Consumo de bebidas alcoólicas e direção de veículos nas capitais brasileiras e no Distrito Federal, segundo dois inquéritos nacionais de saúde / Alcohol consumption and driving in Brazilian capitals and Federal District according to two national health surveys

RESUMO: Objetivo Apresentar os resultados dos indicadores sobre consumo de álcool e direção para as capitais brasileiras obtidos em dois inquéritos populacionais realizados em 2013 no Brasil. Métodos: Estudo transversal realizado com dados da população adulta (≥ 18 anos) participante da Vigilância de Doenças Crônicas por Inquérito Telefônico (Vigitel) e da Pesquisa Nacional de Saúde (PNS). Foram calculadas as prevalências para os indicadores de consumo de bebida alcoólica e direção veicular. Resultados: A proporção de motoristas adultos de carro ou moto que dirigiram logo depois de beber foi significativamente maior no sexo masculino (29,3% - Vigitel; 24,4% - PNS), entre jovens de 18 a 29 anos (31,6% - Vigitel; 24,1% - PNS) e entre os residentes das capitais da Região Centro-Oeste (33,7% - Vigitel; 28,3% - PNS). A proporção de adultos que referiram beber e dirigir foi maior no sexo masculino (9,4% - Vigitel; 7,4% - PNS), no grupo de 18 a 29 anos (7,1% - Vigitel; 4,5% - PNS) e entre os residentes das capitais da Região Centro-Oeste (7,9% - Vigitel; 6,1% - PNS). Conclusão: O estudo permitiu estimar a prevalência do hábito de dirigir após ingestão de bebida alcoólica entre motoristas e na população em geral e mostrou coerência entre os resultados dos dois inquéritos epidemiológicos de abrangência nacional.

ABSTRACT: Objective: To present the results of indicators of alcohol consumption and driving for Brazilian capitals based on two population surveys performed in Brazil in 2013. Methods: Cross sectional study with data from adults (≥ 18 years) participants of the Telephone Survey on Risk and Protective Factors for Chronic Diseases (Vigitel) and the National Health Survey (NHS). Prevalence for indicators of alcohol consumption and driving was then calculated. Results: The proportion of adult drivers who drove soon after drinking was significantly higher among males (29.3% - Vigitel and 24.4% - NHS), the young aging 18 to 29 years (31.6% - Vigitel and 24.1% - NHS) and among residents of the capitals of the Midwest (33.7% - Vigitel and 28.3% - NHS). The proportion of adults who reported drinking and driving was higher among males (9.4% - Vigitel and 7.4% - NHS) in the 18 to 29 age group (7.1% - Vigitel; 4.5% - NHS), and among residents of the capitals of the Midwest (7.9% - Vigitel and 6.1% - NHS). Conclusion: The study estimated the prevalence of the habit of driving after alcohol consumption among drivers and in the general population. There was consistency between the results from two nationwide surveys.

Prevalência de doenças crônicas não transmissíveis e associação com autoavaliação de saúde: Pesquisa Nacional de Saúde, 2013 / Prevalence of chronic non-communicable diseases and association with self-rated health: National Health Survey, 2013

Resumo: Objetivo: Analisar o perfil de dez doenças crônicas não transmissíveis investigadas na Pesquisa Nacional de Saúde realizada no Brasil em 2013 e sua associação com a autoavaliação da saúde. Métodos: Estudo transversal de base populacional e abrangência nacional com 60.202 indivíduos com 18 anos ou mais. Foi utilizado processo amostral por conglomerado com três estágios de seleção: setor censitário, domicílio e indivíduo. Calculou-se a prevalência das doenças crônicas e os intervalos de confiança de 95% por idade, sexo e escolaridade, a idade média do primeiro diagnóstico e a proporção de limitação das atividades habituais. Para testar a associação com a autoavaliação de saúde, utilizou-se o procedimento de regressão logística ajustada por sexo e idade. Resultados: As doenças mais prevalentes foram hipertensão arterial (21,4%), depressão (7,6%), artrite (6,4%) e diabetes mellitus (6,2%). Indivíduos com diagnóstico de acidente vascular cerebral (AVC) referiram maior limitação das atividades habituais (38,6%). Observou-se um gradiente na prevalência segundo idade e escolaridade, e todas as doenças foram mais frequentes entre as mulheres. Pior autoavaliação de saúde foi encontrada entre aqueles com diagnóstico de AVC (OR = 3,60; valor de p < 0,001) e nos que referiram duas doenças (OR = 5,53; valor de p < 0,001) ou três ou mais doenças (OR = 10,86; valor de p < 0,001). Conclusões: Por se tratar de doenças associadas a fatores de risco modificáveis, a prevenção com foco populacional é a melhor estratégia para redução da carga dessas doenças.

