Genetic determinants of cardiometabolic risk factors in rural families in Brazil.

OBJECTIVES: The purpose of this study was to estimate the heritability of genetic and environmental correlations between cardiometabolic risk factors in extended pedigrees. METHODS: The Jequitinhonha Community Family Study Cohort (JCFSC) consists of individuals aged ≥18 years living in rural villages. Family pedigrees were constructed of the cohort. The following data were collected: demographic and socioeconomic status, lifestyle variables, anthropometrics, and lipid traits. RESULTS: The JCFSC consists of 931 individuals distributed into 69 pedigrees with 4,907 members in total. The heritabilities were 0.47 for total cholesterol (TC), 0.44 for triglycerides (TG) and 0.42 for high-density lipoprotein cholesterol (HDLc), 0.49 for metabolic syndrome, approximately 0.60 for anthropometric traits and 0.30 for blood pressure/hypertension. Significant genetic correlations (ρg ) were found mainly between TG and TC (ρg = 0.58) and hypertension and TG (ρg = 0.52). Systolic blood pressure (SBP) was correlated with TG (ρg = 0.39) and HDLc (ρg = -0.30). Diastolic blood pressures correlated with TG (ρg =0.56) and TC (ρg =0.30). Genetic correlations were also found between anthropometric traits, including: body mass index (BMI) and TG (ρg =0.34), waist circumference (WC) and TG (ρg =0.42), and WC and HDLc (ρg =-0.33). Household effects were found for HDLc (c(2) = 0.19), SBP (c(2) = 0.14) and Hypertension (c(2) = 0.14). CONCLUSIONS: To some phenotypes, including lipids, hypertension, blood pressure, and anthropometric traits, genetic contribution is important in the determination of cardiometabolic risk factors. This study provides a foundation for future studies. These will mainly focus on rare variants that could describe the genetic mechanisms influencing cardiometabolic risk. Am. J. Hum. Biol. 28:619-626, 2016. © 2016 Wiley Periodicals, Inc.

Heritability of phenotypes associated with glucose homeostasis and adiposity in a rural area of Brazil.

We aimed to estimate the heritability and genetic correlation between glucose homeostasis and adiposity traits in a population in a rural community in Brazil. The Jequitinhonha Community Family Study cohort consists of subjects aged ≥18 years residing in rural areas in Brazil. The data on the following traits were assembled for 280 individuals (51.7% women): body mass index (BMI), body fat percentage, waist and mid-upper arm circumferences, triceps skinfold, conicity index, insulin, glucose, high-density lipoprotein cholesterol (HDLc), triglycerides and C-reactive protein. Extended pedigrees were constructed up to the third generation of individuals using the data management software PEDSYS. The heritability and genetic correlations were estimated using a variance component method. The age- and sex-adjusted heritability values estimated for insulin (h(2) = 52%), glucose (h(2) = 51%), HDLc (h(2) = 58%), and waist circumference (WC; h(2) = 49%) were high. Significantly adjusted genetic correlations were observed between insulin paired with each of the following phenotypes; (BMI; ρg = 0.48), WC (ρg = 0.47) and HDLc (ρg = -0.47). The homeostasis model assessment of insulin resistance (HOMA-IR) was genetically correlated with BMI (ρg = 0.53) and HDLc (ρg = -0.58). The adjusted genetic correlations between traits were consistently higher compared with the environmental correlations. In conclusion, glucose metabolism and adiposity traits are highly heritable and share common genetic effects with body adiposity traits.

Association of a NOD2 gene polymorphism and T-helper 17 cells with presumed ocular toxoplasmosis.

Retinochoroiditis manifests in patients infected with Toxoplasma gondii. Here, we assessed 30 sibships and 89 parent/case trios of presumed ocular toxoplasmosis (POT) to evaluate associations with polymorphisms in the NOD2 gene. Three haplotype-tagging single-nucleotide polymorphisms (tag-SNPs) within the NOD2 gene were genotyped. The family-based association test showed that the tag-SNP rs3135499 is associated with retinochoroiditis (P = .039). We then characterized the cellular immune response of 59 cases of POT and 4 cases of active ocular toxoplasmosis (AOT). We found no differences in levels of interferon γ (IFN-γ) and interleukin 2 produced by T-helper 1 cells when comparing patients with AOT or POT to asymptomatic individuals. Unexpectedly, we found an increased interleukin 17A (IL-17A) production in patients with POT or OAT. In patients with POT or AOT, the main cellular source of IL-17A was CD4(+)CD45RO(+)T-bet(-)IFN-γ(-) T-helper 17 cells. Altogether, our results suggest that NOD2 influences the production of IL-17A by CD4(+) T lymphocytes and might contribute to the development of ocular toxoplasmosis.

