Years Of Age In Brazil Research Articles

Nutritional status of children under 5 years of age in Brazil: evidence of nutritional epidemiological polarisation.

The objective of this study was to evaluate the nutritional status of children under 5 years of age in Brazil in 2009 and its association with social and demographic factors. Data from the Household Budget Survey (Pesquisa de Orçamento Familiar - POF 2008-2009) were used, in which the nutritional profile was evaluated according to the weight-for-age (W/A), height-for-age (H/A) and weight-for-height (W/H) indices (n = 14,569). The association was estimated by applying the Pearson association test, a logistic regression and a correspondence analysis. The correspondence analysis showed a higher association of thinness with children in the North and Northeast regions, in families with lower levels of income and in those of black colour/race. Overweight and obesity had a stronger relationship with children living in the South, Southeast and Central-West, in males, in those from urban areas, in those of Caucasian colour/race, in those aged 3 years and in those from families with intermediate income ranges. Overweight and obesity showed a heterogeneous spatial distribution amongst Brazilian states. A nutritional epidemiological polarisation that presents a major challenge for public health is indicated: we must reduce nutritional deficiencies and promote healthy eating habits from childhood to improve the nutritional and epidemiological profiles and mortality of the population.

Treatment of childhood injuries and violence in public emergency services

This study aimed to analyze the profile of treatment for accidents and violence involving children under 10 years of age in Brazil in the year 2011. This was a cross-sectional descriptive study in 71 emergency services in the Brazilian Unified National Health System (SUS), located in the national capital and 24 state capitals. Data were obtained from the Ministry of Health's system of sentinel surveillance services for Violence and Accidents (VIVA Survey). The highest proportion of injuries (67.4%) occurred inside the child's home. Among unintentional injuries, falls were the most frequent (52.4%), followed by running into objects or persons (21.8%) and traffic injuries (10.9%), especially as passengers (bicycles were an important means of transportation involved in the injuries). The vast majority of unintentional injuries are avoidable, and educational measures should be adopted, especially with parents, teachers, the community, and health workers, calling attention to the risks and the adoption of safe behaviors in the home, at school, and in leisure-time activities. Cases of violence are subject to mandatory reporting, and prompt measures should be taken to protect victims.

African ancestry, lung function and the effect of genetics.

African-Americans have smaller lung function compared with European-Americans. The aim of this study was to disentangle the contribution of genetics from other variables on lung function.A cohort was followed from birth to 30 years of age in Brazil. Several variables were collected: genomic analysis based on DNA; forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) obtained by spirometry; height measured by anthropometrists; and thorax circumference evaluated by photonic scanner. Crude and adjusted linear regression models were calculated according to African ancestry.The sample comprised 2869 participants out of 3701 members of the cohort. Males with higher African ancestry by DNA analysis had a smaller FEV1 (−0.13 L, 95% CI −0.23– −0.03 L) and FVC (−0.21 L, 95% CI −0.32– −0.09 L) compared with those with less African ancestry, having accounted for height, sitting to standing height ratio and other confounders. Similar effects were seen in females.After adjustment, ancestry remained significantly associated with lung function, but the large effect of adjustment for confounding among males (but not females) does not allow us to exclude the possibility that residual confounding may still account for these findings.

Impact of 10-valent pneumococcal conjugate vaccine on pneumococcal meningitis in children up to two years of age in Brazil.

The objective of this study was to analyze the impact of vaccination against Streptococcus pneumoniae on the morbidity and mortality from pneumococcal meningitis in children ≤ 2 years in Brazil, from 2007 to 2012. This is a descriptive study and ecological analysis using data from the Information System on Notifiable Diseases. Pre-vaccination (2007-2009) and post-vaccination (2011-2012) periods were defined to compare incidence rates and mortality. A total of 1,311 cases and 430 deaths were reported during the study period. Incidence decreased from 3.70/100,000 in 2007 to 1.84/100,000 in 2012, and mortality decreased from 1.30/100,000 to 0.40/100,000, or 50% and 69% respectively, with the greatest impact in the 6-11 month age group. This decrease in Pneumococcal meningitis morbidity and mortality rates two years after introduction of the 10-valent pneumococcal conjugate vaccine suggests its effectiveness.

