Protocolo provisional para la vigilancia genómica de SARS-CoV-2 / Interim Protocol for SARS-CoV-2 Genomic Surveillance

En los antecedentes se presentan estadísticas del COVID-19 a la fecha en la que se elaboró el documento (enero 2021) y aborda las tres mutaciones del virus conocidas hasta la fecha del documento: Reino Unido e Irlanda del Norte, República de Sudáfrica y Brasil, siendo la de mayor transmisibilidad, según el documento, la del Reino Unido Destaca la importancia de los protocolos, puesto que ellos han sido parte primordial en la lucha contra la pandemia: "Asimismo, la secuenciación genómica del SARS-CoV-2 y la liberación oportuna de la información no solo permitió la caracterización del agente etiológico involucrado en el brote inicial, sino también el desarrollo oportuno de protocolos de diagnóstico y seguimiento a la evolución de la pandemia de COVID-19. Así, la secuenciación genómica se ha convertido en una herramienta esencial para generar datos virológicos de SARS-CoV-2, para impulsar la respuesta de laboratorio, y entender mejor los patrones de dispersión y evolución de SARS-CoV-2 " Por ello, el objetivo general del documento es: "Contribuir a la generación de datos de las variantes genómicas del virus SARS-CoV-2 para establecer patrones de dispersión y evolución." Así como: "Establecer y actualizar protocolos de detección y tratamiento de COVID-19 utilizando la información generada a partir de la secuenciación de las muestras" (objetivo específico 1).

What is epidemiology? Changing definitions of epidemiology 1978-2017.

CONTEXT: Epidemiology is a discipline which has evolved with the changes taking place in society and the emergence of new diseases and new discipline related to epidemiology. With these evolutions, it is important to understand epidemiology and to analyse the evolution of content of definitions of epidemiology. OBJECTIVES: The main objective of this paper was to identify new definitions of epidemiology available since 1978. Secondary objectives were to analyse the content of these definitions, to compare them with those used by Lilienfeld and to determine whether changes have taken place over the last forty years. METHODS: A review of grey literature and published literature was conducted to find the definitions of epidemiology written between 1978 and 2017. RESULTS: 102 definitions of epidemiology were retained. They helped to highlight 20 terms and concepts related to epidemiology. Most of them were already used in the definitions used by Lilienfeld. Five terms were present in more than 50% of definitions from the period 1978 to 2017: "population", "study", "disease", "health" and "distribution". Several developments have occurred: strengthening of the terms "control" and "health" already used, the concept of "disease" was less frequently encountered whereas the concepts "infectious diseases", "mass phenomenon" are no longer used in definitions from 1978 to 2017. CONCLUSION: This evolution of content of definition of epidemiology is absent from books on epidemiology. A thematic analysis of definitions of epidemiology could be conducted in order to improve our understanding of changes observed.

Factors associated with the prevalence of helminths in Mangalarga Marchador horses in southern of Minas Gerais, Brazil / Fatores associados com a prevalência de helmintos em cavalos da raça Mangalarga Marchador em propriedades do Sul de Minas Gerais

Horses are highly susceptible to parasitism. Helminth infections cause great harm to the animals and to their breeders. This study aimed at evaluating socioeconomic, cultural and management factors associated with the prevalence of gastrointestinal helminths of horses. A total of 40 farmas the Mangalarga Marchador horse breed were visited in southern Minas Gerais, Brazil, where interviews were conducted. Horse feces were collected on the farms and coproparasitological laboratory tests were conducted to quantify the infection and to identify parasites. Data were tabulated in Epidata and analyzed using the SPSS 20.0 software. A great similarity between breeds was observed, specifically in their profiles, as well as in their animal management techniques and in their parasite control habits. The cyathostome was the most prevalent helminth, followed by Oxyuris and large strongyles. The farms which prioritize only equine production are less likely to have animals with massive helminth infection.(AU)

Os equinos são animais muito susceptíveis ao parasitismo. As helmintoses causam grandes prejuízos tanto para os animais, quanto para os criadores. Este estudo teve como objetivo avaliar os fatores sócio-econômicos-culturais e de manejo associados à prevalência de helmintos gastrointestinais de equinos. Foram visitados 40 criatórios de equinos Mangalarga Marchador no Sul de Minas Gerais, nos quais foram realizadas entrevistas. Foram coletadas fezes dos animais nas propriedades e realizados exames laboratoriais coproparasitológicos a fim de quantificar a infecção dos animais e identificar os parasitos. Os dados foram tabulados no Epidata e analisados no software SPSS 20.0. Observou-se uma grande semelhança no perfil dos criadores, assim como na caracterização da propriedade, manejo e controle de parasitos. Os ciatostomíneos foram os helmintos mais prevalentes, seguidos pelo Oxyuris e os grandes estrôngilos. As propriedades que priorizam a equinocultura têm menor chance de apresentar animais com infecção maciça.(AU)

Caracterização clínico-patológica da papilomatose laríngea / Clinical-pathological characterization of laryngeal papillomatosis

