Percepções de gestantes acerca do cuidado pré-natal na atenção primária à saúde / Percepciones de gestantes acerca del cuidado prenatal en la atención primaria a la salud / Perceptions of pregnant women about prenatal care in primary health care

Resumo OBJETIVO Compreender as percepções das gestantes acerca do cuidado recebido durante o pré-natal, no âmbito da atenção primária à saúde. MÉTODO Estudo qualitativo, baseado na Grounded Theory. A coleta de dados foi realizada de agosto a dezembro de 2016, através de entrevista semiestruturada com 12 gestantes que realizaram acompanhamento pré-natal na atenção primária do município de Florianópolis/SC/Brasil. A coleta e análise dos dados foram realizadas concomitantemente. Na análise de dados utilizou-se a codificação aberta e axial. RESULTADOS Foram elaboradas três categorias, sendo elas: O cuidado antes e durante a gestação. Participação em grupos de gestantes e, Cuidado de qualidade durante a gestação. CONCLUSÃO As percepções das gestantes acerca do cuidado recebido durante o pré-natal estão relacionadas à atenção dispensada, ao acolhimento humanizado, consideração da subjetividade da gestante e amparo nos momentos difíceis que tornam este período satisfatório.

Resumen OBJETIVO Comprender las percepciones de las gestantes acerca del cuidado recibido durante el prenatal, en el ámbito de la atención primaria a la salud. MÉTODO Estudio cualitativo, basado en la Grounded Theory. La recolección de datos fue realizada de agosto a diciembre de 2016, a través de entrevista semiestructurada con 12 gestantes en la atención primaria a la salud del municipio de Florianópolis/SC/Brasil. La recolección y análisis de los datos se realizaron concomitantemente. En el análisis de datos se utilizó la codificación abierta y axial. RESULTADOS Fueron elaboradas tres categorías, siendo ellas: El cuidado antes y durante la gestación, Participación en grupos de gestantes y, Cuidado de calidad durante la gestación. CONCLUSIÓN Las percepciones de las gestantes acerca del cuidado recibido durante el prenatal están relacionadas la atención dispensada, acogida humanizada, consideración de la subjetividad de la gestante y amparo en los momentos difíciles que hacen este período satisfactorio.

Abstract OBJECTIVE To understand the perceptions of pregnant women about the care received during prenatal care, in the field of primary health care. METHOD Qualitative study, based on Grounded Theory. Data collection was performed from August to December 2016, through a semi-structured interview with 12 pregnant women who received prenatal care in the city of Florianópolis/SC/Brazil. Data collection and analysis were performed concomitantly. Data analysis was performed using open and axial coding. RESULTS Three categories were elaborated: Care before and during gestation, Participation in groups of pregnant women, and Quality care during pregnancy. CONCLUSION The perceptions of the pregnant women about the care received during the prenatal care is related to the care given, humanized reception, consideration of the pregnant woman's subjectivity and support in the difficult moments that make this period satisfactory.

The maturation state of the auditory nerve and brainstem in rats exposed to lead acetate and supplemented with ferrous sulfate / Estado de maturação do nervo auditivo e tronco encefálico em ratos expostos a acetato de chumbo e suplementados com sulfato ferroso

Abstract Introduction The literature has reported the association between lead and auditory effects, based on clinical and experimental studies. However, there is no consensus regarding the effects of lead in the auditory system, or its correlation with the concentration of the metal in the blood. Objective To investigate the maturation state of the auditory system, specifically the auditory nerve and brainstem, in rats exposed to lead acetate and supplemented with ferrous sulfate. Methods 30 weanling male rats (Rattus norvegicus, Wistar) were distributed into six groups of five animals each and exposed to one of two concentrations of lead acetate (100 or 400 mg/L) and supplemented with ferrous sulfate (20 mg/kg). The maturation state of the auditory nerve and brainstem was analyzed using Brainstem Auditory Evoked Potential before and after lead exposure. The concentration of lead in blood and brainstem was analyzed using Inductively Coupled Plasma-Mass Spectrometry. Results We verified that the concentration of Pb in blood and in brainstem presented a high correlation (r = 0.951; p < 0.0001). Both concentrations of lead acetate affected the maturation state of the auditory system, being the maturation slower in the regions corresponding to portion of the auditory nerve (wave I) and cochlear nuclei (wave II). The ferrous sulfate supplementation reduced significantly the concentration of lead in blood and brainstem for the group exposed to the lowest concentration of lead (100 mg/L), but not for the group exposed to the higher concentration (400 mg/L). Conclusion This study indicate that the lead acetate can have deleterious effects on the maturation of the auditory nerve and brainstem (cochlear nucleus region), as detected by the Brainstem Auditory Evoked Potentials, and the ferrous sulphate can partially amend this effect.

Resumo Introdução A literatura relatou a associação entre o chumbo e os efeitos auditivos, com base em estudos clínicos e experimentais. No entanto, não há consenso em relação aos efeitos do chumbo no sistema auditivo, ou sua correlação com a concentração do metal no sangue. Objetivo Investigar o estado de maturação do sistema auditivo, especificamente do nervo auditivo e do tronco encefálico, em ratos expostos ao acetato de chumbo e suplementados com sulfato ferroso. Método 30 ratos machos desmamados (Rattus norvegicus, Wistar) foram distribuídos em seis grupos de cinco animais e expostos a uma de duas concentrações de acetato de chumbo (100 ou 400 mg/L) e suplementados com sulfato ferroso (20 mg/kg). O estado de maturação do nervo auditivo e do tronco encefálico foi analisado pelo Potencial Evocado Auditivo do Tronco Encefálico antes e após a exposição ao chumbo. A concentração de chumbo no sangue e tronco encefálico foi analisada utilizando-se Espectrometria de Massa com Plasma Indutivamente Acoplado. Resultados Verificamos que as concentrações de Pb no sangue e no tronco encefálico apresentaram alta correlação (r = 0,951, p < 0,0001). Ambas as concentrações de acetato de chumbo afetaram o estado de maturação do sistema auditivo, a maturação foi mais lenta nas regiões correspondentes à porção do nervo auditivo (onda I) e dos núcleos cocleares (onda II). A suplementação com sulfato ferroso reduziu significativamente a concentração de chumbo no sangue e no tronco encefálico no grupo exposto à menor concentração de chumbo (100 mg/L), mas não para o grupo exposto à maior concentração (400 mg/L). Conclusão Esse estudo indica que o acetato de chumbo pode ter efeitos deletérios na maturação do nervo auditivo e do tronco encefálico (região do núcleo coclear), como detectado pelos potenciais evocados auditivos do tronco encefálico, e que o sulfato ferroso pode diminuir parcialmente esse efeito.

