Oral and oropharyngeal cancer: time from first symptoms to treatment initiation and associated factors.

The aim of this study was to evaluate the time elapsed from first symptoms to the treatment of oral and oropharyngeal cancer (OOC) and to identify variables associated with treatment delay. This is an observational study with retrospective and prospective data collection. Patients with a diagnosis of OOC seen at the Head and Neck Surgery outpatient clinic of a Brazilian public hospital were included and followed up to treatment initiation. Participants answered a questionnaire for the collection of socioeconomic, demographic, cultural, and clinical information, as well as information about the time elapsed from first symptoms to the first appointment with a head and neck surgeon. Time to treatment was classified into four intervals: 1- first symptoms to first medical appointment; 2- first medical appointment to specialized medical care; 3- specialized medical care to preparation for treatment; and 4- preparation for treatment to treatment initiation. Bivariate statistics were computed. Out of 100 participants, nine died before treatment. Mean time to treatment was 217 days. Highest mean time was observed for interval 2 (94 days), followed by interval 1 (63 days), interval 4 (39 days), and interval 3 (21 days). At interval 1, a longer time was associated with severe alcohol consumption, severe smoking, and family history of cancer. At interval 2, the delay was associated with appointment with a general practitioner, clinical diagnosis of disease other than cancer, and antibiotic prescription. At interval 4, delay in treatment was associated with surgical treatment. Patients with OOC experience delays from symptom onset to treatment initiation. The longest interval was associated with professional delay, followed by patient delay in help-seeking.

Oral and oropharyngeal cancer: time from first symptoms to treatment initiation and associated factors

Abstract The aim of this study was to evaluate the time elapsed from first symptoms to the treatment of oral and oropharyngeal cancer (OOC) and to identify variables associated with treatment delay. This is an observational study with retrospective and prospective data collection. Patients with a diagnosis of OOC seen at the Head and Neck Surgery outpatient clinic of a Brazilian public hospital were included and followed up to treatment initiation. Participants answered a questionnaire for the collection of socioeconomic, demographic, cultural, and clinical information, as well as information about the time elapsed from first symptoms to the first appointment with a head and neck surgeon. Time to treatment was classified into four intervals: 1- first symptoms to first medical appointment; 2- first medical appointment to specialized medical care; 3- specialized medical care to preparation for treatment; and 4- preparation for treatment to treatment initiation. Bivariate statistics were computed. Out of 100 participants, nine died before treatment. Mean time to treatment was 217 days. Highest mean time was observed for interval 2 (94 days), followed by interval 1 (63 days), interval 4 (39 days), and interval 3 (21 days). At interval 1, a longer time was associated with severe alcohol consumption, severe smoking, and family history of cancer. At interval 2, the delay was associated with appointment with a general practitioner, clinical diagnosis of disease other than cancer, and antibiotic prescription. At interval 4, delay in treatment was associated with surgical treatment. Patients with OOC experience delays from symptom onset to treatment initiation. The longest interval was associated with professional delay, followed by patient delay in help-seeking.

Psychometric properties of CVFQ7-BR-toxo to evaluate vision-related quality of life in children with congenital toxoplasmosis in Brazil / Propriedades psicométricas do CVFQ7-BR-toxo para avaliar a qualidade de vida relacionada à visão em crianças com toxoplasmose congênita no Brasil

ABSTRACT Purpose: The high prevalence and severity of congenital toxoplasmosis in Brazil, with several affected individuals progressing to low vision, emphasize the importance of evaluating their quality of life. In this study, the Children's Visual Function Questionnaire (CVFQ) was adapted to the sociocultural context of Brazilian children, and its psychometric properties were investigated for evaluating the vision-related quality of life of these individuals. Methods: This was a nested cross-sectional epidemiological study that prospectively monitored a cohort of 142 preschool children at a single referral university hospital in Belo Horizonte, Brazil. All children underwent complete ophthalmological examination, including visual acuity testing and binocular indirect ophthalmoscopy. Questionnaires were applied to their parents and caregivers to evaluate quality of life perception, as well as socioeconomic status of their families. Psychometric properties of the quality of life scale were evalua­ted by multivariate statistical analyses. Results: Adaptation to the Brazilian version of CVFQ-7 resulted in CVFQ-BR-toxo, a questionnaire for evaluating the perception of parents/caregivers about the vision-related quality of life of preschool children with congenital toxoplasmosis. The following six subscales were identified based on description, variability structure, and interpretation/grouping of items: general health, visual acuity, visual performance/functional vision, personal and social behavior, impact on family, and treatment. Children with low vision related to congenital toxoplasmosis had significantly lower scores for the following subscales: visual acuity (p=0.004), visual performance/functional vision (p=0.008), impact on family (p=0.001), and overall health (p=0.001). Conclusion: Psychometric properties were appropriate concerning the validity of the quality of life construct. CVFQ-BR-toxo could demonstrate the impact of vision impairment on families of children with congenital toxoplasmosis.

RESUMO Objetivo: A alta prevalência e gravidade da toxoplasmose congênita no Brasil, com muitos indivíduos afetados desenvolvendo baixa visão, reforça a importância da avaliação da sua qualidade de vida. Este estudo tem como objetivo adaptar o Children's Visual Function Questionnaire (CVFQ) para a realidade sociocultural de crianças brasileiras e investigar suas propriedades psicométricas para avaliação da qualidade de vida relacionada à visão nesses indivíduos. Métodos: Estudo epidemiológico transversal aninhado de coorte de 142 crianças pré-escolares acompanhadas prospectivamente em hospital universitário de referência em Belo Horizonte, Brasil. Todas foram submetidos a exame oftalmológico completo, incluindo medida da acuidade visual e oftalmoscopia binocular indireta. Questionários foram aplicados aos pais e cuidadores, para avaliar a percepção da qualidade de vida, bem como o nível sócio-econômico das famílias. Análise estatística multivariada foi realizada para avaliar as propriedades psicométricas da escala de qualidade de vida. Resultados: Adaptações na versão brasileira do Children's Visual Function Questionnaire-7 originaram o Children's Visual Function Questionnaire-7-BR-toxo, um questionário para avaliar a percepção de pais/cuidadores sobre a qualidade de vida relacionada à visão de crianças pré-escolares com toxoplasmose congênita. Pela descrição, estrutura de variabilidade, e interpretação do agrupamento dos itens do questionário adaptado, identificaram-se seis subescalas: saúde geral, capacidade visual, desempenho visual/visão funcional, comportamento social e pessoal, impacto na família e tratamento. Crianças com baixa visão associada a toxoplasmose congênita tiveram escores mais baixos nas seguintes subescalas: acuidade visual (p=0,004), desempenho visual/visão funcional (p=0,008), impacto na família (p=0,001) e saúde geral (p=0,001). Conclusão: As propriedades psicométricas foram adequadas no tocante à validade do construto. O Children's Visual Function Questionnaire-7-BR-toxo foi capaz de registrar o impacto da deficiência visual nas famílias de crianças com toxoplasmose congênita.

