Health promotion initiatives at school related to overweight, insulin resistance, hypertension and dyslipidemia in adolescents: a cross-sectional study in Recife, Brazil.

BACKGROUND: The emergence of diseases such as dyslipidemia, systemic arterial hypertension, insulin resistance and metabolic syndrome in children and adolescents has brought about a change in the epidemiologic profile of the pediatric population. As action to promote health in the school environment is a useful tool for changing the pattern of health/disease in the young population, the present study aimed to identify schools that promote healthy eating and physical activity and to study the relationship between these practices and the prevalence of overweight, hypertension, insulin resistance and hypercholesterolemia in adolescents. METHODS: A cross-sectional population-based study was conducted with 2400 adolescents aged from 12 to 17 years old and participating in the "Study of Cardiovascular Risk in Adolescents" (ERICA - Estudo de Riscos Cardiovasculares em Adolescente). The association between dependent (overweight, insulin resistance, hypertension and dyslipidemia) and independent variables (implementation of health promoting initiative in schools) was investigated using the chi-square test and prevalence ratio (PR) with a confidence index (CI) of 95%. RESULTS: The unsatisfactory implementation of a "health promoting environment" (PR = 1.02; CI 95%: 1.0; 1.04) and "partnerships with the health sector" (PR = 1.03; CI 95%: 1.01; 1.05) were linked to a high prevalence of overweight in adolescents. Hypercholesterolemia was found to be higher in the schools with unsatisfactory implementation of "healthy eating and health on the scholar curriculum" (PR = 1.71; CI 95%: 1.22; 2.44) and those lacking a "healthy-eating promoting environment" (PR = 1.29; CI 95%: 1.10; 1.54). Schools with unsatisfactory implementation of a "health-eating promoting environment" (PR = 1.36; CI 95%: 1.04; 1.79) and those lacking "partnership with the health sector" (PR = 2.12; CI 95%: 1.38; 3.24) had more adolescents with insulin resistance. There was no association between hypertension and any other component studied. CONCLUSION: Schools which have implemented adequate health promotion in their curriculums showed a lower prevalence of overweight, insulin resistance and hypercholesterolemia in adolescents.

The impact of an intervention to improve diabetes management in primary healthcare professionals' practices in Brazil.

AIMS: To evaluate the results of a structured intervention in primary healthcare to improve type 2 diabetes management. METHODS: The intervention was implemented in 2011-2012 in two cities in the State of Pernambuco, Brazil, and evaluated in 2013 by interviewing healthcare professionals about their practices in all primary care facilities of these two cities (intervention group), and of two paired control cities (control group). Comparisons between the intervention and control groups were made using standard parametric tests. RESULTS: The percentage of professionals who measured adherence to treatment, developed educational actions to control high-risk situations or prevent complications, or declared that they "explained" the disease to the patients, was higher in the control group (p<0.05). Multidisciplinary involvement, requests for electrocardiograms and referrals to specialists were also more frequent in the control group (p<0.01). The only differences favoring the intervention group were the higher proportion of nurses (p<0.05) and community health workers (p<0.01) trained for diabetes management and a greater frequency of discussing the cases of diabetic patients at team meetings (p<0.01). CONCLUSIONS: These negative results raise questions about the effectiveness of actions aiming to improve diabetes management in primary care, and reinforce the need for careful evaluation of their impact.

Description of a prospective 17DD yellow fever vaccine cohort in Recife, Brazil.

From September 2005 to March 2007, 238 individuals being vaccinated for the first time with the yellow fever (YF) -17DD vaccine were enrolled in a cohort established in Recife, Brazil. A prospective study indicated that, after immunization, anti-YF immunoglobulin M (IgM) and anti-YF IgG were present in 70.6% (IgM) and 98.3% (IgG) of the vaccinated subjects. All vaccinees developed protective immunity, which was detected by the plaque reduction neutralization test (PRNT) with a geometric mean titer of 892. Of the 238 individuals, 86.6% had IgG antibodies to dengue virus; however, the presence of anti-dengue IgG did not interfere significantly with the development of anti-YF neutralizing antibodies. In a separate retrospective study of individuals immunized with the 17DD vaccine, the PRNT values at 5 and 10 years post-vaccination remained positive but showed a significant decrease in neutralization titer (25% with PRNT titers < 100 after 5 years and 35% after 10 years).

Fatores de risco para poliparasitismo intestinal em uma comunidade indígena de Pernambuco, Brasil / Risk factors for multiple intestinal parasites in an indigenous community of the State of Pernambuco, Brazil

No perfil etnoepidemiológico da comunidade dos Indios Pankararus - interior do Estado de Pernambuco -, as parasitoses intestinais representam importante problema de saúde pública, por atingir a quase totalidade da populaçäo. A fim de conhecer possíveis fatores de risco ambientais deste quadro, utilizou-se parte da base de dados do inquérito original para relacionar as condiçöes de moradia ao número de parasitas diferentes verificado entre seus moradores. Com base na seleçäo da quantidade de exames coprológicos efetuados entre as pessoas da família, a amostra para análise contou 84 famílias dentre as 112 da amostra aleatória original. Para o número médio de 6,1 pessoas por família, constatou-se que o de parasitas diferentes presentes no lar era 5,0, número crescente quando a casa era de taipa (6,0 contra 4,9 para as de alvenaria; p <0,03), ou a água usada na moradia näo era tratada (5,1 contra 4,5 para água tratada; p < 0,05). Outros fatores que caracterizam a moradia e sua higiene näo parecem influenciar o número médio de parasitas na casa. Conclui-se que o poliparasitismo nos Indios Pankararus de Pernambuco chega a representar a regra e está referido sobretudo às fontes de água de beber e ao seu tratamento.