Chi-square Test For Linear Trend Research Articles

Investigation of Tooth Wear and its Associated Etiologies in Adult Patients Visiting Dental Institute in India

Aim: To evaluate the prevalence, severity and patient?s awareness of tooth wear in adults visiting VSPMDCRC Nagpur. Methodology: A cross-sectional study was designed. The sample size was determined by using single proportion formula. A validated questionnaire was used to evaluate prevalence, grade of severity of tooth wear. Other factors such as presence of dentinal sensitivity and habits were also included. A total of 570 patients were examined, both male and females of age group 25-55 years with periodontally sound dentition were included in the study. Results: Chi-square test for linear trend was applied for statistical analysis. Total 570 patients were investigated out of which 245 (43%) patients showed signs of tooth wear. Prevalence of tooth wear was 45% for males and 41% for females. Prevalence of tooth wear and its severity increased with advancing age. 38% of patients with tooth wear complained of dentinal hypersensitivity. Majority of patients 55% who had tooth wear reported habit of chewing of tobacco related products. Patients with tooth wear of grade 1 and 2 showed lack of awareness of their condition however those with grade 3 showed increased awareness (35%) and it doubled as the grade progressed to 4. Conclusion: Tooth wear is a prevalent condition in this population. The severity increased as the age progressed. Tobacco chewing is also prevalent in patients showing tooth wear. There was lack of awareness in patients showing initial tooth wear however as the wear progressed 74% of patients sought the treatment. Clinical Significance: The implication for dentists is that efforts should be made to increase the awareness about tooth wear. Also, early diagnosis and prevention are vital to the well being of the patients.

Educational inequality in the occurrence of abdominal obesity:Pró-Saúde Study.

OBJECTIVE To estimate the degree of educational inequality in the occurrence of abdominal obesity in a population of non-faculty civil servants at university campi.METHODS In this cross-sectional study, we used data from 3,117 subjects of both genders aged 24 to 65-years old, regarding the baseline of Pró-Saúde Study, 1999-2001. Abdominal obesity was defined according to abdominal circumference thresholds of 88 cm for women and 102 cm for men. A multi-dimensional, self-administered questionnaire was used to evaluate education levels and demographic variables. Slope and relative indices of inequality, and Chi-squared test for linear trend were used in the data analysis. All analyses were stratified by genders, and the indices of inequality were standardized by age.RESULTS Abdominal obesity was the most prevalent among women (43.5%; 95%CI 41.2;45.9), as compared to men (24.3%; 95%CI 22.1;26.7), in all educational strata and age ranges. The association between education levels and abdominal obesity was an inverse one among women (p < 0.001); it was not statistically significant among men (p = 0.436). The educational inequality regarding abdominal obesity in the female population, in absolute terms (slope index of inequality), was 24.0% (95%CI 15.5;32.6). In relative terms (relative index of inequality), it was 2.8 (95%CI 1.9;4.1), after the age adjustment.CONCLUSIONS Gender inequality in the prevalence of abdominal obesity increases with older age and lower education. The slope and relative indices of inequality summarize the strictly monotonous trend between education levels and abdominal obesity, and it described educational inequality regarding abdominal obesity among women. Such indices provide relevant quantitative estimates for monitoring abdominal obesity and dealing with health inequalities.

Computed Tomograpy Venography diagnosis of iliocaval venous obstruction in advanced chronic venous insufficiency

