ResumoIntrodução: Sintomas psiquiátricos são freqüentes após o parto, momento marcado por alterações hormonais e mudanças no caráter social, na organização familiar e na identidade feminina. A Escala de Depressão Pós-Parto de Edimburgo (EPDS) é instrumento de auto-avaliação para rastrear depressão após a gestação, nem sempre adequadamente reconhecida pelos profissionais de saúde. O objetivo deste estudo foi avaliar prevalência de depressão pós-parto em mulheres atendidas em unidades básicas de saúde. Métodos: Estudo transversal com aplicação da EPDS em 292 mulheres que se encontravam entre 31 e 180 dias após o parto. Adotamos o ponto de corte < 12 na EPDS como depressão. Resultados: Do total, 115 (39,4%) apresentaram escores < 12, na EPDS, foram consideradas deprimidas; 177 (60,6%), com escores < 12, foram consideradas não-deprimidas. Mulheres com menor escolaridade, maior número de gestações, maior paridade, maior número de filhos vivos e menor tempo de relacionamento apresentaram mais depressão. Conclusão: A elevada freqüência de depressão pós-parto está relacionada com fatores sociais, demonstrando a importância dos profissionais de atenção básica na detecção precoce da depressão, tendo como auxílio instrumentos como a EPDS, pela sua eficácia e praticidade. Descritores: Depressão pós-parto, epidemiologia, escala de Edimburgo. AbstractIntroduction: Psychiatric symptoms are frequent in the postpartum period, a moment marked by hormonal alterations and changes in social character, family organization and women's identity. The Edinburgh Postnatal Depression Scale (EPDS) is a selfreporting instrument to track depression after pregnancy, unfortunately not always properly supported by health care professionals. This study aimed at verifying the prevalence of postpartum depression in women receiving care at basic health units. Methods: Cross-sectional study including 292 women in the postpartum period (from day 31 to 180) who answered the EPDS questionnaire. Cut-off point < 12 for EPDS depression was used. Results: A total of 115 women (39.4%) had scores < 12 in EPDS, classified as depressive; 177 (60.6%) had scores < 12 and were not considered depressive. Women with lower education, higher number of pregnancies, higher parity, higher number of live children and shortest relationship time had more depression. Conclusion: High frequency of postpartum depression is associated with social factors, which shows the importance of health care professionals in early detection of depression, with the aid of instruments such as EPDS, due to its efficacy and practicability.
OBJECTIVE:To develop a diet quality index and to analyze socioeconomic factors associated with low child diet quality. METHODS:A cross-sectional study was performed with a representative sample of 1,282 children aged between seven and ten years, living in the city of Vitória, Southeastern Brazil, in 2007. Children were randomly selected from 26 public schools and six private schools. Data on socioeconomic characteristics and life habits of children were obtained from a structured questionnaire, sent to homes and preferably completed by mothers. A food frequency questionnaire was created from studies performed with Brazilian children and tested in a public school. An index entitled Índice de Alimentação do Escolar (ALES -School Child Diet Index) was designed to assess diet quality, taking in consideration the nutritional recommendations for the Brazilian population and the habit of having breakfast. The association between diet quality and socioeconomic factors was analyzed using multinomial logistic regression. Adjusted odds ratios and 95% confi dence intervals were estimated for the variables that remained in the model. RESULTS:According to the ALES index, approximately 41% of the children studied had low diet quality (boys= 37.7%, girls= 42.7%, p= 0.179). There were no signifi cant differences between sex, age, maternal employment status and living with the mother and diet quality. The variables that remained associated with low diet quality were low maternal level of education (OR= 3.93; 95% CI: 2.58;5.99), father not present in the household (OR= 2.03; 95% CI: 1.68;2.99) and not having lunch at the table (OR= 1.47; 95% CI: 1.12;1.93). CONCLUSIONS:Low maternal level of education increased the probability of a child not consuming a good quality diet, whether due to lack of access to healthy foods and adequate information or poorer ability to discern what is healthy.
