ABSTRACT Hepatitis A virus (HAV) infection has been considered one of the leading causes of acute hepatitis. The aim of the present study was to estimate the prevalence of HAV among children and adolescents in a population-based study in the capitals of the States of the North, Southeast and South of Brazil and identify predictive factors for the infection. A multi-stage sampling was used to select subjects aged between 5-9 and 10-19 years. Individual and household levels aside from the level of variables in the areas were collected. The outcome was the total IgG antibodies to HAV levels detected using a commercial Enzyme Immuno Assay (EIA). The associations between HAV and the independent variables were assessed using the odds ratio. A multilevel analysis was performed by GLLAMM using the Stata software. The prevalence of HAV infection in the 5-9 and 10-19 age groups was 28.7% and 67.5%, respectively for the North, 20.6% and 37.7%, for the Southeast and 18.9% and 34.5% for the South Region. The prevalence of HAV increased according to age in all sites. Variables related to education at the individual level (North and South), family and area level (South and Southeast) and family income level (Southeast and South) were independently associated with HAV infection. This emphasizes the need for individualized strategies to prevent the infection.

ABSTRACT Objective: Osteocalcin has been associated with several effects on energy and glucose metabolism. However, the physiological role of undercarboxylated osteocalcin (U-osc; the hormonally active isoform of osteocalcin) is still controversial. To correlate the serum levels of U-osc with bone mineral density (BMD) values and metabolic parameters in postmenopausal women. Subjects and methods: Cross-sectional study including 105 postmenopausal women (age 56.5 ± 6.1 years, body mass index [BMI] 28.2 ± 4.9 kg/m2) grouped based on the presence of three or less, four, or five criteria of metabolic syndrome according to the International Diabetes Federation (IDF). The subjects underwent dualenergy x-ray absorptiometry (DXA) for the assessment of body composition and BMD and blood tests for the measurement of U-osc and bone-specific alkaline phosphatase (BSAP) levels. Results: The mean U-osc level was 3.1 ± 3.4 ng/mL (median 2.3 ng/mL, range 0.0-18.4 ng/mL) and the mean BSAP level was 12.9 ± 4.0 ng/mL (median 12.1 ng/mL, range 73-24.4 ng/mL). There were no associations between U-osc and BSAP levels with serum metabolic parameters. Lower fasting glucose levels were observed in participants with increased values of U-osc/femoral BMD ratio (3.61 ± 4 ng/mL versus 10.2 ± 1.6 ng/mL, p = 0.036). When the participants were stratified into tertiles according to the U-osc/ femoral BMD and U-osc/lumbar BMD ratios, lower fasting glucose levels correlated with increased ratios (p = 0.029 and p = 0.042, respectively). Conclusion: Based on the ratio of U-osc to BMD, our study demonstrated an association between U-osc and glucose metabolism. However, no association was observed between U-osc and metabolic parameters.The U-osc/BMD ratio is an innovative way to correct the U-osc value for bone mass.

Resumo Fundamento: A importância da anatomia coronariana na predição de eventos cardiovasculares é bem conhecida. O uso de escores anatômicos tradicionais na cineangiocoronariografia de rotina, entretanto, não foi incorporado à prática clínica. O SYNTAX escore (SXescore) é um sistema de escore que estima a extensão anatômica da doença arterial coronariana (DAC). Sua capacidade para predizer desfechos com base na cineangiocoronariografia diagnóstica de base ainda não foi testada. Objetivo: Avaliar o desempenho do SXescore para predizer eventos cardíacos adversos maiores (MACE) em pacientes encaminhados para cineangiocoronariografia diagnóstica. Métodos: Coorte prospectiva de 895 pacientes com suspeita de DAC encaminhados para cineangiocoronariografia diagnóstica eletiva de 2008 a 2011, em hospital universitário no Brasil. Os pacientes tiveram seus SXescores calculados e foram estratificados em três categorias: 'sem DAC significativa' (n = 495); SXescoreBAIXO-INTERMEDIÁRIO: < 23 (n = 346); e SXescoreALTO: ≥ 23 (n = 54). O desfecho primário foi composto de morte cardíaca, infarto do miocárdio e revascularização tardia. Os desfechos secundários foram MACE e morte por todas as causas. Resultados: Em média, os pacientes foram acompanhados por 1,8 ± 1,4 anos. Desfecho primário ocorreu em 2,2%, 15,3% e 20,4% nos grupos 'sem DAC significativa', SXescoreBAIXO-INTERMEDIÁRIO e SXescoreALTO, respectivamente (p < 0,001). Morte por todas as causas foi significativamente mais frequente no grupo de SXescoreALTO comparado ao grupo 'sem DAC significativa', 16,7% e 3,8% (p < 0,001), respectivamente. Após ajuste para fatores de confusão, todos os desfechos permaneceram associados com o SXescore. Conclusão: O SXescore prediz independentemente MACE em pacientes submetidos a cineangiocoronariografia diagnóstica. Seu uso rotineiro nesse contexto poderia identificar pacientes de pior prognóstico.

