Estudo de base populacional sobre mortalidade infantil / Population-based study on infant mortality

Resumo Embora o Brasil tenha diminuído na última década as disparidades sociais, econômicas e de indicadores de saúde, as diferenças intra e inter-regionais das taxas de mortalidade infantil (TMI) persistem em regiões como a capital do estado de Mato Grosso. Estudo de base populacional que objetivou investigar fatores associados à mortalidade infantil em cinco coortes de nascidos vivos (NV) de mães residentes em Cuiabá (MT), Brasil, 2006-2010, através de linkage probabilístico em 47.018NV. Utilizou-se regressão logística, por meio de análise hierarquizada. Dos 617 óbitos infantis, 48% ocorreram no período neonatal precoce. A TMI variou de 14,6 a 12,0 óbitos por mil NV. Permaneceram independentemente associados ao óbito: mães sem companheiro (OR = 1,32); baixo número de consultas de pré-natal (OR = 1,65); baixo peso ao nascer (OR = 4,83); prematuridade (OR = 3,05); Apgar ≤ 7 no 1º minuto (OR = 3,19); Apgar ≤ 7 no 5º minuto (OR = 4,95); malformação congênita (OR = 14,91) e sexo masculino (OR = 1,26). Houve redução da mortalidade infantil em Cuiabá, porém, há necessidade de direcionamento de políticas públicas de saúde de assistência no período pré-natal e perinatal para alcançar a diminuição da mortalidade neonatal precoce e novos estudos para identificar quais as causas de óbitos evitáveis.

Abstract Although Brazil has reduced social, economic and health indicators disparities in the last decade, intra- and inter-regional differences in child mortality rates (CMR) persist in regions such as the state capital of Mato Grosso. This population-based study aimed to investigate factors associated with child mortality in five cohorts of live births (LB) of mothers living in Cuiabá (MT), Brazil, 2006-2010, through probabilistic linkage in 47,018 LB. We used hierarchical logistic regression analysis. Of the 617 child deaths, 48% occurred in the early neonatal period. CMR ranged from 14.6 to 12.0 deaths per thousand LB. The following remained independently associated with death: mothers without companion (OR = 1.32); low number of prenatal consultations (OR = 1.65); low birthweight (OR = 4.83); prematurity (OR = 3.05); Apgar ≤ 7 at the first minute (OR = 3.19); Apgar ≤ 7 at the fifth minute (OR = 4.95); congenital malformations (OR = 14.91) and male gender (OR = 1.26). CMR has declined in Cuiabá, however, there is need to guide public healthcare policies in the prenatal and perinatal period to reduce early neonatal mortality and further studies to identify the causes of preventable deaths.

Reference index and reduction in physical fitness tests proposed by proesp-br

The purpose of this study was to create an unifying index of the PROESP-BR tests for school aged teenagers and propose a reduction in the physical fitness tests. A total of 414 adolescents between the ages of 15 and 17 years old, representative of the public school population in the city of Cuiaba were evaluated. The tests include general physical fitness, proposed by PROESP-BR. Multivariate factorial analysis was used, observing the commonality/representativeness of each test with regard to the set, and the index was created for girls and boys. With this analysis we can choose to use the following tests: female - throwing medicine ball, horizontal jump and run 20 meters; male - throwing medicine ball, representing the overall performance. The created index was divided into quintiles and allowed you to view the whole performance of the six tests, as well as their distribution within the group and away from the ideal reference.

