Publications by authors named "Maria Regina Alves Cardoso"

53 Publications

Prevalence of hot flashes in women of 40 to 65 years of age with metabolic syndrome.

Rev Assoc Med Bras (1992) 2020 Dec;66(12):1628-1632

Ph.D., Departamento de Saúde Materno-Infantil, Faculdade de Saúde Pública, Universidade de São Paulo, SP, Brasil.

Objective: Hot flashes have a negative impact on the quality of life of women during the menopausal transition and thereafter. The progressive reduction in gonadal estrogen levels associated with aging promotes an accumulation of abdominal fat, dyslipidemia, and arterial hypertension, all of which are components of metabolic syndrome (MetS). The objective of the present study was to estimate the prevalence of hot flashes and evaluate their relationship with MetS in women ≥ 40 years of age.

Methods: This was a cross-sectional study involving women aged between 40 and 65 years. We used the Kupperman index to quantify the climacteric symptoms and the National Cholesterol Education Program Adult Treatment Panel III criteria for the diagnosis of MetS.

Results: 1,435 women were initially selected, and we obtained information from 647. The mean age at menopause was 45.99 years (SD 6.61 years) and the prevalence of hot flashes and MetS were 55.83% (95% CI: 52.35-59.25%) and 46.29% (95% CI: 44.75-52.53%), respectively. We identified a positive association between MetS and hot flashes (OR 1.16; 95% CI: 1.01-1.33).

Conclusions: In women ≥ 40 years of age, hot flashes are highly prevalent and appear to be associated with MetS.
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http://dx.doi.org/10.1590/1806-9282.66.12.1628DOI Listing
December 2020

Accidental falls in middle-aged women.

Rev Saude Publica 2020 16;54:141. Epub 2020 Dec 16.

Universidade de São Paulo. Faculdade de Medicina. Programa de Pós-Graduação em Ciências da Reabilitação. São Paulo, SP, Brasil.

Objective: To estimate the prevalence of accidental falls in women and to identify possible associations of sociodemographic, clinical and lifestyle variables with falls, in 2007 and 2014.

Methods: Two cross-sectional studies were performed, in 2007 and 2014, within the Projeto de Saúde de Pindamonhangaba (PROSAPIN - Pindamonhangaba Health Project), with women aged between 35 to 75 years. Probabilistic samples were selected among women living in the municipality and participating in the Health Family Strategy. Data collection included: face-to-face interview, anthropometric examination and blood test. The outcome variable "have you fallen in the last six months?" was raised during the interview. The prevalence of falls in 2007 and 2014 were estimated by score with a 95% confidence interval (95%CI). Multiple logistic regression models were constructed to identify the association of independent variables with the occurrence of falls for each year based on the odds ratio (OR). We used the Stata 14.0 software for statistical analysis.

Results: The prevalence of accidental falls were: 17.6% (95%CI 14.9-20.5) in 2007 and 17.2% (95%CI 14.8-19.8) in 2014. In 2007, factors associated with falls were: aged 50-64 years (OR = 1.81; 95%CI 1.17-2.80), high school (OR = 1.76; 95%CI 1.06-2.93), hyperuricemia (OR = 3.74; 95%CI 2.17-6.44), depression (OR = 2.07; 95%CI 1.31-3.27), poor sleep (OR = 1.78; 95%CI 1.12-2.82) and daytime sleepiness (OR = 1.86; 95%CI 1.16-2.99). In 2014, they were: aged 50-64 years (OR = 1.64; 95%CI 1.04-2.58), hyperuricemia (OR = 1.91; 95%CI 1.07-3.43) and depression (OR = 1.56; 95%CI 1.02-2.38), plus metabolic syndrome (OR = 1.60; 95%CI 1.03-2.47) and musculoskeletal pain (OR = 1.81; 95%CI 1.03-3.18).

Conclusions: Falls occur significantly in women aged 50 years or over, indicating that they are not restricted to older adults and that there is a need to initiate preventive measures earlier. Both studies showed similar magnitudes of occurrence of accidental falls and reinforced their multifactorial nature. In addition, hyperuricemia may be a potential new factor associated with falls.
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http://dx.doi.org/10.11606/s1518-8787.2020054002579DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7726919PMC
January 2021

Mortality trend due to Hepatitis B and C in the city of São Paulo, 2002-2016.

Rev Saude Publica 2020 4;54:124. Epub 2020 Dec 4.

Universidade de São Paulo. Faculdade de Medicina. Departamento de Medicina Preventiva. São Paulo, SP, Brasil.

Objective: To describe mortality due to hepatitis B and C as underlying cause in the municipality of São Paulo, verifying the trend of these rates, and to assess the association of these diseases with others, from 2002 to 2016.

Methods: This is a time series study on mortality due to hepatitis B and C according to sex, with data from the Sistema de Informação de Mortalidade (SIM - Mortality Information Sistem). Prais Winsten regression was used in rate trend analysis.

Results: The findings of this study showed a trend of decline of mortality from hepatitis B and C in recent years, particularly among males. These infections were important associated causes of liver cell carcinoma and HIV. The proportion of deaths under 70 years of age stands out.

Conclusions: The study provides a baseline for research on mortality trend and the impact of interventions, given the history of expanded detection and supply of treatments, including the most recent antivirals in Brazil, since 2015.
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http://dx.doi.org/10.11606/s1518-8787.2020054002231DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7688257PMC
January 2021

Residential traffic exposure and lymphohematopoietic malignancies among children in the city of São Paulo, Brazil: An ecological study.

Cancer Epidemiol 2021 Feb 23;70:101859. Epub 2020 Nov 23.

Department of Environmental Health, School of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP, CEP01246-904, Brazil. Electronic address:

Background: Despite widespread evidence that air pollution is carcinogenic, there is little evidence from low-middle income countries, especially related to childhood malignancies. We examined the role of traffic related pollution on lymphohematopoietic malignancies among under-14 s in Sao Paulo.

Methods: All incident cases between 2002 and 2011 were collected from a population-based registry. Exposures were assigned on residential address at diagnosis via traffic density database (for the year 2008) and a satellite derived NO land use regression model (averaged between 1997 and 2011). Incidence rate ratios (IRRs) were calculated via Poisson Regression adjusted by age, gender and socioeconomic status (SES), with additional stratification by SES.

