Anthropometric assessment and food intake of children younger than 5 years of age from a city in the semi-arid area of the Northeastern region of Brazil partially covered by the bolsa família program

OBJETIVO: Avaliar as condições de saúde e nutrição de crianças menores de cinco anos, e associar a qualidade do consumo alimentar aos beneficiários do Programa Bolsa Família de um município do semiárido brasileiro. MÉTODOS: Foram avaliadas 189 crianças, a partir de uma amostragem de 411 domicílios do município de João Câmara (RN). Foram realizadas medidas de peso e altura, e levantadas às condições socioeconômicas e determinação dos hábitos alimentares. Para o diagnóstico nutricional das crianças foram utilizados os indicadores Peso/Idade, Altura/Idade e Peso/Altura. Análises univariadas foram realizadas e modelos bivariados e multivariados de regressão logística foram construídos para testar a hipótese do estudo. RESULTADOS: O déficit de peso foi de 4,3% e o de altura de 9,9%, e o excesso de peso de 14,0%. Não foram encontradas diferenças estatísticas entre o estado nutricional de crianças beneficiárias e não beneficiárias do Programa Bolsa Família. Em ambos os grupos, os consumos de frutas, verduras e legumes foram baixos e semelhantes entre si. As crianças do programa bolsa família têm risco três vezes maior de consumir guloseimas (OR 3,06 - IC 1,35-6,95). CONCLUSÃO: Os resultados do padrão de consumo alimentar dessa população apontam para uma situação de "risco alimentar e nutricional", e exigem uma intervenção por parte dos profissionais de saúde para a promoção da alimentação saudável.OBJECTIVE: The objective of this study was to assess the health and nutritional status of children under five years of age and to associate the quality of the foods consumed with the Bolsa Família Program in a city located in the Brazilian semi-arid region. METHOD: A total of 189 children from a sample of 411 households in the city of João Câmara (RN) were assessed. Weight and height were measured and socioeconomic and food habits were determined with the use of questionnaires. The nutritional status of the children was determined with the weight-for-age, height-for-age and weight-for-height indicators. Univariate analyses were done and bivariate and multivariate logistic regression models were constructed to test the hypothesis of the study. RESULTS: Of the studied children, 4.3% were underweight, 9.9% were stunted and 14.0% were overweight. The nutritional status of children whose families receive the Bolsa Família financial aid was not significantly different from those whose families do not receive the aid. In both groups, the consumption of fruits and non-starchy vegetables was low and similar. Children from families who receive the aid were 3 times more likely to eat junk food (OR 3.06 - CI 1.35-6.95). CONCLUSION: The food intake patterns of this population indicate that they are at food and nutritional risk. Health professionals need to intervene in order to promote healthier eating habits

Alterações das propriedades elásticas dos pulmões e broncomotricidade em coelhos, na doença de Chagas crônica induzida experimentalmente

Com o intuito de estudar a denervação brônquiea na fase crônica da doença de Chagas investigaram-se as propriedades mecânicas e a motricidade brônquiea de 6 coelhos chagásicos crônicos e 4 controles. Utilizou-se o método da pletismografia de corpo inteiro e todas as medidas foram feitas antes e depois da administração endovenosa de cloridrato de histamina (0,11 mg/kg). No grupo chagásico crônico obteve-se um menor acréscimo da capacidade residual funcional e uma quase inalteração do pico de fluxo na expiração passiva após a administração de histamina. Este grupo apresentou também um desvio para a direita na curva estática de pressão transpulmonar/volume. Estes resultados sugerem uma alteração na árvore brônquiea, que consiste principalmente numa broncoreatividade diminuída.In order to study the role of bronchial denervation in Chagas' disease, the mechanical properties and the hronchomotricity o£ 6 chronic chagasic and 4 control rabbits were investigated. The whole-body plethysmograph method was used and the measurements were performed before and after intravenous administration of histamine chlorhydrate (0.11 mg/kg body weight). A smaller increase of the functional residual capacity, an almost unchanged peak passive expiratory flow after the histamine administration and a shift to the right of the static transpulmonary pressure/volume curve observed in the chagasic animals indicate an alteration of the bronchial tree, mainly consisting of a decreased bronehoreactivity

Clinico-Pathological Discrepancies in a General University Hospital in São Paulo, Brazil

INTRODUCTION: The autopsy rate has continuously diminished over the past few decades, reducing the quality of medical care and the accuracy of statistical health data. OBJECTIVE: To assess the accuracy of clinical diagnoses by comparing pre- and postmortem findings, and to identify potential risk factors for misdiagnoses. METHODS: Retrospective evaluations performed between June 2001 and June 2003 in a 2500-bed tertiary university hospital in São Paulo, Brazil, including 288 patients who died at that institution and had a postmortem examination. RESULTS: Clinical and autopsy records were reviewed and compared for categorization using the adapted Goldman criteria. The overall major and minor discrepancy rates were 16.3% and 28.1%, respectively. The most common missed diagnoses were pulmonary embolism, pneumonia, and myocardial infarction, and the most prevalent underlying diseases were infectious diseases, cerebro-cardiovascular conditions, and malignancies. Patients age 60 or older had an increased risk of diagnostic disagreement, as did female patients. The period of hospitalization, last admission unit at the hospital and underlying disease were not significantly related to the pre-mortem diagnostic accuracy. DISCUSSION: The discrepancy rate found in this study is similar to those reported globally. The factors influencing diagnostic accuracy as well as the most commonly missed diagnoses are also consistent with the literature. CONCLUSION: Autopsy remains a crucial tool for improving medical care, and effort must be focused on increasing its practice worldwide