Desempenho nas habilidades da linguagem em crianças nascidas prematuras e com baixo peso e fatores associados / Language abilities performance of children born preterm and low birth weight and associated factors

Objetivo: Analisar as habilidades do desenvolvimento da linguagem em crianças de 2 a 3 anos de idade, nascidas prematuras e com baixo peso e os fatores de risco associados. Métodos Estudo transversal com aplicação do teste de Denver II (Denver Developmental Screening Test) e escala ELM (Early Language Milestone Scale). Foi utilizado o teste de Qui-quadrado e todas variáveis com p<0,20 entraram no modelo de regressão logística binária, nível de significância (p<0,05). Resultados: Das 77 crianças avaliadas, 36,4% apresentaram desempenho global alterado no teste de Denver II, considerando os quatro setores, e 37,6% apresentaram cautelas e atrasos no setor da linguagem, especificamente na avaliação da habilidade de linguagem pela escala ELM, 32,5% das crianças apresentaram alterações. O desempenho alterado, considerando os quatro setores do teste de Denver II e da linguagem na escala ELM, após regressão logística, permaneceu associado com: suspeita dos pais de alterações no desenvolvimento (Denver II e ELM); peso <1500 g e cesariana (Denver II somente); hemorragia intracraniana e renda familiar mensal per capita ≤1/2 salário mínimo (ELM somente). Conclusão Crianças nascidas prematuras e com baixo peso apresentaram atraso na aquisição de habilidades no desenvolvimento da linguagem, com maior comprometimento da função auditiva expressiva, associado a fatores de risco socioeconômicos e de histórico. .

Purpose : To examine the language development at chronological age 2 to 3 years of children born preterm with low birth weight and its associated risk factors. Methods In this cross-sectional study, children were assessed using the Denver Developmental Screening Test (Denver II test) and Early Language Milestone Scale (ELM scale). The chi-square test was used and all variables with p<0.20 were entered in a binary logistic regression model; statistical significance was set at p<0.05. Results Among the 77 children studied, 36.4% had abnormal Denver II test performance in its four sectors and 37.6% had cautions and delays in the area of language specifically. On assessment of language ability by the ELM scale, 32.5% of the children showed altered responses. The abnormal performance of the four sectors of the Denver II and language in the ELM scale, after logistic regression, remained associated with suspected developmental abnormalities by parents (Denver II and ELM), weight less than 1500 g and caesarean section (Denver II only), and intracranial hemorrhage and family per capita income less than half the minimum wage (ELM only). Conclusion Children born preterm with low birth weight showed delayed language development, with greater impairment in the expressive auditory function associated with socioeconomic risk factors and child’s history. .

Purpose: To examine the language development at chronological age 2 to 3 years of children born preterm with low birth weight and its associated risk factors. Methods In this cross-sectional study, children were assessed using the Denver Developmental Screening Test (Denver II test) and Early Language Milestone Scale (ELM scale). The chi-square test was used and all variables with p<0.20 were entered in a binary logistic regression model; statistical significance was set at p<0.05. Results Among the 77 children studied, 36.4% had abnormal Denver II test performance in its four sectors and 37.6% had cautions and delays in the area of language specifically. On assessment of language ability by the ELM scale, 32.5% of the children showed altered responses. The abnormal performance of the four sectors of the Denver II and language in the ELM scale, after logistic regression, remained associated with suspected developmental abnormalities by parents (Denver II and ELM), weight less than 1500 g and caesarean section (Denver II only), and intracranial hemorrhage and family per capita income less than half the minimum wage (ELM only). Conclusion Children born preterm with low birth weight showed delayed language development, with greater impairment in the expressive auditory function associated with socioeconomic risk factors and child’s history. .

Efeito de dietas hiperlipídicas com extrato de baru e chocolate sobre a área de adipócitos de ratos submetidos ao exercício físico / Effects of high fat diets with baru extract and chocolate on adipocyte area of rats subjected to physical exercise

