Iodine deficiency in women of childbearing age in Brazil: systematic review and meta-analysis / Deficiencia de yodo en mujeres en edad fabricante en Brasil: revisión sistemática y metanálisis

Background: Despite current policies of salt iodination, iodine deficiency is still a global public health problem, especially in women. So far, conflicting evidence has been suggested for the prevalence of iodine deficiency in Brazil. Objective: To estimate the prevalence of iodine deficiency and associated factors in women of childbearing age in Brazil. Methods: A systematic review was conducted using databases (PubMed, LILACS, WHO, Scopus, and Capes' dissertation and thesis), from inception to May 2020. Meta-analyses of proportions were performed using the variance inverse for the fixed model. Reporting and methodological quality were assessed using the Joanna Briggs Institute tool to prevalence studies. Results: Our review identified seven studies published between 2002 e 2017, including 1354 participants, especially pregnant women. All studies presented at least one quality limitation, mainly regarding the sampling method (i.e., convenience) and small sample size. The prevalence of iodine deficiency ranged among studies from 16% to 62%. In contrast, the meta-analysis identified a mean prevalence of 40% (95% confidence interval, CI 37%-43%) for pregnant women and 13% (95% CI 4%-24%) for non-pregnant women. Cumulative meta-analysis suggests a tendency of higher iodine deficiency prevalence from 2018 in pregnant women. Conclusions: Although this systematic review identified studies with poor methodological and reporting quality, a high prevalence of iodine deficiency was identified in pregnant women, reinforcing the importance of national nutritional policies for monitoring iodine status in this population. Future studies should consider random probabilistic sampling, appropriate sample size, and pre-defined subgroup analysis to adequately inform the prevalence of iodine deficiency and associated factors in women of childbearing age and support health policies

Antecedentes: A pesar de las políticas actuales de yodación de la sal, la deficiencia de yodo sigue siendo un problema de salud pública mundial, especialmente en las mujeres. Hasta ahora, se han sugerido pruebas contradictorias sobre la prevalencia de la deficiencia de yodo en Brasil. Objetivo: Estimar la prevalencia de deficiencia de yodo y factores asociados en mujeres en edad fértil, en Brasil. Métodos: Se realizó una revisión sistemática, buscando en PubMed, LILACS, OMS, Scopus y la base de datos de disertaciones y tesis de Capes desde el inicio hasta mayo de 2020. Se realizaron metanálisis de proporciones utilizando la variancia inversa para el modelo fijo. La calidad de información y metodológica se evaluó utilizando la herramienta del Institute Joanna Briggs para estudios de prevalencia. Resultados: Nuestra revisión identificó siete estudios publicados entre 2002 y 2017, incluyendo 1354 participantes, especialmente mujeres embarazadas. Todos los estudios presentaron al menos una limitación de calidad, principalmente con respecto al método de muestreo (es decir, la conveniencia) y el pequeño tamaño de la muestra. La prevalencia de la deficiencia de yodo varió entre los estudios del 16% y el 62%, mientras que el metanálisis identificó una prevalencia media del 40% (intervalo de confianza del 95%, IC 37%-43%) para las mujeres embarazadas y del 13% (IC del 95% 4%-24%) para mujeres no embarazadas. El metanálisis acumulativo sugiere una tendencia a una mayor prevalencia de deficiencia de yodo a partir de 2018 en mujeres embarazadas. Conclusiones: Si bien esta revisión sistemática identificó estudios con mala calidad metodológica y de reporte, se identificó una alta prevalencia de deficiencia de yodo en mujeres embarazadas, lo que refuerza la importancia de las políticas nutricionales nacionales para monitorear el estado de yodo en esta población. Los estudios futuros deben considerar el muestreo probabilístico aleatorio, el tamaño de muestra apropiado y el análisis de subgrupos predefinidos para informar adecuadamente la prevalencia de la deficiencia de yodo y los factores asociados en mujeres en edad fértil y para respaldar las políticas de salud

The Prevalence of Asymptomatic Cervical and Lumbar Facet Arthropathy: A Computed Tomography Study

STUDY DESIGN: Case control study. PURPOSE: To determine the prevalence and degree of asymptomatic cervical and lumbar facet joint arthritis. We retrospectively reviewed 500 computed tomography (CT) scans of cervical facet joints obtained from 50 subjects. Moreover, 500 lumbar facet joints obtained from an additional 50 subjects were reviewed. OVERVIEW OF LITERATURE: Numerous reports in the literature indicate that joint arthritis is a major source of axial neck and low back pain. However, the diagnostic value of this condition, based on degenerative changes seen on radiological studies, remains controversial because significant imaging findings may not correlate with corresponding symptoms. The CT scan is a sensitive method for facet joint evaluation and may reveal degenerative abnormalities. Previous studies have described the prevalence of facet arthropathy in symptomatic patients, according to radiological findings; however, no study to date has assessed its prevalence in asymptomatic patients. METHODS: We retrospectively reviewed the neck and abdominal CT scans of patients had been examined for non-spinal pathologies (i.e., thyroid disease, rule out cancer, ascites). Electronic medical records were reviewed to exclude patients with histories of either neck or back pain. Arthritis severity was graded using a previously published four-point CT scale. RESULTS: The prevalence of asymptomatic cervical facet arthritis (grade 1–3) was 33% (grade 1, 19%; grade 2, 11%; and grade 3, 3%). Among asymptomatic patients, 37% had scalable lumbar facet join arthritis (grade 1, 24%; grade 2, 9%; and grade 3, 4%). There was a statistically significant difference (chi-square test, p<0.0001) in the number of older individuals with arthritic degeneration at the cervical and lumbar levels compared with that of younger individuals. The C6–C7 and L5–S1 levels were the most likely to show arthritic changes. CONCLUSIONS: Arthritic changes to the cervical and lumbar facet joints are prevalent among patients, and in some cases are asymptomatic. These findings were more common in older patients and at lower spinal levels.

