Temporal and spatial distribution trends of polio vaccine coverage in less than one-year old children in Brazil, 2011-2021.

BACKGROUND: Low polio vaccine coverage can result in the spread of Poliovirus to areas free from viral circulation. This study analyzed the temporal trends and spatial distribution of polio vaccine coverage in one year-old children in Brazil, between 2011 and 2021. METHODS: This was an ecological, time-series study (2011 to 2021) with annual vaccine coverages against poliomyelitis, extracted from the Information System of the National Immunization Program from the 26 States and the Distrito Federal (DF). The percentage reductions in vaccination coverage in Brazil and in the Regions were calculated. Prais-Winsten regression models were used to analyze time series for the Regions and States, and spatial analysis identified the distribution of clusters (high-high; low-low; high-low and low-high) of vaccination coverages across Brazilian municipalities, using a 5% significance level. RESULTS: From 2011 to 2021, the coverage of polio vaccines decreased by 29,9%. There was a progressive increase observed in clusters resulting in low vaccination coverages (140 low-low Brazilian municipalities in 2011 vs. 403 in 2021), mostly reported in the North and Northeast regions of the country. There was a downward trend in vaccination coverages in 24 of the 26 States and DF (p ≤ 0.05). CONCLUSIONS: The reduction in polio vaccine coverage, as observed in the North and Northeast regions of Brazil, may favor the spread of Poliovirus. Therefore, vaccination strategies should be prioritized for children residing in areas with sharp and recurrent declines in vaccination coverages, including travelers, migrants, and refugees.

Number of doses of Measles-Mumps-Rubella vaccine applied in Brazil before and during the COVID-19 pandemic.

BACKGROUND: Due to the social isolation measures adopted in an attempt to mitigate the risk of transmission of SARS-CoV-2, there has been a reduction in vaccination coverage of children and adolescents in several countries and regions of the world. OBJECTIVE: Analyze the number of doses of vaccine against Measles-Mumps-Rubella (MMR) applied before and after the beginning of mitigation measures due to COVID-19 pandemic in Brazil. METHODS: The data collected refer to the number of doses of the MMR vaccine applied monthly to the target population residing in Brazil: cahildren, aged 12 months (first dose) and children, aged 9 years (second dose), from April 2019 to December 2020. Differences in MMR vaccine doses from April 2019 to March 2020 (before the start of mitigation measures) and April 2020 to September 2020 (after the start of the mitigation measures) were evaluated. Spatial analysis identified clusters with a high percentage of reduction in the median of applied doses no Brazil. RESULTS: There was a reduction in the median of doses applied in the Regions North (- 33.03%), Northeast (- 43.49%) and South (- 39.01%) e nos Estados Acre (- 48.46%), Amazonas (- 28.96%), Roraima (- 61.91%), Paraíba (- 41.58%), Sergipe (- 47.52%), Rio de Janeiro (-59.31%) and Santa Catarina (- 49.32) (p < 0.05). High-high type spatial clusters (reduction between 34.00 and 90.00%) were formed in the five regions of Brazil (Moran's I = 0.055; p = 0.01). CONCLUSION: A reduction in the number of MMR vaccine doses was evidenced as a possible effect by the restrictive actions of COVID-19 in Brazil.

Covid-19 pandemic impacts on follow-up of child growth and development.

OBJECTIVE: To analyze the impact of the covid-19 pandemic on the use of primary health care services to follow-up the child growth and development in Brazil. METHOD: A total of 7.9 million consultations of children (0-2 years old) across Brazil between March 2017 and May 2020 were studied. Differences between medians were analyzed using non-parametric tests, the Global Moran Index (IGM) and the Local Indicators of Spatial Association. RESULTS: During the initial period of the pandemic, the median number of consultations was significantly lower than the same period in previous years, reducing more than 50%. The drop in 2020, compared to 2019, ranged from 49% to 62.2% across all regions of the country, except the South. The percentage reduction registered in 2019-2020 showed significant spatial autocorrelation (IGM = 0.20; p = 0.04), with the presence of low-low (states with reduction between 29% and 51%) and high-high (states with reduction between 55% and 69%) spatial clusters. CONCLUSION: The covid-19 pandemic impacted the follow-up of child growth and development in primary health care services in Brazil, with a geographically uneven reduction.

Impact of the COVID-19 Pandemic on Human Papillomavirus Vaccination in Brazil.

Objective: To analyze the number of applied HPV vaccine doses before (from April 2019 to March 2020) and after (from April 2020 to September 2020) social distancing measures in response to the COVID-19 pandemic in states and regions of Brazil. Methods: Ecological time-series study, using data from the Brazilian National Immunization Program (PNI). Using the Mann-Whitney test, we evaluated the difference between the median number of applied doses during the periods April 2019 to March 2020 and from April 2020 to September 2020. Spatial analysis identified clusters with a high or low percentage reduction in the median applied doses. Prais-Winsten regression models identified temporal trends in the applieddoses from both periods. Results: There was a significant reduction in the median HPV vaccine doses applied, formation of spatial clusters and, after a sharp drop in the number of applieddoses during the months following social distancing. There was a tendency to increase the applied vaccines doses. Conclusion: The COVID-19 pandemic resulted in reduction of the number of HPV vaccine doses applied as a possible effect of restrictive measures caused by the pandemic.

