Single lesion as an indicator to monitor the leprosy trend to elimination in hyperendemic areas

INTRODUÇÃO: As taxas de detecção e prevalência de hanseníase não são suficientes para mostrar a real magnitude de mudanças nos padrões epidemiológicos da doença. OBJETIVOS: Avaliar a aplicabilidade e utilidade da medida de proporção de casos de hanseníase com lesão única de pele como potencial indicador de avaliação do progresso da eliminação da hanseníase em áreas hiperendêmicas. METODOLOGIA: Estudo retrospectivo baseado na análise de dados secundários de casos novos de hanseníase notificados entre 1997 e 2002 na cidade de Palmas, estado de Tocantins, Brasil. Os registros de pacientes com lesão única foram comparados àqueles registrados com mais de uma lesão. Odds ratio foi utilizado como medida de associação. RESULTADOS: De um total de 1.303 casos novos de hanseníase notificados, 481 (36,9 por cento) apresentavam lesão única de pele. Verificou-se tendência de incremento na proporção de casos de casos novos diagnosticados com lesão única variando de 20,3 por cento em 1999 para 49,1 por cento em 2002 (p < 0,001), simultaneamente à redução do registro de número de casos novos após 1999. Maior proporção de pacientes com lesão única de pele foi verificada em pacientes do sexo feminino, menores de 15 anos, paucibacilares nas formas clínicas tuberculóide e indeterminada, com baciloscopia negativa, com lesões do tipo mácula, sem incapacidades físicas e diagnosticados em unidades básicas de saúde. CONCLUSÕES: Os resultados confirmam que a proporção de pacientes com lesão única de pele pode ser utilizada como indicador na avaliação do progresso da eliminação da hanseníase em áreas hiperendêmicas.

INTRODUCTION: Prevalence and detection rates of leprosy are not sufficient to show the real magnitude of changes in epidemiological patterns. OBJECTIVES: Evaluate the feasibility and usefulness of the proportion of new leprosy patients with a single skin lesion (SSL) as a potential indicator of the elimination of leprosy. METHODS: We conducted a retrospective study based on secondary data analyzing newly reported cases of leprosy between 1997 and 2002, in the city of Palmas, Tocantins, Brazil. Patients with a single lesion were compared to remaining patients, and the odds ratio was used as measure of association. RESULTS: Out of the 1,303 new cases of leprosy, 481 (36.9 percent) had a SSL. An increasing time-trend was observed in the proportion of new cases detected with a single lesion, which grew from 20.3 percent in 1999 to 49.1 percent in 2002 (linear trend p<.001) while a reduction in the number of new cases was observed simultaneously after 1999. The proportion of patients with a single lesion was higher in women, young age, paucibacillary, tuberculoid and indeterminate clinical forms, residents of urban areas, those with negative baciloscopy, with macular lesions, without physical disabilities, and mainly detected in primary health care units. CONCLUSIONS: These findings confirm that the proportion of patients with a SSL can be used as a sensitive and feasible indicator to assess the progress of the elimination of leprosy in hyperendemic areas.

[Household smoking and respiratory disease in under-five children]. / Tabagismo no domicílio e doença respiratória em crianças menores de cinco anos.

Environmental tobacco smoke is an important respiratory tract irritant in young children. To identify factors associated with respiratory disease and determine the main source of smoking exposure in the household, a cross-sectional study of 2,037 children who were immunized in primary health care clinics was conducted (in a sample of 10 out of 38 clinics with 200 children each). Parents answered a questionnaire about children's birth, passive smoking, former and current respiratory morbidity, socio-demographic characteristics, and living conditions. Analysis was based on hierarchical logistic regression. Prevalence of respiratory symptoms was 59.9% for children who live with smokers. Asthma and bronchitis showed the strongest association with smoking. In multivariate logistic regression, the following variables remained associated with asthma/bronchitis: socioeconomic status (OR = 2.93; 95%CI: 1.57-5.45), maternal schooling (OR = 1.46; 95%CI: 1.08-1.98)] and occupation (OR = 1.68; 95%CI: 1.04-2.74), neighborhood (OR = 1.47; 95%CI: 1.06-2.02), child's age (OR = 3.38; 95%CI: 2.31-4.95) and sex (OR = 1.46; 95%CI: 1.09-1.94), breastfeeding (OR = 1.66; 95%CI: 1.15-2.40), and household smoking (OR = 1.58; 95%CI: 1.18-2.11). Children with lower socioeconomic status and exposed to household smoking showed increased risk of respiratory disease.