Psychometric properties of CVFQ7-BR-toxo to evaluate vision-related quality of life in children with congenital toxoplasmosis in Brazil.

PURPOSE: The high prevalence and severity of congenital toxoplasmosis in Brazil, with several affected individuals progressing to low vision, emphasize the importance of evaluating their quality of life. In this study, the Children's Visual Function Questionnaire (CVFQ) was adapted to the sociocultural context of Brazilian children, and its psychometric properties were investigated for evaluating the vision-related quality of life of these individuals. METHODS: This was a nested cross-sectional epidemiological study that prospectively monitored a cohort of 142 preschool children at a single referral university hospital in Belo Horizonte, Brazil. All children underwent complete ophthalmological examination, including visual acuity testing and binocular indirect ophthalmoscopy. Questionnaires were applied to their parents and caregivers to evaluate quality of life perception, as well as socioeconomic status of their families. Psychometric properties of the quality of life scale were evalua-ted by multivariate statistical analyses. RESULTS: Adaptation to the Brazilian version of CVFQ-7 resulted in CVFQ-BR-toxo, a questionnaire for evaluating the perception of parents/caregivers about the vision-related quality of life of preschool children with congenital toxoplasmosis. The following six subscales were identified based on description, variability structure, and interpretation/grouping of items: general health, visual acuity, visual performance/functional vision, personal and social behavior, impact on family, and treatment. Children with low vision related to congenital toxoplasmosis had significantly lower scores for the following subscales: visual acuity (p=0.004), visual performance/functional vision (p=0.008), impact on family (p=0.001), and overall health (p=0.001). CONCLUSION: Psychometric properties were appropriate concerning the validity of the quality of life construct. CVFQ-BR-toxo could demonstrate the impact of vision impairment on families of children with congenital toxoplasmosis.

Vision-Related Quality Of Life And Depression In Brazilian Patients With Toxoplasmic Retinochoroiditis.

PURPOSE: To investigate visual-related quality of life (VRQL) and prevalence and severity of depressive symptoms in Brazilian individuals with toxoplasmic retinochoroiditis (TRC). DESIGN: Comparative observational cross-sectional study. The National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25) and Beck Depression Inventory-II (BDI-II) were applied to respectively assess VRQL and depression in individuals consecutively seen at a uveitis referral center. Clinical/demographical data were collected. Descriptive/analytic statistics were employed, with P<0.05. RESULTS: Patients and controls were comparable concerning age, sex and socioeconomic level. VRQL scores for all subscales were significantly lower in TRC when compared with controls, particularly associated (P<0.05) with female sex, history of ≥2 prior TRC recurrences, concomitant use of systemic corticosteroids, monocular vision and blindness. Depressive symptoms were more prevalent in TRC (55/188; 29.2%) than in controls (34/182; 18.7%) (P=0.023), also being associated with lower VRQL scores (P<0.001). Seropositive and seronegative controls for toxoplasmosis had similar VRQL scores and comparable rates of depressive symptoms. CONCLUSION: TRC affects VRQL in Brazilian individuals, particularly women, using systemic corticosteroids, with visual impairment and presenting recurrences of TRC. One-third of patients with TRC had evidence of depression, which was also associated with lower VRQL scores. Mental health issues in subjects with TRC should not be overlooked.

STATURE ESTIMATE OF CHILDREN WITH CEREBRAL PALSY THROUGH SEGMENTAL MEASURES: A SYSTEMATIC REVIEW.

OBJECTIVE: To review studies that evaluate the correspondence between the estimate height via segmental measures and the actual height of children with cerebral palsy. DATA SOURCES: Systematic literature review between 1995-2018, guided by the PRISMA criteria (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), in PubMed, BVS, MEDLINE and Lilacs databases. The descriptors, connected by the AND Boolean Operators, were: anthropometry, cerebral palsy, child and body height. The research comprised papers in Portuguese, English and Spanish, with Qualis-CAPES equal or superior to B3 that addressed the question: "Is there any correlation between estimate height by equations and direct height measures in children with cerebral palsy?" 152 studies were recovered and seven were selected. Their methodological quality was assessed by the scale of the Agency for Healthcare Research and Quality (AHRQ). DATA SYNTHESIS: Most studies showed no correspondence between estimated and real height. Studies that showed coincidence of the measures contain limitations that could jeopardize the results (sample losses, small samples and exclusion of patients with severe contractures, scoliosis and severe cerebral palsy). Japanese researchers developed an equation which harmoniously aligns the statures; the study comprised only Japanese patients, though. CONCLUSIONS: Given the importance of accuracy in height measures to evaluate infant health, it is crucial to carry out more researches in order to safely establish an association between both estimate and real statures. The development of anthropometric protocols, emerged from such researches, would benefit the follow-up of children with severe psychomotor disabilities.

Stature estimate of children with cerebral palsy through segmental measures: a systematic review / Estimativa de estatura em crianças com paralisia cerebral por meio de medidas segmentares: uma revisão sistemática

ABSTRACT Objective: To review studies that evaluate the correspondence between the estimate height via segmental measures and the actual height of children with cerebral palsy. Data sources: Systematic literature review between 1995-2018, guided by the PRISMA criteria (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), in PubMed, BVS, MEDLINE and Lilacs databases. The descriptors, connected by the AND Boolean Operators, were: anthropometry, cerebral palsy, child and body height. The research comprised papers in Portuguese, English and Spanish, with Qualis-CAPES equal or superior to B3 that addressed the question: "Is there any correlation between estimate height by equations and direct height measures in children with cerebral palsy?" 152 studies were recovered and seven were selected. Their methodological quality was assessed by the scale of the Agency for Healthcare Research and Quality (AHRQ). Data synthesis: Most studies showed no correspondence between estimated and real height. Studies that showed coincidence of the measures contain limitations that could jeopardize the results (sample losses, small samples and exclusion of patients with severe contractures, scoliosis and severe cerebral palsy). Japanese researchers developed an equation which harmoniously aligns the statures; the study comprised only Japanese patients, though. Conclusions: Given the importance of accuracy in height measures to evaluate infant health, it is crucial to carry out more researches in order to safely establish an association between both estimate and real statures. The development of anthropometric protocols, emerged from such researches, would benefit the follow-up of children with severe psychomotor disabilities.