Motivation and difficulties to reduce or quit smoking.

OBJECTIVE: To understand what factors motivate people to reduce or stop tobacco use and what difficulties they face in this process. METHOD: Qualitative, empirical and interpretative research that used a focal group technique for data collection and Discourse Analysis as a theoretical reference for analysis. RESULTS: The responses centered on the following aspects: motivation for reduction or cessation of smoking, family and community support received during treatment, benefits from cessation of tobacco, difficulties encountered and strategies for overcoming triggers. FINAL CONSIDERATIONS: The results showed that the users expressed their desire for cessation of tobacco use and that to achieve this goal, family and group support, professional help and changing habits are key factors for this process.

[Estimated prevalence of hypertension and associated factors in Krenak indigenous adults in the state of Minas Gerais, Brazil]. / Prevalência estimada e fatores associados à hipertensão arterial em indígenas adultos Krenak do Estado de Minas Gerais, Brasil.

This cross-sectional study in 2016 aimed to describe the estimated prevalence of systemic arterial hypertension and associated factors in Krenak adults and elderly in an indigenous community located along the Rio Doce in eastern Minas Gerais state, Brazil. We measured weight, height, waist circumference, systolic blood pressure, diastolic blood pressure, and capillary blood glucose. Sociodemographic and lifestyle information was obtained from a face-to-face questionnaire. Poisson regression models were constructed to estimate independent associations between the target variables and hypertension. Prevalence of hypertension was 31.2% (95%CI: 24.4-37.9) in Krenak indigenous. The final model showed an independent association with increasing age, abdominal obesity, and hyperglycemia. The results highlight the need for effective measures in prevention, diagnosis, and follow-up of modifiable risk factors for hypertension, since high prevalence of this condition was observed in the Krenak indigenous community.

Estudo transversal realizado em 2016, cujo objetivo foi descrever a prevalência estimada e os fatores associados à hipertensão arterial sistêmica entre adultos e idosos Krenak, em Terra Indígena localizada na beira do rio Doce, na região leste de Minas Gerais, Brasil. Foram aferidos peso, estatura, perímetro da cintura, pressão arterial sistólica, pressão arterial diastólica e glicemia capilar. Informações sociodemográficas e de estilo de vida foram obtidas via aplicação de questionário face a face. Modelos de regressão de Poisson foram construídos para estimar a associação independente entre as variáveis de interesse e a hipertensão arterial sistêmica. A prevalência da hipertensão arterial sistêmica foi de 31,2% (IC95%: 24,4-37,9) entre os indígenas Krenak. Houve associação independente no modelo final para o aumento da idade, obesidade abdominal e hiperglicemia. Destaca-se a necessidade de ações eficazes de prevenção, de diagnóstico e acompanhamento frente aos fatores modificáveis da hipertensão arterial sistêmica, uma vez que foi observada elevada prevalência dessa condição na comunidade indígena Krenak.

Estudio transversal realizado en 2016, cuyo objetivo fue describir la prevalencia estimada y los factores asociados a la hipertensión arterial sistémica entre adultos y ancianos Krenak, en Terra Indígena localizada en la ribera del río Doce, en la región este de Minas Gerais, Brasil. Se midieron peso, estatura, perímetro de la cintura, presión arterial sistólica, presión arterial diastólica y glucemia capilar. Informaciones sociodemográficas y de estilo de vida se obtuvieron vía la aplicación de un cuestionario cara-a-cara. Modelos de regresión de Poisson se construyeron para estimar la asociación independiente entre las variables de interés y la hipertensión arterial sistémica. La prevalencia de la hipertensión arterial sistémica fue de 31,2% (IC95%: 24,4-37,9) entre los indígenas Krenak. Hubo asociación independiente en el modelo final para el aumento de edad, obesidad abdominal e hiperglicemia. Se destaca la necesidad de acciones eficaces de prevención, de diagnóstico y acompañamiento frente a los factores modificables de la hipertensión arterial sistémica, ya que se observó una elevada prevalencia de esa condición en la comunidad indígena Krenak.

Anthropometric changes and their effects on cardiometabolic risk factors in rural populations in Brazil.

This article aims to evaluate associations between anthropometric changes in five years with lipid and blood pressure levels in Brazilian rural population. This longitudinal study evaluated 387 individuals aged 18 to 75 residents of two rural communities. Demographic, lifestyle, anthropometric, biochemical and hemodynamic characteristics were assessed in 2004 and repeated in 2009. Multivariate linear regression was used. Positive change in BMI was associated with increased diastolic blood pressure (DBP) (ß = 0.07; 95%CI: 0.03-0.11), low-density lipoprotein (LDL-C) (increase of 0.01% to 10%: ß = 0.08; 95%CI: 0.02-0.14, more than 10% increase: ß = 0.09; 95%CI: 0.01-0.16) and low density lipoprotein/high density lipoprotein cholesterol ratio (LDL-C/HDL-C) (increase of 0.01% to 10%: ß = 0.15; 95%CI: 0.06-0.25, more than 10% increase: ß = 0.14; 95%CI: 0.02-0.25). Our results showed no association between positive changes in WC and lipid levels increase, only with blood pressure levels increase (SBP: ß = 0.06; CI95%:0.02-0.10; DBP: ß = 0.09; CI95%: 0.04;0.13). Positive changes in BMI are independent predictors of increased lipid and blood pressure levels and positive changes in WC of increased blood pressure.

