Classification of postural profiles among mouth-breathing children by learning vector quantization.

BACKGROUND: Mouth breathing is a chronic syndrome that may bring about postural changes. Finding characteristic patterns of changes occurring in the complex musculoskeletal system of mouth-breathing children has been a challenge. Learning vector quantization (LVQ) is an artificial neural network model that can be applied for this purpose. OBJECTIVES: The aim of the present study was to apply LVQ to determine the characteristic postural profiles shown by mouth-breathing children, in order to further understand abnormal posture among mouth breathers. METHODS: Postural training data on 52 children (30 mouth breathers and 22 nose breathers) and postural validation data on 32 children (22 mouth breathers and 10 nose breathers) were used. The performance of LVQ and other classification models was compared in relation to self-organizing maps, back-propagation applied to multilayer perceptrons, Bayesian networks, naive Bayes, J48 decision trees, k, and k-nearest-neighbor classifiers. Classifier accuracy was assessed by means of leave-one-out cross-validation, area under ROC curve (AUC), and inter-rater agreement (Kappa statistics). RESULTS: By using the LVQ model, five postural profiles for mouth-breathing children could be determined. LVQ showed satisfactory results for mouth-breathing and nose-breathing classification: sensitivity and specificity rates of 0.90 and 0.95, respectively, when using the training dataset, and 0.95 and 0.90, respectively, when using the validation dataset. CONCLUSIONS: The five postural profiles for mouth-breathing children suggested by LVQ were incorporated into application software for classifying the severity of mouth breathers' abnormal posture.

Security requirements for a lifelong electronic health record system: an opinion.

This article discusses the authors' views on the security requirements of a central, unique electronic health record. The requirements are based on the well-known principles of confidentiality and integrity and the less discussed principles of control and legal value. The article does not discuss any technical or legal solutions to the requirements proposed herein.

Decision support system for the diagnosis of schizophrenia disorders.

Clinical decision support systems are useful tools for assisting physicians to diagnose complex illnesses. Schizophrenia is a complex, heterogeneous and incapacitating mental disorder that should be detected as early as possible to avoid a most serious outcome. These artificial intelligence systems might be useful in the early detection of schizophrenia disorder. The objective of the present study was to describe the development of such a clinical decision support system for the diagnosis of schizophrenia spectrum disorders (SADDESQ). The development of this system is described in four stages: knowledge acquisition, knowledge organization, the development of a computer-assisted model, and the evaluation of the system's performance. The knowledge was extracted from an expert through open interviews. These interviews aimed to explore the expert's diagnostic decision-making process for the diagnosis of schizophrenia. A graph methodology was employed to identify the elements involved in the reasoning process. Knowledge was first organized and modeled by means of algorithms and then transferred to a computational model created by the covering approach. The performance assessment involved the comparison of the diagnoses of 38 clinical vignettes between an expert and the SADDESQ. The results showed a relatively low rate of misclassification (18-34%) and a good performance by SADDESQ in the diagnosis of schizophrenia, with an accuracy of 66-82%. The accuracy was higher when schizophreniform disorder was considered as the presence of schizophrenia disorder. Although these results are preliminary, the SADDESQ has exhibited a satisfactory performance, which needs to be further evaluated within a clinical setting.

Decision support system for the diagnosis of schizophrenia disorders

Clinical decision support systems are useful tools for assisting physicians to diagnose complex illnesses. Schizophrenia is a complex, heterogeneous and incapacitating mental disorder that should be detected as early as possible to avoid a most serious outcome. These artificial intelligence systems might be useful in the early detection of schizophrenia disorder. The objective of the present study was to describe the development of such a clinical decision support system for the diagnosis of schizophrenia spectrum disorders (SADDESQ). The development of this system is described in four stages: knowledge acquisition, knowledge organization, the development of a computer-assisted model, and the evaluation of the system's performance. The knowledge was extracted from an expert through open interviews. These interviews aimed to explore the expert's diagnostic decision-making process for the diagnosis of schizophrenia. A graph methodology was employed to identify the elements involved in the reasoning process. Knowledge was first organized and modeled by means of algorithms and then transferred to a computational model created by the covering approach. The performance assessment involved the comparison of the diagnoses of 38 clinical vignettes between an expert and the SADDESQ. The results showed a relatively low rate of misclassification (18-34%) and a good performance by SADDESQ in the diagnosis of schizophrenia, with an accuracy of 66-82%. The accuracy was higher when schizophreniform disorder was considered as the presence of schizophrenia disorder. Although these results are preliminary, the SADDESQ has exhibited a satisfactory performance, which needs to be further evaluated within a clinical setting.

