Transtorno mental comum e condição socioeconômica em adolescentes do Erica

INTRODUCTION: Adolescence is a stage of great social, family and emotional demands, and the literature has related common mental disorder (CMD) with poor living conditions. OBJECTIVE: To investigate the relationship between CMD and socioeconomic status in Brazilian adolescents aged 12 to 17 years. METHOD: This is a cross-sectional study with data from the Study of Cardiovascular Risk in Adolescents (ERICA – Estudo de Riscos Cardiovasculares em Adolescentes). The outcome was CMD and the exposure was socioeconomic status assessed by race/skin color, maternal schooling, resident/room relationship, type of school, existence of maid and bathroom at home, and work activity. For the calculation of prevalence, the survey mode was used and, in the multivariate analysis, logistic regression with p < 5%, as well as the 95% confidence interval. RESULTS: The prevalence of CMD in girls was 23.3%, and in boys, 11.1%. The variables associated with CMD in girls were age between 15 and 17 years (OR = 1.34; 1.17–1.51), studying in private school (OR = 1.13; 1.01–1.27), having a housemaid (OR = 1.15; 1.00–1.34) and, as a protective factor, unpaid work (OR = 0.64; 0.55–0.75). Boys also had a higher chance of CMD in the highest age group (OR = 1.42; 1.18–1.71) and when they had a housemaid (OR = 1.26; 1.02–1.57), whereas unpaid work decreased this chance (OR = 0.79; 0.67–0.95). CONCLUSION: Socioeconomic variables that were associated with CMD were suggestive of higher economic class, whereas unpaid work favored the mental health of adolescents, results contrary to the literature on socioeconomic status and CMD.INTRODUÇÃO: A adolescência é uma fase de grande demanda social, familiar e emocional, e a literatura tem relacionado o transtorno mental comum (TMC) com piores condições de vida. OBJETIVO: Investigar a relação entre TMC e a condição socioeconômica em adolescentes brasileiros de 12 a 17 anos. MÉTODO: Estudo seccional com os dados do Estudo de Riscos Cardiovasculares em Adolescentes (Erica). O desfecho foi o TMC e a exposição foi a condição socioeconômica avaliada por raça/cor, escolaridade materna, relação morador/cômodo, tipo de escola, existência de empregada e banheiro no domicílio e atividade laboral. Para o cálculo das prevalências, foi utilizado o modo survey e, na análise multivariada, a regressão logística com p < 5%, assim como o intervalo de confiança de 95%. RESULTADOS: A prevalência de TMC em meninas foi 23,3% e em meninos, 11,1%. As variáveis associadas ao TMC nas meninas foram ter idade entre 15 e 17 anos (OR = 1,34; 1,17–1,51), estudar em escola privada (OR = 1,13; 1,01–1,27), ter empregada doméstica (OR = 1,15; 1,00–1,34) e, como fator de proteção, o trabalho não remunerado (OR = 0,64; 0,55–0,75). Os meninos também apresentaram maior chance de TMC na faixa etária mais alta (OR = 1,42; 1,18–1,71) e quando tinham empregada (OR = 1,26; 1,02–1,57), enquanto o trabalho não remunerado diminuiu essa chance (OR = 0,79; 0,67–0,95). CONCLUSÃO: As variáveis socioeconômicas que estiveram associadas ao TMC foram sugestivas de classe econômica mais elevada, enquanto o trabalho não remunerado favoreceu a saúde mental dos adolescentes, resultados contrários à literatura sobre condição socioeconômica e TMC

Waist-to-height ratio as an anthropometric marker of health risk: a population-based study on brazilian adults and elderly persons.

