Stela Verzinhasse Peres

Desenvolvimento e validação de um questionário de avaliação da atividade física para adolescentes

OBJETIVO: Desenvolver um questionario de atividade fisica para adolescentes brasileiros e verificar sua validade e reprodutibilidade. METODOS: Participaram do estudo 94 adolescentes (30 meninos e 64 meninas) com idade entre 11 a 16 anos, em 2004. O questionario foi composto por 17 questoes sobre atividades habituais exercidas nos ultimos 12 meses (exercicios fisicos/esportes e atividades de locomocao) e foi padronizado para gerar escores semanal e anual. Como metodo de referencia utilizou-se o teste de corrida vai-e-vem de 20 metros com as variaveis tempo em minutos, velocidade maxima em km/h, consumo maximo de oxigenio e frequencia cardiaca maxima. Para a analise de validacao, foram utilizados o coeficiente de Spearman e correlacao ajustada por idade. Para a analise da reprodutibilidade, utilizou-se medida repetida com intervalo de 15 dias e coeficiente de correlacao intraclasse. RESULTADOS: Para o escore semanal de atividade fisica, os maiores coeficientes de correlacao foram obtidos com o tempo total para a analise em conjunto (r=0,19), velocidade total para os meninos (r=0,20), e consumo maximo de oxigenio e tempo total para as meninas (r=0,17). Para o escore anual de atividade fisica, os maiores coeficientes de correlacao foram obtidos com o tempo total para a analise em conjunto (r=0,30), frequencia cardiaca final apos o ajuste pela idade para os meninos (r=0,22) e tempo total para as meninas (r=0,23). Nas analises de reprodutibilidade, a correlacao do escore semanal foi de 0,61 e a do escore anual foi de 0,68. CONCLUSOES: O questionario apresentou evidencias de validade e reprodutibilidade. Recomenda-se sua utilizacao para avaliacao da atividade fisica habitual em estudos epidemiologicos com adolescentes.

A mídia e o corpo: o que o jovem tem a dizer?

The aim of this article is to verify the perception of the young about the relation between the media, especially the TV and magazine access and the body of the adolescent. It is a cross-section study carried out with 121 adolescents of a private school in Sao Paulo. A semi-structured individual interview was applied and recorded in magnetic ribbon using the methodology of the discourse of the collective subject based in the concept of social representation. The data were tabulated using three methodological approaches: central idea; key expressions and discourse of the collective subjective. The discourses of adolescents were evaluated, indicating that 95% of central ideas expressed relations among TV, magazines and the body and the most common ideas were about the stimulation of the thinness ideal physicist and the negative influence with hazard experience and illnesses appear. In 5% of central ideas registered no relation among TV, magazines and the body. We could conclude that young people show the knowledge about the intense medias interference in the adolescent body.

Simultaneous Chlamydia trachomatis and HPV infection in pregnant women.

Pregnancy is associated with HPV infection and with Chlamydia trachomatis (CT) infection mostly due to the natural immunosuppression. In addition, pregnancy associated to CT infection can lead to adverse conditions to the woman and fetus, and CT is also believed to be a co‐factor in human immunodeficiency virus infection and HPV‐induced cervical cancer. The aim of this study was to establish the odds ratios (OR) of CT infection in to HPV‐infected pregnant women and vice versa of women stratified by age (<25 years) and marital status. This work is part of a national multicentric transversal study carried out in six Brazilian cities supported by the Ministry of Health of Federal Government of Brazil in 2003. Cervical scrapes of 371 pregnant women were sampled. We performed a hybrid capture‐2 technique to diagnose these samples on HPV and CT infection, and the women responded a questionnaire. Significant association was observed between nonstable marital status and hr‐HPV infection [OR = 2.61 (1.38–4.97) P = 0.003)], and age <25 years old [OR = 2.26 (1.09–4.71) P = 0.029]. Nonstable marital status was also associated with lr‐HPV infection [OR = 2.67 (1.59–4.50) P < 0.001), and age <25 years old [OR = 2.55 (1.51–4.32) P < 0.001). Fifty of the 371 pregnant women were infected with hr‐HPV (13.5%) and 111 (30.0%) were infected with lr‐HPV. The coinfections of HPV and CT were found in 31 women, that is, 8.36% of the pregnant women (P < 0.001). The high rate of simultaneous CT and HPV infection in pregnant women favors the recommendation to screen pregnant women for both CT and HPV. Diagn. Cytopathol. 2010.