Efetividade da suplementação de sulfato ferroso na prevenção da anemia em crianças: revisão sistemática da literatura e metanálise / Effectiveness of ferrous sulfate supplementation in the prevention of anemia in children: a systematic literature review and meta-analysis / Eficacia del suplemento de sulfato ferroso en la prevención de la anemia en niños: revisión sistemática de la literatura y metaanálisis

Revisão sistemática e metanálise de estudos que avaliaram a efetividade da suplementação de sulfato ferroso na prevenção da anemia em crianças menores de cinco anos de idade. Foram pesquisadas as bases PubMed, Scopus, SciELO e LILACS e incluídos artigos publicados entre 1980-2011 em espanhol, inglês ou português, utilizando os unitermos: criança, pré-escolar, lactente, anemia, prevenção, suplementação e ferro. Foram selecionados 13 estudos, que mostraram que independentemente da dose e do tempo de suplementação, o esquema diário foi mais consistente na melhoria dos níveis de hemoglobina (efeito combinado 0,56mg/dL, IC95%: 0,31; 0,81, p < 0,001) do que o semanal (efeito combinado 0,28mg/dL, IC95%: -0,22; 0,78, p = 0,273). Não houve efeito da suplementação na redução da prevalência de anemia, mesmo com doses diárias, e a administração conjunta com outros micronutrientes não trouxe benefícios adicionais em comparação com a administração exclusiva do suplemento. A suplementação diária de sulfato ferroso mostrou-se mais efetiva do que doses semanais na melhoria dos níveis de hemoglobina.

This was a systematic review and meta-analysis of studies evaluating the effectiveness of ferrous sulfate supplementation in the prevention of anemia in children under five. The database search included PubMed, Scopus, LILACS, and SciELO. Articles published between 1980 and 2011 in Spanish, English, or Portuguese were included, using the keywords child, preschool, infant, anemia, prevention, and iron supplementation. The authors selected 13 studies, which showed that regardless of dose and duration of supplementation, daily regimen was more consistently related to improvement in hemoglobin levels (pooled effect 0.56mg/dL, 95%CI: 0.31; 0.81, p < 0.001) as compared to weekly intervention (pooled effect 0.28mg/dL, 95%CI: -0.22; 0.78, p = 0.273). Iron supplementation was not associated with decreased prevalence of anemia, even with daily doses, and administration with other micronutrients did not bring additional benefits compared to the exclusive administration of iron supplement. Daily supplementation of ferrous sulfate was more effective than weekly doses in improving hemoglobin levels.

Revisión sistemática y metaanálisis de estudios que evaluaran la efectividad del suplemento de sulfato ferroso para la prevención de anemia en niños menores de cinco años de edad. Fueron investigadas las bases PubMed, Scopus, SciELO y LILACS e incluidos artículos publicados entre 1980-2011 en español, inglés o portugués, utilizando los unitérminos: niño/niña, preescolar, lactante, anemia, prevención, suplemento e hierro. Fueron seleccionados 13 estudios que mostraron que, independientemente de la dosis y tiempo de toma de suplementos, el esquema diario fue más consistente en la mejoría de los niveles de hemoglobina que el esquema semanal. La toma de suplementos no se mostró efectiva en la reducción de la prevalencia de anemia, inclusive con dosis diarias, y la administración conjunta con otros micronutrientes no trajo beneficios adicionales en comparación con la administración exclusiva del suplemento. La toma de suplementos diarios de sulfato ferroso fue más efectiva que las dosis semanales en la mejoría de los niveles de hemoglobina.

Antiviral effect of dietary germanium biotite supplementation in pigs experimentally infected with porcine reproductive and respiratory syndrome virus

Germanium biotite (GB) is an aluminosilicate mineral containing 36 ppm germanium. The present study was conducted to better understand the effects of GB on immune responses in a mouse model, and to demonstrate the clearance effects of this mineral against Porcine reproductive and respiratory syndrome virus (PRRSV) in experimentally infected pigs as an initial step towards the development of a feed supplement that would promote immune activity and help prevent diseases. In the mouse model, dietary supplementation with GB enhanced concanavalin A (ConA)-induced lymphocyte proliferation and increased the percentage of CD3+CD8+ T lymphocytes. In pigs experimentally infected with PRRSV, viral titers in lungs and lymphoid tissues from the GB-fed group were significantly decreased compared to those of the control group 12 days post-infection. Corresponding histopathological analyses demonstrated that GB-fed pigs displayed less severe pathological changes associated with PRRSV infection compared to the control group, indicating that GB promotes PRRSV clearance. These antiviral effects in pigs may be related to the ability of GB to increase CD3+CD8+ T lymphocyte production observed in the mice. Hence, this mineral may be an effective feed supplement for increasing immune activity and preventing disease.

