INTRODUÇÃO: O virus linfotrópico de células T humanas do tipo 1 (HTLV-1) é endêmico em várias partes do mundo e transmitido primariamente através de relações sexuais ou da mãe para o filho. MÉTODOS: Estes modos de transmissão foram investigados na coorte de pacientes com HTLV-1 acompanhados no Instituto de Infectologia Emílio Ribas de São Paulo comparando-se casais soroconcordantes e sorodiscordantes, para estudo da transmissão sexual, e binômios mãe-filho soroconcordantes e com filho soronegativo para estudo da transmissão vertical. Os dados foram consolidados e depois analisados utilizando o sistema RedCap (Research Electronic Data Capture) e o programa computacional estatístico Stata/IC 13.1. Resultados com valor de p < 0,05 foram considerados estatisticamente significativos. Variáveis com p < 0,2 na análise bivariada foram incluídos na análise multivariada. RESULTADOS: Entre janeiro de 2013 e maio de 2015, de 178 pacientes com HTLV-1 que se declararam casados, 107 (46 homens e 61 mulheres) tinham parceiro testado, resultando em 81 casais (26 homens e 26 mulheres já formavam pares entre si). Foram excluídos aqueles com HIV ou HTLV-2. A taxa de soroconcordância entre casais foi 46,9%. A carga proviral (PVL) de HTLV-1 foi comparada entre 19 casais soroconcordantes e 37 sorodiscordantes, e os casais soroconcordantes apresentaram cargas provirais mais elevadas (p = 0,03). Não houve diferença entre os grupos de acordo com idade, tempo de relacionamento, ter mãe ou irmão com HTLV-1, raça, local de nascimento, escolaridade, história de hemotransfusão, HAM/TSP, ATL ou soropositividade para hepatite C. Na análise multivariada, no entanto, o tempo de relacionamento (> 20 anos) manteve-se independentemente associado com a ocorrência de soroconcordância entre casais (p = 0,031). Por sua vez, no período de junho de 2006 a agosto de 2016 havia 192 mães com infecção pelo HTLV-1, resultando em 499 filhos expostos. Destes, 288 (57,7%) foram testados para HTLV-1, constituindo-se na amostra final para o estudo, juntamente com respectivas 134 mães. Entre os filhos testados, 41 foram positivos para HTLV-1, indicando taxa de transmissão vertical de 14,2%. Sete dos 134 núcleos familiares concentraram 20 (48,8%) do total de 41 filhos soropositivos e cinco apresentavam prole com três ou mais filhos soropositivos para HTLV-1. Estiveram associadas à soropositividade do filho: duração da amamentação >= 12 meses, PVL materna >= 100 cópias/104 PBMC, idade da mãe no parto > 26 anos, raça/etnia asiática, estado civil divorciada, filho com avó soropositiva para HTLV-1, ter irmão com HTLV-1. Na análise multivariada, amamentação >= 12 meses, PVL materna elevada e ter irmão com HTLV-1 mantiveram-se independentemente associados ao desfecho. CONCLUSÕES: Os resultados indicam que o HLTV-1 vem sendo transmitido ativamente na coorte, tanto por via sexual como materno infantil, com agregação familiar de casos e que o risco de transmissão entre casais persiste após décadas (mais de 20 anos) de sorodiscordância. Foi observada associação entre PVL e transmissão do vírus, tanto por via sexual como materno-infantil, mesmo depois de anos após o desfecho. PVL materna elevada e amamentação prolongada estiveram independentemente associados à transmissão vertical, sendo necessários outros estudos avaliando a influência de fatores genéticos. / INTRODUCTION: Human T-cell lymphotropic virus type 1 (HTLV-1) is transmitted primarily either through sexual intercourse or from mother to child. METHODS: The current study investigated sexual and vertical transmission among individuals diagnosed as HTLV-1-positive who have been followed up at the Institute of Infectious Diseases \"Emilio Ribas\". In order to study the sexual transmission and mother-to-child transmission, the selected individuals with their respective pairs (couples or mother and son, repectively) were classified into seroconcordant or serodiscordant groups according to serological findings. Data were collected and managed using Research Electronic Data Capture (REDCap) and Stata/IC 13.1 for Windows. p values < 0.05 were considered statistically significant. Variables with p < 0.2 in bivariate analysis were included in multivariate analysis. RESULTS: Between January 2013 and May 2015, 178 HTLV-1-positive patients had spouses, 107 of which (46 men and 61 women) had tested partners, thus forming the initial sample (81 couples). Individuals co-infected with HTLV-2 or human immunodeficiency virus were