Lipohipertrofias en niños con diabetes mellitus tipo 1 / Lipohypertrophy in child with type 1 diabetes mellitus

ntroducción: La diabetes mellitus tipo 1 (DM1) es la enfermedad crónica más frecuente en la edad pediátrica. La educación del niño con DM1 es fundamental para un adecuado control de la enfermedad. Las lipohipertrofias son una de las complicaciones más frecuentes que se producen por el tratamiento con insulina. Estas son consideradas problemas de colaboración y, por lo tanto, es labor de la enfermera controlar su aparición e intervenir para minimizar sus consecuencias. Objetivo: Determinar las características de las lipohipertrofias en niños diagnosticados con diabetes mellitus tipo 1. Métodos: Estudio descriptivo transversal mediante muestreo por conveniencia. Se evaluó la presencia, localización y tamaño de las lipohipertrofias y la relación de la persona que administra la insulina con el régimen de tratamiento. Se estudiaron pacientes de edades comprendidas entre 2 y 18 años que tuviesen, al menos, 3 meses de tratamiento insulínico. Se calculó el tamaño de la muestra mediante estimación de la proporción. Resultados: La prevalencia de lipohipertrofias fue del 44,5 por ciento. Sin embargo, entre los niños estudiados que se encontraban en tratamiento con múltiples dosis de insulina, el porcentaje se elevó a 53,8 por ciento. Los análogos de acción rápida eran inyectados principalmente en abdomen y brazo, los de acción lenta en glúteo y muslo. Los lugares con más lipohipertrofias eran muslos (superando el 50 por ciento), seguido de brazos y abdomen. Conclusiones: Se detectaron diferencias significativas en la aparición de lipohipertrofias entre los niños que portan bomba de insulina y los que utilizan un régimen de múltiples dosis de insulina. Por lo tanto, se podría recomendar la utilización de bomba de insulina o de catéteres de infusión subcutánea (i-Port ®) para la disminución de estas(AU)

Introduction: Type 1 diabetes mellitus (T1DM) is the most common chronic disease in the pediatric age. In order to obtain a positive control of this illness, the T1DM child education is basic. Lipohypertrophies are one of the most frequent difficulties that appear as a consequence of the insulin treatment. When this happen, is nurse's responsibility to monitor the appearance of lipohypertrophies and to try to reduce their consequences. Objectives: Establish the prevalence of lipohypertrophy in children with T1DM performed at the Pediatric Endocrinology Unit of the Hospital Universitario La Paz. Methods: To analyze lipohypertrophy it has been performed a descriptive study. The method used for the sampling was for convenience. Appearance, location and size of lipohypertrophies were evaluated. This has been related with person who administers the insulin and the treatment regimen. Results: Lipohypertrophy prevalence in the sample represented a 44.5 percent, however, between patients which were in a treatment with multiple daily injections this was 53.8 percent. Quick action analogues were mainly injected in abdomen and arms, slow action analogues were aministered in buttocks and leg. Legs were the part of the body with the most lipohypertrophies concentration (exceeded 50 percent), follow by arms and abdomen. Conclusions: Meaningful differences are shown in the appearance of lipohypertrophies between children in treatment with continuous subcutaneous insulin infusion and those that use a multiple daily injections treatment. Therefore, we concluded considering the possibility to recommend the use of continuous subcutaneous insulin infusion or indwelling catheters (i-Port ®) in order to decrease lipohypertrophies(AU)

Spontaneous and induced abortion trends and determinants in the Northeast semiarid region of Brazil: a transversal series / Tendência de abortos espontâneos e induzidos na região semiárida do Nordeste do Brasil: uma série transversal

Abstract Objectives: this study intends to estimate the rates, associated factors and trends of selfreported abortion rates in the northeast of Brazil. Methods: series of population-based surveys realized in Ceará, northeast of Brazil, one of the poorest states in the country. A sample of about 27,000 women of reproductive age was used. Abortion was assessed according to women´s information and rates were calculated using official population estimates. The trends and the association among socioeconomic and reproductive factors were studied using regressive models. Results: a trend for reduction in rates was identified. For induced abortion, the determinants were: not having a partner, condom in the last sexual intercourse, first child up to 25years old (AOR= 5.21; ACI: 2.9 - 9.34) and having less than 13years old at first sexual intercourse (AOR= 5.88; ACI: 3.29 - 10.51). For spontaneous abortion were: having studied less than 8 years, knowledge and use of morning-after pill (AOR= 26.44; ACI: 17.9 - 39.05) and not having any children (AOR= 3.43). Conclusions: rates may have been low due to self-reporting. Young age and knowledge about contraceptive methods were associated to both kinds of abortion, while education level along with spontaneous and marital status with induced. Programs to reduce abortion rates should focus on single younger women with low education.