Results: A positive association between traffic and NO with some lymphohematopoietic malignancies was observed with the degree of effect differing by SES. For example, lymphoid leukemia IRRs in the lower SES group were 1.21 (95 % CI: 1.06, 1.39) for traffic density and 1.38 (95 % CI: 1.13, 1.68) for NO. In the higher group they were 1.06 (95 % CI: 1.00, 1.14) and 1.37 (95 % CI: 1.16, 1.62).

Conclusion: NO and traffic density were associated with Hodgkin lymphoma and lymphoid leukemia among children in São Paulo. Differing IRRs by gender and SES group indicate differences in underlying risk and/or exposure profiles.
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http://dx.doi.org/10.1016/j.canep.2020.101859DOI Listing
February 2021

Air pollution and its impact on the concentration of airborne fungi in the megacity of São Paulo, Brazil.

Heliyon 2020 Oct 7;6(10):e05065. Epub 2020 Oct 7.

School of Public Health - USP, Department of Epidemiology, Brazil.

In the context of megacities in an urban environment, air quality is an important issue, due to the direct correlation to population's health. The biomonitoring of pollutants can indicate subtle environmental alterations, for that, anemophilous fungi can be monitored for changes in atmospheric conditions related to pollution. In the present study, the concentration of fungi and bacteria in the atmosphere was measured during a specific vehicle fleet reduction in the city of São Paulo, Brazil, from May 24 to 30, 2018, using impactor air samplers. The number of isolated developed colonies was related to atmospheric conditions and the concentration of other air pollutants constantly monitored. and a were identified. The number of colony-forming units increased by approximately 80% during the sampling period in response to environmental changes favored by the fleet reduction. This result implies the relation between fuel emissions, concentration of atmospheric pollutants, and the presence of viable fungal spores in the urban environment, which highlights the importance of combined public policies for air quality in large cities.
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http://dx.doi.org/10.1016/j.heliyon.2020.e05065DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7550922PMC
October 2020

Increase in fall-related hospitalization, mortality, and lethality among older adults in Brazil.

Rev Saude Publica 2020 14;54:76. Epub 2020 Aug 14.

Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.

OBJECTIVE To estimate the trends of fall-related hospitalization, mortality, and lethality among older adults in Brazil and regions. METHODS This is a descriptive study based on data from the Hospital Information System of the Brazilian Unified Health System. We included records of every older adult, aged 60 years or older, hospitalized for accidental fall from January, 1998 to November, 2015 in all Brazilian regions. We selected the codes E885, E886, E880, E884, E884 from the International Classification of Diseases, 9th revision, and W01, W03, W10, W17, W18 from the 10th revision, and calculated fall-related hospitalization and mortality rates per 100,000 inhabitants, as well as lethality. To estimate trends, we applied the Prais-Winsten regression for time series analysis. RESULTS During the period, 1,192,829 fall-related hospitalizations occurred, among which 54,673 had a fatal outcome; lethality was 4.5%. Hospitalization rates showed upward trends, with seasonality, in Brazil (11%), and in the Northeast (44%), Midwest (13%), and South regions (14%). The North showed a decreasing hospitalization rate (48%), and the Southeast a stationary one (3%). CONCLUSIONS In Brazil, fall-related hospitalizations, mortality, and lethality among older adults showed an upward trend from 1998 to 2015, with seasonal peaks in the second and third quarters. Considering we are in plain demographic transition, to improve hospital healthcare and encourage falls prevention programs among older adults is essential.
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http://dx.doi.org/10.11606/s1518-8787.2020054001691DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7416763PMC
August 2020

Invasive pneumococcal disease among hospitalized children in Brazil before and after the introduction of a pneumococcal conjugate vaccine.

Vaccine 2020 02 23;38(7):1740-1745. Epub 2019 Dec 23.

Department of Pediatrics, Universidade Federal de Uberlândia, Avenida Pará 1720, Uberlândia, MG 38405-320, Brazil.

Background: Most of the available data on invasive pneumococcal disease in Latin America are derived from laboratory-based surveillance systems. There is a lack of epidemiological data on the disease severity and mortality from hospitalized patients with pneumococcal infection.

Methods: In this hospital-based retrospective historical series of hospitalized children with laboratory-confirmed IPD, we evaluated changes in disease episodes, in-hospital fatality rates, and need for intensive care unit admission after the inclusion of PCV10 in the Brazilian vaccination schedule. Invasive pneumococcal strains isolated by culture were serotyped. Changes over time were assessed, and pre-vaccination (2005-2009) to post-vaccination (2011-2015) disease rates and serotypes were compared.

Results: 260 patients with IPD and positive pneumococcal isolates were identified (198 during the pre-PCV10 period). When comparing both periods, hospitalizations were reduced from 20 cases to 5 cases per 10,000 pediatric admissions (p < 0.0001). Likewise, fatalities reduced from 6.6 to 2.0 cases per 10,000 pediatric admissions (p < 0.0001). Pneumonia was the most frequent clinical diagnosis (58%) - of which 49.6% had pleural effusion - followed by meningitis (22%) and bacteremia (15.9%). Overall 30% of cases were sent to ICU, with no percentual changes after PCV10. Additional PCV13 serotypes increased from 7% before vaccine introduction to 21% after PCV10 use. Similarly, serotypes not included in PCV13 increased from 11% to 29%.

Conclusions: There was a significant reduction in the hospitalizations rates, ICU admissions, and fatalities due to IPD after PCV10 introduction in Brazil. Cases due to PCV10 serotypes were reduced, while infections rates caused by non-PCV10 serotypes increased.
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http://dx.doi.org/10.1016/j.vaccine.2019.12.038DOI Listing
February 2020

Bayesian modeling of hematologic cancer and vehicular air pollution among young people in the city of São Paulo, Brazil.

Int J Environ Health Res 2020 Oct 26;30(5):504-514. Epub 2019 Apr 26.

Department of Environmental Health, School of Public Health, University of São Paulo , São Paulo, Brazil.

