Acute toxicity of essential oils of Aloysia triphylla (L'Hér.) Britton, Lippia gracilis Schauer, and Piper aduncum L. in Colossoma macropomum (Cuvier, 1818).

The aim of this study was to determine the acute toxicity of the essential oils (EOs) of Aloysia triphylla, Lippia gracilis and Piper aduncum in juvenile tambaqui (Colossoma macropomum), and evaluate the possible histopathological alterations in their gills. For the acute toxicity tests, juvenile tambaqui (n=24/treatment) were distributed in six treatments with three replicates, which comprised the control and five EO concentrations of A. triphylla (60, 80, 100, 120 and 140 mg L-1), L. gracilis (35, 40, 45, 50 and 55 mg L-1) and P. aduncum (42.5, 45, 47.5, 50 and 52.5 mg L-1), with an exposure period of 4 h. The mortality rate and severity of damage to the tambaqui gills were proportional to the increase in the concentration of the EO, with LC50-4 h values estimated at 109.57 mg L -1 for A. triphylla, 41.63 mg L -1 for L. gracilis and 48.17 mg L -1 for P. aduncum. The main morphological damages observed in the gills of the tambaqui exposed to the three EOs, were Grade I: hypertrophy and hyperplasia of lamellar epithelial cells, lamellar fusion, epithelial detachment, capillary dilation and constriction, proliferation of chloride cells and mucosal cells and edema; in low frequency Grade II damage as epithelial rupture and lamellar aneurysm. Necrosis (Grade III damage) was observed only in gill lamellae exposed to P. aduncum EO (47.5, 50.0 and 52.5 mg L-1). Concentrations of EOs below LC50-4 h can be used sparingly, for short periods of exposure for the treatment of diseases in tambaqui breeding.

ADAMTS5 is required for normal trabeculated bone development in the mandibular condyle.

OBJECTIVE: Determine the role of the extracellular matrix protease ADAMTS5 in development of the trabeculated bone of the mandibular condyle. METHODS: The mandibular condyles of wild type and mice deficient in the protease ADAMTS5 were examined for histopathology with Safranin O staining. Microcomputed tomography was performed to analyze the developing bone of the mandibular condyle. RNAscope and immunohistochemistry were utilized to investigate cell type and extracellular matrix expression. RESULTS: Mice deficient in Adamts5, (Adamts5tm1Dgen/J) exhibit an increase in trabecular separation (n = 37 wild type; n = 27: P < 0.0001) and reduction of trabecular thickness P = 0.0116 and bone volume fraction P = 0.0869 in the mandibular condylar head compared to wild type littermates. The altered bone parameters were more pronounced in male Adamts5-/- mice compared to female Adamts5-/- mice (TbSp; P = 0.03). Adamts5 was co-expressed with versican and Gli1 in mesenchymal, stem-like cells in the transition zone where the trabeculated bone is adjacent to mature hypertrophic chondrocytes. Loss of Adamts5 caused a reduction of Bglap expressing osteoblasts throughout mandibular condylar development and in young adult mice. The protease Mmp13, that is involved in mineralization and is expressed by hypertrophic chondrocytes and osteoblasts, was reduced in the mandibular condyle of Adamts5 deficient mice. CONCLUSION: This is the first report of a novel and critical role for Adamts5 in bone formation within the mandibular condyle of the temporomandibular joint. These data indicate Adamts5 may be required in the transdifferentiation of hypertrophic chondrocytes to osteoblasts during trabecular bone formation in development of the mandibular condyle.

Sarcopenia en pacientes oncológicos en tratamiento Quimioterápico / Sarcopenia in oncological patients in chemotherapy Treatment

