Waist circumference as high blood pressure predictor in school age children / Circunferência da cintura como preditora da pressão arterial elevada em escolares

Abstract Childhood hypertension is becoming more common with the increasing numbers of child obesity, which has encouraged new studies to identify a good anthropometric marker for high blood pressure levels. The objective this study was to identify the best anthropometric predictor of risk of hypertension in children between 8-10 years of age. The Children were evaluated for socioeconomic status and their blood pressure (BP), weight, height, waist circumference (WC) and percentage of body fat (PBF) were measured. The study included 445 children, of which 50.1% were females. The prevalence of obesity defined by body mass index (BMI) was 14.6%. Increased BP was found in 3.4% and 2.2% of the children, considering the pre-hypertension and hypertension classifications respectively. The arithmetic mean of BP value correlated significantly with BMI, WC and PBF. After height control, the correlations that were maintained significant were between WC and systolic blood pressure (SBP) and between WC and diastolic blood pressure (DBP). The variable with the highest predictive power of the occurrence of hypertension was WC. The results indicate that, in this population of children between 8 and 10 years old, WC is a measurement of higher value in predicting increased BP.

Resumo A hipertensão na infância está aumentando com a epidemia de obesidade infantil, o que tem incentivado estudos para identificar um bom marcador antropométrico dos níveis pressóricos aumentados. O objetivo do presente estudo foi identificar o melhor preditor antropométrico de risco de hipertensão arterial em crianças entre 8 e 10 anos de idade. Foi realizada avaliação socioeconômica e aferidos pressão arterial (PA), peso, estatura, circunferência da cintura (CC) e percentual de gordura corporal (%GC). Das 445 crianças que participaram do estudo, 50,1% eram do sexo feminino. A prevalência de obesidade definida pelo índice de massa corporal (IMC) foi 14,6%. A PA aumentada foi observada em 3,4% e 2,2% das crianças, considerando as classificações pré-hipertensão e hipertensão, respectivamente. As médias dos valores pressóricos correlacionaram-se significativamente com IMC, CC, e %GC e, após o controle da estatura, as correlações que se mantiveram significativas foram entre CC e pressão arterial sistólica (PAS) e CC e pressão arterial diastólica (PAD). A variável que apresentou maior poder preditivo da ocorrência de hipertensão foi a CC. Os resultados indicam que na população estudada de crianças entre 8 e 10 anos de idade a CC é uma medida de valor superior para predizer PA aumentada.

Sickle Cell Disease: quality of life in patients with hemoglobin SS and SC disorders

OBJECTIVE Sickle cell disease comprises chronic, genetically determined disorders, presenting significant morbidity and high prevalence in Brazil. The goal of this study was to evaluate the quality of life of sickle cell disease patients (hemoglobin SS and SC) and their sociodemographic and clinical characteristics. METHODS Data was collected from clinical records and semi-structured interviews consisting of clinical questionnaires and the World Health Organization Quality of Life-brief questionnaire. RESULTS Interviews were conducted with 400 patients, aged between 18 and 72, treated in the Fundação HEMOMINAS in Belo Horizonte. The participants predominantly had sickle cell disease hemoglobin SS variant (65.5%), were female (61.8%), single (55.3), with up to 8 years of schooling (49.6%), and self-defined as mulattos (50%). Pain crises, hospitalizations, blood transfusions, and other morbidities of sickle cell disease had a significant impact on the quality of life of these patients. CONCLUSION Within this group, the social profile was that of low income and unemployed with sickle cell disease considered to be a significant impediment to finding a job. Evaluating quality of life as a determining factor of health is essential for the creation of specific policies and measures, appropriate for the specific characteristics and social context of sickle cell disease.