A papilomatose laríngea (PL) é uma doença rara e grave, dividida em dois grupos: juvenil (PLJ) e adulta (PLA), ambas causadas pelo papilomavírus humano (HPV). Seu curso pode ser agressivo, com inúmeras recidivas, risco de malignização, disseminação pulmonar e obstrução das vias aéreas. Para identificar os casos mais agressivos e nortear os tratamentos foram desenvolvidas escalas laringoscópicas, dentre elas; a escala desenvolvida por Derkay et al. (1998). O objetivo deste projeto foi caracterizar a PL e correlacionar suas características clínico-patológicas com com a escala laringoscópica de Derkay. Os dados e biópsias de 36 pacientes com PLJ e 56 com PLA foram coletados e analisados por meio da microscopia de luz. Os pacientes foram separados em grupos de acordo com os índíces de Derkay: ≥20 para os mais agressivos e <20 para os casos menos agressivos. Foram realizadas reações de imuno-histoquímicas anti- Fator XIIIa, CD3, CD4, CD8, CD15, CD20, CD68, FoxP3 e MUM-1. As células inflamatórias foram quantificadas. Todas as características clínico-patológicas e os resultados da reação imuno-histoquímica encontrados foram comparados entre os grupos propostos através do teste estatístico de Qui-Quadradro e correlacionados através do teste de correlação de Spearman. O nível de significância considerado foi de 5%. Ao comprar a severidade entre os grupos PLJ e PLA, o grupo PLJ foi considerado mais agressivo (P=0,02). Os pacientes entre as amostras com score ≥20 apresentaram maior incidência de traqueostomia e dificuldade respiratória grave. As displasias de alto grau foram associadas à presença de células FatorXIII+ e CD68+ (P<0,05) e tanto para PLJ quanto para PLA não houve associação destas displasias com a severidade (P=0,55 e P=0,87, respectivamente). A média do índice de Derkay para as amostras com mitoses acima da camada basal e atípicas foi 10,65 (± 5,93), maior do que a média das amostras que não apresentavam esta característica (8,02 ± 4,64), sendo estatisticamente significante (P=0,03). Amostras de PLA apresentaram maior quantidade de células CD3+. CD8+ e MUM1+ (P<0,05). A presença de CD15+ é diretamente proporcional ao índice de Derkay (P<0,05), enquanto MUM-1 é inversamente proporcional (P=0,01). Baseados nestes resultados, conclui-se que a PL é mais severa no pacientes jovens; mitoses atípicas e nas camadas mais superiores do epitélio foram mais frequentes na PLJ e estas foram correlacionadas com a maior severidade. As células inflamatórias também foram relacionadas a severidade e diferiram entre os grupos PLJ e PLA (AU)

Laryngeal papillomatosis (LP) is a rare and serious disease, divided into two groups: juvenile (JLP) and adult (ALP), both caused by the human papillomavirus (HPV). Its course can be aggressive, with numerous relapses, risk of malignancy, pulmonary dissemination and airway obstruction. To identify the most aggressive cases and guide the treatments, laryngoscopic scales were developed, among them; the scale developed by Derkay et al. (1998). The objective of this project was to characterize LP and to correlate its clinical-pathological characteristics with Derkay's laryngoscopic scale. The data and biopsies of 36 patients with JLP and 56 patients with ALP were collected and analyzed by light microscopy. The patients were separated into groups according to the Derkay indices: ≥20 for the most aggressive and <20 for the less aggressive cases. Anti-Factor XIIIa, CD3, CD4, CD8, CD15, CD20, CD68, FoxP3 and MUM-1 immunohistochemical reactions were performed and the inflammatory cells were quantified. All the clinical-pathological characteristics and the results of the immunohistochemical reaction were compared between the groups proposed using the Chi-Square test and correlated through the Spearman correlation test. The significance level considered was 5%. When comparing aggressivity between the JLP and ALP groups, the JLP group was considered more aggressive (P = 0.02). Patients among the samples with score ≥20 had a higher incidence of tracheostomy and severe respiratory distress. High-grade dysplasias were associated with the presence of Factor XIII+ and CD68+ cells (P <0.05), and for both JLP and ALP there was no association of these dysplasias with aggressivity (P = 0.55 and P = 0.87, respectively). The mean of the Derkay index for the samples with mitoses above the basal and atypical layer was 10.65 (± 5.93), higher than the mean of the samples that did not show this characteristic (8.02 ± 4.64), (P = 0.03) being statistically significant. The ALP samples showed higher quantities of CD3+ cells, CD8+ and MUM1+ (P <0.05). The presence of CD15+ is directly proportional to the Derkay index (P <0.05), while MUM-1 is inversely proportional (P = 0.01). Based on these results, it is concluded that LP is more aggressive in young patients; atypical mitoses and in the uppermost layers of the epithelium were more frequent in JLP and these were correlated with aggressivity. Inflammatory cells were also related to aggressiveness and differed between the groups PLJ e PLA (AU)

Epidemiología de la lepra en la región del Norte Araguaia, MT, Brasil, en el período entre 2001 y 2012 (parte III) / No disponible

No disponible

Epidemiology of food allergy in Latin America

Food allergy is growing worldwide at an alarming rate. A group of eight foods account for over 90% of the reactions in Europe and the United States. However, little is known about the frequency of sensitization to these foods in Latin American, and if other native foods from this region are an important source of sensitization. The objective of this review was to analyse the epidemiological studies in Latin America about food allergy and to compare them with the studies in the United States and Europe

No disponible

Epidemiología y datos clínicos de la infección por el virus respiratorio sincitial en niños mayores de 2 años hospitalizados. Estudio multicéntrico nacional (FIVE) / Epidemiology and clinical evidence of infection by respiratory syncytial virus in children over 2 of age. National multicenter study (FIVE)

