Factors associated with women diagnosed with syphilis who received prenatal care in a primary healthcare unit

OBJECTIVE

To estimate the prevalence of syphilis and its associated factors in women who were treated at public maternity hospitals and received prenatal care in a primary healthcare unit.

METHODS

This cross-sectional study included 399 postpartum women. Interviews were conducted, and additional data were extracted from the pregnant woman's booklet, medical records, and printed tests. The dependent variable was a gestational syphilis diagnosis. The independent variables were grouped into socioeconomic and demographic, behavioral, reproductive, and prenatal blocks. The prevalence, prevalence ratios, and 95% confidence intervals (95%CI) were calculated. The χ 2 test was also performed (p≤0.05). Multivariate analysis was performed using Poisson regression models.

RESULTS

The prevalence of gestational syphilis was 9.61% (95%CI: 7.14-12.83). We identified the following determining factors (adjusted prevalence ratios): history of sexually transmitted infections (2.3), first sexual intercourse by the age of 15 (2.42), partner having a history of syphilis (5.98), partner using crack/cocaine (6.42) and marijuana and others (3.02), not having a partner (3.07), low income (2.85), history of stillbirth (5.21), beginning prenatal care in the third trimester (3.15), and prenatal care received in a primary healthcare unit (without a Family Health Strategy team) (0.35).

CONCLUSION

Individual and prenatal factors were associated with gestational syphilis. To control congenital syphilis, targeted interventions are needed to control syphilis in the adult population including expansion of access to quality prenatal care with identification of risks for syphilis and connection between prevention and treatment actions, implementation of strategies focused on early sexual education, effective establish prenatal care involving both partners, and effective implementation of the National Men's Health Policy (PNAISH - Política Nacional de Atenção Integral à Saúde dos Homens ).

Double screening for syphilis and HIV in pregnant women in a priority municipality for the elimination of vertical transmission in Brazil: incidence, risk factors and spatial analysis

BACKGROUND

The Brazilian Ministry of Health (MoH) recommends double screening (DS) for syphilis and HIV during the first and third trimesters of antenatal care (ANC) to mitigate vertical transmission. We surveyed DS outcomes and their associated factors in a priority Brazilian municipality with >100 000 inhabitants who face challenges for both health problems.

METHODS

A total of 399 women were followed up throughout pregnancy using medical records. Spatial and multinomial logistic analyses were performed.

RESULTS

There was an incidence rate of 24.8%, 59.4% and 15.8% for 'full DS', 'partial DS' and 'without DS', respectively. Younger women and those with a history of both prematurity and multiparity were less likely to be in the 'full DS' category. There was an overlap of high-density clusters of 'full DS' and 'ANC in better quality basic health units', adherent to both the Family Health Strategy and the National Program for Access and Quality Improvement in Primary Care.

CONCLUSIONS

The poor DS outcomes presented in 75% of the cases were mostly linked to delays in starting ANC appointments or their discontinuity. Thus, the MoH recommendations, accompanied by ongoing training, technical assistance and the periodic evaluation of their implementation, need to effectively reach providers and promote counseling and awareness about the importance of DS for pregnant women.

Prevenção da sífilis congênita na atenção primária à saúde: contribuições do estudo de avaliabilidade

Introdução: A ocorrência continuada de sífilis congênita é um indicativo de inadequação do pré-natal, de contextos de vulnerabilidade e/ou de baixa qualidade de programas de controle. Em 1993, o Ministério da Saúde propôs um Projeto de Eliminação da Sífilis Congênita enquanto problema de saúde pública, em consonância com a proposta de controle do agravo nas Américas, formulado pela Organização Pan-americana de Saúde. Durante esses anos, os compromissos foram renovados e a meta de eliminação não foi atingida. Objetivo: Ampliar a compreensão do Programa de Controle de Sífilis Congênita no Brasil, no contexto local da APS e promover condições para a avaliação propriamente dita. Métodos: Foi realizado um estudo qualitativo, com abordagem colaborativa, empregando as etapas propostas por Thurston e Ramaliu. Realizaram-se análises de documentos e reuniões com profissionais interessados. As reuniões foram registradas em diário de campo, seguindo um roteiro estruturado. A amostra dos profissionais foi intencional, não probabilística e a escolha ocorreu pelo tipo de envolvimento no controle da sífilis congênita. Resultados: O estudo permitiu entender as bases conceituais e operacionais do Programa de Controle da Sífilis Congênita com ajustes no modelo lógico do Programa e construção do modelo teórico da posterior Avaliação de Implementação. Observaram-se empecilhos para o controle da sífilis congênita a serem problematizados na avaliação propriamente dita, a saber: falhas das atividades de educação em saúde e de referência e contrarreferência, da disponibilização e da aplicação da penicilina na Atenção Primária à Saúde, das notificações de casos, da integração entre a Vigilância Epidemiológica e a Atenção Primária à Saúde; e a falta de um programa de educação permanente. Conclusões: Identificou-se a viabilidade metodológica e operacional para desenvolver a pesquisa avaliativa posterior e a possibilidade de maior utilidade dos seus resultados, devido ao envolvimento dos profissionais desde o início do estudo.

Assistência pré-natal e perinatal em Governador Valadares, Minas Gerais, Brasil

Resumo Introdução: O acompanhamento pré-natal e as condutas adotadas durante o parto são essenciais para garantir o bom desenvolvimento da gestação, prevenir complicações e proporcionar um parto saudável, sem impacto na saúde da puérpera e do recém-nascido. Objetivo: Analisar a assistência pré-natal e perinatal oferecida em Governador Valadares, Minas Gerais, e verificar se há associação entre a adequação do pré-natal e os fatores socioeconômicos, demográficos, comportamentais e reprodutivos. Métodos: Estudo transversal com base de dados pré-existente. Para a análise da adequação do pré-natal foram utilizados três critérios: 1) início até 16ª semana e número mínimo de consultas de acordo com a idade gestacional; 2) práticas dos profissionais nas consultas de pré-natal; 3) orientações oferecidas às gestantes pelos profissionais. Para a análise dos dados foi utilizada regressão logística multivariada. Resultados: Participaram do estudo 437 puérperas. A assistência pré-natal foi considerada adequada para 72,5%, 93,1% e 50,1% das puérperas, considerando os critérios 1, 2 e 3, respectivamente. As gestantes que apresentaram maior chance de terem o pré-natal inadequado, com relação ao critério 1, foram as com menor escolaridade (RC = 1,68; p = 0,046), que não possuíam companheiro (RC = 2,18; p = 0,002), que não trabalharam durante a gestação (RC = 2,18; p = 0,003) e as que não planejaram a gravidez (RC = 1,76; p = 0,023). Com relação à assistência perinatal, a presença de acompanhante e contato pele a pele foram apropriados, mas a amamentação na primeira hora de vida foi inadequada. Conclusão: Observou-se a necessidade de aprimorar as orientações fornecidas pelos profissionais e incluir a amamentação na primeira hora de vida. Os resultados podem contribuir para otimizar os serviços de saúde materno-infantil em Governador Valadares.

