Therapeutic versus prophylactic anticoagulation for patients admitted to hospital with COVID-19 and elevated D-dimer concentration (ACTION): an open-label, multicentre, randomised, controlled trial.

BACKGROUND: COVID-19 is associated with a prothrombotic state leading to adverse clinical outcomes. Whether therapeutic anticoagulation improves outcomes in patients hospitalised with COVID-19 is unknown. We aimed to compare the efficacy and safety of therapeutic versus prophylactic anticoagulation in this population. METHODS: We did a pragmatic, open-label (with blinded adjudication), multicentre, randomised, controlled trial, at 31 sites in Brazil. Patients (aged ≥18 years) hospitalised with COVID-19 and elevated D-dimer concentration, and who had COVID-19 symptoms for up to 14 days before randomisation, were randomly assigned (1:1) to receive either therapeutic or prophylactic anticoagulation. Therapeutic anticoagulation was in-hospital oral rivaroxaban (20 mg or 15 mg daily) for stable patients, or initial subcutaneous enoxaparin (1 mg/kg twice per day) or intravenous unfractionated heparin (to achieve a 0·3-0·7 IU/mL anti-Xa concentration) for clinically unstable patients, followed by rivaroxaban to day 30. Prophylactic anticoagulation was standard in-hospital enoxaparin or unfractionated heparin. The primary efficacy outcome was a hierarchical analysis of time to death, duration of hospitalisation, or duration of supplemental oxygen to day 30, analysed with the win ratio method (a ratio >1 reflects a better outcome in the therapeutic anticoagulation group) in the intention-to-treat population. The primary safety outcome was major or clinically relevant non-major bleeding through 30 days. This study is registered with ClinicalTrials.gov (NCT04394377) and is completed. FINDINGS: From June 24, 2020, to Feb 26, 2021, 3331 patients were screened and 615 were randomly allocated (311 [50%] to the therapeutic anticoagulation group and 304 [50%] to the prophylactic anticoagulation group). 576 (94%) were clinically stable and 39 (6%) clinically unstable. One patient, in the therapeutic group, was lost to follow-up because of withdrawal of consent and was not included in the primary analysis. The primary efficacy outcome was not different between patients assigned therapeutic or prophylactic anticoagulation, with 28 899 (34·8%) wins in the therapeutic group and 34 288 (41·3%) in the prophylactic group (win ratio 0·86 [95% CI 0·59-1·22], p=0·40). Consistent results were seen in clinically stable and clinically unstable patients. The primary safety outcome of major or clinically relevant non-major bleeding occurred in 26 (8%) patients assigned therapeutic anticoagulation and seven (2%) assigned prophylactic anticoagulation (relative risk 3·64 [95% CI 1·61-8·27], p=0·0010). Allergic reaction to the study medication occurred in two (1%) patients in the therapeutic anticoagulation group and three (1%) in the prophylactic anticoagulation group. INTERPRETATION: In patients hospitalised with COVID-19 and elevated D-dimer concentration, in-hospital therapeutic anticoagulation with rivaroxaban or enoxaparin followed by rivaroxaban to day 30 did not improve clinical outcomes and increased bleeding compared with prophylactic anticoagulation. Therefore, use of therapeutic-dose rivaroxaban, and other direct oral anticoagulants, should be avoided in these patients in the absence of an evidence-based indication for oral anticoagulation. FUNDING: Coalition COVID-19 Brazil, Bayer SA.

Therapeutic versus prophylactic anticoagulation for patients admitted to hospital with COVID-19 and elevated D-dimer concentration (ACTION): an open-label, multicentre, randomised, controlled trial