Introducción y objetivos: La infección por el virus respiratorio sincitial (VRS) está bien caracterizada en lactantes. Sin embargo, pocos estudios analizan la patología por VRS en niños mayores de 2 años. El objetivo de nuestro trabajo es conocer las características de los niños mayores de 2 años hospitalizados a causa de una infección por el VRS, dentro del contexto del estudio multicéntrico FIVE. Pacientes y métodos: Se presenta un subestudio del estudio FIVE (prospectivo, observacional, realizado en 26 hospitales pertenecientes a todas las comunidades autónomas de nuestro país, entre diciembre de 2011 y marzo de 2012), en el que se valoran únicamente los niños mayores de 2 años hospitalizados, tanto con patología de base como sin ella. El estudio FIVE recoge como casos clínicos los niños con una patología subyacente y como controles los niños sanos que fueron hospitalizados a causa de una infección por el VRS (proporción de 1:2). Resultados: Fueron incluidos un total de 225 casos y 460 controles. De ellos, 70 niños eran mayores de 2 años (10,2%), que son los valorados en este estudio. La media de edad fue de 35 meses (con una desviación estándar de 9), el 58% eran varones y el 23% tenían antecedentes de prematuridad. El motivo de ingreso fue la dificultad respiratoria en el 78% de los casos. El 80% de los pacientes precisó oxigenoterapia. Ocho niños (11,6%) precisaron el ingreso en la unidad de cuidados intensivos pediátricos y 1 falleció. El diagnóstico al alta más frecuente fue el episodio de sibilancias recurrentes (62%), seguido de la neumonía (30%). Los mayores de 2 años tenían una patología subyacente (n= 54; 77%) de forma más habitual que los menores (odds ratio= 8,74; intervalo de confianza del 95%: 4,8- 15,7; p <0,0001). Las patologías de base más frecuentes fueron las enfermedades respiratorias (66%), las cardiovasculares (20%) y las neurológicas (11%). Entre las patologías respiratorias, el asma presentó una mayor frecuencia (59%). Conclusiones: Los niños mayores de 2 años que ingresan a causa de una infección por el VRS tienen un riesgo de presentar una patología de base 8,7 veces superior a los menores de esta edad. La patología de base más habitual es el asma. El diagnóstico más común es el de episodio de sibilancias recurrentes, y un porcentaje muy elevado precisa oxigenoterapia (AU)

Title: Epidemiology and clinical evidence of infection by respiratory syncytial virus in children over 2 of age. National multicenter study (FIVE) Introduction and objectives: Respiratory syncytial virus (RSV) infections are well characterized in infants. However, few studies are focused in RSV disease in children over 2 of age. Our goal is to analyze the characteristics of children older than 2 hospitalized due to RSV infection in the context of the FIVE study. Patients and methods: This is a substudy of the FIVE study (prospective, observational, and multicenter) performed in 26 hospitals in all Spanish regions, between December 2011 and March 2012. In the FIVE study, children under 5 years of age hospitalized due to RSV infection were analyzed, comparing patients with underlying conditions (clinical cases) with a group of previously healthy children (ratio 1/2). In this occasion, 2-5 year-old children were more widely analyzed. Results: A total of 225 cases and 460 controls were included in the FIVE study. Among those, 70 children were >2 years old (10.2%). The mean age was 35 months (SD= 9), 58% were male and 23% had a history of prematurity. Breathlessness was the cause of hospitalization in 78% of cases. Hypoxemia (SatO2 <92%) was present in 80%. Eight children (11.6%) were admitted to PICU and one of them died. The most common discharge diagnose was recurrent wheezing episode (62%), followed by pneumonia in 30%. 77% of children (54) had an underlying disease (OR= 8.74; 95% CI: 4.8 to 15.7; p <0.0001). The most common underlying diseases observed were respiratory (66%), cardiovascular (20%) and neurologic (11%). The most frequent respiratory disease observed was asthma (59%).Conclusions: Children >2 years hospitalized due to RSV infection are at risk from having underlying disease 8.7 times more than the <2 years. The most common underlying pathology is asthma. The most common diagnosis is an episode of recurrent wheezing and most patients need oxygen therapy (AU)

Estudo epidemiológico sobre as condições de saúde bucal de crianças menores de cinco anos de idade no município de Diadema, São Paulo - 2012 / Epidemiological survey of oral health status of children under five years-old in Diadema, São Paulo - 2012

O presente estudo teve como objetivos avaliar a prevalência, gravidade e fatores associados à Cárie Dentária (CD), Lesão Dentária Traumática (LDT) e Desgaste Dentário Erosivo (DDEr) em crianças menores de 5 anos de idade no Município de Diadema, São Paulo. Em posse de esses dados, também foram objetivos investigar a tendência da prevalência desses problemas de saúde bucal e avaliar o impacto que esses problemas causam na Qualidade de Vida Relacionada à Saúde Bucal (QVRSB) das crianças examinadas e de seus pais. Cirurgiões dentistas treinados e calibrados examinaram 1215 crianças de 1, 2, 3 e 4 anos de idade para CD e LDT e 839 crianças de 3 e 4 anos de idade para DDEr nas 19 Unidades Básicas de Saúde (UBS) do Município de Diadema durante o dia da Campanha de Multivacinação Infantil em 2012. Para a avaliação dos problemas de saúde foram utilizados os índices de Knutson, ceo-d e ceo-s para CD, os critérios modificados de Andreasen para LDT e o índice de O´Brien modificado para DDEr. A ocorrência de fatores associados foi investigada por meio de um questionário elaborado especificamente para esta pesquisa, com base na literatura. Para avaliar a QVRSB os pais ou responsáveis responderam à versão brasileira do Early Childhood Oral Health Impact Scale (B-ECOHIS). Os dados foram analisados estatisticamente utilizando a regressão de Poisson (IC 95%) para determinar os fatores associados e a QVRSB dos problemas de saúde bucal estudados. Para determinar a tendência da prevalência foi utilizado o Teste de Qui-quadrado para tendência com um nível de significância de 5%. Na população estudada foi encontrada uma prevalência de CD, LDT e DDEr de 20,3%, 20,1% e 51,3% respectivamente.

