OBJECTIVETo analyze the evolution in the prevalence and determinants of malnutrition in children in the semiarid region of Brazil.METHODSData were collected from two cross-sectional population-based household surveys that used the same methodology. Clustering sampling was used to collect data from 8,000 families in Ceará, Northeastern Brazil, for the years 1987 and 2007. Acute undernutrition was calculated as weight/age < -2 standard deviation (SD); stunting as height/age < -2 SD; wasting as weight/height < -2 SD. Data on biological and sociodemographic determinants were analyzed using hierarchical multivariate analyses based on a theoretical model.RESULTSA sample of 4,513 and 1,533 children under three years of age, in 1987 and 2007, respectively, were included in the analyses. The prevalence of acute malnutrition was reduced by 60.0%, from 12.6% in 1987 to 4.7% in 2007, while prevalence of stunting was reduced by 50.0%, from 27.0% in 1987 to 13.0% in 2007. Prevalence of wasting changed little in the period. In 1987, socioeconomic and biological characteristics (family income, mother’s education, toilet and tap water availability, children’s medical consultation and hospitalization, age, sex and birth weight) were significantly associated with undernutrition, stunting and wasting. In 2007, the determinants of malnutrition were restricted to biological characteristics (age, sex and birth weight). Only one socioeconomic characteristic, toilet availability, remained associated with stunting.CONCLUSIONSSocioeconomic development, along with health interventions, may have contributed to improvements in children’s nutritional status. Birth weight, especially extremely low weight (< 1,500 g), appears as the most important risk factor for early childhood malnutrition.

Prevalência e determinantes de obesidade e sobrepeso em mulheres em idade reprodutiva residentes na região semiárida do BrasilPrevalence and determinants of obesity and overweight among reproductive age women living in the semi-arid region of Brazil

Introdução: Estudos comparam taxa de óbitos de Unidade de Terapia Intensiva (UTI) no Brasil que se encontra acima da internacional, não se sabendo se isso é devido ao sistema público brasileiro ou a falhas de registro. Objetivo: Traçar uma relação entre mortalidade prevista e características dos pacientes internados na UTI de hospital terciário de grande porte do município de Fortaleza, Ceará. Métodos: Trata-se de um estudo retrospectivo, analítico e transversal sobre pacientes internados na UTI do Hospital Geral de Fortaleza de janeiro a novembro de 2016. Resultados: No período da pesquisa, foram estudados 137 pacientes; desse total vieram a óbito 31 pacientes (24,48%). De acordo com a prioridade estabelecida pela Society Critical Care Medicine para Unidade de Terapia Intensiva, tivemos 53,3% na prioridade I, 10,0% na prioridade II, 30,0% na prioridade III, 3,3% na prioridade IVA e 3,3% na prioridade IVB, resultados estatisticamente significantes (p=0,012). Constatou-se neste trabalho que 80,6% dos óbitos haviam desenvolvido sepse durante o internamento na UTI (p<0,001). Aplicando-se os escores de mortalidade APACHE-II e SOFA, observa-se que o APACHE-II com escore médio de 22 pontos e com mortalidade prevista média de 55,7 (p<0,001), enquanto, o SOFA teve média no primeiro dia de 7 pontos (p<0,001), no quinto dia de 5 pontos (p=0,004) e no décimo dia de 5 pontos (p=0,004). Conclusão: Observou-se a importância da análise epidemiológica em relação aos óbitos ocorridos em Unidades de Terapia Intensiva, visando demonstrar a necessidade de se conhecer melhor a aplicabilidade dos escores SOFA e APACHE II e as medidas que devem ser adotadas.