Iron supplementation reduces the erosive potential of a cola drink on enamel and dentin in situ

Iron has been suggested to reduce the erosive potential of cola drinks in vitro.OBJECTIVE: The aim of this study was to evaluate in situ the effect of ferrous sulfate supplementation on the inhibition of the erosion caused by a cola drink. MATERIAL AND METHODS: Ten adult volunteers participated in a crossover protocol conducted in two phases of 5 days, separated by a washout period of 7 days. In each phase, they wore palatal devices containing two human enamel and two human dentin blocks. The volunteers immersed the devices for 5 min in 150 mL of cola drink (Coca-ColaTM, pH 2.6), containing ferrous sulfate (10 mmol/L) or not (control), 4 times per day. The effect of ferrous sulfate on the inhibition of erosion was evaluated by profilometry (wear). Data were analyzed by paired t tests (p<0.05). RESULTS: The mean wear (±se) was significantly reduced in the presence of ferrous sulfate, both for enamel (control: 5.8±1.0 µm; ferrous sulfate: 2.8±0.6 µm) and dentin (control: 4.8±0.8 µm; ferrous sulfate: 1.7±0.7 µm). CONCLUSIONS: The supplementation of cola drinks with ferrous sulfate can be a good alternative for the reduction of their erosive potential. Additional studies should be done to test if lower ferrous sulfate concentrations can also have a protective effect as well as the combination of ferrous sulfate with other ions.

Double-blind randomized controlled trial of rolls fortified with microencapsulated iron / Estudo duplo-cego randomizado controlado com pães fortificados com ferro microencapsulado

OBJECTIVE: To evaluate the impact of the fortification of rolls with microencapsulated iron sulfate with sodium alginate on the hemoglobin levels in preschoolers as compared to controls. METHODS: Double-blind randomized controlled trial comprised of children aged 2 to 6 years with initial hemoglobin exceeding 9 g/dL from four not-for-profit daycares randomly selected in the city of São Paulo - Brazil. Children of 2 daycares (n = 88) received rolls with fortified wheat flour as the exposed group (EC) and children of 2 daycares (n = 85) received rolls without fortification as the control group (CG) over a 24-week period. Rolls with 4 mg iron each were offered once a day, five days a week. Hemoglobin concentrations were determined in capillary blood by HemoCue® at three moments of trial: baseline (Ml), after 12 and 24 weeks of intervention (M2, M3). RESULTS: Hemoglobin concentration presented significant increase up to M3 in EG (11.7-12.5-12.6 g/dL) and in CG (11.1-12.4-12.3 g/dL) with higher elevations in children initially with anemia. There was significant reduction in the occurrence of anemia from 22 percent to 9 percent in EG and from 47 percent to 8.2 percent in CG at M3. CONCLUSION: Rolls fortified with microencapsulated iron sulfate were well tolerated, increased hemoglobin levels and reduced the occurrence of anemia, but with no difference compared to the control group.

OBJETIVO: A deficiência de ferro é a carência nutricional mais frequente no Brasil, tendo como principal etiologia a baixa ingestão do mineral. A fortificação alimentar é medida sustentável e de melhor custo-benefício para a prevenção e controle. O objetivo foi avaliar o impacto da fortificação de pães com sulfato ferroso microencapsulado com alginato de sódio sobre os níveis de hemoglobina em pré-escolares, comparados com controles. MÉTODOS: Estudo duplo-cego randomizado controlado incluindo crianças de 2 a 6 anos com hemoglobina inicial maior que 9 g/dL procedentes de 4 creches filantrópicas selecionadas aleatoriamente, São Paulo - Brasil. Crianças de 2 creches (n = 88) receberam pães com farinha de trigo fortificada, constituindo o grupo exposto (EC), e de outras 2 creches (n = 85) receberam pães não fortificados, compondo o grupo-controle (CG), durante 24 semanas. Pães contendo 4 mg de ferro foram oferecidos uma vez ao dia, cinco dias por semana. As concentrações de hemoglobina foram determinadas no sangue capilar por HemoCue® em três momentos do estudo: momento inicial (M1), após 12 e 24 semanas da intervenção (M2, M3). RESULTADOS: A concentração de hemoglobina apresentou aumento significativo até M3 no EG (11,7-12,5-12,6 g/dL) e no CG (11,1-12,4-12,3 g/dL) com maiores elevações nas crianças inicialmente anêmicas. Houve redução significativa na ocorrência de anemia de 22 por cento a 9 por cento no EG e de 47 por cento a 8,2 por cento no CG em M3. CONCLUSÃO: Os pães fortificados com sulfato ferroso microencapsulado foram bem tolerados, elevando os níveis de hemoglobina e reduzindo a ocorrência de anemia, porém sem diferenças em relação ao grupo-controle.

Disponibilidad potencial in vitro de hierro y zinc en una dieta infantil con pan fortificado con distintas fuentes de hierro o con agregado de promotores de la absorción / Iron and zinc in vitro potential availability in an infant diet with fortified bread with different iron sources or with the adition of different iron absorption promoters

Los alimentos complementarios más utilizados son las dietas caseras. En el presente trabajo se evaluó la disponibilidad de hierro y zinc en una dieta infantil de consumo habitual conteniendo pan fortificado con diferentes fuentes de hierro: sulfato ferroso, bisglicinato ferroso, NaFeEDTA. También se utilizó pan sin fortificar con agregado de ácido ascórbico, citrato de sodio o Na2EDTA como promotores de la absorción, combinada con diversas bebidas. La dieta (papa, zapallo, sémola, pan y manzana) se combinó con agua, leche, té, bebida cola y bebida artificial a base de naranja. La dializabilidad (D) mineral, como indicador de la disponibilidad potencial fue determinada utilizando un método in vitro. El análisis estadístico se realizó utilizando ANOVA, con test de Tukey a posteriori. No hubo diferencias significativas en la DFe entre las dietas del pan fortificado con sulfato o bisglicinato; con el NaFeEDTA aumentó significativamente (p<0,05). El aumento de la DFe fue mayor en las dietas que tenían panes con promotores que en las que tenían panes fortificados. La bebida a base de naranja aumentó la DFe, mientras que el té y la leche la disminuyeron significativamente (p<0,05). La DZn aumentó en forma significativa cuando el pan estaba fortificado con sulfato o NaFeEDTA, pero no cuando se fortificó con bisglicinato. El agregado de té o leche disminuyó la DZn mientras que la bebida a base de naranja la aumentó significativamente (p<0,05). En relación a los promotores, las mayores DFe y DZn se observaron en las dietas con el pan sin fortificar, con agregado de Na2EDTA.