not included in the analysis. The rate of seroconcordance was 59.8%. The HTLV-1 proviral load was compared between 19 and 37 seroconcordant and serodiscondant couples, respectively, and the concordant couples showed higher proviral loads (p = 0.03). There were no differences between the groups according to age, relationship length, having a mother or sibling with HTLV-1, race, ethnicity, nationality, education, history of blood transfusion, HAM/TSP, ALT, or hepatitis C virus status. In multivariate analysis, relationship time (over 20 years) was shown associated with ocurrence of seroconcordance status (p = 0.031). In turn, between June 2006 and August 2016 there were 192 mothers with HTLV-1 infection, resulting in 499 exposed children. Of these, 288 (57.7%) were tested for HTLV-1, forming the final sample for the study with 134 respective mothers. Among the tested soons, 41 were positive for HTLV-1, indicating vertical transmission rate of 14.2%. Of 41 positive sons for HTLV-1, 40 (48.8%) were clustered in seven of 134 households, and five households had their offspring with three or more sons seropositive for HTLV-1. The following variables were associated with positive son for HTLV-1: breastfeeding duration >= 12 months, maternal PVL >= 100 copies/104 PBMC, mother\'s age at delivery > 26 years, asian race/ethnicity, divorced marital status, child with grandmother seropositive for HTLV-1, have brother with HTLV-1. In multivariate analysis, breastfeeding >= 12 months, higher maternal proviral load and have brother with HTLV-1 remained independently associated with the outcome. CONCLUSIONS: The results indicate that the HLTV-1 is actively transmitted in the cohort both sexually and vertically, with ocurrence of familial clustering. The sexual transmission risk persists among couples even after decades (over 20 years) of serodiscordance. PVL remained associated with the outcome even several years after the occurrence of the transmission both sexually and vertically. High maternal provirus load and breastfeeding beyond 12 months were independently associated with positive son for HTLV-1, but it is necessary further studies to evaluating the influence of genetic factors on the mother-to-child transmission.

INTRODUÇÃO: O virus linfotrópico de células T humanas do tipo 1 (HTLV-1) é endêmico em várias partes do mundo e transmitido primariamente através de relações sexuais ou da mãe para o filho. MÉTODOS: Estes modos de transmissão foram investigados na coorte de pacientes com HTLV-1 acompanhados no Instituto de Infectologia Emílio Ribas de São Paulo comparando-se casais soroconcordantes e sorodiscordantes, para estudo da transmissão sexual, e binômios mãe-filho soroconcordantes e com filho soronegativo para estudo da transmissão vertical. Os dados foram consolidados e depois analisados utilizando o sistema RedCap (Research Electronic Data Capture) e o programa computacional estatístico Stata/IC 13.1. Resultados com valor de p < 0,05 foram considerados estatisticamente significativos. Variáveis com p < 0,2 na análise bivariada foram incluídos na análise multivariada. RESULTADOS: Entre janeiro de 2013 e maio de 2015, de 178 pacientes com HTLV-1 que se declararam casados, 107 (46 homens e 61 mulheres) tinham parceiro testado, resultando em 81 casais (26 homens e 26 mulheres já formavam pares entre si). Foram excluídos aqueles com HIV ou HTLV-2. A taxa de soroconcordância entre casais foi 46,9%. A carga proviral (PVL) de HTLV-1 foi comparada entre 19 casais soroconcordantes e 37 sorodiscordantes, e os casais soroconcordantes apresentaram cargas provirais mais elevadas (p = 0,03). Não houve diferença entre os grupos de acordo com idade, tempo de relacionamento, ter mãe ou irmão com HTLV-1, raça, local de nascimento, escolaridade, história de hemotransfusão, HAM/TSP, ATL ou soropositividade para hepatite C. Na análise multivariada, no entanto, o tempo de relacionamento (> 20 anos) manteve-se independentemente associado com a ocorrência de soroconcordância entre casais (p = 0,031). Por sua vez, no período de junho de 2006 a agosto de 2016 havia 192 mães com infecção pelo HTLV-1, resultando em 499 filhos expostos. Destes, 288 (57,7%) foram testados para HTLV-1, constituindo-se na amostra final para o estudo, juntamente com respectivas 134 mães. Entre os filhos testados, 41 foram positivos para HTLV-1, indicando taxa de transmissão vertical de 14,2%. Sete dos 134 núcleos familiares concentraram 20 (48,8%) do total de 