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Introduction: Epidemiological data allow to know the needs of the communities and can provide subsidies for planning and actions in the health services, hence, it is necessary to investigate illness and chronic non-communicable diseases in the population of interest. Objective: The objectives of this study are to describe and verify the association between the most prevalent self-reported morbidities in adults regarding the characteristics: socioeconomic, demographic and lifestyle. Methods: This is a population-based survey conducted with adults (?18 years of age), living in Rio Branco, Acre State, Brazil, during the period 2007/2008. The sample consisted of 1516 individuals, from a probabilistic sampling in two stages of a draw. Results: The most prevalent self-reported morbidity was spine/back disease with a percentage of 30.8%, followed by hypertension (28.3%), malaria (28.3%) and depression (18.7%). Regarding socioeconomic and demographic aspects, the most prevalent characteristics were: female gender and low level of formal education, with statistical significance. As for life habits, the most common characteristics with statistical significance were: smoking and physical inactivity. Conclusion: In view of the scarcity of studies of this nature in the North region of Brazil, and especially in the State of Acre, the results regarding the most prevalent self-reported morbidities in the adult population of Rio Branco are of fundamental importance, to alert researchers and health professionals. This contributes to a better adaptation and/or implementation of public strategies for promotion, protection and health assistance.

Introdução: O estado nutricional de crianças é considerado um instrumento importante na aferição das condições de saúde e qualidade de vida de uma população. A prevalência crescente da obesidade em crianças é um problema de saúde pública significante, pois é um fator de risco importante para a obesidade na vida adulta. Objetivo: Avaliar a prevalência e os fatores associados à obesidade infantil no município de Rio Branco – Acre. Método: Realizou-se análise de banco de dados provenientes do Inquérito de Fatores de Risco e Morbidade por Doenças Não-Transmissíveis no Município de Rio Branco / Saúde e Nutrição de Adultos e Crianças em 2008. Trata-se de um estudo transversal onde foram examinadas 687 crianças na faixa de 0 a 60 meses nas zonas urbana e rural. A análise estatística considerou a expansão e o desenho da amostra. A prevalência da obesidade infantil segundo os índices antropométricos P/I (peso-para-idade), P/E (peso-para-estatura), e IMC/I (Índice de Massa Corporal-para-idade) foram respectivamente de 6,85% (IC95% = 5,30 – 8,80), 6,66% (IC95% = 3,22 – 13,27) e 6,61% (IC95% = 3,25 – 12,98). Resultados: O modelo final apresentou maior prevalência de obesidade para o índice IMC/I nas seguintes condições: local de domicílio na zona urbana (RP=6,81; IC95% = 1,27 – 36,38), iluminação elétrica sem medidor (RP=2,10; IC95% = 1,22 – 3,59), altura da mãe maior que 163cm (RP=2,24; IC95% = 1,12 – 4,47) e obesidade materna (RP=2,37; IC95% = 1,19 – 4,72). Conclusão: A prevalência da obesidade do índice IMC/I foi elevada e está relacionada à fatores socioeconômicos e características maternas específicas. É necessária a promoção de ações que levem a formação de um estilo de vida saudável ainda na infância.

Objetivo: Avaliar a influência que a infecção por parasitas intestinais exerce sobre o crescimento pondo-estatural durante a infância na cidade de São Paulo. Método: Estudo de uma amostra probabilística de 1.278 crianças menores de cinco anos de idade, realizado por intermédio de analise transversal e longitudinal. O estudo longitudinal compõe-se de um período de seis meses de seguimento sem intervenção e seis meses de seguimento após tratamento das parasitoses intestinais. As análises foram realizadas usando-se regressão linear múltipla, tendo como variáveis dependentes altura, peso, incrementos de peso e altura nos períodos de seguimento, sendo a variável independente presença ou ausência de parasitas intestinais nas fezes, ajustada para sexo, idade e variáveis sociais significativamente relacionadas com o crescimento infantil. Resultados: O parasita mais freqüente foi Giardia duodenalís (5,8%), seguido de Ascaris lumhricoides (4,4%) e Tríchuris trichiura (1,1%). No estudo transversal, as crianças parasitadas possuíam, em média, menos 0,53 em de altura (menos 0,83 em para helmintíase e menos 0,08 em para giardíase), estas diferenças não atingiram significância estatística. Em relação ao peso, as crianças parasitadas possuíam, em média, menos 227 g de peso (p=0,209) (menos 542 g para helmintíase (p=0,031) e mais 139g para giardíase (p=0,562), quando comparadas com o grupo não-parasitado com ajuste para idade, sexo e variáveis sociais com potencial de confusão. No período de seguimento sem intervenção, as crianças parasitadas apresentaram ganhos de altura semelhante e peso (p=0,051) inferior ao das crianças não-parasitadas. No período de seguimento após intervenção, os déficits de altura e peso reduziram-se. Do primeiro para o segundo período de seguimento, com ajuste para as variáveis idênticos ao período anterior, o déficit de peso das crianças com giardíase, em relação ao grupo controle aumentou em 223 gramas (p=0,058) e de altura diminuiu em 0,7 mm (0,827); na helmintíase, observou-se recuperação de 159g (p=0,871) e 0,5 mm (p=0,801), quando comparados com o grupo não-parasitado. Conclusões: Os modestos ou inexistentes efeitos das parasitoses intestinais no crescimento infantil podem ter ocorrido em razão da provável baixa carga parasitária e da pequena magnitude do déficits de crescimento existente tanto nas crianças parasitadas quanto nas não-parasitadas. Objective: To evaluate the impact of intestinal parasitie infection on child growth in the city of São Paulo. Method: A probabilistic sample study of 1278 children under the age of five, using cross-sectional and longitudinal analyses. The longitudinal study comprised a period follow-up without intervention and six months of follow-up after treatment of intestinal parasitie. Analyses were made using multiple regression adjusted for sex, age and social variables significantly correlated to children growth. Results: The most frequently observed parasite in children was Giardia duodena/is (5,8%), followed by Ascaris lumhricmdes (4,4%) and Trichuris trichiura (1,1%). In the cross-sectional study the children infected with parasites had, on average, a differenee of 0,54 em less in height (p=0,178), (0,83 em for helminthiasis and 0,08 em for giardiasis). Regarding weight, the cross-sectional study showed that the children infected with parasites, on average, weighed 228 g less (p=0,209), (542 g less for helminthiasis and 139 g less for giardiasis) than non-parasitized children, adjusted for age, sex and potentially confounding social variables. In the follow-up period without intervention, children with parasitic infections had height gain (p=0.624) and weight gain (p=0,051) inferior to their non-infected counterparts. In the period following intervention the height and weight deficits diminished. From the first to the second follow-up periods, both identically adjusted for same variables, the weight deficit of the group with giardiasis increases in relation to control group by 223 g (p=0,058) and the height deficit decreases by 0,7 mm (0,827). In the group with helminthiasis, a weight recovery of 159 g (p=0,871) anda height gain of0,5 mm (p=0.801) were observed when compared to the non-parasitic infected group. Conclusions: The modest or nonexistent effects of enteroparasitose on childhood growth could have been due to the low parasite load which probably existed, as well as to the small magnitude of growth-retardation in both infected and non-parasitized children.