Home-made diets are the most frequently used complementary foods. In the present work we evaluated iron and zinc availability in a usually consumed infant diet containing either iron-fortified bread with different iron sources: ferrous sulfate, ferrous bisglycinate, NaFeEDTA. We also used non-fortified bread with absorption promoters: ascorbic acid, sodium citrate, Na2EDTA, combined with different beverages. The diet (potato, pumpkin, grits, bread, and apple) was combined with water, milk, tea, a soft drink and an orange-based artificial drink. Mineral dialyzability (D) as an indicator of potential availability was determined using an in vitro method. Statistical analysis was performed by ANOVA, and a posteriori Tukey test. There were no significant differences in FeD between diets with ferrous sulfate or ferrous bisglycinate fortified bread; in NaFeEDTA fortified bread it increased significantly (p<0.05). Iron D increase was greater in diets with bread containing absorption promoters than in those with fortified bread. The orange-based artificial drink increased FeD, while tea and milk decreased it significantly (p<0.05). Zinc D increased significantly when the bread was fortified either with ferrous sulfate or NaFeEDTA, but remained unchanged in diets with ferrous bisglycinate fortified bread. The addition of tea or milk decreased ZnD while the orange-based artificial drink increased it significantly (p<0.05). Regarding absorption promoters, the greater values both in FeD and ZnD were observed in diets with iron nonfortified bread containing Na2EDTA.

Bioaccesibilidad de minerales en infusiones de yerba mate (Ilex paraguariensis St) y en mezclas con leches fortificadas con hierro

Se evaluó la bioaccesibilidad de diversos minerales en infusiones de yerba mate y en preparaciones con leche fortificada con Fe para determinar la influencia de las infusiones en la biodisponibilidad potencial de minerales intrínsecos y del Fe de fortificación. Se evaluó la dializabilidad (D) de hierro, calcio, magnesio y zinc, como indicador de la bioaccesibilidad, en muestras de leche fortificada con sulfato ferroso (SF), bisglicinato férrico (BGF) y EDTANaFe. También se evaluó en mezclas de leche con mate cocido y en infusiones-cocciones con leches fortificadas. En cada caso se estudió la acción del ácido ascórbico (AA) en una relación Fe:AA 1:4. En el mate cocido la DFe fue nula y aumentó a 15% con el agregado de AA. La DFe en leche con SF, BGF y EDTANaFe (1.2; 1.0 y 27.4 respectivamente), se incrementó con el agregado de AA a 2.9; 3.5 y 24.8. La DFe en la mezcla leche:mate cocido resultó 4.7%; 5.7% y 31.2% para SF, BGF y EDTANaFe respectivamente. Con el agregado de AA resultó de 13.5%; 13.7% y 25.7% En infusiones- cocciones en leche fortificada con SF, los valores resultaron menores a los de la mezcla. La DCa no presentó variaciones importantes en las leches fortificadas y sus preparaciones con yerba mate, mientras que la DMg y la DZn solo mostraron una disminución significativa en la infusión-cocción. El consumo de infusiones de yerba mate no aporta cantidades significativas de minerales. Sin embargo, su consumo en mezclas con leche no afectaría negativamente la disponibilidad de Fe en dicha matriz.

The bioaccesibility of various minerals in infusions of yerba mate (mate cocido) and preparations with Fe-fortified milk was assessed to determine the influence of the infusions on the potential bioavailability of intrinsic minerals and fortified Fe. The dialyzability (D) of iron, calcium, magnesium and zinc was evaluated, as indicator of bioaccesibility in milk samples fortified with ferrous sulfate (FS), ferric bisglicinate GF) and EDTANaFe. Dialyzability was also evaluated in mixtures of milk with mate cocido and in infusions cooked with Fe-fortified milk. In each case the effect of ascorbic acid (AA) in a ratio Fe: AA 1:4 was studied. In the mate cocido FeD was zero and increased to 15% with the addition of AA. The FeD in milk with SF, BGF and EDTANaFe (1.2, 1.0 and 27.4 respectively), increased with the addition of AA to 2.9, 3.5 and 24.8. The FeD in the mixture milk: mate cocido was 4.7%, 5.7% and 31.2% for SF, BGF and EDTANaFe respectively. With the addition of AA was 13.5%, 13.7% and 25.7%. In infusions cooked with SF fortified milk, the values were lower than those of the mixture. The CaD did not show significant changes in Fe fortified milk and its preparations with yerba mate, while the MgD and ZnD only showed a significant reduction in infusion cooked with Fe-fortified milk. The use of infusions of yerba mate does not provide significant amounts of minerals. However, its use in mixtures with milk will not adversely affect the availability of Fe in that matrix.

Dializabilidad de hierro y zinc en cereales para desayunos comerciales fortificados con hierro elemental, sulfato ferroso o edta férrico sódico / Iron and zinc dialysability in commercial breakfast cereals fortified with elemental iron, ferrous sulphate or ferric sodium edta

Iron (Fe) and Zinc (Zn) dialyzability was compared in 7 commercial ready-to-eat breakfast cereals (BC). Four of them were fortified with elemental Fe and ZnO. Fe and Zn dialyzability of 3 different types of BC fortified with ZnO and FeNa2EDTA or FeSO4 was also performed in our laboratory. An in vitro methodology that measures the percentage of mineral dialyzability (D percent) with controlled pH was used. The DFe percent values obtained for the commercially fortified BC ranged between 0.4 to 15.0 percent without milk and between 1.0 to 5.6 percent when milk was added to the cereals. In the case of Zn, the values ranged from 3.3 to 16.1 without milk and between 3.3 and 30.8 when milk was added. Almost every BC that was experimentally fortified in our laboratory presented a higher DFe percent (19.5 to 28.6 percent) and DZn percent (12.4 to 29.2) when fortified with FeNa2EDTA (with or without milk). The results obtained suggest that FeNa2EDTA is a viable alternative for the fortification of BC.