RESUMO Objetivo: Revisar estudos que avaliam correspondência entre a altura estimada por medidas segmentares e a estatura real de crianças com paralisia cerebral. Fonte de dados: Revisão sistemática da literatura entre 1995 e 2018, guiada pela diretriz Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), nas bases de dados PubMed, Biblioteca Virtual em Saúde (BVS), Medical Literature Analysis and Retrieval System Online (MEDLINE) e Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). Os descritores, combinados pelo operador booleano "and", foram: "anthropometry", "cerebral palsy", "child" e "body height". A pesquisa englobou artigos em português, inglês e espanhol, classificadas pelo Quali-CAPES igual ou superior a B3 e que respondiam à questão guia: "Existe correlação entre a altura estimada por equações em crianças com paralisia cerebral e as medidas diretas de altura?". Dos 152 artigos inicialmente recuperados, sete foram selecionados e sua qualidade metodológica foi avaliada pela escala da Agency for Healthcare Research and Quality (AHRQ). Síntese dos dados: A maioria dos trabalhos não encontrou correspondência entre altura real e estimada. Estudos que exibiram coincidência das medidas apresentaram limitações que poderiam comprometer os resultados (perda de amostra, amostra pequena e exclusão de indivíduos com contraturas severas, escoliose e paralisia cerebral grave). Pesquisadores japoneses desenvolveram equação que apresenta boa concordância entre as estaturas. Contudo, o estudo compreendeu apenas indivíduos japoneses. Conclusões: Dada a importância da precisão das medidas de estatura para avaliar a saúde infantil, tornam-se necessárias mais pesquisas visando estabelecer, de maneira mais segura, a associação entre a estatura estimada e a real. O desenvolvimento de protocolos antropométricos, resultantes dessas pesquisas, beneficiaria o acompanhamento de crianças com sequelas psicomotoras graves.

Evaluation of functionality in children aged 4-6 years presenting congenital toxoplasmosis and retinochoroiditis / Avaliação da funcionalidade em crianças de 4-6 anos apresentando toxoplasmose congênita e retinocoroidite

Abstract Introduction: In Brazil, congenital toxoplasmosis (CT) is the main cause of visual impairment in childhood. It causes retinochoroiditis, which should lead to blindness. Minas Gerais has a prevalence of 1 newborn with congenital toxoplasmosis for every 770 live births. Objective: To evaluate visual functionality and tasks of self-care with TC classified in groups according to a visual acuity. Method: A cross-sectional study with 96 preschoolers with CT. Ophthalmologic examination and assessment of some functionalities were performed: The Functional Vision Evaluation (AVIF-2 at 6 years) and the Pediatric Disability Assessment Inventory (PEDI-Brazilian version). Results: Children were classified into three groups according to visual acuity: moderate / severe visual loss (n=16), low level (n=39) and normal vision (n=41). The chance of difference is not greater than AVIF-2 at 6 years among the three groups (p=0.001), being (p <0.0001) between the groups with moderate/severe visual and normal vision. The domain scores are displayed as the end result (p=0.022). The test PEDI is not able to make a difference between the groups. It is not different between the scores of the tests carried out. Conclusion: Children with CT without moderate / severe visual impairment, compromising visual functionality with greater impairment without visual accompaniment. The AVIF-2 at 6 years test demonstrated the impairment between groups with different visual acuities. The PEDI (self-care) test was not performed with a significant difference in scores between the groups. The AVIF-2 at 6 years test may contribute to the more effective intervention in the visual habilitation of children with CT and low vision.

Resumo Introdução: No Brasil, a toxoplasmose congênita (TC) é a principal causa de deficiência visual na infância. É causa de retinocoroidite, que pode levar à cegueira. Minas Gerais apresenta prevalência de um neonato com TC para cada 770 nascidos vivos. Objetivo: Avaliar funcionalidade visual e tarefas do autocuidado de crianças com TC classificadas em grupos de acordo com a acuidade visual. Método: Estudo transversal com 96 pré-escolares com TC. Realizado exame oftalmológico e avaliada a funcionalidade por dois instrumentos: O teste Avaliação da Visão Funcional (AVIF-2 a 6 anos) e Inventário de Avaliação Pediátrica de Incapacidade (PEDI-versão brasileira). Resultados: As crianças foram classificadas em três grupos conforme a acuidade visual: perda visual moderada/grave (n=16), perda leve (n=39) e visão normal (n=41). Houve diferença significativa no escore total do AVIF-2 a 6 anos entre os três grupos (p=0,001), e entre os grupos com perda visual moderada/grave e visão normal (p<0,0001). Os escores do domínio seguimento visual apresentaram pior resultado (p=0,022). O teste PEDI não mostrou diferença significativa entre os grupos. Não houve correlação entre os escores dos testes aplicados. Conclusão: Crianças com TC e perda visual moderada/grave apresentaram comprometimento da funcionalidade visual com maior prejuízo no seguimento visual. O teste AVIF-2 a 6 anos demonstrou esse comprometimento entre os grupos com diferentes acuidades visuais. O teste PEDI (autocuidado) não mostrou diferença estatística significativa dos escores entre os grupos. O teste AVIF- 2 a 6 anos pode contribuir para intervenção mais objetiva na habilitação visual de crianças com TC e baixa visão.

Prevalência e fatores associados à prematuridade em Divinópolis, Minas Gerais, 2008-2011: análise do Sistema de Informações sobre Nascidos Vivos / Prevalencia y factores asociados con la prematuridad en Divinopolis, Minas Gerais, Brasil, 2008-2011: análisis del Sistema de Informaciones sobre Nacidos Vivos / Prematurity and associated factors in Divinópolis, Minas Gerais state, Brazil, 2008-2011: analysis of the Information System on Live Births

Objetivo: estimar a prevalência e os fatores associados à prematuridade em Divinópolis, Minas Gerais, Brasil, 2008-2011. Métodos: estudo transversal, com dados de 9.987 registros da base do Sistema de Informações sobre Nascidos Vivos (Sinasc); foi empregado modelo de regressão logística múltipla. Resultados: a prevalência de prematuridade foi de 8,0%, significativamente maior entre nascidos por parto cesáreo (8,9%), filhos de mães com 15 ou menos (14,4%) e 35 ou mais anos (9,3%), que fizeram 6 ou menos consultas de pré-natal (16,0%) e que tiveram quatro ou mais filhos vivos (11,7%); após o ajuste, a chance de prematuridade foi maior entre filhos de mães menores de 15 anos (OR=1,22; IC95% 1,01;1,49), com 6 ou menos consultas de pré-natal (OR=3,76; IC95% 3,24;4,38) e nascidos por parto cesáreo (OR=1,73; IC95% 1,48;2,04). Conclusão: a prematuridade esteve associada ao parto cesáreo, à realização de menos de sete consultas pré-natal e à menor idade materna.