Analysis of childhood leukemia mortality trends in Brazil, from 1980 to 2010

ObjectiveLeukemias comprise the most common group of cancers in children and adolescents. Studies conducted in other countries and Brazil have observed a decrease in their mortality. This study aimed to evaluate the trend of mortality from leukemia in children under 19 years of age in Brazil, from 1980 to 2010. MethodsThis was an ecological study, using retrospective time series data from the Mortality Information System, from 1980 to 2010. Calculations of mortality rates were performed, including gross, gender‐specific, and age‐based. For trend analysis, linear and semi‐log regression models were used. The significance level was 5%. ResultsMortality rates for lymphoid and myeloid leukemias presented a growth trend, with the exception of lymphoid leukemia among children under 4 years of age (percentage decrease: 1.21% annually), while in the sub‐group “Other types of leukemia”, a downward trend was observed. Overall, mortality from leukemia tended to increase for boys and girls, especially in the age groups 10‐14 years (annual percentage increase of 1.23% for males and 1.28% for females) and 15‐19 years (annual percentage increase of 1.40% for males and 1.62% for females). ConclusionsThe results for leukemia generally corroborate the results of other similar studies. A detailed analysis by subgroup of leukemia, age, and gender revealed no trends shown in other studies, thus indicating special requirements for each variable in the analysis.

Analysis of childhood leukemia mortality trends in Brazil, from 1980 to 2010

ObjectiveLeukemias comprise the most common group of cancers in children and adolescents. Studies conducted in other countries and Brazil have observed a decrease in their mortality.This study aimed to evaluate the trend of mortality from leukemia in children under 19 years of age in Brazil, from 1980 to 2010. MethodsThis was an ecological study, using retrospective time series data from the Mortality Information System, from 1980 to 2010. Calculations of mortality rates were performed, including gross, gender-specific, and age-based. For trend analysis, linear and semi-log regression models were used. The significance level was 5%. ResultsMortality rates for lymphoid and myeloid leukemias presented a growth trend, with the exception of lymphoid leukemia among children under 4 years of age (percentage decrease: 1.21% annually), while in the sub-group “Other types of leukemia”, a downward trend was observed. Overall, mortality from leukemia tended to increase for boys and girls, especially in the age groups 10-14 years (annual percentage increase of 1.23% for males and 1.28% for females) and 15-19 years (annual percentage increase of 1.40% for males and 1.62% for females). ConclusionsThe results for leukemia generally corroborate the results of other similar studies. A detailed analysis by subgroup of leukemia, age, and gender revealed no trends shown in other studies, thus indicating special requirements for each variable in the analysis.

What is Best for the Child? Early Childhood Education and Care for Children under 3 Years of Age in Brazil and in Finland

Early Childhood Education and Care (ECEC) policies and practices are local, historically and socially context-specific constructions. In addition to local ideals and policies, discursive practices concerning ECEC are influenced by universal ideals that are described and assigned by the member states of the United Nations Convention on the Rights of the Child (1989). This article examines the complex, culture-specific domestication of the universal commitment to the ‘best interests of the child’ in policies and curriculum guidance concerning ECEC for children under 3 years of age in two countries, Brazil and Finland. The qualitative case analysis is based on the main national policies and curricular guidelines on ECEC in both countries. Brazil and Finland both emphasize in their ECEC policies and curriculum guidance the rights of the (young) child to participation and protection. Similarities are also found in their emphasis on the educational nature of ECEC Institutions. Brazil is, however, more diverse in the treatment of its heterogeneous population. In Finland, the ‘best for the child’ is considered to be similar for all, i.e. the concept is domesticated uniformly across the entire population regardless of ethnicity or social class. In Brazil, in contrast, ‘the best’ is differentiated further for different strata of the population. In Brazil, ECEC policies aim to increase attendance in out-of-home care, whereas in Finland, the best for the youngest (0–3 years.) children unfolds as home care supported financially by the state.

Breast cancer incidence and mortality in women under 50 years of age in Brazil

Many countries have reported an increase in breast cancer incidence in young women. The current study's objective was to explore breast cancer distribution in women less than 50 years of age in Brazil. A descriptive study on breast cancer incidence (selected cities) and mortality (Brazil and selected cities) in 2002-2004 was carried out, and the results were compared with those from other countries. The study also analyzed the trend in hospital morbidity and incidence rates for breast cancer. Porto Alegre (Rio Grande do Sul State) showed the highest incidence rates (17.9 and 165.5/100,000 in the 15-39 and 40-49-year age strata, respectively). Regarding mortality, Belo Horizonte (Minas Gerais State) showed the highest rate in the 15-39-year group and Porto Alegre in the 40-49-year group (2.8 and 25.5/100,000). Hospital admissions and incidence rates for breast cancer suggest a change in epidemiological distribution. The results reveal an epidemiological pattern of breast cancer in young Brazilian women with regional distribution characteristics.

