Economic Impact of the COVID-19 Pandemic among Dentists in One of the Poorest Brazilian States: A Cross-Sectional Study

ABSTRACT Objective: To analyze the impact of the COVID-19 pandemic on dentists' income and to identify associated factors in one of the poorest Brazilian states. Material and Methods: A cross-sectional study including dentists who volunteered to answer an electronic questionnaire in Maranhão. Hierarchical multinomial logistic regression analyses were performed, estimating crude and adjusted odds ratios (OR) and respective 95% confidence intervals (95%CI) (alpha=5%). Results: The COVID-19 pandemic impacted the professionals´ income negatively [55.44% (50.26-60.52%)] and also positively [6.9% (4.55-9.94%)]. The negative impact on income was greater among male dentists (OR=2.54; 95%CI: 1.16-5.53), over 30 years of age (OR=3.03; 95%CI: 1.34-6.87), with family income below two minimum wages (OR=4.63; 95%CI: 1.50-14.30), who worked in the continent instead of in the capital island (OR=2.21; 95%CI: 1.14-4.29) and in the private sector (OR=31.43; 95%CI: 11.59-85.22). Moreover, those who had been tested for COVID-19, with a negative result, had a 21.3-fold greater chance of having an increased household income when compared to those who had not been tested. Conclusion: The COVID-19 pandemic negatively impacted the dentists' income in Maranhão, especially the older, males, with lower incomes, and who worked in the private sector, living far from the capital. The SUS played an important role in the social protection of dentists during the COVID-19 pandemic, mitigating the economic impacts on the public sector working class.

Hepatocellular carcinoma: A real-life experience in a specialized center in Bogotá, Colombia / Hepatocarcinoma: experiencia de la vida real en un centro especializado de Bogotá, Colombia

Abstract Introduction: Hepatocellular carcinoma (HCC) is the most frequent malignant primary liver tumor globally. In 2018, it ranked sixth and represented the fourth cause of death from cancer; the five-year overall survival is 18 %. Most cases of HCC develop in patients with cirrhosis of any etiology, especially because of hepatitis B and C viruses, alcohol, and recently nonalcoholic steatohepatitis (NASH). Aim: To analyze the clinical characteristics, diagnostic methods, treatments, prognostic variables, and survival. Materials and methods: This retrospective descriptive study was conducted on a cohort of patients diagnosed with cirrhosis and treated between January 2011 and December 2020 at a health care center in Bogotá. The diagnosis of HCC was confirmed radiologically or by biopsy. We analyzed the information descriptively with absolute frequency measures in the case of categorical variables. For continuous variables, the information was summarized with measures of central tendency (mean or median) and their relevant measures of dispersion. Results: We included 152 patients diagnosed with HCC, with a mean age of 69.4 years; 51.3 % were men. The leading cause of HCC was nonalcoholic fatty liver disease (NAFLD), which accounted for almost a third of cases (32 %); other causes were alcohol (15 %) and hepatitis C virus (14 %). The median manifestation of the tumor was two nodules with a size close to 4 cm. Besides, 35 % of patients had a BCLC (Barcelona Clinic Liver Cancer) stage with curative options, and 25 % received curative treatment options. The first-line systemic therapy used in this cohort was sorafenib®, used in 35 patients (33.7 %). Survival curves showed that women, Child-Pugh class A, and BCLC stage 0 had higher median survival. Multivariate analysis showed a higher risk of death for males (hazard ratio [HR]: 2.16; confidence interval [CI]: 1.24-3.76), Child-Pugh class B (HR: 2.14; CI 1.16-3.95), and Child-Pugh class C (HR: 7.52; CI 2.88-19.57). Conclusions: NAFLD is the leading cause of HCC in this cohort. A third of patients are diagnosed in early BCLC stages with a curative treatment option, and 25 % are treated with curative therapies. Sorafenib was the first-line therapy in advanced HCC. Overall survival after diagnosis of HCC remains low, being necessary to join forces in the follow-up of patients with cirrhosis to improve these outcomes.

Resumen Introducción: el hepatocarcinoma (HCC) es el tumor hepático primario maligno más frecuente en el mundo: en 2018 ocupó la sexta posición y representó la cuarta causa de muerte por cáncer; la supervivencia global a 5 años es del 18 %. La mayoría de los casos de HCC se desarrolla en pacientes con cirrosis de cualquier etiología, especialmente por virus de la hepatitis B y C, alcohol y, recientemente, por la esteatohepatitis no alcohólica (NASH). Objetivo: analizar las características clínicas, métodos de diagnóstico, tratamientos, variables pronósticas y supervivencia. Metodología: estudio descriptivo retrospectivo de una cohorte de pacientes con diagnóstico de cirrosis atendidos entre enero de 2011 y diciembre de 2020 en un centro de atención médica de Bogotá, con diagnóstico de HCC confirmado radiológicamente o por biopsia. La información se analizó de forma descriptiva con medidas de frecuencia absoluta en el caso de las variables categóricas; para las variables continuas se resumió la información con medidas de tendencia central (media o medianas) y su respectiva medida de dispersión. Resultados: se incluyeron 152 pacientes diagnosticados con HCC, con edad promedio de 69,4 años, 51,3 % eran hombres. La principal causa de HCC fue el hígado graso no alcohólico (NAFLD), que representó casi una tercera parte de los casos (32 %); otras causas fueron el alcohol (15 %) y el virus de la hepatitis C (14 %). La mediana de presentación del tumor fue de 2 nódulos con un tamaño cercano a 4 cm. El 35 % de los pacientes tenía un estadio BCLC (Barcelona Clinic Liver Cancer) con opciones curativas y el 25 % de los pacientes recibió opciones curativas de tratamiento. La terapia sistémica de primera línea utilizada en esta cohorte fue el sorafenib®, que se utilizó en 35 pacientes (33,7 %). Las curvas de supervivencia mostraron que las mujeres, el estadio Child-Pugh A y el estadio BCLC 0 presentaron mayores medianas de supervivencia. El análisis multivariado evidenció un mayor riesgo de muerte al ser hombre (Hazard ratio [HR]: 2,16; intervalo de confianza [IC]: 1,24 a 3,76), estar en los estadios Child-Pugh B (HR: 2,14; IC: 1,16 a 3,95) y Child-Pugh C (HR: 7,52; IC: 2,88 a 19,57). Conclusiones: el NAFLD es la principal causa de HCC en la presente cohorte, una tercera parte de los pacientes se diagnostica en estadios BCLC tempranos con opción curativa de tratamiento, y un 25 % se trata con terapias curativas. El sorafenib fue la terapia de primera línea en HCC avanzado. La supervivencia global luego del diagnóstico de HCC sigue siendo baja, y es necesario aunar esfuerzos en el seguimiento de los pacientes con cirrosis para mejorar estos resultados.