Objetivo: estimar la prevalencia y factores asociados con prematuridad en Divinópolis, Minas Gerais, Brasil, 2008-2011. Métodos: estudio transversal de 9987 nacimientos de la base de datos del Sistemas de Informaciones sobre Nacidos Vivos (Sinasc); se utilizó un modelo de regresión logística múltiple. Resultados: la prevalencia de partos prematuros fue 8,0%; siendo significativamente mayor en partos por sección cesárea (8,9%), madres con 15 o menos (14,4%) y 35 o más años (9,3%), que hicieron 6 o menos consultas prenatales (16,0%) y tenían cuatro o más hijos vivos (11,7%); después del ajuste, las probabilidades fueron mayores entre madres menores de 15 años (OR=1,22; IC95% 1,01;1,49), con 6 o menos consultas prenatales (OR=3,76; IC95% 3,24;4,38) y cesarianas (OR=1,73; IC95% 1,48;2,04). Conclusión: la prematuridad se asocia al parto por cesáreo, menos de 7 citas prenatales y menor edad materna.

Objective: to estimate prematurity prevalence and associated factors in Divinópolis, Minas Gerais state, Brazil, 2008-2011. Methods: this is a cross-sectional study with data from 9,987 records held on the Information System on Live Births; a multiple logistic regression model was used. Results: prevalence of preterm births was 8.0%; the higher likelihood of premature newborns were found to cesarean section (8.9%), mothers aged 15 or less (14.4%) and aged 35 or more (9.3%), mothers who went to 6 or fewer prenatal care visits (16.0%), and had had 4 or more live births (11.7%); after adjustment, the odds of preterm birth was higher among mothers aged under 15 years old (OR=1.22; 95%CI 1.01;1.49), mothers with 6 or fewer prenatal care visits (OR=3.76; 95%CI 3.24;4.38) and mothers undergoing cesarean section (OR=1.73; 95%CI 1.48;2.04). Conclusion: prematurity was associated with cesarean delivery, having fewer than 7 prenatal care visits and lower maternal age.

Prematurity and associated factors in Divinópolis, Minas Gerais state, Brazil, 2008-2011: analysis of the Information System on Live Births. / Prevalência e fatores associados à prematuridade em Divinópolis, Minas Gerais, 2008-2011: análise do Sistema de Informações sobre Nascidos Vivos.

OBJECTIVE: to estimate prematurity prevalence and associated factors in Divinópolis, Minas Gerais state, Brazil, 2008-2011. METHODS: this is a cross-sectional study with data from 9,987 records held on the Information System on Live Births; a multiple logistic regression model was used. RESULTS: prevalence of preterm births was 8.0%; the higher likelihood of premature newborns were found to cesarean section (8.9%), mothers aged 15 or less (14.4%) and aged 35 or more (9.3%), mothers who went to 6 or fewer prenatal care visits (16.0%), and had had 4 or more live births (11.7%); after adjustment, the odds of preterm birth was higher among mothers aged under 15 years old (OR=1.22; 95%CI 1.01;1.49), mothers with 6 or fewer prenatal care visits (OR=3.76; 95%CI 3.24;4.38) and mothers undergoing cesarean section (OR=1.73; 95%CI 1.48;2.04). CONCLUSION: prematurity was associated with cesarean delivery, having fewer than 7 prenatal care visits and lower maternal age.

Larvicidal activity of essential oil of Peumus boldus Molina and its ascaridole-enriched fraction against Culex quinquefasciatus.

Culex quinquefasciatus (Say, 1823), known as the domestic mosquito, is a common and abundant species throughout the world, and a cosmopolitan species. The adults of this mosquito are important in terms of public and animal health since they display adaptability to different hosts. In humans, they are responsible for the transmission of various diseases. One manner of control of this vector is the use of insecticidal or larvicidal products, which may have the drawback of toxicity to mammals and can be harmful to the environment. The present work evaluated the larvicidal potential of the essential oil (EO) and ascaridole-enriched fraction (EF4-5) obtained from the leaves of Peumus boldus Molina (boldo). The EO, obtained by steam distillation, was analyzed by GC/MS and fractionated on silica gel. EO and EF4-5, containing 31.4% and 89.5% ascaridole, respectively, were evaluated against C. quinquefasciatus at concentrations of 100, 50 and 25 µg/ml on the third and fourth instars. They showed lethal concentrations (LC50) of 82.14 and 41.85 µg/ml, respectively. Larvae treated with the EF4-5 showed morphological changes in the midgut, with cells possessing a cytoplasm that contained small vacuole-like structures, as well as a nucleus with decondensed chromatin and a cell apex with a short brush border. The cells of the fat body showed larger protein granules, which were acidophilic relative to the larvae of the control group. Moreover, the enriched fraction at a dose of 50 µg/ml showed a residual larvicidal effect according to exposure time on C. quinquefasciatus. This residual effect deserves consideration, since a long-term larvicidal product may be a useful tool for vector control.