Abstract Background: The importance of coronary anatomy in predicting cardiovascular events is well known. The use of traditional anatomical scores in routine angiography, however, has not been incorporated to clinical practice. SYNTAX score (SXscore) is a scoring system that estimates the anatomical extent of coronary artery disease (CAD). Its ability to predict outcomes based on a baseline diagnostic angiography has not been tested to date. Objective: To evaluate the performance of the SXscore in predicting major adverse cardiac events (MACE) in patients referred for diagnostic angiography. Methods: Prospective cohort of 895 patients with suspected CAD referred for elective diagnostic coronary angiography from 2008 to 2011, at a university-affiliated hospital in Brazil. They had their SXscores calculated and were stratified in three categories: no significant CAD (n = 495), SXscoreLOW-INTERMEDIATE: < 23 (n = 346), and SXscoreHIGH: ≥ 23 (n = 54). Primary outcome was a composite of cardiac death, myocardial infarction, and late revascularization. Secondary endpoints were the components of MACE and death from any cause. Results: On average, patients were followed up for 1.8 ± 1.4 years. The primary outcome occurred in 2.2%, 15.3%, and 20.4% in groups with no significant CAD, SXscoreLOW-INTERMEDIATE, and SXscoreHIGH, respectively (p < 0.001). All-cause death was significantly higher in the SXscoreHIGH compared with the 'no significant CAD' group, 16.7% and 3.8% (p < 0.001), respectively. After adjustment for confounding factors, all outcomes remained associated with the SXscore. Conclusions: SXscore independently predicts MACE in patients submitted to diagnostic coronary angiography. Its routine use in this setting could identify patients with worse prognosis.

CONTEXTO E OBJETIVO: Peritonite bacteriana espontânea (PBE) é uma complicação da ascite, especialmente na cirrose. Líquido ascítico com 250 ou mais neutrófilos/mm³ é um critério aceitável para o diagnóstico, mesmo com cultura bacteriana negativa. Os objetivos foram estimar a frequência de PBE em pacientes atendidos na sala de emergência, baseando-se no critério celular e avaliar o perfil bioquímico desses líquidos peritoneais. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo em hospital público terciário. MÉTODOS: Foram avaliados registros laboratoriais de pacientes com ascite atendidos no setor de emergência entre novembro de 2001 e novembro de 2006, cujas amostras de líquido ascítico foram encaminhadas ao laboratório por suspeita de PBE. As 691 amostras incluídas foram divididas em grupo A (PBE presumida: > 250 neutrófilos/mm³; n = 219; 31.7%) e grupo B (Ausência de PBE presumida: < 250 neutrófilos/mm3; n = 472; 68.3%). Também foram avaliados sexo e idade dos pacientes além de características dos líquidos ascíticos: número de neutrófilos, leucócitos e células nucleadas; bacteriologia; e concentrações de proteínas, desidrogenase láctica, adenosina deaminase e glicose. RESULTADOS: Das amostras cultivadas do grupo A, 63 (33,8%) tiveram cultura bacteriana positiva com crescimento de patógenos comumente associados à PBE. O total de amostras do grupo A exibiu maiores níveis de desidrogenase lática que as do grupo B. Este último demonstrou predomínio de linfócitos e macrófagos. CONCLUSÃO: Dos líquidos ascíticos com suspeita clínica de PBE, 31.7% preencheram o critério diagnóstico celular. O isolamento bacteriano foi positivo em 33.8% das amostras cultivadas no grupo PBE presumida