Objective:Iliocaval obstruction is associated with venous hypertension symptoms and may predispose to deep venous thrombosis (DVT). Ultrasonography may fail to achieve noninvasive diagnosis of these obstructions. The possibility of using Computed Tomography Venography (CTV) for these diagnoses is under investigation.Methods:Patients with CVI graded at CEAP clinical classes 3 to 6 and previous treatment failure underwent evaluation with CTV. Percentage obstruction was rated by two independent examiners. Obstruction prevalence and its associations with risk factors and CEAP classification were analyzed.Results:A total of 112 limbs were prospectively evaluated. Mean patient age was 55.8 years and 75.4% were women. Obstructions involved the left lower limb in 71.8% of cases and 35.8% of patients reported a medical history of deep venous thrombosis. Overall, 57.1% of imaging studies demonstrated venous obstruction of at least 50% and 10.7% showed obstruction of &gt;80%. The only risk factor that was found to be independently associated with a significantly higher incidence of &gt;50% venous obstruction was a medical history of DVT (p=0.035) (Fisher's exact test). There was a positive relationship between clinical classification (CEAP) and degree of venous obstruction in the limbs studied (Chi-square test for linear trend; p=0.011).Conclusion:Patients with advanced CVI are often affected by obstructions in the iliocaval venous territory and CTV is able to diagnose the degree of obstruction. There is a positive association between degree of obstruction and both previous history of DVT and severity of symptoms of CVI.

Usefulness of the CHADS2 Score for Prognostic Stratification of Patients With Acute Myocardial Infarction

The Thrombolysis In Myocardial Infarction (TIMI) score and Global Registry of Acute Coronary Events (GRACE) score have been validated as predictors of major adverse cardiovascular events (MACE) in patients with acute myocardial infarction (AMI). This study was undertaken to determine whether the CHADS2 score had good accuracy for predicting clinical outcome in patients with AMI and to compare the discriminatory performance of the 3 risk scores (RSs). We calculated the TIMI RS, GRACE RS, and CHADS2 score for 747 consecutive patients with AMI. The study end point was the combined occurrence of MACE, including death, nonfatal myocardial infarction, and ischemic stroke. All patients were followed up for at least 3years or until the occurrence of a major event. The area under the receiver operating characteristic curve was used to evaluate the predictive ability of each score at different time points. Higher CHADS2 scores were associated with adverse outcome at discharge and 1-year and 3-year follow-ups (chi-square test for linear trend, p <0.001). Both CHADS2 score and GRACE RS demonstrated better discrimination than TIMI RS in predicting 1-year and 3-year MACE (p <0.001). Multivariate Cox regression analysis revealed that the CHADS2 score was an independent predictor of future MACE in patients with AMI (hazard ratio 1.349, 95% confidence interval 1.196 to 1.522). In conclusion, the CHADS2 score provides potentially valuable prognostic information on clinical outcome when applied to patients with AMI.

Seasonality of Burkitt's lymphoma in Uganda.

Background/Aims:Burkitt's lymphoma is the most common childhood oral maxillofacial tumor in Africa and some studies have reported seasonal variation.Materials and Methods:All Burkitt's cases diagnosed from 1969 to 2006, from all over Uganda, at the Makerere University's Department of Pathology, were analyzed, to determine seasonal variation. This was done by evaluation of monthly and rainy versus dry season prevalence.Statistical analysis:The Wilcoxon test was used in both cases, to assess the statistical significance of differences in the diagnostic rates of Burkitt's lymphoma, in comparison to nonspecific chronic inflammation, using the total as the denominator. Yearly variation in prevalence was examined by a Chi-square test for linear trend. Mann-Whitney tests were done to compare the climatic regions. Multivariate analysis of variance (MANOVA) was used to test for differences when gender, seasons and climatic regions were factored in.Results:Although monthly frequencies varied considerably over the period, none of the differences were statistically significant (Pearson's 15.199, degrees of freedom df = 11, P = 0.174). Likewise, there was no statistically significant difference in the total number of Burkitt's and nonspecific chronic inflammation biopsies handled at the Department during the rainy and dry seasons.Conclusion:Although the 38-year period gave us sufficient numbers to use the Edward's method for seasonality, it also meant that a lot of seasonal changes that occurred during the period were not taken into consideration. We hence feel that a review of this data with weather experts, so as to group the biopsies into accurate rainfall and dry patterns, would yield a more authoritative publication.