Propriedades psicométricas do Children's Visual Function Questionnaire adaptado para avaliação de qualidade de vida relacionada à visão de crianças com toxoplasmose congênita / Psychometric properties of the Children's Visual Function Questionnaire adapted to assess vision-related quality of life in children with congenital toxoplasmosis

Introdução: A elevada prevalência da toxoplasmose congênita (TC) no Brasil, verificada também no estado de Minas Gerais, associada ao maior comprometimento ocular observado nas crianças brasileiras comparadas às europeias; e a evolução de muitos desses indivíduos para a baixa visão (BV), nos remetem à necessidade de compreender o impacto da perda visual na qualidade de vida em uma coorte de crianças infectadas identificadas no período neonatal e tratadas com antiparasitários durante o primeiro ano de vida. Objetivo: Adaptar o questionário Children's Visual Function Questionnaire (CVFQ) à realidade sociocultural de crianças brasileiras com toxoplasmose congênita e investigar as propriedades psicométricas para mensuração da qualidade de vida (QV) relacionada à visão nesses pacientes; descrever as lesões retinocoroideanas observadas em uma coorte de crianças pré-escolares com TC em Minas Gerais; avaliar quantitativamente o déficit visual e investigar sua correlação com a pontuação na percepção da QV relacionada à perda visual (CVFQ7-BR-toxo). Método: Estudo epidemiológico transversal aninhado, em uma coorte de 142 crianças acompanhadas prospectivamente nos Serviços de Infectologia Pediátrica e Oftalmologia do Hospital das Clínicas da UFMG. Questionários foram aplicados aos pais e cuidadores para avaliar a percepção sobre a QV de suas crianças com TC e para verificar a situação socioeconômica das famílias. Oftalmologistas do setor de uveite avaliaram a retina das crianças e descreveram as lesões de retinocoroidite quanto à localização, número de lesões, tamanho e lateralidade. No setor de baixa visão, oftalmologistas avaliaram a acuidade visual. Foram usadas técnicas de estatística multivariada para avaliar as propriedades psicométricas da escala de QV e testes de Kruskal Wallis e Mann Whitney para a comparação dos escores medianos da escala de QV em crianças com visão normal, perda visual leve e baixa visão. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da UFMG. Resultado: Adaptações no CVFQ versão brasileira deram origem ao CVFQ7-BR-toxo, questionário para avaliar a percepção de pais/cuidadores sobre qualidade de vida relacionada a baixa visão de crianças com toxoplasmose congênita pré-escolares. Na análise fatorial exploratória o resultado do teste Kaiser-Meyer-Olkin Measure of Sampling Adequacy (KMO) foi de 0,74, indicando boa adequabilidade do modelo fatorial. Seis componentes (fatores) extraídos correspondem a 46,3% da variância total explicada, e são compostos por itens com coeficiente de saturação (carga fatorial) maior ou igual a 0,45. Pela descrição, estrutura de variabilidade, e interpretação do agrupamento dos itens do questionário CVFQ adaptado (CVFQ7-BR-toxo) identificaram-se seis subescalas: saúde geral; capacidade visual; desempenho visual/visão funcional; comportamento social e pessoal, impacto na família e tratamento. A homogeneidade das medidas para o construto QV no CVFQ adaptado foi avaliada pela consistência interna das subescalas. As subescalas Desempenho visual - visão funcional e o Impacto na família se mostraram adequadas, com coeficiente alfa de Cronbach de 0,75 e 0,77 respectivamente. As subescalas comportamento pessoal e social e, tratamento apresentaram valores de alfa de Cronbach menores que 0,7 (0,68 e 0,61 respectivamente). A correlação entre as subescalas e a escala global foram todas significativas (p-valor <0,001) variando de 0,42 a 0,75. As correlações item-escala globais foram significativas (p-valor <0,01) e maiores do que 0,20, sendo estes valores considerados aceitáveis. Verificou-se a validade discriminante do instrumento pelas diferenças significativas (p<0,005) na comparação das escalas do CVFQ7-BR-toxo para escores relatados pelo pai/cuidador de crianças com e sem baixa visão. A validação convergente foi verificada pela correlação (r=0,58; p<0,001) entre o escores globais do CVFQ7-BR-toxo e do PedsQL, com resultado moderado. Para análise dos exames clínicos oftalmológicos, das 142 crianças, duas foram excluídas por não terem realizado todos os exames. Das 140 crianças, 87,1% (121/139) apresentaram pelo menos uma lesão de retinocoroidite e, dentre elas, 20,7% (25/121) foram diagnosticadas com baixa visão (BV). A retinocoroidite esteve presente em ambos os olhos de 81,0% (98/121) das crianças com lesões, sendo que 25,5% (25/98) destas tinham BV. Lesão macular (foveal e/ou extrafoveal) em ambos os olhos ocorreu em 43,9% (43/98) das crianças e 51,2% (22/43) destas apresentaram BV. Pelo menos 50% das crianças com BV apresentaram lesões com tamanho médio superior a 3,0 diâmetros de disco óptico (DD). Ausência de lesão ocorreu em apenas 12,9% (18/140) das crianças. Na percepção dos pais cuidadores (CVFQ7-BR-toxo) das crianças diagnosticadas com BV, os escores medianos foram menores nas dimensões capacidade visual (p=0,002), desempenho funcional/visão funcional (p=0,002), impacto na família (p=0,001) e na QV global (p=0,009) quando comparados às crianças com perda visual leve e com visão normal. Conclusão: As propriedades psicométricas do CVFQ7-BR-toxo se mostraram adequadas quanto à validade do construto QV. O instrumento foi capaz de registrar o impacto no comprometimento da visão funcional e na família de crianças com toxoplasmose congênita. Na avaliação oftalmológica dessa população foram observadas lesões retinocoroideanas de maior gravidade, por serem em sua maioria maculares, múltiplas, bilaterais, resultando em comprometimento da função visual e menor acuidade visual. Na percepção dos pais e cuidadores sobre a QV relacionada a baixa visão, estas crianças apresentaram pior capacidade visual, pior desempenho funcional / visão funcional, com maior impacto nas suas famílias e piora da qualidade de vida global. Esses resultados podem subsidiar políticas para melhor controle e prevenção da toxoplasmose congênita.