Resumo Objetivos: este estudo objetiva estimar as taxas, fatores associados e tendência das taxas de aborto no Nordeste do Brasil. Métodos: série de estudos transversais realizada no Ceará, um dos estados mais pobres do país. Uma amostra de cerca de 27000 mulheres em idade reprodutiva foi utilizada. A ocorrência de aborto foi aferida através de informação dada pela participante e taxas foram calculadas usando estimativas populacionais oficiais. As tendências e associações entre fatores socioeconômicos e reprodutivos foram estudadas através de modelos regressivos. Resultados: foi identificada tendência de redução nas taxas de abortamento. Para aborto induzido, os determinantes foram não ter um parceiro fixo, ter utilizado camisinha na última relação sexual, ter tido o primeiro filho com menos de 25 anos (AOR= 5,21; ACI: 2,9 - 9,34), e ter tido a primeira relação com menos de 13 anos (AOR= 5,88; ACI: 3,29 - 10,51). Para o espontâneo, ter estudado menos de oito anos, conhecimento sobre a pílula do dia seguinte (AOR= 26,44; ACI: 17,9 - 39,05), e não ter filhos (AOR= 3,43). Conclusões: as taxas podem ser subestimadas por serem auto relatadas. Estar na adolescência e ter conhecimento sobre métodos contraceptivos foram associados aos dois tipos de aborto, enquanto nível educacional com o espontâneo e estado conjugal com induzido. Programas para reduzir taxas de abortamento deveriam focar em mulheres solteiras e com baixa educação.

Brucelosis en Cochabamba, Bolivia. Primer estudio de prevalencia departamental / Brucellosis in Cochabamba, Bolivia. First regional prevalence study

Objetivo: establecer la prevalencia de serología positiva por ELISA IgG para Brucella spp y conocer la relación con factores asociados. Métodos: se realizaron ELISA IgG en 276 muestras del Banco de Sangre de Referencia - Cochabamba. Resultados: obtuvimos una prevalencia de 10,87/1 000 habitantes. Conclusiones: los datos de prevalencia obtenidos son congruentes con los reportados por otros países a nivel mundial.

Objective: to establish positive ELISA IgG seroprevalence for Brucella spp and to find associated risk factors. Method: 276 samples provided by the Banco de Sangre de Referencia - Cochabamba" underwent IgG ELISA. Results: we obtained a 10.87/1 000 prevalence rate result.Conclusions: data obtained by this study is consistent with the one reported by country worldwide.

The status of implementation of chain of survival and factors impacting on the outcome of cardiac arrest patients / 中华急诊医学杂志

Objective To evaluate the status of implementation of the chain of survival and the gap between the guideline's recommendations and clinical practice as well as to analyze the factors influencing the prognosis of cardiac arrest (CA) patients.Methods A retrospective analysis of CA in adult patients admitted to Emergency Department of Peking University Third Hospital from January 2012 to December 2013 was carried out.The epidemiology,clinical features,implementations of the chain of survival and outcome were compared between out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) patients,with regard to the analysis of the predictors for survival and neurological outcome.Results A total of 414 patients with 69.8％ male and average age of (61.7 ± 18.0) years were divided into two groups,OHCA group (n =190) and IHCA group (n =224).Cardiogenic cause was found in 30％ of CA patients.There were 27.5％ patients with restoration of spontaneous circulation (ROSC),8.2％ patients discharged in survival and 3.1％ patients with good neurologic outcome (CPC =1 and 2).There were higher proportion of medical responders arriving to CA patients within 5 minutes after onset (99.1％ vs.10.5％,P ＜0.01),bystander carrying out cardiopulmonary resuscitation (100％ vs.15.3％,P ＜0.01),CPR initiated in 5 minutes (98.7％ vs.11.1％,P ＜ 0.01),defibrillation performed in 5 minutes (87.5％ vs.12.5％,P ＜ 0.01) in IHCA group compared with OHCA.There were no statistical differences in epinephrine administration and epinephrine dose,and targeted temperature management between two groups.There were higher proportion of ROSC (37.1％ vs.16.3％,P ＜ 0.05),higher percentage of survivals discharged (31.0％ vs.22.6％,P =0.002) and good neurologic outcome with CPC =1 or 2 (48.1％ vs.0.0％,P =0.029) in IHCA group compared with OHCA.Location of CA occurred and initial arrhythmia rectifiable with defibrillation treatment after ROSC were the favorable predictors for assessing the percentages of ROSC and survivals discharged.In contrast,male and age over 65 years were the unfavorable predictors of ROSC.Conclusions Improvement in outcome of victims with CA is required in every link of the chain of survival,especially in prehospital rescue act,bystander carrying out CPR,defibrillation,and therapeutic hypothermia in unconscious patients after resuscitation.The effective implementation of chain of survival concept can improve the prognosis of CA patients.

Prevalence of dental caries and treatment needs among school going children of Chandigarh.