ABSTRACT: Objective: To analyze the profile of 10 chronic noncommunicable diseases investigated in the National Health Survey carried out in Brazil in 2013 and their association with the self-rated health. Methods: A cross-sectional, population-based nationwide study with 60,202 individuals aged 18 years old or more. Sampling process by conglomerate was carried out in three stages of selection: census tract, household, and individual. The prevalence of chronic diseases by age, gender and educational status and the confidence intervals of 95% , the mean age at the first diagnosis and the proportion of limitation of the usual activities were calculated. To test the association with self-rated health, the logistic regression procedure adjusted for gender and age was used. Results: The more prevalent diseases were hypertension (21.4%), depression (7.6%), arthritis (6.4%), and diabetes mellitus (6.2%). Individuals diagnosed with stroke reported greater limitations in the daily activities (38.6%). There was a gradient in the prevalence by age and educational level, and all the diseases were more frequent among women. A worse self-rated health was observed among those with a diagnosis of stroke (OR = 3.60; p < 0.001) and those who referred two diseases (OR = 5.53; p < 0.001) or three or more diseases (OR = 10.86; p < 0.001). Conclusions: Because these diseases are associated with modifiable risk factors, the prevention with population focus is the best strategy to reduce the burden of these diseases.

Associação entre resiliência e qualidade de vida relacionada à saúde bucal em idosos / Association between resilience and quality of life related to oral health in the elderly

OBJETIVO: Avaliar a associação entre resiliência e qualidade de vida relacionada à saúde bucal, por meio de uma abordagem hierárquica baseada em um modelo teórico conceitual em uma coorte de idosos do Rio Grande do Sul. MÉTODOS: Foi conduzido um estudo transversal aninhado a um estudo de coorte, em 2008. Foram avaliados 498 idosos de Carlos Barbosa, Rio Grande do Sul. As medidas avaliadas foram sociodemográficas, comportamentos de saúde, qualidade de vida relacionada à saúde bucal, medida pelo Oral Health Impact Profile (OHIP-14), Escala de Resiliência e CPOD. A associação entre o potencial de resiliência e os impactos na percepção de saúde bucal relacionados à qualidade de vida foi verificada por meio de regressão binomial negativa. Razões das médias (RM) são apresentadas com seus intervalos de confiança de 95% (IC95%). RESULTADOS: Maiores médias do OHIP foram encontradas entre mulheres (6,7 ± 6,3; p = 0,011), moradores da zona rural (7,3 ± 6,7; p = 0,004) e solteiros (8,0 ± 6,3; p = 0,032). O modelo final da análise multivariada mostrou que ser morador da zona rural (RM = 1,32; IC95% 1,06 - 1,65) e casado (RM = 1,36; IC95% 1,07 - 1,72) foram variáveis independentemente associadas à qualidade de vida relacionada à saúde bucal. Não houve associação entre resiliência e qualidade de vida relacionada à saúde bucal. CONCLUSÃO: Os resultados sugerem que variáveis sociodemográficas estão associados à qualidade de vida relacionada à saúde bucal. A hipótese de que a resiliência pudesse exercer um papel importante no desfecho não foi confirmada. .

OBJECTIVE: To evaluate the association between psychological resilience and oral health related to quality of life through a hierarchical approach based on a conceptual theoretical model in a cohort of elderly residents in Rio Grande do Sul, Brazil. METHODS: We conducted a cross-sectional study nested in a cohort study in 2008. We evaluated 498 elderly residents in Carlos Barbosa, Rio Grande do Sul. The measures included sociodemographic questionnaire, health behavior, quality of life related to oral health (OHRQOL), measured by the Oral Health Impact Profile (OHIP-14), Resilience Scale, and DMFT. The association between resilience and potential impacts on perceptions of oral health-related quality of life was assessed through negative binomial regression. Mean ratios (MR) are presented with 95% confidence intervals (95%CI). RESULTS: Higher means of OHIP were found in women 6.7 ± 6.3; p = 0.011), in rural dwellers (7.3 ± 6.7; p = 0.004) and singles (8.0 ± 6.3; p = 0.032). The final model of multivariate analysis showed that being a rural dweller (MR = 1.32; 95%CI 1.06 - 1.65) and being married (MR = 1.36; 95%CI 1.07 - 1.72) were independently associated with OHRQOL. There was no association between resilience and OHRQOL. CONCLUSION: The results suggest that factors such as sociodemographic variables are associated with OHRQOL. The hypothesis that resilience might play a role in the outcome has not been confirmed. .

