Introdução - O uso de bicos artificiais é um hábito cultural com alta prevalência em diversos países. Profissionais e mães acreditam que o uso desses utensílios seja inofensivo, ou mesmo necessário, para o desenvolvimento da criança, tendo atitude indiferente ou permissiva frente ao seu uso indiscriminado. Há mais de 30 anos, consenso científico internacional reconhece bicos artificiais e leites industriais como responsáveis por parte dos índices de morbimortalidade infantil e alterações na saúde da criança. Objetivo - Analisar a influência de fatores socioeconômicos, biológicos e da atuação dos serviços de saúde sobre o uso de bicos artificiais (chupetas e mamadeiras) entre crianças menores de um ano nas capitais brasileiras e Distrito Federal(DF). Métodos- Estudo com delineamento transversal realizado a partir do banco de dados da II Pesquisa de Prevalência de Aleitamento Materno nas Capitais e DF em 2008 na segunda fase da Campanha Nacional de Multivacinação. Foi utilizada amostra por conglomerados, com sorteio em dois estágios. O questionário era composto por questões fechadas incluindo perguntas sobre o uso de chupeta e mamadeira no dia anterior à pesquisa. Foram analisados os fatores associados ao uso de bicos artificiais considerando três desfechos: 1)Uso exclusivo da chupeta; 2)Uso exclusivo da mamadeira; e 3)Uso de bicos artificiais (chupeta e mamadeira). As razões de prevalência e os intervalos de confiança foram obtidos por meio da regressão de Poisson seguindo modelo hierárquico. Resultados Participaram 34.366 crianças menores de um ano. Identificou-se como fatores associados ao uso exclusivo de chupeta mãe trabalhar fora do lar (RP=1,18), primiparidade (RP=1,28), não ter mamado na 1ªhora (RP=1,15) e uso de chá no1ºdia em casa (RP=1,37). Para o uso exclusivo de mamadeira, identificou-se: mãe trabalhar fora do lar (RP=1,39), primiparidade (RP=1,28), baixo peso ao nascer (RP=1,21) não ter mamado na 1ªhora (RP=1,08), uso de leite artificial (RP=1,82) e do chá (RP=1,96) no 1ºdia em casa. O uso de bicos artificiais associou-se ao trabalho materno fora do lar (RP=1,43), primiparidade (RP=1,21), parto cesáreo (RP=1,06), bebês do sexo masculino (RP=1,07), baixo peso ao nascer (RP=1,11), ter nascido em hospital não credenciado como Amigo da Criança (RP=1,12), realizar acompanhamento de saúde na UBS/SUS (RP=0,91), ter ingerido leite artificial (RP=2,06), água (RP=1,18) e chá (RP=1,38) no 1ºdia em casa. Conclusão Caracterizaram-se diferentes perfis de usuários de bicos artificiais, chupetas e mamadeiras. Observaram-se semelhanças e diferenças para cada desfecho. As semelhanças indicam os fatores comuns aos quais profissionais da saúde devem estar atentos. Já as diferenças sugerem que a utilização de chupeta e/ou mamadeira envolve diversas dimensões da vida da mulher/criança/família, perpassando aspectos biopsicossociais e culturais. / Introduction - The use of artificial nipples is a cultural habit with a high prevalence in many different countries. Professionals and mothers believe that the use of those tools is harmless or even necessary for the child\'s development therefore they do not discriminate their use having a permissive approach towards them. For over 30 years, international scientific consensus recognizes artificial nipples and industrialized milk as responsible for part of the morbidity and mortality rates and changes in child\'s health. Objective - To analyze the influence of socioeconomic, biological factors and the health services on the use of pacifier and baby\'s bottle among children under one year old in Brazilian Capitals and Federal District (FD). Methods Cross-sectional study conducted from the database of the Second Research Prevalence of Breastfeeding in all the Brazilian Capitals and FD performed in 2008 in the second phase of the National Vaccination Campaign. Cluster sampling was used, with a draw in two-stages. The questionnaire consisted of closed questions including questions about the use of pacifier and baby\'s bottle on the day preceding the survey. We analyzed the factors associated with the use of artificial nipples considering three possible outcomes: 1)Exclusive use of a pacifier, 2)Exclusive use of the baby\'s bottle, and 3)Use of artificial nipples (pacifiers and baby\'s bottle). Prevalence ratios (PR) and confidence intervals were obtained using Poisson regression following a hierarchical model. Results Sample included 34 366 children under one year old. It was identified as factors associated with exclusive use of a pacifier mother working outside the home (PR = 1.18), primiparity (PR = 1.28), not having breastfed within first hour (PR = 1.15) and use of tea on first day at home (PR = 1.37). For the exclusive use of a bottle, were identified: mother working outside the home (PR = 1.39), primiparity (PR = 1.28), low birth weight (PR = 1.21) had not suckled within first hour (PR = 1.08), use of artificial milk (PR = 1.82) and tea (PR = 1.96) on first day at home. The use of artificial teats was associated with maternal employment outside the home (OR = 1.43), primiparity (PR = 1.21), Cesarean section (PR = 1.06), male infants (PR = 1, 07), low birth weight (PR = 1.11), was born in a hospital is not accredited as \"Baby Friendly\" (PR = 1.12), perform health monitoring in the UBS / SUS (PR = 0.91) , having drunk formula (PR = 2.06), water (PR = 1.18) and tea (PR = 1.38) on first day at home. Conclusion - It was found various user profiles of of pacifier and/or baby\'s bottle. It was observed similarities and differences for each outcome. The similarities indicate common factors to which health professionals should be aware. And the differences suggest that the use of artificial nipples, pacifier or baby\'s bottle involves several dimensions of women\'s lives, biopsychosocial and cultural aspects.