Antígenos del sistema sanguíneo ABO como factor de riesgo para la gravedad de la infección por SARS-CoV-2 / Blood system ABO antigens as risk factor for severity of SARS-CoV-2 infection

Resumen Introducción: Se desconoce si existe una influencia del sistema sanguíneo ABO en susceptibilidad y gravedad de la enfermedad. Objetivo: Analizar si existe una asociación entre los antígenos del sistema ABO y la susceptibilidad y gravedad de la infección por SARS-CoV-2. Material y métodos: Se compararon las frecuencias de los antígenos del sistema ABO en 73 casos confirmados de infección por SARS-CoV-2 y 52 donadores clínicamente sanos. La gravedad de la infección se evaluó comparando la frecuencia de los antígenos por gravedad de la enfermedad y la mortalidad. Resultados: El riesgo de padecer infección por SARS-CoV-2 se incrementa en sujetos con antígeno A vs los no-A (OR=1.45; IC95 %:1.061-1.921). El fenotipo sanguíneo O disminuye el riesgo de padecer infección por SARS-CoV-2 (OR=0.686; IC95 %: 0.522-0.903). No se encontraron diferencias entre la gravedad de la enfermedad. En los pacientes graves, el riesgo de mortalidad se incrementó en sujetos con antígeno A vs los no-A (OR= 3.34; IC95 %: 1.417-8.159). Conclusión: El grupo sanguíneo A es un factor de riesgo para padecer infección por SARS-CoV-2, no así en la gravedad de la enfermedad, pero en los pacientes graves fue un factor de riesgo para la mortalidad.

Abstract Introduction: Whether there is an influence of the ABO blood system on susceptibility to the disease and its severity is unknown. Objective: To analyze if there is an association between the ABO blood system phenotypes and susceptibility to SARS-CoV-2 infection and its severity. Material and methods: The frequency of ABO antigens was compared in 73 confirmed cases of SARS-CoV-2 infection and 52 clinically healthy donors. The severity of the infection was evaluated by comparing the frequency of antigens by severity of the disease and mortality. Results: The risk of SARS-CoV-2 infection is increased in subjects with antigen A vs non-A subjects (OR=1.45; 95 %: 1.061-1.921). Blood phenotype O decreases the risk of SARS-CoV-2 infection (OR= 0.686; 95 % CI: 0.522-0.903). No differences were found regarding disease severity. The mortality risk is increased in subjects antigen A vs non-A (OR= 3.34; 95% IC: 1.417-8.159). Conclusion: Blood group A is a risk factor for SARS-CoV-2 infection, but not for disease severity, although in critically ill patients it is a risk factor for mortality.

Prevalencia de lesiones ateroscleróticas carotídeas en radiografía panorámica y su relación con factores de riesgo cardiovascular en brasileños / Prevalence of atherosclerotic carotid lesions on panoramic radiography and relationship with cardiovascular risk factors in Brazilians

RESUMEN: Aunque la radiografía panorámica no es una prueba de diagnóstico inicial para detectar la aterosclerosis carotídea, no podemos ignorar su valor al ver estas lesiones como hallazgos incidentales que pueden ser grandes aliados en el diagnóstico temprano y la prevención de eventos vasculares graves. El objetivo de este estudio fue evaluar la prevalencia de calcificaciones en la bifurcación de la arteria carótida en las radiografías panorámicas de rutina como principio diagnóstico, así como su relación con los factores de riesgo cardiovascular en individuos brasileños. Se analizaron 449 exámenes de radiografía panorámica de la base de datos del Departamento de Radiología de la Facultad de Odontología de Piracicaba, UNICAMP, São Paulo, Brasil. Después de obtener mediciones de la presión arterial e información sobre el tabaquismo y las enfermedades sistémicas, fue buscado en la radiografía panorámica la presencia o ausencia de la masa radiopaca en las regiones de las vértebras cervicales C3-C4. En el caso de una imagen sugestiva de ateroma, se realizó una radiografía anteroposterior para confirmar el diagnóstico. Aplicamos la prueba estadística de Chi-cuadrado con distribución normal y muestras independientes y aleatorias con un intervalo de confianza del 95 %. La confirmación de calcificaciones carotideas se produjo en el 8,5 % de la población de estudio (38 casos). No encontramos ninguna relación entre la presencia de calcificaciones con el tabaquismo, con el sexo o con datos previos de antecedentes familiares. Sin embargo 49,1 % de los casos estaban por encima de sesenta años y tenía asociación significativa con la hipertensión (P = 0,006). El mayor riesgo se presenta en pacientes ancianos hipertensos y, por lo tanto, hacemos hincapié en la importancia de una observación minuciosa de las radiografías panorámicas en la búsqueda de cualquier alteración de la anatomía normal y si es así, proceder con la derivación lo antes posible para un diagnóstico concluyente por parte de un especialista, pudiendo así ayudar en la prevención de episodios vasculares graves.

SUMMARY: Although panoramic radiography is not an initial diagnostic test for detecting carotid atherosclerosis, we cannot ignore its value in viewing these lesions as incidental findings that can be great allies in early diagnosis and prevention of serious vascular events. The aim was to evaluate the prevalence of calcifications in the bifurcation of the carotid artery on routine panoramic radiographs as a diagnostic principle, as well as its relationship with cardiovascular risk factors in Brazilians. We analyzed 449 panoramic radiography exams from the database of the Department of Radiology of the Faculty of Dentistry of Piracicaba, UNICAMP, São Paulo, Brazil. After obtaining blood pressure measurements and information on smoking and systemic diseases, the researcher observed on the panoramic radiograph, the presence or absence of the radiopaque mass in the regions of the cervical vertebrae C3-C4. In the case of a suggestive image of atheroma, an anteroposterior radiography was performed to confirm the diagnosis. The Chi-square test of normal distribution for independent and random samples with a 95 % confidence interval was applied to the data. Confirmation of carotid calcifications occurred in 8.5 % of the study population (38 cases). We did not find any relationship between the presence of calcifications with smoking, sex or previous family history. However, 49.1 % of cases occurred above sixty years old and there was a significant relationship with hypertension (P = 0.006). The greatest risk was presented in elderly and hypertensive patients, so we highlight the importance of a thorough observation by the dentist of panoramic radiographs to detect any alteration of the normal anatomy and in the positive case, proceed with the referral as soon as possible for a conclusive diagnosis by a specialist, being able to thus assist in the prevention of severe vascular episodes.