Participation in proficiency programs and promotion of quality in transfusion services of Minas Gerais

OBJECTIVE: This study aimed at identifying associations between the participation of transfusion services in immunohematology external quality control programs and their accuracy in immunohematology testing and adaptation to technical and legal operational procedures. METHODS: From 2007 to 2009, a cross-sectional study was conducted in 219 transfusion services of the State of Minas Gerais who participated in this investigation by responding to a questionnaire and conducting a proficiency test comprising: ABO and RhD phenotyping, irregular RBC antibody screening and cross-matching. Frequencies and bivariate analysis followed by binary logistic regression were used for statistical analysis. RESULTS: Transfusion services who participated in external quality control programs (32.4 percent) and those that did not (67.6 percent) obtained worrying error percentages in proficiency tests which may significantly increase blood transfusion risks. Shortfalls related to the establishment of protocols, standards and internal quality control were also significant. On comparing the two groups, transfusion services that participated in these programs had a 2.35 times higher chance of correct results in the proficiency panel testing, a 3.16 higher chance of having transfusional records and a 2.81 higher chance of performing preventive maintenance of equipment. CONCLUSIONS: The study showed that independent factors associated to participation in external quality control programs suggest that more investment in internal quality control procedures is necessary and that more attention should be paid to current legislation.

Assessment of performance of professionals in immunohematology proficiency tests of the public blood bank network of the state of Minas Gerais

BACKGROUND: Despite significant advances, the practice of blood transfusion is still a complex process and subject to risks. Factors that influence the safety of blood transfusion include technical skill and knowledge in hemotherapy mainly obtained by the qualification and training of teams. OBJECTIVE: This study aimed to investigate the relationship between professional categories working in transfusion services of the public blood bank network in the State of Minas Gerais and their performance in proficiency tests. METHODS: This was an observational cross-sectional study (2007-2008) performed using a specific instrument, based on evidence and the results of immunohematology proficiency tests as mandated by law. RESULTS: The error rates in ABO and RhD phenotyping, irregular antibody screening and cross-matching were 12.5%, 9.6%, 43.8% and 20.1%, respectively. When considering the number of tests performed, the error rates were 4.6%, 4.2%, 26.7% and 11.0%, respectively. The error rates varied for different professional categories: biochemists, biologists and biomedical scientists (65.0%), clinical pathology technicians (44.1%) and laboratory assistants, nursing technicians and assistant nurses (74.6%). A statistically significant difference was observed when the accuracy of clinical pathology technicians was compared with those of other professionals with only high school education (p-value < 0.001). This was not seen for professionals with university degrees (p-value = 0.293). CONCLUSION: These results reinforce the need to invest in training, improvement of educational programs, new teaching methods and tools for periodic evaluations, contributing to increase transfusion safety and improve hemotherapy in Brazil.

Transfusion practices committee of a public blood bank network in Minas Gerais, Brazil

OBJECTIVE: This study aimed to verify the performance of blood transfusion committees in transfusion services linked to the public blood bank network of the state of Minas Gerais. METHODS: A cross-sectional observational study was conducted between 2007 and 2008 using questionnaires and proficiency tests to evaluate the reporting and investigation of transfusion reactions comparing transfusion services with and without transfusion committees in the public transfusion services of the state of Minas Gerais. RESULTS: Nineteen of Hemominas own transfusion services and 207 that contracted the services of the foundation located in 178 municipalities were visited between 2007 and 2008. Established transfusion committees were present in 63.4% of the services visited. Transfusion incidents were reported by 53 (36.8%) transfusion services with transfusion committees and by eight (9.6%) without transfusion committees (p < 0.001) with 543 (97.5%) and 14 (2.5%) notifications, respectively. Of the reported transfusion incidents, 40 (75.5%) transfusion services with transfusion committees and only two (25%) of those without transfusion committees investigated the causes. CONCLUSION: The incidence of notification and investigation of the causes of transfusion reactions was higher in transfusion services where a transfusion committee was present. Despite these results, the performance of these committees was found to be incipient and a better organization and more effective operation are required.