Emotional suffering in old age is largely caused by a variety of psychiatric disorders which are often, however, undertreated and underrecognized. This leads to reduced quality of life and functional status and increased morbidity and mortality. Dementia, delirium and depression are common disorders in the very old, and are similar in several ways. All have multiple causes and are diagnosed by means of symptomatic criteria, are challenging to diagnose and difficult to differentiate from each other in the very old. They often coexist in the same individual, and may have common risk factors. The overall aim of this thesis was to add to our knowledge about threats to successful aging, by investigating the prevalences of dementia, depression and delirium, and factors associated with these three disorders. Further aims were to measure change over time in the prevalence of dementia and depression, respectively, and to investigate the risk factors for incident depression. This thesis uses the population-based Umeå85+/GErontological Regional DAtabase (GERDA) material. In 2000-2002, every other 85-year-old, all 90-year-olds and all people ≥95 years living in six municipalities in Västerbotten, Sweden were invited to participate, and in 2005-2007 the process was repeated, with the additional inclusion of the corresponding populations of two municipalities in Österbotten, Finland. A third data collection was carried out in 2010-2012. Trained assessors carried out assessments in the form of structured interviews during one or more home visits, recorded current medication and reviewed medical records obtained from general practitioners and hospitals. In 2000-2002 the prevalence of dementia was 17% among 85-year-olds, 24% among 90-year-olds and 46% among those aged ≥95 years. In 2005-2007 dementia prevalence reached 28% among 85-year-olds, 40% among 90-yearolds and 45% among those aged ≥95 years. The prevalence of dementia in the total sample was 27% in 2000-2002 and 37% in 2005-2007 (p=0.001). In 2000-2002 the prevalence of depressive disorders was 24% among 85-yearolds, 34% among 90-year-olds and 31% among those aged ≥95 years. In 2005-2007 the prevalence of depressive disorders was 33% among 85-year-olds, 39% among 90-year-olds and 38% among those aged ≥95 years. The prevalence of depressive disorders in the total sample was 29% in 2000-2002 and 37% in 2005-2007 (p=0.025). Among participants not depressed at baseline, 26% had developed depression after five years. Factors independently associated with new cases of depression at follow-up were hypertension, a history of stroke and a higher score on the 15-item Geriatric Depression Scale at baseline. The thirtyday prevalence of delirium in 2005-2007 was 17% among 85-year-olds, 21% among 90-year-olds and 39% among participants aged ≥95 years. Delirium prevalence among individuals with dementia was higher than among those without dementia (52% vs. 5%, p<.001). Factors independently associated with delirium superimposed on dementia in a multivariate logistic regression model were depression, heart failure, living in an institution and prescribed antipsychotics. There was a high prevalence of dementia, depression and delirium in the papers comprising this thesis, and 55% had at least one of the three disorders. The prevalence of dementia and depression also increased between 2000-2002 and 2005-2007, after controlling for age and sex. Dementia and depression were important associated factors for delirium and half of those with dementia were depressed. The increasing age-specific prevalence of depression seems to be associated with the increasing age-specific prevalence of dementia. The papers presented are among the first to report a significantly increasing age-specific prevalence of dementia and depression among very old people. More knowledge about associated factors and risk factors concerning these disorders may be helpful for carers and decision-makers, as well as providing reference values for studies in other regions. Further efforts are needed in both care and research to better prevent, screen for, diagnose and treat dementia, depression and delirium, especially considering the growing number of very old people. / Umeå85+/GERDA

BACKGROUND: Oral communication impairments (OCIs) are a common childhood problem with often long-term negative outcomes for both the child and society. Despite the growing body of knowledge about the epidemiology of this problem, the shift from traditional treatment approaches to population based approaches to management has been slow. One suggested reason for this is a lack of community based population data on such problems with which to plan services more broadly. AIM: The aim of this thesis is to contribute to the population knowledge of children with OCIs by developing and trialing a data collection method at a community level. LITERATURE REVIEW: One of the major issues in understanding OCIs from a population perspective is the disparate and often incongruent nature of epidemiological data reported in the literature. Five areas of epidemiological research were reviewed in order to critically evaluate the existing evidence base and identify gaps for further research. The five areas reviewed were: Prevalence (Regardless of the methodology used to collect prevalence data, OCIs have been described as a common childhood problem), Life Course (Children with OCIs often have ongoing communication problems and are at risk for poorer life outcomes in social, educational and occupational domains), Comorbidities (OCIs rarely occur in isolation and most children will have other developmental or health issues), Risk factors (There is no one easily definable cause of OCIs, however, genetic and environmental factors appear to increase the risk of OCI in the general population), and Service use (Only around half of children with recognised OCIs will access specialist intervention services).The review concluded that local community data measuring the 'burden', or impact, of the problem, comorbidities and service use in children with and without OCIs would assist in service planning. Therefore a methodology would need to be developed which addressed these issues.A further review of the literature considered this methodology development with specific reference to the issues of study design, sampling and identification of OCIs. The review concluded that a cross-sectional survey design of a community sample could provide the necessary data. Parent and teacher report was suggested as a method for identifying OCIs in surveys, however, a tool needed to