Social and biological determinants of iron deficiency anemia

This cross-sectional study aimed to identify the social and biological determinants of anemia in children enrolled in the Brazilian Income Transfer Program (PBF). The study evaluated 446 children (69.1% of the total enrolled) ranging from 6 to 84 months of age, of whom 262 were receiving the income transfer (60.2% of the beneficiaries) and 184 were not (87.6% of the non-beneficiaries). Testing for anemia was performed with the Hemocue portable hemoglobinometer, and the cutoff points were set at 11.0 and 11.5g/dL, according to age bracket. The data were analyzed using Poisson hierarchical regression with robust variance for multivariate analysis. There was no difference in the anemia prevalence rates between the beneficiary and non-beneficiary groups. Risk factors for anemia were low paternal schooling, cesarean birth, consumption of untreated water, stunting, and age less than 24 months. Prevalence of anemia in the group of non-beneficiary children under two years of age was significantly higher than in the beneficiary group in the same age bracket, suggesting the importance of the PBF income transfer for preventing anemia in children.Neste estudo transversal, objetivou-se conhecer a determinação social e biológica da anemia em crianças cadastradas no Programa Bolsa Família (PBF). Foram avaliadas 446 crianças (69,1% do total cadastrado) com idade entre 6 e 84 meses, sendo que 262 (60,2%) recebiam o benefício, e 184 (87,6%) não recebiam. O teste de anemia foi realizado com o hemoglobinômetro portátil Hemocue, e os pontos de corte adotados foram 11,0 e 11,5g/dL, segundo a faixa etária. Utilizou-se regressão de Poisson hierarquizada com variância robusta para análise multivariada. Não houve diferença entre as prevalências de anemia entre os grupos beneficiários e não-beneficiários. Os fatores de risco para essa carência foram baixa escolaridade paterna, parto cesariano, consumo de água sem tratamento, baixa estatura e idade inferior a 24 meses. A prevalência de anemia no grupo de crianças menores de dois anos não-beneficiárias foi significantemente maior do que no grupo beneficiário de mesma idade, o que sugere a importância do benefício do PBF no combate à anemia em crianças

The effects of a muscle resistance program on the functional capacity, knee extensor muscle strength and plasma levels of IL-6 and TNF-α in pre-frail elderly women: a randomized crossover clinical trial - a study protocol

<p>Abstract</p> <p>Background</p> <p>With the increase in the elderly population, a growing number of chronic degenerative diseases and a greater dependency on caregivers have been observed. Elderly persons in states of frailty remain more susceptible to significant health complications. There is evidence of an inverse relationship between plasma levels of inflammatory mediators and levels of functionality and muscle strength, suggesting that muscle-strengthening measures can aid in inflammatory conditions. The purpose of this study will be verified the effect of a muscle-strengthening program with load during a ten-week period in pre-frail elderly women with attention to the following outcomes: (1) plasma levels of interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α), (2) functional capacity and (3) knee extensor muscle strength.</p> <p>Methods/Design</p> <p>The study design is a randomized crossover clinical trial evaluating 26 elderly women (regardless of their race and/or social condition) who are community residents, older than 65, and classified as pre-frail according to the criteria previously described by Fried et al. (2004). All subjects will be assessed using the Timed up and go and 10-Meter Walk Test functional tests. The plasma levels of IL-6 and TNF-α will be assessed by ELISA (<it>enzyme-linked immunosorbent assay</it>) with high sensitivity kits (Quantikine^®HS, R&D Systems Minneapolis, MN, U.S.). Knee extensor muscle strength will be assessed using the <it>Byodex System 3 Pro</it>^{<it>® </it>}isokinetic dynamometer at angular speeds of 60 and 180°/s. The intervention will consist of strengthening exercises of the lower extremities at 50 to 70% of 1RM (maximal resistance) three times per week for ten weeks. The volunteers will be randomized into two groups: group E, the intervention group, and group C, the control group that did not initiate any new activities during the initial study period (ten weeks). After the initial period, group C will begin the intervention and group E will maintain everyday activities without exercising. At the end of the total study period, all volunteers will be reassessed.</p> <p>Discussion</p> <p>To demonstrate and discuss possible influences of load-bearing exercises on the modification of plasma levels of IL-6 and TNF-α and in the functional performance of pre-frail elderly women.</p> <p>Trial Registration</p> <p>ISRCTN62824599</p

