Trends in dermatomyositis- and polymyositis-related mortality in the state of São Paulo, Brazil, 1985-2007: multiple cause-of-death analysis.

BACKGROUND: Dermatomyositis (DM) and polymyositis (PM) are rare systemic autoimmune rheumatic diseases with high fatality rates. There have been few population-based mortality studies of dermatomyositis and polymyositis in the world, and none have been conducted in Brazil. The objective of the present study was to employ multiple-cause-of-death methodology in the analysis of trends in mortality related to dermatomyositis and polymyositis in the state of São Paulo, Brazil, between 1985 and 2007. METHODS: We analyzed mortality data from the São Paulo State Data Analysis System, selecting all death certificates on which DM or PM was listed as a cause of death. The variables sex, age and underlying, associated or total mentions of causes of death were studied using mortality rates, proportions and historical trends. Statistical analysis were performed by chi-square and H Kruskal-Wallis tests, variance analysis and linear regression. A p value less than 0.05 was regarded as significant. RESULTS: Over a 23-year period, there were 318 DM-related deaths and 316 PM-related deaths. Overall, DM/PM was designated as an underlying cause in 55.2% and as an associated cause in 44.8%; among 634 total deaths females accounted for 71.5%. During the study period, age- and gender-adjusted DM mortality rates did not change significantly, although PM as an underlying cause and total mentions of PM trended lower (p < 0.05). The mean ages at death were 47.76 ± 20.81 years for DM and 54.24 ± 17.94 years for PM (p = 0.0003). For DM/PM, respectively, as underlying causes, the principal associated causes of death were as follows: pneumonia (in 43.8%/33.5%); respiratory failure (in 34.4%/32.3%); interstitial pulmonary diseases and other pulmonary conditions (in 28.9%/17.6%); and septicemia (in 22.8%/15.9%). For DM/PM, respectively, as associated causes, the following were the principal underlying causes of death: respiratory disorders (in 28.3%/26.0%); circulatory disorders (in 17.4%/20.5%); neoplasms (in 16.7%/13.7%); infectious and parasitic diseases (in 11.6%/9.6%); and gastrointestinal disorders (in 8.0%/4.8%). Of the 318 DM-related deaths, 36 involved neoplasms, compared with 20 of the 316 PM-related deaths (p = 0.03). CONCLUSIONS: Our study using multiple cause of deaths found that DM/PM were identified as the underlying cause of death in only 55.2% of the deaths, indicating that both diseases were underestimated in the primary mortality statistics. We observed a predominance of deaths in women and in older individuals, as well as a trend toward stability in the mortality rates. We have confirmed that the risk of death is greater when either disease is accompanied by neoplasm, albeit to lesser degree in individuals with PM. The investigation of the underlying and associated causes of death related to DM/PM broaden the knowledge of the natural history of both diseases and could help integrate mortality data for use in the evaluation of control measures for DM/PM.

[Reliability and validity of palmar and conjunctival pallor for anemia detection purposes]. / Confiabilidade e validade da palidez palmar e de conjuntivas como triagem de anemia.

OBJECTIVE: To evaluate the reliability and the validity of the use of simple clinical signs as a method of anemia detection. METHODS: The study was carried out in a S o Paulo, Brazil, day-care center, and included 135 children from ages 3 months-6 years. Hemoglobin level results and palmar and conjunctival pallor assessment were used. Children with Hb under 11g/dl were considered as anemic; subjective criteria were used for the assessment of palmar and conjunctival pallor. Kappa statistics were used in order to verify agreement, and, in order to evaluate the technique's validity, sensitivity and specificity levels were calculated. RESULTS: The results show low levels of agreement. There was a greater level of sensitivity to conjunctival pallor than to palmar pallor. Specificity results may be considered as good. CONCLUSIONS: It is still early to recommend the routine use of this technique. However, it could promote substantial savings if perfected.

Vitamin E concentrations in adults with HIV/AIDS on highly active antiretroviral therapy.

HIV/AIDS patients are probably more predisposed to vitamin E deficiency, considering that they are more exposed to oxidative stress. Additionally, there are an extensive number of drugs in the highly active antiretroviral therapy (HAART) regimens that may interfere with vitamin E concentrations. The objective of this study was to compare serum concentrations of alpha-tocopherol in 182 HIV/AIDS patients receiving different HAART regimens. The patients were divided into three groups according to regimen: nucleoside analog reverse-transcriptase inhibitors (NRTIs) + non-nucleoside analog reverse-transcriptase inhibitors (NNRTIs); NRTIs + protease inhibitors + ritonavir; NRTIs + other classes. Alpha-tocopherol was assessed by high-performance liquid chromatography. Multiple linear regression analysis was used to evaluate the effects of HAART regimen, time of use, and compliance with the regimen on alpha-tocopherol concentrations. Alpha-tocopherol concentrations were on average 4.12 µmol/L lower for the NRTIs + other classes regimen when compared to the NRTIs + NNRTIs regimen (p = 0.037). A positive association (p < 0.001) was observed between alpha-tocopherol and cholesterol concentrations, a finding due, in part, to the relationship between liposoluble vitamins and lipid profile. This study demonstrated differences in alpha-tocopherol concentrations between patients using different HAART regimens, especially regimens involving the use of new drugs. Long-term prospective cohort studies are needed to monitor vitamin E status in HIV/AIDS patients since the beginning of treatment.