Prenatal and perinatal care in Governador Valadares, Minas Gerais state, Brazil

Abstract Introduction: Prenatal care and the procedures adopted during childbirth are essential to ensure a healthy pregnancy and delivery and prevent complications, without affecting the health of the mother and newborn. Objective: To analyze the prenatal and perinatal care provided in Governador Valadares, Minas Gerais state, Brazil, and to determine whether there is an association between adequate prenatal care and socioeconomic, demographic, behavioral and reproductive factors. Methods: Cross-sectional study with a pre-existing database. The adequacy of prenatal care was analyzed based on three criteria: 1) onset up to the 16th week and a minimum number of checkups according to gestational age; 2) professional practices during prenatal checkups; 3) counseling given to the pregnant women by healthcare professionals. Multivariate logistic regression was used for data analysis. Results: Participants were 437 postpartum women. Prenatal care was considered adequate for 72.5, 93.1 and 50.1% of the participants based on criteria 1, 2 and 3, respectively. The pregnant women who were most likely to receive inadequate prenatal care in relation to criterion 1 were those with the lowest schooling level (OR = 1.68; p = 0.046), who were single (OR = 2.18; p = 0.002), did not work during their pregnancy (OR = 2.18; p = 0.003) and whose pregnancy was unplanned (OR = 1.76; p = 0.023). With respect to perinatal care, the presence of a birth companion and skin-to-skin contact were adequate, but breastfeeding in the first hour of life was not. Conclusion: There is a need to improve the counseling provided by healthcare professionals and include breastfeeding in the first hour of life. The results could contribute to optimizing maternal and child health services in Governador Valadares.

Factors associated with premature birth: a case-control study

Objective:

To analyze the socioeconomic, demographic, environmental, reproductive, behavioral, and health-care factors associated with preterm birth.

Methods:

Case-control study, with case group composed of preterm infants and the control group by full term live births. Each case was paired with two controls according to sex and date of birth. Interviews were carried out with the mothers, as well as analysis of medical records. A logistic regression model was used for data analysis following the hierarchical order of entry of the blocks.

Results:

221 live births were allocated in the case group and 442 in the control group. After analysis adjusted for other factors under study, the highest chances of prematurity were associated with being the first child (OR 1.96; 95%CI 1.34–2.86; p=0.001); mothers with the highest income (OR 2.08; 95%CI 1.41–3.08; p<0.001), mothers with previous preterm births (OR 3.98; 95%CI 2.04–7.79; p<0.001), mothers that suffered violence during pregnancy (OR 2.50; 95%CI 1.31–4.78; p=0.005) and underwent cesarean section (OR 2.35; 95%CI 1.63–3.38; p<0.001). Live births to mothers who had more than six prenatal consultations had a lower risk of prematurity (OR 0.39; 95%CI 0.26–0.58; p<0.001).

Conclusions:

The factors associated with a higher chance of prematurity were: higher family income, previous preterm child, primiparity, violence against pregnant women and cesarean section. Having attended more than six prenatal visits was associated with a lower chance of premature birth. Violence against pregnant women showed a strong and consistent association, remaining in all final models, and should serve as an alert for the population and professionals.

Violence against pregnant women and associated factors in the city of Governador Valadares

OBJECTIVE

To characterize violence against women during pregnancy and to verify its association with socioeconomic, demographic, obstetric, behavioral factors, health care and diseases during pregnancy.

METHODS

Cross-sectional study carried out with puerperal women whose birth took place at the Municipal Hospital of Governador Valadares, in Minas Gerais, from May 2017 to July 2018. Data collection was performed through interviews, and complementary information was obtained by analyzing the prenatal file and medical records. For data analysis, logistic regression was used.

RESULTS

The total of 771 puerperal women participated in the study. Of these, 62 (8.0%) reported having suffered physical, psychological or sexual violence during pregnancy. The pregnant women most likely to have suffered violence were alcohol dependent (OR = 4.97; 95%CI 2.30–10.75; p < 0.001), those who did not perform prenatal care (OR = 3.88; 95%CI 1.00–15.09; p = 0.050), those who used health services in an emergency during pregnancy (OR = 2.47; 95%CI 1.42–4.30; p = 0.001) and who had gestational diabetes (OR = 2.59; 95%CI 1.06–6.32; p = 0.037) and sexually transmitted diseases (OR = 3.85; 95%CI 1.41–10.50; p = 0.009).

CONCLUSION

Violence against pregnant women is associated with behavioral factors and related to health care and diseases during pregnancy. It is essential to recognize factors associated by health professionals through actions to track situations of violence against women since the beginning of prenatal care, in order to enable early intervention.

Short communication: Effects of different blood buffers administered in electrolyte solution to grain-fed veal calves experiencing diarrhea

Calf diarrhea can commonly lead to dehydration and metabolic acidosis due to the loss of fluid and electrolytes. The objective of this randomized clinical trial was to examine differences between treating male dairy calves experiencing diarrhea with either a basic bicarbonate electrolyte powder (BBP) composed of sodium bicarbonate (50.7 mmol/L); a mixed buffer powder (MBP) including sodium bicarbonate (33.8 mmol/L), sodium citrate (8.4 mmol/L), sodium acetate (6.3 mmol/L), and potassium citrate (1.9 mmol/L); or a liquid electrolyte (HAL) composed of sodium acetate (50.1 mmol/L). All 3 electrolyte solutions were standardized to provide 50 mmol/L blood buffers and a similarly strong ion difference (74.4, 74.9, and 82.6 mEq/L for BBP, MBP, and HAL, respectively). Holstein male calves (n = 80) were sourced from auction barns or local farms and delivered in 1 batch to the research facility. Calves were housed in individual pens and fed a 24% crude protein and 17% fat calf milk replacer (CMR) twice daily. Starter grain and water were offered ad libitum. Calves were randomly enrolled in 1 of the 3 treatments when experiencing either 2 consecutive days of a fecal score of 2 (runny, spreads easily) or 1 d with a fecal score of 3 (liquid devoid of solid material). Calves were blocked by the different enrollment criteria. The respective electrolyte solution was administered via esophageal tube 1 h after feeding CMR until the fecal score returned to 0 (normal consistency) or 1 (semiformed or pasty). Blood gas measurements were taken at 1, 8, and 24 h post the initial electrolyte feeding, and weight was measured at 1, 2, 7, 14, and 28 d postenrollment. Mixed repeated measure linear regression models were built to assess the effect that the electrolyte solutions had on the blood gas measurements and body weight. A total of 45 calves were enrolled in the trial with 14, 16, and 15 calves randomly assigned to the MBP, HAL, and BBP groups, respectively. As compared with BBP, MBP increased blood CO₂ at 8 and 24 h, increased bicarbonate at 24 h, increased base excess at 8 and 24 h, and increased anion gap at 24 h. Calves in the BBP and HAL groups noted more severe eye recession when compared with the MBP group. Average daily gain did not differ between treatments at any time point. Although a severe dehydration challenge was not present, which should be considered a limitation of the study, MBP improved the acid-base status of calves compared with BBP, whereas HAL performed similarly to MBP.

Combined effects of caloric restriction and fish oil attenuated anti-depressant and anxiolytic-like effects of fish oil: association with hippocampal BDNF concentrations

Omega-3-enriched fish oil (FO) and caloric restriction (CR) are nutritional therapeutic approaches that exert an important impact on brain function, behavior, memory, and neuroprotection. Here, we investigate the synergic effects of both therapeutic approaches combined (CR + FO) on behavior (memory, anxiety-like behavior, antidepressant-like behavior), as well as its association with hippocampal brain-derived neurotrophic factor (BDNF) concentrations. Adult male Wistar rats were divided into four dietary groups: Control group (C) - chow ad libitum; CR group - 30 % CR, considering C group food intake; FO group - FO-enriched chow ad libitum; and CR + FO group - FO-enriched 30 % CR chow. After 12 weeks of dietary treatment, behavioural analysis set was conducted, and hippocampal BDNF concentrations were measured. FO group presented anxiolytic-like and antidepressant-like behaviors as well as improved memory in the Morris' water maze. These effects were attenuated by the combined CR + FO treatment. FO group also presented higher BDNF concentrations. There was a positive association between the number of entries in the platform quadrant in the MWM and hippocampal BDNF concentrations (β = 0.39; R² = 0.15; p = 0.042) and an inverse association between forced swim immobility time and BDNF concentrations (β = -0.39; R² = 0.15; p = 0.041). Taken together, our data showed that the 12-week FO dietary treatment promoted anxiolytic-like and antidepressant-like behaviors as well as memory improvement, and these effects were associated with BDNF concentrations. Synergic effects of interventions attenuated FO-related behavioral responses and BDNF concentrations and probably reduced hippocampal neuroplasticity.