ObjectiveWe evaluated the effect of home fortification with multiple micronutrient powder (MNP) on anaemia and micronutrient status of young Amazonian children.DesignA pragmatic controlled trial was performed. A control group (CG) of children aged 11–14 months was recruited in the routine of primary health-care centres for assessing anaemia and micronutrient status. At the same time, an intervention group (IG) of infants aged 6–8 months was recruited in the same health centres to receive MNP daily in complementary feeding for 2 months. The IG children were assessed 4–6 months after enrolment (n112) when they had reached the age of the CG participants (n128) for comparisons.SettingPrimary health centres in Rio Branco city, Brazilian Amazon.SubjectsA total of 240 children agedResultsIn the CG, the prevalence of anaemia (Hb8·3 mg/l) and vitamin A deficiency (VAD; serum retinol ConclusionsHome fortification of complementary feeding delivered through primary health care was effective in reducing iron and vitamin A deficiencies among young Amazonian children.

Background: Ideal Cardiovascular (CV) Health is characterized by four ideal lifestyle parameters and absence of cardiovascular risk factors. The prevalence of ideal CV health in the Amazon Basin and the influence of job strain on CV health in this setting are uncertain. Objective: To evaluate the prevalence of ideal CV health and its relationship with job strain in a secluded area from a developing country. Methods: Job strain was evaluated in 478 employees from an university in the Amazon Basin by a questionnaire that classified participants as passive, active, low or high strain, according to the demand-control model. CV health was evaluated using the American Heart Association 7 health factors (diet, physical activity, body mass index (BMI), smoking, hypertension, diabetes and hypercholesterolemia). Participants were classified as having ideal, intermediate or poor CV health. The level of significance was set at p < 0.05. Results: The mean age was 44.3 ± 12 years, 65% were men, and 35% were faculty. No participant fulfilled the criteria for ideal CV health. Intermediate CV health was found in 44 (9%) and poor in 434 (91%) individuals. Considering low strain as a reference group, individuals classified as high strain, active and passive had a non-significant (p > 0.05) increase in the chances of having poor CV health. When adjusting for possible confounders, high job strain was associated with poor BMI (> 30 kg/m2), (OR 2.11, 95%CI 1.06-4.22; p = 0.034) and poor diet (OR 2.31, 95% CI 1.29-4.13; p = 0.005). Conclusion: Job strain was not associated with cardiovascular health, but high job strain was related to obesity and poor diet. Given the high prevalence of poor CV health and lack of participants with ideal CV health, policies focusing on health education and lifestyle interventions are paramount to this population. Resumo Fundamento: Saúde cardiovascular (CV) ideal é caracterizada por quatro parâmetros de estilo de vida ideal e ausência de fatores de risco CV. A prevalência da saúde CV ideal na Bacia Amazônica e sua relação com estresse no trabalho é desconhecida. Objetivo: Avaliar a prevalência da saúde CV ideal e sua relação com o estresse no trabalho em uma área isolada de um país em desenvolvimento. Métodos: O estresse no trabalho foi avaliado em 478 funcionários de uma universidade na Bacia Amazônica através de um questionário validado que classificou os participantes como passivos, ativos, baixa tensão ou alta tensão no trabalho, de acordo com o modelo de demanda e controle. A saúde CV foi avaliada usando os 7 parâmetros usados pela American Heart Association (dieta, atividade física, IMC, tabagismo, hipertensão, diabetes e hipercolesterolemia). Os participantes foram classificados em saúde CV ideal, intermediária ou ruim. O nível de significância adotado foi de 5% (p < 0,05). Resultados: A idade média foi de 44,3 ± 12 anos, 65% eram homens e 35% eram professores. Nenhum participante preencheu os critérios de saúde CV ideal. A saúde CV intermediária foi encontrada em 44 (9%) e ruim em 434 (91%) dos entrevistados. Considerando a baixa tensão como grupo de referência, indivíduos classificados como de alta tensão, ativos e passivos tiveram um aumento não significativo (p > 0,05) nas chances de ter saúde CV ruim. Ao ajustar para possíveis fatores de confusão, a alta tensão no trabalho foi associada à obesidade (IMC > 30 kg/m2): OR 2,11 (IC 95% 1,06-4,22; p = 0,034) e dieta inadequada: OR 2,31 (IC 95%: 1,29-4,13 p = 0,005). Conclusão: Não houve associação entre saúde CV e estresse no trabalho, mas a obesidade e a má alimentação foram relacionadas à alta tensão. Dada a alta prevalência de saúde CV ruim e ausência de participantes com saúde CV ideal, as políticas voltadas para a educação em saúde e as intervenções de estilo de vida são primordiais para essa população.

ObjectiveTo describe trends in the prevalence of anaemia and Fe deficiency in children under 2 years of age living in a town in western Brazilian Amazonia.DesignTemporal analysis of two cross-sectional population-based surveys. Information on socio-economic status, morbidity and breast-feeding was obtained using a structured questionnaire. Child weight and length were measured for anthropometric evaluation. Concentrations of blood Hb, plasma ferritin and soluble transferrin receptor were measured.SettingThe town of Acrelândia, state of Acre, north-west Brazil.SubjectsA total of 170 and 224 participants of the 2003 and 2007 surveys, respectively.ResultsComparison between the 2003 and 2007 surveys revealed no statistically significant differences in the prevalence of anaemia (48 (95 % CI 39, 56) % to 40 (95 % CI 33, 47) %) or Fe-deficiency anaemia (39 (95 % CI 30, 48) % to 37 (95 % CI 30, 45) %), respectively. However, an increase in the overall prevalence of Fe deficiency from 62 (95 % CI 51, 68) % to 81 (95 % CI 75, 86) % was observed (χ2 test, P ≤ 0·001). In age- and sex-adjusted analyses for risk of Fe deficiency, only early introduction of cow's milk (ConclusionsNo improvements were observed in the prevalence of anaemia, exposing a worrying scenario for public health, while a significant increase was found in the prevalence of Fe deficiency in the studied infants and toddlers.