Se comparó la dializabilidad de Fe y Zn en 7 cereales para desayuno comercialmente fortificados o no, con Fe elemental y ZnO y se comparó la dializabilidad de Fe y Zn en tres tipos diferentes de cereales experimentalmente fortificados con ZnO y FeNa2EDTA o FeSO4 en el laboratorio. Se utilizó una metodología in vitro que mide el porcentaje de dializabilidad (D por ciento) del mineral en condiciones controladas de pH. Los cereales comercialmente fortificados presentaron valores de DFe por ciento entre 0,4 y 15,0 y entre 1,0 y 5,6; sin y con leche. Para DZn por ciento los valores fueron entre 3,3 y 16,1 y entre 3,3 y 30,8, sin y con leche. Casi todos los cereales fortificados en el laboratorio presentaron mayor DFe por ciento (entre 19,5 y 28,6) y DZn por ciento (entre 12,4 y 29,2) cuando fueron fortificados con FeNa2EDTA (con y sin leche). Los resultados obtenidos muestran al FeNa2EDTA como una alternativa viable para la fortificación de cereales para desayuno.

Developmental profile in children with iron deficiency anemia and its changesafter therapeutic iron supplementation.

Objective. To evaluate the developmental profile of children with iron deficiency anemia (IDA) and the changes following iron supplementation. Methods. Study was conducted prospectively in a tertiary care teaching institution. Subjects were children aged 6 months to 5-years, with IDA, proven by hematological parameters and iron studies. Complete blood counts and iron studies were performed at the beginning and following 3-months therapy with iron. Simultaneously, development was assessed by Developmental profile II (DPII), which was interpreted using IQ equivalent (IQE) scores and ‘fractional months differential’ (FMD). Results. Thirty five children fulfilled predetermined inclusion criteria. The mean-age was 22.3±13.4 months. Majority (71.4%) had moderate, while 5 (14.3%), each had mild and severe anemia. Significant developmental delay was observed in iron deficient children. Maximum delay was observed in academic and communication domains. 6 (17.2%) failed developmental screening, with IQE scores of <70. Significant improvement in DPII scores was noticed following therapy. Although some gain in IQE scores was noticed in the majority (88.6%), significant improvement (e =>10-point gain) was observed in about half (51.4%). Interpretation of DPII by FMD revealed significant improvement in all the domains as well. Conclusion. Children with IDA have suboptimal developmental scores. The delayed development is variably reversible following oral iron therapy. Hb =<7 g/dl and age >24 months predict suboptimal outcome. FMD is a useful method of interpreting DPII.

Adherence and side effects of three ferrous sulfate treatment regimens on anemic pregnant women in clinical trials / Adesão e efeitos colaterais em ensaio clínico comparando três esquemas de tratamento com sulfato ferroso em gestantes anêmicas

The objective of this study was to analyze adherence and side effects of three iron supplement regimens (ferrous sulfate) on anemic pregnant women. The clinical trial involved 150 women between the 16th and 20th gestational weeks, at low obstetric risk and with hemoglobin concentration of between 8.0 and 11.0g/dL. Treatment was provided by ferrous sulfate with 60mg of elemental iron during 16 (± 1) weeks, in three regimens: single tablet a week (n = 48); single tablet twice a week (n = 53) or single tablet a day (n = 49). The outcomes were adherence, assessed through interviews and by counting tablets, and side effects, according to patient information. The adherence showed a declining trend (92 percent, 83 percent and 71 percent; p = 0.010) and the side effects revealed a growing trend (40 percent, 45 percent and 71 percent; p = 0.002) as the dosage increased. Diarrhea and epigastric pain were significantly associated with the dose administered (p = 0.002). These results suggest that in anemic pregnant women, complaints are directly proportional and the compliance is inversely proportional to the amount of medicinal iron.

O objetivo deste estudo foi analisar a adesão e os efeitos colaterais de três esquemas de suplementação com sulfato ferroso em gestantes anêmicas. O ensaio clínico incluiu 150 mulheres entre a 16ª e 20ª semanas de gestação, de baixo risco obstétrico e com concentração de hemoglobina entre 8,0 e 11,0g/dL. A intervenção foi realizada com 60mg de ferro elementar, durante 16 (±1) semanas, em três esquemas: uma drágea semanal (n = 48); uma drágea duas vezes por semana (n = 53) ou uma drágea diariamente (n = 49). Os desfechos foram adesão, verificada por entrevista e contagem das drágeas, e efeitos colaterais auto-relatados pelas pacientes. A adesão apresentou tendência declinante (92 por cento, 83 por cento e 71 por cento; p = 0,010) e os efeitos colaterais, ascendente (40 por cento, 45 por cento e 71 por cento; p = 0,002) com o aumento da dose prescrita. Diarréia e dor epigástrica estiveram significativamente associadas à dose administrada (p = 0,002). Os resultados sugerem que em gestantes anêmicas as queixas e a adesão ao tratamento com sulfato ferroso são, respectivamente, direta e inversamente proporcionais à quantidade do ferro medicamentoso.