Reproductive factors associated with overweight in adult women attended by the Family Health Strategy

Overweight stands out as a growing health problem in the population, resulting in individual and societal burdens. This study aimed to identify the association between reproductive factors and overweight in women of reproductive age attended by a Primary Health Care Unit (UAPS).This is a cross-sectional study with home capitation and data collection in two PHC Units, in the city of Juiz de Fora (MG), Brazil, in women aged 20 to 59 years, whose outcome was the overweight measured by the Body Mass Index. The prevalence of overweight was 61.0% among the 2,018 women included in the analysis. In the multivariate analysis, overweight was associated with the variables age at menarche before 12 years of age, having children, age greater than or equal to 30years, and hypertension. The prevalence of overweight in women who had menarche before 12 years of age was 12.4% higher than those who had menarche aged 12 years or more, and the prevalence of overweight in women who had children was 58.2% higher than those who never had any. There was a high prevalence of overweight in the adult female population, emphasizing the influence of reproductive factors.

Factors associated with low birthweight: a case-control study in a city of Minas Gerais

OBJECTIVE To analyze the many factors regarding socioeconomic and healthcare-related variables linked to maternal diseases and the possible impact of the environmental disaster of Mariana, given the prenatal exposure to different water sources for human consumption that were associated with low birthweight in full-term live births in the Municipal Hospital of Governador Valadares, Minas Gerais. METHODS Case-control study, carried out with live births at the Municipal Hospital of Governador Valadares, from May 2017 to July 2018. The case group consisted of full-term live births and low birthweight, and the control group consisted of full-term live births with adequate weight, matched by gender and date of birth. For each case, two controls were selected. Data collection was performed through interviews with the puerperal women, and complementary information was obtained by analyzing the prenatal card and medical records. For data analysis, logistic regression was performed. RESULTS The study included 65 live births from the case group and 130 from the control group. After the analysis was adjusted for other factors under study, we found that the higher risks of low birthweight are associated with the first childbirth (OR = 2.033; 95%CI = 1.047-3.948; p = 0.036), smoking during pregnancy (OR = 2.850; 95%CI = 1.013-8.021; p = 0.047) and consumption of water supplied by the municipalities affected by the tailings from the Fundão dam failure (RC = 2.444; 95%CI = 1.203-4.965; p = 0.013). CONCLUSIONS The variables "water consumed during pregnancy," "previous pregnancies" and "maternal smoking" were associated with low birthweight in the population studied. The importance of epidemiological studies that assess water quality and its adverse health effects is reinforced, as well as greater prenatal control of first-time pregnant women and greater support of policies against smoking, especially during pregnancy.

Acute effect of passive cycle-ergometry and functional electrical stimulation on nitrosative stress and inflammatory cytokines in mechanically ventilated critically ill patients: a randomized controlled trial

Early mobilization is beneficial for critically ill patients because it reduces muscle weakness acquired in intensive care units. The objective of this study was to assess the effect of functional electrical stimulation (FES) and passive cycle ergometry (PCE) on the nitrous stress and inflammatory cytometry in critically ill patients. This was a controlled, randomized, open clinical trial carried out in a 16-bed intensive care unit. The patients were randomized into four groups: Control group (n=10), did not undergo any therapeutic intervention during the study; PCE group (n=9), lower-limb PCE for 30 cycles/min for 20 min; FES group (n=9), electrical stimulation of quadriceps muscle for 20 min; and FES with PCE group (n=7), patients underwent PCE and FES, with their order determined randomly. The serum levels of nitric oxide, tumor necrosis factor alpha, interferon gamma, and interleukins 6 and 10 were analyzed before and after the intervention. There were no differences in clinical or demographic characteristics between the groups. The results revealed reduced nitric oxide concentrations one hour after using PCE (P<0.001) and FES (P<0.05), thereby indicating that these therapies may reduce cellular nitrosative stress when applied separately. Tumor necrosis factor alpha levels were reduced after the PCE intervention (P=0.049). PCE and FES reduced nitric oxide levels, demonstrating beneficial effects on the reduction of nitrosative stress. PCE was the only treatment that reduced the tumor necrosis factor alpha concentration.

Salivary density of Streptococcus mutans and Streptococcus sobrinus and dental caries in children and adolescents with Down syndrome

Streptococcus mutans and Streptococcus sobrinus are strongly associated with dental caries. However, the relationship between oral streptococci and dental caries in children with Down syndrome is not well characterized.

Salivary Periodontopathic Bacteria in Children and Adolescents with Down Syndrome

OBJECTIVE

To assess and compare salivary periodontopathic bacteria between groups of Down syndrome and non-Down syndrome children and adolescents.

MATERIALS AND METHODS

This study included a sample of 30 Down syndrome children and adolescents (G-DS) and 30 age- and sex-matched non-Down syndrome subjects (G-ND). Clinical examination determined the gingival bleeding index (GBI) and plaque index. Unstimulated whole saliva samples were collected from all participants. The fluorescence in situ hybridization (FISH) technique identified the presence and density of eight periodontopathic bacteria in saliva. The statistical analysis included chi-square and Mann-Whitney U tests.

RESULTS

In the G-DS group, bleeding on probing was more frequent (p = 0.037) and higher densities of Campylobacter rectus (p = 0.013), Porphyromonas gingivalis (p = 0.025), Treponema denticola (p = 0.026), Fusobacterium nucleatum (p = 0.013), Prevotella intermedia (p = 0.001) and Prevotella nigrescens (p = 0.008) were observed. Besides, in the G-DS, the densities of bacteria from the orange complex were significantly higher in the age group 3-7 years for F. nucleatum (p = 0.029), P. intermedia (p = 0.001) and P. nigrescens (p = 0.006). C. rectus was higher in the age group 8-12 years (p = 0.045).

CONCLUSION

The results showed that children and adolescents with Down syndrome have higher susceptibility to periodontal disease and number of periodontopathic bacteria.

[Opportunistic screening versus missed opportunities: non-adherence to Pap smear testing in women attending prenatal care]

The objectives were to estimate the prevalence of non-adherence to Pap smear testing in women attending prenatal care and to identify associated factors. This was a cross-sectional population-based study in 308 women from a rural municipality (county) in Minas Gerais State, Brazil. Complex stratified cluster sampling was used. Statistical analysis used the chi-square test and logistic regression model with the variables that presented p-value ≤ 0.05 in the bivariate model. Prevalence of lack of Pap smear test was 21.3%. Among women 25 years or older, prevalence was 15.1%. Non-adherence was more common in young, single women and those with low schooling. Low schooling remained associated with non-performance of Pap smear (OR = 0.41), indicating that women with more schooling enjoyed higher odds of testing. Contact with the prenatal clinic did not determine guaranteed access to the test, thus indicating missed opportunities when opportunistic screening is employed.