CONTEXT AND OBJECTIVE: Spontaneous bacterial peritonitis (SBP) is a complication of ascites, especially in cirrhosis. Ascitic fluid with 250 or more neutrophils/mm³ is an acceptable criterion for diagnosis, even when bacterial fluid cultures are negative. The aims here were to estimate SBP frequency among emergency room patients based on cellular criteria and evaluate the biochemical profile of these fluids. DESIGN AND SETTING: Retrospective study at a public tertiary hospital. METHODS: Laboratory records of patients with ascites attended in emergency rooms between November 2001 and November 2006, from whom ascitic fluid samples were sent to the laboratory due to suspected SBP, were evaluated. The 691 samples included were divided into group A (presumed SBP: > 250 neutrophils/mm³; n = 219; 31.7%) and group B (no presumed SBP: < 250 neutrophils/mm3; n = 472; 68.3%). Patients' sex and age; ascitic fluid characteristics (numbers of neutrophils, leukocytes and nucleated cells); bacteriological characteristics; and protein, lactate dehydrogenase, adenosine deaminase and glucose concentrations were evaluated. RESULTS: Among group A cultured samples, 63 (33.8%) had positive bacterial cultures with growth of pathogens commonly associated with SBP. In total, the group A samples showed higher lactate dehydrogenase levels than seen in the group B samples. The latter presented predominance of lymphocytes and macrophages. CONCLUSION: Among the ascitic fluid samples with clinically suspected SBP, 31.7% fulfilled the cellular diagnostic criteria. Positive bacterial isolation was found in 33.8% of the cultured samples from the presumed SBP group

OBJETIVO: Determinar a associação entre índice de massa corporal (IMC), índice cintura-quadril e cintura com a prevalência de hipertensão arterial (HAS) em amostra representativa de 1088 adultos de Porto Alegre, Brasil. MÉTODOS: Foram considerados hipertensos indivíduos com pressão sistólica (PAS) > ou = 160mmHg ou diastólica (PAD) > ou = 95mmHg e definidos como obesos aqueles com IMC > ou = 27kg/m², ou com razão cintura/quadril > ou = 0,95 (homens) e > ou = 0,80 (mulheres) ou com cintura > ou = 96cm (homens) e > ou = 92cm (mulheres). RESULTADOS: A obesidade aferida pelo IMC associou-se com a prevalência de HAS em ambos sexos (RR 1,9, IC 1,0 - 3,2 masculino; RR 2,2, IC 1,3 - 3,8 feminino). Os outros índices associaram-se, significativamente, apenas nas mulheres. CONCLUSÃO: IMC > ou = 27,0kg/m² associou-se mais, consistentemente, com o risco de HAS. A magnitude similar das associações dos demais indicadores demonstram sua utilidade na avaliação do risco para hipertensão.

PURPOSE: To evaluate the association between body mass index (BMI), waist-hip ratio and waist circumference with the prevalence of hypertension in a representative sample of 1088 adults of Porto Alegre (RS), Brazil. METHODS: In this cross-sectional survey, subjects were considered as having hypertension if they had systolic blood pressure > or = 160mmHg or diastolic > or = 90mmHg, and were considered obese if they had BMI > or = 27kg/m², or had a waist-hip-ratio > or = 0.95cm (men) or 0.80 (women) or had a waist circumference > or = 96 (men) or 92 (women). RESULTS: Obesity defined by the BMI was associated with hypertension in both genders (RR 1.9, CI 1.0 - 3.2 in men; RR 2.2, CI 1.3 - 3.8 in women). The other indices were significantly associated with hypertension just in women. CONCLUSION: BMI > or = 27.0kg/m² was strongly associated with increased odds to have hypertension. Similar magnitude of the association with the other indices indicate their utility to estimate the risk of hypertension.

Com o objetivo de avaliar a prevalência de tabagismo em Porto Alegre, RS, Brasil, e os fatores associados, executou-se estudo observacional, de delineamento transversal e base populacional. Através de amostragem aleatória proporcional, por estágios múltiplos e conglomerados, selecionaram-se 1.091 indivíduos, a partir de 18 anos, que responderam a um questionário, em entrevista domiciliar. Aferiu-se o hábito de fumar através de perguntas dirigidas ao tipo de fumo, freqüência e tempo de exposição. A prevalência foi de 34,9% (IC 31,9 - 37,8), sendo de 41,5% (IC 38,5 - 44,4) entre os homens e 29,5% (IC 26,8 - 32,2) entre as mulheres. O início foi, em média, aos 16 (±5,6) e 17,8 (±6,7) anos, com moda de 15 e 14 anos, respectivamente. Os homens fumavam 19,0 ± 14,0 cigarros por dia e as mulheres 14,5 ± 10,3. Analisaram-se as associações através de regressão logística, incluindo-se no modelo sexo, idade, educação, renda, qualificação profissional e consumo de álcool. O hábito de fumar foi mais freqüente entre os homens, indivíduos de menor nível socioeconômico, dos 30 aos 39 anos, e entre os usuários de bebidas alcoólicas. Conclui-se que o tabagismo é freqüente em Porto Alegre, constituindo-se problema de saúde pública similar ao referido pela literatura. O consumo de álcool deve estar associado ao fumo por serem ambos comportamentos de risco, com determinantes comuns.