Public engagement for the conduct of a controlled human infection study testing vaccines against Necator americanus (hookworm) in areas of active hookworm transmission in Brazil.

Controlled Human Infection Models (CHIS) involve administering human pathogens to healthy participants in controlled medical settings, which can elicit complex bioethical issues. Understanding how the community perceives such studies can significantly increase the participant's sense of cooperation and increases the researcher's and the participant's transparency. The current study describes the development of an educational intervention to achieve these ends as it aims to (1) analyze perceptions of the Controlled Human Infection Studies (CHIS), and (2) evaluate the participants' comprehension of the CHIS. METHODS: This is a qualitative action research that includes the development of an educational intervention with residents of a rural area in Minas Gerais, Brazil, where there is continuous natural transmission of the human pathogen Necator americanus ("hookworm"). In this area, it is intended to carry out a proposed phase 3 vaccine clinical trial in the future to test the efficacy of hookworm vaccines using controlled human infection. Two data collection strategies were used: an educational intervention and a focus group. RESULTS: The participants' perceptions showed distinct perspectives on CHIS. On one side, they recognized that the investigation is essential for the community, but on the other side, they thought that there would be resistance to its conduct by fear of infection. The idea that the study would generate a benefit for the greater good, contributing to the prevention of hookworm infection, was clearly stated. The participants perceived that the study offered concrete risks that could be reduced by constant monitoring by the researchers. They also mentioned the importance of access to information and the positive influence those who express interest in participating in the study can exert in the community. In relation to comprehension the participants memorized the information, mobilized it to explain everyday situations and created strategies to disseminate the study and engage the community in its development. By repeating and making sense of the information, the participant not only assimilates the knowledge transmitted, but also creates new knowledge. CONCLUSION: We concluded that an educational process of discussion and dialogue around participants' perceptions about the CHIS, promotes understanding and allows ways to disseminate information about the research to be collectively created.

Elucidating the temporal and spatial dynamics of Biomphalaria glabrata genetic diversity in three Brazilian villages.

OBJECTIVE: The freshwater snail Biomphalaria glabrata is the principal intermediate host for the parasite Schistosoma mansoni within Brazil. We assessed the potential effects of snail population dynamics on parasite transmission dynamics via population genetics. METHODS: We sampled snail populations located within the confines of three schistosome-endemic villages in the state of Minas Gerais, Brazil. Snails were collected from individual microhabitats following seasonal periods of flood and drought over the span of 1 year. Snail spatio-temporal genetic diversity and population differentiation of 598 snails from 12 sites were assessed at seven microsatellite loci. RESULTS: Average genetic diversity was relatively low, ranging from 4.29 to 9.43 alleles per locus, and overall, subpopulations tended to exhibit heterozygote deficits. Genetic diversity was highly spatially partitioned among subpopulations, while virtually, no partitioning was observed across temporal sampling. Comparison with previously published parasite genetic diversity data indicated that S. mansoni populations are significantly more variable and less subdivided than those of the B. glabrata intermediate hosts. DISCUSSION: Within individual Brazilian villages, observed distributions of snail genetic diversity indicate temporal stability and very restricted gene flow. This is contrary to observations of schistosome genetic diversity over the same spatial scale, corroborating the expectation that parasite gene flow at the level of individual villages is likely driven by vertebrate host movement.

Rural electrification in Brazil and implications for schistosomiasis transmission: a preliminary study in a rural community in Minas Gerais State, Brazil.

OBJECTIVES: To evaluate the potential transmission of Schistosoma mansoni through well water pumped into households in a rural Brazilian community within the context of Brazil's rural electrification program Luz Para Todos (Light for All). METHODS: All households were interviewed about their water facilities and domestic water use, all household members were examined for S. mansoni infections and positives treated, and malacological and water contact studies were performed between 2001 and 2009. RESULTS: Thirty-one of the 142 households in the Virgem das Graças study area owned wells with electric pumps in 2009, vs. no wells in 2001, and the number of water storage tanks increased from 85 to 131. The potential for schistosomiasis transmission through piped well water was indicated by the recovery of Biomphalaria gabrata, including S. mansoni-infected snails, from wells, the presence of Biomphalaria in tanks and the ability of S. mansoni cercariae to remain infective for considerable distances in flowing water. However, access to well water was not associated with higher S. mansoni infection rates. CONCLUSIONS: Our results indicate that further studies are needed to determine the infectivity of well water and its impact on schistosomiasis transmission.