RESUMEN La sarcopenia se caracteriza por la tríada de reducción de masa muscular en asociación con reducción de la fuerza muscular y/o desempeño físico. Entre las enfermedades crónicas, el cáncer se configura como una condición relacionada al desarrollo de la sarcopenia, debido a la condición inflamatoria, al catabolismo proteico y a la inapetencia alimentaria atribuida a los diversos efectos colaterales del tratamiento de quimioterapia. Objetivo: Describir la prevalencia de sarcopenia en pacientes oncológicos en tratamiento quimioterapéutico. Método: Estudio transversal realizado con pacientes de ambos sexos, en un hospital universitario del nordeste brasileño. Se determinó la sarcopenia a través de la circunferencia muscular del brazo (percentil <10); fuerza de prensión palmar: <20 kg/f y < 30 kg/f para mujeres y hombres ancianos respectivamente, menor tercil: <28,7kg/f y <15,6 kg/f para hombres y mujeres adultas respectivamente y velocidad de marcha (<0.8 m/s). Se evaluaron las variables de asociación, como datos sociodemográficos, estilo de vida, clínico y antropométrico. Resultados: La muestra fue compuesta por 117 pacientes, con edad promedio 60,5 ±13,2 años con prevalencia del sexo femenino (el 59,8%). Se verificó una prevalencia de sarcopenia del 27,4%, y se observó que el 53,1% tenían sarcopenia severa. Los ancianos fueron los más sarcopénicos (p= 0,003). Se encontró también una asociación positiva con el estado nutricional (p<0,001). Conclusión: La prevalencia de la sarcopenia fue significativa y semejante a otros estados, siendo más prevalentes en los pacientes desnutridos y ancianos.

ABSTRACT Sarcopenia is characterized by the triad of reduced muscle mass in association with reduced muscle strength and / or physical performance. Among chronic diseases, cancer is a condition related to the development of sarcopenia because of, among other factors, inflammation, protein catabolism and loss of appetite attributed to the side effects of chemotherapy treatment. Objective: To describe the prevalence of sarcopenia in cancer patients undergoing chemotherapy. Method: A cross-sectional study was carried out with patients of both sexes, in a university hospital in Northeastern Brazil. Sarcopenia was determined by arm circumference (percentile <10); hand grip strength (<20 kg/f and <30 kg/f for women and men, respectively; lowest tertile: <28.7 kg/f and <15.6 kg/f for men and women, respectively) and gait velocity (<0.8 m/s). Sociodemographic, lifestyle, clinical and anthropometric variables were also evaluated. Results: The sample consisted of 117 patients (59.8% female), with a mean age of 60.5 ± 13.2 years. There was a prevalence of sarcopenia of 27.4% and 53.1% had severe sarcopenia. Sarcopenia was more common in older participants (p= 0.003). There was also a positive association with nutritional status (p<0.001). Conclusion: The prevalence of sarcopenia was significant and similar to other studies, being more prevalent in undernourished and elderly participants.

Fragilidad en ancianos oncológicos en tratamiento con quimioterapia / Frailty in elderly oncology patients in chemotherapy treatment

RESUMEN Los ancianos están más expuestos al desarrollo del cáncer, pues el envejecimiento deja las células más susceptibles a la transformación maligna. Identificar la fragilidad puede contribuir a mejorar resultados en el tratamiento antineoplásico. El objetivo de este estudio fue identificar la prevalencia y grado de fragilidad en ancianos oncológicos en tratamiento con quimioterapia e investigar factores asociados al síndrome. Se incluyeron pacientes ≥60 años en nivel ambulatorio. La fragilidad se evaluó a partir del fenotipo desarrollado en la Universidad Johns Hopkins. El nivel de significancia adoptado para todas las pruebas fue menor que p<0,05. De la muestra de 60 individuos, el 55,0% era hombres, con promedio de edad 69,8±7,6. Entre los pacientes evaluados, el 66,7% presentaron fragilidad y el 33,3% pre-fragilidad. Las mujeres fueron más frágiles (81,5% vs 54,5%; p= 0,028) y la fragilidad tendió a ser mayor entre los caquécticos (81,8% vs 57,9%; p= 0,051). Concluimos que hubo un porcentaje elevado de pacientes frágiles y pre-frágiles. El sexo femenino y el sedentarismo se presentaron como factores asociados.

ABSTRACT The elderly are more at risk for developing cancer, as aging leaves cells more susceptible to malignant transformations. Identifying frailty can contribute to improved outcomes in antineoplastic treatment. The purpose of this study was to identify the prevalence and degree of frailty in elderly cancer patients undergoing chemotherapy treatment and investigate factors associated with this syndrome. Ambulatory patients> 60 years were included. Frailty was assessed from the phenotype developed by Johns Hopkins University. The significance level adopted for all tests was p<0.05. From the sample of 60 individuals, 55.0% were men, with mean age 69.8 ± 7.6. Among the patients evaluated, 66.7% presented frailty, and 33.3% pre-frailty. Women were more frail (81.5% vs 54.5%; p= 0.028) and frailty tended to be higher among cachectic patients (81.8% vs 57.9%; p= 0.051). We concluded that there was an elevated percentage of frail and pre-frail patients. Female sex and sedentarism were associated factors.

