Selected anthropometric variables and aerobic fitness as predictors of cardiovascular disease risk in children.

The aim of this study was to assess the suitability of body mass index, waist circumference, waist-to-height ratio and aerobic fitness as predictors of cardiovascular risk factor clustering in children. A cross-sectional study was conducted with 290 school boys and girls from 6 to 10 years old, randomly selected. Blood was collected after a 12-hour fasting period. Blood pressure, waist circumference (WC), height and weight were evaluated according to international standards. Aerobic fitness (AF) was assessed by the 20-metre shuttle-run test. Clustering was considered when three of these factors were present: high systolic or diastolic blood pressure, high low-density lipoprotein (LDL) cholesterol, high triglycerides, high plasma glucose, high insulin concentrations and low high-density lipoprotein (HDL) cholesterol. A ROC curve identified the cut-off points of body mass index (BMI), WC, waist-to-height ratio (WHtR) and AF as predictors of risk factor clustering. BMI, WC and WHR resulted in significant areas under the ROC curves, which was not observed for AF. The anthropometric variables were good predictors of cardiovascular risk factor clustering in both sexes, whereas aerobic fitness should not be used to identify cardiovascular risk factor clustering in these children.

Prospective surveillance applying the national nosocomial infection surveillance methods in a Brazilian pediatric public hospital.

BACKGROUND: A hospital-wide, traditional prospective surveillance for nosocomial infections was commenced in 1992 in Centro Geral de Pediatria in Minas Gerais, Brazil, to describe the epidemiology of nosocomial infection in this pediatric hospital and to implement cross-infection prevention and control policies. METHODS: We performed a prospective cohort nosocomial infection surveillance of all patients receiving acute care according to the hospital-wide and intensive care unit components of the National Nosocomial Infections Surveillance System from January 1993 to December 1997 (14,892 discharges; 131,764 patient-days). The Centers for Disease Control and Prevention (Atlanta) 1988-definitions and the Brazilian Ministry of Health-Legislation 930 (1992) were used. RESULTS: The average overall nosocomial infection rate per 1000 patient-days was 8.9 in units 2 and 3 and 16.4 in the pediatric intensive care unit. Over time, the overall hospital infection rate decreased from 16.6 nosocomial infections per 1000 patient-days in 1993 to 7.0 in 1997 (P <.05). We believe this can be attributed to interventions and data reporting during the period. The five most frequent sites of infections were eye-ear-nose-throat (38%), skin (22%), pneumonia (12%), soft tissue (5%) and laboratory-confirmed bloodstream infection (4%). In the pediatric intensive care unit, the most frequent nosocomial infection sites were pneumonia related to mechanical ventilators (22%), with rates ranging from 0 to 42 per 1000 ventilator-days; and sepsis related to central lines (11%), with rates ranging from 0 to 32 per 1000 central line-days. CONCLUSIONS: Describing the epidemiology of nosocomial infections in this hospital enabled us to establish infection occurrence, distribution, and expected incidence, as well as to recognize trends and keep track of possible outbreaks. The knowledge acquired through this surveillance allowed us to target more specific and continuous quality improvement projects, to upgrade health care quality in pediatric public hospitals in Brazil, and to implement preventive strategies. Methods from the National Nosocomial Infections Surveillance System can be successfully applied in pediatric public hospitals in Brazil.

Prevalence and impact of chronic otitis media in school age children in Brazil. First epidemiologic study concerning chronic otitis media in Latin America.

OBJECTIVE: The first epidemiological study carried out in Latin America to investigate the prevalence of otological disease and its impact in a representative random sample of the school children population. METHODS: A cross sectional epidemiological survey to investigate the epidemiology of otitis in a representative random sample of 1119 children and adolescents from a total of 486166 elementary and high-school students, aged 6-18 years, regularly registered in one of the 521 public and private schools of the city of Belo Horizonte, in the state of Minas Gerais, southern Brazil. The interviews were conducted individually, in the school, by an otolaryngologist or a pediatrician. The interview included all of the personal data and also detailed questions regarding otological disorders and hearing. The otological examination was carried out with Mini-Heine otoscopes and the audiometric evaluation with the AudioScope 3 with 25dB intensity. The questionnaire and basic procedures for medical examination had been previously tested through a pilot test in two schools. RESULTS: The prevalence of chronic otitis media was 0.94%. Impacted wax was found in 12.3% of the students. The prevalence of abnormalities (excluding wax) in the otoscopy examination was 10.5%. It was found that 8.3% of students had a past history of otitis and 7.7% had a past history of otorrhea. These two special groups presented statistically significant associations with chronic otitis media, hearing loss and otolaryngological surgeries (when compared with the other school children). Parents and school children seemed significantly able to identify a special group of children with past history of otitis during childhood.