Anthropometry and body composition in ethnic Japanese and Caucasian adolescent girls: considerations on ethnicity and menarche.

OBJECTIVE: This study aimed to compare the various anthropometric and body composition parameters based on the ethnicity and the absence or presence of menarche. DESIGN: A cross-sectional study with incomplete sampling, using the subject as the evaluation unit. SUBJECTS: The final sample of 550 subjects was composed of 122 Japanese and 179 Caucasian premenarcheal adolescents, and 72 Japanese and 177 Caucasian postmenarcheal adolescents. METHODS: The variables of body composition were measured through the following methods: bioelectrical impedance analysis, near-infrared interactance (NIR), Slaughter cutaneous skinfold equations and body mass index. Weight, height and sitting height were also evaluated. RESULTS: The Japanese pre- and postmenarcheal girls presented lower weight and height values when compared with the Caucasian girls. In general, the Japanese premenarcheal girls presented less fat and fat-free mass than the premenarcheal Caucasian girls. This fact was demonstrated through NIR results. Conversely, the Japanese postmenarcheal adolescents accumulated more fat than their Caucasian counterparts. However, significant differences were solely encountered in the values of cutaneous skinfold percent body fat. With regard to menarche, it was verified that, regardless of ethnicity, all the anthropometric and body composition variables reached higher values among postmenarcheal adolescents when compared with premenarcheal adolescents. CONCLUSION: Different results of weight and height between the ethnic groups may bring back the discussion concerning separate growth curves for different ethnic groups. The results of the body composition analysis indicated high adiposity levels among postmenarcheal adolescents.

A Web-based distance education course in nutrition in public health: case study.

BACKGROUND: Strict work timetables, personal and professional duties or an inability to be absent from home or work can all represent major constraints for those wishing to improve their professional skills. Within this context, the World Wide Web can allow people to conveniently follow distance courses from their homes. OBJECTIVE: To present an experience in the use of the Web in the continuing education of healthcare professionals in Brazil. METHODS: A Web-based distance education course in nutrition in public health was developed. The methodology was an adaptation of both problem-based and task-based learning. At the end of the course an evaluation questionnaire which covered the course s contents, the educational methodology and resources, the duration and schedule, and the use of the Web as a tool for distance education was given to the students. RESULTS: There were 83 on line registrations from 13 states, 73 of the applicants were female, 62 had a degree in nutrition and 18 were physicians. From these; eleven students from ten states were chosen: nine female nutritionists, two female physicians, and one male physician. Seven students completed the course, took and passed the final exam. Of the other four students, two failed to follow the schedule, one had health problems, and one did not obtain the minimal score for sitting the final exam. The students had a mean age of 35, and a mean of ten years in practice. They all stated that they were unable to attend a regular course, even though they felt that they needed to improve their professional skills. Most of them studied seven days a week for between two and four hours a day. The students also felt that their professional skills had improved and each reported having made changes in their practice as a result of their participation. The students approved of the course s contents, methodology and resources, however they were divided about its duration. The Web as a tool in distance education was approved by the students. If it was not for the Web they could not have taken part in a continuing education program. All students said they would attend another virtual course, if available. Even though most of them did not have difficulty adapting to the virtual environment, they did feel that an adaptation period would be of value. CONCLUSIONS: A Web-based course may be more effective than other distance education methodologies because it is more interactive and dynamic. On-line material can be constantly reviewed and updated, and the students can have the opportunity to submit commentaries or questions directly to the teaching staff. A Web-based course also allows the students to go beyond the course content as they learn how to search and take advantage of the huge resources of information available on the Internet.

Comparison of the body mass index to other methods of body fat evaluation in ethnic Japanese and Caucasian adolescent girls.