Background Attention to prenatal care and child delivery is important for the health of women and children, but in the Amazon these indicators tend to be historically unfavorable, in part by geographical and political isolation. In 2003 both Brazilian and Peru governments have finished paving an international road connecting remotes areas in the Brazilian Amazon to the Pacific coast in Peru. Methods The situation of prenatal care and child delivery with mothers of children under 5 years old living in the urban area of Assis Brasil, Acre was assessed in two cross-sectional studies performed in 2003 and 2011, corresponding to the period before and after the Pacific highway construction. Results In 2003, most mothers were of black/Afro-American ethnicity, or “pardos” (the offspring of a Caucasian with a African descendant) (77.69 %), had more than 4 years of schooling (73.40 %) and had a mean age of 22.18 years. In 2011, the number of as a migration of indigenous women increased from 0 to 14.40 % of the respondents, because of migration from communities along the rivers to urban areas, with no other significant changes in maternal characteristics. No significant improvement in childbirth assistance was noticed between 1997 and 2011; only the percentage of in-hospital vaginal deliveries performed by doctors increased from 17.89 to 66.26 % (p

Resumo O presente estudo investigou os fatores associados à anemia e deficiência de micronutrientes em análise transversal conduzida com 150 crianças de 11 a 14 meses atendidas em unidades básicas de saúde em Rio Branco, Acre. Amostras de sangue venoso foram obtidas para avaliar a ocorrência de anemia, deficiência de ferro (DF) e de vitaminas A (DVA) e B12 (DVB12). Modelos múltiplos de regressão de Poisson foram utilizados para identificar fatores associados à anemia. Anemia, DF, DVA e DVB12 foram observadas em 23%, 76%, 18% e 20% das crianças, respectivamente. Os fatores associados à anemia foram: não ser filho único, residir em domicílio sem acesso a TV a cabo ou internet, déficit de estatura para idade (E/I), introdução tardia da alimentação complementar superior a 240 dias, DVA, DVB12, e evidência de infecção vigente (proteína C reativa plasmática > 5 mg/L). Houve menor ocorrência de anemia entre crianças com peso ao nascer > 3.500g. Do total de crianças, 82% apresentaram pelo menos uma das deficiências de micronutrientes (DF, DVA, DVB12). Ações com ênfase em práticas alimentares saudáveis oportunas, melhor manejo de morbidades e suplementação com outros micronutrientes devem ser priorizadas no aprimoramento do serviço de puericultura da atenção básica à saúde deste município.

Home fortification with multiple micronutrient powder (MNP) is effective in the prevention of anemia in young children. However, the impact on their vitamin A status remains controversial. This study aimed to evaluate the effect of MNP on vitamin A status in young Brazilian children. A multicenter pragmatic, controlled trial was carried out in primary health centers in four Brazilian cities. In the beginning of the study, the control group (CG) consisted of children 11–14 months old (n = 395) attending in routine pediatric health care. In parallel, the intervention group (IG) was composed of children 6–8 months old (n = 399), in the same health centers, who followed the intervention with MNP for 2–3 months. The analysis of the effect of MNP on vitamin A status was performed by comparing the IG with the CG after a 4- to 6-month follow-up when IG children had reached the age of the controls. The prevalence of vitamin A deficiency (VAD; serum retinol

To analyze the contributions of the socioeconomic, hygienic, and sanitation improvements in reducing the prevalence of diarrhea in a city of the Amazon.In this population-based cross-sectional study, we analyzed data from surveys conducted in the city of Jordão, Acre. In 2005 and 2012, these surveys evaluated, respectively, 466 and 826 children under five years old. Questionnaires were applied on the socioeconomic conditions, construction of houses, food and hygienic habits, and environmental sanitation. We applied Pearson's Chi-squared test and Poisson regression to verify the relationship between origin of water, construction of homes, age of introduction of cow's milk in the diet, place of birth and the prevalence of diarrhea.The prevalence of diarrhea was reduced from 45.1% to 35.4%. We identified higher probability of diarrhea in children who did not use water from the public network, in those receiving cow's milk in the first month after birth, and in those living in houses made of paxiúba. Children born at home presented lower risk of diarrhea when compared to those who were born in hospital, with this difference reversing for the 2012 survey.Sanitation conditions improved with the increase of bathrooms with toilets, implementation of the Programa de Saúde da Família (PSF - Family Health Program), and water treatment in the city. The multivariate regression model identified a statistically significant association between use of water from the public network, construction of houses, late introduction of cow's milk, and access to health service with occurrence of diarrhea.Analisar as contribuições das melhorias socioeconômicas, higiênicas e de saneamento na redução da prevalência de diarreia em uma cidade na Amazônia.Neste estudo transversal de base populacional, foram analisados dados dos inquéritos realizados no município de Jordão, Acre. Em 2005 e 2012, foram avaliadas, respectivamente, 466 e 826 crianças menores de cinco anos. Foram aplicados questionários sobre as condições socioeconômicas, construção dos domicílios, hábitos higiênicos e alimentares e saneamento ambiental. Foi aplicado o teste Qui-quadrado de Pearson e a Regressão de Poisson para verificar a relação existente entre procedência da água, tipo de construção do domicílio, idade de introdução de leite de vaca na dieta e local de nascimento e a prevalência de diarreia.A prevalência de diarreia foi reduzida de 45,1% para 35,4%. Foi identificada maior probabilidade de desenvolvimento de diarreia em crianças que não utilizaram água da rede pública, as que receberam leite de vaca no primeiro mês após o nascimento e as residentes em domicílios de paxiúba. As crianças que nasceram no domicílio apresentaram menor risco de diarreia quando comparadas às que nasceram em hospital, com essa diferença se invertendo para o inquérito de 2012.Ocorreu melhora nas condições de saneamento com aumento no número de banheiro com vasos sanitários, implantação do Programa de Saúde da Família e tratamento de água na sede do município. O modelo de regressão multivariada identificou associação estatisticamente significativa entre utilização de água da rede pública, construção da moradia, introdução tardia de leite de vaca e acesso a serviço de saúde com ocorrência de diarreia.