A cross-sectional study was carried out for the purpose of evaluating, the prevalence of smoking and the factors associated with it in Porto Alegre, a city in southern Brazilian. Through proportional, multiple stage, random sampling, 1.091 individuals (92% of those eligible) of 18 or more years of age, were interviewed at home. Exposure to smoking was measured by a questionnaire that inquired about the type, quantity and frequency of tobacco use. The prevalence of smoking was 34.9% (Cl 31.9 - 37.8). It was higher -among men - 41.5% (Cl 38.5 - 44.4) then women - 29.5% (Cl 26.8 - 32.2). The former started smoking at mean age of 16 (± 5.6), with mode of 15 and smoked an average of 19.0 (± 14.0) cigarettes per day. Females started at a mean age of 17.8 (± 6.7), with mode of 14 years old and smoked 14.5 (± 10.3). The association of the drinking habit and demographic and socioeconomic variables with smoking was evaluated through logistic regression. The variables included in the model were sex, age, education, income, professional qualification and alcohol consumption. The prevalence of smoking was greater for men, individuals of lower sociecinomic level, between 30 and 39 years of age, and among those accustomed to consuming alcoholic beverages. In conclusion, this study demonstrated that smoking is a public health problem in Brazil as in another countries. It is associated with sex, age, education and professional qualification, as has been observed elsewhere. The association of alcohol consumption with smoking may be understood as risk behavior, both having similar determinants.

Com o objetivo de avaliar a prevalência de tabagismo em Porto Alegre, RS, Brasil, e os fatores associados, executou-se estudo observacional, de delineamento transversal e base populacional. Através de amostragem aleatória proporcional, por estágios múltiplos e conglomerados, selecionaram-se 1.091 indivíduos, a partir de 18 anos, que responderam a um questionário, em entrevista domiciliar. Aferiu-se o hábito de fumar através de perguntas dirigidas ao tipo de fumo, freqüência e tempo de exposição. A prevalência foi de 34,9% (IC 31,9 - 37,8), sendo de 41,5% (IC 38,5 - 44,4) entre os homens e 29,5% (IC 26,8 - 32,2) entre as mulheres. O início foi, em média, aos 16 (±5,6) e 17,8 (±6,7) anos, com moda de 15 e 14 anos, respectivamente. Os homens fumavam 19,0 ± 14,0 cigarros por dia e as mulheres 14,5 ± 10,3. Analisaram-se as associações através de regressão logística, incluindo-se no modelo sexo, idade, educação, renda, qualificação profissional e consumo de álcool. O hábito de fumar foi mais freqüente entre os homens, indivíduos de menor nível socioeconômico, dos 30 aos 39 anos, e entre os usuários de bebidas alcoólicas. Conclui-se que o tabagismo é freqüente em Porto Alegre, constituindo-se problema de saúde pública similar ao referido pela literatura. O consumo de álcool deve estar associado ao fumo por serem ambos comportamentos de risco, com determinantes comuns.

A cross-sectional study was carried out for the purpose of evaluating, the prevalence of smoking and the factors associated with it in Porto Alegre, a city in southern Brazilian. Through proportional, multiple stage, random sampling, 1.091 individuals (92% of those eligible) of 18 or more years of age, were interviewed at home. Exposure to smoking was measured by a questionnaire that inquired about the type, quantity and frequency of tobacco use. The prevalence of smoking was 34.9% (Cl 31.9 - 37.8). It was higher -among men - 41.5% (Cl 38.5 - 44.4) then women - 29.5% (Cl 26.8 - 32.2). The former started smoking at mean age of 16 (± 5.6), with mode of 15 and smoked an average of 19.0 (± 14.0) cigarettes per day. Females started at a mean age of 17.8 (± 6.7), with mode of 14 years old and smoked 14.5 (± 10.3). The association of the drinking habit and demographic and socioeconomic variables with smoking was evaluated through logistic regression. The variables included in the model were sex, age, education, income, professional qualification and alcohol consumption. The prevalence of smoking was greater for men, individuals of lower sociecinomic level, between 30 and 39 years of age, and among those accustomed to consuming alcoholic beverages. In conclusion, this study demonstrated that smoking is a public health problem in Brazil as in another countries. It is associated with sex, age, education and professional qualification, as has been observed elsewhere. The association of alcohol consumption with smoking may be understood as risk behavior, both having similar determinants.