O ceo-d e ceo-s do total da amostra foi de 0,7 e 1,2 respectivamente. A fratura de esmalte (72,7%) foi a LDT mais prevalente. As lesões de DDEr foram mais prevalentes em incisivos superiores sendo a maioria das lesões encontradas em esmalte (83,3%). Os fatores associados para CD foram a idade da criança e ter 2 ou mais filhos na família; LDT foram a idade e a presença de mordida aberta anterior e/ou sobressaliência acentuada; DDEr foram consumir refrigerante e suco mais de 3 vezes ao dia, deixar a bebida na boca ou beber na mamadeira, relato de refluxo gastroesofágico e morar só com o pai. Observou-se tendências de diminuição, aumento e estacionária nas prevalências de CD, LDT e DDEr respectivamente. Ao avaliar o impacto na QVRSB foi observado que, a CD (RP:3,09; p<0,001) assim como as LDT complicadas (RP:2,10; p=0,048) têm um impacto negativo na QVRSB e o DDEr (RP:0,79; p=0,163) não mostrou ter um impacto na QVRSB. Por tanto, na população estudada, existe uma tendência de declínio da prevalência da CD, de aumento de LDT e uma alta e constante prevalência de DDEr. As lesões de CD e LDT complicadas têm um impacto negativo na QVRSB das crianças e de seus pais ou cuidadores.

The objective of this study was to assess the prevalence, severity and factors associated of Dental Caries (DC), Traumatic Dental Injury (TDI) and Erosive Tooth Wear (ETW) in children the age of five in the municipality of Diadema, São Paulo. Given these data, an additional objective of this study was to investigate the trend of prevalence of these oral health problems and assess the impact that these problems cause on the Oral Health-Related Quality of Life (OHRQoL) in preschool children and their parents. Trained and calibrated dentists examined 1215 children aged 1-4 years for DC and TDI, and 839 children aged 3 and 4 years for ETW in 19 Basic Health Units (BHU) of the municipality of Diadema during the first stage of the National Children's Vaccination in 2012. For the assessment of DC the Knutson, dmf-t and dmf-s index were used, a modified Andreasen criteria was used for TDI and a modified version of the O'Brien index for ETW. Furthermore, the occurrence of associated factors was investigated using a structured questionnaire prepared after reviewing the literature. In order to assess OHRQoL, parents or caregivers answered the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS). Data were statistically analyzed using Poisson regression (CI 95%) which was necessary to evaluate the associated factors and the OHRQoL of the oral health problems studied. In order to determine the trend of prevalence the Chi-square for trend test was used for a significance level of 5%. In the population studied, it was found that the prevalence of DC, TDI, ETW was 20.3%, 20.1% and 51.3% respectively. Enamel fracture (72.7%) was the most prevalent TDI.

ETW lesions were most prevalent in the upper incisors being the most lesions in enamel only (83.3%). The Factors associated with DC were age and having 2 or more children in the family, for TDI the factors were age and presence of anterior open bite and/or increased overjet and for ETW the factors were drinking soft drink or juice more than 3 times a day, keeping the drink in the mouth without swallowing or using baby's bottle, report of gastroesophageal reflux and living with the father only. Findings show decreasing, increasing and stationary trends in the prevalence of DC, TDI and ETW respectively. When evaluating the impact on the OHRQoL, it was observed that DC (PR: 3.09; p <0.001) as well the presence of complicated TDI (PR: 2.10; p=0.048) had a negative impact on the OHRQoL. As a result, in the population studied, there is a decreasing in the prevalence of DC, an increasing trend in the prevalence of TDI and a high and stable prevalence of ETW. DC and the presence of complicated TDI were associated with worse OHRQoL of preschool children and their parents or caregivers.

Estudo epidemiológico sobre as condições de saúde bucal de crianças menores de cinco anos de idade no município de Diadema, São Paulo - 2012 / Epidemiological survey of oral health status of children under five years-old in Diadema, São Paulo - 2012