Tratamiento quirúrgico del hiperparatiroidismo asociado a insuficiencia renal crónica: Experience in 71 patients / Surgical treatment of renal hyperparathyroidism

Background: Surgery is an effective method for the management of renal hyperparathyroidism. Aim: To report the clinical presentation and results of surgical treatment of renal hyperparathyroidism. Material and Methods: Retrospective analysis of 58 patients aged 46 ± 11 years with secondary hyperparathyroidism (HPT2) and 13 patients aged 53 ± 11 years with tertiary hyperparathyroidism (HPT3), operated at a clinical hospital. Results: In 55 cases (77.4%) the indications for surgery were complications of excess parathyroid hormone (PTH) and in 16 patients (22.6%) a failure of medical treatment. Total parathyroidectomy with intraoperative measurement of PTH (PTHop) plus a forearm parathyroid autograft was performed in 54 (93.1%) patients with HPT2 and in all patients with HPT3. PTHop decreased ≥ 75% in 51 patients (88%) with HPT2 and in 9 patients (69.2%) with HPT3, respectively. Cure of the disease was achieved in 52 (89.7%) and 11 (84.6%) patients with HPT2 and 3, respectively. Median follow-up was 41 months. Five (9.6%) patients with HPT2 and two patients (18.2%) with HPT3 had a recurrence of the disease. Conclusions: In patients with renal hyperparathyroidism, the primary indication for surgery was the presence of complications of PTH excess. A drop in PTHop ≥ 75% from baseline predicts healing in 98% and 100% of cases with secondary or tertiary HPT respectively. Surgery was a safe and effective treatment in both groups.

Phylogenetic analysis of human group C rotavirus circulating in Brazil reveals a potential unique NSP4 genetic variant and high similarity with Asian strains

Group C rotaviruses (RVC) cause gastroenteritis in humans and animals worldwide, and the evidence for a possible zoonotic role has been recently provided. To gain information on the genetic diversity and relationships between human and animal RVC, we sequenced the VP4, VP7, and NSP4 genes of 12, 19, and 15 human strains, respectively, detected in São Paulo state during historical (1988 and 1993) and recent (2007 and 2008) Brazilian rotavirus surveillance. All RVC strains analyzed in the present study grouped into human genotype (G4-P[2]-E2), and did not show any evidence of animal ancestry. Phylogenetic analysis showed that RVC samples detected in 1988 and 1993 clustered together with strains from distinct continents, indicating that historical RVC strains circulating in São Paulo were closely related to those strains circulating worldwide. All three genes (VP7, VP4 and NSP4) of São Paulo RVC strains isolated in 2007-2008 exhibited close phylogenetic relationship with human RVC strains isolated in China and Japan, suggesting that they are genetically linked, and that a gene flow could be occurring between this Asian countries and Brazil. We identified two distinct clusters in the NSP4 phylogenetic tree. One cluster formed exclusively by human Brazilian strains detected in 1997 and 2003-2004 in Rio de Janeiro, Bahia, and Rio Grande do Sul states (Subgroup II) previously described in a different study, that displayed low sequence identities to other human strains formerly published, and to the Brazilian RVC strains (Subgroup I) characterized in the present study. These data suggests the circulation of two genetic profiles of the NSP4 gene in Brazil. High sequence diversity in NSP4 gene was previously reported in Asia, and additional diversity in NSP4 RVC strains spreading in the world should be expected. More in-depth molecular and epidemiological analysis of human RVC throughout the world will be needed to understand their diversity and clarify their evolution, as well as to develop classifications schemes.