Fatores socioculturais que contribuem para a qualidade de vida de cuidadores familiares de adultos dependentes de cuidados crônicos: um estudo qualitativo no brasil / Factores socioculturales que contribuyen a la calidad de vida de los cuidadores familiares de adultos dependientes de cuidados crónicos: un estudio cualitativo en brasil / Sociocultural factors contributing to the quality of life of family caregivers of chronic care-dependent adults: a qualitative study in brazil

RESUMO Objetivo: explorar os fatores socioculturais que contribuem para a qualidade de vida de cuidadores familiares de adultos dependentes de cuidados crônicos no Brasil. Método: estudo qualitativo realizado de outubro de 2016 a março de 2017 em Belo Horizonte, Minas Gerais, Brasil. Vinte e cinco cuidadores familiares de adultos dependentes de cuidados crônicos foram entrevistados por dois pesquisadores por meio de visitas domiciliares. Foi utilizado um roteiro com sete questões abertas relacionadas ao processo de cuidar. As entrevistas foram gravadas em áudio, transcritas e, posteriormente, analisadas por meio da análise de conteúdo. O COREQ foi utilizado para adequação da qualidade estrutural do manuscrito. Resultados: os participantes do estudo relataram diferentes fatores socioculturais que contribuem para sua qualidade de vida. Esses fatores foram categorizados em três categorias principais: O impacto dos construtos socioculturais no processo de cuidar; O autocuidado e suas nuances: velhos desafios para os cuidadores; e Estado e cuidadores: desafios e possibilidades. Conclusões: a qualidade de vida do cuidador é influenciada por suas características e condições socioculturais, apresentando relação com seu modo de viver e de se expressar, sendo, portanto, passível de mudanças. O desenvolvimento de políticas sociais e de saúde para famílias cuidadoras é urgente para a prevenção da sobrecarga familiar e para a promoção de famílias sustentáveis que convivem com doenças crônicas não transmissíveis.

RESUMEN Objetivo: explorar los factores socioculturales que contribuyen a la calidad de vida de los cuidadores familiares de adultos dependientes de cuidados crónicos en Brasil. Métodos: este estudio cualitativo se llevó a cabo de octubre de 2016 a marzo de 2017 en Belo Horizonte, Minas Gerais, Brasil. Veinticinco cuidadores familiares de adultos crónicos dependientes de cuidados fueron entrevistados por dos investigadores a través de visitas domiciliarias. Se utilizó un guión con siete preguntas abiertas relacionadas con el proceso de cuidado. Las entrevistas fueron grabadas en audio, transcritas y luego analizadas mediante análisis de contenido convencional. Se utilizó el COREQ para la adecuación de la calidad estructural del manuscrito. Resultados: los participantes en el estudio describieron diferentes factores socioculturales que contribuyen a su calidad de vida. Estos factores se clasificaron en tres categorías principales: El impacto de los constructos socioculturales en el proceso de cuidado; El autocuidado y sus matices: antiguos retos para los cuidadores; y El apoyo desde fuera: retos y posibilidades. Conclusiones: la calidad de vida del cuidador está influenciada por sus características y condiciones socioculturales, presentando una relación con su forma de vivir y expresarse y, por tanto, sujeta a cambios. El desarrollo de políticas sociales y sanitarias para las familias cuidadoras es urgente para la prevención de la carga familiar y la promoción de familias sostenibles que viven con enfermedades crónicas no transmisibles.

ABSTRACT Objective: to explore sociocultural factors contributing to the quality of life of family caregivers of chronic care-dependent adults in Brazil. Methods: this qualitative study was conducted from October 2016 to March 2017 in Belo Horizonte, Minas Gerais, Brazil. Twenty-five family caregivers of care-dependent chronic adults were interviewed by two researchers through home visits. A script with seven open questions related to the care process was used. The interviews were recorded in audio, transcribed and then analyzed through conventional content analysis. COREQ was used for adequacy of the manuscript structural quality. Results: the study participants described different sociocultural factors contributing to their quality of life. These factors were categorized into three main categories: The impact of sociocultural constructs on the caregiving process; Self-care and its nuances: old challenges for caregivers; and Support from outsides: challenges and possibilities. Conclusions: the caregiver's quality of life is influenced by their sociocultural characteristics and conditions, presenting a relation with their way of living and expressing themselves and, therefore, subject to change. The development of social and healthcare policies for caring families is urgent for prevention of family burden and promotion of sustainable families living with chronic non-communicable diseases.

Special attention to women experiencing high-risk pregnancy: Delivery, care assistance and neonatal outcomes in two Brazilian maternity wards.