Cytokine profile, proliferation and phosphorylation of ERK1/2 and Akt in circulating mononuclear cells from individuals during the chronic intestinal phase of Schistosomiasis mansoni infection.

BACKGROUND: The immune response to Schistosoma mansoni is characterized by a granulomatous reaction around the parasite eggs that are trapped in the host liver, and this reaction modulates the immune response during the chronic phase of the disease. The typical peripheral blood mononuclear cell (PBMC) response of patients during the chronic intestinal phase of infection is characterized by a decreased response to an S. mansoni soluble egg antigen. To obtain a greater understanding of Schistosoma infections, this study investigated the effects of the soluble egg antigen (SEA) and soluble adult worm antigen (SWAP) of S. mansoni on cellular proliferation, cytokine production, and ERK1/2 and Akt phosphorylation in PBMCs from infected (XTO) and egg-negative (NI) individuals living in the same endemic area. METHODS: The activation status was evaluated by cell immunophenotypic staining (cytometry). The cell proliferation assay was by CFSE method. Cytokine detection assay (Th1 and Th2) was by Cytometric Bead and Array phosphorylation status was by ELISA. RESULTS: The XTO, NI and BD (blood donor) individuals from an area not endemic for schistosomiasis were compared. The CD4(+) T lymphocyte proliferation rate was lower in the XTO group, but not the NI group, after SEA stimulation compared to the BD group. The CD8(+) T cell proliferation rate was lower in the XTO group in the unstimulated cultures and after both SEA and SWAP stimulation compared to the BD group. Cytokine analysis after either SEA or SWAP stimulation showed a balanced cytokine pattern in the XTO and NI groups. ERK1/2 and Akt phosphorylation were only marginally detected in all groups; however, a decrease in ERK 1/2 phosphorylation was observed in the SWAP-stimulated XTO group compared to both the NI and BD groups. CONCLUSIONS: The data indicate that SEA-stimulated CD4(+) T cells from infected patients have a lower proliferation rate than the same cells from the NI group. Furthermore, we observed that SWAP stimulation influences ERK1/2 phosphorylation in the XTO group.

The role of environmental enteric dysfunction in the pathogenesis of Schistosoma mansoni-associated morbidity in school-aged children.

BACKGROUND: Studies have implicated schistosomiasis as a cause of intestinal barrier disruption, a salient feature of environmental enteric dysfunction (EED), as eggs translocate from the sterile bloodstream through the gut wall. We examined the longitudinal impact of praziquantel (PZQ) treatment on a) EED biomarkers and b) Insulin growth factor I (IGF-1), a key driver of childhood linear growth, since EED has been implicated in linear growth stunting. METHODOLOGY: 290 children infected with S. mansoni in Brazil were treated with PZQ at baseline. EED biomarkers lipopolysaccharide (LPS) and intestinal fatty acid binding-protein (I-FABP) were measured, as well as IGF-1 at baseline, 6 and 12-months. Multivariate regression analysis was applied to assess associations between S. mansoni intensity and plasma biomarkers (LPS, I-FABP, and IGF-1), controlling for potential confounding variables. PRINCIPAL FINDINGS: At baseline, S. mansoni infection intensities were 27.2% light, 46.9% moderate, and 25.9% heavy. LPS concentrations were significantly reduced at the 12-month visit compared to baseline (p = 0.0002). No longitudinal changes were observed for I-FABP or IGF-1 in the 6- or 12-month periods following baseline treatment. After 6-months, I-FABP concentration was significantly higher in high vs low intensity (p = 0.0017). IGF-1 concentrations were significantly lower among children with high and moderate vs low intensity infections at each study visit. CONCLUSIONS/SIGNIFICANCE: We report that S. mansoni infection impacts LPS, I-FABP and IGF-1. These findings suggest a mechanistic role for EED in schistosomiasis-related morbidities, particularly linear growth.