OBJECTIVE: The aim of this study was to assess the body mass index (BMI) and its relationship with other methods of body fat evaluation in pre- and post-menarcheal, Japanese and Caucasian female adolescents, using two different cut-off points for obesity: 28% and 30%. DESIGN: A cross-sectional study with incomplete sampling, using the subject as the evaluation unit. SUBJECTS: A total of 436 Japanese and Caucasian female adolescents in two age groups: 10-11 (pre-menarcheal adolescent); and 16-17 (post-menarcheal adolescents). METHODS: For the BMI the cut-off point for thinness was set at the 5th percentile of the BMI distribution of the NCHS reference population and the cut-off point for overweight and obesity was set at the 85th percentile. Body composition was assessed using foot-to-foot bioelectrical impedance analysis (BIA), near-infrared interactance (NIR) and Slaughter skinfold equations (SKI). The statistical comparison of the methods was performed using the kappa agreement test and the McNemar disagreement test. RESULTS: In the 10- and 11-y-old girls, the BMI was considerably and significantly correlated with the other methods. The major agreements were: in Japanese adolescents BMI x NIR=82.3% (cut-off point of 28%), BMI x BIA=85.7% (cut-off point of 30%); in Caucasian adolescents BMI x NIR=80.7% (cut-off point of 28%), BMI x BIA=87.4% (cut-off point of 30%). The disagreement above the diagonal between BMI x NIR was higher within the two groups for both the cut-off points, revealing that the girls identified as obese by the BMI were considered eutrophic by NIR. In the 16- and 17-y-old adolescents, the BMI demonstrated low or no correlation with the other methods. Furthermore, it presented disagreements below the diagonal, revealing that the BMI identified fewer obese subjects than the other methods. CONCLUSION: Among the 10- and 11-y-olds, the BMI presented a good correlation with the other methods, independent of ethnicity. The BMI can therefore be used in place of these methods, although it may underestimate obesity. Among the 16- and 17-y-olds, the BMI presented low or no agreement with the other methods, suggesting that it is probably not a suitable index for this age-group in studies focusing on the identification of obesity. In such cases the choice of one of the other methods, depending on availability, cost or technical experience, may represent a better approach.

Resting energy expenditure in pre-dialysis diabetic patients.

BACKGROUND: The metabolic derangements of diabetes mellitus (DM) associated with those of chronic renal failure (CRF) may interfere with the energy and protein balance of patients with both diseases. The aim of this study was to verify whether the resting energy expenditure (REE) of non-dialysis chronic renal failure diabetic patients differs from that of chronic renal failure patients without DM. METHODS: REE was measured by indirect calorimetry in 24 CRF diabetic patients (CRF diabetes group), matched for age, gender, and degree of renal impairment to 24 CRF patients without DM (CRF control group). RESULTS: The CRF diabetes group had a significantly higher REE (1538+/-230 kcal/day) than the CRF control group (1339+/-315 kcal/day, P = 0.009). This difference was maintained even when the REE was adjusted for lean body mass (LBM; 30.3+/-4.3 vs 26.3+/-5.4 kcal/kg LBM/day, P = 0.004). Mean protein intake was significantly higher in the CRF diabetes than in the CRF control group (0.89+/-0.20 vs 0.76+/-0.25 g/kg/day, P = 0.02). Mean protein equivalent of nitrogen appearance (PNA) was also significantly higher in the CRF diabetes patients (1.21+/-0.31 vs 1.03+/-0.22 g/kg/day, P = 0.02), reflecting a higher protein intake and/or elevated protein breakdown. Accordingly, REE was directly correlated with PNA mainly in the CRF diabetes group (r = 0.57, P < 0.003). CONCLUSION: Metabolic disturbances of poorly controlled DM may account for the higher REE observed in the CRF diabetes group. The role of the apparently higher protein breakdown in this increased REE remains to be clarified.