Prácticas autoreferidas para controlar la hipertensión y la diabetes mellitus en adultos mayores de Campinas, Brasil, en tres períodos / Self-care management practices for arterial hypertension and diabetes mellitus among elderly people in Campinas, Brazil, in three periods

RESUMEN El objetivo fue estimar la prevalencia de las prácticas autoreferidas para controlar la hipertensión y la diabetes, con y sin medicamentos, en adultos mayores de Campinas, Brasil, en tres períodos. Se analizaron los datos de las encuestas de salud realizadas en tres períodos: 2001-2002, 2008-2009 y 2014-2015. La prevalencia de hipertensión, de diabetes, del uso de medicación continua y las prácticas comportamentales aumentaron durante el período analizado, con una caída significativa en el uso no regular de medicamentos y las consultas médicas de rutina en individuos sin plan de salud privado. Los resultados evidenciaron avances en las prácticas relacionadas con la dieta en aquellas personas sin plan de salud y en quienes declararon contar con plan de salud, destacando mejoras en el tratamiento con medicamentos y la práctica de actividad física. La adherencia al uso de medicamentos y a prácticas comportamentales para controlar las morbilidades se mostró consistente en el período evaluado. Estos indicadores refuerzan la necesidad de mantener y ampliar las políticas dirigidas a la educación sanitaria y la asistencia farmacéutica en el país.

ABSTRACT The objective of this study was to estimate the prevalence of self-care management practices - both with and without medication - in elderly hypertensive and diabetic patients in Campinas, Brazil, in three periods. Data from health surveys conducted in three periods 2001-2002, 2008-2009 and 2014-2015 were analyzed. The prevalence of hypertension, diabetes, the continuous use of medication, and all behavioral practices showed an overall increase in the period analyzed, with a significant drop in both the non-regular use of medications and routine doctor visits on the part of individuals without a private health plan. The results evidenced advances in diet-related practices among individuals without health plans as well as those who reported having healthcare coverage, highlighting improvements in drug treatment and physical activity. Adherence to medication and health behaviors for the management of morbidities was shown to be consistent in the period evaluated. These indicators reinforce the need to maintain and expand policies directed at health education and pharmaceutical assistance in the country.

Comorbilidades y gravedad clínica de la COVID-19: revisión sistemática y meta-análisis / Comorbidities and clinical severity of COVID-19: systematic review and meta-analysis

Introducción: La emergencia de la COVID-19 se ha convertido en un serio problema de salud a nivel mundial. La identificación de comorbilidades asociadas a la presentación clínica grave de la COVID-19, es de importancia para el adecuado abordaje terapéutico de los pacientes afectados. Objetivo: Evaluar el riesgo de COVID-19 con presentación clínica grave en pacientes con comorbilidades. Material y métodos: Se realizó una revisión sistemática y meta-análisis en bases de datos especializadas en busca de artículos publicados hasta el 20 de marzo de 2020, que aportaran información sobre la asociación entre la gravedad de la presentación clínica de la COVID-19 y comorbilidades. Se empleó la razón de probabilidades con un intervalo de confianza de 95 por ciento, y modelos de efectos fijos o aleatorios. Resultados: En el análisis fueron incluidos 13 estudios para un total de 99 817 pacientes. Se obtuvieron los efectos globales para la hipertensión arterial (RP: 4,05; IC 95 por ciento: 3,45-4,74), enfermedad cardiovascular (RP: 4,39; IC 95 por ciento: 3,29-5,87), Diabetes Mellitus (RP: 3,53; IC 95 por ciento: 2,79-4,47), hábito de fumar (RP: 2,87; IC 95 por ciento: 1,81-4,54), enfermedades respiratoria (RP: 2,73; IC 95 por ciento: 2,55-2,94), renal (RP: 5,60; IC 95 por ciento: 4,13-7,60) y hepática crónicas (RP: 1,98 (IC 95 por ciento: 1,08-3,64) e inmunodeficiencias (RP: 2,90; IC 95 por ciento: 2,06-4,09), en pacientes graves en comparación con pacientes no graves. Conclusiones: La enfermedad renal crónica, la enfermedad cardiovascular, la hipertensión arterial y la Diabetes Mellitus están entre las comorbilidades que mayor riesgo implican para una presentación clínica grave en pacientes con COVID-19, seguidas en importancia por las inmunodeficiencias, hábito de fumar, enfermedad respiratoria crónica y enfermedad hepática crónica(AU)

Introduction: The recent emergence of COVID-19 has become a serious global health problem. The identification of comorbidities associated with the clinical severity in COVID-19 patients is of paramount significance for the appropriate therapeutic approach of affected patients. Objective: To evaluate the risk of severe clinical presentation of COVID-19 in patients with comorbidities. Materials and methods: A systematic literature search and meta-analysis was conducted in specialized databases to obtain information from articles published until March 20, 2020. All relevant papers with information on the association between clinical severity and comorbidities were included. The odds ratio with 95 percent confidence interval and fixed or random effect models were used. Results: Thirteen studies were included for a total of 99 817 patients. Global effects were obtained for hypertension (OR: 4.05; 95 percent CI: 3.45-4.74), cardiovascular disease (OR: 4.39; 95 percent CI: 3.29-5.87), diabetes mellitus (OR: 3.53; 95 percent CI: 2.79-4.47), smoking (OR: 2.87; 95 percent CI: 1.81-4.54), chronic lung disease (OR: 2.73; 95 percent CI: 2.55-2.94), chronic kidney disease (OR: 5.60; 95 percent CI: 4.13-7.60), chronic liver disease (OR: 1.98; 95 percent CI: 1.08-3.64), and immunodeficiency (OR: 2.90; 95 percent CI: 2.06-4.09) in severe patients compared with non-severe patients. Conclusions: Chronic kidney disease, cardiovascular disease, hypertension and diabetes are among the comorbidities with the highest risk of severe clinical presentation in COVID-19 patients, followed in importance by immunodeficiency, smoking, chronic lung disease and chronic liver disease(AU)

Prevalencia de malnutrición y factores asociados en adultos mayores del cantón Gualaceo, Ecuador / Prevalence of malnutrition and associated factors among the elderly of Gualaceo, Ecuador

RESUMEN La malnutrición y los factores que la determinan preocupan a nivel mundial; pues muchos de ellos podrían modificarse e impactar en favor de un envejecimiento saludable. El objetivo fue determinar la prevalencia de malnutrición y factores asociados en adultos mayores del cantón Gualaceo, Ecuador, mediante un estudio transversal en 250 adultos mayores, con muestreo probabilístico, estratificado y aleatorizado. Se evaluó el estado nutricional con Mini Nutritional Assessment y factores asociados como: depresión con la Escala abreviada de Depresión Geriátrica de Yesavage, actividad física con el Cuestionario Internacional de Actividad Física, el nivel socioeconómico con la Encuesta de Estratificación del Nivel Socioeconómico del Instituto Nacional de Estadísticas y Censos, y parámetros de laboratorio. Se realizó estadística descriptiva y la asociación con razón de prevalencia y su intervalo de confianza al 95% y análisis multivariado. La prevalencia de malnutrición fue 20.4 %, el riesgo de malnutrición 47.2% y estado nutricional satisfactorio de 32.4%. La media de edad fue 76,3 (±8.2) años. Se evidenció que la quinta parte de la muestra tomada de adultos mayores del cantón Gualaceo tenía malnutrición y se asoció con: depresión, sedentarismo, bajo nivel socioeconómico y anemia, ratificando a la malnutrición como un problema de salud pública.