Distribuição espaço-temporal dos candidatos à doação de sangue da Fundação Hemominas, Belo Horizonte, Minas Gerais, Brasil, nos anos de 1994 e 2004 / Spatial-temporal distribution of potential blood donors at the Hemominas Foundation, Belo Horizonte, Minas Gerais State, Brazil, in 1994 and 2004

Este estudo teve como objetivo descrever a distribuição espacial e temporal dos candidatos à doação de sangue, do Município de Belo Horizonte, Minas Gerais, Brasil, que se apresentaram no hemocentro da Fundação Hemominas, nos anos de 1994 e 2004. Comparou no espaço e no espaço-tempo as características idade, sexo e aptidão clínica destes candidatos. As informações de 1994, obtidas de estudo transversal, e as de 2004, amostrados entre os candidatos à doação durante o ano. As amostras foram georreferenciadas através dos endereços de residência. As técnicas espaciais utilizadas foram: mapas Kernel, mapas temáticos de taxas Bayesianas empíricas e de taxas brutas e o índice de Moran global. Os resultados indicaram que a distribuição espacial de candidatos não foi aleatória. Os mapas Kernel auxiliaram na detecção de locais com maior ou menor concentração de candidatos. Os mapas temáticos descreveram a concentração de candidatos relativos à população para as diferentes categorias analisadas. Estes resultados ajudam na detecção de locais para ações direcionadas à captação de candidatos à doação bem como locais com necessidades de campanhas a públicos específicos.

The main goal of this study was to describe the spatial and temporal distribution of candidates for blood donation in Belo Horizonte, Minas Gerais State, Brazil, who appeared at the Hemominas Foundation in 1994 and 2004. The study also compared the candidates for age, gender, and clinical approval for blood donation in space and space-time. Data were obtained from a cross-sectional study for 1994 and were randomly selected from all donor candidates for 2004. The samples were georeferenced using the residential address. The spatial analysis techniques employed were: Kernel maps, thematic maps of Bayesian empirical rates and crude rates, and Moran Global. According to the findings, spatial distribution of candidates was non-random. The Kernel maps helped detect points with higher or lower concentration of candidates. Thematic maps described the concentration of candidates in relation to the population for the various categories. The results could help detect areas for actions targeting donor recruitment and areas with specific blood donation public campaign needs.

Physical and operational infrastructure of transfusion services of the public blood bank network in the State of Minas Gerais, Brazil, 2007/2008

INTRODUCTION: Within the context of transfusion safety, the immunohematological study of donors and recipients of blood products is currently the most fragile link in the transfusion chain of the public blood bank network of Minas Gerais. OBJECTIVE: The objective of this work was to provide a critical and situational overview of the physical and operational infrastructure of the transfusion services in the state. Method: This was an observational cross-sectional, evidence-based study covering 226 transfusion services; only 19 belong to the Hemominas Foundation and 207 are non-Hemominas transfusion services. The investigation involved the application of questionnaires and red cell panel tests. RESULTS: The results revealed considerable non-compliance with the national law and with the norms of Hemominas. These findings were obtained for the two groups studied; however the frequencies were higher among non-Hemominas transfusion services. CONCLUSION: The study provides information about the situation of the physical and operational infrastructure of transfusion services that may be used to help plan effective measures for improvement and serve as the basis for an evaluation of the impact of future interventions regarding the quality, reliability and safety of transfusions. As primordial factors, we propose compliance with the law, qualified personnel and investment in further qualifications, a review of training methods, and more rigorous inspection of transfusion services. As a suggestion, we propose the establishment of an External Quality Control Program in Immunohematology for the entire network of blood banks in the state and the adoption of the methods presented in this study as a tool to monitor transfusion service performance.

INTRODUÇÃO: No contexto da segurança transfusional, o estudo imuno-hematológico do doador e do receptor de hemocomponentes é hoje o elo mais frágil da cadeia transfusional na hemorrede pública de Minas Gerais. OBJETIVO: O objetivo deste trabalho foi traçar panorama crítico e situacional da infraestrutura física e operacional das Agências Transfusionais (ATs) do estado. Método: Estudo observacional transversal, baseado em evidências, abrangeu 226 ATs, sendo 19 próprias da Fundação Hemominas (PH) e 207 não próprias da Hemominas (NPH), com aplicação de questionários e testes de painel de hemácias. RESULTADOS: Os achados do presente estudo mostraram percentuais expressivos de não conformidades com a legislação vigente no país e com as normas estabelecidas pela Hemominas. Estas foram encontradas nos dois grupos estudados, com algumas exceções, apresentando maiores frequências entre as ATs NPH. CONCLUSÃO: O estudo possibilitou o conhecimento da situação da infraestrutura física e operacional das ATs, podendo subsidiar o planejamento de ações efetivas de melhorias, bem como servir de base para avaliar o impacto de futuras intervenções, com vistas à qualidade, confiabilidade e segurança transfusional. Para isto, propôs como fatores primordiais, o cumprimento da legislação vigente, recursos humanos qualificados e investimentos na sua capacitação, revisão das metodologias de treinamento e maior rigor nas verificações e inspeções das ATs. Como sugestão, propõe ainda a criação, pela Hemominas, de Programa de Controle de Qualidade Externo em Imunohematologia para toda hemorrede do estado e adoção da metodologia deste estudo como instrumento de monitoramento da performance das ATs.