ObjectiveTo assess the prevalence of child development delay and to identify socioeconomic determinants.Study designWe conducted a population-based cross-sectional study of children 2 to 72 months of age residing in the state of Ceará, Brazil. In total, 3200 households were randomly selected for participation in the study and had child development assessed with the Ages and Stages Questionnaire (ASQ) version 3. Development delay was defined as a score of less than -2 standard deviations below the median of the Brazilian ASQ standard. We present population-level prevalence of delay in five development domains and assess socioeconomic determinants.ResultsA total of 3566 children completed the ASQ development assessment of which 9.2% (95% CI: 8.1–10.5) had at least one domain with development delay. The prevalence of delay increased with age in all domains and males were at higher risk for communication, gross motor and personal-social development delays as compared to females (p-values <0.05). We found robust associations of indicators of socioeconomic status with risk of development delay; increasing monthly income and higher social class were associated with reduced risk of delay across all domains (28,2% in the poorest and 21,2% in richest for any delay, p-values <0.05 for all domains). In addition, children in poor households that participated in conditional cash transfer (CCT) programs appeared to have reduced risk of delay as compared to children from households that were eligible, but did not participate, in CCT programs.ConclusionsThere is a relatively high population-level prevalence of development delay in at least one domain among children 0–6 years of age in Ceará, Brazil. Integrated child development, social support, and poverty reduction interventions may reduce the population-level prevalence of development delay in Ceará and similar settings.

ObjectiveTo evaluate the effectiveness of rapid response teams using early identification of clinical deterioration in reducing the occurrence of in-hospital mortality and cardiorespiratory arrest.Data sourcesThe MEDLINE, LILACS, Cochrane Library, Center for Reviews and Dissemination databases were searched.Study selectionWe included studies that evaluated the effectiveness of rapid response teams in adult hospital units, published in English, Portuguese, or Spanish, from 2000 to 2016; systematic reviews, clinical trials, cohort studies, and prepost ecological studies were eligible for inclusion. The quality of studies was independently assessed by two researchers using the Newcastle-Ottawa, modified Jadad, and Assessment of Multiple Systematic Reviews scales.Data extractionsThe results were synthesized and tabulated. When risk measures were reported by the authors of the included studies, we estimated effectiveness as 1-RR or 1-OR. In pre-post studies, we estimated effectiveness as the percent decrease in rates following the intervention.ResultsOverall, 278 studies were identified, 256 of which were excluded after abstract evaluation, and two of which were excluded after full text evaluation. In the meta-analysis of the studies reporting mortality data, we calculated a risk ratio of 0.85 (95%CI 0.76 - 0.94); and for studies reporting cardiac arrest data the estimated risk ratio was 0.65 (95%CI 0.49 - 0.87). Evidence was assessed as low quality due to the high heterogeneity and risk of bias in primary studies.ConclusionWe conclude that rapid response teams may reduce in-hospital mortality and cardiac arrests, although the quality of evidence for both outcomes is low.

Background Due to the current scenario of the COVID-19 pandemic and the social distancing issues, distance learning was implemented in many medical schools. Educational institutions faced the challenge of continuing to promote teaching and learning while keeping teachers and students in their homes, aiming to reduce the spread of the virus. This change compromised the students’ mental health, due to the degree of exhaustion or fatigue attributed to the involvement in videoconferences, called “zoom fatigue”. Despite the importance of zoom fatigue for medical education, it can be observed that there have not been studies on the role of the online teaching and learning process through active methodologies in the genesis of this fatigue. We aimed to assess the association of the teaching method used and the prevalence of zoom fatigue. Methods A cross-sectional, quantitative, analytical study was carried out in Medical Schools of Ceará, Brazil. Problem-Based Learning (PBL) teaching methodology is the only methodology used in the first semester and PBL together with traditional teaching, i.e., hybrid teaching, is used in the other ones. The Zoom Exhaustion & Fatigue Scale (ZEF) was used, with the questions currently validated for Brazilian Portuguese. Chi-square tests were used to verify the statistical association between the measured variables and the teaching methodology. Results The prevalence of zoom fatigue reached 56% in students using the hybrid model, versus 41% in those using the PBL methodology, with a statistically significant difference (p value = 0.027). The mean prevalence of overall zoom fatigue was 48%. Students using the hybrid methodology differed from PBL students by having a significantly higher frequency of feelings of wanting to be alone after a videoconference (16.9 vs. 7.1%, respectively) and needing time to be alone after a video conference (10.2 vs. 3.6%, respectively). Conclusions Considering that zoom fatigue may stay with us for years beyond the COVID-19 pandemic, it is important to know and provide instructions on how to reduce video conferencing fatigue. The present study suggests that the active participation of students and the number of activities are important factors to be considered.