BACKGROUND: COVID-19 is associated with a prothrombotic state leading to adverse clinical outcomes. Whether therapeutic anticoagulation improves outcomes in patients hospitalised with COVID-19 is unknown. We aimed to compare the efficacy and safety of therapeutic versus prophylactic anticoagulation in this population. METHODS: We did a pragmatic, open-label (with blinded adjudication), multicentre, randomised, controlled trial, at 31 sites in Brazil. Patients (aged ≥18 years) hospitalised with COVID-19 and elevated D-dimer concentration, and who had COVID-19 symptoms for up to 14 days before randomisation, were randomly assigned (1:1) to receive either therapeutic or prophylactic anticoagulation. Therapeutic anticoagulation was in-hospital oral rivaroxaban (20 mg or 15 mg daily) for stable patients, or initial subcutaneous enoxaparin (1 mg/kg twice per day) or intravenous unfractionated heparin (to achieve a 0·3­0·7 IU/mL anti-Xa concentration) for clinically unstable patients, followed by rivaroxaban to day 30. Prophylactic anticoagulation was standard in-hospital enoxaparin or unfractionated heparin. The primary efficacy outcome was a hierarchical analysis of time to death, duration of hospitalisation, or duration of supplemental oxygen to day 30, analysed with the win ratio method (a ratio >1 reflects a better outcome in the therapeutic anticoagulation group) in the intention-to-treat population. The primary safety outcome was major or clinically relevant non-major bleeding through 30 days. This study is registered with ClinicalTrials.gov (NCT04394377) and is completed. FINDINGS: From June 24, 2020, to Feb 26, 2021, 3331 patients were screened and 615 were randomly allocated (311 [50%] to the therapeutic anticoagulation group and 304 [50%] to the prophylactic anticoagulation group). 576 (94%) were clinically stable and 39 (6%) clinically unstable. One patient, in the therapeutic group, was lost to follow-up because of withdrawal of consent and was not included in the primary analysis. The primary efficacy outcome was not different between patients assigned therapeutic or prophylactic anticoagulation, with 28 899 (34·8%) wins in the therapeutic group and 34 288 (41·3%) in the prophylactic group (win ratio 0·86 [95% CI 0·59­1·22], p=0·40). Consistent results were seen in clinically stable and clinically unstable patients. The primary safety outcome of major or clinically relevant non-major bleeding occurred in 26 (8%) patients assigned therapeutic anticoagulation and seven (2%) assigned prophylactic anticoagulation (relative risk 3·64 [95% CI 1·61­8·27], p=0·0010). Allergic reaction to the study medication occurred in two (1%) patients in the therapeutic anticoagulation group and three (1%) in the prophylactic anticoagulation group. INTERPRETATION: In patients hospitalised with COVID-19 and elevated D-dimer concentration, in-hospital therapeutic anticoagulation with rivaroxaban or enoxaparin followed by rivaroxaban to day 30 did not improve clinical outcomes and increased bleeding compared with prophylactic anticoagulation. Therefore, use of therapeutic-dose rivaroxaban, and other direct oral anticoagulants, should be avoided in these patients in the absence of an evidence-based indication for oral anticoagulation.

Randomized clinical trial to evaluate a routine full anticoagulation Strategy in Patients with Coronavirus Infection (SARS-CoV2) admitted to hospital: Rationale and design of the ACTION (AntiCoagulaTlon cOroNavirus)-Coalition IV trial.

BACKGROUND: Observational studies have suggested a higher risk of thrombotic events in patients with coronavirus disease 2019 (COVID-19). Moreover, elevated D-dimer levels have been identified as an important prognostic marker in COVID-19 directly associated with disease severity and progression. Prophylactic anticoagulation for hospitalized COVID-19 patients might not be enough to prevent thrombotic events; therefore, therapeutic anticoagulation regimens deserve clinical investigation. DESIGN: ACTION is an academic-led, pragmatic, multicenter, open-label, randomized, phase IV clinical trial that aims to enroll around 600 patients at 40 sites participating in the Coalition COVID-19 Brazil initiative. Eligible patients with a confirmed diagnosis of COVID-19 with symptoms up to 14 days and elevated D-dimer levels will be randomized to a strategy of full-dose anticoagulation for 30 days with rivaroxaban 20 mg once daily (or full-dose heparin if oral administration is not feasible) vs standard of care with any approved venous thromboembolism prophylaxis regimen during hospitalization. A confirmation of COVID-19 was mandatory for study entry, based on specific tests used in clinical practice (RT-PCR, antigen test, IgM test) collected before randomization, regardless of in the outpatient setting or not. Randomization will be stratified by clinical stability at presentation. The primary outcome is a hierarchical analysis of mortality, length of hospital stay, or duration of oxygen therapy at the end of 30 days. Secondary outcomes include the World Health Organization's 8-point ordinal scale at 30 days and the following efficacy outcomes: incidence of venous thromboembolism , acute myocardial infarction, stroke, systemic embolism, major adverse limb events, duration of oxygen therapy, disease progression, and biomarkers. The primary safety outcomes are major or clinically relevant non-major bleeding according to the International Society on Thrombosis and Haemostasis criteria. SUMMARY: The ACTION trial will evaluate whether in-hospital therapeutic anticoagulation with rivaroxaban for stable patients, or enoxaparin for unstable patients, followed by rivaroxaban through 30 days compared with standard prophylactic anticoagulation improves clinical outcomes in hospitalized patients with COVID-19 and elevated D-dimer levels.

