Survey of calcium supplementation to prevent preeclampsia: the gap between evidence and practice in Brazil.

BACKGROUND: Preeclampsia is a major cause of maternal and perinatal morbidity and mortality worldwide and especially in Latin America. High quality evidence indicates that calcium supplementation during pregnancy significantly reduces the incidence of preeclampsia and its consequences, including severe maternal morbidity and death. Few studies have assessed the implementation of this intervention in clinical practice. The study aimed to assess the proportion of pregnant women who received calcium supplements in Brazilian public antenatal care clinics. METHODS: This cross-sectional study interviewed women waiting for antenatal care visits in 9 public clinics in 4 Brazilian cities in 2010-2012. Trained interviewers used a standardized anonymous questionnaire to collect socio demographic and obstetric data, information on ingestion of dairy products and on prescriptions received during current pregnancy. RESULTS: A total of 788 valid questionnaires were analyzed. Participants were young (mean age 25.9), mostly multiparous (71.3%) and in the 2nd or 3rd trimesters of pregnancy at the time of interview (87.6%). Only 5.1% (40/788) had received a prescription for calcium supplements. Based on their reported ingestion of dairy products, the mean daily dietary calcium intake of the participants was 210 (+ 265) mg/day and over 90% consumed less than 1 g of calcium/day. CONCLUSIONS: Despite good quality evidence indicating the benefits of this practice especially for women with low calcium diets, less than 6% of a sample of women receiving antenatal care in Brazilian public clinics received a prescription for calcium supplements. There is an urgent need to upscale the implementation of this life-saving intervention.

Low-level laser therapy for treatment of pain associated with orthodontic elastomeric separator placement: a placebo-controlled randomized double-blind clinical trial.

OBJECTIVE: The objective of this study was to evaluate the effectiveness of the use of irradiation with a low-level laser therapy (LLLT), wavelength 830 nm, for treating pain inherent to tooth movement caused by orthodontic devices, simulated by positioning interdental elastomeric separators. METHODS: Sixty orthodontic patients were randomly assigned to two groups: GA (ages 12-25 years; mean 17.1 years) was the control, and GB (ages 12-26 years; mean 17.9 years) the intervention group. All patients received elastomeric separators on the mesial and distal surfaces of one of the lower first molars, and immediately after insertion of the separators received irradiation as randomly indicated. The intervention group (GB) received irradiation with LLLT (aluminum gallium arsenide diode), by a single spot in the region of the radicular apex at a dose of 2 J/cm(2) and application along the radicular axis of the buccal surface with three spots of 1 J/cm(2) (wavelength 830 nm; infrared). Control group (GA) received irradiation with a placebo light in the same way. This was a double-blind study. All the patients received a questionnaire to be filled out at home describing their levels of pain 2, 6, and 24 h and 3 and 5 days after orthodontic separator placement, in situations of relaxed and occluded mouth. RESULTS: The patients in the intervention group (LLLT) had lower mean pain scores in all the measures. The incidence of complete absence of pain (score=0) was significantly higher the intervention group. CONCLUSIONS: Based on this study, authors concluded that single irradiation with LLLT of wavelength 830 nm efficiently controlled the pain originating from positioning interdental elastomeric separators, to reproduce the painful sensation experienced by patients when fixed orthodontic devices are used.

Biological, behavioral, and socioeconomic factors associated with death from AIDS in Brasília, Brazil, in 2007.