ABSTRACT Malnutrition and its underlying factors are a worldwide concern; as many of them can be modified, which in turn would positively impact healthy aging. The objective of this study was to determine the prevalence of malnutrition and associated factors among the elderly of Gualaceo, Ecuador, using a cross-sectional design with 250 elderly participants. Sampling was probabilistic, stratified and randomized in Gualaceo, Ecuador. Nutritional status was assessed using the Mini Nutritional Assessment; depression with the Yesavage Geriatric Depression Scale; physical activity with the International Physical Activity Questionnaire, socioeconomic level with the Survey Of Stratification of the Socioeconomic Level of the National Institute of Statistics and Censuses, and laboratory parameters. Descriptive statistics, prevalence ratios with 95% confidence intervals were calculated and multivariate analysis was conducted. The prevalence of malnutrition was 20.4%, the risk of malnutrition 47.2%, and 32.4% had a satisfactory nutritional status. The mean age was 76.3 (±8.2) years. One fifth of the sample of elderly residents of the Gualaceo town had malnutrition and is associated with depression, sedentary lifestyle, low socioeconomic status and anemia, ratifying malnutrition as a public health problem.

Are women with breast cancer more likely to follow dietary recommendations and have sufficient vitamin A intake compared to healthy c ontrols? / ¿Es posible que las mujeres con cáncer de mama sigan las recomendaciones dietéticas y tengan una ingesta suficiente de vitamina A en comparación con las mujeres controles?

To evaluate differences in dietary habits among women with breast cancer versus healthy controls. We conducted a case-control study with 160 women with and without cancer, pairing 1:1. Socio-demographic variables and food consumption were investigated through three food recalls, which was corrected for energy variation using the residual method. Data analysis was performed using Kolmogorov- Smirnov, Student's t, Mann-Whitney/Wilcoxon Two-Sample tests and calculating odds ratios with level of significance of p<0.05. The majority (87.5%) of women with breast cancer did not follow dietary recommendations. Women with breast cancer (cases) had higher odds of not following dietary recommendations compared to controls (OR= 3.37, 95%CI= 1.50-7.58, p= 0.004). Regarding consumption of micro and macronutrients, breast cancer patients had increased odds of insufficient vitamin A intake compared to controls (OR= 2.46, 95%CI= 1.19-5.05, p<0.01). The results suggest the women with breast cancer are more likely to not follow dietary recommendation and have insufficient consumption of vitamin A compared to women without breast cancer.

Evaluar diferencias en los hábitos alimentarios de mujeres con cáncer de mama y mujeres normales. Estudio de casos y controles con 160 mujeres con y sin cáncer y emparejamiento de l:l. Se investigaron las variablessociodemográ-ficas y el consumo de alimentos mediante tres encuestas alimentarias, sometidas a la corrección de la variación de energía por el método residual. El análisis fueran realizados por Kolmogorov-Smirnov, t-Student, Mann-Whitney/Wilcoxon y Odds Ratio con nivel de significación: p<0,05. La mayoría de las mujeres con cáncer de mama (87,5%) no siguió las recomendaciones dietéticas. Las mujeres con cáncer de mama tuvieron un mayor riesgo de no seguir las recomendaciones dietéticas en comparación con los controles 3.37 (IC 95%= 1.50-7.58, p= 0.004). Con respecto al consumo de micro y macronutrientes, las mujeres concáncer de mama tuvieron un mayor riesgo de ingesta insuficiente de vitamina A en comparación con los controles (OR= 2.46, IC 95%= 1.19-5.05, p<0.0l). Los resultados sugieren que las mujeres con cáncer de mama tienen más riesgo de no seguir las recomendaciones dietéticas con un consumo insuficiente de vitamina A en comparación con las mujeres sin cáncer de mama.

Sobrevida global de pacientes con leucemia aguda en el Hospital de Especialidades Pediátricas de Chiapas, México / Childhood acute leukemia overall survival at the Hospital de Especialidades Pediátricas in Chiapas, México

Resumen: Introducción: A 10 años de la fundación del Hospital de Especialidades Pediátricas en Chiapas, México, es importante valorar la sobrevida global a 5 años de los pacientes con leucemia aguda bajo el régimen del Seguro Popular. Métodos: Estudio descriptivo y de sobrevida de 210 casos de leucemia aguda diagnosticados y tratados entre 2008 y 2012. Empleando curvas de Kaplan-Meier se analizó cada variedad de la enfermedad (B, T y mieloide), y para la leucemia B en función del grupo de riesgo, el sexo, la edad, los leucocitos al diagnóstico, los marcadores de superficie, el índice de DNA, el cariotipo y las translocaciones. Resultados: La edad, el sexo y la proporción de tipos de leucemia aguda (B = 85%; M = 10%; T = 5%) fueron similares al resto del país. El 20% de los pacientes estaban vivos a 5 años; el 53% habían fallecido y el 27% abandonaron el tratamiento. La sobrevida global a 5 años fue del 42% (B = 45%; T = 20%; M = 10%) (mediana: 38.8 meses; intervalo de confianza del 95%: 28.9-48.7). La mediana de «muy alto riesgo¼ fue de 7.7 contra 47 meses; no hubo diferencia entre riesgo habitual y alto riesgo. Los leucocitos < 50,000/µl al diagnóstico y CD10 positivo se asociaron con mejor sobrevida. En el momento del deceso, el 29% se encontraba en remisión. Conclusiones: La sobrevida de la leucemia aguda bajo el Seguro Popular fue desfavorable los primeros 5 años del Hospital de Especialidades Pediátricas. Se identificaron como contribuyentes la alta tasa de mortalidad temprana, de pacientes en remisión y el abandono. Además de revisar la atención médica, se requiere el estudio de elementos extrahospitalarios determinantes del abandono para mejorar el programa.