Pharmacovigilance of patients with multiple myeloma being treated with bortezomib and/or thalidomide

In order to evaluate the main adverse effects of drug protocols using bortezomib and/or thalidomide for the treatment of multiple myeloma, we conducted a prospective study. Data were collected through interviews, clinical observation, and from hospital records. A total of 59 patients were included. There was a predominance of females, 36 (61%) vs 23 (39%) males, and of whites, 49 (83.1%) vs 10 (16.9%) blacks. Age ranged from 40 to 94 years, with a median of 65 years (SD=11.6). Regarding staging at diagnosis, 27 (45.7%) patients were in stage III-A, with 12 (20.3%) patients having serum creatinine ≥2 mg/dL. The main adverse effects in the bortezomib treatment group (n=40) were: neutropenia (42.5%), diarrhea (47.5%), and peripheral neuropathy in 60% of cases, with no difference between the iv (n=26) and sc (n=14) administration routes (P=0.343). In the group treated with thalidomide (n=19), 31.6% had neutropenia, 47.4% constipation, and 68.4% peripheral neuropathy. Neutropenia was associated with the use of alkylating agents (P=0.038). Of the 3 patients who received bortezomib in combination with thalidomide, only 1 presented peripheral neuropathy (33.3%). Peripheral neuropathy was the main adverse effect of the protocols that used bortezomib or thalidomide, with a higher risk of neutropenia in those using alkylating agents. Improving the identification of adverse effects is critical in multiple myeloma patient care, as the patient shows improvements during treatment, and requires a rational and safe use of medicines.

Hospitalizations for ambulatory care-sensitive conditions, Minas Gerais, Southeastern Brazil, 2000 and 2010

OBJECTIVE

To analyze hospitalization rates and the proportion of deaths due to ambulatory care-sensitive hospitalizations and to characterize them according to coverage by the Family Health Strategy, a primary health care guidance program.

METHODS

An ecological study comprising 853 municipalities in the state of Minas Gerais, under the purview of 28 regional health care units, was conducted. We used data from the Hospital Information System of the Brazilian Unified Health System. Ambulatory care-sensitive hospitalizations in 2000 and 2010 were compared. Population data were obtained from the demographic censuses.

RESULTS

The number of ambulatory care-sensitive hospitalizations declined from 20.75/1,000 inhabitants [standard deviation (SD) = 10.42) in 2000 to 14.92/thousand inhabitants (SD = 10.04) in 2010 Heart failure was the most frequent cause in both years. Hospitalizations rates for hypertension, asthma, and diabetes mellitus, decreased, whereas those for angina pectoris, prenatal and birth disorders, kidney and urinary tract infections, and other acute infections increased. Hospitalization durations and the proportion of deaths due to ambulatory care-sensitive hospitalizations increased significantly.

CONCLUSIONS

Mean hospitalization rates for sensitive conditions were significantly lower in 2010 than in 2000, but no correlation was found with regard to the expansion of the population coverage of the Family Health Strategy. Hospitalization rates and proportion of deaths were different between the various health care regions in the years evaluated, indicating a need to prioritize the primary health care with high efficiency and quality.

[Actions geared to tobacco control: a review of their implementation in Primary Health Care]

This survey examined the status of the implementation of policies for tobacco control in a medium-sized municipality through an assessment of actions recommended by the National Tobacco Control Program (NTCP) promoted by Primary Health Care (PHC) units. The coordinator of the local NTCP and professionals from 44 PHC units of Juiz de Fora in the state of Minas Gerais were interviewed, between May and July 2011. It was observed that the actions of treatment and health promotion were being duly executed, the highlight being the training of professionals to implement treatment in PHC. In 40.9%, there is the provision of treatment for smokers, and in 88.6% the actions are concentrated in activities in waiting rooms, groups and individual consultations. Limitations identified are probably not restricted to the municipality, such as inadequate structuring of units, high turnover, the varying degree of involvement of professionals in implementing the service and also the lack of mechanisms to enable them to implement and give continuity to care among their other responsibilities. The major challenge for tobacco control is to conduct intersectoral actions and in primary health care. The results can serve for the formulation of strategic health actions in other parts of the country.

Azathioprine is more effective than mesalazine at preventing recurrent bowel obstruction in patients with ileocecal Crohn's disease

Background

Patients with subocclusive Crohn’s disease (CD) who received azathioprine (AZA) therapy had lower re-hospitalization rates due to all causes and for surgical management of CD compared to those treated with mesalazine during a 3-year period. We investigated whether AZA also was effective for prevention of recurrent bowel obstruction.

Material/Methods

Rates of recurrent bowel occlusion were compared between patients treated with AZA and those treated with mesalazine. We assessed the time interval-off intestinal obstruction as well as the occlusion-free survival for both groups.

Results

There was a significantly lower cumulative rate of patients with recurrent subocclusion in the AZA group (56%) compared with the mesalazine group (79%; OR 3.34, 95% CI 1.67–8.6; P=0.003), with the number needed to treat in order to prevent 1 subocclusion episode of 3.7 favoring AZA. The occlusion-free time interval was longer in the AZA group compared with the mesalazine group (28.8 vs. 18.3 months; P=0.000). The occlusion-free survival at 12, 24, and 36 months was significantly higher in the AZA group (91%, 81%, and 72%, respectively) than in the mesalazine group (64.7%, 35.3%, and 23.5%, respectively; P<0.05 for all comparisons).

Conclusions

In an exploratory analysis of patients with subocclusive ileocecal CD, maintenance therapy with AZA is more effective than mesalazine for eliminating or postponing recurrent intestinal obstruction during 3 years of therapy.

Exercício físico como fator de proteção para a saúde em servidores públicos

INTRODUÇÃO: A atividade física é reconhecida como fator de proteção para a saúde, sendo seus benefícios associados à redução de doenças crônicas e à diminuição do risco de morte prematura por doenças cardiovasculares. Embora a atividade física seja um importante recurso para políticas de promoção de saúde, o baixo nível e a inatividade física são preocupantes em todo o mundo. Em uma sociedade cada vez mais urbanizada e industrializada, exercícios físicos praticados regularmente são importantes recursos para manter o nível de atividade física recomendado, contudo, é preciso identificar as práticas mais adequadas às necessidades preconizadas como efeito protetor do exercício físico para a saúde.OBJETIVO: Analisar a prevalência de atividade física, fatores sociodemográficos, frequência, modalidades e motivos para a prática de exercício físico em servidores públicos de uma universidade.MÉTODOS: Estudo transversal, amostra aleatória (280 indivíduos) nível de confiança 95%, erro amostral 5%. Para avaliar o nível de atividade física foi utilizado o instrumento IPAQ (International Physical Activity Questionnaire), versão curta, na forma de entrevista. Foi aplicado um questionário sociodemográfico e questionado se os indivíduos praticavam exercício físico regularmente, a modalidade e frequência semanal, bem como os motivos para a prática. Os dados foram analisados utilizando-se o software estatístico SPSS - 14.0.RESULTADOS: A prevalência de inativos e insuficientemente ativos foi de 43,9%. Entre os que fazem exercício físico, 92,5% o fazem para a saúde (p<0,005), porém 29% são inativos ou insuficientemente ativos. Das modalidades mais praticadas, ao contrário do esperado, a caminhada não foi significativa.CONCLUSÕES: Houve diferenças no nível de atividade física quanto à idade, sexo, estado civil e ocupação, bem como nos motivos, na escolha e diversidade de modalidades praticadas. Além de encorajar e monitorar a atividade física, é preciso criar estratégias institucionais a fim de que se possam obter benefícios de melhor qualidade para a saúde.

[Factors associated with the use of the Papanicolaou smear screening among older women in the interior of Brazil]

PURPOSE

To verify the coverage, by Pap testing, of older women and the associated factors.