Invasive slug Meghimatium pictum (Stoliczka, 1873) infected by Angiostrongylus costaricensis Morera & Céspedes, 1971, and the possible risk of human infection associated with grape consumption.

Many molluscs may be infected with angiostrongylid larvae. Following the histopathological diagnosis of abdominal angiostrongyliasis in a grape farmer from southern Brazil, molluscs in the area were investigated. During a nocturnal search, 245 specimens of slugs were collected and identified as the invasive Chinese slug Meghimatium pictum. Angiostrongylus costaricensis worms were recovered from mice that were experimentally infected with larvae obtained from 11 (4.5%) of the molluscs. This study presents the first report of M. pictum being identified as an intermediate host for A. costaricensis. Most of the slugs were collected from grape plants, which suggests that transmission may be associated with grape consumption.

High-dose enoxaparin in the treatment of abdominal angiostrongyliasis in Swiss mice.

Abdominal angiostrongyliasis (AA) is caused by Angiostrongylus costaricensis, which inhabits mesenteric arteries. There is no drug treatment for AA, and since intestinal infarction due to thrombi is one of the main complications of the disease, the use of anticoagulants may be a treatment option. Thus, we aimed to assess the effect of high doses of enoxaparin on the prevention of ischaemic intestinal lesions and on the survival of mice infected with A. costaricensis. Twenty-four mice were infected with L3 of A. costaricensis and divided equally into two groups: Group 1, control treated with placebo, and Group 2, treated daily with enoxaparin (2.5 mg/kg) for 50 days. All mice were subjected to necropsy and histological analysis. The results from gross and microscopic assessments showed no variation in the prevalence of lesions between the groups. An analysis was also performed among survivors and non-survivors, showing that animals that died often presented lesions, such as granulation tissue in the serosa, and intestinal infarction and adhesion. The mortality rate did not vary between the enoxaparin-treated and control groups. Thus, we showed that high doses of enoxaparin have no protective effect against AA, as the survival rates and lesions of mice did not vary between the treated and control groups. Considering that the use of prophylactic doses was also shown to be ineffective in a previous study, we do not recommend the use of enoxaparin for AA treatment.

First record of larvae of Hysterothylacium (Nematoda: Anisakidae) with zoonotic potential in the pirarucu Arapaima gigas (Osteichthyes: Arapaimidae) from South America.

Third-stage larvae (L3) of Hysterothylacium sp. were collected by the first time in juveniles of pirarucu Arapaima gigas farmed in the Rio Preto da Eva, Amazonas state. Ninety-eight (98) out of 100 examined fish showed to be parasitized. Five hundred and ninety larvae of Hysterothylacium sp. were collected from the intestines, stomach and pyloric caeca. The mean intensity of parasite indexes was 6.02 (±5.75) ranging from 1 to 40 larvae per host and the mean abundance was 5.9 (±5.76). The A. gigas is the new host record for larvae of Hysterothylacium sp. in Brazil, and this is the first record of larvae of Hysterothylacium (Nematoda: Anisakidae) with zoonotic potential in the pirarucu from South America.

First record of larvae of Hysterothylacium (Nematoda: Anisakidae) with zoonotic potential in the pirarucu Arapaima gigas (Osteichthyes: Arapaimidae) from South America / Primeiro registro de larvas de Hysterothylacium sp.(Nematoda: Anisakidae) com potencial zoonótico em pirarucu Arapaima gigas (Osteichthyes: Arapaimidae) na América do Sul

Abstract Third-stage larvae (L3) of Hysterothylacium sp. were collected by the first time in juveniles of pirarucu Arapaima gigas farmed in the Rio Preto da Eva, Amazonas state. Ninety-eight (98) out of 100 examined fish showed to be parasitized. Five hundred and ninety larvae of Hysterothylacium sp. were collected from the intestines, stomach and pyloric caeca. The mean intensity of parasite indexes was 6.02 (±5.75) ranging from 1 to 40 larvae per host and the mean abundance was 5.9 (±5.76). The A. gigas is the new host record for larvae of Hysterothylacium sp. in Brazil, and this is the first record of larvae of Hysterothylacium (Nematoda: Anisakidae) with zoonotic potential in the pirarucu from South America.