Overweight has been considered one of the major aggravating factors in health and significantly contributes to the increase in morbidity-mortality. The issue must be monitored through nutritional surveillance actions aiming to adequate public policies on the prevention, promotion, and recovery of health. Thus, several nutritional assessment methods have been recommended, especially anthropometry given its convenience, low cost, and precise diagnosis, with widespread use of body mass index, waist circumference, and waist-to-hip ratio. More recently, the ratio between waist circumference and height has been proposed as an anthropometric measure to assess core adiposity since it is strongly associated with cardiometabolic risk factors and related to mortality regardless of body weight. This anthropometric marker circumvents the limitations of waist circumference by including height in the index, which prevents potential confounding of height in cardiometabolic risk. This measure has also been suggested as a health risk marker instead of the combination matrix between body mass index and waist circumference for its greater ability of early identification of persons at risk. With that in mind, the present thesis aimed to carry out a systematic review on the validity of the waist-to-height ratio as an anthropometric measure to diagnose adiposity in the elderly population and its association with non-communicable diseases and disorders. The review also sought to identify the cut-off point of this marker with greater sensitivity, specificity, and accuracy for this population by using the body mass index as an anthropometric reference and, finally, to assess whether the waist-toheight ratio is as able to identify health risks as the association matrix between the body mass index and waist circumference in both adults and elderly persons. Data on a household-based epidemiologic survey with a representative sample of the Brazilian population between 2008 and 2009 were used. The sample comprised 8,235 adults and 5,494 elderly persons with the anthropometric measures required for the analyses proposed who lived in the urban areas of 100 small, medium-sized, and large municipalities of the 23 states of Brazil. The first original paper used the ROC (Receiver Operating Characteristic) curve to determine the ideal cut-off point of the waist-to-height ratio as a marker for overweight, using the body mass index as an anthropometric reference. The second original paper featured analyses of the prevalence ratio so as to verify the association between systemic arterial hypertension and the health risk categories assessed by the waist-to-height ratio and by the association between the body mass index and waist circumference. The results presented show that the waist-to-height ratio is a simple measure that has good predicting power as an anthropometric marker of overweight. In addition, the waist-to-height ratio identified more persons at early health risk compared to the combination matrix between the body mass index and waist circumference and showed comparable ability to identify health risk irrespective of sex or age group regarding prevalence ratios for arterial hypertension. That shows the waist-to-height ratio is a useful and effective measure both for professionals and for healthcare managers. Thus, we recommend and incentive the use of the waist-to-height ratio as a measure to replace the body mass index and its association with waist circumference both in epidemiological research and in individual and collective clinical practice as an anthropometric marker of health risk.Sem bolsaO excesso de peso tem sido considerado um dos maiores agravantes à saúde dos indivíduos, contribuindo expressivamente para o aumento da morbimortalidade, devendo ser monitorados por meio de ações de vigilância nutricional, com vistas à adequação de politicas públicas relacionadas a prevenção, promoção, e recuperação da saúde. Assim sendo, vários métodos para a avaliação nutricional tem seu uso preconizado, com destaque para a antropometria pela praticidade, baixo custo e precisão diagnóstica, onde o índice de massa corporal, a circunferência da cintura e a razão cintura-quadril têm seu uso largamente difundido. Mais recentemente, a razão entre a circunferência da cintura e a estatura tem sido proposta como medida antropométrica para avaliar adiposidade central, por estar fortemente associada aos fatores de risco cardiometabólicos e por sua relação com a mortalidade, independente do peso corporal. Este marcador antropométrico contorna as limitações da circunferência da cintura devido à inclusão da estatura no índice, evitando potencial confusão da estatura no risco cardiometabólico. Essa medida também tem sido sugerida como marcador de risco à saúde em substituição a matriz de combinação entre o índice de massa corporal e a circunferência da cintura, pela maior capacidade de identificar precocemente indivíduos em risco. Isto posto, a presente tese teve como objetivo realizar uma revisão sistemática sobre a validade da razão cintura-estatura como medida antropométrica para o diagnóstico de adiposidade na população idosa e associação com doenças e agravos não transmissíveis, além de identificar o ponto de corte desse marcador com melhor sensibilidade, especificidade e acurácia para essa população, utilizando o índice de massa corporal como referência antropométrica e, finalmente avaliar se a razão cintura-estatura tem a mesma habilidade na identificação de risco à saúde comparada a matriz de associação entre o índice de massa corporal e a circunferência da cintura, tanto para adultos como para idosos. Foram utilizados dados de um inquérito epidemiológico de base domiciliar, com amostra representativa da população brasileira, realizado nos anos de 2008 e 2009. A amostra foi composta por 8.235 adultos e 5.494 idosos com medidas antropométricas necessárias para as análises propostas, residentes em áreas urbanas de 100 municípios de pequeno, médio e grande porte, dos 23 estados brasileiros das cinco regiões do país. No primeiro artigo original, foi utilizado a curva ROC ((Receiver Operating Characteristic) para determinação do ponto de corte ideal da razão cintura-estatura como marcador de excesso de peso, utilizando o índice de massa corporal como referência antropométrica. Já para o segundo artigo original foram realizadas análises de razão de prevalência, a fim de verificar a associação entre hipertensão arterial sistêmica e as categorias de risco à saúde avaliadas por meio da razão cintura-estatura e pela medida de associação entre o índice de massa corporal e a circunferência da cintura. Os resultados apresentados revelam que a razão cintura-estatura é uma medida simples, com bom poder de predição como marcador antropométrico de excesso de peso. Somado a isto, a razão cintura-estatura identificou mais indivíduos em risco precoce à saúde comparada a matriz de combinação entre o índice de massa corporal e a circunferência da cintura e apresentou habilidades comparáveis na identificação de risco à saúde, independentemente do sexo e da faixa etária, no que tange às razões de prevalência para hipertensão arterial, mostrando ser uma medidaútil e efetiva tanto para os profissionais como para os gestores em saúde. Sendo assim, recomendamos e incentivamos o uso da razão cintura-estatura como medida substituta ao índice de massa corporal e a associação deste com a circunferência da cintura tanto em pesquisas epidemiológicas, como na prática clínica individual e coletiva, como marcador antropométrico de risco à saúde