Increasing Resistance of Coagulase-Negative Staphylococci in Total Hip Arthroplasty Infections: 278 THA-Revisions due to Infection Reported to the Norwegian Arthroplasty Register from 1993 to 2007.

We investigated bacterial findings from intraoperative tissue samples taken during revision due to infection after total hip arthroplasty (THA). The aim was to investigate whether the susceptibility patterns changed during the period from 1993 through 2007. Reported revisions due to infection in the Norwegian Arthroplasty Register (NAR) were identified, and 10 representative hospitals in Norway were visited. All relevant information on patients reported to the NAR for a revision due to infection, including bacteriological findings, was collected from the medical records. A total of 278 revision surgeries with bacterial growth in more than 2 samples were identified and included. Differences between three 5-year time periods were tested by the chi-square test for linear trend. The most frequent isolates were coagulase-negative staphylococci (CoNS) (41%, 113/278) and Staphylococcus aureus (19%, 53/278). The proportion of CoNS resistant to the methicillin-group increased from 57% (16/28) in the first period, 1993–1997, to 84% (52/62) in the last period, 2003–2007 (P = 0.003). There was also significant increase in resistance for CoNS to cotrimoxazole, quinolones, clindamycin, and macrolides. All S. aureus isolates were sensitive to both the methicillin-group and the aminoglycosides. For the other bacteria identified no changes in susceptibility patterns were found.

Iniquidades em saude bucal: escolares beneficiarios do Bolsa Familia sao mais vulneraveis?

OBJECTIVETo evaluate the association between being a recipient of the Bolsa Família program and oral health conditions in Brazilian schoolchildren.METHODSA cross-sectional study was conducted with 1,107 schoolchildren aged between eight and 12 years from 20 public and private schools in Pelotas, RS, Southern Brazil. A list of all children receiving the Bolsa Família program was provided by the participant schools. Demographic, socioeconomic and oral hygiene information were assessed using a questionnaire completed by the schoolchildren and their parents. Dental exams were performed to assess the presence of dental plaque and prevalence of dental caries. Data were analyzed by Chi-square test, Chi-square test for linear trend and multivariate Poisson Regression (prevalence ratio; 95% confidence interval).RESULTSSchoolchildren from non-nuclear families, with a DMFT ≥ 1 and who had never visited a dentist were associated with receiving the Bolsa Família. Final model showed that caries prevalence was twice as high (PR 2.00; 95%CI 1.47;2.69) in schoolchildren benefiting from the Bolsa Família . It was also showed that schoolchildren benefiting from the program presented greater severity of dental caries compared to school children from private schools (RR 1.53; 95%CI 1.18;2.00). After final adjustments, the prevalence of schoolchildren who have never visited a dentist was six times higher in children who received the government benefit (PR 6.18; 95%CI 3.07;12.45) compared to those from private schools.CONCLUSIONSSchoolchildren benefiting from the Bolsa Família program experienced more caries lesions and have less frequently accessed dental care services, which suggest the need to include oral health in the program.

Evolución del consumo de tabaco en trabajadores de un hospital de Cataluña

In terms of tobacco consumption, health workers have been considered as reference group, however smoking prevalence in this group is higher than in general population. This study aimed to estimate the prevalence of tobacco consumption among workers of a health institution in Catalonia during a period of 10 years (2001-2011), and to describe their characteristics. The questionnaire on tobacco consumption prevalence was validated, and was administered in 2001, 2004, 2008 and 2011. A random sampling was carried out in two acute care institutions. The characteristics of the study sample and the differences between smokers were analyzed using the chi-square test for linear trend. A logistic regression model was performed including all the surveys. The smoking prevalence among health care workers for 2001, 2004, 2008 and 2011, was 30.00%, 34.42%, 36.21% and 29.42%, respectively. Women had the highest consumption prevalence (33,40%). Tobacco smoking decreased in medical staff, from 25.97% in 2001, to 18.88% in 2011 (p=0.005), and in nurses from 35,15% in 2001 to 25.61% in 2011 (p=0.007), but not among the administrative staff. Overall and for the first time, smoking prevalence in health workers begins to decrease. However, it does not decrease in the same way among all types of healthcare workers and the prevalence remains high when compared with the population prevalence. This consumption reduction coincides with the measures introduced by the program after the legislative changes.