RESUMO: Objetivo: Estimar a prevalência de desnutrição infantil e fatores associados em um município de elevado risco nutricional do Brasil. Métodos: Estudo transversal de base populacional com amostra de 478 crianças menores de 5 anos do município de Jordão, Acre. Foram calculados os indicadores peso para idade (P/I), altura para idade (A/I) e peso para altura (P/A) utilizando como referências as curvas de crescimento da Organização Mundial da Saúde de 2006, que adota ponto de corte -2 escores z para identificação dos desnutridos. Razões de prevalência (RP) ajustadas foram obtidas por modelos múltiplos de regressão de Poisson com estimativa de erro robusta (p < 0,05). Resultados: Observou-se elevada prevalência de déficit de A/I (35,8%). Crianças com ascendência indígena residentes na área rural do município apresentaram as maiores prevalências de desnutrição (59,4%). Após ajuste para sexo, idade e ascendência indígena, os fatores positivamente associados ao déficit de crescimento foram: residir na área rural (RP = 1,6; IC95% 1,2 - 2,1); menor terço do índice de riqueza domiciliar (RP = 1,6; IC95% 1,1 - 2,3); morar em casa de paxiúba (RP = 1,6; IC95% 1,1 - 2,4); altura materna inferior ou igual a 146,4 cm (RP = 3,1; IC95% 1,9 - 5,0) e introdução de leite de vaca antes de 30 dias de idade (RP = 1,4; IC95% 1,0 - 1,8). Apresentar cartão de vacina em dia foi inversamente associado ao déficit de crescimento (RP = 0,7; IC95% 0,5 - 0,9). Conclusão: A desnutrição infantil permanece um grave problema de saúde pública no interior da Amazônia, indicando dificuldades adicionais para o enfrentamento do problema nessa região do país. ABSTRACT: Objective: To estimate the prevalence of child undernutrition and associated factors in a municipality with high nutritional risk in Brazil. Methods: This cross-sectional, population-based study was conducted with a sample of 478 children aged under 5 years in the city of Jordão, Acre, Brazil. The following indicators were calculated: weight for age (W/A), height for age (H/A), and weight for height (W/H), using the growth curves of the WHO as reference, which adopts a cutoff of -2 z scores for identification of malnourished children. Adjusted prevalence ratios (PRs) were obtained using multiple Poisson regression models with robust error estimate (p < 0.05). Results: A high prevalence of stunting (35.8%) was observed. Children with indigenous ancestry living in rural areas showed the highest prevalence of malnutrition (59.4%). After controlling for age, gender, and indigenous ancestry, the factors associated with stunting risk were: living in rural area (PR = 1.6; 95%CI 1.2 - 2.1); lower tertile of household wealth index (PR = 1.6; 95%CI 1.1 - 2.3); living in houses made of walking palm (PR = 1.6; 95%CI 1.1 - 2.4); maternal height less than or equal to 146.4 cm (PR = 3.1; 95%CI 1.9 - 5.0); and history of introduction of cow's milk before 30 days of age (PR = 1.4; 95%CI 1.0 - 1.8). Children with updated vaccination cards were inversely associated with stunting risk (PR = 0.7; 95%CI 0.5 - 0.9). Conclusion: Child undernutrition remains a serious public health problem in the Amazon, indicating additional difficulties in facing the problem in this region of the country.

Made available in DSpace on 2018-11-26T16:28:02Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-02-01. Added 1 bitstream(s) on 2021-07-15T14:31:46Z : No. of bitstreams: 1 S0034-89102016000200310.pdf: 372625 bytes, checksum: c5c3237ead7af8e68d5280f01ef0f3e5 (MD5) Department of Science and Technology of the Secretariat of Science, Technology and Strategic Inputs of the Ministry of Health (Decit/SCTIE/MS) Health Sectorial Fund (Fundo Setorial de Saude - CT-Saude) of the Ministry of Science, Technology and Innovation (MCTI) FINEP Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Research Incentive Fund of the Hospital de Clinicas de Porto Alegre - (Fundo de Incentivo a Pesquisa do Hospital de Clinicas de Porto Alegre - FIPE-HCPA) OBJECTIVE: To determine the prevalence of metabolic syndrome and its components in Brazilian adolescents. METHODS: We evaluated 37,504 adolescents who were participants in the Study of Cardiovascular Risks in Adolescents (ERICA), a cross-sectional, school-based, national study. The adolescents, aged from 12 to 17 years, lived in cities with populations greater than 100,000 inhabitants. The sample was stratified and clustered into schools and classes. The criteria set out by the International Diabetes Federation were used to define metabolic syndrome. Prevalences of metabolic syndrome were estimated according to sex, age group, school type and nutritional status. RESULTS: Of the 37,504 adolescents who were evaluated: 50.2% were female; 54.3% were aged from 15 to 17 years, and 73.3% were from public schools. The prevalence of metabolic syndrome was 2.6% (95% CI 2.3-2.9), slightly higher in males and in those aged from 15 to 17 years in most macro-regions. The prevalence was the highest in residents from the South macro-region, in the younger female adolescents and in the older male adolescents. The prevalence was higher in public schools (2.8% [95% CI 2.4-3.2]), when compared with private schools (1.9% [95% CI 1.4-2.4]) and higher in obese adolescents when compared with nonobese ones. The most common combinations of components, referring to 3/4 of combinations, were: enlarged waist circumference (WC), low HDL-cholesterol (HDL-c) and high blood pressure; followed by enlarged WC, low HDL-c and high triglycerides; and enlarged WC, low HDL-c, high triglycerides and blood pressure. Low HDL was the second most frequent component, but the highest prevalence of metabolic syndrome (26.8%) was observed in the presence of high triglycerides. CONCLUSIONS: ERICA is the first Brazilian nation-wide study to present the prevalence of metabolic syndrome and describe the role of its components. Despite the prevalence of Metabolic Syndrome being low, the high prevalences of some components and participation of others in the syndrome composition shows the importance of early diagnosis of this changes, even if not grouped within the metabolic syndrome. Univ Estado Rio de Janeiro, Fac Ciencias Med, Nucleo Estudos Saude Adolescente, BR-20550011 Rio De Janeiro, RJ, Brazil Univ Fed Rio de Janeiro, Inst Estudos Saude Colet, Rio De Janeiro, RJ, Brazil Fundacao Oswaldo Cruz, Escola Nacl Saude Publ, Rio De Janeiro, RJ, Brazil Univ Estado Rio de Janeiro, Inst Med Social, Programa Posgrad Saude Colet, BR-20550011 Rio De Janeiro, RJ, Brazil Univ Fed Rio Grande do Sul, Hosp Clin Porto Alegre, Porto Alegre, RS, Brazil Univ Fed Rio Grande do Sul, Inst Nutr Josue de Castro, Porto Alegre, RS, Brazil Fundacao Inst Brasileiro Geog & Estat, Escola Nacl Ciencias Estat, Porto Alegre, RS, Brazil Fed Univ Para, Inst Ciencias Saude, BR-66059 Belem, Para, Brazil Univ Sao Paulo, Dept Enfermagem Saude Colet, Sao Paulo, SP, Brazil Univ Estadual Feira de Santana, Dept Saude, Feira De Santana, BA, Brazil Univ Fed Amazonas, Inst Saude & Biotecnol, Manaus, Amazonas, Brazil Univ Estado Rio de Janeiro, Dept Nutr, BR-20550011 Rio De Janeiro, RJ, Brazil Univ Fed Minas Gerais, Hosp Clin, Belo Horizonte, MG, Brazil Univ Estado Rio de Janeiro, Ctr Biomedi Nutr, BR-20550011 Rio De Janeiro, RJ, Brazil Univ Fed Amapa, Macapa, AP, Brazil Inst Fed Educ Tecn Tecnol Tocantins, Palmas, TO, Brazil Univ Fed Amazonas, Fac Educ Fis & Fisioterapia, Manaus, Amazonas, Brazil Univ Fed Espirito Santo, Dept Enfermagem, Vitoria, ES, Brazil Univ Fed Santa Catarina, Dept Nutr, Ctr Ciencias Saude, Florianopolis, SC, Brazil Univ Fed Rio Grande do Norte, Ctr Biociencias, Dept Morfol, BR-59072970 Natal, RN, Brazil Univ Fed Mato Grosso, Inst Saude Colet, Dept Saude Colet, Cuiaba, MT, Brazil Univ Fed Bahia, Hosp Ana Neri, Salvador, BA, Brazil Pontificia Univ Catolica Parana, Escola Med, Curitiba, Parana, Brazil Univ Fed Pernambuco, Ctr Acad Vitoria, Recife, PE, Brazil Univ Brasilia, Dept Nutr, Brasilia, DF, Brazil Univ Fed Rondonia, Nucleo Saude, Dept Educ Fis, Porto Velho, RO, Brazil Univ Estadual Campinas, Fac Enfermagem, Campinas, SP, Brazil Univ Fed Piaui, Ctr Ciencias Saude, Dept Nutr, Teresina, PI, Brazil Univ Fed Acre, Dept Ciencias Saude & Educ Fis, Rio Branco, AC, Brazil Univ Fed Goias, Fac Med, Goiania, Go, Brazil Univ Fed Maranhao, Programa Posgrad Saude Colet, Sao Luis, MA, Brazil Univ Fed Ceara, Fac Med, Dept Saude Comunitaria, Fortaleza, Ceara, Brazil Univ Fed Sergipe, Ctr Ciencias Biol & Saude, Dept Med, Aracaju, SE, Brazil Univ Fed Paraiba, Ctr Ciencias Saude, Dept Nutr, Campus 1, BR-58059900 Joao Pessoa, Paraiba, Brazil Univ Fed Alagoas, Dept Nutr, Maceio, AL, Brazil Univ Fed Roraima, Ctr Ciencias Saude, Boa Vista, RR, Brazil Univ Estadual Paulista, Fac Med Botucatu, Dept Pediat, Botucatu, SP, Brazil Univ Estadual Paulista, Fac Med Botucatu, Dept Pediat, Botucatu, SP, Brazil FINEP: 01090421 CNPq: 2010/565037-2 Research Incentive Fund of the Hospital de Clinicas de Porto Alegre - (Fundo de Incentivo a Pesquisa do Hospital de Clinicas de Porto Alegre - FIPE-HCPA): 405.009/2012-7