El kininógeno de alto peso molecular: su participación en la respuesta inflamatoria y en la angiogénesis. Propiedades y posible aplicación terapéutica / High molecular weight kininogen in inflammation and angiogenesis: a review of its properties and therapeutic applications

The plasma kallikrein-kinin system (KKS) participates in the pathogenesis of inflammatory reactions involved in cellular injury, coagulation, fibrinolysis, kinin formation, complement activation, cytokine secretion and release of proteases. It has been shown that KKS activation in the systemic inflammatory response syndrome results in decrease of its component plasma proteins. Similar changes have been documented in diabetes, sepsis, children with vasculitis, allograft rejection, disseminated intravascular coagulation, patients with recurrent pregnancy losses, hereditary angioedema, adult respiratory distress syndrome and coronary artery disease. Direct involvement of the KKS in the pathogenesis of experimental acute arthritis and acute and chronic enterocolitis has been documented by previous studies from our laboratory using experimental animal models. It has been found that in HK deficient Lewis rats, experimental IBD was much less severe. We showed a genetic difference in kininogen structure between resistant Buffalo and susceptible Lewis rats, which results in accelerated cleavage of HK and it is responsible for the susceptibility to the inflammatory process in the Lewis rats. It has been demostrated that therapy with a specific plasma kallikrein inhibitor (P8720) modulated the experimental enterocolitis, arthritis and systemic inflammation. Furthermore, it has been shown that a bradykinin 2 receptor (B2R) antagonist attenuates the inflammatory changes in the same animal model. We have showed that a monoclonal antibody targeting HK decreases angiogénesis and arrests tumor growth in a syngeneic animal model. In summary, these results indicate that the plasma KKS plays a central role in the pathogenesis of chronic intestinal inflammation, arthritis and angiogenesis.

Se ha demostrado la participación del sistema plasmático de kalikreína-kininas (KKS) en el proceso inflamatorio, el cual incluye reacciones de daño celular, coagulación y fibrinólisis, formación de kininas, activación del complemento, secreción de citoquinas y liberación de proteasas. El KKS se encuentra activado en el síndrome de respuesta inflamatoria sistémica con una disminución en la concentración plasmática de las proteínas que lo constituyen. También se ha demostrado una activación similar en la diabetes, choque séptico, vasculitis en infantes, enfermedad injerto-huésped, coagulación intravascular diseminada, pacientes con abortos de repetición, angioedema hereditario, el síndrome de estrés respiratorio del adulto y enfermedad coronaria arterial. Mediante el uso de modelos animales experimentales, nuestro laboratorio ha demostrado una participación directa del KKS en la patogénesis de la artritis experimental aguda y la enterocolitis aguda y crónica. Se ha demostrado que en la rata tipo Lewis, cuando es deficiente de kininógeno de alto peso molecular (HK), la enfermedad inflamatoria intestinal es menos severa comparada con la presentada en ratas con niveles normales de HK como la Buffalo. Nosotros mostramos una diferencia entre el gene que codifica la molécula del kininógeno de la rata tipo Buffalo (resistentes) y Lewis (susceptibles), que resulta en un incremento de la actividad proteolítica de kalikreína sobre su substrato HK, lo cual predispone a las ratas Lewis al desarrollo de la enfermedad inflamatoria crónica. Se ha demostrado una disminución en las manifestaciones inflamatorias sistémicas de la enterocolitis y artritis experimental mediante el uso de un inhibidor específico de la kalikreína (P8720). Además, el antagonista del receptor 2 de la bradikinina (BR2) atenuó los cambios inflamatorios en el mismo modelo animal. Asimismo, se ha demostrado que las ratas Lewis deficientes de kininógeno desarrollaron inflamación intestinal sistémica menos severa. Mediante el uso del anticuerpo monoclonal C11C1 contra HK se logró una disminución de la angiogenesis y, consecuentemente, el crecimiento tumoral. En conclusión, los resultados demuestran que el sistema plasmático de KKS desempeña un papel preponderante en la patogénesis de la artritis reumatoide, la enfermedad intestinal crónica y en el proceso angiogénico.

Prevalência de genótipos e de mutantes pré-core A-1896 do vírus da hepatite B e suas implicações na hepatite crônica, em uma população da Amazônia oriental / Prevalence of hepatitis B virus genotypes and the occurrence of precore mutation A-1896 and to correlate them with the clinical presentation of chronic hepatitis, in a population group of the eastern Amazon region

A infecção pelo virus da hepatite B apresenta amplo espectro de manifestações clínicas. Objetivando conhecer os genótipos do HBV mais prevalentes e determinar a ocorrência da mutação pré-core A-1896, em uma população da Amazônia oriental, correlacionando com o diagnóstico clínico, foram selecionados 51 pacientes portadores crônicos de HBsAg e HBV-DNA positivos e divididos em três grupos: grupo A (n=14, pacientes assintomáticos); grupo B (n=20, sintomáticos HBeAg positivos) e grupo C (n=17, sintomáticos HBeAg negativos), sendo usado o sequenciador automático ABI modelo 377 para identificação de genótipos e mutantes pré-core. Os resultados evidenciaram o genótipo A como o mais prevalente, 81,8%, 89,5% e 93,7%, nos grupos A, B e C, respectivamente. A mutação pré-core A-1896 foi encontrada em 11,5% (3/26), sendo todos assintomáticos. Concluiu-se que na população estudada o genótipo A foi o mais prevalente e houve baixa ocorrência do mutante pré-core A-1896, ambos não se constituindo fatores agravantes da doença hepática.