METHODS

A population-based study was conducted by home interviews. The inclusion criteria were women aged 60 and over, living on the north side of the city of Juiz de Fora, Minas Gerais, Brazil, self-sufficient to answer the questionnaire or having someone to answer on their behalf. The interview consisted of sociodemographic questions, regarding the general health of the older women, and preventive practices in women's health. The selection was made by random sampling, stratified and clustered in multiple stages. To analyze associated factors, a theoretical model was formulated with three hierarchical blocks of variables, adjusted to each other in each block. The variables that had a level of significance of 0.2 or less were included in the Poisson regression model and adjusted to their next highest level (p<0.1).

RESULTS

Pap testing occurred in 84.1% of cases (95%CI 79.0-88.4). Based on multivariate regression analysis, three variables remained significantly associated with access to Pap testing: the marital status "without partner" (older women who were single, widowed, separated or divorced), self-sufficiency to perform Instrumental Activities of Daily Living (IADLs) and adherence to mammography. In the interblock analysis these variables remained significantly associated with the outcome variable, and self-sufficiency for IADLs had the highest association.

CONCLUSIONS

Among the older women comprising the study sample, was observed variation in the use of Pap testing. An adjustment of public health policies towards the formulation of policies giving priority to universal preventive care may be an alternative to solve the disparities observed.

[Hospitalizations for primary care-sensitive conditions in a Southern Brazilian municipality]

OBJECTIVE

To study the most frequent causes of hospitalizations for primary care-sensitive conditions (HPCSC) in the city of Juiz de Fora, MG, Brazil, by age group and gender, over the periods of 2002 to 2005 and of 2006 to 2009.

METHODS

This was a descriptive study, with data collected from the Hospital Information System of the Unified Health System (Sistema de Informação Hospitalar do Sistema Único de Saúde - SIH-SUS) and from population projections by the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística - IBGE). HPCSC rates were calculated for 1,000 inhabitants, and the most frequent causes were studied by gender and age group, comparing both periods.

RESULTS

HPCSP showed rates of 7.74/1,000 between 2002 and 2005 and 8.81/1,000 between 2006 and 2009. The main causes were heart failure, cerebrovascular diseases, angina pectoris, pulmonary diseases, and kidney and urinary tract infections, which together represented 4.9/1,000 in the first period and 5.6/1,000 in the second period. The evolution of the rates between both periods occurred differently by age group and gender.

CONCLUSION

The study did not exhibit any remarkable differences in HPCSC rates between the periods. Regarding the most frequent causes, reduced hospitalization rates for gastroenteritis, asthma, high blood pressure, and cerebrovascular diseases were observed, as well as increased hospitalizations for heart failure, pulmonary diseases, epilepsies, and kidney and urinary tract infections; these hospitalizations occurred differently by gender and age group. The results showed that a deep reflection regarding the determinants of hospitalizations for avoidable causes is needed.

[Non adherence to cancer screening guidelines for cervical cancer among women who attended prenatal care]

PURPOSE

To estimate the prevalence and identify the factors associated with delayed pap smear test of the cervix (carried out more than three years ago) among mothers with sons under two years of age, who attended the prenatal care.

METHODS

Cross-sectional, population-based household survey. Women with sons under two years old, living in the northern area of the city of Juiz de Fora (MG), Brazil, were interviewed. Stratification and clustering were used in a complex sampling procedure. We applied a survey questionnaire to capture women's demographic and socioeconomic characteristics of women and information about prenatal and practices for preventing cancer of the cervix. For statistical analysis of the possible bivariate association of factors, we used χ² test and a logistic regression model with the explanatory variables that had a significance less than or equal to 0.05 in the bivariate analysis.

RESULTS

We found a delayed test prevalence of 26.6% (95%CI 21.3 - 32.6), including women who were never submitted to the exam. The variables associated with the non-adherence to the examination within the stipulated time were: to be married (OR 0.5; 95%CI 0.2 - 0.9), and divorced/widowed (OR 0.1; 95%CI 0.02 - 0,8), having performed gynecological examination in prenatal care (OR 0.3; 95%CI 0.1 - 0.6) and number of prenatal visits (OR 0.09; 95%CI 0.03 - 0.25 for more than 11 visits), being all protection factors.

CONCLUSIONS

The prevalence of adherence to Pap smear guidelines is slightly lower than the percentage recommended by the World Health Organization. Apart from that, the fact that the woman was submitted to the prenatal care did not guarantee the adherence to Pap smear frequency guidelines.

Effect of azathioprine or mesalazine therapy on incidence of re-hospitalization in sub-occlusive ileocecal Crohn's disease patients

Background

Although the cost of Crohn’s disease (CD) treatment differs considerably, hospitalization and surgery costs account for most of the total treatment cost. Decreasing hospitalization and surgery rates are pivotal issues in reducing health-care costs.

Material/Methods

We evaluated the effect of azathioprine (AZA) compared with mesalazine on incidence of re-hospitalizations due to all causes and for CD-related surgeries. In this controlled, randomized study, 72 subjects with sub-occlusive ileocecal CD were randomized for AZA (2–3 mg/kg per day) or mesalazine (3.2 g per day) therapy during a 3-year period. The primary end point was the re-hospitalization proportion due to all causes, as well as for surgical procedures during this period evaluated between the groups.

Results

On an intention-to-treat basis, the proportion of patients re-hospitalized within 36 months due to all causes was lower in patients treated with AZA compared to those on mesalazine (0.39 vs. 0.83, respectively; p=0.035). The AZA group had also significantly lower proportions of re-hospitalization for surgical intervention (0.25 vs. 0.56, respectively; p=0.011). The number of admissions (0.70 vs. 1.41, p=0.001) and the length of re-hospitalization (3.8 vs. 7.7 days; p=0.002) were both lower in AZA patients.

Conclusions

Patients with sub-occlusive ileocecal CD treated with AZA had lower re-hospitalization rates due to all causes and for surgical management of CD compared to those treated with mesalazine during a 3-year period. The long-term use of AZA in ileocecal CD patients recovering from a sub-occlusion episode can save healthcare costs.

Heat shock effects on seed germination of five Brazilian savanna species

Fire is considered an important factor in influencing the physiognomy, dynamics and composition of Neotropical savannas. Species of diverse physiognomies exhibit different responses to fire, such as population persistence and seed mortality, according to the fire frequency to which they are submitted. The aim of this study is to investigate the effects of heat shocks on seed germination of Anadenanthera macrocarpa (Benth.) Brenan, Dalbergia miscolobium Benth., Aristolochia galeata Mart. & Zucc., Kielmeyera coriacea (Spreng.) Mart. and Guazuma ulmifolia Lam., which are native species of the Brazilian savanna. The temperatures and exposure times to which the seeds were submitted were established according to data obtained in the field during a prescribed fire: 60 °C (10, 20 and 40 min), 80 °C (5, 10 and 20 min) and 100 °C (2, 5 and 10 min). Untreated seeds were used as controls. Seeds of A. galeata and K. coriacea showed high tolerance to most heat treatments, and seeds of A. macrocarpa showed a significant reduction in germination percentage after treatments of 80 °C and 100 °C. Treatments of 100 °C for 10 min reduced germination percentage for all species except G. ulmifolia, which has dormant seeds. For this species, germination was accelerated by heat treatments. The high temperatures applied did not interfere with the time to 50% germination (T(50) ) of the tolerant seeds. Seeds of the savanna species K. coriacea and A. galeata were more tolerant to heat shocks than seeds of the forest species A. macrocarpa. Guazuma ulmifolia, the forest species with seeds that germinate after heat shock, also occurs in savanna physiognomies. Overall, the high temperatures applied did not affect the germination rate of the tolerant seeds.