Abstract: Background: At the 10th anniversary of the Hospital de Especialidades Pediátricas in Chiapas, Mexico, it was important to assess the 5-year acute leukemia overall survival under the Seguro Popular program (Popular Insurance). Methods: A descriptive and survival study of 210 acute leukemia patients diagnosed and treated during 2008-2012 was performed. Kaplan-Meier survival curves were developed for all patients, each leukemia type (B, T and myeloid) and for B type related to risk group, age, sex, leukocytes, cell markers, DNA index, karyotype, and translocations. Results: Age, gender and proportion of leukemia types (B = 85%; M = 10%; T = 5%), were similar to other parts of the country. At the end of the 5-year treatment, 20% of the patients were alive, 53% had died and 27% had abandoned the treatment. Global survival was 42% (B = 45%; T = 20%; M = 10%) (median: 38.8 months; confidence interval of 95% = 28.9-48.7). Very high-risk median survival was 7.7 versus 47 months. There was no difference between standard and high-risk groups. The initial leukocyte count < 50,000/µL and CD10 positive were related to better B survival; no other variables were related. At the time of death, 29% of patients were in remission. Conclusions: Global survival of acute leukemia at Hospital de Especialidades Pediátricas under the Seguro Popular during its first 5 years was surprisingly poor given the medical resources available through the insurance. Early mortality, death during remission and high desertion rates contributed to these results. A detailed revision of treatment protocols and reasons for abandoning treatment is mandatory.

Treatment of cutaneous leishmaniasis with thermotherapy in Brazil: an efficacy and safety study

Abstract: BACKGROUND: Pentavalent antimonials remain as the standard drugs in the treatment of cutaneous leishmaniosis. The high cost, difficult administration, long treatment time, toxicity and increasing morbidity are factors that limit the use of these drugs. OBJECTIVES: To describe the response to radiofrequency thermotherapy in the treatment of localized cutaneous leishmaniasis in Brazil, and to evaluate its safety and tolerability. METHODS: We conducted a non-comparative open trial with a total of 15 patients confirmed to have cutaneous leishmaniasis on parasitological examination. A single radiofrequency thermotherapy session at 50ºC for 30 seconds was applied to the lesion and its edges. In patients with more than one lesion, only the largest one was treated initially. If after 30 days there was no evidence of healing, the smaller lesion was also treated with thermotherapy. Clinical cure was defined as visible healing for three months after treatment. The patients were followed-up for six months and there was no follow-up loss. RESULTS: Of all 23 lesions, only two evolved to complete healing without the need of treatment. Of 21 lesions, 18 (85.7%) achieved full healing. The main observed side effects were itching, burning sensation, pain and blisters. STUDY LIMITATIONS: Sample with a small number of patients and short follow-up. CONCLUSION: Thermotherapy can be considered a therapeutic alternative in localized cutaneous leishmaniasis, especially in cases of single cutaneous lesions and with formal contraindications to conventional treatment with pentavalent antimonials.

Home care in the Federal District: factors associated with the first occurrence of acute lower respiratory infection and death

Abstract INTRODUCTION: We aimed to evaluate the frequency and associated factors of acute respiratory infection and death among home care patients in Sobradinho/DF, Brazil. METHODS: Data were obtained from patients' medical records. Bivariate and multivariate analyses were performed. Odds ratio and 95% confidence interval were estimated. RESULTS: Factors associated with respiratory infection were ages <40 and >80 years and accommodation. Female sex was a protective factor. Age >30 years and dependency for daily activities were associated with death. CONCLUSIONS: These factors can improve clinical results in this specific home care and open new opportunities and questions for future research.

Factors associated with failed weaning from mechanical ventilation in adults on ventilatory support during 48 hours or more / Factores asociados a destete fallido de la ventilación mecánica en adultos con soporte ventilatorio igual y mayor a 48 horas

Abstract Introduction: Failed weaning from mechanical ventilation (MV) has been reported in a proportion ranging from 10% to 20% of patients requiring ventilation support; this population has a longer duration of MV and risk of mortality. Objective: To evaluate factors associated with failed weaning from MV. Methodology: Descriptive study of a cohort of 139 patients, who participated in the clinical trial. Efficacy of respiratory muscle training (RMT) for weaning from MV in patients on MV during 48 hours or more. Clinical and sociodemographic exposure variables were measured. The outcome variable evaluated was failed weaning from MV. A descriptive analysis was carried out, and relative risks (RRs) were estimated using the Poisson regression. Single and multiple models were built. Results: The incidence of failed weaning was 24.09%, 95% confidence interval (CI) 16.83 to 31.33. Independent associated factors were the respiratory system as the main compromised system upon admission to the intensive care unit (RR: 3.89; 95% CI 1.33-11.37; P = 0.01) and the Apache score (RR 0.96; 95% CI 0.920.98; P = 0.02). Modifiable factors such as pulmonary rehabilitation interventions, physical rehabilitation, RMT, and specific ventilatory strategies showed no association (P >0.05). Conclusion: There are non-modifiable factors related to failed weaning from MV in adults. Patients admitted to the intensive care unit with the respiratory system as the main system compromised have a higher risk of failed weaning; modifiable factors were not found to be associated with failed weaning in the population studied.

Resumen Introducción: El destete fallido de la ventilación mecánica se ha reportado en una proporción que va del 10 al 20% de los pacientes que requieren soporte ventilatorio; esta población presenta mayor duración de la ventilación mecánica y riesgo de mortalidad. Objetivo: Evaluar factores asociados a destete fallido de la ventilación mecánica en pacientes adultos con soporte ventila-torio igual y mayor a 48 horas Metodología: Estudio observacional de una cohorte de 139 pacientes, quienes participaron en el ensayo clínico. Eficacia del entrenamiento muscular respiratorio en el destete de la ventilación mecánica en pacientes con ventilación mecánica por 48 horas o más; variables de exposición clínicas y sociodemográficas fueron medidas. La variable resultado evaluada fue destete fallido de la ventilación mecánica. Se realizó análisis descriptivo, y se estimaron riesgos relativos a través de la regresión Poisson. Se construyeron modelos simples y un modelo múltiple. Resultados: La incidencia de destete fallido fue 24.09% [C95%:16.83-31.33.Los factores independientemente asociados fueron sistema respiratorio como principal comprometido al ingreso a UCI (RR:3.89 IC95%:1.33-11.37 p = 0.01) y apache (RR:0.96 IC95%:0.92-0.98 p = 0.02).Factores modificables como intervenciones de rehabilitación pulmonar, rehabilitación física, entrenamiento muscular respiratorio, y estrategias ventilatorias especificas no mostraron asociación (p>0.05). Conclusiones: Factores no modificables están relacionados con el destete fallido de la ventilación mecánica en la población estudiada. El sistema respiratorio como principal comprometido al ingreso a la unidad de cuidado intensivo fue el factor de riesgo asociado a falla en el destete de la ventilación mecánica, los factores no modificables no se encontraron asociados con el evento estudiado.