Resumo Larvas de terceiro estágio (L3) de Hysterothylacium sp. foram coletadas pela primeira vez em juvenis de pirarucu Arapaima gigas cultivados no Rio Preto da Eva, Estado do Amazonas. Noventa e oito (98) dos 100 peixes examinados estavam parasitados. Quinhentos e noventa larvas de Hysterothylaciumsp.foram coletados no intestino, estômago e cecos pilóricos. O índice parasitário de intensidade média foi de 6,02 (±5,75) variando de 1 a 40 larvas por hospedeiro e o de abundância média foi de 5,9 (±5,76). A. Gigas é um novo registro de hospedeiro para larvas de Hysterothylacium sp. no Brasil, também sendo, o primeiro registro de larvas de Hysterothylacium sp. com potencial zoonótico em pirarucu da América do Sul.

Carbon nanotubes: Properties, biomedical applications, advantages and risks in patients and occupationally-exposed workers.

Since the beginning of the 21st century, carbon-based nanomaterials (CNTs) have been introduced in pharmacy and medicine for drug delivery system in therapeutics. CNTs have proved able to transport a wide range of molecules across membranes and into living cells; therefore, they have attracted great interest in biomedical applications such as advanced imaging, tissue regeneration, and drug or gene delivery. Although there are many data on the advantages in terms of higher efficacy and less adverse effects, several recent findings have reported unexpected toxicities induced by CNTs. The dose, shape, surface chemistry, exposure route, and purity play important roles in these differential toxicities. Mapping these risks as well as understanding their molecular mechanisms is a crucial step in the development of any CNT-containing nanopharmaceuticals. This paper seeks to provide a comprehensive review of all articles published on cellular response to CNTs, underlining their therapeutic applications and possible toxicity in patients and occupationally exposed workers.

Relaxometric investigations and MRI evaluation of a liposome-loaded pH-responsive gadolinium(III) complex.

Accurate measurement of the tissue pH in vivo by MRI may be of clinical value for both diagnosis and selection/monitoring of therapy. To act as pH reporters, MRI contrast agents have to provide responsiveness to pH that does not require prior knowledge of the actual concentration of the contrast agent. This work deals with the use of a paramagnetic gadolinium(III) complex, loaded into liposomes, whose relaxometric properties are affected by the pH of the medium. In this system, the amphiphilic metal complex, which contains a moiety whose protonation changes the coordination properties of the metal chelate, experiences a different intraliposomial distribution depending on the pH conditions. The pH of the solution can be unambiguously identified by exploiting the peculiar characteristics of the resulting NMRD profiles, and a ratiometric pH-responsive method has been set up by comparing the relaxation enhancement at different magnetic field strengths.

[Evaluation in vitro of the cardiotoxic effects of 5-fluorouracil for the prevention of cardiovascular damage in health workers occupationally exposed]. / Valutazione in vitro degli effetti cardiotossici da 5-fluorouracile per la prevenzione dei danni cardiovascolari negli operatori sanitari professionalmente esposti.

The occupational exposure to antineoplastic drugs in health care workers determines a risk of absorption through inhalation of vapors or skin contact with drops. Even if many data confirm the cardiotoxicity of anthracyclines, is not clear the evidence of cytotoxicity of 5-Fluorouracil, thoug in a percent of patients receiving this chemotherapy, there is the presence of heart pain, aspecific ECG disorders and induction of coronary disease. This experimental study wants to analyze on the H9c2 cardiomyocyte cell model the effects of 5-Fluorouracil, commonly used in hospital realities of the South Italy, for the prevention of the possible cardiovascular damage in workers occupationally exposed.

Avaliação antropométrica de crianças em creches do município de Bezerros, PE / Anthropometric evaluation of children from day care centers in the municipality of Bezerros, Pernambuco, Brazil