[Does orphanhood by aids or by homicide effect nutritional status of children?]. / Orfandade por aids ou por homicídio apresenta efeitos sobre o estado nutricional das crianças?

The aims of this paper were to evaluate the nutritional status of children orphaned by aids or homicides in the city of São Paulo and to estimate the association of nutritional indexes with orphanhood-related variables. The study was a household survey carried out between 2006 and 2007. We sampled 484 children representative of São Paulo, 5-14 years old who lost either or both of their parents from aids or homicides between 2000 and 2004. We selected body-mass-index-for-age (BMI) and height-for-age (height) as outcomes for analysis. Multiple linear regression in the light of a conceptual hierarchical approach was used for estimating BMI-for-age and height-for-age associated factors. Children from aids and homicides groups differed in terms of orphanhood-related variables and age. Economic, household, health and nutritional conditions were similar between groups. Underweight accounted for 1.3% and 2.1% of children under the age of 10 and adolescents, respectively. Stunting accounted for 0.7% and 4.0% of children and adolescents, respectively. Overweight accounted for 19% and 20% of children and adolescents, respectively. BMI and height were unaffected by orphanhood-related variables after adjusting for selected classical determinants of nutritional status in the hierarchical model. Economic status was the main determinant of the nutritional profile. Nutritional status of children orphaned by aids or homicides in São Paulo was similar and mainly influenced by economic status. The nutritional profile, characterized by being overweight, suggests that these orphans have not shown additional risks due to those orphanhood-related variables.

Orfandade por aids ou por homicídio apresenta efeitos sobre o estado nutricional das crianças? / Does orphanhood by aids or by homicide effect nutritional status of children?

O artigo tem como objetivos avaliar o estado nutricional de órfãos por aids ou homicídios residentes em São Paulo e estimar a associação de índices nutricionais com variáveis relacionadas à orfandade. Trata-se de estudo transversal de base domiciliar que utilizou amostra representativa de 484 indivíduos de 5 a 14 anos que perderam um ou ambos os pais durante os anos de 2000 e 2004 devido à aids ou a homicídio no município de São Paulo. A avaliação nutricional foi feita com o índice de massa corporal-para-idade (IMC) e da altura-para-idade (altura). A associação entre os índices nutricionais e as variáveis relacionadas à orfandade foi estimada em análise hierárquica, com uso de modelo de regressão linear múltiplo. Órfãos por aids ou homicídios diferiram quanto às características da orfandade e à idade média. As condições econômicas, domiciliares, o estado de saúde e o estado nutricional foram semelhantes entre os grupos. O déficit de IMC ocorreu em 1,3% das crianças abaixo de 10 anos e em 2,1% dos adolescentes. O déficit de altura ocorreu em 0,7% das crianças e em 4,0% dos adolescentes. O excesso de peso ocorreu em 19% e 20% das crianças e adolescentes, respectivamente. A análise hierárquica indicou ausência de efeito das variáveis relacionadas à orfandade sobre o IMC ou a altura; o principal determinante do estado nutricional foi de natureza econômica. Os órfãos por aids ou homicídio de São Paulo apresentaram estado nutricional semelhante e majoritariamente influenciado pela situação econômica. O perfil nutricional identificado no grupo, caracterizado pelo excesso de peso, sugere que os órfãos de São Paulo não apresentam riscos adicionais decorrentes da orfandade.

The aims of this paper were to evaluate the nutritional status of children orphaned by aids or homicides in the city of São Paulo and to estimate the association of nutritional indexes with orphanhood-related variables. The study was a household survey carried out between 2006 and 2007. We sampled 484 children representative of São Paulo, 5-14 years old who lost either or both of their parents from aids or homicides between 2000 and 2004. We selected body-mass-index-for-age (BMI) and height-for-age (height) as outcomes for analysis. Multiple linear regression in the light of a conceptual hierarchical approach was used for estimating BMI-for-age and height-for-age associated factors. Children from aids and homicides groups differed in terms of orphanhood-related variables and age. Economic, household, health and nutritional conditions were similar between groups. Underweight accounted for 1.3% and 2.1% of children under the age of 10 and adolescents, respectively. Stunting accounted for 0.7% and 4.0% of children and adolescents, respectively. Overweight accounted for 19% and 20% of children and adolescents, respectively. BMI and height were unaffected by orphanhood-related variables after adjusting for selected classical determinants of nutritional status in the hierarchical model. Economic status was the main determinant of the nutritional profile. Nutritional status of children orphaned by aids or homicides in São Paulo was similar and mainly influenced by economic status. The nutritional profile, characterized by being overweight, suggests that these orphans have not shown additional risks due to those orphanhood-related variables.