Nutritional status of hemodialysis patients with secondary hyperparathyroidism

The repercussions of secondary hyperparathyroidism on the nutritional status of chronic renal failure patients have not been well established. Therefore, the aim of this study was to compare the nutritional indices of hemodialysis patients with and without secondary hyperparathyroidism. Sixteen hemodialysis patients with serum parathyroid hormone (PTH) levels higher than 420 pg/ml (hyperparathyroidism group) were matched for gender, age and length of dialysis treatment to 16 patients with serum PTH between 64 and 290 pg/ml (control group). The following parameters were assessed: anthropometric indices (body mass index, skinfold thickness, midarm muscle circumference and body fat), 4-day food diaries, protein catabolic rate, biochemical indices (blood urea nitrogen, serum creatinine, albumin, ionized calcium, inorganic phosphorus, serum alkaline phosphatase, PTH, pH and HCO3) and dialysis efficiency. We did not observe differences in the anthropometric indices between the two groups. Only calcium intake was significantly different between groups (307.9 mg/day for the hyperparathyroidism group vs 475.8 mg/day for the control group). Protein catabolic rate tended to be higher in the hyperparathyroidism group compared to the control group (1.3 vs 0.9 g kg-1 day-1; P = 0.08). Except for blood urea nitrogen (86.4 vs 75.7 mg/dl), alkaline phosphatase (175 vs 65 U/l) and PTH (898 vs 155 pg/ml), no other differences were found between groups in the biochemical indices studied. PTH was directly correlated with protein catabolic rate (r = 0.61; P<0.05) and length of dialysis (r = 0.53; P<0.05) only in the hyperparathyroidism group. Considering the indices used, we could not demonstrate the deleterious effect of high PTH levels on the nutritional status of hemodialysis patients. Indirect evidence, however, suggests an action of PTH on protein metabolism

Nutritional status of hemodialysis patients with secondary hyperparathyroidism.

The repercussions of secondary hyperparathyroidism on the nutritional status of chronic renal failure patients have not been well established. Therefore, the aim of this study was to compare the nutritional indices of hemodialysis patients with and without secondary hyperparathyroidism. Sixteen hemodialysis patients with serum parathyroid hormone (PTH) levels higher than 420 pg/ml (hyperparathyroidism group) were matched for gender, age and length of dialysis treatment to 16 patients with serum PTH between 64 and 290 pg/ml (control group). The following parameters were assessed: anthropometric indices (body mass index, skinfold thickness, midarm muscle circumference and body fat), 4-day food diaries, protein catabolic rate, biochemical indices (blood urea nitrogen, serum creatinine, albumin, ionized calcium, inorganic phosphorus, serum alkaline phosphatase, PTH, pH and HCO(3)) and dialysis efficiency. We did not observe differences in the anthropometric indices between the two groups. Only calcium intake was significantly different between groups (307.9 mg/day for the hyperparathyroidism group vs 475.8 mg/day for the control group). Protein catabolic rate tended to be higher in the hyperparathyroidism group compared to the control group (1.3 vs 0.9 g kg(-1) day(-1); P = 0.08). Except for blood urea nitrogen (86.4 vs 75.7 mg/dl), alkaline phosphatase (175 vs 65 U/l) and PTH (898 vs 155 pg/ml), no other differences were found between groups in the biochemical indices studied. PTH was directly correlated with protein catabolic rate (r = 0.61; P<0.05) and length of dialysis (r = 0.53; P<0.05) only in the hyperparathyroidism group. Considering the indices used, we could not demonstrate the deleterious effect of high PTH levels on the nutritional status of hemodialysis patients. Indirect evidence, however, suggests an action of PTH on protein metabolism.

High sodium chloride intake is associated with low bone density in calcium stone-forming patients.

BACKGROUND: Although renal stone disease has been associated with reduced bone mass, the impact of nutrient intake on bone loss is unknown. SUBJECTS AND METHODS: The present study was undertaken to investigate the influence of nutrient intake on bone density of 85 calcium stone-forming (CSF) patients (47 male and 38 premenopausal females) aged 41+/-11 years (X+/-SD). Bone mineral density (BMD) was measured using dual energy X-ray absorptiometry at the lumbar spine (L2-L4) and femoral neck sites, and low BMD was defined as a T score < -1 (WHO criteria). A 4-day dietary record and a 24-hour urine sample were obtained from each patient for the assessment of nutrient intake and urinary calcium (U(Ca)), sodium (U(Na)), phosphate and creatinine excretion. RESULTS: Forty-eight patients (56%) presented normal BMD and 37 (44%) low BMD. There were no statistical differences regarding age, weight, height, body mass index, protein, calcium and phosphorus intakes between both groups. The mean U(Ca), phosphorus and nitrogen appearance also did not differ between groups. However, there was a higher percentage of hypercalciuria among low vs normal BMD patients (62 vs 33%, p < 0.05). Low BMD patients presented a higher mean sodium chloride (NaCl) intake and excretion (UNa) than normal BMD (14+/-5 vs 12+/-4 g/day and 246+/-85 vs 204+/-68 mEq/day, respectively p < 0.05). The percentage of patients presenting NaCl intake > or = 16 g/day was also higher among low vs normal BMD patients (35 vs 12%, p < 0.05). After adjustment for calcium and protein intakes, age, weight, body mass index, urinary calcium, citrate and uric acid excretion, and duration of stone disease, multiple-regression analysis showed that a high NaCl intake (> or = 16 g/day) was the single variable that was predictive of risk of low bone density in CSF patients (odds ratio = 3.8). CONCLUSION: These data suggest that reducing salt intake should be recommended for CSF patients presenting hypercalciuria and osteopenia.