Breastfeeding may protect against persistent stuttering

PurposeThis study investigated the hypothesis that breastfeeding in infancy might protect against persistent stuttering in children. MethodWe collected new data from the mothers of current and past participants in the Illinois Stuttering Research Program on their children's feeding history during infancy. We obtained 47 usable responses, for 17 children with persistent stuttering and 30 children who recovered naturally after a period of stuttering. ResultsA chi-squared test for linear trend revealed a significant relationship between breastfeeding duration and the likelihood of natural recovery for the boys in the sample. Mothers of children in the persistent group were no more likely to report early feeding difficulties which might have suggested an underlying oral motor deficit in children predisposed toward persistent stuttering. ConclusionsOur results offer preliminary support for the idea that breastfeeding may confer a measure of protection against persistent stuttering. The fatty acid profile of human milk, with its potential to affect both gene expression and the composition of neural tissue, may explain this association. Further research is called for.Learning outcomes: The reader will be able to discuss at least one reason why human milk may make a difference in neurodevelopment generally and with regard to stuttering outcomes specifically. Additionally, the reader will be able to describe the relationship between breastfeeding duration and stuttering recovery observed in this sample.

Antioxidant Sestrin-2 Redistribution to Neuronal Soma in Human Immunodeficiency Virus-Associated Neurocognitive Disorders

Sestrin-2 is involved in p53-dependent antioxidant defenses and in the maintenance of metabolic homeostasis. We hypothesize that sestrin-2 expression is altered in the brains of subjects diagnosed with human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) due to neuronal oxidative stress. We studied sestrin-2 immunoreactivity in 42 isocortex sections from HIV-1-infected subjects compared to 18 age-matched non-HIV controls and 19 advanced Alzheimer's disease (AD) cases. With HIV infection, the sestrin-2 immunoreactivity pattern shifted from neuropil predominance (N) to neuropil and neuronal-soma co-dominance (NS) and neuronal-soma predominance (S; P < 0.0001, Chi-square test for linear trend). Among HIV cases showing the NS or S pattern, HAND cases were preferentially associated with the S pattern (n = 10 of 20) compared to cognitively intact cases (n = 1 of 11; P = 0.047, Fisher's exact test). In AD brains, sestrin-2 immunoreactivity was mostly intense in the neuropil and co-localized with phospho-Tau immunoreactivity in a subset of neurofibrillary lesions. Phospho-Tau-immunoreactive neurofibrillary lesions were rare in HIV cases and their occurrence was not associated with HAND. Levels of isocortical 8-hydroxy-deoxyguanosine (marker of nucleic acid oxidation) immunoreactivity were not significantly altered in HAND cases compared to cognitively intact HIV cases. In conclusion, the sestrin-2 immunoreactivity redistribution to neuronal soma in HAND suggests unique involvement of sestrin-2 in the pathophysiology of HAND, which is different from the role of sestrin-2 in AD pathogenesis. Alternatively, the difference in sestrin-2 immunoreactivity distribution between HAND and AD may be related to different degrees of severity or stages of oxidative stress.

