ABSTRACT Children have an increased likelihood of becoming carriers of the chronic hepatitis B virus. A total of 1,381 children and adolescents were assessed in five municipalities of Maranhao State, Brazil, for detection of anti-HBc, HBsAg and anti-HBs serologic markers and sociodemographic and behavioral features. Among those who were HBsAg negative and anti-HBc negative, the proportion of anti-HBs positives was calculated after the individuals had completed the vaccination schedule. The robust variance of the Poisson’s regression model was used in order to have adjusted tables and calculate the prevalence ratio. Multivariate analysis was performed to identify the factors associated with the prevalence of anti-HBc with or without HBsAg and the vaccine response. It was observed that 163 children were anti-HBc positive and nine individuals were HBsAg positive. The factors associated with the infection were: municipality of residence (residing in Morros municipality or Humberto de Campos municipality), residence in a rural area, aged between 13 and 15 years old, and illicit drug use. The percentage of individuals who were anti-HBc negative and received all three doses of the vaccine was 48.5%. Among these, only 276 (38.9%) had antibodies at protective concentrations. In an adjusted analysis, Morros municipality presented an increased positivity of vaccine response (p < 0.001), and the age ranging between 6 and 10 years old presented a reduced frequency of response. This study reveals a high prevalence of current and past HBV infection within the targeted age group which, in addition to the low vaccination coverage and serological responses, raises concerns about the management of prevention measures, especially the quality of vaccination in these locations.

AIM: To evaluate and compare the perception of parents of children with and without disabilities about the occurrence of local and systemic manifestations during the eruption of primary teeth and to investigate the parents' practices used to alleviate teething disturbances. METHODS: A cross-sectional study was conducted in a sample of parents of children without disabilities (GI) and parents of children with disabilities (GII) treated at a University Pediatric Dentistry Clinic. Data from GI and GII were collected using a structured questionnaire applied during an interview with the parents, and were analyzed using descriptive statistics. Mann-Whitney and Wilcoxon tests were employed and the level of significance was set at p<0.05. RESULTS: The questionnaires were filled out by 86 parents, being 45 in GI and 41 in GII. For GI, the most frequent local manifestations were edema around the tooth (84.44%) and increased suction (75.56%); and for GII were edema and erythema around the tooth (78.05% and 70.73%, respectively). The most frequent systemic manifestations, according to parents of both groups, were irritability and fever. There was no statistically significant difference between groups (p<0.05). It was observed that 46.66% and 68.3% of parents of GI and GII, respectively, adopted different practices to alleviate teething disturbances. CONCLUSIONS: During primary teeth eruption, local and systemic manifestations may occur and different practices were adopted by the Interviewed parents, mainly those with children with disabilities.

O objetivo desse estudo foi identificar as correlações existentes entre o número de óbitos de indivíduos idosos e as alterações climáticas no município de São Carlos (SP) em um período de 10 anos (1997-2006). Foram colhidas informações do registro de óbitos por meio do DATASUS, de pessoas com 60 anos ou mais, falecidas entre 1997 e 2006 no município. Os dados mensais da média das Temperaturas Máxima, Média e Mínima e da Umidade Relativa do Ar no município de São Carlos foram fornecidos pelo Instituto Nacional de Meteorologia. Calcularam-se os coeficientes de mortalidade do município, por sexo e faixa etária e os dados foram analisados com teste t, ANOVA de fator único, teste de Bonferroni e teste de Pearson. Ocorreram 8.304 óbitos, com predominância de indivíduos na faixa dos 80 anos ou mais, do sexo masculino. As doenças do aparelho circulatório foram as principais causas de óbito. Houve correlação positiva entre mortalidade por doenças infecciosas e Umidade Mínima e correlação negativa entre mortalidade por doenças infecciosas e Temperatura Mínima Mínima, entre mortalidade por doenças respiratórias e Umidade Mínima, entre mortalidade por doenças endócrinas e Temperatura Mínima Mínima e Temperatura Máxima Máxima. Dessa forma, foi possível concluir que houve relação entre o clima e a mortalidade de idosos em São Carlos.