Avaliaçäo do comportamento alimentar em crianças e adolescentes de Belo Horizonte / Assesment of eating attitudes of children and adolescents in Belo Horizonte city

Estudo da prevalência do comportamento alimentar de estudantes com relaçäo à imagem corporal, à prática de hiperfagia ou orgia alimentar, ao uso de dieta para emagrecimento e métodos purgativos para perda de peso (anorexígenos, diuréticos, laxantes e vômitos auto-induzidos). Delineamento tipo in

[Breast-feeding habits in Ouro Preto, MG, Brazil]. / Práticas de amamentação no município de Ouro Preto, MG, Brasil.

OBJECTIVE: To identify the frequency and median duration of breast-feeding in children aged 0-24 months in the city of Ouro Preto, Brazil. METHODS: A cross-sectional study was carried out to identify the median duration of breastfeeding in children aged 0-24 months. A sample of 229 children from 1800 households was drawn by clusters at three different occasions and stratified according to the area (urban or rural). The frequency and median duration of breast-feeding were calculated using the life table technique. RESULTS: A median duration of 198 days was found for breast-feeding as a whole: 71 days for the group of exclusive plus mainly breastfeeding and 17 days for exclusive breastfeeding. CONCLUSION: The current pattern of breast-feeding is of a short-term practice. This evidence suggests the need for intervention programs to promote breast-feeding for longer periods and delay the introduction of food supplementation, preventing the early weaning.

Modification of the cognitive model for bulimia via path analysis on a Brazilian adolescent sample.

Eating disturbances in middle-class Brazilian adolescents attending three high schools (one Military, two Private schools) were investigated. Participants from both Private schools were similar to U.S. samples on the EAT-26. Path analysis on the Private schools revealed the following. Higher body weight leads to weight concerns most strongly through greater discrepancy from the ideal, but it also leads directly to weight concern. Thus, both the reality of being heavier and the perception that one is larger than ideal (which could be due to being heavier and/or having a thin ideal) contribute to weight concern. Greater weight concern is associated most directly with lower self-esteem, which in turn is associated with endorsing greater importance of weight and shape. Importance of weight and shape contributes most powerfully to eating pathology through dieting, but this variable has a modest direct effect as well. These paths were not significant for the Military school sample in which participants reported lower levels of weight concern, dieting, body dissatisfaction, and a larger ideal figure. However, the Military sample rated importance of weight and shape as high as did Private-school participants. The results provide support for variables identified as important in the cognitive model of bulimia and suggest the model may be enhanced by including body weight and one's perceived ideal body shape as additional variables.

[Blood pressure in school children and adolescents - The Belo Horizonte study] / Pressão arterial em escolares e adolescentes - O estudo de Belo Horizonte.

OBJECTIVE: To investigate epidemiological aspects of blood pressure (BP) levels, and the prevalence of arterial hypertension in a representative sample of the whole elementary and high school population of the city of Belo Horizonte (state of Minas Gerais, southeastern Brazil). To describe the blood pressure levels found and the prevalence of BP levels above the 90th and 95th percentiles in the first and second measurements. To evaluate prevalence using four different normality references separately to assess the impact of choice of reference. To study the frequency at which the students blood pressure has been evaluated.METHODS: In an observational cross-sectional epidemiological study, we studied a sample of 1005 students, aged 6 to 18 year, randomized from an universe of 486,166 students from the 521 public and private elementary and high schools in the city. Each student was evaluated by means of a personal interview, anthropometric measurements, and two blood pressure measurements in a single visit and at a 10-minute interval.RESULTS: The systolic and diastolic blood pressure levels, by age and gender, were slightly lower than those described by the Task Force Report (1987) and by Rosner et al. (1993). The prevalence of BP levels (systolic or diastolic) over the 95th percentile were, according to the reference used: 8.7% - Task Force Report (1987); 5.5% - Rosner et al. (1993); 6.5% - Update on the Task Force Report (1996); and 9.8% - the 95th percentile from our own study. In the second measurement these prevalence rates dropped to 4.9%; 2.4%; 3.5% and 5.8%, respectively.CONCLUSIONS: We present a detailed description (mean values and standard deviations, and the 90th, 95th and 99th percentiles by age and gender) of the BP levels found in both measurements. Mean values and upper percentiles found in this study are very close to those found in the American references, which validates the current use of these references in Brazil. The prevalence of 9.0% of BP levels above the 90th percentile in two measurements made at random hints at the number of children who should be monitored for hypertension, and reinforces the importance of routine evaluation of blood pressure at every pediatric examination.