Expression of IL-1β, IL-6, TNF-α, and iNOS in pregnant women with periodontal disease

Periodontal disease is one of the most prevalent oral diseases. An association between this disease and pregnancy has been suggested, but available findings are controversial. We evaluated the expression levels of interleukins (IL-1β and IL-6), tumor necrosis factor-alpha (TNF-α), and inducible nitric oxide synthase (iNOS) in pregnant women with and without periodontal disease in comparison with non-pregnant women with and without periodontal disease since studies have suggested a relationship between periodontitis and the expression levels of these genes. The women in the sample were distributed into four groups: pregnant and non-pregnant women, with or without periodontal disease, a total of 32 women. The periodontal condition was evaluated according to the probing depth, clinical attachment level and bleeding on probing. Analysis of gene expression was performed by real-time PCR. Comparisons were made of the level of gene expression among the four groups. Expression of IL-1β in the non-pregnant women with periodontal disease was 12.6 times higher than in the non-pregnant women without periodontal disease (P < 0.01), while expression of TNF-α in the non-pregnant women without periodontal disease was 3.5 times higher than in the pregnant women with periodontal disease (P < 0.05). Despite these differences, our overall findings indicate no differences in the expression levels of the cytokines IL-1β, IL-6, TNF-α, and iNOS in pregnant women with and without periodontal disease in comparison with expression of the same genes in non-pregnant women with and without periodontal disease, suggesting that periodontal disease is not influenced by pregnancy.

Coping religioso-espiritual e consumo de alcoólicos em hepatopatas do sexo masculino

Estudo transversal realizado com o objetivo de avaliar uso do Coping Religioso-Espiritual (CRE) e verificar suas possíveis modulações com o padrão de consumo de alcoólicos em pacientes atendidos em ambulatório de hepatologia entre abril e dezembro de 2009, utilizando o CAGE, o AUDIT e a escala CRE. Foram encontradas associações entre coping religioso-espiritual negativo (CREN) e consumo de alcoólicos na vida no último ano e com a combinação resultante. Sujeitos identificados como CAGE negativos com uso de baixo risco no último ano tiveram frequência acima da esperada na categoria abaixo da mediana. Os identificados como CAGE positivo com uso de médio risco foram relativamente mais frequentes na categoria acima da mediana (p=0,017). Resultados reforçam a relevância do CREN na avaliação de eventos relacionados com a saúde.

Prevalência de perda auditiva incapacitante em Juiz de Fora, Brasil

Data on the prevalence of disabling hearing loss (DHL) in Brazil is scarce, which impacts healthcare professionals' knowledge on the extent of the problem.

Objectives: This study aimed at estimating DHL prevalence in the municipality of Juiz de Fora, Minas Gerais, to identify individual-related variables and find risk areas.

Materials and Methods: This was a descriptive sectional population study held from January to October of 2009. We randomly selected 349 households with 1,050 individuals who with ages ranging between 4 days and 95 years. The data collection instruments were: WHO structured questionnaire, ENT examination and laboratory tests. Chi-square and Poisson regression models were used for analyses.

Results: DHL prevalence was estimated at 5.2% (95% CI = 3.1 to 7.3) which was classified as moderate in 3.9% (95% CI = 0.001 to 0.134), severe in 0.9% (95% CI = 0.001 to 0.107) and profound in 0.4% (95% CI = 0.001 to 0.095). We found correlation between DHL and tinnitus; age over 60 years and low educational level.

Conclusions: Our data obtained pointed to the need to create hearing health programs targeted to specific risk groups, promoting quality of life for hearing impaired patients.

[Opportunities in the home environment for motor development]

OBJECTIVE

To assess the opportunities present in the home environment for motor development of infants.

METHODS

This was a cross-sectional population-based epidemiological study on 239 infants aged three to 18 months who were living in the municipality of Juiz de Fora, Southeastern Brazil, in 2010. The participants were selected by means of stratified random sampling, in clustered multiple stages. To assess the quality and quantity of motor stimulus in the home environment, the "Affordances in the Home Environment for Motor Development - Infant Scale" instrument was used. Bivariate analysis was performed, with application of the chi-square test followed by multinomial logistic regression, in order to investigate associations between the opportunities present in the home and biological, behavioral, demographic and socioeconomic factors.

RESULTS

The opportunities for environmental stimulation were relatively low. In the bivariate analysis, for the age group from three to nine months, associations with the following factors were found: birth order (p = 0.06), socioeconomic classification (p = 0.08), monthly income (p = 0.06) and per capita income (p = 0.03). In the regression model, the socioeconomic classification prevailed (OR = 7.46; p = 0.03). For the age group from 10 to 18 months, bivariate analysis showed that the following factors were associated: mother's marital status (p < 0.01), father living with the child (p = 0.08), head of the family (p = 0.04), number of people in the household (p = 0.05), mother's schooling level (p < 0.01), father's schooling level (p < 0.01), socioeconomic classification (p < 0.01) and per capita income (p = 0.03). In the regression model, the mother's marital status (OR = 4.83; p = 0.02), mother's schooling level (OR = 0.29; p = 0.03) and father's schooling level (OR = 0.33; p = 0.04) remained associated with the opportunities for environmental stimulation.

CONCLUSIONS

Stable partnership between the parents, higher maternal and paternal schooling levels and higher economic level were the factors associated with better opportunities for motor stimulation in the home.

[The socioeconomic and demographic characterization of children and adolescents who study and work outside their home]

The objective of this study was to identify the socioeconomic and demographic characteristics of children and adolescents who study and work outside their home. This non-experimental, correlational, cross-sectional study was performed using questionnaires applied to primary education students, enrolled in public schools in Ribeirão Preto (Brazil). Two schools were selected through a draw. Data analysis was performed using Statistical Package for Social Sciences, version 14.0. Of the 133 students who answered the questionnaire, 36 (27.7%) reported working outside their home, 20.6% were between 11 and 13 years of age, and 66.7% were male (p=0.000) and had started working early to help with the family income (p=0.003). The salary they received helped comprise the family income, and it was found that as the family income increased, the need for the youngsters to work was reduced. It was found that many factors contribute to these subjects' early start at work, including family size, structure and poverty.

Treatment dropout at a secondary mental health service

OBJECTIVE

To investigate mental health dropout rates in secondary care and to identify possible associations between this variable and social, demographic, psychopathologic, and health care process-related variables.

METHOD

This prospective, observational study included 994 patients referred to a secondary service by four primary care units and evaluated by a specialist mental health team between 2004 and 2008. The dependent variable was treatment dropout. Bivariate analyses investigated possible associations between treatment dropout and 57 independent variables.

RESULTS

The overall dropout rate from specialist mental health treatment was relatively low (mean = 25.6%). Only four independent variables were associated with dropout: one socioeconomic, two psychopathological, and one health care process variable. All associations were marginally significant (p < 0.1).

CONCLUSION

Our findings suggest that family members, patients, and health care professionals are well engaged in this mental health care system based on a model of primary care. The use of this mental health model of care should be extended to other regions of our country.

Infection profile of patients undergoing autologous bone marrow transplantation in a Brazilian institution

CONTEXT AND OBJECTIVE

Hematopoietic stem cell transplantation (HSCT) has been widely used for treating oncological and hematological diseases. Although HSCT has helped to improve patient survival, the risk of developing infection during hospitalization is an important cause of morbidity and mortality. This study aimed to analyze the infection profile during hospitalization and the associated risk factors among patients undergoing autologous HSCT at the University Hospital, Universidade Federal de Juiz de Fora.

DESIGN AND SETTING

This was a cross-sectional study on patients undergoing autologous HSCT at a public university hospital.