be developed and trialed to ensure this method was effective, valid and reliable. PILOT STUDY: A survey tool for parents was designed which included the Child Health Questionnaire (PF - 28), questions relating to socio-demographic features, health and development conditions, service use and specifically developed questions regarding OCIs. The survey methodology was trialed in one school and one childcare centre. The results of the study were reviewed and suggestions made for methodological changes before a community trial was carried out. The reliability and validity of the questions designed to identify OCIs was assessed in a number of ways. Test-retest reliability of parent completed questionnaires proved to be good. Interrater reliability was examined by comparing parent and teacher responses. Parents and teachers agreed on identification of OCI in over 75% of cases for each of the OCIs studied. Criterion validity was assessed by comparing parent report to speech pathologist evaluation in a clinical sample and by comparing parent and teacher report to screening assessments of communication skills in a school sample. Both parents and teachers tended to over-identify children, however, when parent and teacher reports were considered together the validity approached that of the 'gold standard'. Construct validity was assessed by comparing reported OCIs with reports of other developmental conditions known to be commonly comorbid with OCIs. Once again using both parent and teacher report proved to be the most valid method of identifying OCIs using the developed tool. COMMUNITY STUDY: A targeted community survey of 3 to 7 year old children was conducted in a regional centre in Queensland, Australia. Children were sampled through schools and childcare centres. Information letters were distributed to the parents of 898 eligible children. Completed questionnaires were received for 397 children. Teachers completed questionnaires on 375 children which was 42% of the population sampled. Parents and teachers identified OCIs in 16% of the children. However, only 3% of the population were rated by parents or teachers as having severe problems. Over 70% of parents and teachers of children with a reported OCI rated the problem as having an impact on the child's life. Ratings of impact were not related to parent/teacher ratings of severity. Children with OCIs were reported to have significantly more health, developmental and behaviour problems than their peers. Children with OCIs were rated lower by their parents on most aspects of the Child Health Questionnaire (PF-28). In particular, parents reported impacts on their own time and family activities due to the child's problems. No significant differences were found between children with and without reported OCIs on any of the socio-demographic variables studied. Children with reported OCIs used more health and educational services than their peers. Around 60% of children with reported OCIs had seen a speech pathologist, but many parents had also sought advice from a range of other health and educational professionals. Those with two or more OCI conditions were more likely to have seen a professional, however socio-demographic variables did not generally predict service use. Parents reported that the type of service they chose was most commonly influenced by advice from a doctor or teacher. The limitations of this methodology for collecting this type of data are discussed. However despite these limitations data were collected which has major implications for the provision of population based services for children with OCI. CONCLUSION: This thesis has contributed to the understanding of children with OCIs by researching the development of a methodology to study this problem in a defined community sample. The information gained from the literature review and the community study were considered within two models of service provision. The models encompass service delivery from individualised to more population based approaches to the management of OCIs in children. From these models, specific suggestions for the community involved in the study were discussed. This thesis, therefore, provided a survey methodology that is resource efficient in the collection of community data useful in suggesting improved services for children with oral communication impairments.

Introdução: o crack é uma forma extremamente aditiva de cocaína, provocando intensa fissura e um comportamento persistente e intenso de busca pela droga com negligência da alimentação. A alimentação insuficiente pode levar à carência de tiamina. O uso de latas e folhas de alumínio na confecção de cachimbos para o consumo de crack aumenta a exposição de usuários de crack a este metal. Deficiência de tiamina somada a acúmulo cerebral de alumínio pode inibir o metabolismo energético dependente da glicose, levando à neurodegeneração e, possivelmente, à encefalopatia de Wernicke. Objetivos: avaliação dos níveis sanguíneos de tiamina difosfato e de alumínio de dependentes de crack e comparação com os de controles. Método: estudo transversal controlado, avaliou 35 dependentes de crack e 35 controles, do sexo masculino, com 18 anos ou mais. Os casos foram recrutados entre pacientes internados na Unidade de Adição do Hospital de Clínicas de Porto Alegre ou na Emergência em Saúde Mental IAPI, os controles foram recrutados entre as pessoas que circulam na área ambulatorial do Hospital de Clínicas de Porto Alegre. Todos participantes tiveram seu peso e estatura medidos e sangue coletado para determinação dos níveis de tiamina difosfato e de alumínio. Os casos passaram, também, por uma breve avaliação neurológica. Resultados: as características dos casos são semelhantes à amostra do principal estudo nacional sobre o uso de crack no Brasil: sexo masculino, cerca de 30 anos de idade, com baixa escolaridade, desempregados, usuários de múltiplas substâncias psicoativas, consumidores de crack há aproximadamente 8 anos. O índice de massa corporal dos casos foi significativamente mais baixo (p<0.0001). Seis casos (17.65%) apresentaram índice de massa corporal abaixo do normal. Dois casos apresentaram nível de tiamina abaixo dos valores de referência, enquanto os níveis dos controles estavam acima deste limite. Comparando os resultados do primeiro quartil do nível sanguíneo de tiamina dos casos (N= 9; mediana 3.6μg/dL, amplitude interquartil 3.05μg/dL -4.10μg/dL) com o dos controles (N=14, mediana 4.3μg/dL, amplitude interquartil 3.7μg/dL-4.4μg/dL), os casos apresentaram níveis significativamente mais baixos (p=0.024). Os níveis de