Sampling plan and methodological aspects: a household healthcare survey in Piauí

OBJECTIVE

To describe the methodological aspects of the Piauí home healthcare survey (ISAD-PI) and assess the relation between sampling plan, precision, and design effects, assuming that population health surveys are relevant instruments for health monitoring.

METHODS

ISAD-PI was a population-based cross-sectional study that analyzed the living conditions and health status of the population residing in urban areas in the municipalities of Teresina and Picos, in Piauí. Sampling was carried out by conglomerates in two stages: Primary Sampling Units and households. To calculate the sample size, we considered the stratification of the population in both cities, according to the age of the individuals. We evaluated the “non-response” rate (NRR) and estimated the proportions according to sex and age, as well as the prevalence of social determinants of health in order to assess the compliance of the sampling plan. Analyses related to the precision according to the coefficient of proportion variation of the standard error (Cv-pˆ) and the design effect (deff). Cv-pˆ less than 20% and deff less than 1.5 were considered adequate. The total NRR of households was 38.2% in Teresina and 38.3% in Picos. We carried out twenty-four proportion estimates in relation to age and sex and 48 prevalence of social and health determinants estimates, totaling 72 estimates. Among them, 71 had Cv-pˆ less than 20% and 61 had deff less than or equal to 1.5.

CONCLUSION

Data generated from the ISAD-PI may contribute to the assessment of health and morbidity conditions in the population. Furthermore, methodological aspects employed in this research may serve as a basis for studies carried out in other cities in Brazil.

Construction and validation of educational material on promoting breastfeeding in schools

OBJECTIVE

to build and validate an educational technology on the promotion of breastfeeding for schoolchildren.

METHODS

a methodological study was developed through a bibliographic survey, situational diagnosis, creation of illustrations, layout, design and texts, validation of the material with the help of expert judges and target audience.

RESULTS

the content judges enabled the validation of the material with an overall Content Validity Index of 90%, the judges of the design Suitability Assessment of Materials of 90.4% and the target audience with a 95.6% agreement. The readability percentage proved to be excellent, with an overall score of 100%.

CONCLUSION

the educational technology proved to be a valid and reliable instrument to promote a breastfeeding culture among schoolchildren.

SCREENING FOR NEUROPSYCHOMOTOR AND SOCIAL-EMOTIONAL DEVELOPMENT IN CHILDREN UNDER 24 MONTHS OF AGE IN THE BRAZILIAN SEMI-ARID REGION

Objective:

To screen children under 24 months of age for neuropsychomotor and social-emotional development in a municipality of the Brazilian semi-arid region, using the Survey of Well-Being of Young Children (SWYC) scale.

Methods:

This is a quantitative cross-sectional study with a non-probabilistic sample, involving children aged 1 to 24 months and their respective mothers, recruited from primary care services in the municipality of Picos, Piauí, Northeastern Brazil. The screening for neuropsychomotor and social-emotional development using the SWYC scale also provided information about the family context. In addition, we administered a questionnaire to assess the children’s demographic and socioeconomic factors. Descriptive data analysis was performed.

Results:

The sample consisted mostly of adult mothers (84.0%), with more than 8 years of schooling (83.3%), belonging to the C, D, and E socioeconomic classes (75.3%). The prevalence of suspected cases of delayed neuropsychomotor development and social-emotional changes was 12.7 and 42.2%, respectively.

Conclusions:

The results point to the existence of children at risk of delayed development, particularly in the social-emotional domain, reaffirming the need to adopt child development screening as a health service routine, with the implementation of appropriate intervention programs.

No Relation Between Zinc Status and Inflammatory Biomarkers in Adolescent Judokas

This study aimed to assess the relation between zinc status and inflammation biomarkers in adolescent judokas. This cross-sectional study included 52 male adolescents, aged between 14 and 19 years, who were subdivided into two groups: judoka group (n = 25) and control group (n = 27). Zinc intake was monitored using 3-day food records and the NutWin software version 1.5. The plasma and erythrocyte zinc concentrations were determined by flame atomic absorption spectrophotometry. Analysis of cytokines (IL-1β, IL-6, and TNF-α) was performed. The mean values of zinc concentration in the diet were found to be higher than those recommended (11.0±3.9 mg/day and 20.3±11.9 mg/day for control group and judokas, respectively) although there was no significant difference between the groups. The mean plasma concentrations of zinc were below the reference range (71.4±16.0 μg/dL and 71.9±13.8 μg/dL for control group and judokas, respectively), without a significant difference between the groups. The mean concentrations of zinc erythrocyte were within the reference range (41.2±8.6 μg/gHb and 42.6±11.3 μg/gHb for control group and judokas, respectively), without a significant difference between the groups. There was no significant difference in the inflammatory biomarkers between the judokas and controls. There was not a significant correlation between biochemical parameters of zinc and inflammation biomarkers in adolescent judokas. Regarding the data found in the study, it can be concluded that the athletes evaluated have low plasma zinc concentrations, normal erythrocyte values, and high dietary intake of zinc. Moreover, the study don't show a relationship between zinc parameters and inflammatory markers evaluated.

