Vânia Matos Fonseca

Índice de massa corporal e circunferência da cintura como marcadores de hipertensão arterial em adolescentes

OBJECTIVE To evaluate the sensitivity and specificity of anthropometric measurements of body fat in a sample of Brazilian adolescents for the prediction of hypertension. METHODS The arterial blood pressure was measured on two visits in a sample of 456 students aged 12 to 17 years, from public and private schools of the Fonseca neighborhood, in Niterói, between 2003 and 2004. A subject was defined as hypertensive if he/she had systolic and diastolic pressures above the 95th percentile for sex, age and height. A questionnaire was applied and Body Mass Index (BMI) and waist circumference (WC) measurements were made. RESULTS A statistically significant correlation was observed between hypertension and the cutoff points considered unfavorable, both for BMI and WC. The greatest association was with the cutoff point proposed for the Brazilian population. As to the BMI sensitivity used for American Black or White populations or for the Brazilian population, we found 52.4% to 57.1% and 52.4%, respectively. And BMI specificity was 69.3%, 70.0% and 80.88%, respectively. The sensitivity found in our sample, relative to the cutoff points for WC proposed for all American ethnic groups, was also low (45.0%) and specificity was a little higher (77.6% and 74.5%, respectively). CONCLUSION Existing American WC measurements showed low sensitivity and specificity for hypertension in our population. As to BMI, the available cutoff points also showed a low level of sensitivity. There is a need to establish body fat cutoff points that can provide a better prediction of cardiovascular risk.

Resultado do teste rápido anti-HIV após o parto: uma ameaça à amamentação ao nascimento

OBJECTIVE To analyze factors associated with failure to breastfeed during the first hour of life, especially the influence of time of delivery of rapid HIV test results. METHODS Cohort study, beginning with the administration of the rapid test and ending the first time the baby is breastfed. The study population included 944 delivering mothers that received rapid HIV testing with a negative result in five Baby-Friendly hospitals of the High-Risk Pregnancy System in the city of Rio de Janeiro, Southeastern Brazil, in 2006. Trained interviewers obtained data from laboratory and patient charts and interviewed mothers shortly after delivery. The influence of sociodemographic variables and antenatal and delivery care characteristics on failure to breastfeed during the first hour of life was determined through a multilevel model. RESULTS Among participants, 15.6% received the result of rapid HIV testing before delivery, 30.8% after delivery, and 53.6% had not yet been informed of their results at the time of the interview. Prevalence of failure to breastfeed in the first hour of life was 52.5% (95% CI: 49.3;55.8). After adjustment, having received the result of rapid testing only after delivery doubled the risk of failing to breastfeed in the first hour (RR=2.06; 95% CI: 1.55;2.75). Other risk factors included nonwhite skin color, maternal income of up to one minimum wage, delivery by C-section, mothers lack of desire to breastfeed at birth, and mothers report that the hospital staff did not listen to her. Lack of knowledge of HIV testing from the mothers part was found to be a protective factor. CONCLUSIONS The major risk factor for not breastfeeding in the first hour of life was failure to receive the results of rapid HIV testing prior to delivery. HIV testing should be made widely available during antenatal care; rapid testing should be performed upon admission, only when indicated, and with active search and prompt delivery of results to expecting mothers.OBJETIVO: Analisar fatores associados a nao-amamentacao na primeira hora de vida, sobretudo a influencia do momento do resultado do teste rapido anti-HIV. METODOS: Estudo de coorte, sendo o ponto inicial a submissao ao teste rapido e o final a primeira mamada do bebe. A populacao estudada incluiu 944 parturientes submetidas ao teste rapido anti-HIV, com resultado negativo, em 2006, nos cinco hospitais amigos da crianca do Sistema de Gestacao de Alto Risco no municipio do Rio de Janeiro, RJ. Entrevistadoras treinadas obtiveram dados do laboratorio e do prontuario e no pos-parto aplicaram questionario para entrevista as maes. O modelo multinivel foi adotado para analisar a influencia de caracteristicas sociodemograficas, de assistencia pre-natal e ao parto sobre a nao-amamentacao na primeira hora de vida. RESULTADOS: Dentre as participantes, apenas 15,6% receberam seu resultado antes do parto, 30,8% depois do parto e 53,6% ainda desconheciam o resultado ao ser entrevistada. A prevalencia de nao-amamentacao na primeira hora de vida foi de 52,5% (IC 95%: 49,3;55,8). Apos ajuste, o recebimento do resultado do teste rapido apos o parto dobrou o risco da nao-amamentacao na primeira hora de vida (RR=2,06; IC 95%: 1,55;2,75). Outros fatores de risco foram: cor nao branca, renda materna de um salario minimo ou menos, parto cesareo, mae nao querer amamentar o bebe ao nascimento e mae referir que a equipe hospitalar nao a escutava. O desconhecimento da realizacao do teste rapido anti-HIV pela mae se mostrou como fator de protecao. CONCLUSOES: O principal fator de risco para a nao-amamentacao na primeira hora de vida foi o recebimento do resultado do teste rapido apos o parto. O teste anti-HIV deve ser amplamente disponibilizado no pre-natal e o teste rapido deve ser realizado sob indicacao, na admissao, com busca ativa e pronta comunicacao do resultado a mulher.