BACKGROUND: To compare two care models of high-risk pregnant women--a House for Pregnant Women, staffed by nurse-midwives, versus a traditional care model in a hospital maternity ward. DESIGN: This was across-sectional study conducted in two reference maternity hospitals for high-risk pregnancies, in Belo Horizonte, Minas Gerais, Brazil. The sample consisted of 312 high-risk pregnant women consecutively admitted from January 1st to December 31st, 2010, either to the House for Pregnant Women (n=247), or the hospital maternity ward (n=65). Gestational ages varied from 22 weeks to 36 weeks and six days. We measured individual, demographic, obstetric, labour and delivery variables, and newborn characteristics. For data analysis, we used descriptive, bivariate and multivariate statistics using Poisson regression, with a 5% significance level. FINDINGS: At the conventional hospital maternity ward, more women had six or more antenatal exams, greater frequencies of diagnosis related to blood pressure, and a greater number of women underwent either a C-section or a vaginal delivery with an episiotomy and analgesia. At the House for Pregnant Women, the majority of the hospitalizations were related to preterm labour and premature rupture of membranes. There were no statistical differences in the newborn characteristics. KEY CONCLUSIONS: The House for Pregnant Women care model, utilizing midwives was less interventionist, yet with results as favorable as in a conventional maternity hospital setting.

Covid-19 pandemic impacts on follow-up of child growth and development

ABSTRACT OBJECTIVE To analyze the impact of the covid-19 pandemic on the use of primary health care services to follow-up the child growth and development in Brazil. METHOD A total of 7.9 million consultations of children (0-2 years old) across Brazil between March 2017 and May 2020 were studied. Differences between medians were analyzed using non-parametric tests, the Global Moran Index (IGM) and the Local Indicators of Spatial Association. RESULTS During the initial period of the pandemic, the median number of consultations was significantly lower than the same period in previous years, reducing more than 50%. The drop in 2020, compared to 2019, ranged from 49% to 62.2% across all regions of the country, except the South. The percentage reduction registered in 2019-2020 showed significant spatial autocorrelation (IGM = 0.20; p = 0.04), with the presence of low-low (states with reduction between 29% and 51%) and high-high (states with reduction between 55% and 69%) spatial clusters. CONCLUSION The covid-19 pandemic impacted the follow-up of child growth and development in primary health care services in Brazil, with a geographically uneven reduction.

Direct Method for Determination of Al, Cd, Cu, and Pb in Beers In Situ Digested by GF AAS Using Permanent Modifiers.

The object of the present study was to development of safe, reliable fast, and efficient methodologies for the direct determination of Al, Pb, Cu, and Cd in non-digested beer samples of widely consumed brand name beers sold in Brazil, using graphite furnace absorption spectrometry (GF AAS). Pyrolysis and atomization temperature curves of selected chemical modifiers (iridium, rhodium, ruthenium, zirconium, and non-modifier use) were used to stabilize each metal and sensitivity in a beer sample was diluted to 1:1 with 0.2 % v/v nitric acid after degasification. The best modifier for aluminum was permanent zirconium, with a characteristic mass of 4.2 pg (recommended is 10 pg), demonstrating a symmetrical peak with a corrected background using a deuterium arc lamp. For cadmium and copper, the best modifier was permanent ruthenium with characteristic masses of 0.3 and 7 pg (recommended are 0.35 and 4 pg, respectively, for Cd and Cu), respectively. The best condition for lead was using a non-modifier, with a characteristic mass of 6.9 pg (recommended is 10 pg). The limits of detection and mean recoveries, done over three consecutive days for aluminum, copper, lead, and cadmium, were 1.9, 2.9, 0.8, and 0.6 pg and 105, 104, 101, and 102 %, respectively. From the observed results, we may conclude that some metals, such as Al, Cd, Cu, and Pb, can be determined easily with graphite furnace atomic absorption spectrometry without sample digestion using a dilute nitric acid solution.

Prevalência estimada e fatores associados à hipertensão arterial em indígenas adultos Krenak do Estado de Minas Gerais, Brasil / Estimated prevalence of hypertension and associated factors in Krenak indigenous adults in the state of Minas Gerais, Brazil / Prevalencia estimada y factores asociados a la hipertensión arterial en indígenas adultos Krenak del Estado de Minas Gerais, Brasil

Estudo transversal realizado em 2016, cujo objetivo foi descrever a prevalência estimada e os fatores associados à hipertensão arterial sistêmica entre adultos e idosos Krenak, em Terra Indígena localizada na beira do rio Doce, na região leste de Minas Gerais, Brasil. Foram aferidos peso, estatura, perímetro da cintura, pressão arterial sistólica, pressão arterial diastólica e glicemia capilar. Informações sociodemográficas e de estilo de vida foram obtidas via aplicação de questionário face a face. Modelos de regressão de Poisson foram construídos para estimar a associação independente entre as variáveis de interesse e a hipertensão arterial sistêmica. A prevalência da hipertensão arterial sistêmica foi de 31,2% (IC95%: 24,4-37,9) entre os indígenas Krenak. Houve associação independente no modelo final para o aumento da idade, obesidade abdominal e hiperglicemia. Destaca-se a necessidade de ações eficazes de prevenção, de diagnóstico e acompanhamento frente aos fatores modificáveis da hipertensão arterial sistêmica, uma vez que foi observada elevada prevalência dessa condição na comunidade indígena Krenak.

This cross-sectional study in 2016 aimed to describe the estimated prevalence of systemic arterial hypertension and associated factors in Krenak adults and elderly in an indigenous community located along the Rio Doce in eastern Minas Gerais state, Brazil. We measured weight, height, waist circumference, systolic blood pressure, diastolic blood pressure, and capillary blood glucose. Sociodemographic and lifestyle information was obtained from a face-to-face questionnaire. Poisson regression models were constructed to estimate independent associations between the target variables and hypertension. Prevalence of hypertension was 31.2% (95%CI: 24.4-37.9) in Krenak indigenous. The final model showed an independent association with increasing age, abdominal obesity, and hyperglycemia. The results highlight the need for effective measures in prevention, diagnosis, and follow-up of modifiable risk factors for hypertension, since high prevalence of this condition was observed in the Krenak indigenous community.