Introdução de alimentos complementares nos primeiros dois anos de vida de crianças de escolas particulares no município de São Paulo / Introduction of complementary foods in the first two years of life of children attending private schools in the city of São Paulo, Brazil

OBJETIVOS: Verificar a idade de introdução de alimentos complementares nos primeiros dois anos de vida e sua relação com variáveis demográficas e socioeconômicas de crianças matriculadas em pré-escolas particulares do município de São Paulo. MÉTODOS: Estudo transversal com informações demográficas e socioeconômicas de 566 crianças, sendo verificada a idade em meses de introdução dos alimentos complementares. Foi considerada como variável dependente a idade em meses da introdução dos alimentos complementares e, como variáveis independentes ou explanatórias, a idade e escolaridade maternas, a condição de trabalho materno e a renda familiar. Para análise da relação entre as variáveis, utilizou-se a técnica de regressão múltipla de Cox. RESULTADOS: 50 por cento das crianças eram do sexo masculino e 61 por cento maiores de 4 anos. A maior proporção das mães tinha nível superior de escolaridade e trabalhava fora. A renda familiar mostrou uma população de alto nível socioeconômico. A água e/ou chá, frutas e leite não-materno foram introduzidos antes do sexto mês de vida. A variável 'idade da mãe' mostrou associação com introdução de três grupos de alimentos: cereais, carne e guloseimas. CONCLUSÃO: Alimentos complementares foram introduzidos precocemente nessa população de nível socioeconômico elevado e a única variável que se associou à introdução desses alimentos foi a idade materna.

OBJECTIVE: To verify the age of complementary food introduction in the first two years of life and its relation to demographic, social, and economic status of preschool children of private schools in the city of São Paulo, Brazil. METHODS: Cross-sectional survey with demographic, social and economic status information. The studied population included 566 children. The age in months of complementary foods introduction was verified. The dependent variable was the age in months of complementary foods introduction. Independent or explanatory variables were: mother's age and education, maternal work conditions and household income. The relation between variables was analyzed by Cox multiple regression. RESULTS: 50 percent of the children were males and 61 percent were older than 4 years old. Most mothers had higher education and were employed. The household income showed a population of high social and economic level. Water and/or tea, fruits and non-breast milk were introduced before the sixth month of life. The variable 'maternal age' showed association with the introduction of three groups of foods: cereals, meat and junk food. CONCLUSION: Early complementary food introduction occurred in this population of high socioeconomic level, and the only variable associated with this occurrence was maternal age.

A situação de aleitamento materno de crianças atendidas em creches da Secretaria da Assistência Social do Município de São Paulo - região Freguesia do Ó / Breast-feeding in children in day care centers of the Social Welfare Department of the Municipaliyy of São Paulo - Freguesia do Ó area

Objetivos: avaliar a situação de aleitamento materno entre crianças menores de dezoito meses que frequentam creches e identificar as variáveis associadas ao desmame. Métodos: foram entrevistadas, no mês de fevereiro de 2000, mães de 235 crianças menores de 18 meses que frequentavam as creches ligadas à Secretaria da Assistência Social do Município de São Paulo, São Paulo, Brasil, (região Freguesia do Ó). Foi investigado a associação do aleitamento com idade e escolaridade maternas, tipo de parto e peso ao nascer das crianças. O teste X2 foi empregado para comparação das proporções quando se estudaram os fatores associados ao desmame precoce. Foi calculado o risco relativo para as prevalências. Para a análise da duração do aleitamento materno utilizou-se a técnica da tábua da vida. Resultados: a prevalência de amamentação das crianças que foram amamentadas alguma vez por suas mães foi 92,7 por cento com uma duração média de 5,6 meses. 80,4 das crianças foram amamentadas no primeiro mês de vida e no final do quarto mês, 50 por cento já se encontravam desmamadas. Conclusões: nenhuma das variáveis estudadas apresentou condições para entrada em um modelo multivariado: também não mostraram associação com o desmame.

Confiabilidade e validade da palidez palmar e de conjuntivas como triagem de anemia / Reliability and validity of palmar and conjunctival pallor for anemia detection purposes

OBJETIVO: Avaliar a confiabilidade e a validade do uso de sinais clínicos simples de palidez palmar e de conjuntivas, como método para triagem de anemia. MÉTODOS: Estudo realizado em uma creche municipal de Säo Paulo, SP, com 135 crianças >3 meses e <6 anos. Utilizaram-se resultados do nível de hemoglobina, e avaliaçäo dos sinais clínicos de palidez palmar e de conjuntivas. Considerou-se anêmica a criança com hemoglobina <11,0 g/dl e utilizaram-se critérios subjetivos para classificar a palidez palmar e de conjuntivas. Para verificaçäo de concordância utilizou-se a estatística Kappa e, para avaliar a validade, calcularam-se a sensibilidade e a especificidade da técnica. RESULTADOS: Os resultados indicaram baixa concordância. Houve uma maior sensibilidade para a palidez da conjuntiva em relaçäo à palidez palmar e baixa sensibilidade em relaçäo ao diagnóstico de anemia. Os resultados para especificidade podem ser considerados bons. CONCLUSOES: É prematuro recomendar a utilizaçäo da técnica como rotina, porém, desde que aprimorada, pode representar economia de recursos