Hazard analysis and critical control point system approach in the evaluation of environmental and procedural sources of contamination of enteral feedings in three hospitals.

BACKGROUND: The administration of contaminated diets may contribute to severe infections, mainly in immunosuppressed patients. To determine the microbiologic quality of enteral feedings and the critical control points involved in the processing of the formulas, a study was carried out in three hospitals in São Paulo, Brazil. METHODS: One hundred sixteen diets were evaluated according to the system known as hazard analysis and critical control points (HACCP). The techniques included the monitoring of the cleaning and disinfection of utensils, surfaces, and equipment; time and temperature controls; and microbiologic analyses that comprised the enumeration of facultative aerobic mesophilic bacteria, yeasts and molds, coliforms, and Escherichia coli. The diets were assessed based on the British Dietetic Association and the Food and Drug Administration standards. RESULTS: The hospital-formulated diets and the commercially made powdered feeds presented statistically significant higher counts of mesophilic bacteria and percentages of no compliance with the standards for coliforms when compared with the commercially prepared, ready-to-feed enteral formula supplied in cans. According to the British standards, 77% and 38% of the diets were inadequate for mesophilic and coliform bacteria, respectively, just after preparation. After 24-hour storage in refrigerators, the percentages rose to 83% and 45%, respectively; the mesophilic and coliforms counts were also significantly higher. The following critical control points (CCP) were identified: cleaning and disinfecting of surfaces, utensils, and equipment; the time spent in preparation; the water used for reconstitution; the final temperature of the diet; the exposure to room temperatures; the lack of a chilling step; the refrigeration temperature; the inadequate disinfecting of the handlers' hands; and the lack of external cleaning and disinfecting of the cans before opening. CONCLUSIONS: The results of this study are worrisome and show the need for implementation of good practices of hygiene and handling of the diets, and the regular monitoring of their preparation. The microbiologic quality of the enteral diets was compromised according to international standards, representing a potential risk of infection to the patients who require enteral nutrition.

Overweight and obesity in Brazilian adolescents.

OBJECTIVE: This study aimed to describe the prevalence of overweight and obesity (OW+O) among Brazilian adolescents and to identify risks for subpopulations defined according to the five country macro-regions and situation (urban-rural) of the domiciles, income, years of school attendance, age and sex. DESIGN: A nationwide home-based survey representative of the Brazilian civilian noninstitutionalized population, performed in 1989. METHODS: The sampling plans followed a stratified, multistage, probability cluster design in The National Research of Health and Nutrition sample, which collected anthropometric data of 14,455 domiciles. In all, 13,715 adolescents ranging from 10 to 19 y of age were studied. The OW+O was defined from a body mass index (BMI) equal or superior to the 85th percentile of the reference population of the NCHS. The prevalences in the different studied groups were compared using the adjusted odds ratio in logistic regression models. RESULTS: The prevalence of OW+O was of 7.7%, reaching 10.6% within the female group and 4.8% within the male group. A direct relation could be established between the socioeconomic level and OW+O. Adolescents of the most industrialized region of the country presented a risk of OW+O 1.86 (95% CI 1.51-2.30) times higher than that found in the least developed region. Male youngsters who lived in urban areas were more liable (OR=1.71, 95% CI 1.30-2.25) to overweight than their counterparts of rural areas. The occurrence of menarche increased two and a half times (OR=2.58, 95% CI 2.11-3.15) the risk of OW+O within the female group of adolescents. CONCLUSIONS: The results demonstrate a low prevalence of OW+O among Brazilian adolescents when compared with adolescents of more industrialized regions. The OW+O is twice as high within the female group, which represents a much greater difference than the one encountered in industrialized countries, probably owing to the muscular work carried out preponderantly by male adolescents of lower socioeconomic levels. Higher prevalences in subpopulations of higher socioeconomic level and of more industrialized regions show the great need for differentiated actions to control overweight and obesity in the country.