OBJETIVO: Avaliar o estado nutricional de crianças matriculadas em creches da rede pública de ensino do município de Bezerros, Pernambuco. MÉTODOS: Estudo transversal que analisou os indicadores antropométricos de 735 crianças com idade entre um e sete anos (70 por cento das matrículas do ano letivo de 2008 no município). Para classificação do estado nutricional, foram utilizados os índices estatura/idade (E/I) e peso/estatura (P/E), expressos em valores de escore Z com base na curva do CDC (2000). O software utilizado para análise dos dados foi o Epi-Info, versão 6,04. RESULTADOS: Das crianças estudadas, 53,7 por cento eram do sexo masculino e 72,7 por cento provenientes de creches situadas em área urbana. A avaliação nutricional apontou uma prevalência de déficit nutricional de 6,8 e 0,7 por cento segundo os índices E/I e P/E, respectivamente. A prevalência de obesidade segundo o P/E foi de 6,1 por cento. Houve maior prevalência de baixa estatura entre as crianças do sexo feminino e risco para baixa estatura para o sexo masculino. Não foram observadas diferenças no estado nutricional das crianças de creches de área urbana e rural. Das crianças com déficit de E/I, 10 por cento apresentaram obesidade associada. Calculando-se a razão entre a prevalência de obesidade e déficit de P/I, verificou-se razão de 1,7:1, sendo 1,3:1 e 5:1 para as crianças do meio urbano e rural, respectivamente. CONCLUSÕES: A baixa estatura e a obesidade foram os distúrbios nutricionais mais prevalentes na população de estudo, com maior expressividade do processo de transição nutricional nas crianças de área rural.

OBJECTIVE: To evaluate the nutritional status of children from day care centers of the public educational system in the municipality of Bezerros, Pernambuco, Brazil. METHODS: This cross-sectional study examined the anthropometric indicators of 735 children aged between one and seven years old, which accounted for 70 percent of the children enrolled at the educational system of Bezerros municipality in 2008. The indicators used for classification of the nutritional status were height/age (H/A), weight/age (W/A) and weight/height (W/H), all expressed as Z-score values. The software used for data analysis was the Epi-Info, version 6.04. RESULTS: In the studied group, 53.7 percent of the children were males and 72.7 percent were from day care centers located in the urban area. The nutritional assessment revealed a prevalence of nutritional deficit of 6.8 and 0.7 percent according to H/A and W/H, respectively. The prevalence of obesity according to the W/H was 6.1 percent. A nutritional risk for short stature was observed among males, and a higher prevalence of short stature was verified among female children. There were no differences between urban and rural day care centers in relation to children nutritional status. Obesity was associated to H/A deficits in 10 percent of the children. The ratio between the prevalence of overweight and deficit of W/A was 1.7:1, being 1.3:1 for children from the urban areas and 5:1 for those from rural areas. CONCLUSION: Short stature and obesity were the most prevalent nutritional disorders in the studied population. The nutritional transition process was more evident in children of rural area.

Considerations on methodology used in the World Health Organization 2000 Report.

The article analyzes the World Health Organization Report for 2000, with emphasis placed on the methodology used to analyze the indicators utilized to compare and classify the performance of the health systems of the 191 member countries. The Report's contribution was the compromise of monitoring the performance of the health systems of member countries, but because of the inconsistent way it was elaborated, and the utilization of questionable scientific evaluation methodologies, the Report fails to give a clear picture. A criterion-based methodology revision is imposed. The main problems in evidence are the choice of individual indicators of disparity in health that discount the population profile, the inadequate control of the impact of social disparities over the performance of the systems, the evaluation of the responsibility of systems that are only partially articulated to the right of the citizens, the lack of data for a great number of countries, consequently having inconsistent estimations, and the lack of transparency in the methodological procedures in the calculation of some indicators. The article suggests a wide methodological revision of the Report.

Health sector reform in Brazil: a case study of inequity.

Health sector reform in Brazil built the Unified Health System according to a dense body of administrative instruments for organizing decentralized service networks and institutionalizing a complex decision-making arena. This article focuses on the equity in health care services. Equity is defined as a principle governing distributive functions designed to reduce or offset socially unjust inequalities, and it is applied to evaluate the distribution of financial resources and the use of health services. Even though in the Constitution the term "equity" refers to equal opportunity of access for equal needs, the implemented policies have not guaranteed these rights. Underfunding, fiscal stress, and lack of priorities for the sector have contributed to a progressive deterioration of health care services, with continuing regressive tax collection and unequal distribution of financial resources among regions. The data suggest that despite regulatory measures to increase efficiency and reduce inequalities, delivery of health care services remains extremely unequal across the country. People in lower income groups experience more difficulties in getting access to health services. Utilization rates vary greatly by type of service among income groups, positions in the labor market, and levels of education.