INTRODUÇÃO: O acúmulo de tecido adiposo provoca uma série de distúrbios metabólicos, os quais poderiam ser atenuados pela modulação dietética e prática de exercícios físicos. OBJETIVO: Avaliar os efeitos de dietas hipercalóricas/hiperlipídicas com extrato de baru e chocolate associadas ao exercício aeróbio sobre a área de adipócitos e triglicérides hepáticos (TGLhep) de ratos. MÉTODOS: Após o desmame, ratos da linhagem Wistar, com exceção dos controles (dieta Nuvilab®; 3,48kcal/g), foram alimentados com dieta à base de chocolate (4,17kcal/g), por dois meses, para indução da obesidade. Feito isso, os animais foram distribuídos em seis grupos: controle sedentários (CS), controle exercitados (CE), baru sedentários (BS), baru exercitados (BE), chocolate sedentários (CHOS), chocolate exercitados (CHOE), de acordo com a introdução da dieta com extrato de baru e treinamento de natação (2% do peso corporal., 8 sem., 5x/semana, 1h/sessão). Após a morte dos animais, o conteúdo de TGLhep foi determinado e os tecidos adiposos retroperitoneal, inguinal e omental foram removidos, pesados e submetidos à avaliação da área de adipócitos. RESULTADOS: As dietas hipercalóricas aumentaram o peso e a área de células do tecido retroperitoneal em relação à dieta controle (p < 0,05). O exercício reduziu a área de células do tecido omental (CHOE: 6.370,91 ± 7.776,13 < CHOS: 7.341,28 ± 5.862,24µm²) e inguinal (CHOE: 5.147,49 ± 5.712,71 < CHOS: 7.083,11 ± 7.682,40µm²) do grupo chocolate e inguinal do controle (CE: 2.212,87 ± 1.920,34 < CS: 3.386,11 ± 3.973,09µm²). O conteúdo de TGLhep dos animais sedentários apresentou-se mais elevado em relação aos animais exercitados e alimentados com as dietas hipercalóricas (BS: 1,36 ± 0,50 > BE: 0,88 ± 0,43mg.100mg-1; CHOS: 1,77 ± 0,64 > CHOE: 0,86 ± 0,41mg.100mg-1). CONCLUSÃO: O treinamento físico em intensidade leve à moderada reduziu significativamente os depósitos adiposos omental (visceral) e inguinal dos animais alimentados com dieta controle e chocolate. Esse mesmo comportamento não foi reproduzido com a dieta à base de extrato de baru. Os animais exercitados apresentaram menor conteúdo de TGLhep, mesmo na persistência das dietas hiperlipídicas/hipercalóricas.

INTRODUCTION: Fat tissue accumulation provokes several metabolic disorders, which may be attenuated by dietetic modulation and physical exercise. OBJECTIVE: The effects of hypercaloric/hyperlipidic diets with additional baru extract associated to aerobic exercise on adipocytes from different regions as well as on hepatic triglycerides (TGLhep)of Wistar rats were evaluated. METHODS: The animals, except for the control ones (Nuvilab® diet: 3.48kcal/g), were fed with a chocolate-based diet (4.17 kcal/g) during 2 months in order to induce obesity. The animals were then distributed into 6 groups, according to the introduction of baru extract diet as well as to swimming training: Sedentary Control (SC); Trained Control (TC); Sedentary Baru (SB); Trained Baru (TB); Sedentary Chocolate (SCho) and Trained Chocolate (TCho). The trained animals were subjected to swimming exercise supporting overload equivalent to 2% of body weight, during 8 weeks, 5x/week, and 1h/day. At the end, the animals were killed and the TGLhep content was determined. The retroperitoneal (RET), inguinal (IN), and omental (OM) fat tissues were excised, weighted, and submitted to adipocyte area evaluation. RESULTS: The hypercaloric diet increased both body weight and cell areas of RET if compared to the control diet (P<0.05). The physical training decreased the OM (TCho: 6370.91 ± 7776.13 < SCho: 7341.28 ± 2.24 µm2) and IN (TCho: 5147.49 ± 5712.71 < SCho: 7083.11±7682.40 µm2) cell areas of chocolate group as well as IN cell areas of TC (TE: 2212.87 ± 1920.34 < SC: 3386.11 ± 3973.09µm²). The TGLhep contents of sedentary animals were higher in comparison to the trained rats fed with hypercaloric diets (SB: 1.36 ± 0.50 > TB: 0.88 ± 0.43mg.100mg-1; SCho: 1.77 ± 0.64 > TCho: 0.86 ± 0.41mg.100mg-1). CONCLUSION: In the conditions of the present study, the exercise training protocol seemed more effective than the diet protocol in attenuating lipid tissue accumulation in rats.