Alta prevalência de sedentarismo em adolescentes que vivem com HIV/Aids

Objective: To assess the prevalence of physical inactivity among adolescents with HIV/AIDS, as well as associated factors. Methods: Ninety-one adolescents (from 10 to 19 years old) with HIV/AIDS who are patients at a university follow-up service were interviewed. Anthropometric data (weight, height, and waist circumference) were measured twice; clinical information was obtained from medical records, and habitual physical activity was assessed by a questionnaire proposed by Florindo et al. The cutoff point for sedentariness was 300 minutes/week. Results: The prevalence of inadequate height for age, malnutrition, and overweight/obesity was 15.4%, 9.9% and 12.1%, respectively. The most common physical activities were soccer (44.4%), volleyball (14.4%) and cycling (7.8%). The median times spent with physical activity and walking/bicycling to school were 141 min and 39 min, respectively. Most adolescents (71.4%) were sedentary and this proportion was higher among girls (p=0.046). Conclusions: A high prevalence of physical inactivity among adolescents with HIV/AIDS was observed, similar to the general population. Promoting physical activity among adolescents, especially among girls with HIV/AIDS, as well as monitoring it should be part of the follow-up routine of these patients.

Prevalência de excesso de peso e seus fatores associados em adolescentes da rede de ensino público de Piracicaba, São Paulo

Objective: To estimate the prevalence of excess weight and the factors associated with its occurrence in adolescents enrolled at public schools in Piracicaba, SP, Brazil. Methods: This was a cross-sectional study of 269 adolescents of both sexes aged 10 to 14 years. Questionnaires were administered to collect data on dietary intake, sexual maturity, physical activity level and demographic characteristics. Univariate and multivariate logistic regression were used for statistical analysis. Results: The prevalence of excess weight was 35.7% for the boys and 26.2% for the girls. Factors significantly asso ciated with excess weight were only identified for the girls, among whom it was found that being in the 2nd tertile for carbohydrate intake (adjusted Odds Ratio [OR]: 0.28) and the accelerating/peak growth phase (adjusted OR: 0.37) were protective factors against excess weight . Conclusions: The findings of this study reveal a worrying prevalence of excess weight among the adolescents studied. The accelerating/peak growth phase and high carbohydrate intake were identified as protective factors against excess weight for the girls. It is, however, suggested that the second of these be treated with caution since this link has not been detected in other studies.

The evaluation of an instrument for pediatric oncology patient classification

The objectives of this study were to assess the interrater reproducibility of the instrument to classify pediatric patients with cancer; verify the adequacy of the patient classification instrument for pediatric patients with cancer; and make a proposal for changing the instrument, thus allowing for the necessary adjustments for pediatric oncology patients. A total of 34 pediatric inpatients of a Cancer Hospital were evaluated by the teams of physicians, nurses and nursing technicians. The Kappa coefficient was used to rate the agreement between the scores, which revealed a moderate to high value in the objective classifications, and a low value in the subjective. In conclusion, the instrument is reliable and reproducible, however, it is suggested that to classify pediatric oncology patients, some items should be complemented in order to reach an outcome that is more compatible with the reality of this specific population.The objectives of this study were to assess the interrater reproducibility of the instrument to classify pediatric patients with cancer; verify the adequacy of the patient classification instrument for pediatric patients with cancer; and make a proposal for changing the instrument, thus allowing for the necessary adjustments for pediatric oncology patients. A total of 34 pediatric inpatients of a Cancer Hospital were evaluated by the teams of physicians, nurses and nursing technicians. The Kappa coefficient was used to rate the agreement between the scores, which revealed a moderate to high value in the objective classifications, and a low value in the subjective. In conclusion, the instrument is reliable and reproducible, however, it is suggested that to classify pediatric oncology patients, some items should be complemented in order to reach an outcome that is more compatible with the reality of this specific population.

Avaliação de um instrumento para classificação de pacientes pediátricos oncológicos

The objectives of this study were to assess the interrater reproducibility of the instrument to classify pediatric patients with cancer; verify the adequacy of the patient classification instrument for pediatric patients with cancer; and make a proposal for changing the instrument, thus allowing for the necessary adjustments for pediatric oncology patients. A total of 34 pediatric inpatients of a Cancer Hospital were evaluated by the teams of physicians, nurses and nursing technicians. The Kappa coefficient was used to rate the agreement between the scores, which revealed a moderate to high value in the objective classifications, and a low value in the subjective. In conclusion, the instrument is reliable and reproducible, however, it is suggested that to classify pediatric oncology patients, some items should be complemented in order to reach an outcome that is more compatible with the reality of this specific population.The objectives of this study were to assess the interrater reproducibility of the instrument to classify pediatric patients with cancer; verify the adequacy of the patient classification instrument for pediatric patients with cancer; and make a proposal for changing the instrument, thus allowing for the necessary adjustments for pediatric oncology patients. A total of 34 pediatric inpatients of a Cancer Hospital were evaluated by the teams of physicians, nurses and nursing technicians. The Kappa coefficient was used to rate the agreement between the scores, which revealed a moderate to high value in the objective classifications, and a low value in the subjective. In conclusion, the instrument is reliable and reproducible, however, it is suggested that to classify pediatric oncology patients, some items should be complemented in order to reach an outcome that is more compatible with the reality of this specific population.