INTRODUCTION: In the jurisdiction of Brasília, Brazil, significant reductions in mortality rates and lethality resulting from acquired immunodeficiency syndrome (AIDS) were observed shortly after the introduction of highly active antiretroviral therapy. In recent years, however, the decline of these rates has not been as significant. Non-adherence to treatment and delayed diagnosis appear to be the main factors that increase the risk of death from AIDS. Behavioral, socioeconomic, and biological factors could also be associated with increased risk of death due to AIDS. This study aimed to identify which of these factors were associated with deaths from AIDS in Brasília. METHODS: A case-control study was undertaken using the data recorded in the Information System of Notifiable Diseases. Cases consisted of AIDS deaths occurring in 2007, residing in Brasília, and over 12 years of age. Controls consisted of AIDS patients who did not die until December 31 2007, also residing in Brasília, and over 12 years of age. For each group, frequency and proportion tables for the variables were prepared. The statistical association of each factor in isolation with the occurrence of the deaths was verified through a model of multivariate analysis using logistic regression. RESULTS: The factors that were associated with an increased risk of death were intravenous drug use, age 50 years or more, and residing in a region whose residents have low per capita income. CONCLUSIONS: We identified factors associated with death due to AIDS that can guide health planning.

Brazilian health technology assessment bulletin: editorial process, dissemination strategies, critical appraisal, and initial impact.

OBJECTIVES: This study reports on the Brazilian experience of developing a specialized bulletin, the Brazilian Health Technology Assessment Bulletin (BRATS), on health technology assessments (HTA). METHODS: The editorial process, format, and dissemination strategy of the publication are presented. A critical appraisal of the available issues was made using the checklist for HTA reports of the International Network of Agencies for Health Technology Assessment. The initial impact was estimated based on a retrospective observational measurement of the types of publications that cite the bulletin as a source of information. The publications citing BRATS were identified using Google Scholar. RESULTS: Since June 2008, fourteen issues of the bulletin have been produced. BRATS has not presented any significant limitation that would compromise generalizations of its results within the Brazilian context. The initial impact of the bulletin, however, has been small, which may be due to its exclusively electronic dissemination format and technical language. We found nine publications citing BRATS in Google Scholar. CONCLUSIONS: It is hoped that the bulletin will promote the continuity of HTA actions among health-sector managers and professionals in Brazil.

The expression of vulnerability through infant mortality in the municipality of Embu.

CONTEXT AND OBJECTIVE: Infant mortality expresses a set of living, working and healthcare access conditions and opens up possibilities for adopting interventions to expand equity in healthcare. This study aimed to investigate vulnerability and the consequent differences in access to health services and occurrences of deaths among infants under one year of age in the municipality of Embu. DESIGN AND SETTING: This was a descriptive study in the municipality of Embu. METHODS: Primary data were collected through interviews with the families of children living in the municipality of Embu who died in the years 1996 and 1997 before reaching one year of age. Secondary data were obtained from death certificates. The variables collected related to living conditions, income, occupation, prenatal care, delivery and the healthcare provided for children. These data were compared with the results obtained from a study carried out in 1996. RESULTS: Statistically significant differences were found with regard to income, working without a formal employment contract and access to private health plans among the families of the children who died. There were also differences in access to and quality of prenatal care, frequency of low birth weight and neonatal inter-ocurrences. CONCLUSIONS: The employment/unemployment situation was decisive in determining the degree of family stability and vulnerability to the occurrence of infant deaths, in addition to the conditions of access to and quality of healthcare services.

[Prevalence and factors associated with iron deficiency in infants treated at a primary care center in Belém, Pará, Brazil]. / Prevalência e fatores associados à deficiência de ferro em lactentes atendidos em um centro de saúde-escola em Belém, Pará, Brasil.

The objective was to verify the occurrence of iron deficiency and associated factors in infants. This cross-sectional study included 365 infants (defined here as 6-24 months of age) treated at a primary care center in Belém, Pará, Brazil. Iron-deficiency anemia (hemoglobin < 11 g/dl and ferritin < 12 microg/l) was diagnosed in 55.1% of the sample, depletion of body iron reserves (hemoglobin < 11 g/dl and ferritin < 12 microg/l) in 15.3%, and iron sufficiency (hemoglobin < 11 g/dl and ferritin < 12 microg/l) in 18.1%. The results of the logistic regression model showed associations between iron deficiency (ferritin < 12 microg/l) and: 6-12 month age group, OR (odds ratio) = 3.67 and 95% CI: 1.93-7.04; non-utilization of iron-fortified formula as the first milk used after interrupting breastfeeding, OR = 1.93 and 95%CI: 1.04-3.60; and per capita income < or = 1 minimum wage, OR = 2.69 and 95%CI: 1.30-5.59. The occurrence of iron deficiency was high, showing the need to adopt effective measures to prevent this important public health problem.