Hepatitis B virus (HBV) infection presents itself with a variety of clinical manifestations. The present work aims to describe the prevalence of HBV genotypes and the occurrence of precore mutation A-1896 in a population group of the Eastern Amazon region of Brazil and to correlate them with the clinical presentation of chronic HBV infection. 51 HBsAg carriers (HBV-DNA positive) were selected and divided into three groups: A (14 asymptomatic subjects), B (20 HBeAg positive symptomatic patients) and C (17 HBeAg negative symptomatic patients). Using an automa ed DNA sequencer ABI model 377 by sequencing for determined of genotypes and precore mutation. The results showed that the genotype A was the most commonly found (81,1%, 89,5% and 93,7% in groups A, B and C, respectively) and precore mutation A-1896 was described in 11,5% (3/26) of group A subjects. Genotype A of HBV was the most prevalent (89,1%) and low occurrence of precore mutation A-1896, both not associate with the worst outcome of the chronic infection of HBV.

Determinación del RNA genómico y replicativo del virus de la hepatitis C en pacientes tratados con interferón / Determination of genomic RNA and replicative hepatitis C viruses in patients treated with interferon

En este ensayo se trató de correlacionar la evolución clínica e histológica de un grupo de pacientes tratados con IFN, con la presencia del RNA genómico y replicativo del HCV en plasma y tejido hepático. Se estudiaron 11 pacientes con hepatitis crónica "C" diagnosticada por elevación de transaminasas durante los últimos 6 meses, anti-HCV positivo "(Elisa II)", y cuadro histológico compatible. En todos ellos se efectuó biopsia hepática y extracción de sangre en paralelo, inmediatamente antes y después de finalizar el tratamiento con 4.5 millones de IFN Alfa2a administrado 3 veces por semana, durante 6 meses. El tecijo hepático se almacenó a-80§c y el plasma a-20§c hasta su procesamiento. La extracción de RNA se realizó a partir de 100microliter de plasma y de 20mg de tejido hepático con isotiocianato de guanidinio (Chomcznski). La transcripción reversa se llevó a cabo "primers" sense o antisense para detectar la hélice replicativa (-) o genómica (+) respectivamente. El cDNA de la región 5' no codificante fue amplificado por el sistema "nested". Antes del tratamiento los 11 pacientes evidenciaron la presencia de la hélice genómica en tecijo hepático y plasma. En cambio la hélice replicativa se detectó en 5 casos en hígado, 7 pacientes se revelaron como respondedores y 4 como no respondedores. En los pacientes respondedores las hélices genómica y replicativa en hígado desaparecieron en un 43 por ciento y 57 por ciento respectivamente, y en plasma se observó un descenco del 71 por ciento para la hélice genómica y de un 100 por ciento para la hélice replicativa. En los 4 pacientes no respondedores la hélice genómica permaneció en tecijo hepático y plasma, en cambio la replicativa se mantuvo en tejido hepático y se negativizó en un 75 por ciento en plasma. El índice de Knodell, que determina el estadío histológico, disminuyó en 5 de lo 7 respondedores y permaneció igual en 3 de los 4 no respondedores...

The chronic presence of the parasite, and anti-P autoimmunity in Chagas disease: the Trypanosoma cruzi ribosomal P proteins, and their recognition by the host immune system

Molecular expression cloning techniques revealed that patients with the severest clinical form of Chagas disease, chronic Chagas heart disease, presented a strong humoral response against the cloned C-terminal portion of a Trypanosoma cruzi ribosomal P protein. Parasite P antigens identification led to characterize the ribosomal P protein system in T. cruzi. Their exposed location on the ribosome, and the ®amplification® of their parasite specific, serine free C-terminal domain, generate a strong parasite specific anti-P response, that in certain cases may induce anti-P autoimmunity