Características epidemiológicas e óbitos de prematuros atendidos em hospital de referência para gestante de alto risco

ObjectiveTo analyze the process of care provided to premature infants in a neonatal intensive care unit and the factors associated with their mortality. MethodsCross-sectional retrospective study of premature infants in an intensive care unit between 2008 and 2010. The characteristics of the mothers and premature infants were described, and a bivariate analysis was performed on the following characteristics: the study period and the "death" outcome (hospital, neonatal and early) using Pearson's chi-square test, Fisher's exact test or a chi-square test for linear trends. Bivariate and multivariable logistic regression analyses were performed using a stepwise backward logistic regression method between the variables with p<0.20 and the "death" outcome. A p value <0.05 was considered to be significant. ResultsIn total, 293 preterm infants were studied. Increased access to complementary tests (transfontanellar ultrasound and Doppler echocardiogram) and breastfeeding rates were indicators of improving care. Mortality was concentrated in the neonatal period, especially in the early neonatal period, and was associated with extreme prematurity, small size for gestational age and an Apgar score <7 at 5 minutes after birth. The late-onset sepsis was also associated with a greater chance of neonatal death, and antenatal corticosteroids were protective against neonatal and early deaths. ConclusionsAlthough these results are comparable to previous findings regarding mortality among premature infants in Brazil, the study emphasizes the need to implement strategies that promote breastfeeding and reduce neonatal mortality and its early component.

Tendência temporal de tabagismo em população urbana: um estudo de base populacional no Sul do Brasil

This study evaluated time trends in smoking prevalence according to gender and family income among individuals 20 years or older in Pelotas, Rio Grande do Sul State, Brazil. Five population-based surveys using census tracts were conducted in the city from 2002 to 2010. Smoking was defined as consumption of one or more cigarettes per day for at least one month. Time trend was assessed using the chi-square test for linear trend. 15,136 individuals were enrolled in these surveys. During this period, overall smoking prevalence decreased from 28% (25.8-30.4) in 2002 to 21% (19.5-23.5) in 2010. This 23% decline was similar in both genders, but differed significantly according to family income (smoking prevalence increased as income dropped). From 2002 to 2010, smoking decreased by 26% in the lowest income quintile and 39% in the highest. Despite such reductions, smoking prevalence is still high, indicating the need to boost control measures, especially among low-income groups.

HIV Seroprevalence Among Surgical Specialty Outpatients at a Teaching Hospital

Background: HIV infection rate is higher in densely populated and heavily industrialized communities like Kano. The risk of transmission of the infection from patients to health workers, and from mother to child is very high among antenatal women and surgical patients if their HIV status is not known, because of the higher probability of breaching the universal precautions. Objective: To determine the sero-prevalence of Human Immunodeficiency Virus (HIV) infection among Surgical Specialty outpatients Clinic attendees (Antenatal and Surgical Outpatient Clinics) Methodology: A prospective observational study of all the clinic attendees who consented to be included in this study between January and December 2004 was carried out at Aminu Kano Teaching Hospital, Kano, Nigeria. The clinic attendees had pre-test counseling, followed by voluntary testing and post test counseling for those who were sero-positive and negative. The data obtained were analyzed using chi-square test, and analysis for linear trend in proportions was done using chi-square test for linear trend. Odds ratio and 95% Confidence Interval were determined where appropriate. Results: The sero-prevalence of HIV infection among the clinic attendees that were screened was 37.5%. There was higher prevalence of the infection among the low socio-economic class (X2trend= 53.028, P= 0.0000). The prevalence of the infection increased with increasing age up to 50 years, and thereafter decreased with increasing age (X2trend = 8.597, P= 0.00337). Ambulatory status (OR= 0.78, CI= 0.60-1.01, P &gt; 0.05), and sex (OR= 1.01, CI= 0.80- 1.28, P &gt; 0.05) of the patients did not show statistically significant difference in the prevalence of the infection. Conclusion: The high prevalence of HIV infection among the clinic attendees that were screened, call for mandatory screening of all antenatal and surgical patients, especially before a procedure is carried out.Key words: HIV sero-prevalence, surgical specialty outpatients, ELISA,