Introduction: Dental caries is the most common chronic disease of childhood that interferes with normal nutrition intake, speech, and daily routine activities. Dental caries is a lifetime disease, and the highest priority risk group is school children. Aim: To assess the prevalence of dental caries and treatment needs among school going children of Chandigarh. Materials and Methods: A cross-sectional study was done among school going children of Chandigarh in the age group of 3-17 years. The subjects were selected from four randomly selected schools. All the children from the selected schools were examined. A total of 4493 subjects formed the sample size. Dentition status was assessed using dft index by Gruebbel for primary dentition and DMFT index by Klein, Palmer, Knutson for permanent dentition, respectively. Chi-square test was used to find an association between the study variables. Independent t-test and one-way ANOVA were used to compare the mean difference. Results: Among the 4493 study subjects, caries prevalence was found to be 47.3%. Mean dft and DMFT score of the population was 1.06 ± 1.995 and 0.41 ± 1.022, respectively. When analyzing the treatment needs among various age groups 42.6% of the study subjects required oral prophylaxis and 45% required restorative procedures. Conclusion: Based on the findings, it can be concluded that high prevalence of caries was found in primary dentition than permanent dentition and most of the decayed teeth were untreated. This study emphasize the need for treating dental caries at its earliest possible stage and parents should be made aware of caries preventive measures for their children.

Radiographic analysis and prevalence of impacted maxillary canine teeth in children between 8 and 16 years / Análisis radiográfico y prevalencia de caninos maxilares retenidos en niños entre 8 y 16 años

The objective of this study was to determine the prevalence of impacted maxillary canines and analyze variables associated with its retention in panoramic radiographs. Manual and Retrospective observational study of 16,835 records. A sample of 1,353 panoramic radiographs was obtained. The variables measured were canine angle, distance from the canine apex to occlusal plane, vertical and horizontal canine location. For reliable measurement an intra class Fleiss and Cohen correlation coefficient was used (0.997). Prevalence was 2.3%. 31 subjects had one or both retained canines. Average age 10.77±2.45, 61.3% were women. 64.5% presented unilateral retaining of which the largest percentage was left. A total of 41 retained canines were observed. Distance to occlusal plane 19 mm on average. In relation to the vertical location the highest percentage (48.7%) was found in the apical third. Regarding the horizontal location the highest percentage (77.6%) was found in sectors 1, 2 and 3. When analyzing the canine angle it was found that 83% measured 31 degrees or more. Radicular resorption was observed in 2 lateral incisors. The prevalence found is similar to that reported in the international literature. It occurred more frequently in women and left unilateral both not statistically significant.

El objetivo de este trabajo fue determinar la prevalencia de dientes caninos maxilares retenidos y analizar variables asociadas a su retención, en radiografías panorámicas. Se realizó un estudio observacional retrospectivo y manual de 16.835 fichas. Se obtuvo una muestra de 1.353 radiografías panorámicas. Las variables medidas fueron ángulo del canino, distancia de la cúspide del canino al plano oclusal, localización vertical y horizontal del canino. Para la fiabilidad de las mediciones se usó el coeficiente de correlación intraclase de Fleiss & Cohen (0,997). La prevalencia fue 2,3%. Treinta y un sujetos presentaron 1 o ambos caninos retenidos. La edad promedio fue 10,77±2,45, y el 61,3% fueron mujeres. El 64,5% presentó retención unilateral, principalmente del lado izquierdo. Se observó un total de 41 caninos retenidos. La distancia al plano oclusal en promedio fue 19 mm. En relación a la localización vertical, el mayor porcentaje (48,7%) se encontró en el tercio apical. Respecto a la localización horizontal, el mayor porcentaje (77,6%) se encontró en los sectores 1, 2 y 3. Al analizar el ángulo canino, se encontró que 83% midió 31 o más. Se observó reabsorción radicular de dos incisivos laterales. La prevalencia encontrada es similar a la reportada en la literatura internacional. La retención se presentó con mayor frecuencia en mujeres y de manera unilateral en el lado izquierdo, pero en ambos casos no es significativa.

The prevalence of tic disorders in children and adolescents in Brazil / A prevalência dos transtornos dos tiques em crianças e adolescentes no Brasil

Tourette syndrome (TS) and tic disorders represent events of familiar magnitude characterized by involuntary movements and/or vocalization. To determine the prevalence of TS/tic disorders we studied a sample of 762 subjects (388 M, 374 F), between 1992 and 1997, age 6 to 43 years old, taken out of a population of 10,155 subjects (4,918 M, 5,237 F; age: 3-56 years old). A structured 4-item questionnaire, direct interview (multistaged), >1 yr follow-up, were used. 9,565 subjects (4,614 M, 4,951 F) sent back the questionnaires, 3,354 of these (1,671 M, 1,683 F) with positive answers to tics. 42 subjects (31 M, 11 F, age: 7-21 years old, mean: 11 years old) met the DSM-III-R criteria. The total minimal prevalence of TS is 0.43%, with a 3:1 ratio male/female. The minimal prevalence of chronic tic disorder is 2.27%. The total minimal prevalence for tic disorders at all is 2.91%. No special education students participation.

Síndrome de Tourette e transtornos de tiques representam eventos de magnitude familiar caracterizados por movimentos involuntários e/ou vocalização. Para determinar a prevalência de TS/transtornos de tiques, estudamos uma amostra de 762 indivíduos (286 M, 376 F), entre 1992 e 1997, de 6 a 43 anos de idade, retirados de uma população de 10.155 indivíduos (4.918 M, 5.237 F, idade: 3-56 anos). Questionário de avaliação inicial (4 itens), entrevista direta, follow-up >1 ano, foram utilizados. 9.565 indivíduos (4.614 M, 4.951 F) retornaram seus questionários, 3.354 (1.671 M, 1.683 F), com respostas positivas para tiques. 42 sujeitos (idade 31 M, 11 F, 7-21 anos, média: 11 anos) preencheram os critérios diagnósticos do DSM-III-R. A prevalência total mínima para TS é de 0,43% (3 M:1 F), e para transtornos de tiques crônicos é de 2,27%. A prevalência total mínima para transtornos dos tiques é 2,91%. Nenhuma participação de estudantes de classe especial.