Tabagismo no domicílio e doenca respiratória em criancas menores de cinco anos / Household smoking and respiratory disease in under-five children

A fumaca do tabaco no ambiente doméstico é o principal irritante do trato respiratório de criancas. Avaliaram-se os fatores associados aos sintomas e às enfermidades respiratórias, assim como a principal fonte de exposicão ao tabagismo no domicílio de 2.037 criancas menores de cinco anos atendidas para vacinacão em 10 dos 38 postos de saúde de Cuiabá, Mato Grosso, Brasil (aproximadamente duzentas criancas por posto). Exposicão ao tabagismo, a morbidade respiratória e as características sócio-demográficas foram obtidas por entrevista com o responsável pela crianca. A prevalência de sintomáticos respiratórios foi de 59,9 por cento, sendo maior para os que convivem com fumantes. A asma/bronquite foi a patologia que esteve mais fortemente associada com o tabagismo, sendo as variáveis que permaneceram associadas em modelo logístico hierarquizado: nível socioeconômico (OR = 2,93; IC95 por cento: 1,57-5,45), escolaridade (OR = 1,46; IC95 por cento: 1,08-1,98) e ocupacão da mãe (OR = 1,68; IC95 por cento: 1,04-2,74), distrito sanitário (RP = 1,47; IC95 por cento: 1,06-2,02), faixa etária (OR = 3,38; IC95 por cento: 2,31-4,95) e sexo da crianca (OR = 1,46; IC95 por cento: 1,09-1,94), aleitamento natural (OR = 1,66; IC95 por cento: 1,15-2,40) e tabagismo dos moradores (OR = 1,58; IC95 por cento: 1,18-2,11). Criancas pertencentes aos níveis socioeconômicos mais baixos e expostas ao tabagismo dos moradores do domicílio apresentam maior associacão com a doenca respiratória.

Tabagismo no domicílio e baixa estatura em menores de cinco anos / Household smoking and stunting for children under five years

O tabagismo durante a gestação é um dos responsáveis pelo menor peso e comprimento ao nascer. No entanto, a exposição à fumaça do tabaco, no período pós-natal, não tem sido explorada nos estudos de crescimento. Sabe-se que a prevalência do tabagismo é alta no nível sócio-econômico mais baixo e que a estatura de crianças está também associada com variáveis sócio-econômicas. O objetivo deste estudo foi verificar o efeito das variáveis sócio-econômicas e da exposição à fumaça do tabaco sobre o crescimento. Foram medidos e pesados os menores de cinco anos atendidos nos postos de saúde, para imunização (n = 2.037). Os pais responderam a um questionário sobre o tabagismo no domicílio e características sócio-demográficas das famílias. A prevalência da baixa estatura foi 4,3 por cento. Verificou-se na análise bivariada associação negativa entre a estatura e o tabagismo gestacional, e associações positivas com nível sócio-econômico, renda familiar e escolaridade dos pais. A análise de regressão linear hierarquizada mostrou que o tabagismo dos pais permaneceu associado com a baixa estatura mesmo após ajuste para tabagismo durante a gravidez e para variáveis sócio-demográficas.

[Household smoking and stunting for children under five years]. / Tabagismo no domicílio e baixa estatura em menores de cinco anos.

Maternal tobacco use during pregnancy is one of the most important factors for low birth weight and length. However, postnatal exposure to environmental tobacco smoke has not been explored in children's growth studies. It is known that smoking is more prevalent in low socioeconomic groups and that stunting is also associated with socioeconomic variables. The objective of this study was to verify the effect of socioeconomic variables and environmental tobacco smoke on growth. Children under five years (n = 2,037) attending a primary health care clinic had their weight and stature measured, and a questionnaire on exposure to household passive smoking and socio-demographic characteristics was applied to parents. Prevalence of stunting (defined as a z-score lower than -2) was 4.3%. There was a negative association between stature and smoking during pregnancy, and positive associations with socioeconomic levels, family income, and parents' education. Linear hierarchical regression analysis showed that maternal and paternal smoking remains associated with low stature even after adjusting for maternal smoking during pregnancy and for socio-demographic variables.

[Smoking in households in Brazil with children younger than 5 years of age]. / Tabagismo domiciliar em famílias com crianças menores de 5 anos no Brasil.