[Reasons for irregular use of ferrous sulfate tablet in women referred to health centers in Bourojen city, 2005-2006]

Both the pregnant and breast feeding women are of the groups who are predisposed to iron deficiency anemia [IDA]. Although there is a regular program about consumption of ferrous sulfate tablet by these women, about 67 percent of them do not use their tablet regularly. Therefore, this study was aimed to investigate the reasons for irregular use of ferrous sulfate tablet in women referred to health centers in bourojen city. In this descriptive and analytical study which conducted in health centers of boroujen in 1384-85, 270 pregnant women with 16[th] week of pregnancy to two mounts after delivery were selected and interviewed. A questionnaire, including their demographic information, tablet consumption, attitude and behavior was filled in. Data were analyzed using Chai-square, Mann Whitney, Wilkakson, and Cruscal-Valis. The results showed that%33.1 of the women used their tablet regularly,%56.8 of them consumed it irregularly and%10.2 did not take it at a1. There was no relationship between regular consumption of the tablet and familial level of socio-economical statues. Some of the reasons for irregular consumption of this tablets were forgetting of time interval of consumption [48.4%], nausea and vomiting during pregnancy [%12.4], and lack of knowledge and attitude toward necessity of consumption [%16.4]. There were no significant relationship between number of delivery or pregnancy and age, employment, knowledge and attitude of the women [P<0.05]. Our results showed that in mothers increasing knowledge and information by educational methods such as class and booklet, intermittent consumption of tablet can decrease forgotten dose of tablet and improve level of information

Treament and prevention of anemia with ferrous sulfate plus folic acid in children attending daycare centers in Goiânia, Goiás State, Brazil: a randomized controlled trial / Resposta terapêutica e profilática com ferro e ácido fólico na anemia em crianças de creches públicas em Goiânia, Goiás, Brasil: ensaio clínico randomizado

The objective of this study was to assess the prevalence of anemia and the therapeutic and prophylactic response to ferrous sulfate and folic acid. A double-blind, randomized, controlled clinical trial was conducted with 196 children 6 to 24 months of age enrolled in municipal daycare centers in Goiânia, Goiás State, Brazil. The children were assigned to two treatment groups that received a daily dose (5 times a week) of either 4.2mg/kg/day of ferrous sulfate + folic acid (50µg) or 4.2mg/kg/day of ferrous sulfate + folic acid placebo. One of the prevention groups received 1.4mg/kg/day of ferrous sulfate + folic acid (50µg/day) and the other 1.4mg/kg/day of ferrous sulfate + folic acid placebo. Supplementation lasted approximately three months. Baseline anemia prevalence was 56.1 percent (95 percentCI: 48.9-63.1). After treatment, anemia prevalence in the folic acid group (14 percent) was lower than in the placebo group (34.9 percent) (p = 0.02). After prophylaxis in the non-anemic children, the incidence of anemia did not differ between the groups, but there was an increase in hemoglobin level in the folic acid group (p = 0.003). Iron plus folic acid was effective for the treatment of anemia and improvement of hemoglobin level in non-anemic children.

Avaliar a prevalência de anemia e a resposta terapêutica e profilática do sulfato ferroso e ácido fólico. Realizou-se um ensaio clínico controlado randomizado, duplo-cego, com 196 crianças de 6 a 24 meses, dos Centros Municipais de Educação Infantil de Goiânia, Goiás, Brasil. As crianças foram alocadas em dois grupos de tratamento que receberam dose diária (5x/semana) com 4,2mg/kg/dia de sulfato ferroso + ácido fólico (50µg) ou 4,2mg/kg/dia de sulfato ferroso + placebo de ácido fólico. Um dos grupos de prevenção recebeu 1,4 mg/kg/dia de sulfato ferroso + ácido fólico (50µg/dia) e o outro 1,4mg/kg/dia de sulfato ferroso + placebo de ácido fólico. A suplementação durou cerca de três meses. A prevalência de anemia inicial foi de 56,1 por cento (IC95 por cento: 48,9-63,1). Após o tratamento, a prevalência de anemia no grupo ácido fólico (14 por cento) foi menor que no grupo placebo (34,9 por cento; p = 0,02). Após profilaxia dos não anêmicos, a incidência de anemia não diferiu entre os grupos, porém, houve incremento da hemoglobina no grupo ácido fólico (p = 0,003). O ferro associado com ácido fólico foi eficaz no tratamento da anemia e na melhoria da hemoglobina nos não anêmicos.

Efetividade de diferentes estratégias de intervenção com ferro nos níveis de hemoglobina e ferritina em escolares de Teresina, Piauí, Brasil / Effectiveness of different iron supplementation strategies on hemoglobin and ferritin levels among schoolchildren in Teresina, Piauí State, Brazil

O estudo avaliou o efeito das intervenções com sulfato ferroso e com ferro bisglicina quelato nas concentrações de hemoglobina e ferritina sérica em escolares de 7-11 anos, de ambos os sexos, de Teresina, Piauí, Brasil. Foi desenvolvido ensaio clínico-comunitário, randomizado, envolvendo 138 escolares, com níveis de hemoglobina < 11,5g/dL, alocados, individualmente, em dois grupos de tratamento. Um grupo (n = 71) recebeu 40mg de sulfato ferroso, uma vez/semana, e o outro (n = 67) 3,8mg de ferro bisglicina quelato, fracionados em biscoitos consumidos três vezes/semana, durante oito semanas. Houve um incremento (p < 0,01) médio, nas concentrações de hemoglobina, de 1,1g/dL entre os escolares que receberam sulfato ferroso e de 0,9g/dL para aqueles que receberam ferro bisglicina quelato, embora sem diferença (p > 0,05) na comparação intergrupos. Nenhum impacto foi observado (p > 0,05) nas reservas corporais de ferro. Entretanto, escolares que apresentaram depleção das reservas corporais de ferro (< 15ng/mL), no início dos tratamentos, tiveram aumento (p < 0,01) nas concentrações médias de ferritina sérica, após a intervenção, embora com efeito similar (p > 0,05) entre os grupos de tratamento. Os resultados confirmam a efetividade das intervenções e ratificam o uso do esquema semanal com sulfato ferroso e com ferro bisglicina quelato no tratamento da deficiência do mineral e da anemia ferropriva.