Familial history of cancer and leukemia in children younger than 2 years of age in Brazil

The objective of this study was to determine the contribution of a familial history of cancer (FHC) to the development of leukemia in children below 2 years of age. This is a national hospital-based case-control study of children 0-24 months of age recruited from 15 Brazilian hospitals from several regions providing oncological care and local general hospitals. Participants' FHC antecedents were obtained through face-to-face interviews with the mothers of cases and controls using a standardized questionnaire. Unconditional logistic regression was used to determine crude and adjusted (adj.) odds ratios (OR), and the respective 95% confidence intervals (CI), of acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) after adjustment for selected variables. FHC antecedents were obtained from 178 ALL, 51 AML, and 428 controls. FHC in second-degree relatives (grandparents, uncles, cousins) showed an adj. OR=1.66 (95% CI 1.12-2.45) for ALL. Antecedents of two or more relatives with cancer showed a statistically significant two-fold higher risk of either ALL or AML. Paternal, and joint paternal and maternal antecedents of cancer also showed statistically significant higher adj. OR, respectively: 1.80 and 1.89 for ALL, and 2.34 and 3.23 for AML. Hematological malignancies among second-degree relatives showed an adj. OR=3.48 (95% CI 1.72-7.09) for ALL. According to the anatomic site, antecedents of leukemia/lymphoma among case relatives, compared with the control ones, showed an OR=2.98 (95% CI 1.52-5.82) for ALL, whereas stomach cancer antecedents showed an OR=3.55 (95% CI 1.02-12.39) for AML. The observed results support the hypothesis that FHC antecedents are associated with leukemogenesis in children below 2 years of age.

Asthma mortality among Brazilian children up to 19 years old between 1980 and 2007

To evaluate asthma mortality among Brazilian children up to 19 years old in 1980 to 2007. This ecological time-series study used the database of the Brazilian Unified Health System, from which data were collected about the number of asthma deaths and the population under 19 years of age in Brazil. Mortality rates were calculated as the number of asthma deaths divided by population and multiplied by 100,000. Linear regression was used to assess the trend of mortality. For the analysis, participants were assigned to three separate age groups: 1-4 years, 5-9 years and 10-19 years. During the study period, there were 9,051 deaths due to asthma in children under 19 years of age. Of these, 69% (6,270 records) of the children were younger than 5 years. There was a significant decrease in asthma mortality during the study in all age groups. The mean annual reduction of asthma mortality rates among children was 0.022 (p < 0.0001). The reduction was 0.076, 0.005 and 0.004 for the 1- to 4-, 5- to 9- and 10- to 19-year-old age groups (p < 0.0001). Asthma mortality among Brazilian children is low and has kept a downward trend during the study in all pediatric age groups.

Income transfer policies and the impacts on the immunization of children: the Bolsa Família Program

This paper investigates the impact of the Bolsa Família Program on the immunization of children from 0 to 6 years of age in Brazil and its regions. The Bolsa Família program is a conditional cash transfer program. One of its conditionalities is the compliance of children with the immunization schedule ordered by the Ministry of Health. The evaluation was performed using the Propensity Score Matching technique. We used data from a survey conducted in 2005 evaluating the program - Pesquisa de Avaliação de Impacto do Programa Bolsa Família. The main findings suggest that the Bolsa Família Program does not affect the immunization status of children.

Childhood cancer and pediatric oncologic care in Brazil: access and equity

Cancer in children and adolescents is rare and highly curable if treatment is started early, yet it is still the main cause of death from disease in this age group. The aim of this study is to discuss access to health services for cancer patients under 19 years of age in Brazil, mapping deaths and treatment modalities in the Brazilian Unified National Health System (SUS). Data from 2000 to 2007 were analyzed according to health regions. Maps of cancer mortality rates and cancer care indicators - hospitalizations, chemotherapy, and radiotherapy financed by the national health system - revealed inequality in access, based on the small number of procedures for children in poorer regions of the country. Even with the usual concentration of specialized services in more heavily populated areas, access begins with clinical suspicion in primary care, followed by referral to more complex levels, where the diagnosis is made and treatment begins. Training pediatricians in clinical suspicion of childhood cancer and definition of more streamlined patient flows could improve the situation, thereby increasing the odds of cure.