Traffic-related air pollution is being associated with hematologic cancer in young individuals. This study performed a spatial analysis of the hematologic cancer incidence and mortality among younger people, using a Bayesian approach, to associate with traffic density in the city of São Paulo, Brazil. Two databases were employed: incidence (2002-2011) and mortality (2002-2013). The relationships between the cases of hematologic cancer and the covariates - traffic density, the Municipal Human Development Index (MHDI), and population density - were evaluated using a Besag-York-Mollié ecological model with relative risks (RRs) estimates. Per 1-unit standard-deviation increase in traffic density, in the MHDI, and in population density, the RR for the incidence was 1.06 (95% CI: 0.97-1.14), 1.28 (95% CI: 1.16-1.42), and 1.01 (95% CI: 0.94-1.08), respectively. For mortality, no covariates were considered risk factors. Our findings suggest significant association between living in regions with better socioeconomic conditions, where traffic density is usually higher, and risk of hematologic cancer in younger people.
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http://dx.doi.org/10.1080/09603123.2019.1608916DOI Listing
October 2020

[Influence of vehicular traffic density on hospital admissions due to respiratory tract cancer in the city of São Paulo, Brazil].

Cad Saude Publica 2019 01 21;35(1):e00128518. Epub 2019 Jan 21.

Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brasil.

Pollution related to traffic is a major problem in urban centers and a large portion of the population is vulnerable to its health effects. This study sought to identify a potential association between hospital admissions due to respiratory tract cancer and vehicular traffic density in the city of São Paulo, Brazil. It is an ecological study of the public (Hospital Inpatient Authorization - AIH, in Portuguese) and private (Hospital Inpatient Communication - CIH, in Portuguese) health care systems, from 2004 to 2006, geocoded by individuals' residential addresses. Using a Besag-York-Mollié ecological model, we initially evaluated the relationship between number of cases of hospital admission due to respiratory tract cancer in each weighting area and the standardized co-variables: traffic density and Municipal Human Development Index (MHDI) as indicator of socioeconomic status. Using a classic Poisson model, we then evaluated the risk associated with growing traffic density categories. The Besag-York-Mollié model estimated a RR = 1.09 (95%CI: 1.02-1.15) and RR = 1.19 (95%CI: 1.10-1.29) of admission due to respiratory tract cancer for each increase of one standard deviation of traffic and MHDI, respectively. The Poisson model also showed a clear exposure-response gradient for admission due to respiratory tract cancer (IRR = 1.11; 95%CI: 1.07-1.15, for each 10 units of added traffic density). This study suggests that there is an association between residing in areas with high traffic density and hospital admissions due to respiratory tract cancer in the city of São Paulo.
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http://dx.doi.org/10.1590/0102-311X00128518DOI Listing
January 2019

Incidence and mortality for respiratory cancer and traffic-related air pollution in São Paulo, Brazil.

Environ Res 2019 03 18;170:243-251. Epub 2018 Dec 18.

Department of Environmental Health, School of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP CEP 01246-904, Brazil. Electronic address:

Background: Multiple lines of evidence have associated exposure to ambient air pollution with an increased risk of respiratory malignancies. However, there is a dearth of evidence from low-middle income countries, including those within South America, where the social inequalities are more marked.

Objectives: To quantify the association between exposures to traffic related air pollution and respiratory cancer incidence and mortality within São Paulo, Brazil. Further, we aim to investigate the role of socioeconomic status (SES) upon these outcomes.

Methods: Cancer incidence between 2002 and 2011 was derived from the population-based cancer registry. Mortality data (between 2002 and 2013) was derived from the Municipal Health Department. A traffic density database and an annual nitrogen dioxide (NO) land use regression model were used as markers of exposure. Age-adjusted Binomial Negative Regression models were developed, stratifying by SES and gender.

Results: We observed an increased rate of respiratory cancer incidence and mortality in association with increased traffic density and NO concentrations, which was higher among those regions with the lowest SES. For cancer mortality and traffic exposure, those in the most deprived region, had an incidence rate ratio (IRR) of 2.19 (95% CI: 1.70, 2.82) when comparing the highest exposure centile (top 90%) to the lowest (lowest 25%). By contrast, in the least deprived area, the IRR for the same exposure contrast was.1.07 (95% CI: 0.95, 1.20). For NO in the most deprived regions, the IRR for cancer mortality in the highest exposed group was 1.44 (95% CI: 1.10, 1.88) while in the least deprived area, the IRR for the highest exposed group was 1.11 (95% CI: 1.01, 1.23).

Conclusions: Traffic density and NO were associated with an increased rate of respiratory cancer incidence and mortality in São Paulo. Residents from poor regions may suffer more from the impact of traffic air pollution.
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http://dx.doi.org/10.1016/j.envres.2018.12.034DOI Listing
March 2019

Shift work and sex are variants across Karolinska Sleep Questionnaire and the application of linking analysis as a step forward using Item Response Theory.

Chronobiol Int 2019 01 7;36(1):42-56. Epub 2018 Nov 7.

a School of Public Health , São Paulo University , Brazil.

The frequency of sleep disturbances is considerably higher in the night and shift workers and in females than in day workers and males, respectively. However, a subjective sleep scale must be invariant across these groups, independently of the level of their members on the scale. This study is aimed to test the invariance of the Karolinska Sleep Questionnaire's (KSQ) items by shift work and sex. We used the data from a census that covered more than 90% (N = 1648) of the nurses from the main institute of the largest public hospital complex of Brazil. Firstly, we intend to find the KSQ's dimensionality using factorial analysis and Item Response Theory (IRT) performed by Graded Response Model. Differential Item Functioning (DIF) was the technique used to test the invariance of each KSQ's dimensions. In case of variance detection, we applied the linking analysis. Intending to test the KSQ's consistency with external variables, we assessed correlations between KSQ's dimensions with health variables, i.e., self-reported health status and musculoskeletal pain. We have found one scale and two subscales from one general and another bidimensional factor structure of the KSQ, respectively. In these dimensions, the KSQ's items fitted well to the IRT and we have identified DIF by shift work. However, we have found DIF by sex just in one item on the general factor. Linking analysis showed as a possible step forward in the variance issue placing on to the same scale the shift work groups in the items with DIF. All correlations between KSQ's dimensions with health variables were significant. Our findings allow us to argue that KQS's items were variant by shift work and sex in a nursing staff census from the largest public hospital complex of Brazil, but we can go on using linking analysis. This could be used as an evidence for the construct validity should go beyond the traditional dimensionality assessment. The dimensionalities of KSQ fit well for other population but individuals living in Scandinavian countries.
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http://dx.doi.org/10.1080/07420528.2018.1515773DOI Listing
January 2019

Exposure to road traffic noise: Annoyance, perception and associated factors among Brazil's adult population.

