severe maternal morbidity/near miss of Waterstone et al, Mantel et al. and the World Health Organization (WHO). RESULTS: Among the 1,544 admissions during the period studied, 89 women with severe maternal morbidity were identified, considering all criteria. The occurrence of severe maternal morbidity/near misses ranged from 81.4 to 9.4 per 1,000 live births (LB), depending on the criterion used. The mortality rate was 3.2%, reaching 23% in the WHO criteria. Only 40% of these women had more than six prenatal visits and 10% did not have any visit at all. The most common markers found were severe preeclampsia, followed by severe hemorrhage, ICU admissions, HELLP syndrome, and eclampsia. There were three maternal deaths with a MMR = 280/100.000 LB and one late death. The WHO criterion showed greater specificity, identifying more severe cases, while the Waterstone criterion was more sensitive. CONCLUSIONS: The study of severe maternal morbidity/near misses in a regional reference hospital can contribute to the knowledge of this events magnitude, as well as to identify its most frequent characteristics and clinical conditions, being essential for dealing with maternal morbidity and mortality.

Mortalidade materna no Brasil: o que mostra a produção científica nos últimos 30 anos?

The aim of this study was to analyze maternal mortality in Brazil in the last 30 years, by means of a literature review. The authors performed an electronic search of scientific articles from 1980 to 2010 in LILACS and MEDLINE and found 486 abstracts, of which 50 articles were selected. Studies showed a decrease in the maternal mortality ratio (MMR), although varying across regions of the country. A few articles evaluated maternal mortality factors, identifying social inequalities associated with skin color and schooling. There was persistent underreporting of maternal deaths and inadequate completion of death certificates. Direct obstetric causes were the most frequent, mainly hypertensive diseases of pregnancy. Analysis of avoidability revealed deficiencies in prenatal and childbirth care. Despite the relevance of maternal mortality in Brazil, there are few studies on the subject. Although MMR has decreased, it is still above the desired levels. Improvements are thus needed in the quality of prenatal and perinatal care.

Desigualdades no pré-natal em cidade do Sudeste do Brasil

The scope of this article is to evaluate the association between adequate prenatal care and sociodemographic variables in Niteroi in the state of Rio de Janeiro. It involved a cross-sectional study conducted between 2000 and 2009 evaluating 62,449 live births using data from the Brazilian Live Birth Information System (SINASC). Multivariate analysis by logistic regression was performed considering quantitatively adequate prenatal care - seven or more visits - as the dependent variable, and maternal age, educational level and skin color as independent variables. The time trends of mothers age, educational level and prenatal visits were also analyzed. The significance level was 5%. There was an improvement in educational level, reduction in adolescent pregnancy and an increase in mothers aged over 35 in Niteroi. Women who attended seven or more prenatal visits remained above 80%, though with differences according to age, education and skin color. Adult women (OR = 1.4; IC95% 1.39-1.56). women with eight or more years of schooling (OR = 2.5; IC95% 2.45-2.70) and white women (OR = 2.4; IC95% 2.30-2.53) had more chances of adequate prenatal care. Health inequalities in maternal health care on offer in Niteroi were identified, despite improvements in social and demographic indicators in the city.

Fetal deaths in Brazil: a systematic review

OBJECTIVE To review the frequency of and factors associated with fetal death in the Brazilian scientific literature. METHODS A systematic review of Brazilian studies on fetal deaths published between 2003 and 2013 was conducted. In total, 27 studies were analyzed; of these, 4 studies addressed the quality of data, 12 were descriptive studies, and 11 studies evaluated the factors associated with fetal death. The databases searched were PubMed and Lilacs, and data extraction and synthesis were independently performed by two or more examiners. RESULTS The level of completeness of fetal death certificates was deficient, both in the completion of variables, particularly sociodemographic variables, and in defining the underlying causes of death. Fetal deaths have decreased in Brazil; however, inequalities persist. Analysis of the causes of death indicated maternal morbidities that could be prevented and treated. The main factors associated with fetal deaths were absent or inadequate prenatal care, low education level, maternal morbidity, and adverse reproductive history. CONCLUSIONS Prenatal care should prioritize women that are most vulnerable (considering their social environment or their reproductive history and morbidities) with the aim of decreasing the fetal mortality rate in Brazil. Adequate completion of death certificates and investment in the committees that investigate fetal and infant deaths are necessary.