alumínio dos casos que tiveram as amostras de sangue coletadas até 24h após o último consumo da substância, foram maiores (mediana1.85μg/L, amplitude interquartil0.65-4.425μg/L) que os dos controles (mediana 0.95μg/L, amplitude interquartil 0.7-1.22μg/L), mas esta diferença não atingiu significância estatística (p=0.07). Conclusões: dependentes de crack tem índice de massa corporal menor e estão mais expostos ao alumínio que os controles. Alguns tem deficiência de tiamina, a qual pode levar à encefalopatia de Wernicke e declínio cognitivo. Portanto, tiamina parenteral profilática deve ser considerada para alguns dependentes de crack. / Background: Crack-cocaine is an extremely additive form of cocaine and its compulsive use can last days until exhaustion, driving its users to neglect feeding. Poor feeding may cause thiamine deficiency. In Brazil, crack-cocaine is usually smoked in pipes made of aluminum cans or with aluminum foils. Insufficient brain levels of thiamine plus brain aluminum accumulation, may impair glucose energy metabolism, promoting neurodegeneration and possibly Wernicke’s encephalopathy. Objectives: The aim of this study was to evaluate thiamine and aluminum blood levels in crack-cocaine addicts and compare them to healthy controls. Methods: cross-sectional controlled study, included 35 crack-cocaine addicts and 35 healthy controls, all males, 18 or older. Cases were recruited at the Addiction Unit of Hospital de Clínicas de Porto Alegre or at the Mental Health Emergency IAPI, controls were recruited between people circulating in the outpatient clinic area of Hospital de Clínicas de Porto Alegre. Weight and height were measured and blood samples collected for determination of thiamine diphosphate and aluminum levels. Cases were also submitted to a brief neurological examination. Results: cases characteristics were similar to the sample of the main national study related to crack-cocaine use in Brazil: mainly males, about 30 years old, with low education level, unemployed, multiple drug abusers, consuming crack-cocaine for approximately 8 years. Body mass index was significantly lower in cases (p<0.0001). Six cases (17.65%) had body mass index lower than normal, while no control was below this limit. Two cases presented thiamine levels below the laboratory reference range, while controls were all above this limit. Comparing the lower quartile of thiamine blood levels, cases (3.6 μg/dL) had significantly lower levels of thiamine than controls (4.3μg/dL) (p=0.024). Blood aluminum median of crack-cocaine addicts (1.85μg/L, interquartile range 0.65-4.425μg/L) whose samples were drawn until 24h after last drug consumption was higher than controls (0.95μg/L, interquartile range 0.7-1.22μg/L), but the difference did not achieve statistical significance (p=0.07). Conclusions: Crack-cocaine addicts have lower BMI and are more exposed to aluminum in comparison to healthy controls. Also, some of them have thiamine deficiency which may lead to Wernicke’s encephalopathy and cognitive impairment. Thus, prophylactic parenteral thiamine should be considered to some crack-cocaine addicts.

Os miomas uterinos (MU) são considerados os tumores mais comumente encontrados no sistema reprodutor feminino. Este estudo buscou investigar associação entre o ganho de peso na idade adulta e a ocorrência de miomas. Esta relação foi explorada em estudos internacionais na maior parte americanos. No Brasil nenhum estudo havia abordado este tema até o término desta dissertação. Para investigar como a associação entre o ganho de peso na idade adulta afeta o risco de miomas, foi conduzido um estudo transversal referente aos dados da linha de base (1999-2001) do estudo longitudinal Pró-Saúde onde 2594 servidores técnico-administrativos de uma universidade pública do Rio de Janeiro são participantes, entre eles foram selecionadas 1560 mulheres com diagnóstico médico autorrelatado de MU e que tiveram seus pesos aos vinte anos de idade autorrelatados em questionário autopreenchível cujas idades variaram entre 22 a 67 anos. Foi avaliada a mudança de peso desde os 20 anos até o momento da entrada no estudo. As prevalências de miomas encontradas neste grupo foram23.3% (IC95% - 21,2; 25,4), situando-se em posição intermediária quando comparada as prevalências encontradas nos estudos norte-americanos. A maior prevalência de ganho de peso foi encontrada no 4 quintil cujos valores variaram entre ganho maior que 0,7 Kg/ano e menor que 1,1 Kg/ano. A faixa etária com maiores prevalências de diagnóstico médico auto-relatado de miomas ficou compreendida entre 45 a 54 anos (39,1%).Os valores de peso aos 20 anos informados pelas respondentes variaram entre 30,0 e 96,0 kg. O IMC aos 20 anos de idade se situou está dentro da categoria de normalidade entre a maior parte das participantes. Os resultados não sugerem associação entre o ganho de peso na idade adulta e miomas nesta população de estudo / The uterine fibroids (MU) are considered the most common tumors found in the female reproductive system. This study investigated the association between weight gain in adulthood and the occurrence of fibroids. This relationship was explored in international studies mostly Americans. In Brazil, no studies had addressed this issue until the end of this dissertation. To investigate how the association between weight gain in ddulthood affects the risk of fibroids, a crosssectional study was conducted for the data from the baseline (1999-2001) longitudinal study of the Pro-Saúde where2594 technical and administrative staff of a public university in Rio de Janeiro are participating, among them were selected in 1560 women with self-reported medical diagnosis of MU and had their weights at the age of twenty self-reported in self-administered questionnaire whose ages ranged from 22-67 years. Weight change since 20 years was evaluated until the entry into the study. The prevalence of fibroids found in this group were 23.3% (95% CI - 21.2, 25.4), standing at an intermediate position compared the prevalence found in American studies. The highest prevalence of weight gain was found in the 4th quintile values ranged between gain greater than 0.7 kg / year and less than 1.1 kg / year. The age group with highest prevalence of self-reported medical diagnosis of fibroids was between 45 and 54 (39.1%). The weight at age 20 reported by respondents ranged between 30.0 and 96.0 kg. The BMI at 20 years old stood in the category is normal among most participants. The results suggest no association between weight gain in adulthood and fibroids in this study population.