41 filhos soropositivos e cinco apresentavam prole com três ou mais filhos soropositivos para HTLV-1. Estiveram associadas à soropositividade do filho: duração da amamentação >= 12 meses, PVL materna >= 100 cópias/104 PBMC, idade da mãe no parto > 26 anos, raça/etnia asiática, estado civil divorciada, filho com avó soropositiva para HTLV-1, ter irmão com HTLV-1. Na análise multivariada, amamentação >= 12 meses, PVL materna elevada e ter irmão com HTLV-1 mantiveram-se independentemente associados ao desfecho. CONCLUSÕES: Os resultados indicam que o HLTV-1 vem sendo transmitido ativamente na coorte, tanto por via sexual como materno infantil, com agregação familiar de casos e que o risco de transmissão entre casais persiste após décadas (mais de 20 anos) de sorodiscordância. Foi observada associação entre PVL e transmissão do vírus, tanto por via sexual como materno-infantil, mesmo depois de anos após o desfecho. PVL materna elevada e amamentação prolongada estiveram independentemente associados à transmissão vertical, sendo necessários outros estudos avaliando a influência de fatores genéticos. / INTRODUCTION: Human T-cell lymphotropic virus type 1 (HTLV-1) is transmitted primarily either through sexual intercourse or from mother to child. METHODS: The current study investigated sexual and vertical transmission among individuals diagnosed as HTLV-1-positive who have been followed up at the Institute of Infectious Diseases \"Emilio Ribas\". In order to study the sexual transmission and mother-to-child transmission, the selected individuals with their respective pairs (couples or mother and son, repectively) were classified into seroconcordant or serodiscordant groups according to serological findings. Data were collected and managed using Research Electronic Data Capture (REDCap) and Stata/IC 13.1 for Windows. p values < 0.05 were considered statistically significant. Variables with p < 0.2 in bivariate analysis were included in multivariate analysis. RESULTS: Between January 2013 and May 2015, 178 HTLV-1-positive patients had spouses, 107 of which (46 men and 61 women) had tested partners, thus forming the initial sample (81 couples). Individuals co-infected with HTLV-2 or human immunodeficiency virus were not included in the analysis. The rate of seroconcordance was 59.8%. The HTLV-1 proviral load was compared between 19 and 37 seroconcordant and serodiscondant couples, respectively, and the concordant couples showed higher proviral loads (p = 0.03). There were no differences between the groups according to age, relationship length, having a mother or sibling with HTLV-1, race, ethnicity, nationality, education, history of blood transfusion, HAM/TSP, ALT, or hepatitis C virus status. In multivariate analysis, relationship time (over 20 years) was shown associated with ocurrence of seroconcordance status (p = 0.031). In turn, between June 2006 and August 2016 there were 192 mothers with HTLV-1 infection, resulting in 499 exposed children. Of these, 288 (57.7%) were tested for HTLV-1, forming the final sample for the study with 134 respective mothers. Among the tested soons, 41 were positive for HTLV-1, indicating vertical transmission rate of 14.2%. Of 41 positive sons for HTLV-1, 40 (48.8%) were clustered in seven of 134 households, and five households had their offspring with three or more sons seropositive for HTLV-1. The following variables were associated with positive son for HTLV-1: breastfeeding duration >= 12 months, maternal PVL >= 100 copies/104 PBMC, mother\'s age at delivery > 26 years, asian race/ethnicity, divorced marital status, child with grandmother seropositive for HTLV-1, have brother with HTLV-1. In multivariate analysis, breastfeeding >= 12 months, higher maternal proviral load and have brother with HTLV-1 remained independently associated with the outcome. CONCLUSIONS: The results indicate that the HLTV-1 is actively transmitted in the cohort both sexually and vertically, with ocurrence of familial clustering. The sexual transmission risk persists among couples even after decades (over 20 years) of serodiscordance. PVL remained associated with the outcome even several years after the occurrence of the transmission both sexually and vertically. High maternal provirus load and breastfeeding beyond 12 months were independently associated with positive son for HTLV-1, but it is necessary further studies to evaluating the influence of genetic factors on the mother-to-child transmission.