METHODS

Patients with febrile neutropenia between 2004 and 2009 were retrospectively evaluated regarding their infection profile and associated risk factors.

RESULTS

Infection occurred in 57.2% of 112 patients with febrile neutropenia. The main source of infection was the central venous catheter (25.9%). Infection was chiefly due to Gram-positive bacteria, although Gram-negative-related infections were more severe and caused a higher death rate. Sex, age, skin color, nutritional status and underlying disease were not associated with the development of infection. Patients with severe mucositis (Grades III and IV) had a higher infection rate (P < 0.001). Patients who developed pulmonary complications during hospitalization had higher infection rates (P = 0.002). Infection was the main cause of death (57.1%) in the study sample.

CONCLUSION

Strategies aimed at reducing infection-related mortality rates among patients undergoing autologous HSCT are necessary.

Concession of sickness benefit to social security beneficiaries due to mental disorders

OBJECTIVE

Assess the odds of having an initial claim for statutory sickness benefit awarded (ascribed to mental disorder as the main registered diagnosis), in relation to institutional, clinical, sociodemographic and welfare factors in Juiz de Fora-MG, Brazil.

METHOD

Two models of logistic regression, taking into account the categories of the medical examiners, were built with the aim of characterizing the relative weight of several variables affecting the medical conclusion.

RESULTS

The factors more strongly related to an award of benefit were claimants assessed by a physician without a specialization in psychiatry; with a diagnosis of psychosis; up to 29 years of age; with other non-psychiatric (musculoskeletal and cardiovascular) co-morbidities; registered with the national insurance system as employed; and male.

DISCUSSION

In both models, examiners with a specialization in psychiatry were associated with a lower likelihood of award of benefit. This suggests that examinations undertaken by doctors having a specialty related to the diagnosis supporting the sickness benefit claim are stricter than those undertaken by non-specialists.

CONCLUSION

The results suggest that benefit award odds were associated with the specialty of the examiner, medical diagnosis, age, gender and claimant category.

Prevalence of falls and associated factors in elderly individuals

OBJECTIVE

To estimate the prevalence of falls in elderly individuals and to analyze associated factors.

METHODS

Cross-sectional study with 420 elderly subjects (aged 60 years or older) living in the city of Juiz de Fora (Southeastern Brazil) in 2010. A household survey was conducted and the occurrence of falls in the 12 previous months was described. For the analysis of factors associated with the outcome, a theoretical determination model with three hierarchical blocks was built. The variables were adjusted among each other within each block; those with level of significance < 0.20 were included in the Poisson regression model and adjusted to the immediately higher level, with 5% significance level.

RESULTS

The prevalence of falls among the elderly was 32.1% (95%CI: 27.7; 36.9). Among those who experienced falls, 53% had a single fall and 19% had fractures as a consequence. Most of the falls (59%) occurred at the elderly person's home. The occurrence of falls was associated with old age, female sex, need of help for locomotion and self-reported diagnosis of osteoporosis.

CONCLUSIONS

Falls are frequent among the elderly. Knowledge of the factors associated with the occurrence of this event can aid the development of prevention strategies and adequate health services.

Influência da posição do objeto na frequência de alcances manuais em lactentes com desenvolvimento típico

O objetivo deste estudo foi verificar a frequência de alcances no período de três a cinco meses de idade e se há influência da posição de apresentação do objeto. Treze lactentes com desenvolvimento típico foram avaliados aos três, quatro e cinco meses, em supino, sendo o objeto apresentado na linha média e nas linhas axilares direita e esquerda. O procedimento foi filmado e analisado para registro do número de alcances realizados nas posições de apresentação. Para análise foram utilizados os testes de Friedman e Wilcoxon, considerando o nível de significância α=0,05. As frequências médias de alcances aumentaram até o quinto mês, sendo encontrada diferença significativa entre o terceiro e o quinto (p=0,011) e entre o quarto e o quinto meses (p=0,008). O número de alcances na linha média aumentou significativamente do terceiro para o quinto (p=0,011) e do quarto para o quinto mês (p=0,025), e houve tendência de diferenciação (0,1>p>0,05) entre o terceiro e o quarto mês (p=0,058). Aos três meses, encontrou-se tendência de diferenciação (p=0,066) entre a frequência de alcances nas linhas axilar (D ou E) e média. Aos quatro e cinco meses, não foi encontrada diferença estatisticamente significativa entre as posições. Concluiu-se que a frequência de alcances aumenta significativamente de três a cinco meses e a posição de apresentação do objeto parece influenciá-la na fase inicial de aquisição desta habilidade.

[The influence of Social Security legislation changes on the profile of the granting of disability benefits for mental disorders]

This article is a preliminary study on possible influences of legal regulation changes (Copes and PP) on the result of initial expertise examination in Juiz de Fora (State of Minas Gerais, Brazil), following a request for social benefits due to a mental disorder.

METHOD

retrospective analysis of data drawn from an official data bank (Dataprev) related to examinations concluded between July/2004 and December/2006. Four periods were considered: (1º) July/2004 to July/ 2005 before the legal regulation Copes took effect; (2º) August/2005 to November/2005, with Copes in effect and examinations by third part experts; (3º) December/2005 to April/2006, without third part experts; (4º) May/2006 to December/2006, with PP in effect.

RESULTS

reduction on the frequency of benefit granting from 81.9% to 49.5% from 1º to 4º period. Increase of favorable conclusions on requests for re-evaluations (from 52.0% in 1º period to 75.3% after Copes) and reduction in 4º period (36.5%). Reduction on average number of benefit renewal (from 3.5 to 1.7, respectively in 1º and 4º periods). The mean period of work dismissal was longer in 1º period and shorter in 4º period (respectively 397.4 and 247.6 days). The results highlighted changes on the profile of benefits granted during the period of time in which the new regulations came into force.

Adherence to drug therapy in kidney disease

Non-adherence to drug therapy has not been extensively studied in patients with chronic kidney disease (CKD). The objective of the present study was to identify determinants of non-adherence to drug therapy in patients with CKD, not on dialysis. A prospective cohort study involving 149 patients was conducted over a period of 12 months. Adherence to drug therapy was evaluated by the self-report method at baseline and at 12 months. Patients who knew the type of drug(s) and the respective number of prescribed pills in use at the visit preceding the interview were considered to be adherent. Patients with cognitive decline were assessed by interviewing their caregivers. Mean patient age was 51 ± 16.7 years. Male patients predominated (60.4%). Univariate analysis performed at baseline showed that non-adherence was associated with older age, more pills taken per day, worse renal function, presence of coronary artery disease, and reliance on caregivers for the administration of their medications. In multivariate analysis, the factors that were significantly associated with non-adherence were daily use of more than 5 pills and drug administration by a caregiver. Longitudinal evaluation showed an increase in non-adherence over time. Medication non-adherence was lower (17.4%) at the baseline period of the study than after 1 year of the study (26.8%). Compared to the baseline period, the percentage of adherent patients who became non-adherent (22%) was lower than the percentage of non-adherent patients who became adherent (50%). In CKD patients not on dialysis, non-adherence was significantly associated with the number of pills taken per day and drug administration by third parties. Adherence is more frequent than non-adherence over time.