Behavioral disorders and low quality of life in children and adolescents with chronic kidney disease.

Recent years has seen an increasing interest in the quality of life (QOL) of children with chronic kidney disease (CKD). The objective of this cross-sectional study was to investigate the prevalence of behavioral disorders and to assess the health-related QOL (HRQOL) in 136 patients with CKD. To estimate the prevalence of behavior disorders and analyze HRQOL, we used the Strengths and Difficulties Questionnaire (SDQ) and Pediatric Inventory of Quality of Life (PedsQL) Core Scales as assessment tools for both the patients and caregivers. When compared to healthy controls, the CKD group had significantly lower scores in almost all PedsQL domains. After adjustment, only absence of religion/other religions remained significantly associated with a lower global HRQOL score [odds ratio (OR) 6.2, P=0.009]. Among the parents, two factors remained significantly associated with a lower global HRQOL score: patients' age >10 years (OR 5.4, P=0.033) and absence of religion/other religions (OR 3.2, P=0.038). The CKD group demonstrated a higher proportion of behavioral and emotional disorders in all SDQ domains. There was a negative correlation between the presence of behavior and emotional disorders and HRQOL score (r= -0.552, P<0.001). Our findings suggest the importance of evaluating behavioral and social repercussions of CKD in order to improve the life quality of this pediatric population.

Construction and validation of instrument to assess the quality of infection control programs.

OBJECTIVE: To build and validate an instrument to assess hospital infection control programs. METHOD: Methodological study that was developed in seven stages. The instrument items were categorized into the structure, process and result components. 10 expert judges participated, who evaluated the psychometric properties and validated the content using the Likert scale. The pre-test was carried out with 98 health professionals, from April to July 2018. For reliability analysis, Cronbach's alpha test was used. RESULTS: Regarding the content validity index, the score made by expert judges ranged from 0.777 to 1.00, with mean of 0.902 (± 0.076). The Cronbach's alpha test showed good internal consistency of the items (0.82). CONCLUSION: An instrument to assess hospital infection control programs was developed and validated, which showed good reliability and can be efficiently used at national level.

The role of population movement in the epidemiology and control of schistosomiasis in Brazil: a preliminary typology of population movement.

This paper examines recent developments in migration studies. It reviews literature related to the potential role of internal population movement in the occurrence of schistosomiasis in Brazil and modifies Prothero's typology of population movement for use in Brazil. This modified classification system may contribute to a better understanding of schistosome transmission as well as improved research and control programs. The results of this study indicate that population movement in Brazil primarily involves economically-motivated rural-urban and interregional movement. However, several movement patterns have become increasingly important in recent years as a result of changing socioeconomic and urbanisation dynamics. These patterns include urban-urban, intracity and urban-rural movement as well as the movement of environmental refugees and tourists. Little is known about the epidemiological significance of these patterns. This paper also highlights the role of social networks in the decision to migrate and to settle. Prothero's classic population movement typology categorises movement as either one-way migrations or circulations and examines them along spatial and temporal scales. However, the typology must be modified as epidemiological information about new patterns becomes available. This paper identifies areas that require further research and offers recommendations that can improve the measurement and spatial analysis of the relationship between population movement and schistosomiasis.

Accessibility to and utilisation of schistosomiasis-related health services in a rural area of state of Minas Gerais, Brazil.

The objective of the present paper was to compare accessibility and utilisation of schistosomiasis diagnostic and treatment services in a small village and the surrounding rural area in northern part of the state of Minas Gerais Brazil. The study included 1,228 individuals: 935 central village residents and 293 rural residents of São Pedro do Jequitinhonha. Schistosoma mansoni infection rates were significantly higher in the central village than in the rural area during a survey in 2007 (44.3% and 23.5%, respectively) and during the 2002 schistosomiasis case-finding campaign (33.1% and 26.5%, respectively) (p < 0.001). However, during the 2002-2006 period, only 23.7% of the villagers and 27% of the rural residents obtained tests on their own from health centres, hospitals and private clinics in various nearby towns. In 2007, 63% of the villagers and 70.5% of the rural residents reported never having received treatment for schistosomiasis. This paper reveals considerable variation in the accessibility and utilisation of schistosomiasis-related health services between the central village and the rural area. A combination of low utilisation rates between 2002-2006 and persistently high S. mansoni infection rates suggest that the schistosomiasis control program must be more rapidly incorporated into the primary health services.