[A descriptive study of burn injuries in children and adolescents] / Estudo descritivo de queimaduras em crianças e adolescentes.

OBJECTIVE: To investigate the frequency of different kinds of burns, associated factors, major complications and their relations to other variables. METHODS: Descriptive study performed at Hospital João XXIII from January to December of 1992 with five hundred and thirtyseven children and adolescents. RESULTS: The age distribution was as follows: 408 patients were children (76%) and 129 were teenagers (24%). Most of the accidents, 398 cases (74%) happened at home, 235 of which (59%) in the kitchen. 80 patients were interned. They had the highest relative frequency of accidents outside home (p<0.05). Of these interned patients, 7 (9.0%) developed septicemia. The flame was the predominant agent within the group of inpatients (p<0.01) and was responsible for the highest extension of burning (p<0.05). Teenagers had the largest body burned surface compared to children (p<0.01). Local treatment with pomade or home made medicine was observed in 290 cases (54%); local wash with water only in 32 (6.0%). Dehydration was the most frequent complication and occurred in 28 (5,0%) patients. The average amount of internment was 30-/+33 days. CONCLUSIONS: Most of burning were consequence of domestic accidents, especially in youngers than 7 years old; hot liquids are the most frequent agents and kitchen the most frequent place. Flame, which determined the largest and deepest lesions, was the first cause of burns in teenagers and the second in children. Dehydration is the most frequent complication in the earlier phases and septicemia in the others.

[Experience of the Baby Friendly Hospital initiative]. / Experiência iniciativa Hospital Amigo da Criança.

In the study is analyzed and described the initiative called "Initiative Baby Friendly Hospitals", a program which started in Brazil, 1992. This initiative intends to support, to protect and to promote the breastfeeding as proposed in a meeting in 1990 in Florence, Italy, which was promoted by WHO and UNICEF. The basic goal of this initiative is to mobilize health professionals and hospital or maternity workers for changing their routines and conducts aiming to prevent the early wean. The health establishments are evaluated based on the "ten steps for success of breastfeeding, a group of goals created in the same meeting. In Brazil, the evaluation is coordinated by the Federal Government through the PNIAM (Programa Nacional de Incentivo ao Aleitamento Materno). A baby friendly hospital, if approved, receives from the Minister of Health, a Federal Governmental Agency (SUS) a differential payment for childbirth assistance and prenatal accompaniment, 10% and 40%, more respectively. Until 1998 year there were 103 baby friendly hospitals in Brazil, with the majority of them located in the northeast area (68.1%). However, taking in accounting the number of 5650 hospitals linked to SUS in the country, less than 2.0% are baby friendly hospitals. On the basis of the experience and according with PNIAM data the implementation of the ten steps and the incentive to breastfeeding through baby friendly hospitals have resulted in a significant increase of breastfeeding incidence and duration in Brazil.

Experiência iniciativa Hospital Amigo da Criança / Experience of the initiative baby friend hospitals in Brazil