This dissertation presents a data-driven computational epidemic framework to simulate disease epidemics at global mass gatherings. The annual Muslim pilgrimage to Makkah, Saudi Arabia is used to demonstrate the simulation and analysis of various disease transmission scenarios throughout the different stages of the event from the arrival to the departure of international participants. The proposed agent-based epidemic model efficiently captures the demographic, spatial, and temporal heterogeneity at each stage of the global event of Hajj. Experimental results indicate the substantial impact of the demographic and mobility patterns of the heterogeneous population of pilgrims on the progression of the disease spread in the different stages of Hajj. In addition, these simulations suggest that the differences in the spatial and temporal settings in each stage can significantly affect the dynamic of the disease. Finally, the epidemic simulations conducted at the different stages in this dissertation illustrate the impact of the differences between the duration of each stage in the event and the length of the infectious and latent periods. This research contributes to a better understanding of epidemic modeling in the context of global mass gatherings to predict the risk of disease pandemics caused by associated international travel. The computational modeling and disease spread simulations in global mass gatherings provide public health authorities with powerful tools to assess the implication of these events at a different scale and to evaluate the efficacy of control strategies to reduce their potential impacts.

Introduktion: Infektioner är vanligt bland barnen i förskolan. Vissa infektioner är av mer allvarlig karaktär, som antibiotikaresistenta bakterier. Det ger konsekvenser för samhället och folkhälsan, men innebär även en arbetsmiljörisk för personal på förskolan.Syfte: Att undersöka hur väl förskolechefer/rektorer följer arbetsmiljölagstiftningens krav på hygien och förebyggande smittskyddsåtgärder.Metod: Kvantitativ studie där en webbenkät skickades ut till 163 förskolechefer/rektorer i kommunala och fristående förskolor i tre olika regioner (Västra Götaland, Stockholm och Västmanland). Svaren analyserades med hjälp av statistikprogrammet SPSS, version 27.Resultat: Svarsfrekvens på webbenkäten var 39,9% (65 svar utav 163 skickade enkäter). Skillnad (p &lt; 0,001) mellan regionerna kunde påvisas beträffande hygienutbildning av personal. Det var att vanligare att personalen fick hygienutbildning inom kommunalaförskolor jämfört med fristående förskolor (p=0,049) och att kommunala förskolor städas dagligen till skillnad mot fristående (p=0,016). Personal som varit yrkesverksamma en längre tid var bättre på att informera vikarier om hygienrutiner (p=0,005), förskolor med fler än 45 barn hade en högre frekvens av daglig städning (p=0,002) och förskolor med 5 eller fler avdelningar var bättre på att ge personal hygienutbildning (p=0,043). Samtliga förskolor svarade att de använder ytdesinfektionsmedel för rengöring av skötbord.Slutsats: Det finns signifikanta skillnader i hur vanligt det är att personalen fick hygienutbildning mellan regionerna och mellan kommunala och fristående förskolor. Det är vanligare med daglig städning av lokaler på kommunala förskolor. Samtliga förskolor använde ytdesinfektionsmedel och engångshandskar vid behov. Vid framtida studier skulle urvalet behöva vara större, framförallt andelen fristående förskolor och ett större deltagande eftersträvas. / Introduction: Infections are common among preschool children. Some infectious agents, such as antibiotic-resistant bacteria have consequences for society and public health and pose a risk to the occupational health and safety of preschool staff.Aim: To investigate how well preschool principals comply with occupational health and safety legislation's requirements for preventive measures against risks of infections.Methods: A cross-sectional quantitative study was implemented. This study consisted of a web-based survey, sent via an e-mail link to 163 preschool principals in municipal and private preschools in three different regions of Sweden (Västra Götaland, Stockholm and Västmanland). Data were analyzed using the statistical program SPSS, version 27.Results: Of 163 email surveys sent, 65 responses (39.9%) were received. A difference (p &lt; 0.001) between regions was demonstrated in terms of hygiene training of personnel. It was more common with hygiene training of personnel in municipal preschools (p=0.049) and daily cleaning was more common among municipal preschools (p=0.016). Staff who had worked for a longer time were better at informing substitutes about hygiene practices (p=0.005), preschools with more than 45 children had a higher frequency of daily cleaning(p=0.002) and preschools with 5 or more departments were better at hygiene training of personnel (p=0.043). All preschools used surface disinfectants to clean changing tables.Conclusion: There were differences in the level of hygiene training of personnel between regions and between municipal and private preschools. Daily cleaning among municipal preschools was more common. All preschools use surface disinfectants and disposable gloves when needed. Future surveys should include a larger sample size and focus on higher participation.