PREVALÊNCIA DO ALEITAMENTO MATERNO EXCLUSIVO E SEUS FATORES DE RISCO

Investigar a prevalência do aleitamento materno exclusivo ao nascer e seus fatores de risco. A população foi composta por todas as crianças nascidas vivas e suas respectivas mães no período de janeiro a dezembro de 2015, no alojamento conjunto de um hospital público do Piauí, totalizando 546 nascidos vivos. A pesquisa foi aprovada pelo Comitê de Ética com parecer 1.144.279. Das mães pesquisadas, 97,6% realizaram pré-natal, destas 67% receberam orientações sobre aleitamento materno. A prevalência de aleitamento materno exclusivo e aleitamento materno foi de 92,7 e 2,9%, respectivamente. Constatou-se que 20,7% das crianças faziam uso de chupeta e 4,4% de mamadeira. Faz-se necessário realizar intervenções de prevenção dos fatores de risco e desmame precoce por meio de atividades educativas que orientem mães e familiares envolvidos na amamentação.

Expression of the zinc transporters genes and metallothionein in obese women

Research has investigated the participation of zinc transport proteins and metallothionein in the metabolism of this mineral. However, studies about the genetic expression of these proteins in obese patients are scarce. The study determined the expression of zinc transporter protein codifying genes (ZnT-1, Zip-1 and Zip-3) and of metallothionein in 55 obese women, aged between 20 and 56 years. The assessment of body composition was carried out using anthropometric measurements and bioelectrical impedance. Zinc intake was obtained by recording diet over a 3-day period, and the nutritional analysis was carried out using NutWin software version 1.5. The plasmatic and erythrocytary zinc were analyzed by atomic absorption spectrophotometry (λ=213. 9 nm). The determination of mRNA expression of the zinc transporter proteins and metallothionein was carried out using blood, using the RT-PCR method. The mean values of body mass index were 37.9±5.5 kg/m2. The average intake of zinc was 9.4±2.3 mg/day. The analysis of the zinc plasma concentrations showed values of 58.4±10.9 μg/dL. The mean values of zinc in the erythroytes were 38.7±9.1 μg/g Hb. The metallothionein gene had a higher expression in the blood, when compared to zinc transporters ZnT-1, Zip-1, and Zip-3 (p=0.01). The study shows that there are alterations in the biochemical parameters of zinc in obese patients assessed, as well as higher expression of the codifying gene metallothionein, when compared to the investigated zinc transporters.

Effect of zinc supplementation on thyroid hormone metabolism of adolescents with Down syndrome

Studies have evidenced that zinc metabolism is altered in the presence of Down syndrome, and zinc seems to have a relationship with the metabolic alterations usually present in this syndrome. In this work, the effect of zinc supplementation on thyroid hormone metabolism was evaluated in adolescents with Down syndrome. A prospective study was carried out on 16 adolescents with Down syndrome (age: 10-19 years) who were randomized for treatment with 30 mg zinc daily for 4 weeks. Diet evaluation was accomplished y using a 3-day dietary record, and the analysis was performed by the NutWin program, version 1.5. Anthropometric measurements were performed for evaluation of body composition. The Zn-related nutritional status of the groups was evaluated by means of zinc concentration determinations in plasma and erythrocytes using the method of atomic absorption spectroscopy, and the thyroid hormone was obtained by radioimmunoassay. The diet of patients with Down syndrome, before and after the intervention presented reduced energy level and adequate zinc concentrations. Mean plasma zinc values were 59.2 +/- 13.2 and 71.0 +/- 21.9 microg/dL before and after the intervention, respectively. Erythrocyte concentrations of the mineral before supplementation, instead, were 51.5 microg/dL +/- 11.1 microg Zn/gHb, and at the end of the experiment, they were 42.9 +/- 8/5 microg Zn/gHb, with a significant statistical difference (p < 0.05). Serum concentrations of T(4) hormone before and after zinc supplementation were 1.26 +/- 0.20 and 1.54 +/- 0.63 pg/mL, respectively. Mean T(3) values before intervention were 2.47 +/- 037 pg/mL and, after supplementation, 2.25 +/- 0.67 pg/mL, without significant statistical difference (p > 0.05). Intervention with zinc showed to be effective in the stabilization of the concentrations of this mineral in plasma and erythrocytes, but had no influence on the metabolism of thyroid hormones.

Zinc nutritional status in adolescents with Down syndrome

Studies have evidenced that zinc metabolism is altered in presence of Down syndrome, and zinc seems to have a relationship with the metabolic alterations usually present in this syndrome. In this work, the Zn-related nutritional status of adolescents with Down syndrome was evaluated by means of biochemical parameters and diet. A case-control study was performed in a group of adolescents with Down syndrome (n = 30) and a control group (n = 32), of both sexes, aged 10 to 19 years. Diet evaluation was accomplished by using a 3-day dietary record, and the analysis was performed by the NutWin program, version 1.5. Antropometric measurements were performed for evaluation of body composition. The Zn-related nutritional status of the groups was evaluated by means of zinc concentration determinations in plasma and erythrocytes, and 24-h urinary zinc excretion, by using the method of atomic absorption spectroscopy. The diet of both groups presented adequate concentrations of lipids, proteins, carbohydrates, and zinc. The mean values found for zinc concentration in erythrocytes were 49.2 +/- 8.5 microg Zn/g Hb for the Down syndrome group and 35.9 +/- 6.1 microg Zn/g Hb for the control group (p = 0.001). The average values found for zinc concentration in plasma were 67.6 +/- 25.6 microg/dL for the Down syndrome group and 68.9 +/- 22.3 microg/dL for the control group. The mean values found for zinc concentration in urine were 244.3 +/- 194.9 microg Zn/24 h for the Down syndrome group and 200.3 +/- 236.4 microg Zn/24 h for the control group. Assessment of body composition revealed overweight (26.7%) and obesity (6.6%) in the Down syndrome group. In this study, patients with Down syndrome presented altered zinc levels for some cellular compartments, and the average zinc concentrations were low in plasma and urine and elevated in erythrocytes.