INTRODUÇÃO: As chances de adoecer e de mortalidade são maiores, em crianças com estado nutricional (EN) inadequado nos primeiros meses de vida. Fatores de risco para o EN inadequado, incluem os aspectos psicossociais maternos, como a ansiedade, a depressão pós-parto (DPP), a ausência de suporte social. No entanto, são poucos os estudos sobre o papel destes fatores na determinação do EN infantil e seus resultados controversos. OBJETIVO: Investigar a relação entre depressão no pós-parto e o estado nutricional infantil inadequado no segundo mês de vida. MÉTODOS: Trata-se de um estudo seccional com 466 crianças aos dois meses de vida (média= 65 dias; DP=0,5) oriundas de unidades básicas de saúde do município do Rio de Janeiro, realizado entre junho de 2005 e dezembro de 2009. Para compor o desfecho, médias de peso-para-idade foram expressas em escores z e comparadas às informações da nova curva de referência WHO (2006) para menores de cinco anos. Foram classificadas como estado nutricional inadequado, crianças com escore z abaixo de -2, baixo peso-para-idade, e crianças com escore z acima de +2, excesso de peso-para- idade. Informações referentes à DPP foram obtidas por meio da aplicação da versão em português do instrumento EPDS (Edinburgh Postnatal Depression Scale). As análises das associações entre a DPP e os desfechos foram verificadas via modelos de regressão logística multinomial, mediante estimativas de razões de chances (OR) brutas e ajustadas e seus respectivos intervalos de confiança de 95% (IC 95). RESULTADOS: A amostra revelou escores z médios de -0,22 para peso-para-idade, 4,51%(n=21) apresentaram baixo peso-para- idade e 1,72% (n=8) de excesso de peso-para-idade. A prevalência de depressão foi de 27,6%. Nas análises brutas, filhos de mães deprimidas apresentavam 2,45 mais chance (OR=2,45; I.C. 95%=1,01-5,93;p-valor=0,050) de baixo peso-para-idade e 0,38 chance de excesso de peso-para-idade (OR=0,38;I.C. 95%=0,04-3,17;p-valor=0,38), do que os filhos de mães não deprimidas, porém esta associação apresentou nível de significância maior que 5%. Após ajuste pelo peso ao nascer, condições ambientais, posse de utensílios, prematuridade, idade materna e escolaridade materna a associação entre depressão e estado nutricional infantil não apresentou significância estatística (OR=2,39;I.C. 95%=0,74-7,71;p- valor>0,05).CONCLUSÃO: A DPP não foi associada ao estado nutricional infantil. / INTRODUCTION: The chances of illness and mortality are higher in children with nutritional status (NS) inadequate in the first months of life. Risk factors for EN inadequate maternal include the psychosocial aspects, such as anxiety, postpartum depression (PPD), the lack of social support. However, few studies on the role of these factors in determining child EN and its controversial results. OBJECTIVE: To investigate the relationship between postpartum depression and inadequate nutritional status in the second month of life. METHODS: This is a cross-sectional study with 466 children at two months of life (mean = 65 days, SD = 0.5) derived from basic health units in the municipality of Rio de Janeiro, conducted between June 2005 and December 2009. To make the outcome, mean weight-for- age z scores were expressed as compared with information from new reference WHO (2006) for children under five years. Were classified as inadequate nutritional status of children with z scores below -2, underweight-for-age, and children with z scores above +2, excess weight- for-age. Information regarding the DPP were obtained by applying the version in Portuguese of the EPDS (Edinburgh Postnatal Depression Scale). Analyses of associations between the DPP and the outcomes were verified via multinomial logistic regression models, estimated by odds ratios (OR) and its unadjusted and adjusted confidence intervals of 95% (IC 95). RESULTS: The sample was -0.22 z-scores for the average weight for age, 4.51% (n = 21) had lower weight-for-age and 1.72% (n = 8) of overweight -for-age. The prevalence of depression was 27.6%. In crude analyzes, children of depressed mothers had 2.45 more likely (OR = 2.45, 95% CI = 1.01 to 5.93, p = 0.050) of low weight-for-age and 0.38 chance of excess weight-for-age (OR = 0.38, 95% CI = 0.04 to 3.17, p = 0.38), than children of non-depressed mothers, but this association presented level of significance greater than 5%. After adjustment for birth weight, environmental conditions, possession of utensils, prematurity, maternal age and maternal education the association between depression and nutritional status was not statistically significant (OR = 2.39, 95% CI = 0.74 to 7, 71, p-value> 0.05). CONCLUSION: The DPP was not associated with child nutritional status.

INTRODUÇÃO: As chances de adoecer e de mortalidade são maiores, em crianças com estado nutricional (EN) inadequado nos primeiros meses de vida. Fatores de risco para o EN inadequado, incluem os aspectos psicossociais maternos, como a ansiedade, a depressão pós-parto (DPP), a ausência de suporte social. No entanto, são poucos os estudos sobre o papel destes fatores na determinação do EN infantil e seus resultados controversos. OBJETIVO: Investigar a relação entre depressão no pós-parto e o estado nutricional infantil inadequado no segundo mês de vida. MÉTODOS: Trata-se de um estudo seccional com 466 crianças aos dois meses de vida (média= 65 dias; DP=0,5) oriundas de unidades básicas de saúde do município do Rio de Janeiro, realizado entre junho de 2005 e dezembro de 2009. Para compor o desfecho, médias de peso-para-idade foram expressas em escores z e comparadas às informações da nova curva de referência WHO (2006) para menores de cinco anos. Foram classificadas como estado nutricional inadequado, crianças com escore z abaixo de -2, baixo peso-para-idade, e crianças com escore z acima de +2, excesso de peso-para- idade. Informações referentes à DPP foram obtidas por meio da aplicação da versão em português do instrumento EPDS (Edinburgh Postnatal Depression Scale). As análises das associações entre a DPP e os desfechos foram verificadas via modelos de regressão logística multinomial, mediante estimativas de razões de chances (OR) brutas e ajustadas e seus respectivos intervalos de confiança de 95% (IC 95). RESULTADOS: A amostra revelou escores z médios de -0,22 para peso-para-idade, 4,51%(n=21) apresentaram baixo peso-para- idade e 1,72% (n=8) de excesso de peso-para-idade. A prevalência de depressão foi de 