O presente estudo teve como objetivos avaliar a prevalência, gravidade e fatores associados à Cárie Dentária (CD), Lesão Dentária Traumática (LDT) e Desgaste Dentário Erosivo (DDEr) em crianças menores de 5 anos de idade no Município de Diadema, São Paulo. Em posse de esses dados, também foram objetivos investigar a tendência da prevalência desses problemas de saúde bucal e avaliar o impacto que esses problemas causam na Qualidade de Vida Relacionada à Saúde Bucal (QVRSB) das crianças examinadas e de seus pais. Cirurgiões dentistas treinados e calibrados examinaram 1215 crianças de 1, 2, 3 e 4 anos de idade para CD e LDT e 839 crianças de 3 e 4 anos de idade para DDEr nas 19 Unidades Básicas de Saúde (UBS) do Município de Diadema durante o dia da Campanha de Multivacinação Infantil em 2012. Para a avaliação dos problemas de saúde foram utilizados os índices de Knutson, ceo-d e ceo-s para CD, os critérios modificados de Andreasen para LDT e o índice de O´Brien modificado para DDEr. A ocorrência de fatores associados foi investigada por meio de um questionário elaborado especificamente para esta pesquisa, com base na literatura. Para avaliar a QVRSB os pais ou responsáveis responderam à versão brasileira do Early Childhood Oral Health Impact Scale (B-ECOHIS). Os dados foram analisados estatisticamente utilizando a regressão de Poisson (IC 95%) para determinar os fatores associados e a QVRSB dos problemas de saúde bucal estudados. Para determinar a tendência da prevalência foi utilizado o Teste de Qui-quadrado para tendência com um nível de significância de 5%. Na população estudada foi encontrada uma prevalência de CD, LDT e DDEr de 20,3%, 20,1% e 51,3% respectivamente.O ceo-d e ceo-s do total da amostra foi de 0,7 e 1,2 respectivamente. A fratura de esmalte (72,7%) foi a LDT mais prevalente. As lesões de DDEr foram mais prevalentes em incisivos superiores sendo a maioria das lesões encontradas em esmalte (83,3%). Os fatores associados para CD foram a idade da criança e ter 2 ou mais filhos na família; LDT foram a idade e a presença de mordida aberta anterior e/ou sobressaliência acentuada; DDEr foram consumir refrigerante e suco mais de 3 vezes ao dia, deixar a bebida na boca ou beber na mamadeira, relato de refluxo gastroesofágico e morar só com o pai. Observou-se tendências de diminuição, aumento e estacionária nas prevalências de CD, LDT e DDEr respectivamente. Ao avaliar o impacto na QVRSB foi observado que, a CD (RP:3,09; p<0,001) assim como as LDT complicadas (RP:2,10; p=0,048) têm um impacto negativo na QVRSB e o DDEr (RP:0,79; p=0,163) não mostrou ter um impacto na QVRSB. Por tanto, na população estudada, existe uma tendência de declínio da prevalência da CD, de aumento de LDT e uma alta e constante prevalência de DDEr. As lesões de CD e LDT complicadas têm um impacto negativo na QVRSB das crianças e de seus pais ou cuidadores.

The objective of this study was to assess the prevalence, severity and factors associated of Dental Caries (DC), Traumatic Dental Injury (TDI) and Erosive Tooth Wear (ETW) in children the age of five in the municipality of Diadema, São Paulo. Given these data, an additional objective of this study was to investigate the trend of prevalence of these oral health problems and assess the impact that these problems cause on the Oral Health-Related Quality of Life (OHRQoL) in preschool children and their parents. Trained and calibrated dentists examined 1215 children aged 1-4 years for DC and TDI, and 839 children aged 3 and 4 years for ETW in 19 Basic Health Units (BHU) of the municipality of Diadema during the first stage of the National Children's Vaccination in 2012. For the assessment of DC the Knutson, dmf-t and dmf-s index were used, a modified Andreasen criteria was used for TDI and a modified version of the O'Brien index for ETW. Furthermore, the occurrence of associated factors was investigated using a structured questionnaire prepared after reviewing the literature. In order to assess OHRQoL, parents or caregivers answered the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS). Data were statistically analyzed using Poisson regression (CI 95%) which was necessary to evaluate the associated factors and the OHRQoL of the oral health problems studied. In order to determine the trend of prevalence the Chi-square for trend test was used for a significance level of 5%. In the population studied, it was found that the prevalence of DC, TDI, ETW was 20.3%, 20.1% and 51.3% respectively. Enamel fracture (72.7%) was the most prevalent TDI. ETW lesions were most prevalent in the upper incisors being the most lesions in enamel only (83.3%). The Factors associated with DC were age and having 2 or more children in the family, for TDI the factors were age and presence of anterior open bite and/or increased overjet and for ETW the factors were drinking soft drink or juice more than 3 times a day, keeping the drink in the mouth without swallowing or using baby's bottle, report of gastroesophageal reflux and living with the father only. Findings show decreasing, increasing and stationary trends in the prevalence of DC, TDI and ETW respectively. When evaluating the impact on the OHRQoL, it was observed that DC (PR: 3.09; p <0.001) as well the presence of complicated TDI (PR: 2.10; p=0.048) had a negative impact on the OHRQoL. As a result, in the population studied, there is a decreasing in the prevalence of DC, an increasing trend in the prevalence of TDI and a high and stable prevalence of ETW. DC and the presence of complicated TDI were associated with worse OHRQoL of preschool children and their parents or caregivers.