Ideación suicida en estudiantes de medicina: prevalencia y factores asociados / Suicide Ideation Among Medical Students: Prevalence and Associated Factors

Introducción: Los médicos tienen mayores tasas de suicidio en comparación con la población general. Este riesgo tiende a incrementarse incluso a partir del inicio de la formación de pregrado en medicina. Existen pocos estudios que evalúen la frecuencia de conductas suicidas en estudiantes de pregrado de medicina, especialmente en Latinoamérica. Objetivo: Determinar la prevalencia de vida y factores asociados con la ideación suicida e intentos suicidas en una muestra de estudiantes de medicina de Bucaramanga, Colombia. Materiales y métodos: Se condujo un estudio observacional analítico de corte transversal, para determinar la prevalencia de vida de ideación suicida e intentos suicidas, en una muestra no probabilística de estudiantes de medicina matriculados en las 3 facultades de medicina de Bucaramanga. El cuestionario autoaplicado fue respondido de forma voluntaria y anónima por los participantes. Las versiones validadas de las escalas CES-D y CAGE fueron utilizadas para evaluar síntomas depresivos y uso problemático de alcohol, respectivamente. Se generó un modelo multivariado de regresión logística, con el fin de ajustar los estimadores de las variables asociadas con el desenlace «ideación suicida alguna vez en la vida¼. Resultados: La muestra de estudio estuvo formada por 963 estudiantes. El 57% (n = 549) de los participantes fueron mujeres. El promedio de edad fue de 20,3 años (DE 2,3 años). En relación con la prevalencia de ideación suicida, el 15,7% (n = 149) de los estudiantes informó haber tenido por lo menos un episodio de ideación suicida serio a lo largo de la vida. El 5% (n = 47) señaló haber realizado por lo menos un intento suicida. El 13,9% (n = 131) de los estudiantes informó haber ingerido antidepresivos durante su entrenamiento médico. Las variables asociadas con la ideación suicida en el modelo de regresión logística fueron: síntomas depresivos clínicamente significativos (OR: 6,9; IC 95%: 4,54-10,4), historia de consumo de sustancias psicoactivas ilícitas (OR: 2,8; IC 95%: 1,6-4,8) y percepción del regular o mal rendimiento académico durante el último año (OR: 2,2; IC 95%: 1,38-3,63). El modelo de regresión logística clasificó correctamente al 85% de los sujetos con antecedente de ideación suicida. Conclusión: La ideación suicida es un fenómeno de frecuente ocurrencia en estudiantes de medicina. Es necesario que las facultades de medicina establezcan programas de detección e intervención temprana que permitan disminuir la probabilidad de ocurrencia de desenlaces negativos.

Introduction: It is well documented that physicians have higher rates of suicide than the general population. This risk tends to increase even from the beginning of undergraduate training in medicine. There are few studies evaluating the frequency of suicidal behaviors in undergraduate medical students, particularly in Latin America. Objective: To determine the lifetime prevalence and the variables associated with suicidal ideation and suicide attempts in a sample of medical students from the city of Bucaramanga, Colombia. Materials and methods: An analytical cross-sectional observational study was conducted to determine the lifetime prevalence of suicidal ideation and suicide attempts in a nonrandom sample of medical students enrolled in three medical schools in Bucaramanga. A self-administered questionnaire was voluntarily and anonymously answered by the participants. Validated versions of the CES-D and CAGE scales were used to assess the presence of depressive symptoms and problematic alcohol use, respectively. A multivariate logistic regression model was generated in order to adjust the estimates of variables associated with the outcome «suicidal ideation in life¼. Results: The study sample consisted of 963 medical students, of which 57% (n = 549) of the participants were women. The average age was 20.3 years (SD = 2.3 years). Having had at least one episode of serious suicidal ideation in their lifetime was reported by 15.7% (n = 149) of the students, with 5% (n = 47) of the students reported having made at least one suicide attempt. Having taken antidepressants during their medical training was reported by 13.9% (n = 131) of the students. The variables associated with the presence of suicidal ideation in the logistic regression model were: clinically significant depressive symptoms (OR: 6.9, 95% CI; 4.54-10.4), history of illicit psychoactive substance use (OR 2.8, 95% CI; 1.6-4.8), and perception of poor academic performance over the past year (OR: 2.2, 95% CI; 1.4-3.6). The logistic regression model correctly classified 85% of the subjects with a history of suicidal ideation. Conclusion: Suicidal ideation is a frequently occurring phenomenon in medical students. Medical schools need to establish screening procedures for early detection and intervention of students with emotional distress and suicide risk.