Quality of the hospital infection control programs: an integrative review.

OBJECTIVE: To analyze the quality of health in relation to the components of structure, process, and outcome in actions for the prevention and control of infections. METHOD: An integrative literature review in the LILACS, Web of Science, Scopus, and SciELO databases. The time delimitation covered articles published between January 2009 and May 2019. RESULTS: The final sample consisted of 10 articles published, mainly in Scopus (60%), and in Web of Science (30%). The structural elements varied among the study countries, suggesting opportunities for improvement of organizational characteristics and human resources. Regarding the process of the implemented routines, inconsistencies were found to comply with the guidelines. The result component was not emphasized among the studies included in the review. CONCLUSION: The quality of hospital infection control programs has yet to be improved among the health services, highlighting the need for investment in the structure, process, and outcome components.

Factors associated with chronic kidney disease: epidemiological survey of the National Health Survey. / Fatores associados à doença renal crônica: inquérito epidemiológico da Pesquisa Nacional de Saúde.

OBJECTIVE: To identify the prevalence of chronic kidney disease (CKD) self-reported in Brazil and characterize the factors associated with it. METHODS: This study was a cross-sectional health survey with a household-based, the National Health Survey, performed in 2013. The outcome in the present study was the prevalence of CKD. The groups of explanatory variables were socio-demographic characteristics, lifestyles, chronic self-reported diseases, anthropometry, and health evaluation. The prevalence of CKD, e their 95% respective confidence interval were estimated, univariate analysis and the multiple logistic regression model were calculated, and remained the variables statistically significant (p < 0.05). RESULTS: It noticed that 1.42% (95%CI 1.33 - 1.52) of the 60,202 interviewees self-reported CKD. The OR increased progressively with age, being 2.68 among the elderly with 65 years or more (95%CI 1.75 - 4.09). Having health plans with OR = 1.51 (95%CI 1.28 - 1.78), as well as smoking, hypertension and high cholesterol and poor self-reported health with OR = 1.75 (95%CI 1.45 - 2.12), OR = 1.20 (95%CI 1.02 - 1.42), OR = 1.83 (95%CI 1.56 - 2.15), OR = 4.70 (95%CI 3.75 - 5.88), respectively, showed a higher chance of CKD. CONCLUSIONS: The associated variables were increasing age, health plan coverage, smoking, hypertension, hypercholesterolemia, and regular or poor health status. The knowledge of CKD prevalence in Brazil and risk and protection factors are essential for disease prevention and the establishment of supporting public health policies.

OBJETIVOS: Identificar a prevalência da doença renal crônica (DRC) autorreferida no Brasil e caracterizar os fatores associados a essa enfermidade. MÉTODOS: Trata-se de um inquérito epidemiológico de base domiciliar, a Pesquisa Nacional de Saúde (PNS) realizada em 2013. O desfecho analisado foi a prevalência de DRC. Os grupos de variáveis explicativas foram: características sociodemográficas, estilos de vida, doenças crônicas autorreferidas, antropometria e avaliação de saúde. Foram estimadas as prevalências de DRC e os respectivos intervalos de confiança de 95% e foram realizados a análise univariada e o modelo de regressão logística múltipla, permanecendo as variáveis estatisticamente significativas (p < 0,05). RESULTADOS: Observou-se que 1,42% (intervalo de confiança de 95% - IC95% 1,33 - 1,52) dos 60.202 entrevistados referiram ser portadores de DRC. O odds ratio (OR) aumentou com a idade, sendo 2,68 entre os idosos com 65 anos ou mais (IC95% 1,75 - 4,09). Apresentaram chance maior de DRC: possuir planos de saúde, com OR = 1,51 (IC95% 1,28 - 1,78), tabagismo, hipertensão, colesterol elevado e autoavaliação de saúde ruim, com OR = 1,75 (IC95% 1,45 - 2,12), OR = 1,20 (IC95% 1,02 - 1,42), OR = 1,83 (IC95% 1,56 - 2,15), OR = 4,70 (IC95% 3,75 - 5,88), respectivamente. CONCLUSÕES: A prevalência de DRC foi maior em idade mais avançada, baixa escolaridade, possuir plano de saúde, tabagismo, hipertensão, hipercolesterolemia e avaliação regular ou ruim do estado de saúde. O conhecimento da prevalência da DRC e dos fatores de risco e de proteção são essenciais para prevenção da doença e para subsidiar as políticas públicas de saúde.