Fuzzy linguistic model for bioelectrical impedance vector analysis.

BACKGROUNDS & AIMS: The boundaries between the categories of body composition provided by vectorial analysis of bioimpedance are not well defined. In this paper, fuzzy sets theory was used for modeling such uncertainty. METHODS: An Italian database with 179 cases 18-70 years was divided randomly into developing (n = 20) and testing samples (n = 159). From the 159 registries of the testing sample, 99 contributed with unequivocal diagnosis. Resistance/height and reactance/height were the input variables in the model. Output variables were the seven categories of body composition of vectorial analysis. For each case the linguistic model estimated the membership degree of each impedance category. To compare such results to the previously established diagnoses Kappa statistics was used. This demanded singling out one among the output set of seven categories of membership degrees. This procedure (defuzzification rule) established that the category with the highest membership degree should be the most likely category for the case. RESULTS: The fuzzy model showed a good fit to the development sample. Excellent agreement was achieved between the defuzzified impedance diagnoses and the clinical diagnoses in the testing sample (Kappa = 0.85, p < 0.001). CONCLUSIONS: fuzzy linguistic model was found in good agreement with clinical diagnoses. If the whole model output is considered, information on to which extent each BIVA category is present does better advise clinical practice with an enlarged nosological framework and diverse therapeutic strategies.

Índice h de docentes em Saúde Coletiva no Brasil / H-index of Collective Health professors in Brazil / Índice h de docentes en Salud Colectiva en Brasil

OBJETIVO: Estimar valores de referência e função de hierarquia de docentes em Saúde Coletiva do Brasil por meio de análise da distribuição do índice h. MÉTODOS: A partir do portal da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, 934 docentes foram identificados em 2008, dos quais 819 foram analisados. O índice h de cada docente foi obtido na Web of Science mediante algoritmos de busca com controle para homonímias e alternativas de grafia de nome. Para cada região e para o Brasil como um todo ajustou-se função densidade de probabilidade exponencial aos parâmetros média e taxa de decréscimo por região. Foram identificadas medidas de posição e, com o complemento da função probabilidade acumulada, função de hierarquia entre autores conforme o índice h por região. RESULTADOS: Dos docentes, 29,8 por cento não tinham qualquer registro de citação (h = 0). A média de h para o País foi 3,1, com maior média na região Sul (4,7). A mediana de h para o País foi 2,1, também com maior mediana na Sul (3,2). Para uma padronização de população de autores em cem, os primeiros colocados para o País devem ter h = 16; na estratificação por região, a primeira posição demanda valores mais altos no Nordeste, Sudeste e Sul, sendo nesta última h = 24. CONCLUSÕES: Avaliados pelos índices h da Web of Science, a maioria dos autores em Saúde Coletiva não supera h = 5. Há diferenças entres as regiões, com melhor desempenho para a Sul e valores semelhantes entre Sudeste e Nordeste.

OBJECTIVE: To estimate reference values and the hierarchy function of professors engaged in Collective Health in Brazil by analyzing the distribution of the h-index. METHODS: From the Portal da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Portal of Coordination for the Improvement of Higher Education Personnel ), 934 authors were identified in 2008, of whom 819 were analyzed. The h-index of each professor was obtained through the Web of Science using search algorithms controlling for namesakes and alternative spellings of their names. For each Brazilian region and for the country as a whole, we adjusted an exponential probability density function to provide the population parameters and rate of decline by region. Ranking measures were identified using the complement of the cumulative probability function and the hierarchy function among authors according to the h-index by region. RESULTS: Among the professors analyzed, 29.8 percent had no citation record in Web of Science (h=0). The mean h for the country was 3.1, and the region with greatest mean was the southern region (h=4.7). The median h for the country was 3.1, and the greatest median was for the southern region (3.2). Standardizing populations to one hundred, the first rank in the country was h=16, but stratification by region shows that, within the northeastern, southeastern and southern regions, a greater value is necessary for achieving the first rank. In the southern region, the index needed to achieve the first rank was h=24. CONCLUSIONS: Most of the Brazilian Collective Health authors, if assessed on the basis of the Web of Science h-index, did not exceed h=5. Regional differences exist, with the southeastern and northeastern regions being similar and the southern region being outstanding.