Estudio transversal realizado en 2016, cuyo objetivo fue describir la prevalencia estimada y los factores asociados a la hipertensión arterial sistémica entre adultos y ancianos Krenak, en Terra Indígena localizada en la ribera del río Doce, en la región este de Minas Gerais, Brasil. Se midieron peso, estatura, perímetro de la cintura, presión arterial sistólica, presión arterial diastólica y glucemia capilar. Informaciones sociodemográficas y de estilo de vida se obtuvieron vía la aplicación de un cuestionario cara-a-cara. Modelos de regresión de Poisson se construyeron para estimar la asociación independiente entre las variables de interés y la hipertensión arterial sistémica. La prevalencia de la hipertensión arterial sistémica fue de 31,2% (IC95%: 24,4-37,9) entre los indígenas Krenak. Hubo asociación independiente en el modelo final para el aumento de edad, obesidad abdominal e hiperglicemia. Se destaca la necesidad de acciones eficaces de prevención, de diagnóstico y acompañamiento frente a los factores modificables de la hipertensión arterial sistémica, ya que se observó una elevada prevalencia de esa condición en la comunidad indígena Krenak.

Motivation and difficulties to reduce or quit smoking / Motivación y dificultades para reducir o abandonar el consumo de tabaco / Motivação e dificuldades para reduzir ou cessar o uso de tabaco

ABSTRACT Objective: To understand what factors motivate people to reduce or stop tobacco use and what difficulties they face in this process. Method: Qualitative, empirical and interpretative research that used a focal group technique for data collection and Discourse Analysis as a theoretical reference for analysis. Results: The responses centered on the following aspects: motivation for reduction or cessation of smoking, family and community support received during treatment, benefits from cessation of tobacco, difficulties encountered and strategies for overcoming triggers. Final Considerations: The results showed that the users expressed their desire for cessation of tobacco use and that to achieve this goal, family and group support, professional help and changing habits are key factors for this process.

RESUMEN Objetivo: Comprender qué factores motivan a las personas a reducir o abandonar el consumo de tabaco y las dificultades que enfrentan en este proceso. Método: Investigación cualitativa, empírica e interpretativa en la cual se utilizó la técnica del grupo focal para la recolección de datos y el análisis del discurso como referencia teórica para el análisis. Resultados: Los discursos trataron los siguientes aspectos: motivación para reducir o dejar de fumar; apoyo familiar y comunitario recibido durante el tratamiento; beneficios de dejar el tabaco; dificultades encontradas y estrategias para superar los disparadores. Consideraciones finales: Los resultados mostraron que los usuarios expresaron su deseo de dejar de usar el tabaco y que para lograr este objetivo, el apoyo familiar y grupal, la ayuda profesional y los cambios en los hábitos demostraron ser factores determinantes en el proceso.

RESUMO Objetivo: Compreender quais fatores motivam as pessoas a reduzirem ou cessarem o uso de tabaco e as dificuldades enfrentadas neste processo. Método: Pesquisa qualitativa, empírica e interpretativa que empregou a técnica de grupo focal para a coleta de dados e a Análise de Discurso como referencial teórico de análise. Resultados: Os discursos versaram acerca dos seguintes aspectos: motivação para redução ou cessação de fumar; apoio familiar e comunitário recebido durante o tratamento; benefícios obtidos com a cessação do tabaco; dificuldades encontradas e as estratégias para vencer os gatilhos. Considerações Finais: Os resultados mostraram que os usuários se expressaram desejosos pela cessação do uso de tabaco e que para alcançar esta meta, o apoio familiar e do grupo, a ajuda profissional e as mudanças de hábitos se revelaram fatores determinantes no processo.

Recent experience with fortification of foods and beverages with iron for the control of iron-deficiency anemia in Brazilian children.

Iron-deficiency-anemia affects 30% of the world population. Women of reproductive age and children are the most affected. Iron supplementation in the form of tablets and syrups has not been successful in developing countries, and iron deficiency is still the most important deficiency related to malnutrition. Iron-deficiency anemia affects physical and cognitive development at an early age in children, often resulting in irreversible outcomes. Studies from the last two decades have shown that the prevalence of iron-deficiency anemia can be reduced given adequate investments and political will directed at iron fortification of foods and liquids. A successful low-cost iron-fortification program incorporates implementation and strategic use of communication for program inception where education is in the forefront. A review of the available reports from experience in Brazil with iron fortification of foods and liquids is presented.