Alimentação saudável, escolaridade e excesso de peso entre mulheres de baixa renda

The scope of this study was to analyze the factors associated with the prevalence of being overweight and obesity in a population of low-income adult women living in a metropolitan region and its association with socioeconomic, demographic, reproductive and lifestyle variables, highlighting the importance of healthy eating. A population-based, cross-sectional study was conducted with a random sample of 758 women aged 20 or older living in Campos Eliseos - Duque de Caxias - State of Rio de Janeiro. Bivariate and multivariate hierarchical regression was used to identify factors associated with overweight and obesity. A prevalence of 23% of obesity was found, and a prevalence of 56% of being overweight and obesity combined. An inverse association was found between years of study, being overweight and obesity. Most of the women reported having a healthy diet (73.6%) that increased positively with income, education and age. Failure to consume vegetables weekly was associated with being overweight and not having a healthy diet was associated with obesity. The results of this study demonstrate that even in low-income populations, a higher level of education has an impact on prevention of this problem and in food choices.

Justificativas para uso de suplemento em recém-nascidos de baixo risco de um Hospital Amigo da Criança

The Baby-Friendly Hospital Initiative recommends not giving newborn infants any food or drink other than breast milk unless medically indicated. This study investigated the prevalence and alleged reasons for giving formula supplementation to rooming-in newborns at a Baby-Friendly Hospital. Participants were 300 formula-supplemented, exclusively rooming-in newborns at a Baby-Friendly Hospital in Rio de Janeiro, Brazil. Reasons for formula supplementation were classified as acceptable or unacceptable in accordance with the WHO/UNICEF Baby-Friendly Hospital Initiative guidelines. A supplementation prevalence of 33.3% was found. The main allegations were: hypogalactia/ agalactia (36.8%), conditions involving risk of hypoglicemia (21.1%), cesarean section (7.9%), stomatognathic system-related conditions (7.4%), maternal conditions (6.3%), and absence of maternal HIV serology (4.5%). Cesarean section was associated with a higher risk of supplementation (RP = 2.1; 95%CI: 1.77-2.55) as compared to vaginal delivery. Supplementation prevalence was high, and only 9% of the allegations were justified.

Increased production of tumor necrosis factor-alpha in whole blood cultures from children with primary malnutrition

Because low tumor necrosis factor-alpha (TNF-alpha) production has been reported in malnourished children, in contrast with high production of TNF-alpha in experimental protein-energy malnutrition, we reevaluated the production of TNF-alpha in whole blood cultures from children with primary malnutrition free from infection, and in healthy sex- and age-matched controls. Mononuclear cells in blood diluted 1:5 in endotoxin-free medium released TNF-alpha for 24 h. Spontaneously released TNF-alpha levels (mean +/- SEM), as measured by enzyme immunoassay in the supernatants of unstimulated 24-h cultures, were 10,941 +/- 2,591 pg/ml in children with malnutrition (N = 11) and 533 +/- 267 pg/ml in controls (N = 18) (P < 0.0001). TNF-alpha production was increased by stimulation with lipopolysaccharide (LPS), with maximal production of 67,341 +/- 16,580 pg/ml TNF-alpha in malnourished children and 25,198 +/- 2,493 pg/ml in controls (P = 0.002). In control subjects, LPS dose-dependently induced TNF-alpha production, with maximal responses obtained at 2000 ng/ml. In contrast, malnourished patients produced significantly more TNF-alpha with 0.02-200 ng/ml LPS, responded maximally at a 10-fold lower LPS concentration (200 ng/ml), and presented high-dose inhibition at 2000 ng/ml. TNF-alpha production a) was significantly influenced by LPS concentration in control subjects, but not in malnourished children, who responded strongly to very low LPS concentrations, and b) presented a significant, negative correlation (r = -0.703, P = 0.023) between spontaneous release and the LPS concentration that elicited maximal responses in malnourished patients. These findings indicate that malnourished children are not deficient in TNF-alpha production, and suggest that their cells are primed for increased TNF-alpha production.