OBJETIVO: Estimar valores de referencia y función de jerarquía de docentes en Salud Colectiva de Brasil por medio de análisis de distribución del índice h. MÉTODOS: A partir del Portal de la Coordinación de Perfeccionamiento de Personal de Nivel Superior 934 docentes fueron identificados en 2008, de los cuales 819 fueron analizados. El índice h de cada docente fue obtenido en la Web of Science mediante algoritmos de búsqueda con control para homonimias y alternativas de grafía de nombre. Para cada región y para Brasil como un todo se ajustó función de densidad de probabilidad exponencial a los parámetros promedio y tasa de decrecimiento por región. Fueron identificadas medidas de posición y, con el complemento de la función probabilidad acumulada, función de jerarquía entre autores conforme el índice h por región. RESULTADOS: De los docentes, 29,8 por ciento no tenían registro alguno de citación (h=0). El promedio de h para Brasil fue 3,1, con mayor promedio en la región Sur (4,7). La mediana de h para el país fue 2,1, también con mayor mediana en el Sur (3,2). Para una estandarización de población de autores en cien, los primeros colocados para el país deben tener h=16; en la estratificación por región, la primera posición demanda valores más altos en el Noreste, Sureste y Sur, siendo en ésta última h=24. CONCLUSIONES: Evaluados por los índices h de la Web of Science, la mayoría de los autores en Salud Colectiva no supera h=5. Hay diferencias entre las regiones, con mejor desempeño para el Sur y valores semejantes entre Sureste y Noreste.

H-index of Collective Health professors in Brazil.

OBJECTIVE: To estimate reference values and the hierarchy function of professors engaged in Collective Health in Brazil by analyzing the distribution of the h-index. METHODS: From the Portal da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Portal of Coordination for the Improvement of Higher Education Personnel ), 934 authors were identified in 2008, of whom 819 were analyzed. The h-index of each professor was obtained through the Web of Science using search algorithms controlling for namesakes and alternative spellings of their names. For each Brazilian region and for the country as a whole, we adjusted an exponential probability density function to provide the population parameters and rate of decline by region. Ranking measures were identified using the complement of the cumulative probability function and the hierarchy function among authors according to the h-index by region. RESULTS: Among the professors analyzed, 29.8% had no citation record in Web of Science (h=0). The mean h for the country was 3.1, and the region with greatest mean was the southern region (h=4.7). The median h for the country was 3.1, and the greatest median was for the southern region (3.2). Standardizing populations to one hundred, the first rank in the country was h=16, but stratification by region shows that, within the northeastern, southeastern and southern regions, a greater value is necessary for achieving the first rank. In the southern region, the index needed to achieve the first rank was h=24. CONCLUSIONS: Most of the Brazilian Collective Health authors, if assessed on the basis of the Web of Science h-index, did not exceed h=5. Regional differences exist, with the southeastern and northeastern regions being similar and the southern region being outstanding.

Sensibilidade e especificidade de três classificações para excesso de peso em adolescentes / Sensibility and specificity of three overweight classifications in adolescents / Sensibilidad y especificidad de tres clasificaciones de exceso de peso en adolescentes

O objetivo deste artigo é estimar a sensibilidade e a especificidade de três critérios para triagem do excesso de peso em adolescentes pós-menarca. Trata-se de estudo transversal que utilizou dados de 78 adolescentes, entre 14 e 19 anos, estudantes da rede pública de ensino do município de Alfenas (MG). Utilizaram-se as medidas de peso, altura e pregas cutâneas triciptal, biciptal, subescapular e suprailíaca. Todas as medidas foram obtidas de forma padronizada.Calculou-se o Índice de Massa Corporal (IMC) e o excesso de peso foi classificado segundo IMC para idade com uso de critérios norte americano, internacional e brasileiro. A variável de referência gordura corporal foi expressa como o resíduo padronizado da prega cutânea triciptal. Estimaram-se sensibilidade, especificidade e áreas ROC de cada classificação. Os resultados mostraram baixa sensibilidade e elevada especificidade para os três critérios de classificação do excesso de peso e pior desempenho para classificação norte americana Must. Concluiu-se que o uso de critérios com dados nacionais parece minimizar erros no diagnóstico de excesso de peso em adolescentes do sexo feminino.