É realizada uma análise descritiva do programa de incentivo ao aleitamento materno denominado de "Iniciativa Hospital Amigo da Criança, IHAC", idealizada pela OMS e UNICEF em 1990, Florença, Itália, com a participaçao do Brasil. O objetivo básico consiste na mobilizaçao de profissionais de saúde, funcionários de hospitais e maternidades para mudanças em rotinas e condutas, visando prevenir o desmame precoce. Para esta finalidade, criou-se os "dez passos para o sucesso do aleitamento Materno", um conjunto de metas elaborado por um grupo de especialistas de saúde e nutriçao. No Brasil, a IHAC é coordenada pelo Ministério da Saúde (MS), Programa Nacional de Incentivo ao Aleitamento Materno (PNIAM). Os estabelecimentos de saúde para se tornarem Hospitais Amigos da Criança precisam preencher critérios estabelecidos pelo PNIAM e cumprir 80 por cento do conjunto de metas no processo de avaliaçao, envolvendo várias etapas. A instituiçao credenciada IHAC vinculada ao SUS, recebe pagamento diferenciado: 40 por cento a mais em atendimentos pré-natal e 10 por cento na assistência ao parto. Em 1998 no Brasil existem 103 hospitais credenciados: 68 por cento Nordeste; 9,7 por cento Sul, 10,6 por cento Centro-Oeste, 8,7 por cento Sudeste, 2,9 por cento Norte. Ainda é pequeno o número de instituiçoes credenciadas, representando apenas 1,7 por cento. Proporcionalmente, os índices de HIAC sao: 3,78 por cento Nordeste, 1,89 por cento Centro-Oeste, 0,89 por cento Sul, 0,53 por cento Sudeste, 0,73 por cento Norte. Resultados da IHAC têm sido um aumento dos índices de amamentaçao. Para ampliar o número de HIAC no país, é necessário empenho dos profissionais de saúde, vontade e decisao política do governo para investir em programas de incentivo, promoçao e apoio ao aleitamento materno.

Short report: endomyocardial fibrosis and cardiomyopathy in an area endemic for schistosomiasis.

An association of schistosomiasis and endomyocardial fibrosis or cardiomyopathy has been suggested. Clinical, stool, abdominal ultrasound, electrocardiogram, and Doppler echocardiogram examinations were performed on 226 patients from an area endemic for schistosomiasis. The diagnosis of schistosomiasis was made in 152 patients (69%) but clinical, electrocardiographic, or Doppler echocardiographic evidence of a schistosome cardiomyopathy or endomyocardial fibrosis could not be detected in any patient.

[Post-graduation aspects in Medical School of the Universidade de Minas Gerais]. / Aspectos da pós-graduação na Faculdade de Medicina da UFMG.

The post-graduation at Medical School of Federal University of Minas Gerais (UFMG) is composed by 9 courses and has been for 30 years. Among these, 6 courses have Masterate and Doctorate levels, and 3 have only Masterate. It has already been produced 584 thesis and dissertati Doctorate courses with A (20%), B (20%), C (60%). The average amount of produced thesis and dissertations has been through 2 and 8 by year. The integration proposal of Medical internship and Masterate will be an opportunity of reducing the length of Masterate. The Post-Graduation Center (CPG) coordenates the post-graduation politics and activities at Medical School of UFMG.

[Late hemorragic disease of the newborn: case report] / Doença hemorrágica do recém-nascido na forma tardia: descrição de casos.

OBJECTIVE: In this study the authors review this subject, and call attention for the late hemorrhagic disease of the newborn, due to the severity and higher risk of mortality and neurological sequelae.METHODS: In this article, four cases of children, age raging from 12 to 21 days, with late hemorrhagic disease associated with vitamin K deficiency were reported. RESULTS: All newborns had multiple hemorrhagic manifestations of the disease. The systems more affected were digestive tract, urinary system, umbilical cord, respiratory system and nervous system.CONCLUSION: Three forms of hemorrhagic disease of newborn have been related with vitamin K deficiency. However, late vitamin K deficiency bleeding is not common and may not be diagnosed by pediatrician. This form of disease can be prevented by vitamin K prophylaxis administration after birth.

[Bacterial contamination of breast milk collected through manual expression and stored at room temperature] / Contaminação bacteriana do leite humano coletado por expressão manual e estocado à temperatura ambiente.

OBJECTIVES: To the determine the bacterial contamination profile of unheated expressed breast milk, collected without rigid hygienic precautions and stored at room temperature for nine hours. The purpose was to give poor lactating mothers the alternative of storing their own milk out of refrigerator. A research on cultural, social and economical aspects as well as on donators knowledge about breastfeeding was considered necessary. METHODS: 35 donators were interviewed and an experimental investigation was performed with 33 samples of breast milk stored at room temperature (17 masculine C to 30.5 masculine C) and bacteriologically analyzed at zero, three, six and nine hours after collection. The same breast milk was stored at refrigerator (2 masculine C to 6 masculine C) as a control procedure. Total count of bacterial contents and identification of Staphylococcus aureus and Escherichia coli were evaluated.RESULTS: The enterviews revealed the low socio-economical and cultural level of lactating mothers and their little experience in expressing, collecting and using their own milk. Bacteriological data analysis showed mesophyllous average of 7.1x10(3)UFC/mL, acceptable outline of bacterial contamination, despite the use of a simplified hygiene technique. After nine hours, samples stored at room temperature showed final average of bacterial contents similar to the first ones (7.3x10(3)UFC/mL) and without relevant statistic differences from the ones kept under refrigeration (p=0.05) for studied bacterias.CONCLUSION: This study shows that it is possible to use unprocessed breast milk for babýs consumption if it is stored at room temperatures until nine hours after it has been collected. However, mothers have to be told about the possibility of storing breast milk for babies later consumption.