Trabalho e saúde mental dos profissionais da Estratégia Saúde da Família em um município do Estado da Bahia, Brasil / Mental health and work of Family Health Strategy professionals from a municipal district of Bahia State, Brazil

As características do trabalho na Estratégia Saúde da Família (ESF) são complexas e ainda há poucos estudos que abordam a temática. OBJETIVO: descrever características sociodemográficas e do trabalho e a prevalência de Distúrbios Psíquicos Menores (DPM) e de positivos ao teste CAGE (abuso no consumo de álcool) entre médicos, enfermeiros e cirurgiões-dentistas da ESF de Feira de Santana, Bahia. METODOLOGIA: estudo epidemiológico de corte transversal que utilizou questionário padronizado, não identificado, para descrever: o perfil sociodemográfico; as características do trabalho na ESF; a saúde mental e o uso abusivo de bebidas alcoólicas utilizando o Self Reporting Questionnaire (SRQ-20) e o Teste CAGE,. Os dados foram analisados no Statistical Package for Social Scince (SPSS). RESULTADOS: Entre os 152 respondentes, que correspondem a uma taxa de resposta de 86,4%, a prevalência de DPM foi de 16,0%. Entre os médicos, foi de 17,4%; entre os enfermeiros, de 15,5%; e 15,2% entre os cirurgiões-dentistas. Quanto ao uso abusivo de bebida alcoólica, os médicos apresentaram prevalência de 5,0% e os cirurgiões-dentistas de 7,7%. Os resultados apontaram o predomínio do sexo feminino, de adultos jovens, casados, com vínculo cooperativado, carga horária semanal elevada e mais de um vínculo empregatício. CONCLUSÃO: A prevalência de DPM e de positivos ao teste CAGE observada na população estudada foi menor do que a encontrada em outros estudos.

To date, few studies have looked into the complex aspects of work at the Family Health Strategy (FHS). OBJECTIVE: To describe sociodemographics, work aspects, Minor Psychiatric Disorders (MPD), and CAGE positivity (alcoholism) among physicians, nurses and dentists working with FHS in Feira de Santana (Bahia, Brazil). METHODS: Cross-sectional study using standard questionnaires (SRQ-20 and CAGE) to collect anonymous information on the sociodemographic profile, work aspects, mental health, and alcohol consumption. Data were analyzed with SPSS. RESULTS: Based on 152 respondees (response rate: 86.4%), the overall prevalence of MPD was 16.0% (physicians=17.4%, nurses=15.5%, dentists=15.2%). The prevalence of alcoholism was 5.0% among physicians and 7.7% among dentists. The characteristics "female", "young adult", "married", "affiliated to a cooperative", "long work week" and "more than one job" predominated in this population. CONCLUSION: the prevalence of MPD and CAGE positivity was smaller in our sample than in other similar studies.

Adverse reactions following mass drug administration with diethylcarbamazine in lymphatic filariasis endemic areas in the Northeast of Brazil / Reações adversas após tratamento em massa com dietilcarbamazina em áreas endêmicas de filariose linfática no nordeste do Brasil

INTRODUCTION: The Global Programme to Eliminate Lymphatic Filariasis was launched with the goal of eliminating this disease via the annual mass drug administration (MDA) of a single dose of antifilarial drugs. Adverse drug reactions following MDA are a major factor of poor treatment adherence in several countries. This study assessed the occurrence of adverse drug reactions (ADRs) following the first round of mass treatment in two communities treated with different dosages of diethylcarbamazine (DEC) in the City of Recife, Brazil. METHODS: Population-based cross-sectional surveys were conducted in a random sample of the population living in both communities (Areas I and II). The dose of DEC recommended by the WHO (6mg/kg) was calculated based on the individual's weight-for-age. In Area II, weight differences between the genders were also considered when determining dosage. Data were obtained through interviews conducted in the first 12 to 48h and on the 5th day after MDA during household visits. RESULTS: A total of 487 and 365 individuals were interviewed in Areas I and II, respectively. The prevalence of ADRs in Area I (23.6; 95%CI: 19.1-29.5) was higher than in Area II (16.2; 95%CI:11.9-21.5)(p=0.0078). The prevalence of ADRs among females was higher than in males in Area I (p=0.0021). In Area II, no significant difference between the genders was observed (p=0.1840). Age was not associated with ADRs in either area. CONCLUSIONS: Adjusting MDA dosage schedules according to weight-for-age and sex may be may contribute to reduce the occurrence of adverse drug reactions in the population.

INTRODUÇÃO: O Programa Global de Eliminação da Filariose Linfática foi lançado visando à eliminação da doença pela administração de medicamentos em massa (MDA). As reações adversas seguidas ao MDA são um importante fator de baixa adesão ao tratamento em vários países. Este estudo avaliou a ocorrência de reações adversas medicamentosas (ADRs) após a primeira dose de tratamento em massa em duas comunidades tratadas com diferentes doses de dietilcarbamazina (DEC), na Cidade de Recife, Brasil. MÉTODOS: Estudos transversais foram realizados em uma amostra aleatória da população de duas áreas (Áreas I e II). A dose de DEC recomendada pela OMS (6mg/kg) foi calculada com base em parâmetros populacionais de peso para a idade. Na Área II, diferenças de peso entre os sexos também foram consideradas no cálculo. Dados foram obtidos através de entrevistas nas primeiras 12 às 48h e 5º dia após o tratamento durante visitas domiciliares. RESULTADOS: Um total de 487 e 365 pessoas foi entrevistado nas Áreas I e II, respectivamente. A prevalência de ADRs na Área I (23,6; IC95%: 19,1-29,5) foi maior do que na Área II (16,2; IC 95%:11,9-21,5)(p=0,0078). Na Área I, a prevalência de ADRs foi maior nas mulheres do que nos homens (p=0,0021), não se observando diferença na Área II (p=0,1840). Idade não esteve associada à ADRs. CONCLUSÕES: Doses de tratamento em massa (MDA) ajustadas por peso para a idade e sexo parecem contribuir para redução da ocorrência de ADRs na população.