Studies on empire have shown that colonialism generated new disease environments and complicated old disease experiences in Africa. These conditions necessitated a mission to sanitize Africans and their environment in British West Africa since the colonies had to be conducive for European colonial officials and their African labor, especially given the region’s image as the “white man’s grave.” However, colonial administrations lacked the skills, adequate personnel, and materials to transform territories like western Nigeria into desired healthy locations for European personnel or colonized Africans. In the first two decades of the twentieth century, most Africans resisted the preventive health measures introduced in Yoruba towns, including environmental sanitation projects to reduce mosquito breeding spots. This was not simply because the initiative threatened African livelihood but rather because many Africans were too poor to pay the cost of the British modernizing projects, including pipe-borne water and odor-proof latrine buckets. As most Africans resisted some of these initiatives and negotiated others to improve their health and social conditions, their politics of resistance shaped public health development in western Nigeria. This is significant to African history because it reveals how the administrative policing of environmental sanitation and health adds nuance to our understanding of empire, particularly the complex relationship between Africans of different social classes and between Africans and the colonial governments in Western Nigerian towns. / Dissertation / Doctor of Philosophy (PhD) / This dissertation is about the history of British preventive health in western Nigeria from the late nineteenth century to the end of the second world war. It contributes to the social history of medicine, health, and environment as it explores Africans’ experience of British imperial hygiene and public sanitation programs. Specifically, the study focuses on how public health projects such as potable water, public latrine, and waste management shaped people’s lives and how Africans shaped the health initiatives in return. The study argues that most of the preventive health programs the British colonial authorities introduced in western Nigerian towns during the period under review had a minimal impact on African health. This was because the colonial government and most Africans had opposing views on how public health initiatives should be executed in an environment of budget restraints and poverty. The study thus shows how Africans resisted some public health initiatives and negotiated others in an attempt to improve their health and social conditions. By exploring major colonial initiatives that sought to transform the Nigerian environment into a more healthy place and the people into environmentally responsible subjects, the study argues that colonized Africans were not passive onlookers during the transformation of their public health system. Rather, their politics of resistance shaped colonial health development.

No description available.

Os objetivos do estudo foram correlacionar a razão entre a circunferência abdominal e altura (CA/A) e o índice de massa corpórea (IMC) com as variáveis cardiometabólicas e inflamatórias em escolares de seis a 10 anos; avaliar a frequência de sobrepeso/obesidade e alterações cardiometabólicas e comparar o desempenho dos referenciais de índice de massa corpórea (IMC) do Centers for Disease Control and Prevention 2000 (CDC) e Organização Mundial de Saúde 2007 (OMS) no diagnóstico de sobrepeso/obesidade e alterações cardiometabólicas. Métodos: estudo de corte transversal, que incluiu 175 crianças, provenientes do Centro de Referência para Tratamento da Criança e do Adolescente (CRTCA), em Campos, Rio de Janeiro. As crianças foram divididas segundo os escores z do CDC e OMS em: não obesas (z do