Associação entre ângulo de fase, PRISM I e gravidade da sepse

BACKGROUND AND OBJECTIVES: Phase angle (PA) is the difference between voltage and current and can be used as an indicator of body cell mass. Clinical studies show that low phase angle is associated with morbidity and mortality of critical patients. The purpose of this study was to know the relation between phase angle and the Pediatric Risk of Mortality I (PRISM I) score, associating this score with the severity of sepsis. METHODS: A transversal study was performed at the Pediatric Intensive Care Unit (PICU) in Instituto Fernandes Figueira. The patients were classified according to age, gender, sepsis severity, cause of respiratory failure, PRISM I score, multiple organ dysfunction syndromes (MODS). Electrical bioimpedance analysis (BIA) was performed in all patients. Phase angle was calculated directly from reactance (Xc) and resistance (R). AF = arc-tangent reactance/resistance x 180o/Pi. RESULTS: 75 patients (68 septic) were evaluated. The incidence of septic shock was 39.7%, severe sepsis 42.6% and sepsis 17.6%. There was no significative statistical difference between the mean values of BIA and the categories of PRISM I, MODS, or the length of stay the PICU. The PAs lowest values (1.5o-2.2o) were associated to the greatest PRISMs scores (> 30%). CONCLUSIONS: Pediatric critical patients show low phase angle values, which might have prognostic implication.

Prevalence of bone mineral disease among adolescents with cystic fibrosis

OBJECTIVE To evaluate the prevalence of bone mineral disease among adolescents with cystic fibrosis and to relate the findings with the variables studied. METHODS The study enrolled 37 adolescents who were assessed for: nutritional status according to height/age and body mass/age ratios; bone mineral density of the lumbar spine and entire body by densitometry with dual emission X-ray; daily dietary intake according to a 3-day dietary recall; and pulmonary function by the forced expiratory volume in one second test. RESULTS Mean age was 13.2 (+/-2.8) years. Nutritional status was adequate in 70.3 and 75.7% of patients according to the height/age and body mass/age indices, respectively; 54.1% of the patients exhibited reduced lumbar spine bone mineral density and 32.5% for the whole body. There was a positive correlation between bone mineral density and body mass index (p = 0.04). Lung disease and pancreatic insufficiency exhibited a correlation with altered bone mineral density. The dietary recall revealed adequate percentages of calcium, phosphorous and calories, according to the nutritional recommendations laid out in the European Cystic Fibrosis Consensus. The multivariate analysis indicated that these variables were not statistically significant. CONCLUSIONS There is a high prevalence of bone mineral disease among adolescents. Good nutritional status, pancreatic enzyme replacement and control of lung disease may have a protective effect on bone mass.

Utilização de serviços de reabilitação pelas crianças e adolescentes dependentes de tecnologia de um hospital materno-infantil no Rio de Janeiro, Brasil

The objective of this study was to describe the dependence on technology and use of rehabilitation services by children and adolescents in a maternal and child hospital in Rio de Janeiro, Brazil. Using a cross-sectional design, the following variables were analyzed: gender and age of the children and adolescents, socioeconomic characteristics of the family, technology dependence, and use of rehabilitation services. The majority of the study population consisted of preschoolers (56.3%), boys (58.3%), residing in Greater Metropolitan Rio de Janeiro (89.3%), from low-income families (70.9%), and cared for mainly by their mothers (93.8%), who in turn have low schooling (54.2%) and are unemployed (89.6%). Of the entire study population, 22.9% were dependent on more than three different technologies, with medication as the most prevalent. Government and nonprofit institutions fund the rehabilitation, and physical therapists are the most widely used health professionals during treatment (60.4%). The target hospital provides all of the specialized medical treatment and most of the rehabilitation.