Prevalence of sleep disorders among 3173 elderly in Taiyuan city:a cross-sectional study / 中华流行病学杂志

Objective To investigate the prevalence rates of sleep disorders and the correlatives in the elderly from Taiyuan city.Methods All of the 3173 elderly (aged 60 years to 100 years) in Taiyuan city were investigated at home through questionnaires,regarding their sleep condition.Subjects with sleep disorders were then screened through questionnaires and reexamined/diagnosed by special doctors.Results (1) Among the 3173 elderly,2132 subjects complained of having sleep disorders.The total prevalence of sleep disorders was 67.2%.The prevalence rates of chronic insomnia,multi-dreams,habitual snoring and daytime drowsiness were 39.65%,38.58%,26.66% and 34.32% respectively.(2)In the male elderly,the prevalence rates of being awaken early,having more urination at night,daytime drowsiness,sleep-respiratory disturbance and indiscriminate sleep rhythm increased with age(P＜0.01).However,in the female elderly,the prevalence rates of being awaken early,having daytime drowsiness and indiscriminate sleep rhythm also had a tendency of increase (P＜0.01).(3) Living alone,emotional disorder,pain and nocturia (P＜0.01) were the risk factors of chronic insomnia in the male elderly while living alone,numbness/pruritus(P＜0.01),emotional disorder (P＜0.05),were the risk factors of chronic insomnia in the female elderly.Conclusion The prevalence rates of some sleep disturbances in the elderly in Taiyuan city were generally correspondent with prevalence rates reported elsewhere that called for more attention be paid to the effect of mood disturbance and diseases related to sleep condition among the eldexly.

A Cross-Sectional Study of Senile Dementia in Shanghai / 中国康复理论与实践

@#ObjectiveTo investigate the epidemiology of senile dementia in Shanghai.Methods15158 residents aged 65 or over were selected by stratified random cluster sampling from 3 districts in Shanghai. Two stages was carried to ascertain dementia: in the first stage, Mini Mental State Examination (MMSE) and Activity of Daily Living Scale (ADL) were used as screening tools; in the second stage, DSM-Ⅳ criteria for dementia was applied to diagnosis.ResultsScreening positive rate of MMSE and ADL are both 9.9%. 1271 cases of elderly with dementia were identified. The crude and age-standardized prevalence in residents aged 65 or over was 8.1% and 6.1%. The female, older age, lower education and worse marriage seemed to be more susceptible to senile dementia(P<0.01).ConclusionSenile dementia has become one of major diseases harmful to elderly's health.

Epidemiological study on disability caused by injury in the Chinese population / 中华流行病学杂志

Objective To describe and analyze the prevalence and epidemiological features of people with disability caused by injury in the Chinese population, and to provide scientific basis for developing the prevention and control programs on injuries. Methods Statistics and infervention measures were used to analyze the data from the Second China National Sample Survey on injury-caused Disability. Cluster analysis was used to analyze the differences in regions. Results The overall prevalence of disability caused by injury was 99.68/10 000 which occupied 15.59% of all the disability, with multiple disability excluded. Physical disability and hearing disability accounted for 65.59% and 23.35% of all the injury-caused disability respectively, while those ranked Grade Ⅳ and Ⅲ making up the majority(55.14% and 25.83%)of the disability, respectively. There were significant differences in the distribution of injury-caused disability among different age groups(x2= 23 106.14,P＜0.001)and gender(x2=2161.74, P＜0.001). Ageing and being males having a higher risk on injury- caused disability. Five clusters were identified by cluster analysis, in which injury-caused disability were severe in the fifth(Sichuan province)and the fourth clusters(Hunan, Chongqing,Guizhou, Ningxia province). Conclusion Problems discovered by injury-caused disability in the Chinese population should not be ignored. Both physical and hearing disabilities appeared to be the two main types of disability while age, gender and region were related to injury-caused disability.Targeted strategies should be developed to decrease the injury-caused disability in China.

Epidemiologia, clínica e imunologia da infecção humana por Leishmania (Leishmania) infantum chagasi em área edêmica de leishmaniose visceral no Pará / Epidemiologic, clinical and immunologic on the human Leishmania (Leishmania) infantum chagasi infection in edemic area of visceral leishmaniasis in Pará

Objetivos: identificar portadores àe infecção assintomática e/ou sintomática por Leishmania (L.) i. chagas i, em área endêmica de leishmaniose visceral americana (LVA), Barcarena, Pará e avaliar a infecção do pontode vista clínico-imunológico e determinar a prevalência da infecção. Método: estudo seccional de 946 indivíduos, ambos os sexos, ≥1 ano de idade, utilizando-se a reação intradérmica de Montenegro (RIM) e reação de imunofluorescência indireta (RIFI) para diagnóstico da infecção. Resultados: foram diagnosticados 120 casos da infecção, com prevalência de 12.6%; 8 casos apresentaram alta soro-reatividade (1.280 a 10.240, IgG) para RIFI e ausência de reatividade para RIM, sendo 4 casos típicos de LVA e outros 4 infecção sub-clínica oligosintomática. Conclusão: os dois métodos imunodiagnósticos analizados, simultaneamente, com exame clínico dos infectados, permitiram identificar 5 perfis clínico-imunológicos: infecção assintomática (IA) 73.4%; infecção sub-clínica resistente (ISR) 15%; infecção sub-clínica oligosintomática (ISO) 3%; infecção sintomática (= LVA) 3% e infecção inicial indeterminada (III) 5%.