Abuso/dependência de álcool e fatores psicossociais do trabalho em profissionais de saúde / Alcohol abuse/dependency and psychosocial factors in the workplace of healthcare professionals

Objective: To estimate the prevalence and factors associated with alcohol abuse/dependency of healthcare professionals. Methods: This was a cross-sectional study, developed with 1,776 health professionals of Belo Horizonte city, Brazil, from 2008 to 2009, to whom a structured questionnaire was applied with items on the following characteristics: demographic, socioeconomic, lifestyle, health conditions and working conditions. Alcohol abuse/dependency was diagnosed with the CAGE questionnaire. Results: The prevalence of alcohol abuse/dependency was 7.2%. After the adjustment of the final model, the following factors increased the chance of alcohol abuse/dependency: atypical work hours (OR: 1.64; 95% CI: 1.08-2.49), male gender (OR: 3.99; 95% CI: 2.62-6.07), diagnosis of common mental disorder (OR: 2.44; 95% CI: 1.52-3.89), smoker (OR: 2.41; 95% CI: 1.52-3.83) and ex-smoker (OR: 1.94; 95% CI: 1.18-3.23). On the other hand, the psychological demand at work (OR: 0.89; 95% CI: 0.81-0,97) decreased the chance of alcohol abuse/dependency. Conclusion: The results reinforce the problem of alcohol abuse/dependency of healthcare professionals. Moreover, work characteristics may contribute to the onset to this problem, which should alert managers to formulate actions of occupational health promotion.

Objetivo: Estimar a prevalência e os fatores associados ao abuso/dependência de álcool em profissionais de saúde. Métodos: Estudo transversal desenvolvido com 1.776 profissionais de saúde de Belo Horizonte/MG entre 2008 a 2009, aos quais foi aplicado um questionário estruturado com itens sobre características demográficas, socioeconômicas, do estilo de vida, das condições de saúde e das condições de trabalho. O abuso/dependência de álcool foi diagnosticado com o uso do questionário CAGE. Resultados: A prevalência de abuso/dependência de álcool foi de 7,2%. Após os ajustes do modelo final, os seguintes fatores aumentaram a chance de abuso/dependência de álcool: o horário de trabalho atípico (OR: 1,64; IC 95%: 1,08-2,49), gênero masculino (OR: 3,99; IC 95%: 2,62-6,07), Transtornos Mentais Comuns (OR: 2,44; IC 95%: 1,52-3,89), tabagismo (OR: 2,41; IC 95%: 1,52-3,83) e ex-tabagismo (OR: 1,94; IC 95%: 1,18-3,23). Em contrapartida, a demanda psicológica no trabalho diminuiu a chance de abuso/dependência de álcool (OR: 0,89; IC 95%: 0,81-0,97). Conclusão: É imprescindível levar em consideração o abuso/dependência de álcool entre os profissionais de saúde. Além disso, as características do trabalho podem contribuir para o início desse problema, o que gera um alerta para os gestores na formulação de políticas de promoção da saúde do trabalhador.

Anthropometric changes and their effects on cardiometabolic risk factors in rural populations in Brazil / Mudanças antropométricas e seus efeitos sobre os fatores de risco cardiometabólicos em populações rurais do Brasil

Abstract This article aims to evaluate associations between anthropometric changes in five years with lipid and blood pressure levels in Brazilian rural population. This longitudinal study evaluated 387 individuals aged 18 to 75 residents of two rural communities. Demographic, lifestyle, anthropometric, biochemical and hemodynamic characteristics were assessed in 2004 and repeated in 2009. Multivariate linear regression was used. Positive change in BMI was associated with increased diastolic blood pressure (DBP) (β = 0.07; 95%CI: 0.03-0.11), low-density lipoprotein (LDL-C) (increase of 0.01% to 10%: β = 0.08; 95%CI: 0.02-0.14, more than 10% increase: β = 0.09; 95%CI: 0.01-0.16) and low density lipoprotein/high density lipoprotein cholesterol ratio (LDL-C/HDL-C) (increase of 0.01% to 10%: β = 0.15; 95%CI: 0.06-0.25, more than 10% increase: β = 0.14; 95%CI: 0.02-0.25). Our results showed no association between positive changes in WC and lipid levels increase, only with blood pressure levels increase (SBP: β = 0.06; CI95%:0.02-0.10; DBP: β = 0.09; CI95%: 0.04;0.13). Positive changes in BMI are independent predictors of increased lipid and blood pressure levels and positive changes in WC of increased blood pressure.

Resumo O objetivo deste artigo foi avaliar associação entre as mudanças antropométricas, em cinco anos de estudo, com os níveis lipídicos e pressóricos em populações rurais brasileiras. Estudo longitudinal, que avaliou 387 indivíduos, entre 18 e 75 anos, residentes em duas comunidades rurais. Características demográficas, de estilo de vida, antropométricas, bioquímicas e hemodinâmicas foram coletadas em 2004 e repetidas em 2009. Utilizou-se a regressão linear. Mudanças positivas do IMC foram associadas com aumento da pressão arterial diastólica (PAD) (β = 0,07; IC95%: 0,03-0,11), lipoproteína de baixa densidade (LDL-C) (aumento de 0,01% a 10%: β = 0,08; IC95%: 0,02-0,14; aumento de mais de 10%: β = 0,09; IC95%: 0,01-0,16) e razão lipoproteína de baixa densidade/lipoproteína de alta densidade (LDL-C/HDL-C) (aumento de 0,01 a 10%: β = 0,15; IC95%: 0,06-0,25; aumento de mais de 10% β = 0,14; IC95%: 0,02-0,25). Não se observou associação entre mudanças positivas na CC e aumento de níveis lipídicos, apenas com aumento da pressão arterial (PAS: β = 0,06; IC95%: 0,02-0,10; PAD: β = 0,09; IC95%: 0,04-0,13). Mudanças positivas no IMC são preditoras independentes para aumento de níveis lipídicos e pressóricos e mudanças positivas na CC para aumento de níveis pressóricos.