Sci Total Environ 2019 Feb 8;650(Pt 1):978-986. Epub 2018 Sep 8.

Federal University of Curitiba, XV de Novembro st, 1299 - Centro, Curitiba, PR 80060-000, Brazil.

Background: One of the major environmental problems of the modern world is noise. A health-related marker of environmental noise exposure that can be considered a predictor of annoyance is noise sensitivity. The aim of this study was to ascertain the correlation between levels of exposure to road traffic noise in residential areas and the resulting annoyance based on the perception and sensitivity reported.

Methods: The study involved noise assessment, with the creation of noise maps of the neighborhood in the city of São Paulo, Brazil, and application of a questionnaire to ascertain the perception of the residents of the neighborhood, regarding the effects of this exposure.

Results: The noise levels at all the measured points were found to exceed the critical level for the area, 55 dB(A). A total of 225 interviews were conducted. Noise-related annoyance was reported by 48.4% of the respondents. Associations were observed between living in areas exposed to traffic noise and feeling annoyed with this noise (p < 0.001).

Conclusions: These findings suggest the importance of reviewing and updating Brazilian public policies regarding environmental noise. We found a high prevalence of annoyance reports, as well as aspects indicative of sensitivity to noise exposure.
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http://dx.doi.org/10.1016/j.scitotenv.2018.09.041DOI Listing
February 2019

Lead exposure from households and school settings: influence of diet on blood lead levels.

Environ Sci Pollut Res Int 2018 Nov 11;25(31):31535-31542. Epub 2018 Sep 11.

Departamento de Saúde Ambiental, Faculdade de Saúde Pública, Universidade de São Paulo, Av. Dr. Arnaldo, 715, Cerqueira César, São Paulo, SP, CEP 01246-904, Brazil.

Lead is known as a potent toxicant to human health, particularly for children while their central nervous system is developing. The aim of this study was to investigate the associations between blood lead levels (BLLs) and lead exposure in the children's diet, home, and school environments. A cross-sectional study was conducted with 153 children aged 1-4 years, in four day care centers (DCCs), where a high prevalence of lead exposure was previously found. Lead determination by graphite furnace atomic absorption spectrometry (GF-AAS) was performed for venous blood, drinking water collected in the DCCs, and the 24-h diet (n = 64). Environmental screenings were conducted to evaluate lead concentrations in the tableware, buildings, and playground items in all DCCs and children's homes (n = 18) by using a field-portable X-ray fluorescence analyzer (FP-XRF). The BLL mean was 2.71 μg dL. Means for 24-h lead concentrations in the diet were 1.61 and 2.24 μg kg of body weight (BW) in two DCCs. Lead concentrations in the water supply were lower than 2 μg L. More than 11% of the DCCs' environmental analyses presented lead concentrations higher than or equal to 1 mg cm, as defined by the USEPA. The diet was not found to be a risk factor for lead exposure, but households and DCC settings raised concern. Children's exposure to lead in DCC environments, where they spend the most part of their weekdays, appeared to be relevant. Graphical abstract ᅟ.
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http://dx.doi.org/10.1007/s11356-018-3114-8DOI Listing
November 2018

Blood lead and cadmium levels in preschool children and associated risk factors in São Paulo, Brazil.

Environ Pollut 2018 Sep 18;240:831-838. Epub 2018 May 18.

Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brazil.

In Brazil, there are scarce data on lead (Pb) and cadmium (Cd) contamination, especially for more vulnerable populations such as preschool children. In this paper, we answer two questions: (1) What are the exposure levels of lead and cadmium in preschool children, in Sao Paulo, Brazil? and (2) What are the risk factors associated with this exposure? This cross-sectional study included 50 day care centers (DCCs), totaling 2463 children aged 1-4 years. Venous blood samples were analyzed by ICP-MS. Questionnaires were administered to the parents. Multiple logistic regression models were used to identify associations between blood lead levels (BLLs) and blood cadmium levels (BCLs) and potential risk factors. The geometric mean for BLLs was 2.16 μg/dL (95% CI: 2.10-2.22 μg/dL), and the 97.5th percentile was 13.9 μg/dL (95% CI: 10.0-17.3 μg/dL). For cadmium exposure, the geometric mean for BCLs was 0.48 μg/L (95% CI: 0.47-0.50 μg/L), and the 95th percentile was 2.57 μg/L (95% CI: 2.26-2.75 μg/L). The DCCs' geographic region was associated with high BLLs and BCLs, indicating hot spots for lead and cadmium exposures. In addition, it was found that the higher the vehicles flow, the higher were the BLLs in children. Red lead in household gates was also an important risk factor for lead exposure. Comparing these results with the findings of the Fourth National Report on Human Exposure to Environmental Chemicals by CDC-2013, it was found that in Brazilian preschool children the BLLs are almost three times higher (97.5th percentile) and the BCLs are almost twelve times higher (95th percentile) than those in U.S. children. This information is essential to formulate public health policies.
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http://dx.doi.org/10.1016/j.envpol.2018.04.124DOI Listing
September 2018

High blood lead levels are associated with lead concentrations in households and day care centers attended by Brazilian preschool children.

Environ Pollut 2018 Aug 28;239:681-688. Epub 2018 Apr 28.

Departamento de Saúde Ambiental, Faculdade de Saúde Pública, Universidade de São Paulo, Av. Dr. Arnaldo, 715, Cerqueira César, CEP 01246-904, São Paulo, SP, Brazil. Electronic address:

Background: A previous study observed high blood lead levels (BLL) in preschool children attending 50 day care centers (DCC) in São Paulo, Brazil.

Objective: To identify whether lead levels found in both homes and DCC environments are associated with high blood lead levels.