Objectives: the objectives ofthe study were i) to identify individuais with the symptomatic and/or asymptomatic infection due to Leishmania (L.) chagasi,ii) to study the two types of infection, both clinically and immunoiogically, and iii) to determine the prevalence of infection at the beginning of the study. Methods: this was a transectional study ofa cohort of 946 individuals of both sexes, from one year old and upwards, living in endemic area of American visceral leishmaniasis (AVL), municipality of Barcarena, Pará, Brazil. For the diagnosis of infection, there were used the delayed hypersensitivity skin reaction (LST) and the indirect fluorescent antibody test (IFAT). Results: there were diagnosed 120 cases of infection, with the prevalence of 12.6%; 8 cases showed high sero-reactivity (1.280 to 10.240, IgG) to IFAT and no reaction to LST; being 4 cases of typical AVL and other 4 cases of sub-clinical oligosymptomatic infection Conclusion: the two immunodiagnostic methods used, simultaneously, with the clinical examination enabled to identify, 5 clinical-immunological profiles: Asymptomatic Infection (AI) 73.4%; Sub-clinical Resistant lnfection (SRI) 15%, Sub-clinical Oligosymptomatic lnfection (SOI) 3%; Symptomatic Infection (= AVL) 3% and, Indeterminate Initial Infection (III) 5%.

Prevalência de hipertensão intracraniana e seguimento ambulatorial de pacientes com meningite aguda internados em UTI pediátrica / Prevalence of intracranial hypertension and outpatient clinics follow up of patients with acute meningitis at Pediatric Intensive Care Unit

Objetivo: Este trabalho tem o objetivo de mostrar a prevalência de hipertensão intracraniana e o seguimento ambulatorial de pacientes com meningite bacteriana internados em UTI pediátrica. Casuística e método: Foram revisados os registros médicos dos pacientes que apresentaram quadro de meningite que necessitaram de internação na UTI Pediátrica do Hospital de Clínicas de Porto Alegre (HCPA) no período de janeiro de 1985 a junho de 2001. Além do diagnóstico de meningite e da ocorrência de hipertensão intracraniana (HIC), pesquisou-se também agente etiológico, sexo, cor, idade na época da internação, tempo de internação, tratamento e acompanhamento ambulatorial. Resultados: Houve uma prevalência de 15% de HIC nos 187 casos de meningite bacteriana. Nos pacientes com HIC, o tempo de internação foi maior, assim como a freqüência de convulsões, de etiologia pneumocócica, lesão cerebral motora, glicorraquia diminuída e de proteinorraquia aumentada no líquor (p < 0,05). Discussão: Deve sempre haver uma forte suspeição clínica para a ocorrência de HIC nos casos de meningite, independente do seu agente etiológico ou mesmo quando houver dúvida quanto à natureza bacteriana da meningite. HIC por si só pode estar relacionada a comprometimento do parênquima cerebral bem como pode ser um marcador para forte reação inflamatória ocorrendo no SNC que pode levar a dano neurológico permanente (AU)

Objective: We demonstrate the prevalence and ambulatorial follow up of patients in intensive care unity with acute bacterial meningitis (ABM) diagnosis with the appearing of intracranial hypertension (HIC). Method: medical papers from inpatients with acute bacterial meningitis at Pediatric Intensive Care Unit from Hospital de Clínicas de Porto Alegre from January 1985 to June 2001. The outcomes were prevalence of intracranial hypertension, ethiologic agent, sex, race, age of diagnosis, internation time, treatment and ambulatorial follow up. Results: there was 15% of HIC prevalence in the 187 cases of ABM. Internation time, seizures occurrence, pneumococal ethiology, cerebral motor injury, low levels of lichoric glucosis and protein from liquor were elevated in pacients with HIC in comparison to controls (p < 0,05). Discussion: occurrence of HIC must be suspected in the cases of ABM, independent of ethiologic agent. HIC per se migth be related to a cerebral parenchyma injury as well be a reliable inflamatory reaction marker (AU)

STUDY ON EPIDEMIOLOGY OF STROKE IN URBAN AND RURAL AREAS OF CHINA: AN ANALYSIS OF PREVALENCE RATES IN 1986 / 解放军医学杂志

Point prevalence rate of complete stroke on December 31, 1986 in China was investigated using a retrospecive section study for 5 814 851 people of 29 provinces and cities (excluding Taiwan province), and 14275 stroke cases were found. Point prevalence rate was 245.49 per 100000 people with 95% CI (confidence interval) 241.57-249.61 per 100000 people. The rate standardized by the constituent ratio of population between city and rural area of China in 1986 was 247.66 per 100000 people. The rate age-standardized by the population of China in 1982 accounted for 191.92 per 100000 and the rate agestandardized by the world standard population was 259.86 per 100000 people.It has also been found that there was a tendency for the prevalence rates to increase gradually from south to north and to decrease progressively from east to west. The linear regression models have been fitted between the point prevalence rates and latitude or longitude respectively. The results were Y= 12.3819?-1107.38 (tb = 4.65 df = 5 P = 0.0056) for longitudes and Y = 12.6279?-146.6266 (tb = 11.7517 df = 4 P = 0.0003) for latitudes. There was a difference statistically among various topographic areas. The prevalence rate was much higher in urban areas than rural areas and much higher in men than in women. The prevalence rate increased with age and their relationships have been fitted well with the logistic curve.