27,6%. Nas análises brutas, filhos de mães deprimidas apresentavam 2,45 mais chance (OR=2,45; I.C. 95%=1,01-5,93;p-valor=0,050) de baixo peso-para-idade e 0,38 chance de excesso de peso-para-idade (OR=0,38;I.C. 95%=0,04-3,17;p-valor=0,38), do que os filhos de mães não deprimidas, porém esta associação apresentou nível de significância maior que 5%. Após ajuste pelo peso ao nascer, condições ambientais, posse de utensílios, prematuridade, idade materna e escolaridade materna a associação entre depressão e estado nutricional infantil não apresentou significância estatística (OR=2,39;I.C. 95%=0,74-7,71;p- valor>0,05).CONCLUSÃO: A DPP não foi associada ao estado nutricional infantil. / INTRODUCTION: The chances of illness and mortality are higher in children with nutritional status (NS) inadequate in the first months of life. Risk factors for EN inadequate maternal include the psychosocial aspects, such as anxiety, postpartum depression (PPD), the lack of social support. However, few studies on the role of these factors in determining child EN and its controversial results. OBJECTIVE: To investigate the relationship between postpartum depression and inadequate nutritional status in the second month of life. METHODS: This is a cross-sectional study with 466 children at two months of life (mean = 65 days, SD = 0.5) derived from basic health units in the municipality of Rio de Janeiro, conducted between June 2005 and December 2009. To make the outcome, mean weight-for- age z scores were expressed as compared with information from new reference WHO (2006) for children under five years. Were classified as inadequate nutritional status of children with z scores below -2, underweight-for-age, and children with z scores above +2, excess weight- for-age. Information regarding the DPP were obtained by applying the version in Portuguese of the EPDS (Edinburgh Postnatal Depression Scale). Analyses of associations between the DPP and the outcomes were verified via multinomial logistic regression models, estimated by odds ratios (OR) and its unadjusted and adjusted confidence intervals of 95% (IC 95). RESULTS: The sample was -0.22 z-scores for the average weight for age, 4.51% (n = 21) had lower weight-for-age and 1.72% (n = 8) of overweight -for-age. The prevalence of depression was 27.6%. In crude analyzes, children of depressed mothers had 2.45 more likely (OR = 2.45, 95% CI = 1.01 to 5.93, p = 0.050) of low weight-for-age and 0.38 chance of excess weight-for-age (OR = 0.38, 95% CI = 0.04 to 3.17, p = 0.38), than children of non-depressed mothers, but this association presented level of significance greater than 5%. After adjustment for birth weight, environmental conditions, possession of utensils, prematurity, maternal age and maternal education the association between depression and nutritional status was not statistically significant (OR = 2.39, 95% CI = 0.74 to 7, 71, p-value> 0.05). CONCLUSION: The DPP was not associated with child nutritional status.

Os miomas uterinos (MU) são considerados os tumores mais comumente encontrados no sistema reprodutor feminino. Este estudo buscou investigar associação entre o ganho de peso na idade adulta e a ocorrência de miomas. Esta relação foi explorada em estudos internacionais na maior parte americanos. No Brasil nenhum estudo havia abordado este tema até o término desta dissertação. Para investigar como a associação entre o ganho de peso na idade adulta afeta o risco de miomas, foi conduzido um estudo transversal referente aos dados da linha de base (1999-2001) do estudo longitudinal Pró-Saúde onde 2594 servidores técnico-administrativos de uma universidade pública do Rio de Janeiro são participantes, entre eles foram selecionadas 1560 mulheres com diagnóstico médico autorrelatado de MU e que tiveram seus pesos aos vinte anos de idade autorrelatados em questionário autopreenchível cujas idades variaram entre 22 a 67 anos. Foi avaliada a mudança de peso desde os 20 anos até o momento da entrada no estudo. As prevalências de miomas encontradas neste grupo foram23.3% (IC95% - 21,2; 25,4), situando-se em posição intermediária quando comparada as prevalências encontradas nos estudos norte-americanos. A maior prevalência de ganho de peso foi encontrada no 4 quintil cujos valores variaram entre ganho maior que 0,7 Kg/ano e menor que 1,1 Kg/ano. A faixa etária com maiores prevalências de diagnóstico médico auto-relatado de miomas ficou compreendida entre 45 a 54 anos (39,1%).Os valores de peso aos 20 anos informados pelas respondentes variaram entre 30,0 e 96,0 kg. O IMC aos 20 anos de idade se situou está dentro da categoria de normalidade entre a maior parte das participantes. Os resultados não sugerem associação entre o ganho de peso na idade adulta e miomas nesta população de estudo / The uterine fibroids (MU) are considered the most common tumors found in the female reproductive system. This study investigated the association between weight gain in adulthood and the occurrence of fibroids. This relationship was explored in international studies mostly Americans. In Brazil, no studies had addressed this issue until the end of this dissertation. To investigate how the association between weight gain in ddulthood affects the risk of fibroids, a crosssectional study was conducted for the data from the baseline (1999-2001) longitudinal study of the Pro-Saúde where2594 technical and administrative staff of a public university in Rio de Janeiro are participating, among them were selected in 1560 women with self-reported medical diagnosis of MU and had their weights at the age of twenty self-reported in self-administered questionnaire whose ages ranged from 22-67 years. Weight change since 20 years was evaluated until the entry into the study. The prevalence of fibroids found in this group were 23.3% (95% CI - 21.2, 25.4), standing at an intermediate position compared the prevalence found in American studies. The highest prevalence of weight gain was found in the 4th quintile values ranged between gain greater than 0.7 kg / year and less than 1.1 kg / year. The age group with highest prevalence of self-reported medical diagnosis of fibroids was between 45 and 54 (39.1%). The weight at age 20 reported by respondents ranged between 30.0 and 96.0 kg. The BMI at 20 years old stood in the category is normal among most participants. The results suggest no association between weight gain in adulthood and fibroids in this study population.