Introduction: The high prevalence of congenital toxoplasmosis (CT) in Brazil, in addition to the high burden of ocular involvement in infected individuals, evolving to low vision (LV) in many of them, highlights the importance of assessing their quality of life (QOL). Objective:To adapt the Children's Visual Function Questionnaire (CVFQ) to the sociocultural reality of Brazilian children with CT, and to investigate the psychometric properties to measure vision-related quality of life (QOL) for these patients; to characterize retinochoroidal changes in a cohort of preschool children with CT in Minas Gerais; to quantitatively evaluate the visual deficit and to investigate its correlation with QOL perception scores (CVFQ7-BR-toxo instrument).Methods: Cross-sectional epidemiological study with nested cohort of 142 children prospectively followed at the Pediatric Infectious Disease and Ophthalmology Services of Hospital das Clínicas da Universidade Federal de Minas GeraisQuestionnaires were applied to parents and carers to evaluate QOL perception of their children with CT and to characterize the socioeconomic status of their families. Number, location, size and laterality of retinochoroidal lesions were recorded. Best-corrected visual acuity was also assessed. Multivariate statistical techniques were used to evaluate psychometric qualities of QOL scale. Kruskal Wallis and Mann Whitney test were employed for comparison of median scores of the QOL scale in children with normal visual, mild vision loss and low vision. Results: Adaptations in the CVFQ-Brazilian version originated the CVFQ7-BR-toxo, a questionnaire to evaluate perception of parents/carers about vision-related QOL of preschool children with CT. In the exploratory factor analysis, result of KaiserMeyer-Olkin Measure of Sampling Adequacy test (KMO) was 0.74, indicating good suitability of the factor model.Six extracted components (factors) explained 46.3% of total variance, consisting of items with saturation coefficient (factor load) ≥ 0.45. Six subscales were identified after description, variability structure and interpretation of grouping of items of CVFQ7-BR-toxo: Overall Health; Visual Acuity; Visual Performance/Functional Vision; Individual and Social Behavior, Impact on Family, and Treatment. Homogeneity of measures for the QOL construct in the adapted CVFQ was evaluated by internal consistency of the subscales: Subscales Visual Performance/Functional Vision and Impact on Family showed to be adequate, with Cronbach's alpha of 0.75 and 0.77 respectively.Subscales Individual and Social Behavior and Treatment showed Cronbach's alpha coefficient smaller than 0.7 (0.68 and 0.61 respectively). The correlations between subscales and the global scale were all statistically significant (p-value <0.001) ranging from 0.42 to 0.75. The global item-scale correlations were also significant (p-value <0.01) and greater than 0.20, with these values being considered acceptable. Discriminant validity of the instrument by significant differences (p <0.005) was verified in the comparison of CVFQ7-BR-toxo scales to the scores reported by the parent/carers of children with and without low vision.The convergent validity was verified by the moderate correlation (r = 0.58; p <0.001) between the overall scores CVFQ7- BR-toxo and PedsQL. For the analysis of the clinical examinations of the 142 children, two were excluded because they did not have all the exams. Of the 140 children, 87.1% (121/139) had at least one retinochoroidal lesion. Among them, 20.7% (25/121) were diagnosed with LV. Retinochoroiditis was found in both eyes in 81.0% (98/121), and 25.5% (25/98) of these had LV. Macular (foveal and/or extrafoveal) lesions in both eyes occurred in 43.9% (43/98); 51.2% (22/43) of these children had low LV. At least 50% of children with LV presented retinochoroidal lesions with an average size > 3 optic disc diameter. Absence of retinochoroidal lesions was recorded in only 12.9% (18/140) of children. In the perception of carers parents (CVFQ7-BR-toxo) of children diagnosed with LV, median scores were lower for visual ability dimensions (p = 0.002), functional performance- visual function (p = 0.002), impact on family (p = 0.001) and overall QOL (p = 0.009) when compared to those of children with mild visual loss and with normal vision. Conclusion: CVFQ7-BR-toxo psychometric properties were appropriate concerning the validity of the QOL construct. The questionnaire was able to register the impact of visual disability on families of children with CT. Retinochoroiditis, was more severe, with frequent multiple, bilateral and macular lesions, resulting in impaired visual function. According to QOL perception of parents and carers, children with LV presented worse scores for visual capacity, functional performance/functional vison, with greater impact on their families and decreased overall quality of life. These results can support policies for better control and prevention of CT.

Determinantes do baixo peso ao nascer a partir das declarações de nascidos vivos / Determinantes del bajo peso al nacer presentes en la declaración de nacido vivo / Low birth weigh determinants present in the statement of live birth

O objetivo desse estudo foi identificar a prevalência e os fatores associados ao baixo peso ao nascer (PBN) em Divinópolis, Brasil. Método: Trata-se de estudo transversal que analisou 9.987 registros de nascidos vivos hospitalares e únicos ocorridos entre 2008 e 2011. Na análise univariada utilizou-se o teste qui-quadrado e a razão de chances fixando um nível de significância de 5%. Para o controle de possíveis fatores de confusão nas associações obtidas, usou-se o modelo de regressão logística binária. Resultados: A tendência do BPN no período estudado mostrou-se estável, variando entre 8,9 e 9,2%. Mais da metade das crianças nasceu prematuro (62,0%) e de parto cirúrgico (63,9%). Os fatores independentes foram: prematuridade, sexo feminino, realização de seis ou menos consultas de pré-natal, mães solteiras. Conclusão: O conhecimento dos determinantes do BPN permite aos profissionais de saúde organizar a rede assistencial na proporção da necessidade e para aqueles em situação de maior vulnerabilidade e risco de agravos à saúde.

The aim of this study was to identify the prevalence and the low birth weight (LBW) associated factors in Divinópolis, Brazil. Method: It is a cross-sectional study. 9,987 hospitalar birth records occurred between 2008 and 2011, were analysed. In univariate analysis, chi-square test and the odds ratio was used setting a significance level of 5%. To control for possible confounding factors in obtained associations, binary logistic regression model was used. Results: The LBW trend during studied period was stable, ranging between 8.9 and 9.2%. More than half of children were born preterm (62.0%) and through operative delivery (63.9%). Independent predictors were prematurity, female, performing six or fewer prenatal visits, single mothers. Conclusion: The knowledge of the determinants of LBW allows health professionals to organize health care network in proportion to the need for those most vulnerable and in risk of health problems.

El objetivo de este estudio fue identificar la prevalencia y los factores asociados con el bajo peso al nacer (BPN) en Divinópolis, Brasil. Material y Método: Se trata de estudio transversal que analizó 9.987 registros de nacimientos individuales vivos que ocurrieron en hospitales entre 2008 y 2011. En el análisis univariado se utilizó la prueba de chi-cuadrado y odds ratio estableciendo un nivel de significación del 5%. Para controlar los posibles factores de confusión en las asociaciones obtenidas, se utilizó el modelo de regresión logística binaria. Resultados: La tendencia de BPN durante el período de estudio se mantuvo estable, oscilando entre el 8,9 y el 9,2%. Más de la mitad de los niños con bajo peso nació prematuro (62,0%) y a través de parto quirúrgico (63,9%). Los predictores independientes fueron la prematuridad, sexo femenino, realizar seis o menos consultas prenatales, madres solteras. Conclusión: El conocimiento de los factores determinantes permite a los profesionales de salud organizar una red de atención de salud proporcional a las necesidades de aquéllos en situación de mayor vulnerabilidad y riesgo de problemas de salud.