[Effect of in-home boiling and refrigeration on bacterial load of pasteurized milk] / Efeito da fervura doméstica e da refrigeração na carga bacteriana do leite pasteurizado tipo C.

OBJECTIVES: To assess the efficacy of in-home boiling of pasteurized milk in reducing the bacterial load and the ability of the refrigeration in preserving the milk after boiling.METHODS: Thirty samples of pasteurized milk bought in São Paulo, Brazil, were submitted to in-home boiling procedure at the laboratory. Portions of samples were taken before and after boiling, and after 2, 4, 6 and 24 hours under refrigeration for microbiological analyses. Methods used were mesophilic bacteria count, and coliforms and Escherichia coli (E.coli) enumeration.RESULTS: No sample presented mesophilic bacteria count above the Brazilian standard for pasteurized milk. E.coli was not recovered from any sample. Ten samples (33%) had coliform bacteria; of these, 3 samples (10%) were above the standard. Mesophilic bacteria count after boiling was significantly lower than before boiling. After 24 hours under refrigeration, mesophilic bacteria count was significantly higher than after boiling. No significant differences were found between the intervals of 2, 4, 6 and 24 hours under refrigeration. Samples before boiling presented significantly higher coliform bacteria. No coliform bacteria were recovered at any time after boiling.CONCLUSIONS: In-home boiling of milk reduced bacterial load, while refrigeration kept bacteria under low counts.

[Diagnosis of child and adolescent nutritional status] / Diagnóstico do estado nutricional da criança e do adolescente.

OBJECTIVE: To present a review on the methods for the assessment of child and adolescent nutritional status, emphasizing anthropometry and the various methods for the assessment of body composition; pointing out their advantages, limitations and risks. METHODS: Chapters of textbooks, theses, and articles relevant to the topic, as well as personal files and authors previous publications were selected. RESULTS: Anthropometry, which consists of the assessment of physical dimensions and global composition of the human body, has been regarded as the most frequently used isolated method for nutritional diagnosis, especially in childhood and adolescence, due to its ease of use, low cost and innocuousness. The most frequently adopted measurements aim at determining body mass, expressed by weight; linear dimensions, especially height; body composition and reserves of energy and proteins, estimated through subcutaneous fat and muscle mass. Laboratorial methods especially developed for the assessment of body composition are presented here. The justification for the use of methods that expose children and adolescents to ionizing radiation is also presented. CONCLUSIONS: On defining methods for the assessment of nutritional status, we should select those that better detect the nutritional deficiencies we want to correct, also taking into consideration their costs, level of personal skill required for their proper application, necessary time for application, acceptability by the studied population and possible health risks.

Risk factors for protein-energy malnutrition in pre-school shantytown children in São Paulo, Brazil.

OBJECTIVES: To investigate the health and nutritional conditions of people living in a shantytown in the city of São Paulo in order to identify risk factors for infant malnutrition. DESIGN: A retrospective cohort study. PARTICIPANTS: Children living in a shantytown was conducted among children less than 72 months of age. METHODS: Home visits were made and information was collected regarding the risk factors for malnutrition. RESULTS: The prevalence of chronic malnutrition was 41.6% according to Gomez, 36.6% according to Waterlow, and 17.6% according to WHO. Risk factors for malnutrition, according to the weight-for-age index, included birthweight, presence of upper respiratory tract infections, number of pregnancies, number of births, maternal body mass index, birthplace of father, and home building material; according to the weight-for-height index, they included birthweight and maternal age at the time of birth; and according to the height-for-age index, they included the number of prenatal medical visits, birthweight, maternal height, maternal body mass index, father's employment being unregistered, and maternal birthplace. An instrument for identifying children at risk of malnutrition was devised from these major risk factors for future malnutrition, which may then be applied to newly-born children.

Bacterial contamination of the lacteal contents of feeding bottles in metropolitan São Paulo, Brazil.