OBJETIVO: Investigar a prevalência da desnutrição e fatores associados em crianças menores de 60 meses em dois municípios do Estado do Acre. MÉTODOS: Estudo transversal de base populacional realizado com 667 crianças da área urbana dos municípios de Acrelândia e Assis Brasil. A prevalência da desnutrição foi calculada pelo padrão de crescimento da Organização Mundial da Saúde de 2006, com o ponto de corte -2 escores Z. Informações sobre condições socioeconômicas, acesso aos serviços e cuidado da criança, peso ao nascer e morbidade foram obtidas por questionário estruturado. A regressão de Poisson foi utilizada para identificar os fatores associados à desnutrição de crianças. RESULTADOS: A prevalência do déficit estatura para idade e déficit peso para estatura foi de 9,9% e 4,1%, respectivamente. Os fatores associados ao déficit estatura para idade foram o baixo índice de riqueza (razão de prevalência [RP]: 1,74; intervalo de confiança em 95% [IC95%]: 0,95 - 3,18), analfabetismo do pai ou padrasto (RP: 1,82; IC95%: 1,01 - 3,27), ter 2 ou mais irmãos menores (RP: 2,88; IC95%: 1,45 - 5,72), ausência da mãe biológica no domicílio (RP: 2,63; IC95%: 1,32 - 5,24) e exposição ao esgoto a céu aberto no âmbito domiciliar (RP: 2,46; IC95%: 1,51 - 4,00). Somente o baixo peso ao nascer mostrou-se como fator associado ao déficit peso para estatura (RP: 2,91; IC95%: 1,16 - 7,24). CONCLUSÕES: Nos municípios estudados, a desnutrição em crianças menores de 60 meses apresenta-se como um importante problema de saúde pública, associado aos indicadores de iniquidades sociais, acesso aos serviços de saúde e ausência da mãe no domicílio.

Estudos populacionais no Brasil apontam aumento da prevalência de excesso de peso e obesidade na população adulta, em todas as regiões. O objetivo deste estudo foi estimar a prevalência e identificar os principais fatores associados ao excesso de peso em adultos, em Rio Branco, Acre, Brasil, por meio de um estudo transversal de base populacional com amostra composta de 1.469 adultos. A análise multivariada foi realizada através de regressão de Poisson, adotando-se, como variável dependente, excesso de peso (IMC > 25kg/m²). A prevalência de excesso de peso foi observada em 46,9% da amostra, sendo mais elevada entre as mulheres. Observou-se tendência de aumento do excesso de peso com o aumento da idade em ambos os gêneros. Observaram-se associações entre o excesso de peso e variáveis socioeconômicas, demográficas e morbidades como hipertensão arterial e dislipidemias. A alta prevalência de excesso de peso em adultos de ambos os sexos sugere um problema de saúde pública. Tornam-se necessárias medidas de controle e prevenção dos riscos à saúde associados ao excesso de peso.

Introduction: Pregnancy can be associated with health risks for both the mother and infant, and specialised care during the pregnancy, delivery and puerperium periods can help reduce complications for the mother-infant binomial. Objective: To assess the demographic, social and reproductive aspects of delivery and the postpartum period in Rio Branco, Acre, Brazil. Methods: A population-based cross-sectional survey was conducted via an interview with 552 mothers with children aged 0 to 5 years between 2007 and 2008. Cluster sampling of the population was performed in two stages (census sectors and domiciles). Results: The majority of the 552 mothers were multiparous (79.6%). Around 70% of pregnancies occurred in teenage mothers. The proportion of caesarean section deliveries was 38.4% in mothers from urban zones and 28.5% in those from rural areas, and was higher in mothers who attended private clinics, who self-reported as being Caucasian, and who had a higher educational level. With regard to puerperal complications, mothers who underwent caesarean section had a higher prevalence of hypertension (71.1%) with an adjusted prevalence ratio of 3.90 (95% CI [2.00, 7.61]). Conclusions: The results revealed a high rate of teenage pregnancy, and arterial hypertension was the leading complication during the postpartum period experienced by women who had undergone caesarean section. These findings merit further attention, and should be used to improve the care provided to Rio Branco.

IgG antibodies to Toxoplasma gondii were detected in, March-April 2004, in 65.8% (95% confidence inter- val, 60.8-70.8%) of 342 systematically sampled subjects 5-90 years of age (87.5% of the eligible) living in a rural settle- ment in Amazonia, with a seroconversion rate of 9% over 1 year of follow-up of 99 seronegative subjects. Multiple logistic regression analysis identified age as the only significant independent predictor of seropositivity at the baseline. Each additional year of age increases the odds of being seropositive by 6%, and 76.8% of the subjects are expected to be sero- positive at 30 years of age. A single high-prevalence spatial cluster, comprising 11.9% of the seropositive subjects, was detected in the area; households in the cluster were less likely to have dogs as pets and their heads had a lower education level, when compared with households located outside the cluster. The challenges for preventing human toxoplasmosis in tropical rural settings are discussed. Here, we describe the epidemiology of human toxoplasmo- sis in one of the largest agricultural settlements in the Amazon Basin of Brazil, the Pedro Peixoto settlement in the state of Acre. We analyzed individual and environmental risk factors for the presence of IgG antibodies to T. gondii among sub- jects 5-90 years of age, estimated the IgG seroconversion rate over nearly 1 year of follow-up, and examined the spatial dis- tribution of seropositive subjects in the study area. We briefly discuss some challenges for the primary prevention of human toxoplasmosis in this and rural settings in the tropical world.