Prevalence and risk factors for giardiasis and soil-transmitted helminthiasis in three municipalities of Southeastern Minas Gerais State, Brazil: risk factors for giardiasis and soil-transmitted helminthiasis

Giardiasis and soil-transmitted helminthiasis (STH) are parasitic diseases that are among the major health concerns observed in economically disadvantaged populations of developing countries, and have clear social and environmental bases. In Brazil, there is a lack of epidemiologic data concerning these infections in the study area, whose inhabitants have plenty of access to health care services, including good dwelling and adequate sanitary conditions. In this survey we investigated the risk factors for giardiasis and STH in three municipalities with good sanitation, situated in Minas Gerais state, Brazil. A cross-sectional survey was conducted in the municipalities of Piau, Coronel Pacheco and Goianá, in both urban and rural areas. The fieldwork consisted of a questionnaire and the examination of 2,367 stool samples using the Hoffmann, Pons and Janer method. Of all individuals from the population sample, 6.1% were found infected with the parasitic diseases included in this work. Hookworm infection was the most prevalent disease, followed by giardiasis, trichuriasis and ascariasis. Infection was more prevalent in males (8.1%, p < 0.001; odds ratio [OR] = 1.975) and in individuals living in rural areas (8.6%, p = 0.003; OR = 1.693). Multivariate analysis showed that variables such as inadequate sewage discharge (p < 0.001), drinking of unsafe water (p < 0.001), lack of sanitary infrastructure (p = 0.015), and host sex (p < 0.001) were the risk factors more strongly associated with infection status (95% confidence interval [CI]). In this study we demonstrate that giardiasis and STH still persist, infecting people who have good housing conditions and free access to public health care and education.

[Characteristics of alcoholics associated to longer adherence to an out-treatment program]

INTRODUCTION

Low adherence rates are frequently found in alcoholics' treatment programs. Many characteristics of alcoholics have already been associated to longer adherence or to higher drop-out rates. Adherence is an outcome already pointed as a simple and practical measure to evaluate treatment results. This study aimed to identify characteristics of alcoholics of a public outpatient treatment program associated to superior adherence, i.e., to longer permanence periods in treatment.

METHOD

This study included 634 alcoholics; from these, 329 concluded the program's assessment stage and 305 did not conclude or fulfill the program's exclusion criteria. Initially, we analyzed socio-demographic differences between patients who completed or did not complete assessment. Crosstabs were performed to verify the association of all other 814 variables in the data bank to adherence to treatment. Logistic regression of variables found at least marginally significant was the performed: first within each dimension involved, contributing to the selection of variables for the multidimensional model. Pearson's Qui-square test was used to verify possible associations.

RESULTS

Only two variables significantly differed patients who completed and did not complete assessment: place of birth and mean age. In bivariate analysis, 65 variables were associated to adherence; however, only five remained significant (p < 0.05) after logistic regression. In the final model, variables significantly associated to adherence were: did not eat while drinking; evaluated as having high insight level; (presented DSM-IV criterion 6 for Dependence (important social, occupational, or recreational activities are given up or reduced because of substance use); when increased consumption, drank to relieve chronic malaise; abdominal pain in the last 30 days before evaluation.

CONCLUSION

The results of this study indicate that, differently from preliminary conclusions, the therapeutic standard used in the program evaluated--namely its focus on the approach of psychiatric comorbidity--did not remain as one of the most relevant factors associated to longer adherence to treatment. Therefore, the results support the need of new studies directed to the assessment of these subgroups that more quickly dropped-out of the treatment routinely offered, in order that diagnose and treatment approaches may be altered in order to become more efficient and effective to its clients.

[Social inequalities in premature cardiovascular mortality in a medium-size Brazilian city]

Cardiovascular diseases are the main cause of death in many countries. In Brazil, premature cardiovascular death is more frequent than in wealthy countries. The aim of this study was to analyze the relationship between premature cardiovascular death and socioeconomic conditions in urban areas. The study design was ecological, with the urban areas of a medium-size municipality in Minas Gerais State, Brazil, as the units of analysis. The relationship between standardized mortality ratio and social development index (SDI) was studied with a binomial negative generalized linear model. The urban regions with the best socioeconomic conditions had significantly lower cardiovascular mortality. The reduction of socioeconomic inequalities in medium-size cities could help decrease health inequities.

Análise comparativa do registro médico-pericial do diagnóstico de transtornos mentais de segurados do Instituto Nacional do Seguro Social requerentes de auxílio-doença

OBJETIVOS: Analisar comparativamente os registros médico-periciais dos diagnósticos de segurados do INSS requerentes de auxílio-doença apresentando transtorno mental. MÉTODO: Estudo retrospectivo de registros de perícias iniciais realizadas em agências da Previdência Social de Juiz de Fora, MG, entre julho/2004 e dezembro/2006. Foram realizadas análises bivariadas de acordo com o local de realização da perícia, categoria de perito médico examinador e período da avaliação RESULTADOS: Transtornos depressivos leves ou moderados e transtornos persistentes do humor (39,6%) e os transtornos de ansiedade (34,5%) - quadros mais leves que não comprometeriam tanto a capacidade laborativa - foram os diagnósticos mais frequentemente registrados. Dentre as comorbidades, transtornos mentais foram mais frequentes (33,6%) que quadros clínicos, especialmente na agência Riachuelo, entre peritos concursados após 2005 e no quarto período estudado. A concordância entre o diagnóstico do benefício atual e o do benefício anterior foi baixa, inferior a 50% na maioria dos casos, mesmo para transtornos mentais graves e com características clínicas mais bem definidas, como as psicoses. A maior taxa de concordância ocorreu com os transtornos por uso de substâncias psicoativas entre peritos credenciados (66,7%). CONCLUSÃO: Este estudo evidencia possíveis falhas no treinamento dos peritos médicos de Juiz de Fora no que se refere ao registro do diagnóstico dos transtornos mentais dos segurados avaliados.

Postnatal development of pups from nursing rats treated with Gingko biloba

The Gingko biloba extract is contraindicated during pregnancy and lactation due to the lack of information about its effects on these reproductive phases. Previous studies have shown that G. biloba extract contains components with estrogenic and antiestrogenic activities, thus nursing dams treated with the extract of this plant could show reduction in milk production, resulting in malnutrition and poor development of pups. This work analyzes the postnatal development of pups, whose mothers were treated with G. biloba extract during the lactation period. Nursing Wistar rats received 3.5 mg/kg/day of G. biloba aqueous extract, corresponding to the highest human dose. Clinical signs of maternal toxicity were evaluated. The growth rate, viability, survival during treatment and lactation indices of the pups were calculated. The physical, motor and sensorial development of the pups was also evaluated. No maternal signs of toxicity were observed. As there were no biological differences between control and G. biloba treated pups, it is possible to assume that, in this experimental design, the administration of G. biloba aqueous extract to nursing rats during the lactation period seems to be devoid of toxic effect to mothers and to the physical, motor and sensory development of the pups.

Avaliação da atenção básica pela ótica político-institucional e da organização da atenção com ênfase na integralidade

Este artigo apresenta parte dos dados de uma avaliação da Atenção Básica, implementada como parte de uma pesquisa com financiamento do Ministério da Saúde durante o ano de 2005. Trinta e um municípios, dos estados de Minas Gerais e Espírito Santo, Brasil, formaram a amostra do estudo. Dados coletados com base em métodos qualitativos (entrevistas e análise de documentos) foram sintetizados com a produção de um conjunto de variáveis categoriais. A distribuição dos diversos valores assumidos pelas variáveis nos diferentes municípios são apresentadas. Essas variáveis foram submetidas à análise de correspondência, que mostrou sua validade interna. Adicionalmente, observações sobre aspectos relevantes do campo são apresentados. Em conclusão, a avaliação mostra avanços da estratégia de saúde na família, com importantes contribuições do Projeto de Expansão e Consolidação do Saúde da Família, embora obstáculos consideráveis ainda permaneçam, em particular no que diz respeito à força de trabalho das estratégias de saúde na família e na utilização local das informações produzidas.