IMC <1) e sobrepeso/obesidade (z do IMC > 1). As variáveis cardiometabólicas analisadas foram: pressão arterial sistólica (PAS) e diastólica (PAD), glicose, lipoproteínas de baixa e alta densidades (LDL e HDL, respectivamente), triglicerídeos (TG), HOMA-IR. Como variáveis inflamatórias, analisamos proteína C reativa ultra-sensível (PCR) e leucometria. Resultados: a média da CA/A do grupo sobrepeso/obesidade foi maior que a do não obeso (0,58 ± 0,007 e 0,45 ± 0,004, respectivamente, p< 0,0001). Houve correlação significativa da CA/A com os escores z do IMC (r = 0,88, p < 0,0001), PAS (r= 0,51, p<0,0001), PAD (r= 0,49, p<0,0001), HOMA-IR (r=0,83, p<0,0001), HDL (r = -0,28, p< 0,0002), TG (r= 0,26, p<0,0006), LDL (r= 0,25, p<0,0008) e PCR (r= 0,51, p<0,0001). Contudo, a CA/A não se correlacionou com glicemia nem leucócitos. A sensibilidade da CA/A se equivaleu à do IMC no diagnóstico das alterações cardiometabólicas. A sensibilidade mais elevada da CA/A foi para o diagnóstico de alteração da PAS (80,0 %), PAD (76,6%) e HOMA-IR (92,6%). O ponto de corte superior a 0,47 foi sensível para o diagnóstico de resistência insulínica, mas acima de 0,50, para os demais distúrbios cardiometabólicos. A frequência de sobrepeso/obesidade nos escolares foi igual a 49,7%. Com exceção de hipertrigliceridemia, todas as outras alterações cardiometabólicas foram mais frequentes no grupo sobrepeso/obesidade (aumento de PA, p<0,0001; glicemia de jejum alterada, p < 0,0048; aumento de LDL, p< 0,015 e redução do HDL, p<0,0001). O referencial da OMS 2007 reclassificou 11 crianças a mais como obesas que o CDC, que apresentaram médias de escores z de PAS (1,71 ± 1,54), PAD (2,64 ± 1,83) e HOMA-IR (1,84 ± 0,98) semelhantes às médias das obesas (PAS = 1,25 ± 2,04; PAD = 1,94 ± 1,19 e HOMA-IR = 2,09 ± 1,12), mas superiores às médias das classificadas como sobrepeso (PAS = 0,49 ± 1,34, p < 0,023; PAD = 1,45 ± 0,97, p < 0,04 e HOMA-IR = 1,24 ± 0,67, p < 0,04 ). Conclusões: a razão CA/A foi tão sensível quanto IMC da OMS 2007 no diagnóstico do risco cardiometabólico e inflamatório. O referencial da OMS 2007 foi o mais sensível não só para o rastreamento de sobrepeso/obesidade, como também para pressão arterial elevada e resistência insulínica, em escolares de seis a 10 anos / This study aims to correlate the waist-to-height ratio (WHtR) and the body mass index (BMI) with the cardiometabolic and inflammatory variables in 6-10 year-old school children; to evaluated the frequency of overweight/obesity and cardiometabolic disturbances, and to compare the 2000 Centers for Disease Control and Prevention (CDC) and 2007 World Health Organization (WHO) body mass index (BMI) references in the diagnosis of overweight/obesity and the cardiometabolic disturbances. Methods: a cross-sectional study which included 175 subjects, selected from the Reference Center for the Treatment of Children and Adolescents, in Campos, Rio de Janeiro. The subjects were classified according to the 2000 CDC and 2007 OMS BMI z scores as non obese (BMI < 1) and overweight/obese ones (BMI > 1). The analized cardiometabolic variables were systolic and diastolic blood pressure (SBP and DBP respectively), fasting glycemia, low and high density lipoproteins (LDL and HDL respectively), trigliceride (TG), homeostatic model assessment (HOMA-IR). As inflammatory markers we analized the ultra-sensitive Creactive protein (CRP) and the leucocyte count. Results: the WHtR mean of the overweight/obese group was higher than that of the non obese ones (0,58 ± 0,007 and 0,45 ± 0,004, respectively,p < 0,0001). There was correlation between the WHtR and BMI z score (r = 0,88, p < 0,0001), SBP (r = 0,51, p < 0,0001), DBP (r = 0,49, p < 0,0001), HOMA-IR (r = 0,83, p < 0,0001), HDL (r = -0,28, p < 0,0002, TG (r= 0,26, p < 0,0006), LDL (r = 0,25, p < 0,0008), and CRP (r = 0, 51, p < 0.0001). However, the WHtR was neither correlated