This study evaluated the effectiveness of supplementation with ferrous sulfate and iron bis-glycinate chelate on hemoglobin and serum ferritin levels among schoolchildren (7-11 years) of both sexes. A randomized community-based trial including 138 anemic children (hemoglobin < 11.5g/dL) was conducted in Teresina, Piauí State, Brazil. Children were assigned to two treatment groups on an individual basis. One group (n = 71) received 40mg iron as ferrous sulfate once weekly and the other group (n = 67) received 3.8mg of iron bis-glycinate chelate-enriched cookies, 3x/week, for 8 weeks. The interventions showed a significant increase (p < 0.01) in hemoglobin levels (1.1g/dL) for children who received ferrous sulfate and 0.9g/dl in those who received iron bis-glycinate chelate, although not significant in the inter-group comparison (p > 0.05). No effect was observed on body iron for either intervention (p > 0.05). Children with depleted iron stores (< 15ng/mL) at the beginning of interventions showed increased serum ferritin concentrations after 8 weeks (p < 0.01), although no difference between treatments (p > 0.05) was observed. The results confirm the effectiveness of the iron supplementation interventions and corroborate the use of iron salts or ferrous bisglycinate chelate on a weekly basis to overcome iron deficiency and anemia.

Impact of weekly treatment with ferrous sulfate on hemoglobin level, morbidity and nutritional status of anemic infants

OBJETIVO: Avaliar o impacto do tratamento com sulfato ferroso, administrado semanalmente, sobre o nível de hemoglobina, morbidade e estado nutricional de lactentes anêmicos da Zona da Mata Meridional de Pernambuco. MÉTODOS: Estudo de intervenção de base comunitária, controlado, realizado com 378 lactentes acompanhados até 18 meses. Foram selecionadas aleatoriamente 245 crianças para avaliação da hemoglobina aos 12 meses. As crianças foram distribuídas em três grupos de estudo: dois com tratamento semanal de 45 mg de ferro elementar, dos 12 aos 18 meses de vida (69 crianças com anemia moderada/grave e 111 com anemia leve) e um sem tratamento, constituído de 65 crianças sem anemia. As 133 crianças restantes constituíram o grupo controle, utilizado para comparação do estado nutricional e da morbidade. RESULTADOS: A prevalência de anemia foi de 73,5 por cento aos 12 meses de vida. Após 6 meses de tratamento, houve recuperação do nível de hemoglobina para valores > 11,0 g/dL em 42,3 por cento dos lactentes anêmicos. O aumento médio foi de 1,6 g/dL, sendo maior (2,5 g/dL) para o grupo com nível inicial mais baixo de hemoglobina. Das crianças sem anemia e não tratadas, 40,3 por cento tornaram-se anêmicas ao término do acompanhamento, com uma redução média do nível de hemoglobina de 0,5 g/dL. Observou-se um ganho de peso significativamente maior nos grupos com tratamento, o mesmo não ocorrendo para crescimento linear e duração da diarréia. CONCLUSÕES: A redução da prevalência da anemia em menos da metade das crianças recebendo sulfato ferroso em doses semanais e o surgimento de anemia nos lactentes não anêmicos e sem suplementação de ferro são indicativos da necessidade de estratégias eficazes para seu controle.

OBJECTIVE: To evaluate the impact of weekly treatment with ferrous sulfate on hemoglobin level, morbidity and nutritional status in a sample of anemic infants from Zona da Mata Meridional in the state of Pernambuco, Brazil. METHODS: A controlled, community-based intervention was carried out with 378 infants who were followed-up for 18 months. Hemoglobin level was measured at 12 months in a total of 245 children randomly selected. Participating infants were divided into three groups: two received 45 mg of elemental iron weekly, from 12 to 18 months of life (69 children with moderate/severe anemia, and 111 with mild anemia); the third group was composed of 65 non-anemic children, who received no intervention. The remaining 133 children constituted the control group, for comparisons on nutritional status and morbidity. RESULTS: The prevalence of anemia was 73.5 percent at 12 months of life. After 6 months of treatment, 42.3 percent of anemic children reached hemoglobin levels > 11.0 g/dL. The mean increase was 1.6 g/dL, being higher (2.5 g/dL) in the group with lower levels of hemoglobin at baseline. Children without anemia at baseline received no treatment, and 40.3 percent of them became anemic at the end of follow-up, with a mean decrease of 0.5 g/dL in hemoglobin levels. A significantly greater weight gain was observed in the two treated groups, while no significant improvements were seen in linear growth and duration of diarrhea. CONCLUSIONS: The fact that less than half the children receiving ferrous sulfate recovered from anemia at the end of follow-up, along with the development of anemia in many untreated, previously non-anemic infants, suggests the need for effective control strategies.

Effect of anti-Helicobacter pylori therapy on outcome of iron-deficiency anemia: a randomized, controlled study.

BACKGROUND: Helicobacter pylori infection may play a role in iron-deficiency anemia. METHODS: In 52 patients with iron-deficiency anemia, H. pylori status was determined using rapid urease test and histology. H. pylori -positive patients were randomly assigned to receive anti- H. pylori treatment either immediately (Group I) or after a delay of one month (Group II); in addition, all patients received oral ferrous sulfate for three months. Patients testing negative for H. pylori (Group III) received only oral ferrous sulfate. Hematological parameters were tested every month. RESULTS: Of 52 patients, 32 (61.5%) had H. pylori infection. At the end of one month, median increase in hemoglobin level was lower in Group II than in Groups I and III (1.1 g/dL vs. 3.6 g/dL and 1.9 g/dL, respectively; p=0.025), as were that in serum iron (19 mcg/dL vs. 55.5 mcg/dL and 41 mcg/dL; p=0.019). During the second month, after H. pylori infection in Group II had been treated, median increase in hemoglobin in this group was comparable to those in Groups I and III (3.7 g/dL vs. 2.5 g/dL and 2.5 g/dL. CONCLUSION: In patients with iron-deficiency anemia, presence of H. pylori infection is associated with a poorer response to oral iron therapy, which improves with treatment for H. pylori infection.