Doença falciforme e qualidade de vida: um estudo da percepção subjetiva dos pacientes da Fundação Hemominas, Minas Gerais, Brasil / Sickle cell disease and quality of life: a study on the subjective perception of patients from the Fundação Hemominas, Minas Gerais, Brazil

Na presente investigação, buscou-se pesquisar se o conceito de qualidade de vida, preconizado pela Organização Mundial de Saúde (OMS) poderia ser utilizado para pacientes com doença falciforme (DF), uma vez que se apresenta como um problema de saúde pública no país. Utilizou-se uma abordagem qualitativa com a seguinte questão norteadora na entrevista: "Para você o que é QV?". De acordo com o relato dos pacientes, procurou-se identificar a presença dos domínios físico, psicológico, nível de independência, relações sociais, meio ambiente e espiritualidade/crenças pessoais na representação da QV. Participaram do estudo 25 pacientes, dos quais 80% eram portadores da hemoglobina SS (HbSS) e 20% com hemoglobina SC (HbSC). A médiada idade encontrada foi de 33,3 anos, 56% eram do sexo feminino e 44% eram casados(as). Em relação à escolaridade, 44% atingiram até 11 anos de estudo e 56% até 8 anos. A DF representou, para 72%, impedimento para o trabalho, o que revela seu impacto negativo no desenvolvimento das habilidades laborais. Todos os domínios de QV preconizados pela OMS foram detectados no relato dos participantes: domínio físico em 84%, psicológico e relações sociais em 76%, nível de independência em 60%,meio ambiente em 52% e espiritualidade/crenças pessoais em 4% deles. Os aspectos referentes à multidimensionalidade e à subjetividade, apresentados no conceito de QV preconizado pela OMS, e representados pelos seus domínios, podem ser tomadoscomo norteadores de estudos que envolvam o conceito de QV em pacientes com DF.

This study aimed at investigating whether the concept of quality of life advocated by the World Health Organization can be applied to sickle cell patients, as this disease is an important public health problem in the country. A qualitative approach was utilized with the following guide question in the interview: "What is quality of life for you?" According to the patients' replies, the following domains were identified: physical, psychological, level of independence, social relationships, environment and spirituality/personal beliefs. Twentyfivepatients took part in the study, 80% had hemoglobin SS and 20% hemoglobin SC. The average age was 33.3 years old, 56% of the patients were women and 44% were married. In relation to schooling, 12% had concluded the 4th grade of elementary school and 24% completed high school. Sickle cell disease represented a barrier in respect to work for 72% of the patients, which demonstrates its negative impact on the development of the work capabilities ofthe individuals. All quality of life domains advocated by the WHO were present in the patients' replies: physical domain in 84%, psychological and social relationships in 76%, level of independence in 60%, environment in 52% and spirituality/personal believes in 4%. To conclude, the aspects referring to multidimensionality andsubjectivity, presented in the quality of life concept advocated by the WHO and represented by their domains, can be taken as a guide for studies which involve the quality of life in sickle cell patients.