The article presents prevalence rates for malnutrition, intestinal parasitic infections, anemia, and iron deficiency in under-five children in a population-based cross-sectional survey performed in the urban area of two counties in the Western Brazilian Amazon, Assis Brasil (n = 200) and Acrelandia (n = 477). Available data included: (a) weight and height measurements, standardized as z-scores using the 1977 NCHS reference population, (b) diagnosis of current intestinal parasitic infection, (c) blood hemoglobin levels, and (d) plasma ferritin and soluble transferrin receptor levels. Overall prevalence rates of low weight-for-height, low weight-for-age, and low height-for-age were 3.7%, 8.7%, and 7.5%, respectively, with similar figures in the two towns. Intestinal parasites were detected in 32.5% children; helminths were uncommon. Anemia and iron deficiency were diagnosed in 30.6% and 43.5% of the children, respectively. Evidence of anemia was found in only 47.6% of the children with depleted iron reserves, indicating that hemoglobin measurement alone would severely underestimate the magnitude of iron deficiency in this population. In both towns, anemia and malnutrition were significantly more prevalent among children in the lowest socioeconomic stratum. As prevalências de desnutrição, parasitoses intestinais, anemia e deficiência de ferro foram avaliadas, por meio de inquéritos transversais de base populacional, em pré-escolares na área urbana de dois municípios das Amazônia Ocidental Brasileira, Assis Brasil (n = 200) e Acrelândia (n = 477). Os índices antropométricos peso/estatura (P/E), peso/idade (P/I) e estatura/idade (E/I) foram calculados como escores z, com base na população de referência do National Center for Health Statistics de 1977. Diagnosticaram-se déficits nutricionais segundo índices P/E, P/I e E/I em 3,7%, 8,7% e 7,5% das crianças, respectivamente. Encontraram-se parasitas intestinais em 32,5% das 554 amostras examinadas, sendo raras as infecções por helmintos. Com base nos níveis de hemoglobina sangüínea e níveis plasmáticos de ferritina e receptor solúvel de transferrina, diagnosticaram-se anemia e deficiência de ferro em 30,6% e 43,5% das crianças, respectivamente. Somente 47,6% das crianças com deficiência de ferro tinham anemia, indicando que a medida isolada de hemoglobina sangüínea subestima a magnitude da deficiência de ferro nesta população. Nos dois municípios, a anemia e a desnutrição foram significantemente mais prevalentes entre as crianças de famílias dos estratos sócio-econômicos mais baixos.

This study analyzed the evolution of socioeconomic, sanitary, and personal factors as well as spatiotemporal changes in the prevalence of helminthiasis and giardiasis in urban Amazonian children between 2003 and 2011. Child age, lack of sanitation, and lack of access to bottled water were identified as significant associated factors for helminthiasis and giardiasis. There was an overall improvement in socioeconomic and sanitary conditions in the city resulting in decreased helminth prevalences from 12.42 to 9.63% between 2003 and 2010, but the prevalence increased to 15.03% in 2011 due to migratory movement and unstable sanitary conditions. As for Giardiasis, socioeconomic and environmental changes were not enough to reduce prevalence (16% in 2003 and 23% in 2011). Spatial analysis identified a significant cluster for helminthiasis in an area of poor housing conditions. Control programs in the Amazon need to target high-risk areas focusing changes in sanitation, water usage, and health education.

Este estudo objetivou analisar a associação da força de preensão manual com morbidades referidas e multimorbidade em adultos de Rio Branco, Acre, Brasil, mediante inquérito de base populacional com 1.395 adultos de ambos os sexos. As associações, por sexo, foram estimadas com a técnica de regressão logística. A média de força de preensão manual nos homens (44,8kg) é maior que entre as mulheres (29kg) e reduz com a idade. A diferença da força de preensão manual média entre aqueles classificados como fortes e fracos foi 21kg e 15,5kg, para homens e mulheres, respectivamente. Controlando para a faixa etária, índice de massa corporal e atividade física quando relevante, homens com baixa força de preensão manual tiveram maiores chances de ocorrência de hipertensão [OR = 2,21 (1,35; 3,61)], diabetes [OR = 4,18 (1,35; 12,95)], distúrbio musculoesquelético [OR = 1,67 (1,07; 2,61)] e multimorbidade [OR = 1,99 (1,27; 3,12)]. Nas mulheres, associações entre força de preensão manual e evento cardiovascular, dislipidemia, distúrbio muscolesquelético e multimorbidade não se mantiveram nos modelos multivariados. Este estudo endossa o uso da força de preensão manual como biomarcador de saúde. El objetivo fue analizar la asociación de la fuerza de prensión manual con las morbilidades y multimorbilidad entre los adultos en Rio Branco, Acre, Brasil, mediante una encuesta poblacional con 1.395 adultos de ambos sexos. Las asociaciones, por sexo, se estimaron mediante regresión logística. La media de la fuerza de prensión manual en los hombres (44,8kg) es mayor que en las mujeres (29kg) y disminuye con la edad. La diferencia de la fuerza de prensión manual media entre los clasificados como fuertes y débil fue 21kg y 15,5kg para hombres y mujeres, respectivamente. Controlando por edad, índice de masa corporal y la actividad física, cuando sea pertinente, los hombres con baja fuerza de prensión manual son más propensos a sufrir de hipertensión [OR = 2,21 (1,35; 3,61)], diabetes [OR = 4,18 (1,35; 12,95), trastorno musculoesquelético [OR = 1,67 (1,07; 2,61)] y multimorbilidad [OR = 1,99 (1,27; 3,12)]. Entre las mujeres, las asociaciones entre fuerza de prensión manual y evento cardiovascular, dislipidemia, trastorno musculoesquelético y multimorbilidad no se mantuvieron en los modelos multivariados. Este estudio respalda el uso de fuerza de prensión manual como un biomarcador de la salud. This study aimed to analyze the association of handgrip strength with self-reported diseases and multimorbidity among adults in Rio Branco, Acre State, Brazil, through a population based survey involving 1,395 adults of both sexes. Associations by sex were estimated by logistic regression analysis. The mean handgrip strength in men (44.8kg) is higher than in women (29kg) and decrease with age. The mean handgrip strength difference between those classified as strong and weak was 21kg and 15.5kg for men and woman, respectively. Controlling for age group, body mass index and physical activity when it was relevant, men with low handgrip strength were more likely to have hypertension [OR = 2.21 91.35; 3.61)], diabetes [OR = 4.18 (1.35; 12.95)], musculoskeletal disorders [OR = 1.67 (1.07; 2.61)] and multimorbidity [OR = 1.99 (1.27; 3.12)]. Among woman, associations between handgrip strength and cardiovascular disease, dyslipidemia, musculoskeletal disorders and multimorbidity were not sustained in the multivariate models. This study endorses the use of handgrip strength as a health biomarker.