DISTRIBUTION AND ABUNDANCE OF HEAVY METALS IN SEDIMENTS FROM VITÓRIA ISLAND ESTUARINESYSTEM. Heavy-metal concentration in sediment is an important parameter for identifying pollution sources and assessing pollution levels in aquatic ecosystems. In this context, the present study aimed at determining concentrations of heavy metals in sediments from the Vitória estuarine system, Brazil. Twenty nine stations were surveyed to assess the spatial distribution of heavy metals. The metals for silt-clay fractions (<63 µm) were analyzed through atomic absorption spectrometry. A discriminant analysis segregated the stations in four groups representing four areas within the estuarine system. The Espírito Santo Bay showed the lowest metal concentrations, while the Vitória harbor canal showed the highest. We concluded that concentrations of heavy metals reflect natural conditions and the contribution of human activities from sewage and industrial effluents. It was not possible to directly associate metal concentrations to specific pollution sources.Keywords: heavy metals; estuarine sediments; sewage. INTRODUÇÃOUma das grandes preocupações ecológicas atuais refere-se ao impacto ambiental causado pela liberação antrópica de metais pesados nos diversos ambientes naturais e, de maior importância, naqueles de maior interação com populações humanas. Tanto águas, materiais particulados, sedimentos como organismos aquáticos têm sido utilizados nesta avaliação, sendo que os três últimos compartimentos bióticos são preferíveis devido às facilidades de coleta, estocagem e tratamento das amostras (minimização de contaminação ou perdas), e às maiores concentrações encontradas, dispensando tarefas de pré-concentração e facilitando os procedimentos de análise 1,2 . Os sedimentos têm sido considerados como um compartimento de acumulação de espécies poluentes a partir da coluna d'água, devido às altas capacidades de sorção e acumulação associadas 3,4 , onde as concentrações tornam-se várias ordens de grandeza maiores do que nas águas correspondentes, possibilitando o uso dos mesmos como um bom indicador de poluição ambiental, tanto atual como remota (p.ex. através da estratificação 5 ), possibilitando ainda o conhecimento das principais fontes de poluição dentro de um determinado sistema aquático. Contudo, diversos processos bióticos e abióticos podem remobilizar tais espécies, constituindo-se em fontes de poluição secundárias 6,7 , afetando a qualidade da água e originando bioacumulação e trocas de transferência na cadeia trófica 1,8 . Em conseqüência, a contaminação de sedimentos é um importante problema ambiental em todo mundo.Muitos trabalhos têm sido publicados a respeito de metais pesados acumulados em sedimentos de regiões tropicais, principalmente em regiões costeiras fortemente industrializadas, como no estado do Rio de Janeiro, São Paulo e Bahia 4-6,9-13 . É interessante destacar o trabalho de Carvalho e Lacerda 4 na Baía de Guanabara onde, após análise química de diversos organismos marinhos bentônicos, não se observaram altas conc...
In our population, prevalence of acute lung injury was low, most cases were diagnosed 2 days after ICU admission, and Berlin definition was not different from American European Consensus conference definition in predicting mortality. There are still several problems with the global epidemiology, definition, and mortality predictive indices that should be added to the classification of this still lethal syndrome to improve its predictive mortality power in the future.
SUMMARY OBJECTIVE To investigate risk factors for delayed sputum culture conversion to negative during anti-tuberculosis treatment, with an emphasis on smoking. DESIGN Nested case-control study of adults with non-cavitary, culture-confirmed pulmonary tuberculosis (TB) participating in an anti-tuberculosis treatment trial in Brazil. A case of delayed culture conversion was a patient who remained culture-positive after 2 months of treatment. Odds ratios with 95% confidence intervals were calculated. RESULTS Fifty-three cases and 240 control patients were analyzed. Smokers had three-fold greater odds of remaining culture-positive after 2 months of treatment (P = 0.007) than non-smokers, while smokers and ex-smokers who smoked >20 cigarettes a day had two-fold greater odds of remaining culture-positive after 2 months of treatment (P = 0.045). CONCLUSION Cigarette smoking adversely affects culture conversion during anti-tuberculosis treatment. Support for smoking cessation should be considered to improve outcomes in TB control programs.
OBJECTIVE To analyze the prevalence and factors associated with multidrug-resistant tuberculosis in Espírito Santo, Brazil.METHODS This is a cross-sectional study of cases of tuberculosis tested for first-line drugs (isoniazid, rifampicin, pyrazinamide, ethambutol, and streptomycin) in Espírito Santo between 2002 and 2012. We have used laboratory data and registration of cases of tuberculosis – from the Sistema Nacional de Agravos de Notificação and Sistema para Tratamentos Especiais de Tuberculose. Individuals have been classified as resistant and non-resistant and compared in relation to the sociodemographic, clinical, and epidemiological variables. Some variables have been included in a logistic regression model to establish the factors associated with resistance.RESULTS In the study period, 1,669 individuals underwent anti-tuberculosis drug susceptibility testing. Of these individuals, 10.6% showed resistance to any anti-tuberculosis drug. The rate of multidrug resistance observed, that is, to rifampicin and isoniazid, has been 5%. After multiple analysis, we have identified as independent factors associated with resistant tuberculosis: history of previous treatment of tuberculosis [recurrence (OR = 7.72; 95%CI 4.24–14.05) and re-entry after abandonment (OR = 3.91; 95%CI 1.81–8.43)], smoking (OR = 3.93; 95%CI 1.98–7.79), and positive culture for Mycobacterium tuberculosis at the time of notification of the case (OR = 3.22; 95%CI 1.15–8.99).CONCLUSIONS The partnership between tuberculosis control programs and health teams working in the network of Primary Health Care needs to be strengthened. This would allow the identification and monitoring of individuals with a history of previous treatment of tuberculosis and smoking. Moreover, the expansion of the offer of the culture of tuberculosis and anti-tuberculosis drug susceptibility testing would provide greater diagnostic capacity for the resistant types in Espírito Santo.
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