OBJECTIVES: To estimate the prevalence of exposure to smoking in households with children younger than 5 years of age in the city of Cuiabá, Mato Grosso, Brazil, and to identify the main determinants of that exposure. METHODS: This cross-sectional, population-based study included 2 037 families from the city of Cuiabá. The parents of the children or other caregivers answered a questionnaire concerning the smoking habits of people living in the household, sociodemographic characteristics of the household, and the household's living conditions. RESULTS: The overall prevalence of smoking in the households was 37.7%. In terms of income, in the households with a monthly per capita income of 2 minimum wages or more, the prevalence of smoking was 24.1%; it was 31.3% in the households with a monthly per capita income between 1 and 1.9 minimum wages; and it was 46.0% in households with a monthly per capita income below 1 minimum wage. With respect to socioeconomic level (the family's material goods and purchasing power and the educational level of the head of the household, divided into five classes, from A (highest) to E (lowest)), the higher the socioeconomic level, the lower was the prevalence of smoking in the household: 26.9% for class A, 26.4% for class B, 34.9% for class C, 45.1% for class D, and 47.2% for class E. There was a higher prevalence of smoking when the father did not live in the home (47.5% versus 35.5%), when the head of the family was someone other than the father or the mother (53.8% versus 33.9% and 38.8%, respectively), when the father was younger than 20 years (52.3% versus 31.2% for fathers 40 or older), and when the mother was younger than 20 years (46.1% versus 22.5% for mothers 40 or older). In terms of occupation, the lowest prevalence of household smoking was found with health professionals and teachers, for both women (18.3%) and men (14.7%). After multivariate logistic regression analysis, the following variables remained associated with household smoking: absence of the father from the household, maternal and paternal schooling, maternal and paternal occupation, child's age, and household monthly per capita income. CONCLUSION: The risk of exposure to household smoking (and thus to passive smoking) in this sample of children younger than 5 years of age was higher in households living in poorer socioeconomic conditions.

Nine months postpartum weight retention predictors for Brazilian women.

OBJECTIVE: To identify factors potentially associated with weight retention measured 9 months after childbirth. DESIGN: Prospective study with four follow-up waves in time (0.5, 2, 6 and 9 months postpartum). SETTING: Rio de Janeiro, Brazil. SUBJECTS AND METHODS: Two hundred and sixty-six Brazilian women of childbearing age. Analysis was based on hierarchical logistic regression. The dependent variable was weight retention and was defined as the difference between weight at 9 months postpartum and pre-pregnancy weight, with a dichotomised cut-off at 7.5 kg. Covariates included demographic and socio-economic data, obstetric history, anthropometric data, and data on the infant. These data were grouped in blocks and ordered according to their influence on the dependent variable. RESULTS: Of the women studied, 19.2% presented weight retention values > or =7.5 kg. According to the logistic regression analysis, the following variables remained associated with weight retention > or =7.5 kg: total family income, difficulty or inability to read a letter, age category > or =30 years, age at first childbirth <23 years, gestational weight gain > or =12 kg, body fat at baseline > or =30% and infant birth weight <3500 g. Infant hospitalisation was only marginally significant. CONCLUSIONS: Determinant factors identified by the analysis highlight the need for nutritional intervention policies during pregnancy and in the first months postpartum as a way of minimising obesity and the diseases resulting from it.

Gestational weight gain and prepregnancy weight influence postpartum weight retention in a cohort of brazilian women.

The objective of the study was to test the association between gestational weight gain, reproductive factors, and postpartum weight retention based on a cohort conducted with 405 women aged 18-45 y with follow-up waves at 0.5, 2, 6, and 9 mo postpartum. The outcome variable, postpartum weight retention, was calculated as the difference between the measured weight at each visit minus the prepregnancy weight. We estimated the statistical associations between the outcome variable and potential explanatory covariates of interest by fitting a longitudinal mixed-effects model. Women with gestational weight gain above the recommendations of the Institute of Medicine (IOM) retained significantly more weight than women with weight gain within or below the recommendations, independently of prepregnancy BMI [weight (kg)/height (m(2))] or body fat at baseline. Women with the highest gestational weight gain and with body fat >/=30 g/100 g at baseline had the highest likelihood of developing maternal obesity. The final longitudinal model showed that 35% of each kilogram of weight gained during pregnancy was retained 9 mo postpartum, even after adjustment for age, prepregnancy BMI, body fat at baseline, and years since first parturition. Each unit of increase in prepregnancy BMI was associated with a decrease of -0.51 kg in postpartum weight retention. In conclusion, gestational weight gain was one of the most important predictors for postpartum weight retention and must be monitored systematically with the aim of preventing postpartum obesity and the diseases that follow.

Breastfeeding and postpartum weight retention in a cohort of Brazilian women.