Epidemiología: El cambio de paradigmas / Epidemiology: change of paradigms

La epidemiología tiene como propósito describir y explicar la dinámica de la salud poblacional, identificar los elementos que la componen y comprender las fuerzas que la gobiernan, además de promover la salud, prevenir y controlar las enfermedades mediante el conocimiento de sus causas, a fin de intervenir en el curso de su desarrollo natural para modificarlas(AU)

Autorrelato de diabetes e atividade física no Brasil / Self-reported of diabetes and physical activity in Brazil

Embora exista um consenso de que a prática de atividade física (AF) ajuda a prevenir o Diabetes Mellitus (DM) e melhorar a qualidade de vida destes indivíduos, ainda é alta a prevalência de inatividade física entre os diferentes grupos etários de pessoas. O presente artigo descreve a prevalência de autorrelato de DM, o nível de AF desta população e variáveis associadas a este desfecho em adultos e idosos brasileiros. Foi realizado um estudo transversal de base populacional com amostra de 12.402 adultos e 6.624 idosos de 23 estados brasileiros. A prevalência de autorrelato de DM na população de adultos foi de 3,5% (IC95% 3,2-3,9), enquanto nos idosos foi de 16,9% (IC95% 15,9-17,8). Em relação à prática de AF observou-se que entre os indivíduos que relataram ter DM, 82,6% (IC95% 79,0-86,1) dos adultos e 88,2% (IC95% 86,3-90,1) dos idosos foram considerados insuficientemente ativos. Por outro lado, entre os indivíduos que não relataram DM a prevalência de indivíduos insuficientemente ativos entre os adultos e idosos foi de 82,5% (IC95% 81,9-83,2) e 86,3% (IC95% 85,4-87,2) respectivamente. É a alta prevalência de inatividade física entre os indivíduos que relatam ou não o DM.

Although there is a consensus that the practice of physical activity (PA) helps prevent Diabetes Mellitus (DM) and improve the quality of life of individuals, it is still a high prevalence of physical inactivity among different age groups of people. This article describes the prevalence of self-report of DM, the level of PA of this population and variables associated with this outcome in Brazilian adults and elderly individuals. A cross-sectional population-based was conducted with a sample of 12,402 adults and 6,624 elderly individuals from 23 Brazilian states. The prevalence of self-reported DM in the adult population was 3.5% (IC95% 3,2-3,9), while in the elderly one was 16.9% (IC95% 15,9-17,8). Regarding the PA practice, it was observed that among individuals reporting diabetes, 82.6% (95% CI 79.0-86.1) of adults and 88.2% (95% CI 86.3-90.1) of the elderly were considered insufficiently active. Moreover, among individuals that did not reported DM, the prevalence of PA insufficient was 82.5% (95% CI 81.9-83.2) and 86.3% (95% CI 85.4-87.2) respectively. It is high the prevalence of physical inactivity among individuals who report or not the DM.

Aflatoxin M1 in the urine of non-carriers and chronic carriers of hepatitis B virus in Maringa, Brazil

Exposure to aflatoxins (AFs) in the diet may favour the development of hepatocellular carcinoma (HCC) and the acute exacerbation of hepatitis in chronic hepatitis B virus (HBV) carriers. Measurement of biomarkers such as aflatoxin M1 (AFM1), a metabolite of aflatoxin B1 (AFB1), in urine allows for the assessment of populations exposed to aflatoxins. The aim of this study was to investigate the occurrence of aflatoxin M1 in the urine of HBV carrier and non-carrier patients. One group included 43 randomly selected HBV carriers treated at two hospitals in the city of Maringa, Brazil, from March to June 2008. Control group consisted of 29 healthy adult volunteers with anti-HBs positive and HBsAg negative test results. Detection of AFM1 was performed by fluorescence using high performance liquid chromatography (HPLC) and post-column derivation with the Kobra Cell®. Of the 72 samples analysed, 05/29 (17.2%) AFM1 positive samples were from HBV non-carriers, and 16/43 (37.2%) of samples were from chronic HBV carriers. This study showed AFM1 in the urine of the two surveyed population. However, there is evidence that the chronic HBV carriers have a higher risk of developing HCC due to additive interaction between AFs and HBV.

A exposição às aflatoxinas (AFs) na dieta é um fator de risco para o desenvolvimento do carcinoma hepatocelular (CHC) e a exacerbação da hepatite aguda em indivíduos portadores do vírus da hepatite B (VHB). O uso de biomarcadores, como a aflatoxina M1 (AFM1) na urina, produto de biotransformação da aflatoxina B1 (AFB1), permite avaliar se a população está exposta às AFs. O objetivo do presente estudo foi investigar ocorrência de AFM1 na urina de portadores e não portadores crônicos do VHB. Foi selecionado um grupo, de forma aleatória, representado por 43 portadores do VHB atendidos em dois hospitais da cidade de Maringá, Brasil, no período de Março a Junho/2008. O grupo controle foi composto por 29 voluntários adultos saudáveis anti-HBs positivo e HBsAg negativo. A determinação de AFM1 foi realizada por meio de detecção por fluorescência em sistema de cromatografia a líquido de alta eficiência com derivação pós-coluna utilizando Kobra Cell®. Das 72 amostras analisadas, 05/29 (17,2%) foram positivas para AFM1 em indivíduos não portadores do VHB, e 16/43 (37,2%) de pacientes portadores do VHB. Este estudo demonstrou a ocorrência de AFM1 na urina dos dois grupos estudados. Entretanto, há evidências de que os portadores do VHB possuam alto risco no desenvolvimento do CHC devido ao efeito aditivo pela interação entre aflatoxinas e VHB.