[Association between adiposity measures, demographic and biochemical variables with C-reactive protein serum levels in rural population]. / Associação entre medidas de adiposidade, variáveis demográficas e bioquímicas com os níveis séricos de proteína C-reativa em população rural.

Association between adiposity measures, demographic and biochemical variables with C-reactive protein serum levels in rural population. Acute-phase proteins as C-reactive protein (CRP) have been associated with cardiovascular diseases. Recent studies have shown the relation between body fat and elevated serum levels of CRP. This study verifies relation between adiposity measures, demographic and biochemical variables with CRP serum levels in a rural population. The study was conducted among individuals aged 18 or more, both sexes and at least two years of residency in the place of study. Pregnant women, diabetic and CRP over 10 mg/l individuals were excluded. Data collection included anthropometric, demographic, lifestyle and biochemical variables. Data was processed in STATA 9.0. From the 536 subjects, 50.37% were men. Age varied from 18 to 94, age mean was 43.34. Overweight and obesity prevalence were significantly higher among women than men. Bivariate analysis found significant correlations between lnCRP and the following variables: BMI, waist circumference, WHR, age, education, systolic and diastolic blood pressure, total cholesterol, LDL-c, HDL-c, triglycerides, fasting insulin and HOMA-IR. After adjusting for confounding variables in multiple linear regression analysis only BMI, age, sex, fasting insulin and HDL-c remained significantly associated with lnCRP. The independent association of traditional risk factors for cardiovascular disease (age, sex, BMI, fasting insulin and HDL-c) with PCR evidences a close relationship between adipose tissue, cardiovascular diseases and inflammation.

Epidemiological profile of healthcare-associated infections caused by Carbapenemase-producing Enterobacteriaceae.

OBJECTIVE: To study the epidemiological profile of Healthcare-associated Infections caused by Enterobacteria which carry the Klebsiella pneumoniae Carbapenemase gene (blaKPC) in the hospital environment. METHOD: A descriptive study was conducted in a private hospital in Belo Horizonte, MG, Brazil, which included all patients with infections caused by Enterobacteriaceae which carry the Klebsiella pneumoniae Carbapenemase gene. The data were collected by the Automated System of Hospital Infection Control and analyzed by descriptive statistics by the Epi Info 7 program. RESULTS: Eighty-two (82) patients participated in the study. Klebsiella pneumoniae was the most frequent species (68%) isolated in blood (30%), bronchoalveolar lavage (22%) and urine (18%), while catheter-associated bloodstream infection (30%) predominated regarding topography. A case fatality rate of 62% is highlighted in evaluating the outcome. CONCLUSION: The resistance genes spread rapidly, limiting the antimicrobial options for treating infectious diseases. The epidemiological profile of Healthcare-Associated Infections found in this study can be prevented by prevention and infection control programs.

Anthropometric indicators associated with high blood pressure in children living in urban and rural areas. / Indicadores antropométricos associados à pressão arterial elevada em crianças residentes em áreas urbana e rural.

OBJECTIVE: to evaluate anthropometric and demographic indicators associated with high blood pressure in children aged 6 to 10 years in urban and rural areas of Minas Gerais. METHOD: this is a cross-sectional study with 335 children. Anthropometric, demographic and blood pressure data were collected. The statistics analyzes were performed using the chi-square, t-student, Mann-Whitney and logistic regression tests, and the odds ratio was the association measure. RESULTS: the prevalence of high blood pressure was significantly higher among rural children. In the urban area, the chance of high blood pressure was higher in children who had a high body mass index (2.97 [1.13-7.67]) and in the rural area, in those who had increased waist circumference (35.4 [3.0-406.2]) and the age range of 9-10 years (4.29 [1.46-12.6]). CONCLUSION: elevated body mass index and waist circumference were important anthropometric indicators for high blood pressure, as well as age in children living in rural area. The evaluation of body mass index and waist circumference, in addition to nutritional assessments, represents an important action for the screening of high blood pressure in children from different territorial contexts.