Cost-effectiveness analysis of routine rotavirus vaccination in Brazil

The objective of this study was to conduct a cost-effectiveness analysis of a universal rotavirus vaccination program among children < or = 5 years of age in Brazil. Considering a hypothetical annual cohort of approximately 3,300,000 newborns followed over 5 years, a decision-tree model was constructed to examine the possible clinical and economic effects of rotavirus infection with and without routine vaccination of children. Probabilities and unit costs were derived from published research and national administrative data. The impact of different estimates for key parameters was studied using sensitivity analysis. The analysis was conducted from both healthcare system and societal perspectives. The vaccination program was estimated to prevent approximately 1,735,351 (54%) of the 3 210 361 cases of rotavirus gastroenteritis and 703 (75%) of 933 rotavirus-associated deaths during the 5-year period. At a vaccine price of 18.6 Brazilian reais (R$) per dose, this program would cost R$121,673,966 and would save R$38,536,514 in direct costs to the public healthcare system and R$71,778,377 in direct and indirect costs to society. The program was estimated to cost R$1,028 and R$1,713 per life-years saved (LYS) from the societal and healthcare system perspectives, respectively. Universal rotavirus vaccination was a cost-effective strategy for both perspectives. However, these findings are highly sensitive to diarrhea incidence rate, proportion of severe cases, vaccine coverage, and vaccine price.

Rotavirus morbidity and mortality in children in Brazil

To study the epidemiology of rotavirus and estimate rotavirus-associated morbidity and mortality in children<or=5 years of age in Brazil in 2004 before introducing the rotavirus vaccine in Brazil's National Immunization Program (Programa Nacional de Imunizações, PNI). To estimate rotavirus morbidity, published studies (1999-2006) addressing incidence of acute diarrhea among children<or=5 years of age and frequency of rotavirus infection among children with diarrhea in Brazil were reviewed. Diarrhea episodes were divided into three categories of severity by level of care: mild cases requiring only home-based care; moderate cases requiring a visit to an outpatient healthcare facility; and severe cases requiring hospitalization. To estimate rotavirus mortality, information on the number of registered deaths from diarrhea in children<or=5 years of age was obtained from the Mortality Information System (Sistema de Informação sobre Mortalidade, SIM) of Brazil's public healthcare system (Sistema Unico de Saúde, SUS) and the proportion of deaths due to rotavirus was calculated. Rotavirus infections were estimated to cause 3,525,053 episodes of diarrhea, 655,853 visits to outpatient healthcare facilities, 92,453 hospitalizations, and 850 deaths of children<or=5 years of age each year in Brazil. Rotavirus infections are an important cause of child morbidity and mortality in Brazil.

Mortalidade de mulheres em idade fértil devido a causas externas no Município de Cascavel, Paraná, Brasil, 1991 a 2000

Injuries comprise the main group of causes of mortality among women 15 to 35 years of age in Brazil. The present study aimed to improve the knowledge concerning mortality by injuries, using a descriptive population-based approach, including all 869 death certificates for resident 10-49-year-old women from Cascavel, Paraná State, who died between 1991 and 2000. Mortality from injuries was analyzed according to cause, age, and calendar year. Pearson chi-square was applied at p < 0.05. Injuries were the main group of causes of death up to 34 years of age and for all women 15-45 (coefficient 29.4/100,000 women) and the third most common among women 35-45. Traffic accidents were the first external cause of death in all age groups. We conclude that female mortality in Cascavel can be greatly reduced by interventions addressed to control external causes of death among young women.

Endemic goiter prevalence survey in Brazilian schoolchildren 6 to 14 years old, 1994-1996

To determine the national and state-level prevalence of endemic goiter associated with iodine deficiency in schoolchildren between 6 and 14 years of age in Brazil, based on data from a national survey carried out from 1994 to 1996. Thyroid inspection and palpation were performed on 178,774 schoolchildren between 6 and 14 years of age, in all the states of Brazil. A subsample was selected to measure the iodine content in their urine as well as the iodine content of the table salt used for cooking in their homes. The last survey before this one was carried out in 1975. We found an 86% decrease in the median prevalence of grade 1 and 2 grade 2 goiter, from 12% to 1%. In 21% of the municipalities, the observed prevalence was zero. From the 16,803 urine samples collected for iodine measurement, 7,702 were matched with the corresponding clinical record (a loss of 54%). The median urinary iodine level was 14.0 micrograms/dL, and without a significant correlation with the clinical data on goiter. The median iodine excretion level for the population in the states of Acre, Amapá, and Tocantins was equal to or below 9.0 micrograms/dL. In three municipalities, urinary iodine was below 2.5 micrograms/dL in all the samples: Paranã (in the state of Tocantins), Conceição (Paraíba), and Nova Roma (Goiás). The supplementary iodine found in the salt collected from households (458 samples collected) was below recommended levels, with 50% of them below 20 mg/kg (20 ppm). In 7% of the samples, the level of iodine was below 10 mg/kg of salt, even in salt-producing states such as Rio Grande do Norte. There is evidence goiter is expanding to parts of Brazil that more recently have been opened up for agriculture, with children in those areas being exposed to low levels of supplementary iodine in the salt used for cooking. We found an increased risk of goiter in areas with deficient iodine supplementation (< 10 mg/kg) (odds ratio = 1.85; Cornfield 95% confidence interval: 1.68-2.03).