Una vez más, de la vieja a la nueva epidemiología / Once again, moving from the old to the new epidemiology

Las nuevas generaciones de epidemiólogos han demorado mucho en comprender cabalmente las palabras de Nájera: "y aún estamos atenidos al enfoque newtoniano. Esa es la razón por la cual todavía pensemos las causas de las enfermedades en términos de uno, dos o cuando muchos unos pocos factores". Es necesario esforzarse en pensar de manera diferente. En este artículo se describen los modelos lineales de causalidad aún vigentes en la mayoría de los estudios epidemiológicos y se propone aceptar el nuevo desafío que representa reconocer una causalidad no lineal. Es interesante y necesario preguntarse si se adaptarán los epidemiólogos a expresarse en un lenguaje predominantemente cualitativo, si lograrán expresar los problemas de salud-enfermedad poblacional sin el predominio de las estadísticas, o si la tendencia general será a desarrollar una nueva forma de epidemiología cuantitativa desde las teorías y no desde las nuevas teorías de la complejidad, donde impera el carácter cualitativo. Actuar según el pensamiento de la complejidad constituye un verdadero desafío para el paradigma matemático-estadístico positivista que dominó el campo de la Epidemiología Clásica.

The new generations of epidemiologists have taken too much time in fully understanding Najera´s words: "we are still tied to the Newton´s approach. This is the reason why we are still thinking of the causes of diseases in terms of one, two or a few factors all the most". It is necessary to make efforts to change our minds. This article described the linear causality models that are yet valid in most of the epidemiological studies, and made suggestions to accept the new challenge of non-linear causality. It is interesting and necessary to wonder if the epidemiologists will adapt to express themselves in a predominantly qualitative language, if they will manage to state the population´s health-disease problems without statistics or if the general tendency will be developing a new form of quantitative epidemiology based on theories rather than on the new complexity theories where the qualitative nature predominates. Acting in line with the complexity thinking is a real challenge for the positivist mathematician-statistician paradigm that has so far prevailed in the field of Classical Epidemiology.

Una vez más, de la vieja a la nueva epidemiología / Once again, moving from the old to the new epidemiology

Las nuevas generaciones de epidemiólogos han demorado mucho en comprender cabalmente las palabras de Nájera: "y aún estamos atenidos al enfoque newtoniano. Esa es la razón por la cual todavía pensemos las causas de las enfermedades en términos de uno, dos o cuando muchos unos pocos factores". Es necesario esforzarse en pensar de manera diferente. En este artículo se describen los modelos lineales de causalidad aún vigentes en la mayoría de los estudios epidemiológicos y se propone aceptar el nuevo desafío que representa reconocer una causalidad no lineal. Es interesante y necesario preguntarse si se adaptarán los epidemiólogos a expresarse en un lenguaje predominantemente cualitativo, si lograrán expresar los problemas de salud-enfermedad poblacional sin el predominio de las estadísticas, o si la tendencia general será a desarrollar una nueva forma de epidemiología cuantitativa desde las teorías y no desde las nuevas teorías de la complejidad, donde impera el carácter cualitativo. Actuar según el pensamiento de la complejidad constituye un verdadero desafío para el paradigma matemático-estadístico positivista que dominó el campo de la Epidemiología Clásica.(AU)

The new generations of epidemiologists have taken too much time in fully understanding Najera´s words: "we are still tied to the Newton´s approach. This is the reason why we are still thinking of the causes of diseases in terms of one, two or a few factors all the most". It is necessary to make efforts to change our minds. This article described the linear causality models that are yet valid in most of the epidemiological studies, and made suggestions to accept the new challenge of non-linear causality. It is interesting and necessary to wonder if the epidemiologists will adapt to express themselves in a predominantly qualitative language, if they will manage to state the population´s health-disease problems without statistics or if the general tendency will be developing a new form of quantitative epidemiology based on theories rather than on the new complexity theories where the qualitative nature predominates. Acting in line with the complexity thinking is a real challenge for the positivist mathematician-statistician paradigm that has so far prevailed in the field of Classical Epidemiology.(AU)

Perfil clínico-epidemiológico do paciente diabético tipo II internado no Hospital de Clínicas Gaspar Vianna

O diabetes mellitus é hoje, e também será no decorrer do século XXI, um dos maiores problemas de saúde pública mundial, por apresentar elevada prevalência, alto custo e evoluir com incapacitações e mortalidade prematura. Desse modo, objetivam os autores traçar o perfil clínico-epidemiológico do paciente diabético tipo II internado no Hospital de Clínicas Gaspar Vianna no período de março a outubro de 2004...Diabetes mellitus is today, and will be throughout the century, one of the biggest public health problems worldwide by have a high prevalence, high cost and evolve with disability and premature mortality. Thus, the authors aim to delineate the clinical and epidemiological profile of the type II diabetic patients admitted to the Hospital de Clinicas Gaspar Vianna from March to October 2004 ...

[The historical and epistemological development of epidemiology and the concept of risk]. / Desenvolvimento histórico-epistemológico da Epidemiologia e do conceito de risco.

Statistical reasoning in health practice was disseminated by epidemiology and is widely used in various health fields. This paper revisits the historical development of epidemiology and the concept of risk, responsible for the use of statistical chance as part of causal thinking in health sciences. The study covered the period from 1872 to 1965, and the documental base consisted of scientific articles related to the development of epidemiology as a field, particularly in the American Journal of Hygiene, as well as scientific books. Three phases were identified in the development of epidemiology: constitution, exposure, and risk. The article proceeds to discuss epistemological and social and health aspects required for the historical understanding of each phase. It concludes by stressing the relevance of critical reflection on epidemiological science and its relationship to health practice, especially in public health, in order to optimize its current use and foster its on-going creative reconstruction.