with glycemia nor with the leucocyte count. The WHtR sensitivity was equivalent to that of the BMI in the diagnosis of all cardiometabolic variables. The highest WHtR sensitivity was to diagnose the SBP (80,0%), DBP (76,6%) and HOMA-IR (92,6%) alterations. The WHtR cut-off higher than 0,47 pointed out to insulin resistance diagnosis, but higher than 0,5, it did to the other metabolic disturbances. The frequency of overweight/obesity was 49,7% in these school children. Except for hypertriglyceridemia, all the remaining cardiometabolic disturbances were more frequent in the overweight/obese group. The 2007 WHO BMI reference reclassified 11 children more as obese than the 2000 CDC, who had means of SBP (1,71 ± 1,54) and DBP z scores (2,64 ± 1,83) and HOMA-IR (1,84 ± 0,98) similar to those of the obese ones (SBP = 1,25 ± 20,4; DBP = 1,94 ± 1,1 and HOMA-IR = 2,09 ± 1,12), but higher than those of the classified as overweight (SBP= 0,49 ± 1,34, p<0,023; DBP= 1,45 ± 0,97, p<0,04 and HOMA-IR= 1,24 ± 0,67, p<0,04). Conclusions: the WHtR was so sensitive as the 2007 WHO BMI z score in diagnosing the cardiometabolic and inflammatory risk. The 2007 WHO reference was the most sensitive not only to screen obesity, but also the high blood pressure and insulin resistance, in 6-10-year-old children

Os objetivos do estudo foram correlacionar a razão entre a circunferência abdominal e altura (CA/A) e o índice de massa corpórea (IMC) com as variáveis cardiometabólicas e inflamatórias em escolares de seis a 10 anos; avaliar a frequência de sobrepeso/obesidade e alterações cardiometabólicas e comparar o desempenho dos referenciais de índice de massa corpórea (IMC) do Centers for Disease Control and Prevention 2000 (CDC) e Organização Mundial de Saúde 2007 (OMS) no diagnóstico de sobrepeso/obesidade e alterações cardiometabólicas. Métodos: estudo de corte transversal, que incluiu 175 crianças, provenientes do Centro de Referência para Tratamento da Criança e do Adolescente (CRTCA), em Campos, Rio de Janeiro. As crianças foram divididas segundo os escores z do CDC e OMS em: não obesas (z do IMC <1) e sobrepeso/obesidade (z do IMC > 1). As variáveis cardiometabólicas analisadas foram: pressão arterial sistólica (PAS) e diastólica (PAD), glicose, lipoproteínas de baixa e alta densidades (LDL e HDL, respectivamente), triglicerídeos (TG), HOMA-IR. Como variáveis inflamatórias, analisamos proteína C reativa ultra-sensível (PCR) e leucometria. Resultados: a média da CA/A do grupo sobrepeso/obesidade foi maior que a do não obeso (0,58 ± 0,007 e 0,45 ± 0,004, respectivamente, p< 0,0001). Houve correlação significativa da CA/A com os escores z do IMC (r = 0,88, p < 0,0001), PAS (r= 0,51, p<0,0001), PAD (r= 0,49, p<0,0001), HOMA-IR (r=0,83, p<0,0001), HDL (r = -0,28, p< 0,0002), TG (r= 0,26, p<0,0006), LDL (r= 0,25, p<0,0008) e PCR (r= 0,51, p<0,0001). Contudo, a CA/A não se correlacionou com glicemia nem leucócitos. A sensibilidade da CA/A se equivaleu à do IMC no diagnóstico das alterações cardiometabólicas. A sensibilidade mais elevada da CA/A foi para o diagnóstico de alteração da PAS (80,0 %), PAD (76,6%) e HOMA-IR (92,6%). O ponto de corte superior a 0,47 foi sensível para o diagnóstico de resistência insulínica, mas acima de 0,50, para os demais distúrbios cardiometabólicos. A frequência de sobrepeso/obesidade nos escolares foi igual a 49,7%. Com exceção de hipertrigliceridemia, todas as outras alterações cardiometabólicas foram mais frequentes no grupo sobrepeso/obesidade (aumento de PA, p<0,0001; glicemia de jejum alterada, p < 0,0048; aumento de LDL, p< 0,015 e redução do HDL, p<0,0001). O referencial da OMS 2007 reclassificou 11 crianças a mais como obesas que o CDC, que apresentaram médias de escores z de PAS (1,71 ± 1,54), PAD (2,64 ± 1,83) e HOMA-IR (1,84 ± 0,98) semelhantes às médias das obesas (PAS = 1,25 ± 2,04; PAD = 1,94 ± 1,19 e HOMA-IR = 2,09 ± 