How can age and lifestyle variables affect DNA damage, repair capacity and endogenous biomarkers of oxidative stress?

Age-related DNA damage has been regarded as one of the possible explanations of aging, and these age-related changes have been associated with lifestyle variables. Considering this, the purpose of this study was to investigate how age and lifestyle may affect DNA damage, DNA repair capacity and endogenous biomarkers of oxidative stress. Sixty-one healthy men (40 to 89 yrs) were enrolled in this study. The results showed that DNA strand breaks (DNA SBs) and DNA repair capacity were greater in the older group (>=65 yrs) compared to the younger group (<65 yrs) (p<0.05). FPG-sensitive sites, total antioxidant capacity and lipid peroxidation (MDA) were not statistically different between groups. The correlation test showed that DNA damage variables were not correlated with any lifestyle variable excepting DNA SBs which was correlated with aerobic capacity (6MWT). DNA SBs and DNA repair were positively correlated with age. The multiple regression analysis revealed that the aerobic capacity (6MWT) and MDA were the predictors for the variation of DNA SBs (41.9%). In conclusion these results suggest that DNA SB damage increases with age but not FPG-sensitive sites. Moreover, base excision repair capacity increases with age without the increase of oxidative damage to DNA. The most predictable variables of DNA SBs were the aerobic capacity and MDA.

Série temporal de características maternas e de nascidos vivos em Niterói, RJ

OBJECTIVES: to describe the tendency over time of characteristics of the mother, care provided and newborns, in Niteroi, a city in the Brazilian State of Rio de Janeiro. METHODS: an ecological time-series study from 2000 to 2009. Data were gathered from the Live Birth Information System (SINASC). Annual variations were described in age, schooling and reproductive history of mother, prenatal care, kind of delivery, color, birth weight and gestational age. RESULTS: the completeness of information was high among the 62,449 live newborns studied. Births fell and primiparity increased. There was reduction in pregnancies among adolescents (2.3% per year) and an increase in mothers aged over 35 years. Schooling improved, with a decrease in the percentage of pregnant women with less than eight years of school. Around 80% of women had attended seven or more prenatal sessions. Caesarean births tended to increase in frequency, with 67.7% of woman having one of these in 2009. Low birth weight showed a tendency to fall by 1.1% per year. Prematurity increased by 7.4 to 7.9%. CONCLUSIONS: there were positive demographic and social changes in Niteroi. Birth weight was not much affected by prematurity. As in other locations in Brazil, there has been an increase in the number of women undergoing Caesarian sections.

Comparison of mechanical and biological prostheses when used to replace heart valves in children and adolescents with rheumatic fever

OBJECTIVE To assess the outcomes in children and adolescents with rheumatic fever of the implantation of mechanical as opposed to biological heart valves. METHODS We assessed 73 patients with rheumatic heart disease under the age of 18 years, who underwent replacement of heart valves between January, 1996, and December, 2005, at the National Institute of Cardiology in Rio de Janeiro, Brazil. Of the group, 71 patients survived, and were divided into a group of 52 receiving mechanical prostheses, and 19 with biological prostheses. We compared endpoints between the groups in terms of mortality, reoperation, haemorrhage, and stroke. Survival curves were estimated using the Kaplan-Meier method and were compared by the Mantel (log-rank) test. RESULTS Overall mortality was 8.2%. In those receiving mechanical prostheses, 2 (3.8%) patients died, 5 (9.6%) underwent reoperation, 2 (3.8%) suffered severe haemorrhage, and 3 (5.8%) had strokes. In those receiving biological valves, 2 (10.5%) patients died, and 4 (21%) underwent reoperation. After 2, 4, and 8 years, overall survival was 96%, 93% and 86%, respectively, with a borderline difference between the groups (p = 0.06). The probabilities of remaining free from reoperation (p = 0.13), and from combined endpoints, showed no statistically significant difference between the groups (p = 0.28). CONCLUSIONS Patients with mechanical prostheses had lower mortality and required fewer reoperations, but when all combined endpoints were considered, the groups did not differ. The biological prosthesis proved to be a good option for cardiac surgery in children and adolescents with difficulties or risks of anticoagulation.