Methods: Children attending 4 DCCs, quoted here as NR, VA, PS and PF, were divided into two groups according to BLL: high exposure (HE: ≥13.9 μg/dL; 97.5 percentile of the 2013 year sample) and low exposure (LE: <5 μg/dL). For in situ lead measurements (lead paint mode: mg/cm and ROHS mode: μg/g) in the children's households and in the DCC environments, a field portable X-ray-fluorescence analyzer was used. Multiple logistic regressions were performed to control for confounding factors. Odds ratios were adjusted for age, sex, day care center's measured lead, and tobacco.

Results: In an NR DCC building, 33.8% of the measurements had lead levels >600 μg/g, whereas such levels were observed in 77.1% of NR playground measurements. In VA DCC, 22% and 23% of the measurements in the building and in the playgrounds had levels higher than 600 μg/g, respectively. The percentage of high lead levels in the children's houses of the LE group was 5.9% (95% CI: 4.3-7.6%) and 13.2 (95% CI: 8.3-18.0%) in the HE group. Moreover, a significant association was found between high BLLs and lead levels found both in households and DCCs (p < 0.001). Most of the high lead measurements were found in tiles and playground equipment.

Conclusions: Lead exposure estimated from the DCCs, where children spend about 10 h/day, can be as relevant as their household exposure. Therefore, public authorities should render efforts to provide a rigorous surveillance for lead-free painting supplies and for all objects offered to children.
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http://dx.doi.org/10.1016/j.envpol.2018.04.080DOI Listing
August 2018

Correction to: Can in vivo surface dental enamel microbiopsies be used to measure remote lead exposure?

Environ Sci Pollut Res Int 2018 04;25(10):9330

Departamento de Ciências Biológicas, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Alameda Otávio Pinheiro Brisolla, 9-75, Vila Nova Cidade Universitária, Bauru, SP, CEP 17012-901, Brazil.

To accomplish the aim A, lead from 90 bovine incisor crowns was determined by graphite furnace atomic absorption spectrometer as a function of exposure time and lead concentration.
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http://dx.doi.org/10.1007/s11356-018-1609-yDOI Listing
April 2018

Can in vivo surface dental enamelmicrobiopsies be used to measure remote lead exposure?

Environ Sci Pollut Res Int 2018 Apr 20;25(10):9322-9329. Epub 2017 Dec 20.

Departamento de Ciências Biológicas, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Alameda Otávio Pinheiro Brisolla, 9-75, Vila Nova Cidade Universitária, Bauru, SP, CEP 17012-901, Brazil.

Measuring lead in the surface dental enamel (SDE) using biopsies is a rapid, safe, and painless procedure. The dental enamel lead levels (DELLs) decrease from the outermost superficial layer to the inner layer of dental enamel, which becomes crucial for the biopsy depth (BD) measurement. However, whether the origin of lead found in SDE is fully endogenous is not yet established. There is also controversy about the biopsy protocol. The aims of this study were to investigate if DELLs are altered by extrinsic contamination (A) and to evaluate the real geometric figure formed by the erosion provoked by biopsy procedure and the respective BD in SDE (B). To accomplish the aim A, lead from 90 bovine incisor crowns lead was determined by graphite furnace atomic absorption spectrometer as a function of exposure time and lead concentration. Two biopsies were performed in each tooth, before and after lead exposure. Six 15-tooth groups differed by exposure time (1 or 30 min) and lead concentrations (A. 0 mg/L-placebo, B. 0.01 mg/L-standard for drinking water, or C. 0.06 mg/L-concentration found in contaminated groundwater). Phosphorus was determined by an inductively coupled plasm optical emission spectrometer to quantify the enamel removed. To compare intakes/losses of lead in SDE among the groups, values of DELL differences between before and after lead exposure were compared by ANOVA (p < 0.05). To attain the objective B, one extracted human permanent tooth was studied by confocal Raman microscopy. Lead measurements and the surface profile were determined. There was no difference in DELL among the groups (p = 0.964). The biopsy bottom surface area, analyzed by microscopy, showed an irregular area, with regions of peaks and valleys, where areas with depth ranging from 0.2 (peaks) to 1.8 μm (valleys) (± 0.1 μm) could be found. BD carried out in vivo is commonly calculated using the cylinder height formula. The real BD was shown to be very similar to already published data. In conclusion, the SDE of erupted teeth does not seem to be susceptible to environmental lead intake, being thus reliable to measure remote exposures to lead.
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http://dx.doi.org/10.1007/s11356-017-0988-9DOI Listing
April 2018

What are the blood lead levels of children living in Latin America and the Caribbean?

Environ Int 2017 Apr 1;101:46-58. Epub 2017 Feb 1.

Departamento de Química Fundamental, Instituto de Química, Universidade de São Paulo, São Paulo, SP, Brazil.

Introduction: Information on the prevalence of lead exposure is essential to formulate efficient public health policies. Developed countries have implemented successful public policies for the prevention and control of lead poisoning. In the United States, Canada, Japan and the European Union, for instance, periodically repeated prevalence studies show that blood lead levels (BLLs) in children have decreased overall. Although BLL of Latino children in the U.S. have also dropped in recent years, the geometric mean remains higher than that of white children. Little is known about lead exposure in children in Latin America and the Caribbean (LAC). In this review, we responded to two questions: What is currently known about lead sources and levels in children in LAC? Are there public policies to prevent children's exposure to lead in LAC?

Method: We conducted a literature review covering the period from January 2000 to March 2014 in the PubMed and Lilacs databases to obtain English, Portuguese and Spanish language studies reporting the prevalence of BLLs in children aged 0-18years living in LAC countries. No specific analytical method was selected, and given the scarcity of data, the study was highly inclusive.

Results: Fifty-six papers were selected from 16 different LAC countries. The children's BLLs found in this review are high (≥10μg/dL) compared to BLLs for the same age group in the U. S. However, most studies reported an association with some type of "lead hot spot", in which children can be exposed to lead levels similar to those of occupational settings. Only Peru and Mexico reported BLLs in children from population-based studies.