Qualidade das práticas de profissionais dos programas de controle de infecção no Brasil: estudo transversal / Calidad de las prácticas de profesionales en programas de control de infecciones en Brasil: un estudio transversal / The quality of professional practices in infection control programs in Brazil: a cross-sectional study

RESUMO Objetivo Analisar a qualidade das práticas de profissionais dos programas de controle de infecção em relação aos componentes de estrutura, processo e resultado. Método Trata-se de um estudo de abordagem quantitativa, do tipo descritivo e transversal realizado em 114 serviços de controle de infecção hospitalar das cinco regiões oficiais do Brasil. Coletaram-se os dados por meio de um instrumento estruturado, cujas propriedades psicométricas foram validadas previamente. O tratamento dos dados foi realizado pela análise de componentes principais e o teste não paramétrico Kruskal-Wallis. Resultados O melhor índice de qualidade dos programas de controle de infecção foi atribuído à região Sul, aos hospitais que continham 300 leitos ou mais, aos que utilizavam o critério National Healthcare Safety Network para vigilância das infecções e aos locais que realizavam busca ativa prospectiva como método de vigilância. Conclusão e implicações para a prática O índice de qualidade dos programas de controle de infecção está relacionado à localização, ao tamanho do hospital e ao método adotado para vigilância de infecções. A criação de um índice de qualidade, até então inédito em estudos nacionais, chama atenção para o desempenho precário dos serviços de saúde.

RESUMEN Objetivo Analizar la calidad de las prácticas de los profesionales de los programas de control de infecciones en relación con los componentes de estructura, proceso y resultado. Método Se trata de un estudio cuantitativo, descriptivo y transversal realizado en 114 servicios de control de infecciones hospitalarias de las cinco regiones oficiales de Brasil. Los datos fueron recolectados mediante un instrumento estructurado, cuyas propiedades psicométricas fueron previamente validadas. El tratamiento de los datos se realizó mediante el análisis de componentes principales y la prueba no paramétrica de Kruskal-Wallis. Resultados El mejor índice de calidad de los programas de control de infecciones se atribuyó a la región Sur, a los hospitales que tenían 300 camas o más, a los que utilizaron el criterio de National Healthcare Safety Network para la vigilancia de infecciones y a los locales que realizaban las búsquedas prospectivas activas como el método de vigilancia. Conclusión e implicaciones para la práctica La calidad de los programas de control de infecciones está relacionada con la ubicación, el tamaño del hospital y el método adoptado para la vigilancia de infecciones. La creación de un índice de calidad, hasta ahora inédito en los estudios brasileños, llama la atención sobre el precario desempeño de los servicios de salud.

ABSTRACT Objective To analyze the quality of professional practices in infection control programs regarding structure, process, and outcome. Method This is a quantitative, descriptive, and cross-sectional study carried out in 114 hospital infection control services in the five official regions of Brazil. The data were collected using a structured instrument whose psychometric properties were previously validated. Data treatment was performed by principal component analysis and non-parametric Kruskal-Wallis test. Results The best quality index of infection control programs was attributed to the South region, to hospitals that had 300 beds or more, to those that used the National Healthcare Safety Network criterion for infection surveillance and to places that carried out an active prospective search as their surveillance method. Conclusion and implications for practice: The quality of infection control programs is related to hospital location, size, and infection surveillance method. The creation of a quality index, hitherto unheard of in Brazilian studies, draws attention to the precarious performance of health services.

Association between sociodemographic and health factors and the practice of walking in a rural area. / Associação entre fatores sociodemográficos e relacionados à saúde com a prática de caminhada em área rural.

The regular practice of walking can contribute to a better quality of life, reducing the risk of cardiovascular disease. OBJECTIVE: To assess the association between sociodemographic and health factors related to adult practice of walking in the Brazilian rural context. METHODS: Cross-sectional study of 567 adults. The outcome variable was the regular practice of walking (≥150 minutes per week) and the explanatory variables were sociodemographic factors, anthropometric measures, laboratory tests and self-perceived health. The chi-square test and Poisson regression were used in analysis, considering p ≤ 0.05. RESULTS: Only 34.7% of the population practices walking regularly. Women (PR 0.84, 95% CI 0.78-0.89), age of 31-45 years (OR 1.11, 95% CI 1.02-1.22, comparing to 18-30 years), and self-perception of poor/fair health (OR 0.90, 95% CI 0.84-0.97 comparing to people with great/good health) remained independently associated with regular practice of walking. Conclusion Age between 31 and 45 years and males were positively associated with walking and the perception of poor/fair health had negative association. These findings may suggest that public policies to encourage physical activity in urban areas should also be applied to rural areas.

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.