Comparação entre diferentes aparelhos de bioimpedância para avaliação do percentual de gordura / Comparison between different instruments for evaluation bioimpedance fat percentage

A bioimpedância (BIA) tetra polar de corpo inteiro é tida como um equipamento com melhor acurácia para a avaliação da composição corporal, porém, seu alto custo restringe sua utilização. Com isso, aparelhos de BIA com menor custo foram desenvolvidos. No entanto, a fidedignidade, confiabilidade e eficácia desses aparelhos ainda são controversas. O presente estudo objetivou comparar diferentes aparelhos de BIA para avaliação do percentual de gordura (%G) em universitários. Participaram do estudo 60 indivíduos (33 homens e 27 mulheres) com idade entre 18 e 38 anos (23,2±4,7 anos). Foram avaliados a massa corporal, a estatura e o índice de massa corporal (IMC=kg/m2). O %G foi determinado nos aparelhos de bioimpedância tetra polar de corpo inteiro Biodynamics® modelo 310 (BIO), de membros superiores OMRON® HBF 306BL (OMR) e de membros inferiores TANITA® FS088R (TAN). Utilizou-se para análise estatística o teste de Kruskal-Wallis para verificar a variância, análise de concordância através do Coeficiente de Correlação Intraclasse e plotagem de Bland-Altman. Não houve diferença estatística entre o %G obtido nos aparelhos BIO; OMR e TAN (16,4%, 14,5% e 17,3%; p=0,09) no grupo masculino e BIO; OMR e TAN (25,7%, 23,5 e 25,0%; p=0,36) para o grupo feminino. Além disso, houve correlação significativa entre os instrumentos TAN x BIO (0,76; p<0,0001), OMR x BIO (0,73; p<0,001) no grupo masculino e TAN x BIO (0,76; p<0,0001) e OMR x BIO (0,71; p<0,0001) no feminino. Foram observadas na plotagem de Bland-Altman diferenças médias próximas de zero. Não foram observadas diferenças significativas para o %G obtido pelos equipamentos de bioimpedância de corpo inteiro (Biodynamics®), de membros superiores (OMRON®) e de membros inferiores (TANITA®). Além disso, houve correlação forte e significativa entre os três aparelhos.

The bioelectrical impedance analysis (BIA) tetra polar body is taken as whole equipment with better accuracy in the assessment of body composition, but its high cost restricts their use. Yet, thetrustworthiness, reliability, and efficiency of these devices are still controversial. This study aimed atcomparing different BIA devices for the assessment of body fat percentage (%TBF) of college students. The study included 60 subjects (33 men and 27 women), ages between 18 and 38 years old (23.2±4.7 years). Weight, height, and body mass index (BMI=kg/m²) were assessed. The %TBF was determined byBiodynamics™ (BIO) full-body tetrapolar bioimpedance device, OMRON™ HBF 306 bl (OMR) upperbody bioimpedance device and TANITA™ FS088R (TAN) lower-body bioimpedance device. It was used for statistical analysis the Kruskal-Wallis test to check the variance, analysis of agreement by intraclasscorrelation and the Bland-Altman. There was no difference between the %TBF values provided by BIO, OMR and TAN devices for men (16.4%, 14.5% and 17.3%; p=0.09) and women (25.7%, 23.5 and 25%; p=0.36). Furthermore, there was a significant correlation between TAN x BIO (0.76; p<0.0001), OMR x BIO (0.73; p <0.001) devices among men, and TAN x BIO (0.76; p<0.0001) and OMR x BIO (0.71; p<0.0001) devices among women. Close to zero average differences were observed in the Bland-Altman plot. There were no significant differences between BIA devices used to determine the %TBF of these individuals. OMRON™ and TANITA™ devices are suitable for use in daily practice.