Stroke risk among patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis

Increased stroke risk among chronic obstructive pulmonary disease patients has not yet been established. In this study, we conducted a systematic review and meta-analysis to assess stroke risk among chronic obstructive pulmonary disease patients. PubMed, EMBASE, and the Cochrane Library were systematically searched from database inception until December 31, 2016 to identify longitudinal observational studies that investigated the association between chronic obstructive pulmonary disease and stroke. Stroke risk was quantified by overall and subgroup analyses, and a pooled hazard ratio was calculated. Study quality was evaluated using the Newcastle-Ottawa Scale. Publication bias was assessed using Begg's rank correlation test. Eight studies met the inclusion criteria. In a random-effects model, significantly increased stroke risk was observed among chronic obstructive pulmonary disease patients (hazard ratio, 1.30; 95% confidence interval, 1.18-1.43). In subgroup analyses stratified by stroke subtype, study quality, and adjustment by socioeconomic status, the association between increased stroke risk and chronic obstructive pulmonary disease patients was robust. Statistically significant publication bias was not detected. In summary, chronic obstructive pulmonary disease was found to be associated with increased stroke risk. Additional prospective studies are required to elucidate the mechanisms underlying the increase in stroke risk and identify effective preventive interventions.

Actitudes y prácticas sobre lactancia materna en puérperas de un hospital público de Lima, Perú / Attitudes and practices about breastfeeding in postpartum women in a public hospital in Lima, Peru

ANTECEDENTES: La lactancia materna es el alimento perfecto, pero las madres deben tener adecuadas prácticas para hacerlo de manera correcta. OBJETIVO: Determinar las actitudes y prácticas sobre lactancia en puérperas y sus factores socio-perinatales asociados. MÉTODOS: Estudio transversal analítico desarrollado entre octubre y diciembre del 2012. Se utilizó un cuestionario previamente validado de respuesta nominal, auto-aplicada con preguntas de opción múltiple sobre actitudes y prácticas de la lactancia materna. Se obtuvo una muestra no probabilística de las mujeres en la unidad obstétrica del Hospital Nacional María Auxiliadora. Se usó la regresión lineal para el análisis bi y multivariado, obteniendo los coeficientes crudos y ajustados con sus intervalos de confianza al 95%. Resultados: Participaron 256 puérperas, la mediana de edades fue de 24,5 años (rango 18-46 años), el 25% tuvieron 7 buenas respuestas de las 20 planteadas. Se encontró una correlación positiva entre mayor número de respuestas correctas y las variables de edad (p=0,002, Coeficiente: 0,1), número de controles prenatales (p=0,031, Coeficiente: 0,1) y una correlación negativa con la información recibida por otra persona que no es profesional de la salud (p=0,033, Coeficiente:-1,2). CONCLUSIONES: Existe una asociación entre las actitudes y prácticas sobre lactancia materna según algunos factores socio-perinatales, siendo esto importante para la planificación de programas de capacitación. Estos resultados coinciden con otras investigaciones que demuestran que hay un incremento de conocimiento a mayor experiencia de la gestante.

BACKGROUND: Breastfeeding is the perfect food, but mothers should have appropriate practices to do it right. AIMS: Determine the attitudes and practices on breastfeeding in postpartum women and their socio-perinatal factors associated. METHODS: Cross-sectional study conducted between October and December 2012. We used a previously validated questionnaire self applied nominal response with multiple choice questions on attitudes and practices of breastfeeding. We obtained a non-probability sample of women in the birthing of Hospital Nacional María Auxiliadora. Linear regression was used for bi and multivariate analysis, obtaining the crude and adjusted coefficients with confidence intervals at 95%. RESULTS: Participants 256 postpartum women, median age was 24.5 years (range 18-46 years), 25% had 7 good answers of the 20 raised. We found a positive correlation between higher number of correct responses and the variables of age (p = 0.002, coefficient: 0.1), number of prenatal visits (p = 0.031, coefficient: 0.1) and a negative correlation with the information received by another person who is not healthcare (p = 0.033, coefficient: -1.2). CONCLUSION: There is an association between attitudes and practices on breastfeeding by socio-perinatal factors, this being important for planning training programs. These results are consistent with other research showing that there is a greater increase in knowledge of pregnant women experience.

Meat intake among adults: a population-based study in the city of Campinas, Brazil. A cross-sectional study / Ingestão de carnes em adultos: estudo de base populacional na cidade de Campinas, Brasil. Um estudo transversal

ABSTRACT CONTEXT AND OBJECTIVE: Meat is a food with high nutritional density that has significant participation in the Brazilian diet. However, in excess it can cause harm to health. The aim of this study was to analyze the meat intake (g/day) among adults according to sociodemographic, behavioral and health situation characteristics, and to assess the types of meat most consumed. DESIGN AND SETTING: Cross-sectional population-based study conducted in the city of Campinas, São Paulo, Brazil, in 2008 and 2009. METHODS: Two-stage cluster sampling was used. The analysis included 948 adults between 20 and 59 years, who were participants in the Campinas Health Survey. Meat intake was assessed using 24-hour dietary recall. RESULTS: The mean meat intake adjusted for sex and age was 182.3 g (95% CI: 170.6-193.9 g), with significantly lower intake among women, individuals aged 50 years or over, those with the presence of two or more self-reported chronic diseases and those with three or more health complaints. Higher meat intake was found in segments with intermediate monthly family income (between 1 and 3 minimum wages), those with 16 or more appliances per household and those who consumed soft drinks seven days a week. Beef was consumed most frequently (44%) among the meats in the diet, followed by poultry, fish and pork. CONCLUSION: The data from this study reveal high meat intake in the population of Campinas and identify the segments that need to be prioritized for strategies directed towards appropriate meat intake.

RESUMO CONTEXTO E OBJETIVO: As carnes são alimentos com elevada densidade nutricional, apresentam expressiva participação na dieta dos brasileiros, porém em excesso provocam prejuízos à saúde. O objetivo deste estudo foi analisar a ingestão de carnes (g/dia) entre adultos segundo características sociodemográficas, comportamentais e de situação de saúde, além de avaliar os tipos de carnes mais consumidos. DESENHO E LOCAL: Estudo transversal de base populacional, realizado em Campinas, SP, Brasil, em 2008 e 2009. MÉTODOS: A amostra foi obtida por conglomerados e em dois estágios. Foram analisados 948 adultos (20-59 anos), participantes do Inquérito de Saúde de Campinas. O recordatório alimentar de 24 horas foi utilizado para estimar a ingestão de carnes. RESULTADOS: A ingestão média de carnes ajustada por sexo e idade foi de 182,3 g (IC 95%: 170,6-193,9 g), sendo significativamente menor nas mulheres, nos indivíduos com 50 anos ou mais, nos que relataram duas ou mais doenças crônicas e nos que apresentavam três ou mais queixas de saúde. Maior ingestão de carnes foi encontrada nos segmentos com renda familiar mensal intermediária entre 1 e 3 salários mínimos, com 16 ou mais equipamentos no domicílio, assim como aqueles que ingeriam refrigerantes nos 7 dias da semana. A carne bovina foi a mais frequente (44%) entre as carnes presentes na dieta, seguida de aves, processadas, peixes e suínas. CONCLUSÃO: Os dados desta pesquisa revelam elevada ingestão de carnes na população de Campinas e identificam os segmentos que devem ser priorizados para estratégias direcionadas a adequar a ingestão desse alimento.