Study of Cardiovascular Risks in Adolescents (ERICA): alcohol consumption and associated factors

ABSTRACT Objective: To analyze factors that influence alcohol consumption by Brazilian adolescents aged 12 to 17 years from the five macro-regions of Brazil, according to sociodemographic, schooling, and family characteristics. Methods: This is a cross-sectional study with data from the Study of Cardiovascular Risks in Adolescents (ERICA). The outcome was assessed by alcohol consumption and considered the variables sex, age, ethnicity/skin color, maternal schooling level, having housemaids, number of bathrooms at home, living or not with parents, and type of school. For the analyses, the survey mode was used for complex samples. Poisson regression was performed to assess the magnitude of factors associated with alcohol consumption among adolescents. Results: The prevalence of alcohol consumption by adolescents was 22.1%. The variables age range of 15 to 17 years, higher socioeconomic status, and living alone or with only one of the parents were factors that remained associated with alcohol consumption by adolescents regardless of their region of residence. Protective factors in alcohol consumption were associated with variables related to lower economic conditions and being of Asian or indigenous descent. Conclusion: The percentage of adolescents who consume alcohol is worrisome and must be tackled with public policies and health education. Understanding which factors are related to this situation contributes to practices and policies aimed to reduce its prevalence and damage to health

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN

Delayed colorectal cancer care during covid-19 pandemic (decor-19). Global perspective from an international survey

Background The widespread nature of coronavirus disease 2019 (COVID-19) has been unprecedented. We sought to analyze its global impact with a survey on colorectal cancer (CRC) care during the pandemic. Methods The impact of COVID-19 on preoperative assessment, elective surgery, and postoperative management of CRC patients was explored by a 35-item survey, which was distributed worldwide to members of surgical societies with an interest in CRC care. Respondents were divided into two comparator groups: 1) ‘delay’ group: CRC care affected by the pandemic; 2) ‘no delay’ group: unaltered CRC practice. Results A total of 1,051 respondents from 84 countries completed the survey. No substantial differences in demographics were found between the ‘delay’ (745, 70.9%) and ‘no delay’ (306, 29.1%) groups. Suspension of multidisciplinary team meetings, staff members quarantined or relocated to COVID-19 units, units fully dedicated to COVID-19 care, personal protective equipment not readily available were factors significantly associated to delays in endoscopy, radiology, surgery, histopathology and prolonged chemoradiation therapy-to-surgery intervals. In the ‘delay’ group, 48.9% of respondents reported a change in the initial surgical plan and 26.3% reported a shift from elective to urgent operations. Recovery of CRC care was associated with the status of the outbreak. Practicing in COVID-free units, no change in operative slots and staff members not relocated to COVID-19 units were statistically associated with unaltered CRC care in the ‘no delay’ group, while the geographical distribution was not. Conclusions Global changes in diagnostic and therapeutic CRC practices were evident. Changes were associated with differences in health-care delivery systems, hospital’s preparedness, resources availability, and local COVID-19 prevalence rather than geographical factors. Strategic planning is required to optimize CRC care