Factores de riesgo ambientales no dietéticos en el cáncer de próstata / Constitutional Risk Factors In Prostate Cancer

Introducción: Se pretende actualizar y divulgar los principales factores de riesgo ambientales, excluyendo los dietéticos, implicados en la etiopatogenia del cáncer de próstata. Material y método: Revisión bibliográfica de los últimos 25 años de los factores de riesgo ambientales no dietéticos asociados a cáncer de próstata entre 1985 y 2010, obtenida del Med-Line, CancerLit, Science Citation Index y Embase. Los perfiles de búsqueda han sido Environmental Risk Factors/Tobacco/Infectious-Inlammation Factors/Pesticides/Vasectomy/OccupationalExposures/Chemoprevention Agents/Radiation y «Cáncer de Próstata». Resultados: Mientras que algunos factores de riesgo ambientales no dietéticos incrementan el riesgo de padecer la enfermedad, otros lo disminuyen. Entre los primeros destacan la exposición al humo del tabaco; los procesos prostáticos infecto-inflamatorios crónicos y la exposición profesional al cadmio, herbicidas y pesticidas. Los principales factores que reducen el riesgo es elempleo de fármacos quimiopreventivos (finasterida, dutasterida) y la exposición a la radiación ultravioleta solar. La vasectomía, con los datos actuales, no influye en el riesgo de desarrollarla enfermedad. Conclusiones: El lento proceso de carcinogénesis prostática es el resultado final de la interacción de factores de riesgo constitucionales y ambientales. Los factores ambientales no dietéticos desempeñan un papel importante en la etiopatogenia de esta enfermedad. Para valorar apropiadamente los factores de riesgo deben analizarse grandes casuísticas que incluyan todas las variables posibles (AU)

Introduction: The aim is to update and disclose the main environmental risk factors, excluding dietary factors, involved in the etiopathology of prostate cancer. Materials and method: Bibliographic review of the last 25 years of non-dietary environmental risk factors associated with prostate cancer between 1985 and 2010, obtained from MedLine, CancerLit, Science Citation Index and Embase. The search profiles were Environmental RiskFactors/Tobacco/Infectious-Inflammatory Factors/Pesticides/Vasectomy/Occupational Exposures/Chemoprevention Agents/Radiation and Prostate Cancer. Results: While some non-dietary environmental risk factors increase the risk of acquiring the disease, others decrease it. Of the former, it is worth mentioning exposal to tobacco smoke, chronic infectious-inflammatory prostatic processes and occupational exposure to cadmium, herbicides and pesticides. The first factors that reduce the risk are the use of chemopreventive drugs (Finasterida, Dutasteride) and exposure to ultraviolet solar radiation. With the current data, a vasectomy does not influence the risk of developing the disease. Conclusions: The slow process of prostate carcinogenesis is the final result of the interaction of constitutional risk and environmental factors. Non-dietary environmental factors play an important role in the etiopathology of this disease. To appropriately assess the risk factors, extensive case studies that include all the possible variables must be analysed (AU)

Hepatitis autoinmune en niños: clínica y manejo / Autoimmune hepatitis in children: clinical and management

La hepatitis autoinmune (HAI), es una enfermedad inflamatoria crónica y progresiva, que se caracteriza histológicamente por un denso infiltrado de células mononucleares en vías portales, y cuya patogenia se le atribuye a una reacción inmune frente a autoantígenos hepatocelulares demostrado serológicamente por la presencia de autoanticuerpos específicos y aumento en los niveles de las aminotransferasas y de inmunoglobulina tipo IgG, en ausencia de una etiología conocida. Son reconocidos dos tipos de HAI en la infancia: HAI tipo I, que se caracteriza por la presencia de anticuerpos (anti músculo liso SMA) y/o antinucleares (ANA), y la HAI tipo II,que se caracteriza por anticuerpos antimicrosomales de riñón hígado (anti-LKM). La etiología de la HAI es desconocida, aunque tanto factores genéticos como ambientales están implicados en su expresión. El fenotipo clínico de la HAI en niños varía en gran medida, va desde una evolución leve a un curso fulminante. La HAI es sensible a la terapia inmunosupresora. El trasplante hepático está indicado en pacientes que presentan insuficiencia hepática fulminante (encefalopatía) y los que desarrollan enfermedad hepática terminal.

Autoimmune hepatitis (HAI) is a chronic and progressive inflammatory disease, characterizedhistologically by a dense infiltrate of mononuclear cells in the process portals, and whose pathogenesis is attributed to an immune response against hepatocellular autoantigens demonstratedserologically by the presence of specific autoant ibodies and increased levels of aminotransferases and immunoglobulin IgG, in the absence of known etiology. Recognized two types of HAI in childhood: type I, characterized by the presence of antibodies (smooth muscle anti SMA) and / or antinuclear (ANA) and type II, characterized by anti-microsomal antibodies liver kidney (anti-LKM). The etiology of HAI is unknown, a l though both gene t i c and environmental factors are involved in its expression. The clinical phenotype of the HAI in children varies greatly, ranging from a slight evolution to a fulminant course. The HAI is sensitive to immunosuppressive therapy. Liver transplantation is indicated in patients with fulminant hepatic failure (encephalopathy) andthose who develop end-stage liver disease.