Feasibility of "directly observed home-based twice-daily iron therapy" (DOHBIT) for management of anemia in rural patients: a pilot study.

BACKGROUND: Iron deficiency anemia (IDA) is a significant public health challenge in resource-poor settings, despite strong evidence for efficacy of iron supplementation. We hypothesized, modeled on the successful initiatives in disorders like tuberculosis or HIV, that directly observed therapy is an effective and practical strategy for control of IDA in such settings. OBJECTIVE: To overcome practical constraints and optimize compliance and effectiveness of iron supplementation by "Directly Observed Home-Based twice daily Iron Therapy" (DOHBIT) through village youth volunteers. DESIGN: Prospective longitudinal evaluation of DOHBIT. SETTING: A remote rural hilly hamlet with 25 families. METHODS AND MATERIAL: 100 mg elemental iron was administered twice daily under direct supervision to 33 anemic patients at home for 90 days. Outcome measures included hemoglobin rise, weight gain and side-effects. STATISTICS: Pre- and post-intervention weight and hemoglobin values were compared using paired t-test. RESULTS: 29 patients completed 3-months twice-daily iron therapy without interruption (compliance 87%). There was significant increase in mean weight (43.3 +/- 6.8 kg vs. 45.1+/- 6.9 kg; P < 0.0001) as well mean hemoglobin concentration (9.5 +/- 0.9 gm% vs. 11.7 +/- 0.7 gm%; P < 0.0001) and prevalence of anemia decreased by 40% from recruitment through the 3-months therapy. In terms of side effects, occasional constipation was stated by 3 patients, transient heartburn by two and diarrhea by none. Vomiting prompted withdrawal of iron therapy in one patient. CONCLUSIONS: Providing iron supplementation as directly observed home based therapy is feasible and successful in decreasing the prevalence of anemia in resource-poor settings.

Efetividade de três esquemas com sulfato ferroso para tratamento de anemia em gestantes / The effectiveness of three regimens using ferrous sulfate to treat anemia in pregnant women

OBJETIVO: Avaliar a efetividade de três esquemas de tratamento utilizando sulfato ferroso em gestantes anêmicas. MÉTODOS: O estudo foi desenvolvido no Centro de Atenção à Mulher do Instituto Materno Infantil de Pernambuco, em Recife, no período de maio de 2000 a dezembro de 2001. Realizou-se um ensaio clínico, aleatório e cego do ponto de vista laboratorial, utilizando comprimidos de 300 mg de sulfato ferroso para administração de 60 mg de ferro elementar. As gestantes foram alocadas em três grupos de tratamento, conforme a freqüência de administração do ferro: uma vez por semana (n =48); duas vezes por semana (n =53); e uma vez ao dia (n =49). Foram comparadas as concentrações de hemoglobina, volume corpuscular médio e ferritina. RESULTADOS: Antes da intervenção, os grupos eram homogêneos e apresentaram as seguintes médias e desvios-padrão nas concentrações de hemoglobina: 10,2 ± 0,5 g/dL para o grupo que recebeu sulfato ferroso uma vez por semana; 10,2 ± 0,6 g/dL para o grupo que recebeu sulfato ferroso duas vezes por semana; e 10,1 ± 0,6 g/dL para o grupo que recebeu sulfato ferroso uma vez ao dia. As médias de volume corpuscular médio foram, respectivamente: 88,5 ± 5,0; 87,6 ± 5,9; e 88,7 ± 5,1 fL. As medianas de ferritina foram 30,2; 37,1; e 52,9 ng/mL. Houve 27 por cento de cura no esquema de uma vez por semana, 34 por cento no grupo tratado duas vezes por semana e 47 por cento no tratamento diário. Houve fracasso terapêutico (hemoglobina <10 g/dL) em 41,6, 13,2 e 2,0 por cento dos casos em cada grupo, respectivamente. Abandono do tratamento por queixa de diarréia ou dor epigástrica só foi observado no tratamento diário. CONCLUSÃO: O tratamento diário continua sendo o mais eficaz. Contudo, o tratamento com sulfato ferroso duas vezes por semana é uma alternativa em caso de dificuldade de adesão ao tratamento diário

Objective. To evaluate the effectiveness of three regimens employing ferrous sulfate to treat pregnant women with anemia. Methods. The study was carried out at the Women's Health Center of the Pernambuco Institute of Maternal and Child Health in the city of Recife, Pernambuco, Brazil, from May 2000 to December 2001. A randomized clinical trial with blinded laboratory analysis was conducted. Iron (60 mg) was administered as 300-mg ferrous sulfate tablets. The women were allocated to three treatment groups, according to the frequency of ingesting the tablets: once a week (48 women), twice a week (53 women), and once a day (49 women). The groups were compared for the values for hemoglobin (Hb) concentration, mean corpuscular volume, and ferritin before and after the treatment. Results. Before the intervention, the groups were homogeneous. They had the following mean (± standard deviation) concentrations of hemoglobin: 10.2 ± 0.5 g/dL for the group receiving iron once a week, 10.2 ± 0.6 g/dL for the group receiving iron twice a week, and 10.1 ± 0.6 g/dL for the group receiving iron once a day. The means of corpuscular volume were, respectively: 88.5 ± 5.0 fL, 87.6 ± 5.9 fL, and 88.7 ± 5.1 fL. The respective medians for ferritin were 30.2 ng/mL, 37.1 ng/mL, and 52.9 ng/mL. The cure rate (Hb > 11 g/dL) was 27% in the patients treated once a week, 34% in those treated twice a week, and 47% in the women treated daily. Treatment failure (hemoglobin < 10 g/dL) was seen in 41.6%, 13.2%, and 2.0% of the patients in the respective groups. Interruption of treatment due to diarrhea or epigastric pain occurred only among the patients treated daily. Conclusion. The regimen with iron administered daily is still the best option for treating anemia. However, treatment with ferrous sulfate administered twice a week is an alternative for patients who are unable to adhere to daily treatment