BACKGROUND: The relation between postpartum weight retention and breastfeeding practices is controversial. OBJECTIVE: Defining breastfeeding as the period when a child is exclusively or predominantly breastfed, we studied the association between breastfeeding duration and postpartum weight retention. DESIGN: We followed 405 women aged 18-45 y who were assessed at 0.5, 2, 6, and 9 mo postpartum. The outcome variable, postpartum weight retention, was expressed as the difference between the observed weight at each follow-up and the reported prepregnancy weight. The main statistical procedure used was the longitudinal mixed-effects model. RESULTS: Mean postpartum weight retention at the end of the study was 3.1 kg. Single women aged > or = 30 y retained more weight than did younger single women or married women. The combined effect of breastfeeding duration and percentage of body fat at baseline was significant only for women with < 30% body fat. According to the model's prediction, when women who had 22% body fat and breastfed for 180 d were compared with those who had 22% body fat and breastfed for only 30 d, each month of breastfeeding contributed -0.44 kg to postpartum weight retention. When only the percentage of body fat was varied, the total effect was 3.0, 1.7, 1.2, and 0.04 kg in women with 18%, 25%, 28%, and 35% body fat, respectively. CONCLUSIONS: These results support the hypothesis of an association between breastfeeding and postpartum weight retention and suggest that encouraging prolonged breastfeeding might contribute to decreases in postpartum weight retention.

Low level methylmercury exposure affects neuropsychological function in adults.

BACKGROUND: The neurotoxic effects of methylmercury (MeHg) have been demonstrated in both human and animal studies. Both adult and fetal brains are susceptible to the effects of MeHg toxicity. However, the specific effects of adult exposures have been less well-documented than those of children with prenatal exposures. This is largely because few studies of MeHg exposures in adults have used sensitive neurological endpoints. The present study reports on the results of neuropsychological testing and hair mercury concentrations in adults (>17 yrs) living in fishing communities of Baixada Cuiabana (Mato Grosso) in the Pantanal region of Brazil. METHODS: A cross-sectional study was conducted in six villages on the Cuiaba River. Participants included 129 men and women older than 17 years of age. They were randomly selected in proportion to the age range and number of inhabitants in each village. Questionnaire information was collected on demographic variables, including education, occupation, and residence history. Mercury exposure was determined by analysis of hair using flameless atomic absorption spectrophotometry. The neurocognitive screening battery included tests from the Wechsler Memory Scale and the Wechsler Adult Intelligence Scale, Concentrated Attention Test of the Toulouse-Pierron Factorial Battery, the Manual Ability Subtests of the Tests of Mechanical Ability, and the Profile of Mood States. RESULTS: Mercury exposures in this population were associated with fish consumption. The hair mercury concentration in the 129 subjects ranged from 0.56 to 13.6 microg/g; the mean concentration was 4.2 +/- 2.4 micrograms/g and the median was 3.7 microg/g. Hair mercury levels were associated with detectable alterations in performance on tests of fine motor speed and dexterity, and concentration. Some aspects of verbal learning and memory were also disrupted by mercury exposure. The magnitude of the effects increased with hair mercury concentration, consistent with a dose-dependent effect. CONCLUSIONS: This study suggests that adults exposed to MeHg may be at risk for deficits in neurocognitive function. The functions disrupted in adults, namely attention, fine-motor function and verbal memory, are similar to some of those previously reported in children with prenatal exposures.

Confiabilidade de variáveis selecionadas para um instrumento sobre o uso de drogas entre estudantes adolescentes trabalhadores e näo-trabalhadores da rede estadual de ensino de Cuiabá, Mato Grosso, Brasil, 1998 / The reliability of variables selected for an instrument on drug abuse among adolecent students workers or not from public schools locoteh at Cuiaba, Mato Grosso, Brazil, 1998

Tem por objetivo elaborar um instrumento composto das variáveis demográficas, condições de trabalho, constituição do núcleo familiar, condições de vida e verificar a sua confiabilidade, a fim de fazer parte de um questionário de auto-preenchimento sobre o uso de drogas entre estudantes adolescentes, trabalhadores e não-trabalhadores. Participaram da pesquisa 275 estudantes do ensino fundamental, médio e educação de jovens e adultos, matriculados no ano de 1998 em quatro escolas da rede estadual de ensino de Cuiabá, MT, Brasil. Os resultados obtidos foram considerados satisfatórios, uma vez que 88,5 por cento dos dados apresentaram Coeficiente Kappa com concordâncias acima de 0,61 (substancial à quase perfeita); 9,9 por cento entre 0,41-0,60 (moderada) e 1,6 por cento entre 0,21-0,40 (fraca). Com esses procedimentos, foram abtidas as questões definitivas do questionário de auto-preenchimento a ser aplicado em um estudo posterior