Social support and common mental disorder among medical students

INTRODUÇÃO:Diferentes formas de sofrimento psíquico têm sido identificadas em estudantes da área da saúde, em especial no curso de Medicina.OBJETIVO:Estimar a prevalência de sofrimento psíquico entre estudantes de Medicina em uma faculdade no Sudeste do Brasil e avaliar sua associação com apoio social.MÉTODO:Trata-se de um estudo transversal. Foram aplicados questionários para alunos do 1º ao 6º ano do curso de Medicina da Universidade Estadual Paulista Júlio de Mesquita Filho, investigando-se características demográficas relacionadas ao curso e à adaptação à cidade. Sofrimento psíquico foi investigado na forma de Transtorno Mental Comum (TMC), avaliado por meio do Self-Reporting Questionnaire (SRQ-20). Apoio social foi avaliado com a Escala de Apoio Social (EAS). As associações entre o desfecho e as variáveis explanatórias foram analisadas por meio do teste do χ2 e, na análise multivariada, por meio da Regressão Logística, com p < 0,05.RESULTADOS:A taxa de resposta foi de 80,7%, não havendo diferença estatística entre a mostra e a população-alvo no que diz respeito ao gênero (p = 0,78). A média de idade foi de 22 anos (desvio padrão - DP = 2,2) com predomínio de mulheres (58,2%) e estudantes que vivem com amigos (62%). A prevalência de TMC foi de 44,9% (IC95% 40,2 - 49,6). Após a análise multivariada, mantiveram-se associados a TMC: sentir-se rejeitado no último ano (p < 0,001), ter pensado ou pensar em abandonar o curso (p < 0,001) e interação, avaliada pela EAS (p = 0,002).CONCLUSÕES:A prevalência de TMC entre estudantes de Medicina mostrou-se elevada, identificando-se o apoio social insuficiente como fator de risco. Esses achados sugerem que intervenções voltadas para propiciar melhores condições de interação social entre estudantes poderiam ser benéficas, diminuindo a prevalência de TMC nesse grupo.INTRODUCTION:Different kinds of psychological distress have been identified for students in the health field, especially in the medical school.OBJECTIVE:To estimate the prevalence of mental suffering among medical students in the Southeastern Brazil and asses its association with social support.METHODS:It is a cross-sectional study. Structured questionnaires were applied for students from the 1st up to the 6th years of the medical school of Universidade Estadual Paulista Júlio de Mesquita Filho, assessing demographic variables related to aspects of graduation and adaptation to the city. Psychological suffering was defined as a common mental disorder (CMD) assessed by the Self Reporting Questionnaire (SRQ-20). Social support was assessed by the social support scale of the Medical Outcomes Study (MOS). The association between the outcome and explanatory variables was assessed by the χ2 test and Logistic Regression, for the multivariate analyses, using p < 0.05.RESULTS:The response rate was of 80.7%, with no differences between sample and the population regarding gender (p = 0.78). The average age was 22 years old (standard deviation - SD = 2.2), mainly women (58.2%) and students who were living with friends (62%). The prevalence of CMD was 44.9% (95%CI 40.2 - 49.6). After the multivariate analyses, the explanatory variables that were associated with CMD were: feeling rejected in the past year (p < 0.001), thinking about leaving medical school (p < 0.001) and interaction in the MOS scale (p = 0.002).CONCLUSIONS:The prevalence of CMD among medical students was high and insufficient social support was an important risk factor. Our findings suggest that interventions to improve social interaction among those students could be beneficial, decreasing the prevalence of CMD in this group.Hospital das Clínicas de Ribeirão PretoUniversidade Estadual Paulista Júlio de Mesquita Filho Faculdade de Medicina de Botucatu Departamento de Neurologia, Psicologia e PsiquiatriaUniversidade Estadual Paulista Júlio de Mesquita Filho Faculdade de Medicina de Botucatu Departamento de Neurologia, Psicologia e Psiquiatri