Conclusions: Most BLLs prevalence studies carried out in LAC were in areas with known emission sources. The percentage of children at risk of lead poisoning in LAC is unknown, and probably underestimated. Thus, there is an urgent need to establish public health policies to quantify and prevent lead poisoning, specifically by prioritizing the identification and control of "hot spots".
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http://dx.doi.org/10.1016/j.envint.2016.12.022DOI Listing
April 2017

Prevalence of Trachoma in Schoolchildren in Brazil.

Ophthalmic Epidemiol 2016 12 8;23(6):360-365. Epub 2016 Nov 8.

e Public Health School , University of São Paulo , Brazil.

Purpose: Trachoma was hyperendemic in Brazil until the 20th century. The prevalence has declined sharply in the past decades. The aim of this study was to estimate trachoma prevalence in schoolchildren in Brazilian municipalities with a Human Development Index (HDI) below the national mean.

Methods: A cluster random sampling survey on trachoma prevalence was carried out. Brazilian municipalities with HDI below the national mean, within each of the 27 states, were stratified into three strata according to population size. In each stratum, schools were systematically selected to comprise a sample of 2400 schoolchildren, totaling 7200 per state. In each selected school, children enrolled from 1st to 4th grade were examined for trachoma. The simplified trachoma grading system was used. At a meeting held in each school, the study was explained to parents, and verbal consent sought.

Results: A total of 185,862 children were enrolled in the selected schools. Of these, 171,973 (92.5%) participated in the study. The overall prevalence of trachomatous inflammation - follicular was 5.0% (95% confidence interval 4.7-5.3%), varying from 1.5% to 9.0% among the states. Prevalence was significantly associated with the sampling stratum (being higher in small municipalities), the zone in which the school was located (higher in rural schools), and with age (higher among younger children).

Conclusion: Trachoma is still a public health problem in Brazil, although at a low level of endemicity. As the country advances towards the elimination of blinding trachoma, this survey provides a baseline for evaluation of ongoing and future elimination interventions.
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http://dx.doi.org/10.1080/09286586.2016.1244274DOI Listing
December 2016

Prevalence and factors associated with urinary incontinence in climacteric.

Rev Assoc Med Bras (1992) 2016 Sep-Oct;62(5):441-6

PhD - Lecturer of the Department of Mother and Child Health, FSP/USP, São Paulo, SP, Brazil.

Objective: To estimate the prevalence and identify associated factors to urinary incontinence (UI) in climacteric women.

Method: In a cross-sectional study with a stratified random sample, 1,200 women aged between 35 and 72 years were studied, enrolled in the Family Health Strategy in the city of Pindamonhangaba, São Paulo. Urinary incontinence was investigated using the International Consultation of Incontinence Questionnaire - Short Form, while associated factors were assessed based on a self-reported questionnaire with socio-demographic, obstetric and gynecological history, morbidities and drug use. The prevalence of urinary incontinence was estimated with a 95% confidence interval (95CI) and the associated factors were identified through multiple logistic regression model performed using Stata software, version 11.0.

Results: Women had a mean age of 51.9 years, most were in menopause (59.4%), married (87.5%), Catholic (48.9%), and declared themselves black or brown (47.2%). The mean age of menopause of women with UI was 47.3 years. The prevalence of UI was 20.4% (95CI: 17.8-23.1%). The factors associated with UI were urinary loss during pregnancy (p=0.000) and after delivery (p=0.000), genital prolapse (p=0.000), stress (p=0.001), depression (p=0.002), and obesity (p=0.006).

Conclusion: The prevalence of UI was lower but similar to that found in most similar studies. Factors associated with the genesis of UI were urinary loss during pregnancy and after delivery, genital prolapse and obesity.
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http://dx.doi.org/10.1590/1806-9282.62.05.441DOI Listing
April 2017

[Association between the degree of implementation of the Brazilian Breastfeeding Network and breastfeeding indicators].

Cad Saude Publica 2016 Mar 22;32(3):e00010315. Epub 2016 Mar 22.

Secretaria de Estado da Saúde Pública de São Paulo, São Paulo, Brazil.

This study aimed to evaluate the implementation of the Brazilian Breastfeeding Network and its impact on breastfeeding indicators. Implementation was analyzed according to type, including 56 primary healthcare units from three Brazilian municipalities. For evaluation of the degree of implementation, a score was created for each unit based on compliance with Ministry of Health certification criteria. Effects of implementation were analyzed according to exclusive and overall breastfeeding rates. Eighteen (32.1%) of the units met the four criteria for certification. The study sample included 1,052 children less than one year of age, of whom 563 were less than six months old. Units that met the four criteria for certification showed higher rates of exclusive breastfeeding (44%) when compared to the other units. Difficulties in implementing the Brazilian Breastfeeding Network were identified, and breastfeeding indicators varied according to the number of certification criteria met by the primary healthcare unit.
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http://dx.doi.org/10.1590/0102-311X00010315DOI Listing
March 2016

Associated factors for higher lead and cadmium blood levels, and reference values derived from general population of São Paulo, Brazil.

Sci Total Environ 2016 Feb 22;543(Pt A):628-635. Epub 2015 Nov 22.

Universidade de São Paulo - USP, Faculdade de Medicina, Departamento de Medicina Preventiva, Brazil.

Human activities are associated with emissions of various metals into the environment, among which the heavy metals lead and cadmium stand out, as they pose a risk to human life even at low concentrations. Thus, accurate knowledge of the levels of these metals exhibited by the overall population, including children, is important. The aim of this study was to estimate the concentrations of lead and cadmium in the blood of adults, adolescents and children residing in the city of São Paulo, assess factors associated with higher lead and cadmium blood levels, and to establish reference values for this population. The study sample consisted of 669 adults over 20 years old, 264 adolescents aged 12 to 19 years old and 391 children under 11 years old from both genders. The samples were collected at the end of 2007 and during 2008 in different city zones. Higher blood lead concentration was significantly associated with gender, smoking, offal intake, area of residence and age. The blood cadmium concentration was significantly associated with gender, smoking, consumption of distilled beverages and age. The reference values of lead and cadmium established for adults above 20 years old were 33 μg/L and 0.6 μg/L, respectively, for adolescents (12 to 19 years old) were 31 μg/L and 0.6 μg/L, respectively and for children under 11 years old were 29 μg/L and 0.2 μg/L, respectively. The results of this study indicate that the exposure levels of the investigated population to lead and cadmium are low.
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http://dx.doi.org/10.1016/j.scitotenv.2015.11.067DOI Listing
February 2016

Noise pollution and annoyance: an urban soundscapes study.