Melhora na qualidade e completitude da base de dados do Registro de Câncer de Base Populacional do município de São Paulo: uso das técnicas de linkage

Objective: The aim of this study was to improve the quality of information and data completeness through probabilistic and deterministic record linkage between Population-based Cancer Registry of São Paulo (PBCR-SP) for incident cancer cases, death database and drugs/medical procedures database. Methods: We used the database of the PBCRP-SP composed of 343,306 incident cancer cases in the municipality of São Paulo in the period between 1997 and 2005 with ages raging from under 1 to 106 years old, from both sexes. Three databases were used for linkage, namely Improvement Program for Mortality Information in São Paulo city (PRO-AIM), Authorization of Procedures of High Complexity/Cost of Outpatient Information System from the Unified Health System (APAC-SIA/SUS), and Foundation State System of Data Analysis (Foundation SEADE). Crude incidence (CIR) and mortality rates (CMR) were calculated and overall survival analysis was performed using the Kaplan-Meier method. Results: After record linkage, it was possible to observe gain of 4.3% for the CIR and 25.8% for CMR. The overall survival analysis showed that before record linkage there was an underestimation of the probability of being alive for all variables (p < 0.001). Conclusion: The linkage techniques contributed with the improvement of the quality of RCBP-SP information both on completeness of data, as in defining the vital status of the patient. In addition, the results found in this study reflect the ability of databases when worked jointly, providing subsidies for various types of studies and information for planning policies and strategic actions.

Determinação de um ponto de corte para a identificação de pares verdadeiros pelo método probabilístico de linkage de base de dados

O objetivo deste estudo foi propor pontos de corte nos escores calculados no processo de linkage probabilistico, para as diversas topografias de câncer. Neste estudo foi utilizada a base de dados do RCBP-SP, composta por 343.306 casos incidentes de câncer do municipio de Sao Paulo, registrados no periodo de 1997 a 2005, com idades que variaram de menos um a 106 anos, de ambos os sexos. Para o linkage probabilistico, realizado no programa Reclink III, foram utilizadas a base de dados do PRO-AIM e APAC-SIA/SUS. Foram calculados os valores da area sob a curva, sensibilidade e especificidade para determinar o ponto de corte do escore de maior precisao na identificacao dos pares verdadeiros. Na analise das topografias, verificou-se que o ponto de corte no escore 18 apresentou boa acuracia, com valores de sensibilidade que variaram de 73,7 a 96,7% e de especificidade de 98,5 a 99,4%. Conclui-se que, acima do escore 18 encontravam-se quase a totalidade dos pares verdadeiros, enquanto que abaixo deste, menos de 1% dos registros vinculados eram verdadeiros.

The impact of erlotinib use in non-small-cell lung cancer patients treated in a private reference general hospital and in a private cancer clinic from 2005 to 2011

ABSTRACT Objective: To report the demographic data and clinical outcomes of non-small-cell lung cancer patients exposed to erlotinib in any line of treatment. Methods: This was a retrospective cohort study of nonsmall-cell lung cancer patients from a reference general hospital and a private oncology clinic, who received erlotinib from 2005 to 2011. Statistical analysis was performed and we evaluated demographic data and response to treatment, by correlating the results of this first cohort published in Brazil with results of current literature. Results: A total of 44 patients were included; 65.9% were diagnosed with adenocarcinoma, and 63.6% had metastatic disease. The mean age was 63.3 years. The median follow-up was 47.9 months. Epidermal growth factor receptor mutation screening was performed in 22.7% of patients (n=10), with mutation present in 30% of patients. The median overall survival was 46.3 months, and there was a higher probability of survival at 60 months for females compared to males (29.4% versus 15.8%; p=0.042). The other variables did not present significant statistical difference. Conclusion: We collected the largest cohort of patients with non-small-cell lung cancer who have used erlotinib in Brazil to date, and demonstrated that outcomes of patients treated at our clinic during the study period were consistent with the results of current literature in similar patients.