Conhecimentos, vivências e crenças no campo sexual: um estudo com alunos do ensino médio com perfis socioeconômicos diferenciados / Knowledge, experiences and beliefs in the sexual field: a study of 1 and 2 year high school students from different socioeconomic backgrounds / Conocimiento, experiencias y creencias en la esfera sexual: un estudio de estudiantes de 1º y 2º año de la escuela secundaria, con diferentes perfiles socioeconómicos

O objetivo neste estudo foi analisar conhecimentos, vivências e crenças no campo sexual de estudantes do 1º e 2º anos do ensino médio,com perfis socioeconômicos diferenciados. Trata-se de uma investigação transversal, descritiva e analítica, com amostragem por conveniência.Aplicou-se questionário estruturado a 258 alunos de Belo Horizonte-MG, de escolas classificadas em A, B2 e C1, segundo critério de classificação econômica. Os resultados mostraram que o nível socioeconômico foi relevante na diferenciação entre os alunos das três escolas, no que serefere à iniciação sexual e a diversos conhecimentos...

The objective of this study was to analyze knowledge, experiences and beliefs in the sexual reproductive field of prevention of Sexually TransmittedDiseases (STDs) in students enrolled in the 1st and 2nd years of high school from different socioeconomic backgrounds. This was a descriptiveand analytical cross-sectional investigation of a convenience sample of 258 students in Belo Horizonte - MG, in schools classified as A, B2 and C1,according to economic status criterion. Results showed that socioeconomic position was relevant to differences between students enrolled at thethree schools as to initiation of sexual intercourse and knowledge...

El objetivo de este estudio fue analizar los conocimientos, las experiencias y creencias en la esfera sexual de alumnos con diferentes perfiles socioeconómicos de 1º y 2º año del secundario. Investigación transversal, descriptiva y analítica con muestreo por conveniencia. Se aplicó un cuestionario estructurado a 258 alumnos de Belo Horizonte - MG, de escuelas clasificadas como A, B2 y C1, según el criterio de clasificación económica.Los resultados mostraron que, en relación a la iniciación sexual y otros conocimientos...

Multivariate approach in the optimization procedures for the direct determination of manganese in serum samples by graphite furnace atomic absorption spectrometry.

A method for direct determination of manganese (Mn) in human serum by graphite furnace atomic absorption spectrometry (GFAAS) was proposed in this work. The samples were only diluted 1:4 with nitric acid 1% (v/v) and Triton(®) X-100 0.1% (v/v). The optimization of the instrumental conditions was made using multivariate approach. A factorial design (2(3)) was employed to investigate the tendency of the most intense absorbance signal. The pyrolysis and atomization temperatures and the use of modifier were available and only the parameter modifier use did not have a significant effect on the response. A Center Composed Design (CCD) presented best temperatures of 430 °C and 2568 °C for pyrolysis and atomization, respectively. The method allowed the determination of manganese with a curve varying from 0.7 to 3.3 µg/L. Recovery studies in three concentration levels (n=7 for each level) presented results from 98 ± 5 to 102 ± 7 %. The detection limit was 0.2 µg/L, the quantifying limit was 0.7 µg/L, and the characteristic mass, 1.3 ± 0.2 pg. Intra- and interassay studies showed coefficients of variation of 4.7-7.0% (n=21) and 6-8%(n=63), respectively. The method was applied for the determination of manganese in 53 samples obtaining concentrations from 3.9 to 13.7 µg/L.

O uso de jogo de tabuleiro na educação em saúde sobre dengue em escola pública / The use of a board game in dengue health education in a public school / El uso de juego de mesa en la educación sanitaria del dengue en escuela publica

Objetivo: avaliar a eficácia de um jogo de tabuleiro sobre a dengue jogado por crianças em escolas públicas. Método: escolares de duas escolas foram randomizados, aleatoriamente, para participar do grupo do jogo de tabuleiro (GJT) ou do grupo controle (GC). Um questionário foi construído para avaliar os conhecimentos e atitudes sobre a dengue e aplicado tanto ao GJT quanto ao GC antes e póx-intervenção. O projeto de pesquisa foi aprovado pelo Comitê de Ética em Pesquisa da UFMG, CAAE nº 0106.0.203,00009. Resultados: o GJT demonstrou mudanças de atitudes (p <0,05) em todas as questões, exceto uma. O GJT mostrou maior conhecimento sobre a dengue, como indicado pela proporção de respostas corretas em relação ao GC, em 12 das 18 perguntas. Conclusão: ferramentas educacionais, como um jogo de tabuleiro, podem ser projetadas especificamente para melhorar o conhecimento e as atitudes sobre a dengue em diferentes contextos em escolares.(AU)