The aim of this study is to estimate the sensitivity and specificity of three criteria for overweight screening in post menarche adolescents. It is a cross-sectional study that used data from 78 adolescents aged 14-19 years old, students in public school in the municipality of Alfenas (MG). Weight, height and triciptal, biciptal, subescapular and suprailiac skinfold thickness measures were used. All measures were obtained by standardized procedures. Body Mass Index (BMI) was calculated and overweight were classified according to BMIto- age, using North-American, International and Brazilian criteria. The reference variable body fatness was expressed as the standardized residual of triciptal skin fold thickness. It was estimated the sensitivity, specificity and ROC curves for each classification.The results showed that all three criteria had low sensibility and high specificity and North- American classification showed the lowest performance. Criteria containing national data may minimize miss-classification in overweight screening in female adolescents.

El objetivo de este trabajo es estimar la sensibilidad y la especificidad de três criterios para la detección de adolescentes con sobrepeso en la post-menarquia. Se trata de un estudio de tipo transversal que utilizó datos de 78 adolescentes entre 14 y 19 años, estudiantes de la enseñanza pública del municipio de Alfenas (MG). Se utilizaron las medidas de peso, talla y el pliegue cutáneo del tríceps, bíceps, subescapular y suprailíaco. Todas lãs mediciones estuvieron de acuerdo a los patrones. Se calculó el Índice de Masa Corporal (IMC) y el sobrepeso se clasificó de acuerdo con el IMC para la edad mediante el uso de critérios Internacionales, de Brasil y de EE.UU. La variable de referencia de materia grasa corporalse expresó como residual estandarizado del pliegue del tríceps. Se estimó la sensibilidad, especificidad, y las áreas ROC para cada clasificación. Los resultados mostraron baja sensibilidad y especificidad alta para los tres criterios de clasificación del sobrepeso y la peor clasificación de desempeño fue la de los EE.UU, Must. Se concluyó que el uso de criterios con datos nacionales parece minimizar los errores en el diagnóstico de sobrepeso en las mujeres adolescentes.

Estado nutricional de órfãos por aids ou homicídios residentes no município de São Paulo / Nutritional status of orphans due to AIDS or homicides residing in the city of Sao Paulo

Introdução A orfandade pode trazer conseqüências importantes para as condições de vida das crianças. Na África subsaariana, por exemplo, órfãos tem apresentado maiores riscos de desnutrição em relação aos não-órfãos. No Brasil, não há relatos sobre as relações entre variáveis relacionadas à orfandade e o estado nutricional de crianças. Objetivos- Avaliar o estado nutricional de órfãos por aids ou homicídios residentes em São Paulo e estimar a associação de índices nutricionais com variáveis relacionadas à orfandade. Métodos - Estudo transversal de base domiciliar que utilizou amostra representativa de 484 indivíduos de 5 a 14 anos que perderam um ou ambos os pais durante os anos de 2000 e 2004 devido à aids ou homicídios no município de São Paulo. A avaliação nutricional foi feita com o índice de massa corporal-para-idade e da altura-para-idade. A associação entre índices nutricionais e variáveis relacionadas à orfandade foi estimada em análise hierárquica, com uso de modelo de regressão linear múltiplo. Resultados- Órfãos por aids ou homicídios diferiram quanto às características da orfandade e à idade média. As condições econômicas, domiciliares, o estado de saúde e o estado nutricional foram semelhantes entre os grupos. O déficit de IMC ocorreu em 1,3 por cento das crianças abaixo de 10 anos e em 2,1 por cento dos adolescentes. O déficit de altura ocorreu em 0,7 por cento das vii crianças e em 4,0 por cento dos adolescentes. O excesso de peso ocorreu em 19 por cento e 20 por cento das crianças e adolescentes, respectivamente. A análise hierárquica indicou ausência de efeito das variáveis relacionadas à orfandade sobre o IMC ou a altura; o principal determinante do estado nutricional foi de natureza econômica. Conclusão - Órfãos por aids ou homicídios de São Paulo apresentaram estado nutricional semelhante e majoritariamente influenciado pela situação econômica. O perfil nutricional identificado no grupo, caracterizado pelo excesso de peso, sugere que órfão...