Noise Health 2015 May-Jun;17(76):125-33

Department of Speech-Language Pathology and Audiology, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.

Since 1972, the World Health Organization (WHO) has declared noise as a pollutant. Over the last decades, the quality of the urban environment has attracted the interest of researchers due to the growing urban sprawl, especially in developing countries. The objective of this study was to evaluate the effects of noise exposure in six urban soundscapes: Areas with high and low levels of noise in scenarios of leisure, work, and home. Cross-sectional study. The study was conducted in two steps: Evaluation of noise levels, with the development of noise maps, and health related inquiries. 180 individuals were interviewed, being 60 in each scenario, divided into 30 exposed to high level of noise and 30 to low level. Chi-Square test and Ordered Logistic Regression Model (P < 0,005). 70% of the interviewees reported noticing some source of noise in the selected scenarios and it was observed an association between exposure and perception of some source of noise (P < 0.001). 41.7% of the interviewees reported some degree of annoyance, being that this was associated with exposure (P < 0.001). There was also an association between exposure in different scenarios and reports of poor quality of sleep (P < 0.001). In the scenarios of work and home, the chance of reporting annoyance increased when compared with the scenario of leisure. We conclude that the use of this sort of assessment may clarify the relationship between urban noise exposure and health.
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http://dx.doi.org/10.4103/1463-1741.155833DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4918656PMC
June 2015

Empyema and bacteremic pneumococcal pneumonia in children under five years of age.

J Bras Pneumol 2014 Jan-Feb;40(1):69-72

Federal University of Minas Gerais, Belo Horizonte, Brazil, Full Professor of Pediatrics. Federal University of Minas Gerais, Belo Horizonte, Brazil.

We compared bacteremic pneumococcal pneumonia (BPP) and pneumococcal empyema (PE), in terms of clinical, radiological, and laboratory findings, in under-fives. A cross-sectional nested cohort study, involving under-fives (102 with PE and 128 with BPP), was conducted at 12 centers in Argentina, Brazil, and the Dominican Republic. Among those with PE, mean age was higher; disease duration was longer; and tachypnea, dyspnea, and high leukocyte counts were more common. Among those with BPP, fever and lethargy were more common. It seems that children with PE can be distinguished from those with BPP on the basis of clinical and laboratory findings. Because both conditions are associated with high rates of morbidity and mortality, prompt diagnosis is crucial.
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http://dx.doi.org/10.1590/S1806-37132014000100010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4075916PMC
October 2014

Use of the International Classification of Functioning, Disability and Health for monitoring patients using cochlear implants.

Codas 2013 ;25(3):216-23

Purpose: To characterize the profile of patients with cochlear implant as proposed by the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY).

Methods: This is a descriptive, cross-sectional retrospective study, which examined 30 medical records of patients using the cochlear implant of Centro de Pesquisas Audiológicas; To characterize the profile of the patients, the ICF-CY was used. Regarding the assessment, researchers relied on procedures performed in clinical routine, besides information registered in the medical record. After reviewing the information, it was related to codes from the ICF-CY; with the addition of a qualifier afterwards.

Results: Overall, 55 codes from the ICF were related to the instruments to characterize this population. Regarding the Body Functions field, most participants did not have disabilities related to reception and expression of oral language and auditory functions, with only written language disabilities being found. These same findings were observed in the Activity and Participation Field. Regarding environmental factors, noise and the non-availability of technology resources to assist in the auditory comprehension of noise were characterized as a barrier, as well as the absence of speech therapy.

Conclusion: This study concluded that most of the participating children showed no deficiency in the body functions, with difficulties being only reported in relation to school performance. Environmental factors (noise, non-availability of technological resources, absence of speech therapy) were characterized as a barrier. The need to expand assessments in the clinical routine was also noted.
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http://dx.doi.org/10.1590/s2317-17822013000300005DOI Listing
July 2014

[Prevalence of trachoma in Brazilian schoolchildren].

Rev Saude Publica 2013 Jun;47(3):451-9

Objective: To estimate the prevalence and describe the distribution of trachoma among schoolchildren in Brazilian municipalities.

Methods: Cross-sectional study, using cluster sampling, of the schoolchildren population of the Brazilian municipalities with Human Development Index - Municipal lower than the national average. This trachoma prevalence survey was conducted by the Ministry of Health, in the period 2002-2007. There were 119,531 schoolchildren selected from 2,270 schools located in 1,156 municipalities. The selected schoolchildren underwent an external ocular examination, with a magnifying glass (2.5X), to detect clinical signs of trachoma according to the WHO criteria. The prevalence of trachoma, by state and national level, and their respective 95% confidence intervals were estimated. Chi-square and Chi-square for trends tests were used to compare categorical variables.

Results: There were 6,030 cases of trachoma detected, resulting in a prevalence of 5.0% (95%CI 4.5;5.4). There was no significant difference between the sexes. The prevalence of trachoma was 8.2% among children under 5 years of age, decreasing among higher age groups (p < 0.01). There was a significant difference in prevalence between urban and rural areas, 4.3% versus 6.2% respectively (p < 0.01). Cases were detected in 901 municipalities (77.7% of the sample), in all regions of the country. In 36.8% of the selected municipalities, the prevalence was higher than 5%.

Conclusions: The study shows that trachoma is a significant public health problem in Brazil, contradicting the belief that the disease had been controlled in the country. The survey provides a baseline for evaluating planned interventions aimed at achieving the goal of global certification of elimination of trachoma as a cause of blindness in Brazil by 2020.
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http://dx.doi.org/10.1590/s0034-8910.2013047003428DOI Listing
June 2013

Measures of quality of life in children with cochlear implant: systematic review.

Braz J Otorhinolaryngol 2013 May-Jun;79(3):375-81

School of Public Health, University of São Paulo, Brazil.