Introdução: o crack é uma forma extremamente aditiva de cocaína, provocando intensa fissura e um comportamento persistente e intenso de busca pela droga com negligência da alimentação. A alimentação insuficiente pode levar à carência de tiamina. O uso de latas e folhas de alumínio na confecção de cachimbos para o consumo de crack aumenta a exposição de usuários de crack a este metal. Deficiência de tiamina somada a acúmulo cerebral de alumínio pode inibir o metabolismo energético dependente da glicose, levando à neurodegeneração e, possivelmente, à encefalopatia de Wernicke. Objetivos: avaliação dos níveis sanguíneos de tiamina difosfato e de alumínio de dependentes de crack e comparação com os de controles. Método: estudo transversal controlado, avaliou 35 dependentes de crack e 35 controles, do sexo masculino, com 18 anos ou mais. Os casos foram recrutados entre pacientes internados na Unidade de Adição do Hospital de Clínicas de Porto Alegre ou na Emergência em Saúde Mental IAPI, os controles foram recrutados entre as pessoas que circulam na área ambulatorial do Hospital de Clínicas de Porto Alegre. Todos participantes tiveram seu peso e estatura medidos e sangue coletado para determinação dos níveis de tiamina difosfato e de alumínio. Os casos passaram, também, por uma breve avaliação neurológica. Resultados: as características dos casos são semelhantes à amostra do principal estudo nacional sobre o uso de crack no Brasil: sexo masculino, cerca de 30 anos de idade, com baixa escolaridade, desempregados, usuários de múltiplas substâncias psicoativas, consumidores de crack há aproximadamente 8 anos. O índice de massa corporal dos casos foi significativamente mais baixo (p<0.0001). Seis casos (17.65%) apresentaram índice de massa corporal abaixo do normal. Dois casos apresentaram nível de tiamina abaixo dos valores de referência, enquanto os níveis dos controles estavam acima deste limite. Comparando os resultados do primeiro quartil do nível sanguíneo de tiamina dos casos (N= 9; mediana 3.6μg/dL, amplitude interquartil 3.05μg/dL -4.10μg/dL) com o dos controles (N=14, mediana 4.3μg/dL, amplitude interquartil 3.7μg/dL-4.4μg/dL), os casos apresentaram níveis significativamente mais baixos (p=0.024). Os níveis de alumínio dos casos que tiveram as amostras de sangue coletadas até 24h após o último consumo da substância, foram maiores (mediana1.85μg/L, amplitude interquartil0.65-4.425μg/L) que os dos controles (mediana 0.95μg/L, amplitude interquartil 0.7-1.22μg/L), mas esta diferença não atingiu significância estatística (p=0.07). Conclusões: dependentes de crack tem índice de massa corporal menor e estão mais expostos ao alumínio que os controles. Alguns tem deficiência de tiamina, a qual pode levar à encefalopatia de Wernicke e declínio cognitivo. Portanto, tiamina parenteral profilática deve ser considerada para alguns dependentes de crack. / Background: Crack-cocaine is an extremely additive form of cocaine and its compulsive use can last days until exhaustion, driving its users to neglect feeding. Poor feeding may cause thiamine deficiency. In Brazil, crack-cocaine is usually smoked in pipes made of aluminum cans or with aluminum foils. Insufficient brain levels of thiamine plus brain aluminum accumulation, may impair glucose energy metabolism, promoting neurodegeneration and possibly Wernicke’s encephalopathy. Objectives: The aim of this study was to evaluate thiamine and aluminum blood levels in crack-cocaine addicts and compare them to healthy controls. Methods: cross-sectional controlled study, included 35 crack-cocaine addicts and 35 healthy controls, all males, 18 or older. Cases were recruited at the Addiction Unit of Hospital de Clínicas de Porto Alegre or at the Mental Health Emergency IAPI, controls were recruited between people circulating in the outpatient clinic area of Hospital de Clínicas de Porto Alegre. Weight and height were measured and blood samples collected for determination of thiamine diphosphate and aluminum levels. Cases were also submitted to a brief neurological examination. Results: cases characteristics were similar to the sample of the main national study related to crack-cocaine use in Brazil: mainly males, about 30 years old, with low education level, unemployed, multiple drug abusers, consuming crack-cocaine for approximately 8 years. Body mass index was significantly lower in cases (p<0.0001). Six cases (17.65%) had body mass index lower than normal, while no control was below this limit. Two cases presented thiamine levels below the laboratory reference range, while controls were all above this limit. Comparing the lower quartile of thiamine blood levels, cases (3.6 μg/dL) had significantly lower levels of thiamine than controls (4.3μg/dL) (p=0.024). Blood aluminum median of crack-cocaine addicts (1.85μg/L, interquartile range 0.65-4.425μg/L) whose samples were drawn until 24h after last drug consumption was higher than controls (0.95μg/L, interquartile range 0.7-1.22μg/L), but the difference did not achieve statistical significance (p=0.07). Conclusions: Crack-cocaine addicts have lower BMI and are more exposed to aluminum in comparison to healthy controls. Also, some of them have thiamine deficiency which may lead to Wernicke’s encephalopathy and cognitive impairment. Thus, prophylactic parenteral thiamine should be considered to some crack-cocaine addicts.