To estimate the prevalence of child undernutrition and associated factors in a municipality with high nutritional risk in Brazil.This cross-sectional, population-based study was conducted with a sample of 478 children aged under 5 years in the city of Jordão, Acre, Brazil. The following indicators were calculated: weight for age (W/A), height for age (H/A), and weight for height (W/H), using the growth curves of the WHO as reference, which adopts a cutoff of -2 z scores for identification of malnourished children. Adjusted prevalence ratios (PRs) were obtained using multiple Poisson regression models with robust error estimate (p0.05).A high prevalence of stunting (35.8%) was observed. Children with indigenous ancestry living in rural areas showed the highest prevalence of malnutrition (59.4%). After controlling for age, gender, and indigenous ancestry, the factors associated with stunting risk were: living in rural area (PR = 1.6; 95%CI 1.2 - 2.1); lower tertile of household wealth index (PR = 1.6; 95%CI 1.1 - 2.3); living in houses made of walking palm (PR = 1.6; 95%CI 1.1 - 2.4); maternal height less than or equal to 146.4 cm (PR = 3.1; 95%CI 1.9 - 5.0); and history of introduction of cow's milk before 30 days of age (PR = 1.4; 95%CI 1.0 - 1.8). Children with updated vaccination cards were inversely associated with stunting risk (PR = 0.7; 95%CI 0.5 - 0.9).Child undernutrition remains a serious public health problem in the Amazon, indicating additional difficulties in facing the problem in this region of the country.

Made available in DSpace on 2015-10-21T13:09:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-02-07. Added 1 bitstream(s) on 2015-10-22T09:53:15Z : No. of bitstreams: 1 WOS000350318700001.pdf: 420438 bytes, checksum: ac059fb8740838b896110631cfe8f11b (MD5) Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Financiadora de Estudos e Projetos (FINEP) Background: The Study of Cardiovascular Risk in Adolescents (Portuguese acronym, "ERICA") is a multicenter, school-based country-wide cross-sectional study funded by the Brazilian Ministry of Health, which aims at estimating the prevalence of cardiovascular risk factors, including those included in the definition of the metabolic syndrome, in a random sample of adolescents aged 12 to 17 years in Brazilian cities with more than 100,000 inhabitants. Approximately 85,000 students were assessed in public and private schools. Brazil is a continental country with a heterogeneous population of 190 million living in its five main geographic regions (North, Northeast, Midwest, South and Southeast). ERICA is a pioneering study that will assess the prevalence rates of cardiovascular risk factors in Brazilian adolescents using a sample with national and regional representativeness. This paper describes the rationale, design and procedures of ERICA.Methods/Design: Participants answered a self-administered questionnaire using an electronic device, in order to obtain information on demographic and lifestyle characteristics, including physical activity, smoking, alcohol intake, sleeping hours, common mental disorders and reproductive and oral health. Dietary intake was assessed using a 24-hour dietary recall. Anthropometric measures (weight, height and waist circumference) and blood pressure were also be measured. Blood was collected from a subsample of approximately 44,000 adolescents for measurements of fasting glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, glycated hemoglobin and fasting insulin.Discussion: The study findings will be instrumental to the development of public policies aiming at the prevention of obesity, atherosclerotic diseases and diabetes in an adolescent population. Universidade Federal do Rio de Janeiro, Instituto de Estudos em Saúde Coletiva Universidade do Estado do Rio de Janeiro, Núcleo de Estudos da Saúde do Adolescente Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública Instituto Brasileiro de Geografia e Estatística, Escola Nacional de Ciências Estatísticas Universidade Federal do Rio de Janeiro, Instituto de Nutrição Josué de Castro Universidade Federal do Pará, Instituto Ciências da Saúde Universidade Federal de Goiás, Faculdade de Enfermagem e Nutrição Universidade Estadual de Feira de Santana, Departamento de Saúde Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre Universidade Federal do Amazonas, Instituto de Saúde e Biotecnologia Universidade do Estado do Rio de Janeiro, Departamento de Nutrição Universidade federal de Minas Gerais, Hospital de Clínicas da UFMG Universidade Federal do Amazonas, Faculdade de Educação Física e Fisioterapia Universidade de São Paulo, Departamento de Enfermagem em Saúde Coletiva Universidade Federal do Espirito Santo, Departamento de Enfermagem Universidade Federal de Santa Catarina, Departamento de Nutrição, Centro de Ciências da Saúde Universidade Federal do Rio Grande do Norte, Departamento de Morfologia, Centro de Biociências Universidade Federal de Mato Grosso,Departamento de Saúde Coletiva, Instituto de Saúde Coletiva Instituto Nacional de Cardiologia, Laboratório de Biologia e Diagnósticos Moleculares Universidade Estadual de Campinas, Departamento de Medicina Preventiva e Social, Faculdade de Ciências Médicas Universidade de Brasília, Departamento de Nutrição Universidade Federal de Rondônia, Departamento de Educação Física, Núcleo de Saúde Universidade Federal do Piauí, Departamento de Nutrição, Centro de Ciências da Saúde Universidade Federal do Acre, Departamento de Ciências da Saúde e Educação Física Universidade Federal de Goiás, Faculdade de Medicina Universidade Federal do Ceará, Departamento de Saúde Comunitária, Faculdade de Medicina Universidade Federal de Sergipe, Departamento de Medicina, Centro de Ciências Biológicas e da Saúde Universidade Federal da Paraíba, Departamento de Nutrição, Centro de Ciências da Saúde Universidade Federal de Alagoas, Departamento de Nutrição Hospital Estadual Getúlio Vargas, Núcleo Hospitalar de Geriatria e Gerontologia Universidade Federal de Roraima, Centro de Ciências da Saúde Universidade Estadual Paulista, Departamento de Saúde Pública, Faculdade de Medicina de Botucatu Universidade Estadual Paulista, Departamento de Pediatria, Faculdade de Medicina de Botucatu FAPERJ: E26/100.332/2013 CNPq: 304595/2012-8 CNPq: 307988/2011-2 CNPq: 302877/2009-6 FINEP: 01090421 CNPq: 565037/2010-2|CNPq: 405009/2012-7 CNPq: CNPq: 565037/2010-2

Study with the objective of identifying the problems of health presented by the nurses in its work place, accomplished 85 close to (51,2%) nurses of the Net of the Hospitals of Rio Branco - Acre - Brazil, and in eight Leaderships of the Service of Nursing, with questionnaire use and glimpses filled by the authors, with regard to the ethical aspects of the research. As results 87,5% possess couple or triple work day. In agreement with the leaderships, 75,0% presented problems in the relationship humor and attendance to the patient; 62,5% complained about problems of health for the conditions of the work; 17,1% made use of medications against the hypertension, and 68,3% solemnity-medication, with use of analgesic. The found diseases were: diseases of the bony and muscular system and of the conjunctive fabric, with 34,9%; diseases of the nervous system, with 23,2% and the symptoms,signs and abnormal discoveries of clinical exams and of laboratory not classified in another part,with 22,0%, where the need is reinforced of implementing prevention programs to the nurses'health.