[Prevalence of malnutrition among children in Embu, São Paulo State, Brazil, 1996-1997]. / Prevalência de desnutrição em crianças residentes no Município de Embu, São Paulo, Brasil, 1996-1997.

This paper focused on the nutritional profile of children in the municipality of Embu, São Paulo State, Brazil, in 1996-1997, to identify vulnerable population segments that require specific action by health services. The sample consisted of 320 children < or = 5 years of age distributed into four socioeconomic strata. The indices were expressed as z-scores: weight/age (W/A), height/age (H/A), and weight/height (W/H) to analyze the nutritional status, and the reference for normality was the NCHS curve. In all population strata and age groups, the height/age index was the most frequently affected, while the weight/height index had the fewest deficits. No statistically significant differences were observed in children's nutritional status between the four population strata or between the different age groups. Children with low birth weight showed the highest prevalence of deficits in all indices. In the municipality, the frequency of deficits were: H/A< 2z: 7.1%, W/H< 2z: 0.2%, and W/A< 2z: 2.9%. Height deficit can be used as an early warning, considering that loss observed over the course of years has future consequences.

[Prenatal and childbirth care equity in an area in Greater Metropolitan São Paulo, 1996]. / Eqüidade na atenção pré-natal e ao parto em área da Região Metropolitana de São Paulo, 1996.

A cross-sectional study was conducted to evaluate prenatal and childbirth care interviewing mothers of infants in the municipality of Embu (Greater Metropolitan São Paulo) in 1996, according to four socioeconomic strata. A door-to-door survey included a probabilistic sample consisting of 483 infants. In all strata more than 90% of the mothers had received prenatal care, but with late access in stratum 4 (residents of favelas, or slums). Breast examination during prenatal care, reported by only 60.8% of the mothers, was the worst single indicator of quality of prenatal care in the municipality. The outcome indicator - first prenatal consultation after the first trimester and total number of consultations less than six - was associated with maternal age (less than 20 years), low per capita family income (less than one minimum wage), and lack of private health plan. As for deliveries, 97.7% occurred in hospital, of which 32.5% by cesarean section, with the latter more frequent in private health care facilities (63.2%). No population segments were identified as being excluded from the health care system, but some indicators suggest greater deficiencies in socioeconomic stratum 4. These results have supported local health system managers in redefining health measures for the municipality.

[Evaluation of practices and knowledge among primary health care professionals in relation to child development surveillance]. / Avaliação das práticas e conhecimentos de profissionais da atenção primária à saúde sobre vigilância do desenvolvimento infantil.

In the present study, the practices and knowledge of 40 physicians and 40 nurses from municipal health care units (UMS) and 40 physicians and 40 nurses from the Family Health Program (FHP) in Belém, Pará State, Brazil, all of whom working in primary health care, were evaluated in relation to child development surveillance. Measures of knowledge of child development showed an average of 63.7% correct answers for UMS physicians, 57.3% for FHP physicians, 62.1% for FHP nurses, and 54.3% for UMS nurses. Only 21.8% of mothers attending appointments mentioned that the health care professional had asked about their children s development, 27.6% of mothers reported that the health care professional had asked about or observed the child s development, and 14.4% mothers reported having received instructions on how to stimulate their children s development. According to this study, primary health care physicians and nurses in the municipality of Belém showed gaps in their knowledge of child development. Child development surveillance is not being conducted satisfactorily in primary health care in the municipality of Belém. It is thus necessary to raise the awareness of health care professionals concerning the problem and provide them with appropriate training.