Sociodemographic profile of medicines users in Brazil: results from the 2014 PNAUM survey / Perfil sociodemográfico dos usuários de medicamentos no Brasil: resultados da PNAUM 2014

ABSTRACT OBJECTIVE To analyze the prevalence of medicine use by the Brazilian population and its distribution according to sociodemographic factors. METHODS Study using data from the Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), a nationwide household survey of a representative sample of the Brazilian urban population. The data were collected between September 2013 and February 2014. The overall use of medicines, defined as the use of any medicine, use of medicines for treating chronic medical conditions and for acute health conditions, was evaluated. The independent variables included gender, age group, socioeconomic position, and region of Brazil. Analyzes included prevalence calculations, 95% confidence intervals (95%CI) and Pearson Chi-square tests to evaluate the differences between groups, considering a 5% level of significance. RESULTS The prevalence of medicines use was 50.7% (95%CI 49.3–52.2), with 39.3% (95%CI 37.5–41.1) accounting for men and 61.0% (95%CI 59.3–62.6) for women. Medicines use was observed to increase with increasing age, except among children within the zero to four years age group. The lowest prevalence for medicines use was found among those with a low socioeconomic position and those who reside in the North region of Brazil. The prevalence of medicine use to treat chronic diseases was 24.3% (95%CI 23.3–25.4), whereas it was 33.7% (95%CI 32.1–35.4) for treating acute diseases. CONCLUSIONS We found extensive variability in the prevalence of medicines use across regions of Brazil. The poorest regions (North, Northeast, and Midwest) have a lower prevalence of medicines use to treat chronic diseases, indicating the need to minimize inequalities in access to medicines within the country.

RESUMO OBJETIVO Analisar a prevalência do uso de medicamentos pela população brasileira e sua distribuição segundo aspectos sociodemográficos. MÉTODOS Estudo com dados da Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM), pesquisa nacional de base populacional, realizada entre setembro de 2013 e fevereiro de 2014 em residências de municípios urbanos. Avaliou-se o uso de todos os medicamentos (global), uso de medicamentos para doenças crônicas e uso de medicamentos para doenças agudas. As variáveis independentes utilizadas foram sexo, idade, classificação econômica e região do País. Foram calculados prevalências e intervalos de confiança de 95% (IC95%) e aplicado teste Qui-quadrado de Pearson para avaliação das diferenças entre os grupos, considerando o nível de significância de 5%. RESULTADOS A prevalência global de uso de medicamentos foi de 50,7% (IC95% 49,3–52,2), sendo 39,3% (IC95% 37,5–41,1) no sexo masculino e 61,0% (IC95% 59,3–62,6) no sexo feminino. Observou-se aumento nas prevalências de uso com a idade (exceto de zero a quatro anos). As menores prevalências de uso ocorreram no grupo mais pobre e na região Norte do País. A prevalência de uso de medicamentos para doenças crônicas foi de 24,3% (IC95% 23,3–25,4) e para doenças agudas foi de 33,7% (IC95% 32,1–35,4). CONCLUSÕES Existe grande variabilidade nas prevalências globais de uso de medicamentos por regiões brasileiras. As regiões consideradas mais pobres (Norte, Nordeste e Centro-Oeste) apresentam menores prevalências de uso de medicamentos para doenças crônicas, o que indica a necessidade de minimizar as desigualdades no acesso aos medicamentos dentro do País.

Association between socioeconomic and biological factors and infant weight gain: Brazilian Demographic and Health Survey - PNDS-2006/07 / Associação entre fatores socioeconômicos e biológicos e o ganho de peso de lactentes: Pesquisa Nacional de Demografia e Saúde (PNDS) de 2006/07

OBJECTIVE: To examine the associations between socioeconomic and biological factors and infant weight gain. METHODS: All infants (0-23 months of age) with available birth and postnatal weight data (n = 1763) were selected from the last nationally representative survey with complex probability sampling conducted in Brazil (2006/07). The outcome variable was conditional weight gain (CWG), which represents how much an individual has deviated from his/her expected weight gain, given the birth weight. Associations were estimated using simple and hierarchical multiple linear regression, considering the survey sampling design, and presented in standard deviations of CWG with their respective 95% of confidence intervals. Hierarchical models were designed considering the UNICEF Conceptual Framework for Malnutrition (basic, underlying and immediate causes). RESULTS: The poorest Brazilian regions (-0.14 [-0.25; -0.04]) and rural areas (-0.14 [-0.26;-0.02]) were inversely associated with CWG in the basic causes model. However, this association disappeared after adjusting for maternal and household characteristics. In the final hierarchical model, lower economic status (-0.09 [-0.15; -0.03]), human capital outcomes (maternal education < 4th grade (-0.14[-0.29; 0.01]), higher maternal height (0.02[0.01; 0.03])), and fever in the past 2 weeks (-0.13[-0.26; -0.01]) were associated with postnatal weight gain. CONCLUSION: The results showed that poverty and lower human capital are still key factors associated with poor postnatal weight gain. The approach used in these analyses was sensitive to characterize inequalities among different socioeconomic contexts and to identify factors associated with CWG in different levels of determination. .