Factors associated with obesity and overweight in school-aged children / Factores asociados a la obesidad y el sobrepeso en la escuela / Fatores associados à obesidade e sobrepeso em escolares

To assess the factors associated with excess weight (overweight/obese) in school children enrolled in the public education network in Divinópolis, Minas Gerais, Brazil. Cross-sectional study with 1187 children between 6 and 14 years of age from municipal schools in Divinópolis, Minas Gerais. The prevalence of obesity and overweight was calculated based on the parameters of the World Health Organization, using the WHO Anthro-Plus Program. Logistic regression was used to identify the variables associated with excess weight, at a significance level of 5%. A prevalence of 24.4% of excess weight was identified. Family income and maternal education were determinants of overweight in the study population (p<0.05). Excess weight was configured as an important health problem among the students. The public power needs to implement intersectoral measures with a view to the prevention and reduction of the prevalence of overweight and obesity among school-aged children.

Evaluar los factores asociados con el exceso de peso (sobrepeso/obesidad) en los niños matriculados en una escuela primaria de la red pública de Divinópolis, Minas Gerais, Brasil. Estudio transversal con 1.187 escolares de 6 a14 años de edad de la red municipal de enseñanza de Divinópolis, Minas Gerais. La prevalencia de la obesidad y el sobrepeso se calculó a partir de los parámetros de la Organización Mundial de la Salud, mediante el Programa WHO Anthro-Plus. Se utilizó la regresión logística para identificar las variables asociadas con el exceso de peso, considerando un nivel de significación del 5%. Se observó una prevalencia de 24,4% de sobrepeso. Los ingresos familiares y la educación materna fueron determinantes con sobrepeso en la población estudiada (p<0,05). El exceso de peso fue configurado como el principal problema de salud en escolares. Medidas de orden intersectorial deben ser implementadas por el gobierno con el fin de prevenir y reducir la prevalencia del sobrepeso y la obesidad en la escuela.

Avaliar os fatores associados ao excesso de peso (sobrepeso/obeso) em escolares matriculados no ensino fundamental da rede pública de ensino de Divinópolis, Minas Gerais, Brasil. Estudo transversal com 1187 escolares de seis a 14 anos de idade da rede municipal de ensino de Divinópolis, Minas Gerais. Prevalência de obesidade e sobrepeso foi calculada a partir dos parâmetros da Organização Mundial de Saúde, utilizando-se o Programa WHO Anthro-Plus. Regressão logística foi usada para identificação das variáveis associadas ao excesso de peso, considerando um nível de significância de 5%. Foi identificada prevalência de 24,4% de excesso de peso. Renda familiar e escolaridade materna foram determinantes do excesso de peso na população do estudo (p<0,05). O excesso de peso configurou-se como importante problema de saúde entre os escolares. Medidas de ordem intersetorial necessitam ser implementadas pelo poder público, visando prevenir e reduzir as prevalências de sobrepeso e obesidade entre os escolares.

Clinical, Molecular, and Epidemiological Analysis of Dengue Cases during a Major Outbreak in the Midwest Region of Minas Gerais, Brazil.

This study aims to perform the first molecular and clinical-epidemiological analysis of dengue cases in Divinopolis, MG, Brazil. Data from 4,110 cases of dengue were accessed and 190 clinical samples were collected for molecular analyses. In this study, 2.7% of the men and 3.0% of the women were admitted to hospital. There was no association between gender and hospital admission. The symptoms observed in this study are according to the Health Ministry, but fever was present in 82.2% and not in 100% of cases. The chance of hospital admission was 1.55 higher in patients with any kind of bleeding (334) and 2.4% of individuals without bleeding were also hospitalized due to other warning signs. In the molecular analyses, 23% of the samples were positive for DENV. DENV-2 and DENV-3 were identified in 2010, DENV-3 in 2011, DENV-1 in 2012, and DENV-1 and DENV-4 in 2013. DENV detection was possible in samples with only one day of symptoms. This first report of dengue data in Divinópolis provided more insight into the viral types and effects of disease in the city, confirming the need for caution in assessing cases of suspected dengue and for revision of the criteria proposed by the Health Ministry to classify cases of the disease.

Cervical uterine lesions: an epidemiological and molecular investigation in midwestern Minas Gerais, Brazil.

Cervical uterine cancer is the second most frequent form of cancer in the female population and the fourth cause of cancer deaths among Brazilian women. In Divinópolis county, Minas Gerais state, cervical cancer accounted for 6.6% of deaths in 2007. The purpose of this study was to conduct an epidemiological and molecular investigation of samples of pre-neoplastic and neoplastic cervical uterine lesions from patients assisted at public healthcare services in the county. The study was based on clinical-epidemiological descriptions retrieved from cytological examination request forms from 2006 to 2010. For molecular analysis, samples from 95 patients were collected and DNA was extracted using the Chelex 100 method. PCR was performed for detection and typing of HPV 6/11, 16, 18, 31, and 33. Of the 52 168 patients who underwent cytological examination, 625 had pre-neoplastic or neoplastic lesions during the study period. Age distribution was consistent with the literature, with a predominance of patients aged 20-49 years. The microorganism found most frequently was Lactobacillus sp. (65%). Prominent among cellular alterations were cervical intraepithelial neoplasia I (39.7%) and atypical squamous cells of undetermined significance (32%). Molecular analysis revealed 72.6% of positive samples for HPV. HPV 16 (26.3%) was the most frequent type, followed by types 6/11 (7.4%), 18 (5.3%), 33 (2.1%), and 31 (1%). The results provided improved understanding of the association between HPV and cancer in Divinópolis, in addition to providing data that can contribute to the design of measures to prevent and control HPV infection in the county investigated.