Dispersão do intervalo QTc nos diferentes padröes geométricos e funcionais do ventrículo esquerdo na hipertensão sistêmica / QTc interval dispersion in different geometric and functional patterns of the left ventricle in systemic arterial hypertension

OBJETIVO: Analisar a dispersão do QTc nos diferentes padröes morfológicos e funcionais da hipertensão arterial sistêmica. PACIENTES E MÉTODOS: Foram estudados prospectivamente 162 pacientes portadores de hipertensão arterial sistêmica (HAS), oriundos de uma mesma instituição, e que foram submetidos a eletrocardiograma (ECG) computadorizado com registro sumultâneo das 12 derivaçöes e a ecocardiograma. Os ECGs foram analisados "off-line" por dois observadores independentes com auxílio do programa APEXPOS. Os índices de massa ventricular foram estimados pelo ecocardiograma modo M guiado pelo bidimensional, através da equação de regressão de Devereux. Os pacientes foram divididos em 64 normais (G1), 25 com remodelagem concêntrica (G2), 20 com hipertrofia ventricular (HVE) excêntrica, 43 com HVE concêntrica (G4) e 10 com disfunção sistólica do ventrículo esquerdo (G5). RESULTADO: Houve correlação significativa da dispersão do QTc com o índice de massa do ventrículo esquerdo (r=0,45 e p<0,001). Após ajuste para a idade, fração de ejeção e número de derivaçöes aferidas, a correlação manteve-se significativa (r= 0,37 e p, 0,001). Em relação à análise multivariada em "stepwise", somente a dispersão do QTc e a idade foram preditores independentes de HVE (p< 0,0001 e 0,05). As médias das dispersöes do QTc foram: ... fórmulas ..., com G4 e G5 diferindo significativamente de G1 e G2 pelo teste de Scheffé (p< 0,05). Num modelo de MANOVA, diferenças persistiram entre grupos após inclusão da idade e da fração de ejeção. CONCLUSÄO: A dispersão do QTc difere significativamente entre os diversos padröes geométricos-funcionais do ventrículo esquerdo na hipertensão arterial sistêmica, sendo preditora independente de hipertrofia ventricular esquerda.

Short report: prevalence of hepatitis C viral antibody among Brazilian children, adolescents, and street youths.

The prevalence of hepatitis C antibodies (anti-HCV) was investigated in 1,378 central Brazilian children, students, and street youths (homeless adolescents without family links or adolescents working in poorly paid activities). Sera were tested with a second generation enzyme-linked immunosorbent assay, and positive samples were retested by a confirmatory assay (line immunoassay). All children attending day care centers were anti-HCV negative. Only one (0.2%) adolescent was positive in the student group. However, higher positivity was found in street youths; four (1.0%) living at home and three (3.0%) living in the streets and anti-HCV antibodies. Among these, the prevalence of anti-HCV increased significantly with age from 0% in the 9-12-year-old group to 6.9% in the 17-20-year-old group. Risk factors including blood transfusion, tattooing, intravenous drug use, and sexual intercourse with multiple partners were significantly associated with the presence of anti-HCV in street youths. These results indicate that apparently healthy children and adolescents attending day care centers or primary schools in central Brazil have a low exposure to HCV infection, but street youths in the same area are at risk for infection with this virus.

Risk factor and prevalence of antibodies against hepatitis a virus (HAV) in children from day-care centers, in Goiania, Brazil

Um estudo seroepidemiologico para o virus da hepatite A (VHA), investigando os marcadores de infeccao passada (anti-VHA total anti-IgG e IgM) e infeccao recente (anti-VHA IgM), foi realizado entre 1991 e 1992, em criancas de creche de Goiania-Brasil central. Das 310 criancas com idade entre 03 meses e 09 anos, 69,7 por cento mostraram soropositividade ao anti-VHA total, sendo 60 por cento, na faixa etaria entre 1 e 3 anos. A prevalencia do marcador anti-VHA IgM foi de 3,2 por cento visto em idade de 1-4 anos e com distribuicao uniforme nas 10 creches estudadas. Entre as variaveis sociodemograficas estudadas, apenas o tempo de frequencia das criancas nas creches, igual ou superior a um ano, mostrou, em analise multivariada ajustada para idade, um risco de 4,7 vezes maior quando comparado com o periodo de um mes (LC 95 por cento 2,3-9,9)...