Reported are the results of a study in São Paulo, Brazil, to evaluate the bacterial contamination of the lacteal contents of feeding bottles prepared in urban households of low (LSE) and high (HSE) socioeconomic groups, involving 100 and 32 mothers of infants, respectively. Samples of the lacteal contents of the feeding bottles were cultured and the medians (25th and 75th percentiles) of the counts (bacteria per ml) were significantly higher in the LSE group: mesophilic bacteria, 555,000 (17,250-4,350,000) in the LSE group and 1615 (20-500,000) in the HSE group; coliforms, 2400 (19-150,000) in the LSE group and 7 (0-7800) in the HSE group. Escherichia coli was isolated from 26% (26/100) of the samples from the LSE group and from 6% (2/32) of those from the HSE group (P = 0.03). In the HSE group, higher coliform counts were associated with foodhandlers other than the mother, lower levels of maternal education, the use of pasteurized milk, and the addition of ingredients other than milk. In the LSE group, feeding bottles prepared using tap water and those prepared for infants aged over 6 months had higher coliform counts. In general, the feeding bottles prepared in the households studied were heavily contaminated, especially in the LSE group.

A retrospective study of kidney transplant recipients from living unrelated donors.

Due to the shortage of cadaveric organs, kidneys from living unrelated donors (LUD) are increasingly being used for transplantation. The long-term outcome for LUD recipients is not completely known. This study was undertaken to evaluate the long-term graft survival in LUD recipients and compare it with that of cadaver donor allograft recipients. Three hundred and sixty-four LUD and 3881 cadaveric kidney recipients were evaluated using data obtained through the Brazilian Renal Transplant Registry. Transplants performed between January 1, 1987, and June 30, 1996, were eligible for analysis. Graft and patient survival were estimated by the Kaplan-Meier method. Sixty percent of the LUD were from spouses. The median duration of follow-up was 23.8 mo (0 to 117.2 mo). Patient survival rates were not significantly different for LUD and cadaveric kidney recipients (69% [95% confidence interval (CI), 61.9 to 76.1%] versus 73.2% [71 to 75.4%] at 5 yr; 69% [61.9 to 76.1%] versus 60.6% [55.1 to 66.1%] at 9.6 yr). Graft survival rates for recipients of LUD allografts were similar to those for cadaveric kidneys at 5 yr (50.1% [43.2 to 57%] versus 50.4% [48.1 to 52.8%]) and higher, although not significantly, at 9.6 yr (45.7% [37.7 to 53.7%] versus 32.7% [26.4 to 39%], respectively, P = 0.14). In a multivariate analysis using the Cox proportional hazards regression model, after adjusting for recipient age, race, history of previous transplantation, and year of transplantation, the risk of graft failure was 16% (95% CI, -3% to 31%) lower for LUD than cadaveric recipients. We conclude that LUD are an excellent alternative to cadaveric kidney donors. The long-term patient and graft survival rates for recipients of LUD allografts are at least as good as those for recipients of cadaveric kidneys.

[Breastfeeding in shantytowns: an educational program through home visits]. / Aleitamento materno em favelas: um programa de incentivo a través de visitas domiciliares.

This is a study of breastfeeding length, with and without a community educational program. It was done through home visits to 125 women residing in Vila Marianaís shantytowns in the city of São Paulo. It was found that breastfeeding lasts an average of more than 6 months after the educational intervention. When comparing the group that received education with the one that didnít, it was observed that in the former the percentage of children breastfed for 6 months or longer was 64%, while in the control group it was 17% (p < 0.001). This shows a significant increase in the number of mothers who nursed their children after an educational program promoting breastfeeding.

Overweight and obesity among mothers of malnourished children--Brazil--PNSN--1989.

OBJECTIVE: To evaluate the relationship between the nutritional status of the youngest child under 48 months of age (in families with the biological mother present) and their mothers among 3906 children selected from a sample of a national survey in 1989 (PNSN). RESULTS: Malnutrition was present in 5.8% of the children. From these, 21.8%, 60.9% and 17.3% had overweight/obese, eutrophic and malnourished mothers, respectively. Stratified analyses taking into account the regions, situation, income distribution and mother's educational level demonstrated that a lower proportion of malnourished children was concurrent with a higher proportion of overweight/obese mothers. The Kappa test evidenced a poor agreement between the nutritional conditions of the child-mother pairs (K < = 0.048). CONCLUSIONS: When the proportion of malnourished children decreased within the analyzed groups, the proportion of overweight/obese mothers increased. Such an epidemiological pattern indicates that within groups in which malnutrition is less prevalent, the proportion of children for whom a lack of food in the household is the main determinant factor for malnutrition is lower.