A cor da dor: iniquidades raciais na atenção pré-natal e ao parto no Brasil El color del dolor: inequidades raciales en la atención pre-natal y partos en Brasil

The results suggest that the levels of particulate matter from biomass burning in the Amazon are associated with adverse effects on the respiratory health of children.

BackgroundThe increase of the elderly population and the high prevalence of chronic diseases have contributed to the increasing importance of functional ability as a global public health problem. This study aimed to assess functional capacity in institutionalized elders, as well as undertake an exploratory analysis of its associated factors.MethodsThis is a cross-sectional study with institutionalized Brazilian elders. Functional capacity was assessed using the Katz Index for Activities of Daily Living (ADL) and the Lawton Scale for Instrumental Activities of Daily Living (IADL). The characteristics of dependent individuals were described and logistic regression models were developed for both scales. Multiple models that included all selected variables were developed using a hierarchical approach. We considered the results from the Wald test (p < 0.05) as a rule for progressing to the next level.ResultsA population of 760 elders was considered. The prevalence of dependence was 50.3% for ADL and 81.2% for IADL. We observed associations between ADL dependence and the following factors: self-report of stroke, difficulty of walking 400 meters, lower total scores in questions related to the temporal orientation section of the cognition test, and self-reports of frequently feeling upset. IADL dependence was associated with educational level, self-report of cancer, difficulty of walking 400 meters, use of glasses, and self-reported memory problems.ConclusionsSociodemographic and health conditions were associated with functional incapacity in institutionalized elders. Based on these findings, we emphasize the importance of both prevention and treatment of chronic conditions as well as social support in the maintenance of individuals’ autonomy.

OBJECTIVE:To investigate the effects of fi ne particulate matter emitted through biomass burning on hospitalizations for respiratory diseases in children living in Manaus, Northern Brazil. METHODS:Descriptive study with ecologic time series design carried out in Manaus from 2002 to 2009. Hospital admission data were obtained from the Unifi ed Health System database. PM 2.5 levels were estimated using aerosol remote sensing through the measurement of aerosol optical depth at a wavelength of 550 nm. Statistical methods were used in the data analysis, with Pearson correlation and multiple linear regression between variables, with a 95% confi dence interval. RESULTS:The region of Manaus showed low PM 2.5 concentrations when compared to the Southern Amazonian region. Between August and November (dry period in the region), was when the highest mean levels of PM 2.5 , estimated between 18 to 23 μg/m³, and the largest number of fi res were observed. For the rainy season, an average of 12 μg/m³, 66% lower than the dry season measurements (20.6 μg/m³) was observed. The highest rates of hospitalization were observed during the rainy season and April was the month with the highest levels at 2.51/1,000 children. A positive association between hospital admissions and relative humidity (R = 0.126; p-value = 0.005) was observed, while the association between admissions and PM 2.5 was negative and statistically signifi cant (R = -0.168; p-value = 0.003). The R² of the fi nal model (Hospitalizations = 2.19*Humidity -1.60*PM 2.5 -0.23*Precipitation) explained 84% of hospitalizations due to respiratory disease in children living in Manaus, considering the independent variables statistically signifi cant (humidity, PM 2.5 , and precipitation). CONCLUSIONS:Hospital admissions for respiratory diseases in children in Manaus, were more related to weather conditions and in particular relative humidity, than to exposure to aerosols emitted by biomass burning in the Amazonian region.

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BackgroundEarly diagnosis of dengue infection is important for decision-making and timely implementation of therapeutic measures. Although rapid NS1 assays have been used for dengue diagnosis since 2008, their performance in DENV-4 cases has not yet been fully assessed.MethodsWe evaluated the accuracy of NS1 Bioeasy™ immunochromatographic strip test and of three clinical criteria for dengue diagnosis. Patients presenting at an emergency care center within 72 h of an acute febrile illness during the 2013 DENV-4 epidemic in Rio de Janeiro were consecutively enrolled for clinical and laboratory evaluation. We classified patients as suspected dengue or not according to three clinical criteria: WHO 2009, WHO 1997, and INI-FIOCRUZ. Dengue diagnosis was defined by RNA detection using RT-PCR and the negative cases were negative for all dengue serotypes and also Platelia™ NS1 ELISA. We obtained accuracy indices for NS1 Bioeasy™ alone and in combination with the clinical criteria.ResultsRT-PCR for DENV-4 was positive in 148 out of 325 patients. Positive likelihood ratio, sensitivity, and specificity of NS1 Bioeasy™ with WHO 2009, WHO 1997, and INI-FIOCRUZ criteria were 22.6 (95 % CI 7.2–70.6), 40.6 % (95 % CI 32.3–49.3), and 98.2 % (95 % CI 94.9–99.6); 18.3 (95 % CI 6.8–49.2), 44.2 (95 % CI 35.8–52.9), 97.6 (95 % CI 94.0–99.3); 26.2 (95 % CI 6.5–106.5), 29.7 (95 % CI 22.4–37.8), 98.9 (95 % CI 96.0–99.9), respectively. WHO 1997 clinical criteria presented high sensitivity to rule out disease, but extremely low specificity. INI-FIOCRUZ had moderate sensitivity and specificity, and could target a group to a more specific test.ConclusionsAlthough the large rates of false negative results using NS1 Bioeasy™ rapid test advise against its use for triaging (rule out) purposes in DENV-4 epidemics, it could be used as a confirmatory tool in a bedside algorithm.

Peso ao nascer e fatores associados ao período pré-natal: um estudo transversal em hospital maternidade de referência Birth weight and factors associated with the prenatal period: a cross-sectional study in a maternity hospital of reference

The evidence provided by the reviewed studies indicates a possible association between the development of prostate cancer and pesticide exposure and/or agricultural occupations.