1,12), mas superiores às médias das classificadas como sobrepeso (PAS = 0,49 ± 1,34, p < 0,023; PAD = 1,45 ± 0,97, p < 0,04 e HOMA-IR = 1,24 ± 0,67, p < 0,04 ). Conclusões: a razão CA/A foi tão sensível quanto IMC da OMS 2007 no diagnóstico do risco cardiometabólico e inflamatório. O referencial da OMS 2007 foi o mais sensível não só para o rastreamento de sobrepeso/obesidade, como também para pressão arterial elevada e resistência insulínica, em escolares de seis a 10 anos / This study aims to correlate the waist-to-height ratio (WHtR) and the body mass index (BMI) with the cardiometabolic and inflammatory variables in 6-10 year-old school children; to evaluated the frequency of overweight/obesity and cardiometabolic disturbances, and to compare the 2000 Centers for Disease Control and Prevention (CDC) and 2007 World Health Organization (WHO) body mass index (BMI) references in the diagnosis of overweight/obesity and the cardiometabolic disturbances. Methods: a cross-sectional study which included 175 subjects, selected from the Reference Center for the Treatment of Children and Adolescents, in Campos, Rio de Janeiro. The subjects were classified according to the 2000 CDC and 2007 OMS BMI z scores as non obese (BMI < 1) and overweight/obese ones (BMI > 1). The analized cardiometabolic variables were systolic and diastolic blood pressure (SBP and DBP respectively), fasting glycemia, low and high density lipoproteins (LDL and HDL respectively), trigliceride (TG), homeostatic model assessment (HOMA-IR). As inflammatory markers we analized the ultra-sensitive Creactive protein (CRP) and the leucocyte count. Results: the WHtR mean of the overweight/obese group was higher than that of the non obese ones (0,58 ± 0,007 and 0,45 ± 0,004, respectively,p < 0,0001). There was correlation between the WHtR and BMI z score (r = 0,88, p < 0,0001), SBP (r = 0,51, p < 0,0001), DBP (r = 0,49, p < 0,0001), HOMA-IR (r = 0,83, p < 0,0001), HDL (r = -0,28, p < 0,0002, TG (r= 0,26, p < 0,0006), LDL (r = 0,25, p < 0,0008), and CRP (r = 0, 51, p < 0.0001). However, the WHtR was neither correlated with glycemia nor with the leucocyte count. The WHtR sensitivity was equivalent to that of the BMI in the diagnosis of all cardiometabolic variables. The highest WHtR sensitivity was to diagnose the SBP (80,0%), DBP (76,6%) and HOMA-IR (92,6%) alterations. The WHtR cut-off higher than 0,47 pointed out to insulin resistance diagnosis, but higher than 0,5, it did to the other metabolic disturbances. The frequency of overweight/obesity was 49,7% in these school children. Except for hypertriglyceridemia, all the remaining cardiometabolic disturbances were more frequent in the overweight/obese group. The 2007 WHO BMI reference reclassified 11 children more as obese than the 2000 CDC, who had means of SBP (1,71 ± 1,54) and DBP z scores (2,64 ± 1,83) and HOMA-IR (1,84 ± 0,98) similar to those of the obese ones (SBP = 1,25 ± 20,4; DBP = 1,94 ± 1,1 and HOMA-IR = 2,09 ± 1,12), but higher than those of the classified as overweight (SBP= 0,49 ± 1,34, p<0,023; DBP= 1,45 ± 0,97, p<0,04 and HOMA-IR= 1,24 ± 0,67, p<0,04). Conclusions: the WHtR was so sensitive as the 2007 WHO BMI z score in diagnosing the cardiometabolic and inflammatory risk. The 2007 WHO reference was the most sensitive not only to screen obesity, but also the high blood pressure and insulin resistance, in 6-10-year-old children

Chong, Ka Chun. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 125-141). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

This project examines the role of immunization registries and their effect on a health care delivery system. Recent efforts to attain coverage of child populations by recommended vaccines have included initiatives by federal and state agencies, as well as private foundations, to develop and implement statewide community-based childhood immunization registries.