Democratização do Saber

A entrevista com o Prof. Dr. Paulo Hilário Nascimento Saldiva, realizada dia 11/09/2020, é o início de uma discussão sobre a seguinte pergunta: “Qual o papel do novo cientista?” Abrindo uma série de podcasts e entrevistas, o Prof. Dr. Paulo Saldiva aborda como a Democratização do Saber é relevante e necessita ser aplicada nos dias de hoje, com enfoque para a importância da divulgação científica. A conversa ocorreu entre o professor, a diretoria da RevMed e seus colaboradores - alunos do curso de medicina da Faculdade de Medicina da Universidade de São Paulo (FMUSP): desse conjunto, o produto final aproxima-se, sobretudo, de uma conversa entre estudantes de medicina e um professor que, preocupado com suas formações, é fonte de inspiração constante a eles

Reliability of reflectance measures in passive filters

Measurements of optical reflectance in passive filters impregnated with a reactive chemical solution may be transformed to ozone concentrations via a calibration curve and constitute a low cost alternative for environmental monitoring, mainly to estimate human exposure. Given the possibility of errors caused by exposure bias, it is common to consider sets of m filters exposed during a certain period to estimate the latent reflectance on n different sample occasions at a certain location. Mixed models with sample occasions as random effects are useful to analyze data obtained under such setups. the intra-class correlation coefficient of the mean of the m measurements is an indicator of the reliability of the latent reflectance estimates. Our objective is to determine m in order to obtain a pre-specified reliability of the estimates, taking possible outliers into account. To illustrate the procedure, we consider an experiment conducted at the Laboratory of Experimental Air Pollution, University of São Paulo, Brazil (LPAE/FMUSP), where sets of m = 3 filters were exposed during 7 days on n = 9 different occasions at a certain location. the results show that the reliability of the latent reflectance estimates for each occasion obtained under homoskedasticity is k(m) = 0.74. A residual analysis suggests that the within-occasion variance for two of the occasions should be different from the others. A refined model with two within-occasion variance components was considered, yielding k(m) = 0.56 for these occasions and k(m) = 0.87 for the remaining ones. To guarantee that all estimates have a reliability of at least 80% we require measurements on m = 10 filters on each occasion. (C) 2014 the Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).INAIRA - Instituto Nacional de Avaliacao Integrada de Risco AmbientalConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Univ São Paulo, Inst Math & Stat, BR-05508 São Paulo, BrazilUniv São Paulo, Sch Med, BR-05508 São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilCNPq: 15/2008FAPESP: 2008/57717-6CNPq: 308613/2011-2Web of Scienc

Iniciação científica e a formação do estudante de Medicina

O texto discute o papel da iniciação científica como instrumento de aprimoramento da educação médica. O conceito que se defende é que o método científico aprimora a capacidade de auto-instrução do estudante, desenvolvendo a sua iniciativa, a capacidade de analisar criticamente a informação e a habilidade de integrar informações. Estas qualidades são de extrema valia no processo atualização constante que o médico necessita, de forma a se manter a para do progresso científico.The role of the exposure of students to research practice as instrument of medical education is discussed. The underlying concept is that the scientific method enhances self-instruction capacity, develops self-initiative and analytical capacity, as well the ability of information processing. These qualities are of paramount importance to continuous medical education, a mandatory condition to keep physicians in pace with the progresses of Medicine

Estudo experimental sobre a disseminação linfática do tumor de Ehrlich na forma sólida em camundongos

Metastasis to regional lymph nodes is an important step in the dissemination of cancer. The mechanisms of this dissemination are poorly understood, probably due to the paucity of authentic experimental models. The aim of the present study was to characterize the Ehrlich tumor as a model of lymphatic metastasis in mice. Animals were inoculated into the footpad and the popliteal lywph nodes were collected at several times post-inoculation in order to evaluate their weight, histopathological aspects,and mast cells quantitation, since these cells are reported to be implicated in host's response to tumor. The migration of tumor cells was detected by a biological assay as early as 1 hour post-inoculation. The solid tumor growth in the footpad was measured until day 30 post-inoculation and the histological alterations during this period were also studied. Ehrlich tumor was considered as a suitable model for the study of lymphatic metastasis.As metástases para linfonodos regionais representam fase importante na disseminação neoplásica. Os mecanismos que concorrem para este processo são pouco conhecidos, devido provavelmente à escassez de modelos experimentais adequados. O objetivo do presente estudo é o de caracterizar o tumor de Ehrlich como modelo para o estudo da disseminação linfática em camundongos. Para tanto, animais foram inoculados com células tumorais no coxim plantar e seus linfonodos poplíteos foram colhidos vários tempos após a inoculação, com a finalidade de avaliar seu peso, aspectos histopatológicos e quantificar os mastócitos, já que estas células parecem estar implicadas na resposta do hospedeiro ao tumor. A migração das células tumorais para os linfonodos poplíteos foi detectada a partir de 1 hora após a inoculação. 0 crescimento do tunor sólido no coxim plantar foi acompanhado até 30 dias após a inoculação, e as alterações histopatológicas foram estudadas durante esse período. 0 tumor de Ehrlich foi considerado un modelo experimental adequado para o estudo da disseminação linfática