Vinculação determinística de bancos de dados sobre mortalidade por Aids / Deterministic record linkage in Aids mortality databases

A vinculação determinística de bancos de dados sobre mortalidade por aids tem apresentado problemas causados por falhas nos arquivos. Assim, os objetivos deste estudo foram: avaliar o desempenho da vinculação determinística em bancos de óbito por aids do Programa de Aprimoramento das Informações de Mortalidade no Município de São Paulo (PRO-AIM) e da Fundação SEADE entre os anos de 2000 e 2004 e estimar a cobertura de cada banco. Utilizou-se a rotina merge de um software para vincular os bancos. A primeira etapa pareou os registros automaticamente e, na segunda etapa, cada banco foi conferido para localizar novos pares. Estimaram-se os óbitos pela soma entre casos pareados e não pareados para calcular a cobertura dos bancos. A primeira etapa da vinculação identificou 91,6 por cento dos pares. A segunda etapa adicionou 457 pares. O total de óbitos foi estimado em 5.855, com cobertura de 97,1 por cento do PRO-AIM e 96 por cento do SEADE. O uso da vinculação determinística cobriu grande parte dos casos. O banco do PRO-AIM proporcionou a maior cobertura, com maior quantidade de informações completas e melhor localização geográfica dos casos.

Deterministic record linkage in AIDS mortality databases has presented problems caused by errors in files. Thus, the aims of this study were to assess the performance of deterministic record linkage in the Aids mortality databases of the Mortality Information Improvement Program of the city of Sao Paulo (PRO-AIM) and of the SEADE Foundation between the years 2000 and 2004 and to estimate the coverage of these databases. A software merge process was used to link the records. The first stage linked automatically and, in the second stage, each database was checked for possible matches. Deaths were estimated by summing the matches and non-matches for each database coverage calculation. The first stage of record linkage identified 91.6 percent matches. The second stage added 457 matches. Deaths were estimated to be 5,855 cases, PRO-AIM covering 97.1 percent and SEADE 96 percent. The use of deterministic record linkage covered a great part of the cases. PRO-AIM databases provided the best case coverage, with the largest amount of complete information and better geographic location.

Diagnóstico nutricional de crianças de zero a cinco anos atendidas pela Rede Pública Municipal de Saúde de Ouro Preto-MG / Nutritional assessment of children up to 5 years old assisted by the public health system in Ouro Preto-MG

The nutritional assessment of children allows to evaluate the health and lifeconditions in a population. Thus, the aim of this paper is to characterizethe nutritional status of children up to 5 years old registered with inSISVAN database in the city of Ouro Preto-MG. A total of 2490 childrenregistered within SISVAN during a couple of months in 2006 were included.Information about weight, height, gender and age were selected for assessing the nutritional adequacy of the following anthropometric indexes: weight/ height, height/age and weight/age ratios. For classifying the nutritional status, children presenting such ratios with values of 2 z scores below the standard population mean were considered undernourished, whilst children presenting weight/height and weight/age ratios with values of 2 z scores above the standard population mean were considered overweight. The results showed that more than 30% of the subjects were aged one year or younger. About 4% of the subjects presented unsatisfactory weight/height ratios, 5% had unsatisfactory weight/age ratios and 10% were defi cient in height/age ratios. There were no differences between nutritional status and gender. The results point out the need for maintaining the nutritional surveillance system in order to prevent and correct nutritional disorders.

El diagnóstico nutricional de niños permiteevaluar las condiciones de vida y salud de unapoblación. El objetivo del estudio fue caracterizarel estado nutricional de niños de cero a cincoaños de edad registrados en el banco de datosdel Sisvan de la ciudad de Ouro Preto-MinasGerais (Brasil). Se incluyeron 2490 niñosacompañados por la red municipal de salud,registrados en el banco de datos del Sisvan en2006. Se recopilaron datos de peso, talla, sexoy edad para evaluar la relación peso/talla,talla/edad y peso/edad. Fueron clasifi cados endéfi cit nutricional los niños que presentarondos escores-z abajo del valor medio de lapoblación estandar y con exceso de peso, losniños cuyos índices peso/altura y peso/edadestaban dos escores- z sobre el valor medio.Los resultados mostraron que más de 30% delos niños estudiados tenian hasta un año deedad. Se detectaron defi ciencias en 4% de losniños para el parámetro peso/talla; en 5% parapeso/edad y en 10% para talla/edad. No hubodiferencia para el estado nutricional en relacióna sexos. Los resultados señalan la necesidad demantención del sistema de vigilancia nutricionalpara prevención y corrección de los problemasnutricionales.