Use of a monitoring tool for growth and development in Brazilian children – systematic review

Abstract Objective: To assess the use of a health monitoring tool in Brazilian children, with emphasis on the variables related to growth and development, which are crucial aspects of child health care. Data source: A systematic review of the literature was carried out in studies performed in Brazil, using the Cochrane Brazil, Lilacs, SciELO and Medline databases. The descriptors and keywords used were “growth and development”, “child development”, “child health record”, “child health handbook”, “health record and child” and “child handbook”, as well as the equivalent terms in Portuguese. Studies were screened by title and summary and those considered eligible were read in full. Data synthesis: Sixty-eight articles were identified and eight articles were included in the review, as they carried out a quantitative analysis of the filling out of information. Five studies assessed the completion of the Childs Health Record and three of the Childs Health Handbook. All articles concluded that the information was not properly recorded. Growth monitoring charts were rarely filled out, reaching 96.3% in the case of weight for age. The use of the BMI chart was not reported, despite the growing rates of childhood obesity. Only two studies reported the completion of development milestones and, in these, the milestones were recorded in approximately 20% of the verified tools. Conclusions: The results of the assessed articles disclosed underutilization of the tool and reflect low awareness by health professionals regarding the recording of information in the childs health monitoring document.

Delivering rapid HIV tests results after delivery: a threat to breastfeeding at birth

OBJECTIVE To analyze factors associated with failure to breastfeed during the first hour of life, especially the influence of time of delivery of rapid HIV test results. METHODS Cohort study, beginning with the administration of the rapid test and ending the first time the baby is breastfed. The study population included 944 delivering mothers that received rapid HIV testing with a negative result in five Baby-Friendly hospitals of the High-Risk Pregnancy System in the city of Rio de Janeiro, Southeastern Brazil, in 2006. Trained interviewers obtained data from laboratory and patient charts and interviewed mothers shortly after delivery. The influence of sociodemographic variables and antenatal and delivery care characteristics on failure to breastfeed during the first hour of life was determined through a multilevel model. RESULTS Among participants, 15.6% received the result of rapid HIV testing before delivery, 30.8% after delivery, and 53.6% had not yet been informed of their results at the time of the interview. Prevalence of failure to breastfeed in the first hour of life was 52.5% (95% CI: 49.3;55.8). After adjustment, having received the result of rapid testing only after delivery doubled the risk of failing to breastfeed in the first hour (RR=2.06; 95% CI: 1.55;2.75). Other risk factors included nonwhite skin color, maternal income of up to one minimum wage, delivery by C-section, mothers lack of desire to breastfeed at birth, and mothers report that the hospital staff did not listen to her. Lack of knowledge of HIV testing from the mothers part was found to be a protective factor. CONCLUSIONS The major risk factor for not breastfeeding in the first hour of life was failure to receive the results of rapid HIV testing prior to delivery. HIV testing should be made widely available during antenatal care; rapid testing should be performed upon admission, only when indicated, and with active search and prompt delivery of results to expecting mothers.OBJETIVO: Analisar fatores associados a nao-amamentacao na primeira hora de vida, sobretudo a influencia do momento do resultado do teste rapido anti-HIV. METODOS: Estudo de coorte, sendo o ponto inicial a submissao ao teste rapido e o final a primeira mamada do bebe. A populacao estudada incluiu 944 parturientes submetidas ao teste rapido anti-HIV, com resultado negativo, em 2006, nos cinco hospitais amigos da crianca do Sistema de Gestacao de Alto Risco no municipio do Rio de Janeiro, RJ. Entrevistadoras treinadas obtiveram dados do laboratorio e do prontuario e no pos-parto aplicaram questionario para entrevista as maes. O modelo multinivel foi adotado para analisar a influencia de caracteristicas sociodemograficas, de assistencia pre-natal e ao parto sobre a nao-amamentacao na primeira hora de vida. RESULTADOS: Dentre as participantes, apenas 15,6% receberam seu resultado antes do parto, 30,8% depois do parto e 53,6% ainda desconheciam o resultado ao ser entrevistada. A prevalencia de nao-amamentacao na primeira hora de vida foi de 52,5% (IC 95%: 49,3;55,8). Apos ajuste, o recebimento do resultado do teste rapido apos o parto dobrou o risco da nao-amamentacao na primeira hora de vida (RR=2,06; IC 95%: 1,55;2,75). Outros fatores de risco foram: cor nao branca, renda materna de um salario minimo ou menos, parto cesareo, mae nao querer amamentar o bebe ao nascimento e mae referir que a equipe hospitalar nao a escutava. O desconhecimento da realizacao do teste rapido anti-HIV pela mae se mostrou como fator de protecao. CONCLUSOES: O principal fator de risco para a nao-amamentacao na primeira hora de vida foi o recebimento do resultado do teste rapido apos o parto. O teste anti-HIV deve ser amplamente disponibilizado no pre-natal e o teste rapido deve ser realizado sob indicacao, na admissao, com busca ativa e pronta comunicacao do resultado a mulher.