Pulmonary hypertension in schistosomiasis mansoni.

To evaluate cardiopulmonary involvement in schistosomiasis mansoni, 246 patients from an endemic area of Brazil were examined; 152 had been previously treated for schistosomiasis. Based on stool examination and/or abdominal ultrasonography, the patients were divided into those with schistosomiasis (69%) and those in whom the disease was not present (31%). M mode measurements were similar in the 2 groups. Pulmonary pressure was measured by Doppler echocardiography; 25% of the subjects had pulmonary hypertension. Those with pulmonary hypertension had a higher prevalence of schistosomiasis (80%) than those without (64%; P = 0.03). No case of cor pulmonale was diagnosed by electrocardiography or Doppler echocardiography. The prevalence of pulmonary hypertension correlated neither with periportal fibrosis nor with prior treatment for schistosomiasis.

[Promoting and supporting breast-feeding: Baby Friendly Hospital Initiative]. / Promoção e incentivo ao aleitamento materno: Iniciativa Hospital Amigo da Criança.

The objective of this article is to analyze the "Baby Friendly Hospital Initiative" in Brazil. This initiative, that intends to support, protect and promote breast-feeding, has been proposed in a meeting in Florence, Italy, in 1990, promoted by OMS and UNICEF. The basic goal of this initiative is to mobilize health professionals and hospital or maternity workers to change their routines and conducts in order to prevent early wean. Health establishments are evaluated based on the "Ten steps for the success of breast-feeding" (a group of goals created in the same meeting by a group of health and nutrition specialists). In Brazil, the evaluation is coordinated by PINAM, and carried out in two steps. If approved, the hospital receives extra payment for childbirth assistance and prenatal follow-up. Up to now 64 hospitals in Brazil have received approval. Data from PNIAM show that the implementation of the ten steps and the encouragement of breast-feeding resulted in significant increase of its levels in Brazil.

[Proposal of residency integrated with medical masters degree at the UFMG Medical School: an evaluation among residents]. / Proposta de residência médica integrada com o mestrado na Faculdade de Medicina da UFMG: uma avaliação junto aos residentes.

A project which integrates medical RESIDENCY with medical masters degree has been discussed and is expected to be set up at UFMG Medical School in the near future. Such project is optional for the entering residents and aims those who are interested in becoming researchers. This paper's objective is to raise the residents' opinion on the project as well as their interests in post graduation level. A 240 university hospital residents (HC-UFMG) and a 114 non-university hospital (IPSEMG) were studied through questionnaire application. From the total population of 354 residents we had a 50% questionnaire devolution, 120 (68%) from HC-UFMG and 57 (32%) from IPSEMG. Residents of different clinical and surgical areas were included, 55% male and 45% female. Most of them work exclusively in residency activities, 69% have interest in specialize after residency, 55% in taking medical masters degree, 52% in taking up academic life and 67% in applying for the integrated residency-master degree program. Twelve (7%) are not particularly interested in join the program because they are not sure whether they are able to carry on adequately both residency and research activities at the same time. This study shows that residents are highly receptive to the UFMG's program and that more detailed information concerning its contents should be handed out in order to generate further discussion.

[Integrated program of post-graduation, medical residence and masters in the Medical School of the Federal University of Minas Gerais]. / Programa Integrado de Pós-graduação, Residência Médica e Mestrado na Faculdade de Medicina da Universidade Federal de Minas Gerais.

An integrated program of medical residence and master ship the UFMG School of Medicine is discussed. Besides the regular activities in the medical residence, after the second year, students could have access to courses such as Epidemiology, Statistics, Research Methodology as part of their scientific formation. At the end of the residence program, the Medical Resident would be able to finish a dissertation an to get a MS degree in Medicine.