Unlabelled: The use of cochlear implant (CI) in children enables the development of listening and communication skills, allowing the child's progress in school and to be able to obtain, maintain and carry out an occupation. However, the progress after the CI has different results in some children, because many children are able to interact and participate in society, while others develop limited ability to communicate verbally. The need for a better understanding of CI outcomes, besides hearing and language benefits, has spurred the inclusion of quality of life measurements (QOL) to assess the impact of this technology.

Objective: Identify the key aspects of quality of life assessed in children with cochlear implant.

Method: Through a systematic literature review, we considered publications from the period of 2000 to 2011.

Conclusion: We concluded that QOL measurements in children include several concepts and methodologies. When referring to children using CI, results showed the challenges in broadly conceptualizing which quality of life domains are important to the child and how these areas can evolve during development, considering the wide variety of instruments and aspects evaluated.
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http://dx.doi.org/10.5935/1808-8694.20130066DOI Listing
September 2013

National prevalence survey in Brazil to evaluate the quality of microbiology laboratories: the importance of defining priorities to allocate limited resources.

Rev Panam Salud Publica 2013 Jan;33(1):73-8

Departamento de Moléstias Infecciosas e Parasitárias and Laboratório de Investigação Médica-LIM 54, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.

This report describes a survey of microbiology laboratories (n = 467) serving Brazilian hospitals with ≥10 intensive care beds and/or involved in the government health care adverse event reporting system. Coordinators were interviewed and laboratories classified as follows: Level 0 (no minimal functioning conditions-85.4% of laboratories); Level 1 (minimal functioning conditions but inadequate execution of basic routine-6.7%); Level 2 (minimal functioning conditions and adequate execution of basic routine but no adequate procedures for quality control-5.8%); Level 3 (minimal functioning conditions, adequate execution of basic routine, and adequate procedures for quality control, but no direct communication with the infection control department-0.9%); Level 4 (minimal functioning conditions, adequate execution of basic routine, adequate procedures for quality control, and direct communication with infection control, but no available advanced resources-none); and Level 5 (minimal functioning conditions, adequate execution of basic routine, adequate procedures for quality control, direct communication with infection control, and available advanced resources-0.9%). Twelve laboratories did not perform Ziehl-Neelsen staining; 271 did not have safety cabinets; and >30% without safety cabinets had automated systems. Low quality was associated with serving hospitals not participating in government adverse-event program; private hospitals; nonteaching hospitals; and those outside state capitals. Results may reflect what occurs in many other countries where defining priorities is important due to limited resources.
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http://dx.doi.org/10.1590/s1020-49892013000100010DOI Listing
January 2013

[Trachoma epidemiological school survey in the city of Embu das Artes--SP].

Arq Bras Oftalmol 2012 Jul-Aug;75(4):264-6

Programa de Tracoma e Hanseníase Ocular, Secretaria Municipal de Embu das Artes - Embu das Artes (SP), Brasil.

Purpose: To estimate the trachoma prevalence in school children in Embu das Artes - SP, aiming the implementation of the disease epidemiological surveillance.

Methods: The city of Embu das Artes - SP, is 25 km far from the capital of the State. In the years of 2003-2004, a trachoma survey was conducted in a cluster sample of school children with the same methodology of the national trachoma student's survey of the Ministry of Health. Previously to the trachoma active search, activities of health education were performed in all schools. External ocular examinations were done in all students to detect trachoma according to the WHO criteria. All cases of trachoma were notified and their families were submitted to an external ocular examination. The cases were treated with 1% tetracycline ointment or systemic azithromycin.

Results: 2,374 students from nine sampled selected public schools were examined. The prevalence of follicular inflammatory trachoma (TF) was 3.1% (IC 95%: 2.4-3.9), varying from 0.5% to 4.2% in the examined schools. The prevalence for males was 3.2% and for females was 3.0%. The greater prevalence (8.6%) was found in 6 year-old children.

Conclusion: The disease showed a mild behavior in this city, because no cases of intense inflammatory trachoma or cicatricial trachoma were detected. However, the prevalence was greater than the one found in the city of São Paulo. Epidemiological surveillance activities of trachoma must be continuous, mainly in places where the greater prevalence had been found.
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http://dx.doi.org/10.1590/s0004-27492012000400009DOI Listing
September 2013

Prevalence of metabolic syndrome and associated factors in women aged 35 to 65 years who were enrolled in a family health program in Brazil.

Menopause 2013 Apr;20(4):470-6

Department of Physical Therapy, Speech Therapy, and Occupational Therapy, University of São Paulo School of Medicine, São Paulo, Brazil.

Objective: The aims of this study were to estimate the prevalence of metabolic syndrome among women aged 35 to 65 years and to identify associated factors.

Methods: This was a cross-sectional study. We randomly selected 581 women (aged 35-65 y) from among those enrolled in a family health program in the city of Pindamonhangaba, Brazil. Metabolic syndrome was identified in accordance with the definition of the National Cholesterol Education Program Adult Treatment Panel III. Health conditions and lifestyle habits were evaluated by a survey, and anthropometric measurements were obtained. The prevalence of metabolic syndrome was estimated, and Poisson regression was used to evaluate the associations between metabolic syndrome `and the factors investigated.

Results: The prevalence of metabolic syndrome was 42.2% (95% CI, 38.1-46.2). The most common metabolic syndrome component was abdominal obesity (60.6%), followed by low levels of high-density lipoprotein cholesterol (51.3%), high levels of triglycerides (41.4%), high blood pressure (31.7%), and diabetes (13.9%). The following factors were associated with metabolic syndrome: the 45- to 54-year age group (prevalence ratio, 1.54; 95% CI, 1.08-2.01), the 55- to 65-year age group (prevalence ratio, 3.51; 95% CI, 1.49-3.10), hyperuricemia (prevalence ratio, 2.95; 95% CI, 1.15-1.86), and sleep apnea risk (prevalence ratio, 2.41; 95% CI, 1.16-1.82). We found an inverse association between metabolic syndrome and having had more than 5 years of schooling (prevalence ratio, 0.65; 95% CI, 0.65-1.04).

Conclusions: The prevalence of metabolic syndrome is high, and the associated clinical factors are hyperuricemia and risk of sleep apnea.
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http://dx.doi.org/10.1097/gme.0b013e318272c938DOI Listing
April 2013