Fatores associados à aptidão clínica para a doação de sangue: determinantes demográficos e socioeconômicos / Factors associated to clinical aptness for blood donation: demographic and socioeconomic determinants

Crescimento significativo da preocupação com a segurança transfusional vem sendo observado nas últimas décadas, paralelo às alterações demográficas e sociais da população, além dos avanços técnico-científicos, que aumentam naturalmente a demanda por transfusões de sangue. Entretanto, apesar dos investimentos na captação de doadores, seu déficit continua sendo crônico. Este trabalho teve como objetivo comparar aspectos demográficos e socioeconômicos entre indivíduos aptos, inaptos temporários e inaptos permanentes na triagem clínica para a doação de sangue, visando identificar fatores diferenciais. Constou de estudo caso-referente realizado no Hemocentro de Belo Horizonte (1994-1995), a partir de um inquérito envolvendo 3.527 candidatos à doação. Comparações das características dos candidatos aptos e inaptos foram realizadas, estratificadas por sexo. Regressão logística multinomial foi utilizada para investigar os fatores associados à aptidão para a doação. Os candidatos à doação se assemelhavam quanto ao nível socioeconômico e eram dissimilares na distribuição por sexo, faixa etária e tipo de doação. Para ambos os sexos, as seguintes características se associaram estatisticamente à aptidão: ser mais jovem (18 a 29 anos), ter união estável, estar trabalhando e não possuir automóvel. Para homens incluiu-se, ainda, ter até duas pessoas por dormitório na residência. Distintos perfis demográficos e socioeconômicos foram identificados, de acordo com o sexo e categorias de aptidão, com maior similaridade entre o perfil dos indivíduos inaptos clínicos temporários, principalmente mulheres, com o dos aptos clínicos. Portanto, justifica-se a adoção de múltiplas estratégias de captação de doadores para atingir públicos alvos específicos.

Over the last decades, growing concern regarding transfusional safety has been observed, parallel to demographic and social changes as well as technological advances and increasing demand for blood transfusions. However, despite investment to increase the number of blood donors, there is a chronic shortage of blood. The aim of this study was to compare demographic and social-economic characteristics comparing individuals that were considered eligible with temporarily and permanent non-eligible blood donors. A case-comparison study was carried out at the Blood Donation Center (Hemocentro) of Belo Horizonte from a survey involving 3,527 candidates for blood donation. Comparisons stratified by gender were made for all characteristics. Multinomial logistic regression was used to verify the association between the variables and eligibility for blood donation. Candidates for blood donation were similar according to the socio-economic level and dissimilar according to gender, age and type of donation. For both genders, the following characteristics were statistically associated in respect to eligibility for blood donation: to be young (18 to 29 years), to have a stable relationship and employment and not to own an automobile. For men, the presence of less than two people per bedroom of their residence was also statistically significant. Distinct demographic and social-economic profiles were identified in relation to gender and eligibility category. Similar profiles were found between temporarily non-eligible and eligible candidates, especially among women. Therefore, adopting multiple strategies in blood donor recruitment is justified in order to make contact with the different groups.

Doença de Chagas em Minas Gerais: situaçäo atual e perspectivas / Chagas' disease in Minas Gerais: current status and perspectives

Através dos dados disponíveis verifica-se que a doença de Chagas é importante em Minas Gerais, com elevadas taxas de dispersäo de vetores,de prevalência e de alto custo médico-social. Caracteriza-se bem a urbanizaçäo da endemia, subsidiando um quadro grave da doença transfusional, mesmo nas áreas näo endêmicas. Verifica-se o bom resultado do controle dos vetores pela SUCAM, mormente após o recente aporte de recursos extraordinários do FINSOCIAL à Campanha de Chagas. Vislumbra-se a erradiaçäo do Triatoma infestans no Estado, observando-se ainda importante decréscimo no grau de infestaçäo domiciliar pelas outras espécies nas áreas sistematicamente tratadas pela SUCAM, onde vários municípios estäo entrando em fase de vigilância epidemiológica. Descortina-se por outro lado uma grande tarefa concernente à transmissäo transfusional e aos indivíduos já infectados, que hoje vai sendo paulatinamente assumida pela Secretaria de Estado da Saúde. Neste quadro observa-se que o controle da doença de Chagas supöe uma açäo integrada de diferentes instituiçöes e áreas do conhecimento que contemple näo apenas as diversas formas de transmissäo e os indivíduos infectados, mas também a expressäo política e social do problema. Em Minas Gerais, hoje, a experiência desta integraçäo poderá fornecer interessantes subsídios para açöes ou programas similares em outras áreas endêmicas do continente