Lobular neoplasia: frequency and association with other breast lesions

BackgroundUsing new molecular biology techniques, recent studies have implicated a common evolutionary pathway between lobular neoplasia, lobular carcinomas, and columnar cell lesions. Our aims were to assess the frequency of lobular neoplasia in a series of breast biopsies that were performed and examined in the same institution and to analyze the association between subtypes of lobular neoplasia and benign and malignant breast lesions.MethodsCases were selected after reviewing archived pathological reports in the Breast Pathology Laboratory, School of Medicine of Federal University of Minas Gerais (1999-2008). Cases of lobular neoplasia were reviewed and classified as atypical lobular hyperplasia, ductal involvement by cells of atypical lobular hyperplasia, lobular carcinoma in situ, and pleomorphic lobular carcinoma in situ. Coexistence of lobular neoplasia with other breast lesions, including columnar cell lesions, invasive ductal carcinoma and invasive lobular carcinoma, was evaluated. The association between lobular neoplasia and breast lesions was analyzed by Fisher's exact test and chi-square test for linear trend.ResultsWe analyzed 5650 breast specimens, selecting 135 breast specimens (2.4%) that had a diagnosis of lobular neoplasia, corresponding to 106 patients. Hematoxylin and eosin-stained slides were available for 84 cases, 5 of which were excluded because they contained only "indeterminate" in situ lesions. Of the 79 remaining cases, columnar cell lesions were present in 78.5%, primarily with columnar cell changes without atypia (67.7%). Invasive carcinoma was present in 45.6% of cases of lobular neoplasia--a similar frequency (47.2%) as invasive ductal carcinoma and invasive lobular carcinoma. We noted a significant linear trend (p < 0.03) of a higher frequency of invasive carcinomas that were concomitant with lobular carcinoma in situ compared with atypical lobular hyperplasia. Invasive lobular carcinomas were associated with lobular carcinoma in situ in 33% of cases, compared with 2.8% of atypical lobular hyperplasia cases.ConclusionsOur findings confirm a frequent association between lobular neoplasia and columnar cell lesions, the majority of which lacked atypia. We also observed a greater frequency of invasive carcinoma, more commonly invasive lobular carcinoma, associated with more developed forms of lobular neoplasia (lobular carcinoma in situ).

Extraction of four premolars in Black patients with bi-protrusion: aesthetic perceptions of professionals and lay people

To assess the aesthetic perceptions and expectations regarding the results of orthodontic treatment for alterations in the profile of Black patients with bi-protrusion through the extraction of four premolars and maximal anchorage. Cross-sectional. Offices of plastic surgeons and orthodontists in the city of Belo Horizonte, Brazil. 152 individuals participated in the study and were divided into four groups: Group 1, 38 orthodontists; Group 2, 38 plastic surgeons; Group 3, 38 White laypersons; and Group 4, 38 Black laypersons. The patient sample was composed of six Black individuals (three males and three females) with varying degrees of bi-protrusion. Each participant was shown altered photographs of the profile of the final result of treatment, simulating three different bi-protrusion reduction options (2, 4 and 6 mm), which were united with the original initial and final photographs. Aesthetic preferences and expectations regarding the true result of treatment. The chi-square test for linear trend with Bonferroni correction (á=P<0·008). The aesthetic preference for the majority of participants was for a straighter profile than those provided by the orthodontic treatment. Moreover, the actual profile resulting from the orthodontic treatment was correctly identified by just 22% of the Black laypersons, 22% of the White laypersons, 21% of the orthodontists and 17% of the plastic surgeons. There were significant differences between groups. This study supports the view that society perceives straight profiles as aesthetically more pleasing in comparison to protruding or slightly protruding profiles.