Bronchial remodeling in asthma

The relationship between structure and function in asthma has been extensively studied. All the compartments of the airway have been shown to have some structural alterations contributing to functional defects. The structural alterations are thought to be a consequence of the chronic inflammation present in asthmatic airways, leading ultimately to remodeling. The decline of the ventilatory function over time in some asthmatic patients may be a consequence of airway remodeling. In this review, the authors describe the phenomena leading to airway remodeling and discuss the role of inflammatory mediators involved in this process. The structural alterations of the asthmatic airways are presented and the possible correlated functional defects are discussed.É sabido que certos pacientes asmáticos apresentam perda parcial e irreversível da função respiratória ao longo do tempo. Postula-se que o processo inflamatório crônico em vias aéreas, característico da doença, poderia, através da liberação de diversos mediadores inflamatórios, ocasionar alterações estruturais irreversíveis nas vias aéreas e conseqüente piora da broncoconstrição, contribuindo assim para o fenômeno de perda de função pulmonar. A este processo creditou-se o nome de remodelamento brônquico. Nesta revisão descrevem-se os mecanismos propostos para o remodelamento brônquico, o papel dos diversos mediadores inflamatórios envolvidos e as diversas alterações patológicas observadas em vias aéreas asmáticas. Para cada alteração estrutural descrita, discute-se a possível conseqüência funcional. O entendimento do remodelamento brônquico é importante para o melhor manejo dos pacientes com asma e para a prevenção da deterioração funcional definitiva.Universidade de São Paulo Faculdade de Medicina Departamento de PatologiaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

Parental smoking patterns and their association with wheezing in children

OBJECTIVE: To investigate parental smoking patterns and their association with wheezing in children. METHODS: We performed a case-control study that included 105 children between 6 and 23 months of age who were divided into two groups: cases (children with 3 previous episodes of wheezing) and controls (healthy children without wheezing). The children's exposure to cigarette smoking was estimated using a questionnaire completed by the mothers and by the children's urinary cotinine levels. RESULTS: Based on both the questionnaire results and cotinine levels, exposure to cigarette smoking was higher in the households of cases in which the incidence of maternal smoking was significantly higher than that of paternal smoking. Children in this group were more affected by maternal smoking and by the total number of cigarettes smoked inside the house. Additionally, the questionnaire results indicated that the risk of wheezing was dose dependent. The presence of allergic components, such as atopic dermatitis and siblings with allergic rhinitis and asthma, greatly increased the odds ratio when wheezing was associated with cotinine levels. CONCLUSION: Children exposed to tobacco smoke have an increased risk of developing wheezing syndrome. This risk increases in association with the number of cigarettes smoked inside the house and the presence of other allergic components in the family

Lean diesel technology and human health: a case study in six Brazilian metropolitan regions

OBJECTIVE: Due to their toxicity, diesel emissions have been submitted to progressively more restrictive regulations in developed countries. However, in Brazil, the implementation of the Cleaner Diesel Technologies policy (Euro IV standards for vehicles produced in 2009 and low-sulfur diesel with 50 ppm of sulfur) was postponed until 2012 without a comprehensive analysis of the effect of this delay on public health parameters. We aimed to evaluate the impact of the delay in implementing the Cleaner Diesel Technologies policy on health indicators and monetary health costs in Brazil. METHODS: The primary estimator of exposure to air pollution was the concentration of ambient fine particulate matter (particles with aerodynamic diameters <2.5 &#956;m, [PM2.5]). This parameter was measured daily in six Brazilian metropolitan areas during 2007-2008. We calculated 1) the projected reduction in the PM2.5 that would have been achieved if the Euro IV standards had been implemented in 2009 and 2) the expected reduction after implementation in 2012. The difference between these two time curves was transformed into health outcomes using previous dose-response curves. The economic valuation was performed based on the DALY (disability-adjusted life years) method. RESULTS: The delay in implementing the Cleaner Diesel Technologies policy will result in an estimated excess of 13,984 deaths up to 2040. Health expenditures are projected to be increased by nearly US$ 11.5 billion for the same period. CONCLUSIONS: The present results indicate that a significant health burden will occur because of the postponement in implementing the Cleaner Diesel Technologies policy. These results also reinforce the concept that health effects must be considered when revising fuel and emission policies