Objective: to evaluate the efficacy of a board game about dengue played by young children in elementary schools in southeastern Brazil. Methods: schoolchildren were randomly assigned to participate in a board game group (BGG) or control group (CG). A questionnaire was designed to assess knowledge and attitudes about dengue fever and applied to both the BGG and CG groups before and after post-intervention. The research was approved by the Research Ethics Committee of UFMG by the CAAE nº 0106.0.203,00009. Results: the BGG demonstrated changes in attitudes (p<0.05) across all questions except one. The BGG showed increased knowledge about dengue as indicated by correct responses compared to the CG in 12 out of eighteen selected test questions. Conclusion: Educational tools such as a board game can be specifically designed to improve knowledge and attitudes about dengue in different classroom settings.(AU)

Objetivo: evaluar la eficacia de un juego de mesa sobre el dengue que desempeñan los niños en las escuelas primarias. Método: los estudiantes fueron asignados aleatoriamente a participar en el juego de mesa (JM) o grupo control (GC). Se construyó un cuestionario para evaluar los conocimientos y actitudes sobre el dengue y aplicado tanto a JM en el GC antes y después de la intervención. La investigación fue aprobada por el Comité de Ética en Investigación de la UFMG con el CAAE nº 0106.0.203,000-09. Resultados: el JM demostró cambios en las actitudes (p < 0,05) en todas las cuestiones excepto uno. El JM mostró un mayor conocimiento sobre el dengue, según lo indicado por las respuestas correctas en comparación con el GC en 12 de las dieciocho preguntas. Conclusión: las herramientas educativas tales como un juego de mesa pueden ser diseñadas específicamente para mejorar los conocimientos y actitudes sobre el dengue en los diferentes contextos de aula.(AU)

Fatores associados à anemia em adolescentes escolares do sexo feminino / Factores asociados con la anemia en adolescentes escolares / Factors associated with anemia in female school adolescents

O objetivo deste estudo foi identificar a prevalência da anemia em meninas adolescentes do município de Vespasiano, Minas Gerais, e sua associação com variáveis socioeconômicas, demográficas e biológicas. Foram avaliadas 736 meninas adolescentes na faixa etária de 11 a 16 anos de idade, matriculadas em 8 escolas do ensino fundamental entre fevereiro e março de 2012. A hemoglobina sanguínea foi determinada por punção digital, pelo método da cianometahemoglobina. Também foi aplicado um questionário às meninas escolares para a obtenção de variáveis biológicas, socioeconômicas e demográficas. Considerou-se anemia a concentração de hemoglobina<12,0 g/dL, segundo a Organização Mundial da Saúde. Foram consideradas significativas as diferenças cujo teste associado tivesse p<0,05. A prevalência de anemia na população estudada foi de 7,3%. A idade média e desvio padrão foram 12,9±1,1 anos. As meninas escolares de 14 a 16 anos completos tiveram 1,8 vezes mais chance de serem anêmicas do que suas colegas da faixa etária inferior (p<0,047). Houve associação significativa entre anemia e número de pessoas no domicílio (p<0,001). Esses resultados demonstram que a anemia neste grupo é um leve problema de saúde pública, o que não descarta a necessidade de instituição de mecanismos de vigilância alimentar e nutricional, permitindo uma intervenção precoce no problema e reduzindo o impacto negativo da anemia em meninas escolares.

The objective of this study was to evaluate anemia prevalence in young adolescent girls and their association with socio-economic, demographic and biological variables in the city of Vespasiano, Minas Gerais, Brazil. Adolescent girls (n=736) between 11 and 16 years of age, enrolled in eight elementary schools, were evaluated for anemia between February and March, 2012. Hemoglobin level was assessed on site by fingerprick blood samples using the cyanmethemoglobin method. Additionally, the adolescent girls were asked to respond to a socio-economic, biological and demographic questionnaire. Anemia was defined as a hemoglobin level<12.0 g/dL, according to the World Health Organization. The adopted significance level was 0.05. Prevalence of anemia observed in the adolescent girl population was 7.3%. Mean age and standard deviation were 12.9±1.1. Adolescent girls aged 14 to 16 years were 1.8 times more anemic than their younger classmates (p<0.047). There was a positive association between anemia and the number of family members living at home (p<0.001). The results demonstrated low anemia prevalence in the young adolescent girl population enrolled in public schools. The implementation of mechanisms for ongoing food and nutrition surveillance is highly recommended in this vulnerable group as part of an ongoing anemia control and prevention program.

El objetivo fue evaluar la prevalencia de anemia en las adolescentes y su asociación con variables socioeconómicas, demográficas y biológicas en la ciudad de Vespasiano, Minas Gerais, Brasil. En adolescentes (n=736) entre 11 y 16 años, matriculadas en escuelas primarias, se evaluó la anemia entre febrero y marzo de 2012. La hemoglobina fue evaluada por punción digital en muestras de sangre utilizando el método cianometahemoglobina. Además, a las adolescentes se les pidió responder al cuestionario socioeconómico, biológico y demográfico. La anemia es una concentración de hemoglobina<12,0 g/dL, según la Organización Mundial de la Salud. El nivel de significación fue 0,05. La anemia en las chicas fue del 7,3%. La edad media fue de 12,9. Las adolescentes de entre 14 y 16 años eran 1,8 veces más anémicas que sus compañeras más jóvenes (p<0,047). Se observó una asociación positiva entre la anemia y el número de miembros de la familia (p<0,001). La prevalencia de anemia en las adolescentes fue baja. La implementación de mecanismos para la alimentación continua y vigilancia de la nutrición es recomendable en este grupo como control de la anemia en curso y programa de prevención.