Initiation of effective postpartum contraceptive use in public hospitals in Guatemala

Low frequency of effective contraceptive use remains a challenging problem. This article examines the frequency of effective postpartum contraception and the methods used before discharge in public hospitals in Guatemala. It also discusses the need to implement best practices in providing family-planning and contraceptive services. In March 2006, a surveillance system was implemented to collect data on the initiation of effective contraceptive methods. Postpartum women were monitored in 34 public hospitals. Univariate and bivariate analyses were performed, and a chi-square test for linear trends was used to compare female surgical sterilization rates after vaginal delivery and cesarean section. Between 1 March 2006 and 31 December 2008, of the 218 656 women who had a postpartum event, 31% received an effective contraceptive method before hospital discharge. The frequency of initiation of effective postpartum methods varied across hospitals. Hospital results were consistent with national data on women of reproductive age. Among women who underwent surgical sterilization, differences between those who had delivered vaginally and those who had a cesarean section were statistically significant. The overall frequency of initiation of effective postpartum contraceptive use is low in public hospitals in Guatemala. It is higher, however, in hospitals at lower health care levels with strong community ties. Routine data collection revealed specific areas for improvement, particularly the need to enhance health providers' knowledge of medical eligibility criteria for effective contraceptive use postpartum. The priority is to promote the provision of high-quality family-planning and contraceptive services in Guatemala's public health system.

Stress ulcer prophylaxis in pediatric intensive care units

To assess use of stress ulcer prophylaxis in patients admitted to five pediatric intensive care units (PICUs) in Porto Alegre, Brazil. This was a multicenter, prospective, cross-sectional observational study. PICUs were visited on randomly defined days between April 2006 and February 2007, and the medical records of admitted patients were reviewed. Patients whose records had been previously assessed were excluded, as were those with upper gastrointestinal bleeding on admission. Data were collected on age, gender, admission diagnosis, severity of illness, administration of stress ulcer prophylaxis, rationale for prophylaxis, and first-line prophylactic agent of choice. Variables were described as absolute and relative frequencies, mean and standard deviation, or median and interquartile range as appropriate. Pearson's chi-square test for linear trend or Fisher's exact test were used to assess possible associations. The level of significance was set at 5% (p ≤ 0.05). 398 patients (57% male) were assessed [median age, 16 months (IQR 4-65); median length of PICU stay, 4 days (IQR 1-9)]. Respiratory illness was the main reason for admission (32.7%). Most patients received stress ulcer prophylaxis (77.5%; range, 66-91%). Mechanical ventilation (22.3%) was the most common rationale provided, followed by informal routine use of prophylaxis (21.4%). Only one of the participating PICUs had a specific care protocol for use of stress ulcer prophylaxis. Ranitidine was the most commonly used drug (84.5% of cases). Evidence of minor gastrointestinal bleeding was found in 3% of patients; none had clinically significant bleeds. Administration of stress ulcer prophylaxis is a common practice in the participating PICUs, with ranitidine the most commonly used drug. Among the various rationales provided, mechanical ventilation and informal routine use were the most prevalent.

Profilaxia para úlcera de estresse em pacientes internados em UTI pediátrica

OBJECTIVE: To assess use of stress ulcer prophylaxis in patients admitted to five pediatric intensive care units (PICUs) in Porto Alegre, Brazil. METHODS: This was a multicenter, prospective, cross-sectional observational study. PICUs were visited on randomly defined days between April 2006 and February 2007, and the medical records of admitted patients were reviewed. Patients whose records had been previously assessed were excluded, as were those with upper gastrointestinal bleeding on admission. Data were collected on age, gender, admission diagnosis, severity of illness, administration of stress ulcer prophylaxis, rationale for prophylaxis, and first-line prophylactic agent of choice. Variables were described as absolute and relative frequencies, mean and standard deviation, or median and interquartile range as appropriate. Pearson's chi-square test for linear trend or Fisher's exact test were used to assess possible associations. The level of significance was set at 5% (p < 0.05). RESULTS: 398 patients (57% male) were assessed [median age, 16 months (IQR 4-65); median length of PICU stay, 4 days (IQR 1-9)]. Respiratory illness was the main reason for admission (32.7%). Most patients received stress ulcer prophylaxis (77.5%; range, 66-91%). Mechanical ventilation (22.3%) was the most common rationale provided, followed by informal routine use of prophylaxis (21.4%). Only one of the participating PICUs had a specific care protocol for use of stress ulcer prophylaxis. Ranitidine was the most commonly used drug (84.5% of cases). Evidence of minor gastrointestinal bleeding was found in 3% of patients; none had clinically significant bleeds. CONCLUSIONS: Administration of stress ulcer prophylaxis is a common practice in the participating PICUs, with ranitidine the most commonly used drug. Among the various rationales provided, mechanical ventilation and informal routine use were the most prevalent.