A lesão periapical de origem endodôntica é consequência de necrose pulpar causada pela presença de microorganismos no interior do sistema de canais radiculares. Essa lesão é geralmente crônica e assintomática e, portanto, os exames de imagem são importantes para sua detecção. A tomografia computadorizada de feixe cônico (TCFC) é uma tecnologia avançada, de grande utilidade para a avaliação de lesões periapicais e suas características. O objetivo deste trabalho foi determinar a prevalência de lesões periapicais no complexo maxilo-mandibular detectadas em imagens de TCFC e classificar as lesões encontradas, de acordo com os seguintes critérios: idade e gênero do paciente; indicação do exame de TCFC; localização e extensão da lesão; grau de comprometimento de cortical óssea e condição do dente associado. Para isso, foram interpretadas imagens de 300 pacientes obtidas em tomógrafo i-CAT Classic da FOB-USP e de um centro radiológico. Em uma primeira etapa, os exames foram selecionados de acordo com os critérios de inclusão (pacientes &#x2265; 12 anos de idade; arcos dentários com pelo menos 1 dente não-retido e protocolos de escaneamento dos exames de FOVs de 6, 8 ou 13cm e tamanhos de voxel de 0,25 ou 0,3) e analisados no software i-CAT Vision. Os dados do paciente como idade e gênero foram anotados, bem como o motivo para realização do exame. Procedeu-se a avaliação individual de cada dente por meio de cortes parassagitais ao arco, anotando a quantidade total de dentes e destacando os que apresentaram lesão periapical para posterior análise. Na segunda etapa do estudo, 2 examinadores, sendo uma radiologista e um endodontista avaliaram apenas os exames nos quais foram detectadas lesões periapicais. Cada lesão foi vista em 3 planos (sagital, axial e coronal) e medidas do maior diâmetro no corte mais expressivo foram feitas, usando ferramenta do software. Localização da lesão, comprometimento de cortical e condição do dente relacionado também foram anotados nessa etapa. Como resultado, obteve-se que 51,40% do total de pacientes cujo exame de TCFC permitia observar apenas 1 arco com lesão ou ambos os arcos dentários (n=214) apresentaram lesão periapical. Do total de 5.585 dentes avaliados de 300 pacientes, 192 apresentaram lesão (3,44%). Em relação à idade dos pacientes com lesão, o grupo de 60-69 anos apresentou maior prevalência (73,07%) e o grupo de 12-19 anos apresentou menor prevalência (15%). Em relação a gênero, a prevalência foi similar entre homens e mulheres, sendo a diferença estatisticamente não-significativa. Os exames solicitados como complementação de avaliação endodôntica apresentaram maior prevalência de lesão. A localização mais frequente de lesões periapicais foi em molares inferiores (5,91%) e a menos frequente em incisivos e caninos inferiores (0,63%). As lesões com dimensão entre 4-8mm de diâmetro foram as mais frequentemente encontradas (30,72%, kappa intra=0,87, kappa inter=0,79). A maioria das lesões não apresentou comprometimento de cortical óssea (76,28%, kappa intra=0,97, kappa inter=0,96). Dentes com tratamento endodôntico inadequado apresentaram maior quantidade de lesões (78,18%, kappa intra=0,95, kappa inter=0,85). A partir da análise da amostra estudada, concluiu-se, portanto, que lesões periapicais são frequentemente encontradas em exames de TCFC com diferentes prescrições e que a presença de lesões periapicais tem associação significativa entre idade do paciente, tipo e condição do dente relacionado. / Periapical lesion of endodontic origin is a consequence of the pulp necrosis caused by the presence of microorganisms within the root canal system. This lesion is usually chronic and asymptomatic and, therefore, the image examinations are important for its detection. Cone beam computed tomography (CBCT) is an advanced new technology, which can be very useful for the assessment of periapical lesions and their features. The aim of this study was to determine the prevalence of periapical lesions in jaws detected in CBCT images, as well as to classify the found lesions into the following criteria: patients age and gender; purpose of the CBCT scan; location and size of the lesion, as well as cortical bone and related tooth condition. The images of 300 patients who underwent a Classic i-CAT CBCT scan in Bauru Dental School (FOB-USP) and in a private radiologic office were assessed. The first part of the study involved the selection of the exams according to the inclusion criteria (patients &#x2265; 12 years old; maxilla/ mandible with at least 1 present tooth and scanning protocols using 6, 8 or 13 cm FOV and 0.25 or 0.3 voxel) using i-CAT Vision software. Data about patients age and gender were recorded, as well as the reason for the CBCT scan. Each tooth has been individually assessed in transversal slices. The total amount of teeth in each jaw and the presence or absence of periapical lesion have been recorded. In the second part of the study, 2 examiners (Dental Radiology and Endodontics experts) assessed the examinations in which periapical lesions have been detected. Each lesion has been evaluated in 3 dimensions (sagittal, axial and coronal) and the measurement was performed using specific tool of the software in the largest diameter (mm) in the most representative slice. The lesion location, cortical bone condition and related tooth condition were also recorded. Periapical lesion was found in 51.40% of the patients who presented CBCT images of a single jaw with lesion or both jaws (n=214). From the total amount of 5585 evaluated teeth of 300 patients, 192 presented lesion (3.44%). Concerning patients age, the 60-69 years old group presented the higher prevalence (73.07%) and the 12-19 years old group presented the lower prevalence (15%). As far as gender is concerned, the prevalence has been similar between men and women and the difference was not statistically significant. The scans performed in order to complement endodontic assessment presented the higher prevalence of periapical lesion. The most frequent location of the lesions was mandibular molars (5.91%) and the less frequent was mandibular incisors and canines (0.63%). The lesions with 4-8mm size were the most frequently found (30.72%, intra kappa=0.87, inter kappa=0.79). The most part of the lesions has not presented cortical bone changes (76.28%, intra kappa=0.97, inter kappa=0.96). The higher prevalence of lesion has been found in teeth with inadequate endodontic treatment (78.18%, intra kappa=0.95, inter kappa=0.85). It is possible to conclude that periapical lesions may be frequently found in CBCT examinations of different purposes and that the presence of periapical lesions has significant association with patients age and tooths type and condition.