Brine shrimp lethality test as a biological model for preliminary selection of pediculicidal components from natural source / Teste de toxicidade frente artemia como modelo preliminar de busca de substâncias pediculicidas a partir de fontes naturais

Brine shrimp lethality test as a biological model for the preliminary selection of pediculicidal components from a natural source. In order to achieve a good correlation between pediculicidal activity and brine shrimp lethality (BSL) test, several pediculicidal substances and active essential oils were tested in BSL test, with the purpose to use the latter as convenient preliminary protocol for pediculicidal activity. Benzyl benzoate, deltametrine and essential oil of Eucalyptus were purchased and clove essential oil obtained by hydrodistillation, besides essential oils, chloroform extracts from Duguetia furfuracea were also submitted to BSL test. All of them were carried out with same protocol described to pediculicidal assay found in the literature, i.e, flask tests were examined every five minutes in the first half hour and then every ten minutes until all the naupli were dead or no movements were observed (knockdown). During the BSL test, it was possible to observe the effect of a particular lethal dose or only a knockdown in the arthropod, as occurred in the test with lice. The results of the BSL test for essential oils and other active substances are essentially in agreement with those described in literature for pediculicidal activity. Extracts and essential oil obtained from aerial parts of D. furfuracea did not present activity, but the essential oil from underground stem bark was active. α-asarone has already been isolated from the underground stem and it has been previously described to possess insecticidal activity.

O teste de toxicidade frente a Artemia salina (TAS) foi utilizado como modelo biológico preliminar na busca de substâncias potencialmente pediculicidas a partir de fontes naturais. Foi encontrada uma boa correlação entre a atividade pediculicida e o TAS, várias substâncias e óleos essenciais descritos como pediculicidas foram testados sobre o microcrustáceo, com o objetivo de se obter um protocolo preliminar e apropriado para detectar aquela atividade. Benzoato de benzila, deltametrina, e óleos essenciais de eucalipto e cravo foram obtidos comercialmente e/ou por extração. Além desses, extratos e óleos essenciais de Duguetia furfuracea também foram testados frente a Artemia. Todas as amostras foram conduzidas utilizando o mesmo protocolo proposto para atividade pediculicida, ou seja, os frascos testes foram lidos a cada cinco minutos na primeira meia hora e depois a cada dez minutos até os nauplios estarem mortos ou sem movimento (knockdown). Durante o TAS foi possível observar a dose letal ou somente o knockdown na larva, como ocorrido no teste com piolho. Os resultados do TAS para os óleos essencial e os demais compostos ativos estão essencialmente de acordo com o descrito na literatura para a atividade pediculicida. Extratos das sementes e óleos essenciais das folhas e sementes D. furfuracea não apresentaram atividade, mas o óleo das cascas do caule subterrâneo foi ativo α-asarona foi isolado das cascas do caule e esta substância apresenta atividade inseticida.

[Susceptibility of Culex quinquefasciatus larvae to different insecticides]. / Suscetibilidade de larvas de Culex quinquefasciatus a diferentes inseticidas.

INTRODUCTION: This study aimed to assess the susceptibility of Culex quinquefasciatus larvae to two pyrethroids (Cypermethrin and Deltamethrin), two derivatives of Avermectin (Ivermectin and Abamectin) and an organophosphate (Temephos). METHODS: Third- and fourth-instar larvae of C. quinquefasciatus were exposed to different concentrations of insecticides (eleven repetitions) according to the World Health Organization's protocol. One hour after exposure, larvae were washed in dechlorinated tap water, transferred to plastic containers containing water without chlorine, fed and observed for periods of 24h until reaching adulthood. To determine lethal concentrations, the obtained values were submitted to regression analysis using the probit model with the Minitab 15 program. RESULTS: The highest concentration used for the LC50 from probit analysis was for Temephos. The evaluated insecticides caused more pronounced larvae mortality in the first 24h with the exception of those exposed to ivermectin. CONCLUSIONS: This study demonstrates that larvae are susceptible to all tested insecticides and that there is a need for monitoring the use of insecticides.

Suscetibilidade de larvas de Culex quinquefasciatus a diferentes inseticidas / Susceptibility of Culex quinquefasciatus larvae to different insecticides

INTRODUÇÃO: O presente estudo teve como objetivo avaliar a suscetibilidade de larvas de Culex quinquefasciatus a dois piretróides (Cipermetrina e Deltametrina), dois derivados da Avermectina (ivermectina e abamectina) e a um organofosforado (Temefós). MÉTODOS: Larvas de 3º e 4º instares de C. quinquefasciatus foram expostas a diferentes concentrações destes (onze repetições) seguindo o protocolo da Organização Mundial de Saúde. Uma hora após a exposição, as larvas foram lavadas em água desclorada, transferidas para recipientes plásticos contendo água sem cloro, alimentadas e observadas por períodos de 24h, até se transformarem em adultos. Para a determinação das concentrações letais, os valores foram submetidos à análise de regressão usando o modelo probit pelo programa Minitab 15. RESULTADOS: Diferenças entre as estimativas da CL50 e CL90 justificaram que a população de mosquitos testada apresenta heterogeneidade em resposta aos inseticidas, sendo a maior concentração utilizada para a CL50, a partir da análise de probit para o Temefós. Todos os inseticidas avaliados causaram mortalidade mais acentuada nas primeiras 24h exceto quando expostas à ivermectina. CONCLUSÕES: As larvas são suscetíveis a todos os inseticidas testados e há uma necessidade de um monitoramento dos inseticidas utilizados.

INTRODUCTION: This study aimed to assess the susceptibility of Culex quinquefasciatus larvae to two pyrethroids (Cypermethrin and Deltamethrin), two derivatives of Avermectin (Ivermectin and Abamectin) and an organophosphate (Temephos). METHODS: Third- and fourth-instar larvae of C. quinquefasciatus were exposed to different concentrations of insecticides (eleven repetitions) according to the World Health Organization's protocol. One hour after exposure, larvae were washed in dechlorinated tap water, transferred to plastic containers containing water without chlorine, fed and observed for periods of 24h until reaching adulthood. To determine lethal concentrations, the obtained values were submitted to regression analysis using the probit model with the Minitab 15 program. RESULTS: The highest concentration used for the LC50 from probit analysis was for Temephos. The evaluated insecticides caused more pronounced larvae mortality in the first 24h with the exception of those exposed to ivermectin. CONCLUSIONS: This study demonstrates that larvae are susceptible to all tested insecticides and that there is a need for monitoring the use of insecticides.

Estatística na área de saúde: conceitos, metodologia, aplicações e prática computacional / Statistics on health: concepts, methodology, practical applications and computational

Enfoca no entendimento dos conceitos e da metodologia estatística, além da interpretação de resultados, e não em contas ou desenvolvimentos teóricos; aplicações em diversos tipos de situações, ilustradas com dados reais e exemplos cuidadosamente selecionados da literatura; inclusão de exercícios para facilitar a fixação dos conceitos apresentados; conteúdo para auxiliar na leitura de periódicos e na análise de dados; vasta bibliografia; destaque para a prática computacional.