Abstract. The aim of this study is to investigate the changes in clinical pattern and therapeutic measures in leptospirosis-associated acute kidney injury; a retrospective study with 318 patients in Brazil. Patients were divided according to the time of admission: 1985-1996 (group I) and 1997. Patients were younger in group I (36 ± 13 versus 41 ± 16 years, P = 0.005) and the numbers of oliguria increased (21% versus 41% in group II, P = 0.014). Higher frequency of lung manifestations was observed in group II ( P < 0.0001). Although increased severity, there was a significant reduction in mortality (20% in group I versus 12% in group II, P = 0.03). Mortality was associated with advanced age, low diastolic blood pressure, oliguria, arrhythmia, and peritoneal dialysis, besides a trend to better mortality with penicillin administration. Leptospirosis is occurring in an older population, with a higher number of oliguria and lung manifestations. However, mortality is decreasing and can be the result of changes in treatment.* Address correspondence to Alexandre B. Libório, Av. Abolição, 4043 ap 1203, Fortaleza, CE, Brazil -CEP: 60.165-082. E-mail: alexandreli borio@yahoo.com.br 480 DAHER AND OTHERS 3. Antibiotic therapy: physicians were oriented to administer penicillin to patients even in later disease presentation. 4. Dialysis therapy: hemodialysis therapy was the preferred method instead of peritoneal dialysis and it was intended to be initiated early after intensive care unit admission and performed daily.All clinical manifestations and laboratory tests were evaluated. A comparison of clinical and laboratory data was performed between the two groups to investigate if there was any difference in the pattern of leptospirosis presentation in the two periods analyzed. A comparison between survivors and non-survivors in the two periods was also done.Ethics. The protocol of this study was approved by the Ethical Committee of the Walter Cantídio University Hospital and São José Infectious Diseases Hospital.Statistical analysis. The results were expressed through tables and summary measures (mean ± standard deviation) in the cases of quantitative variables. All data were analyzed with the programs SPSS version 10.0 (SPSS Inc., Chicago, IL) and Epi Info version 6.04b (Centers for Disease Control and Prevention, Atlanta, GA). Comparison of parameters was done with Student's t test, Mann-Whitney, and Fisher's exact test when appropriated. Mann-Whitney test was used for the parameters with a non-normal distribution. Stepwise backward elimination multivariate analysis was performed for the investigation of factors associated with death. All variables presented were considered and it included the factors that presented a significance level < 10% in the univariate analysis. Allocation into the two defined groups was considered an independent variable. P value < 0.05 was considered as statistically significant in all other cases. RESULTSA total of 374 patients were evaluated initially. Three hundred eighteen patients were include...

Visceral leishmaniasis (VL) is a re-emerging zoonosis of worldwide distribution. Monocyte chemotactic protein-1 (MCP-1) and malondialdehyde (MDA) are inflammation biomarkers that have never been investigated in VL. The aim of this study is to investigate the association between renal abnormalities and inflammation biomarkers in VL. This study is a preliminary prospective study with 16 VL adult patients evaluated before treatment compared with a group of 13 healthy volunteers and 5 VL patients evaluated after treatment. Urinary concentration and acidification tests were performed. MCP-1 and MDA were quantified in urine. Urinary concentration deficit was found in all VL patients before (100%) and four VL patients after (80%) treatment. Urinary acidification deficit was found in nine cases before (56.2%) and two cases after (40%) treatment. Urinary MCP-1 (374 ± 359 versus 42 ± 29 pg/mg creatinine, P = 0.002) as well as urinary MDA (5.4 ± 2.6 versus 2.0 ± 0.8 μmol/mL) showed significant differences between VL patients and controls. These data show that VL patients present urinary concentration and acidification deficit, which can persist even after specific treatment. Urinary MCP-1 and MDA are elevated in patients with VL, which suggests renal inflammation and incipient renal damage.