O diagnóstico nutricional de crianças permite aferir as condições de saúde e de vida de uma população. Diante disso, o objetivo deste artigo é caracterizar o estado nutricional das crianças de zero a cinco anos cadastradas no banco de dados do SISVAN do município de Ouro Preto-MG. Incluíram-se, no estudo, 2490 crianças atendidas pela Rede Municipalde Saúde, cadastradas no banco de dados do SISVAN em 2006. Selecionaram-se os dados de peso, altura, sexo e idade para avaliaçãodos índices peso/altura, altura/idade e peso/ idade. Para classifi cação do estado nutricional, considerou-se em défi cit nutricional todas ascrianças que apresentaram esses índices dois escores z abaixo do valor médio da população padrão e com excesso de peso as crianças cujosíndices peso/altura e peso/idade estavam dois escores z acima do valor médio. Os resultados mostraram que mais de 30% das crianças estudadas apresentavam déficit nutricional até 1 ano de idade. Houve, aproximadamente, 4% de defi ciência no índice peso/altura, 5% nopeso/idade e 10% de defi ciência estatural. Não houve diferença entre as categorias de estado nutricional e o sexo. Os resultados apontampara a necessidade de manutenção do sistema de vigilância nutricional para prevenção e correção dos problemas nutricionais.

Proporcionalidade corporal na avaliação antropométrica de adolescentes pós-menarca / Body proportion in anthropometric assessment of post-menarche adolescents

OBJETIVO: Verificar o comportamento da proporcionalidade corporal em adolescentes pós-menarca e sua influência na avaliação antropométrica desses indivíduos, com ênfase na relação peso/estatura. MÉTODOS: Avaliaram-se 80 adolescentes de uma escola pública de Alfenas, Minas Gerais, com pelo menos 12 meses pós-menarca. As medidas antropométricas foram realizadas conforme procedimentos padronizados. A proporcionalidade corporal foi avaliada pelo índice de Cormic. A população foi dividida em grupos de estudo (índice de Cormic > mediana) e controle (índice de Cormic < mediana). Os grupos foram comparados em relação às idades cronológica e ginecológica, peso, estatura, estatura tronco-cefálica, comprimento de pernas, índice de massa corporal e indicadores de adiposidade global e localizada. RESULTADOS: Os grupos estudados eram homogêneos em relação ao desenvolvimento físico, visto que as médias das idades cronológica e ginecológica não diferiram estatisticamente. A média e o desvio-padrão do índice de Cormic corresponderam a 0,52 e 0,013, respectivamente. Os grupos não diferiram em relação à estatura (p=0,23), porém o grupos de estudo apresentou valores de estatura tronco-cefálica significantemente superiores em relação ao grupo controle (p<0,01). Proporção significantemente superior (67,6 por cento) do grupo de estudo apresentou índice de massa corporal > mediana, em comparação ao grupo controle (37,2 por cento). Quanto aos indicadores de adiposidade global ou localizada, não foram observadas diferenças estatísticas entre os grupos. CONCLUSÃO: As diferenças na proporcionalidade corporal não se relacionaram com a estatura. Altos valores de índice de Cormic parecem estar associados a elevado índice de massa corporal, mas não à composição corporal e à topografia da gordura corporal. Questiona-se, assim, a utilização exclusiva do índice de massa corporal para avaliação antropométrica em serviços de saúde, visto que pode gerar resultados inexatos...

OBJECTIVE: To verify body proportion performance in pos-menarche adolescents and its influence in anthropometric assessment, emphasizing weight-height ratio. METHODS: Eighty adolescents from a public school in Alfenas, Minas Gerais, Brazil, were evaluated, with at least 12 months pos-menarche. Anthropometric measurements were obtained according to standardized procedures. Body proportion was assessed by Cormic Index. The population was divided in studied group ( Cormic Index > median ) and control group ( Cormic Index < median ). The chronological and gynecological ages, weight, height, sitting-height, leg length, body mass index and overall and localized body fat indicators were compared between the groups. RESULTS: The means of chronological and gynecological ages did not differ statistically between the groups, showing homogeneity relating to the physical development. The Cormic Index mean and standard deviation corresponded to 0.52 and 0.013, respectively. The groups did not differ in height (p = 0.23), but the studied group showed significantly higher sitting-height values than the control group (p<0.01). A significantly higher proportion (67.6 percent) of the studied group presented body mass index > median, when compared with the control group (37.2 percent). The overall and localized body fat indicators were not statistically different between the groups. CONCLUSIONS: The differences in body proportion were not related to height. Higher Cormic Index values seem to be associated with a higher body mass index, but not with body composition and body fat distribution. Therefore, we question the exclusive use of body mass index in anthropometric assessment in health services, considering that it can generate inexact results in a population with compromised body proportion.