Estimativa do número de pessoas de 15 a 49 anos infectadas pelo HIV, Brasil, 1998

This study estimates the number of HIV-infected individuals from 15 to 49 years of age in Brazil in 1998 based on sentinel population studies in pregnant women, with a selection bias in the sample. A principal components procedure was used to group 44 counties in homogeneous 13 clusters. Two indicators were constructed for each cluster: a) the logarithm of the accumulated AIDS incidence rate among women from 15 to 34 years of age (1996) and b) the logarithm of the growth ratio for the mean AIDS incidence rate for women from 15 to 34 years of age for the period from 1990-1992 to 1993-1996. Taking the log of the proportion of HIV-infected pregnant women as the dependent variable and the two above-mentioned indicators as the independent variables, a regression line was fitted to the aggregate data. Estimation of the model's parameters allowed us to calculate the proportion of infected individuals by macro-region, by age (15-34 and 35-49 years) and gender. The point estimate was 536 thousand HIV-infected adults with a 68% CI (470.689 - 603.305).

Three-year survival and growth of provenances of Pinus greggii in the tropics and subtropics

Eleven provenance/progeny tests of Pinus greggii Engelm. were assessed for survival and height at 3 years of age in Brazil, Colombia and South Africa. Trees of P. greggii from sources in northern Mexico (≈ 25°N latitude) were less than half as tall as trees from provenances in central Mexico (≈ 21°N latitude) when established in warm climates of Brazil and Colombia, (4.2 m vs. 1.6 m, respectively). The differences in height growth diminished between southern and northern sources in more temperate climates in South Africa (2.9 m vs. 2.1 m, respectively). External morphological differences in foliage were also pronounced between trees of the two regions when grown as an exotic. Trees from northern sources had shorter, stiffer, needles of darker green color than those from southern provenances. The most promising of the southern provenances across all sites were El Madroño (Queretaro) and Laguna Seca (Hidalgo). La Tapona (Nuevo Leon) and Los Lirios (Coahuila) performed well among the northern sources. Pinus greggii should be tested where low rainfall and cold are considered limiting factors for good growth of P. patula.

Genetic and site effects on stem breakage in Pinus tecunumanii

Fifteen provenance/progeny tests of Pinus tecunumanii (Schw.) Eguiluz et Perry were assessed for upper-crown stem breakage at 5 to 8 years of age in Brazil, Colombia and South Africa. Five year results indicated that the mean percent stem breakage was moderate in Colombia (14% to 21%), low in South Africa (2% to 6%) and very low in Brazil (<1%). In the Colombian tests, trees from provenances of Mexican origin were more susceptible to wind damage than those from Central America, 20% versus 14%. Provenance order of percent stem breakage at 5 years of age in Colombia was Montebello (27%), La Soledad (25%), San Jose (20%), Chempil (20%), Jitotol (18%), Las Piedrecitas (18%), Celaque (17%), Km 47 (16%), San Vicente (13%), San Jeronimo (13%), San Lorenzo (12%) and Las Trancas (7%). Two half-sib progeny tests assessed at 8 years of age in Colombia with trees from the Mountain Pine Ridge source of P. tecunumanii exhibited 13% stem breakage. Family variation in stem breakage ranged from 0 to 44% in Colombia and 0 to 33% in South Africa at 5 years of age and were highly significant. The Spearman rank correlations in stem breakage of 36 half-sib families common to tests in Colombia and South Africa were r=0.13 and not significant. Family heritabilities for stem breakage at 5 and 8 years of age ranged from 0.17 to 0.63. Results indicate that stem breakage was more common on trees with branches of large diameter and was not strongly related to growth rate.