OBJETIVO: Examinar as associações entre fatores socioeconômicos e biológicos e o ganho de peso de lactentes. MÉTODOS: Foram selecionados todos os lactentes (0-23 meses de idade) com dados de peso ao nascer e pós-natal avaliados na última pesquisa com representatividade nacional realizada no Brasil (2006/07) por amostragem probabilística complexa. A variável de resultado foi o Evolução Ponderal Condicional (CWG), que representa quanto um indivíduo desviou de seu ganho de peso esperado, considerando o peso ao nascer. As associações foram estimadas utilizando regressão linear simples e múltipla hierárquica, considerando o plano amostal da pesquisa e apresentadas em desvios padrão do CWG com seus respectivos intervalos de confiança de 95%. Os modelos hierárquicos foram estruturados considerando o Modelo Conceitual de Desnutrição da UNICEF (causas básicas, inerentes e imediatas). RESULTADOS: As regiões brasileiras mais pobres (-0,14 [-0,25; -0,04]) e a área rural (-0,14 [-0,26; -0,02]) foram inversamente associadas ao CWG no modelo de causas básicas. Contudo, essa associação desapareceu após o ajuste pelas características maternas e do ambiente familiar. No modelo hierárquico final, a baixa condição econômica (-0,09 [-0,15; -0,03]), as variáveis de capital humano (escolaridade materna < 5° ano (-0,14 [-0,29; 0,01])), maior estatura materna (0,02 [0,01; 0,03])) e febre nas duas semanas anteriores à pesquisa (-0,13 [-0,26; -0,01]) foram inversamente associadas ao ganho de peso pós-natal. CONCLUSÃO: Os resultados mostraram que a pobreza e baixo capital humano ainda são fatores fundamentais associados ao ganho de peso pós-natal abaixo de esperado. A abordagem utilizada em nossas análises foi sensível ao caracterizar desigualdades entre diferentes contextos socioeconômicos e ao identificar fatores associados ao CWG em diferentes níveis de determinação. .

Expenditures in the health care system in Brazil: the participation of states and the Federal District in financing the health care system from 2002 to 2013

OBJECTIVE: To analyze the public expenditures of states on health care and the participation of states and the Federal District in financing the Unified Health System, better known by the acronym SUS. To develop the research, two targets were used: “to rescue expenses per government source (federal, state and municipal) during the period from 2002 to 2013” and “to rescue resource transfers from the federal SUS to the states and also to municipalities”. METHODS: This research is bibliographic, documentary and descriptive and used a quantitative approach. Data were extracted from the Information System Public Health Budget, and additional data were collected from the public managers of states, municipalities and the Federal District during the period from 2002 to 2013. Federal data from the Undersecretary of Planning and Budget (originally extracted from the Integrated System of Financial Administration of the Federal Government and available on the Budget Public Health System webpage) were also collected. RESULTS: The data revealed that during the same researched period, the Federal District has maintained the health care system budget, whereas states and municipalities have increased their budgets for the same spending. CONCLUSIONS: By analyzing the results, there is clearly a disparity regarding the investment expended by the entities of the Federation. Although municipalities and states have gradually increased their application of resources to health care, the federal state has maintained the same budget. These results reveal a bit of concern about public health funding. .

Sensitivity and specificity of different measures of adiposity to distinguish between low/high motor coordination / Sensibilidade e especificidade de diferentes medidas de adiposidade para diferenciação entre pouca/ampla coordenação motora / Sensibilidade e especificidade de diferentes medidas de adiposidade para diferenciação entre pouca/ampla coordenação motora

OBJECTIVE: This study aimed to determine the ability of different measures of adiposity to discriminate between low/high motor coordination and to evaluate the relationship between different measures of adiposity and motor coordination. METHODS: This study included 596 elementary school children aged 9 to 12 years (218 females - 47.1%). Weight, height, and waist circumference were objectively measured by standardized protocols. Body fat percentage was estimated by bioelectric impedance. Body mass index and waist-to-height ratio were computed. Motor coordination was assessed by the Körperkoordination Test für Kinder. Cardiorespiratory fitness was predicted by a maximal multistage 20 m shuttle-run test of the Fitnessgram Test Battery. A questionnaire was used to assess the maternal educational level. RESULTS: The receiver operating characteristic performance of body fat percentage in females and waist circumference in males presented a slightly better discriminatory accuracy than body mass index, waist circumference and waist-to-height ratio in predicting low motor coordination. After adjustments, logistic regression analyses showed that body mass index (ß = 2.155; 95% CI: 1.164-3.992; p = 0.015 for girls; ß = 3.255; 95% CI: 1.740-6.088; p < 0.001 for males), waist circumference (ß = 2.489; 95% CI: 1.242-4.988; p = 0.010 for girls; ß = 3.296; 95% CI: 1.784-6.090; p < 0.001 for males), body fat percentage (ß = 2.395; 95% CI: 1.234-4.646; p = 0.010 for girls; ß = 2.603; 95% CI: 1.462-4.634; p < 0.001 for males) and waist-to-height ratio (ß = 3.840; 95% CI: 2.025-7.283; p < 0.001 for males) were positively and significantly associated with motor coordination in both sexes, with the exception of waist-to-height ratio in girls (ß = 1.343; 95% CI: 0.713-2.528; p = 0.381). CONCLUSION: Body fat percentage and waist circumference showed a slightly better discriminatory accuracy in predicting low motor coordination for females and for ...

OBJETIVO: Este estudo pretende: (i) determinar a capacidade de diferentes medidas de adiposidade para diferenciar pouca/ampla CM; e (ii) avaliar a relação entre diferentes medidas de adiposidade e coordenação motora. MÉTODO: 596 crianças em idade escolar fundamental, de 9 a 12 anos (218 meninas - 47,1%) participaram deste estudo. O peso, a altura e a circunferência da cintura foram mensurados objetivamente pelos protocolos padronizados. O percentual de gordura corporal foi estimado pela impedância bioelétrica. Foram calculados o índice de massa corporal e a razão cintura/estatura. A coordenação motora foi avaliada por meio do teste de coordenação corporal para crianças. A capacidade cardiorrespiratória foi predita por um teste shuttle-run multinível de no máximo 20 m da Bateria de Testes Fitnessgram. Foi usado um questionário para avaliar o nível de escolaridade das mães. RESULTADOS: O desempenho na curva de característica de operação do receptor do percentual de gordura corporal, em meninas, e da circunferência da cintura, em meninos, demonstrou uma precisão discriminatória levemente melhor que o índice de massa corporal, a circunferência da cintura e a razão cintura/estatura em predizer pouca coordenação motora. Após ajustes, as análises de regressão logística demonstraram que o índice de massa corporal (ß = 2,155; Intervalo de Confiança (IC) 95%: 1,164-3,992; p = 0,015 para meninas; ß = 3,255; IC 95%: 1,740-6,088; p < 0,001 para meninos), a circunferência da cintura (ß = 2,489; IC 95%: 1,242-4,988; p = 0,010 para meninas; ß = 3,296; IC 95%: 1,784-6,090; p < 0,001 para meninos), o percentual de gordura corporal (ß = 2,395; IC 95%: 1,234-4,646; p = 0,010 para meninas; ß = 2,603; IC 95%: 1,462-4,634; p < 0,001 para meninos) e a razão cintura/estatura (ß = 3,840; IC 95%: 2,025-7,283; p < 0,001 para meninos) estavam positiva e significativamente relacionados à coordenação motora em ambos os sexos, com exceção da razão cintura/estatura ...