BACKGROUND The Amazon region has the highest seroprevalence of hepatitis A virus (HAV) in Brazil. METHODS In the present study, the seroprevalence of total HAV antibodies in two groups, composed of 147 and 254 children between 1 and 5 years old in Assis Brasil, Acre, was measured in 2003 and 2010, respectively, and compared with socio-economic changes in the city. RESULTS In 2003, the HAV seroprevalence rate was 26.5%, while in 2010, it was 22.4%. There was an overall improvement in socio-economic and sanitary conditions, with the exception of open sewage. In 2003, factors associated with positive serology were child age (aOR [adjusted odds ratio] 1.84; 95% CI: 1.28-2.64), having a latrine or not having a toilet at home (aOR 4.73; 95% CI: 1.06-21.17) and the treatment of drinking water with chlorine (aOR 0.26; 95% CI: 0.07-0.92). In 2010, the main factors associated with positive serology were using rivers, streams and rainwater as sources of water for domestic purposes (aOR 24.36; 95% CI: 3.69-160.85); having a wooden or ground floor at home (OR 2.51; 95% CI: 1.11-5.69) and child age (aOR 2.33; 95% CI: 1.66-3.28). CONCLUSIONS In the Brazilian Amazon, sanitation and water treatment still require improvement and socio-economic development is warranted in order to decrease hepatitis A transmission.

The present study investigated the factors associated with anemia and micronutrient deficiencies in a cross-sectional analysis conducted with 150 children aged 11 to 14 months attending at basic health centers in Rio Branco, Acre. Venous blood samples were obtained to assess the occurrence of anemia and deficiencies of iron (ID), vitamin A (VAD), and B12 (VB12D). Multiple Poisson regression models were used to identify factors associated with anemia. Anemia, ID, VAD and B12D were observed in 23%, 76%, 18% and 20% of children, respectively. The factors associated with anemia were: do not be only child, living in households without access to cable TV or internet, stunting, late introduction of the complementary feeding (more than 240 days), VAD, VB12D, and current evidence of infection (plasma CRP5 mg/L). There was a lower prevalence of anemia among children with birth weight3,500 g. Overall, 82% of the study children had at least one of the micronutrient deficiencies (ID, VAD and VB12D). Actions with emphasis on timely and healthy feeding practices, better management of morbidities and supplementation with other micronutrients should be focused on the improvement of child care services at primary health care in this county.

This study aimed to analyze the association of handgrip strength with self-reported diseases and multimorbidity among adults in Rio Branco, Acre State, Brazil, through a population based survey involving 1,395 adults of both sexes. Associations by sex were estimated by logistic regression analysis. The mean handgrip strength in men (44.8kg) is higher than in women (29kg) and decrease with age. The mean handgrip strength difference between those classified as strong and weak was 21kg and 15.5kg for men and woman, respectively. Controlling for age group, body mass index and physical activity when it was relevant, men with low handgrip strength were more likely to have hypertension [OR = 2.21 91.35; 3.61)], diabetes [OR = 4.18 (1.35; 12.95)], musculoskeletal disorders [OR = 1.67 (1.07; 2.61)] and multimorbidity [OR = 1.99 (1.27; 3.12)]. Among woman, associations between handgrip strength and cardiovascular disease, dyslipidemia, musculoskeletal disorders and multimorbidity were not sustained in the multivariate models. This study endorses the use of handgrip strength as a health biomarker.

Toxocara spp. infection and the seroconversion rate in the Amazon have been poorly investigated. This study analyzed individual and household-level risk factors for the presence of IgG antibodies to Toxocara spp. in urban Amazonian children over a period of 7 years and evaluated the seroconversion rates over a 1-year follow-up. In children < 59 months of age, the overall prevalence rate was 28.08% in 2003 and 23.35% in 2010. The 2010-2011 seroconversion rates were 13.90% for children 6-59 months of age and 12.30% for children 84-143 months of age. Multilevel logistic regression analysis identified child age, previous wheezing, and current infection with hookworm as significant associated factors for Toxocara spp. seropositivity in 2003. In 2010, age, previous helminthiasis, and having a dog were associated with seropositivity, whereas having piped water inside the household was a protective factor. Control programs mainly need to target at-risk children, water quality control, and animal deworming strategies.

ObjectiveTo examine the prevalence of stunting and overweight in children and identify demographic, socio-economic and maternal characteristics, as well as biochemical indicators, associated with these outcomes.DesignA population-based, cross-sectional study was performed. Data from structured questionnaires, anthropometric measurements, and blood and stool samples were used in Poisson regression models to estimate prevalence ratios (PR) according to a hierarchical conceptual framework.SettingAcrelândia, western Brazilian Amazon.SubjectsChildren (n 1139) aged ResultsPrevalence of stunting was 7·1 % (95 % CI 5·1, 9·6 %) and 3·7 % (95 % CI 2·4, 5·7 %) among children aged ConclusionsOverweight was more prevalent than stunting, being associated with higher household wealth, maternal overweight, caesarean delivery, high birth weight, micronutrient deficiencies and high TAG concentration. Improvements in maternal and child health care with sustainable access to healthy food are necessary to reduce short- and long-term health complications related to overweight in this population.

This study describes the epidemiological profile of American cutaneous leishmaniasis in Assis Brasil, a town located at the border of Brazil, Peru and Bolivia, between 2003 and 2010. Leishmaniasis case files were reviewed and frequencies compared using the Fisher Exact Test or Chi-square. There were 579 cases recorded, with a detection coefficient of 191 and 82 cases per 10,000 inhabitants in 2003 and 2010, respectively. Cases were more frequent in males (63.0%), in persons living in rural areas (72.3%), and in those with environment-related jobs (52.5%). Around 81% of patients resided in Assis Brasil, 3.6% lived in neighboring Brazilian towns, 10.4% in Peru, 1.7% in Bolivia and 3.8% had an unknown address. The cutaneous form was more prevalent (53.5%), and there were few cases of relapse (1.7%) recorded during this period. The diagnosis was most commonly confirmed by the intradermal test, while the direct microscopic test was seldom used. Treatment deficiencies occurred due to inadequate prescribed doses (56.3% of mucosal cases) and shortened length of treatment (2.6% of cases). There is an apparent lack of human resources for diagnosis and case notification, and therefore improvements in the basic public health system are needed for efficient disease control.