Growth patterns in early childhood and the onset of menarche before age twelve

OBJECTIVE: To examine the relationship between growth patterns in early childhood and the onset of menarche before age 12. METHODS: The study included 2,083 women from a birth cohort study conducted in the city of Pelotas, Southern Brazil, starting in 1982. Anthropometric, behavioral, and pregnancy-related variables were collected through home interviews. Statistical analyses were performed using Pearson's chi-square and chi-square test for linear trends. A multivariable analysis was carried out using Poisson regression based on a hierarchical model. RESULTS: Mean age of menarche was 12.4 years old and the prevalence of menarche before age 12 was 24.3%. Higher weight-for-age, height-for-age, and weight-for-height z-scores at 19.4 and 43.1 months of age were associated with linear tendencies of increased prevalence and relative risks of the onset of menarche before age 12. Girls who experienced rapid growth in weight-for-age z-score from birth to 19.4 months of age and in weight-for-age or height-for-age z-scores from 19.4 to 43.1 months of age also showed higher risk of menarche before age 12. Higher risk was seen when rapid growth in weight-for-age z-score was seen during these age intervals and the highest risk was found among those in the first tertile of Williams' curve at birth. Rapid growth in weight-for-height z-score was not associated with menarche before age 12. CONCLUSIONS: Menarche is affected by nutritional status and growth patterns during early childhood. Preventing overweight and obesity during early childhood and keeping a "normal" growth pattern seem crucial for the prevention of health conditions during adulthood.

General Surgical Operative Duration Is Associated with Increased Risk-Adjusted Infectious Complication Rates and Length of Hospital Stay

Studies of specific procedures have shown increases in infectious complications with operative duration. We hypothesized that operative duration is independently associated with increased risk-adjusted infectious complication (IC) rates in a broad range of general surgical procedures. We queried the American College of Surgeons National Surgical Quality Improvement Program database for general surgical operations performed from 2005 to 2007. ICs (wound infection, sepsis, urinary tract infection, and/or pneumonia) and length of hospital stay (LOS) were evaluated versus operative duration (OD, ie, incision to closure). Multivariable regression adjusted for 38 patient risk variables, operation type and complexity, wound class and intraoperative transfusion. We also analyzed isolated laparoscopic cholecystectomies in patients of American Society of Anesthesiologists class 1 or 2, without intraoperative transfusion and with a clean or clean-contaminated wound class. In 299,359 operations performed at 173 hospitals, unadjusted IC rates increased linearly with OD at a rate of close to 2.5% per half hour (chi-square test for linear trend, p < 0.001). After adjustment, IC risk increased for each half hour of OD relative to cases lasting <or=1 hour, almost doubling at 2.1 to 2.5 hours (odds ratio = 1.92; 95% CI, 1.82 to 2.03; p < 0.001). In isolated laparoscopic cholecystectomy, IC rates increased linearly with OD (n = 17,018, chi-square test for linear trend, p < 0.001) with rates for 1.1 to 1.5 hour cases (1.4%) doubling those lasting <or=0.5 hour (0.7%). Across all procedures, adjusted LOS increased geometrically with operative duration at a rate of about 6% per half hour (coefficient for natural log transformed LOS = 0.059 per half hour; 95% CI, 0.058 to 0.060; p < 0.001). Operative duration is independently associated with increased ICs and LOS after adjustment for procedure and patient risk factors.