The aim of this study was to identify the correlation between the number of deaths of elderly people and climate change in the district of São Carlos (SP) over a period of 10 years (1997-2006). Records of deaths were obtained from DATASUS for people aged over 60 who died between 1997 and 2006 in São Carlos. The average monthly maximum and minimum temperature data and relative air humidity in São Carlos were provided by the National Institute of Meteorology. The mortality coefficient of the district was calculated by gender and age and the resulting data were analyzed using t test, one-way ANOVA, the Bonferroni test and the Pearson correlation coefficient test. There were 8,304 deaths which predominantly occurred among males aged over 80, and diseases of the circulatory system were the main cause of death. There was a positive correlation between mortality by infectious disease and minimum humidity, and a negative correlation between mortality by infectious diseases and minimum temperatures, between mortality caused by respiratory disease and minimum humidity, between mortality caused by endocrine disease and minimum and maximum temperature. Thereby, it was possible to conclude that there was a correlation between climate change and mortality among elderly individuals in São Carlos.

O objetivo desse estudo foi identificar as correlações existentes entre o número de óbitos de indivíduos idosos e as alterações climáticas no município de São Carlos (SP) em um período de 10 anos (1997-2006). Foram colhidas informações do registro de óbitos por meio do DATASUS, de pessoas com 60 anos ou mais, falecidas entre 1997 e 2006 no município. Os dados mensais da média das Temperaturas Máxima, Média e Mínima e da Umidade Relativa do Ar no município de São Carlos foram fornecidos pelo Instituto Nacional de Meteorologia. Calcularam-se os coeficientes de mortalidade do município, por sexo e faixa etária e os dados foram analisados com teste t, ANOVA de fator único, teste de Bonferroni e teste de Pearson. Ocorreram 8.304 óbitos, com predominância de indivíduos na faixa dos 80 anos ou mais, do sexo masculino. As doenças do aparelho circulatório foram as principais causas de óbito. Houve correlação positiva entre mortalidade por doenças infecciosas e Umidade Mínima e correlação negativa entre mortalidade por doenças infecciosas e Temperatura Mínima Mínima, entre mortalidade por doenças respiratórias e Umidade Mínima, entre mortalidade por doenças endócrinas e Temperatura Mínima Mínima e Temperatura Máxima Máxima. Dessa forma, foi possível concluir que houve relação entre o clima e a mortalidade de idosos em São Carlos.

The aim of this study was to identify the correlation between the number of deaths of elderly people and climate change in the district of São Carlos (SP) over a period of 10 years (1997-2006). Records of deaths were obtained from DATASUS for people aged over 60 who died between 1997 and 2006 in São Carlos. The average monthly maximum and minimum temperature data and relative air humidity in São Carlos were provided by the National Institute of Meteorology. The mortality coefficient of the district was calculated by gender and age and the resulting data were analyzed using t test, one-way ANOVA, the Bonferroni test and the Pearson correlation coefficient test. There were 8,304 deaths which predominantly occurred among males aged over 80, and diseases of the circulatory system were the main cause of death. There was a positive correlation between mortality by infectious disease and minimum humidity, and a negative correlation between mortality by infectious diseases and minimum temperatures, between mortality caused by respiratory disease and minimum humidity, between mortality caused by endocrine disease and minimum and maximum temperature. Thereby, it was possible to conclude that there was a correlation between climate change and mortality among elderly individuals in São Carlos.

OBJETIVO: Descrever os atendimentos ambulatoriais fisioterápicos prestados pelo Sistema Único de Saúde (SUS) no Brasil quanto a sua distribuição geográfica, custos, tipos de procedimento e tipos de prestador. MÉTODOS: Foram utilizados dados do Departamento de Informática do SUS (DATASUS), referentes ao período de 1995 a 2008, que incluíam a quantidade e o valor dos procedimentos aprovados para pagamento pelas Secretarias de Saúde e a quantidade e o valor dos procedimentos apresentados para pagamento. Os coeficientes de atendimento (CoA) foram calculados dividindo-se o número de atendimentos no ano em uma região pela população estimada no mesmo ano e região. RESULTADOS: O CoA no Brasil em 2008 foi de 0,19 e as regiões Norte e Centro-Oeste apresentaram os menores coeficientes (0,13 e 0,10, respectivamente). Entre 1995 e 2007 houve um crescimento no coeficiente nacional de atendimentos de 33,7%, sendo que a região Norte apresentou o maior aumento, de 143,8%, a Centro-Oeste, de 62,1%, e a Nordeste, de 56,1%. O atendimento nas alterações motoras foi o procedimento mais realizado (61,8%) e os valores de pagamento aprovados foram menores que os apresentados pelos gestores dos serviços em 2008 (10,4%). Estabelecimentos privados com fins lucrativos prestaram 44,5% dos atendimentos fisioterápicos pagos pelo SUS em 2008. Os estabelecimentos municipais responderam por 26,6% dos atendimentos e os federais por apenas 0,9%. Entre 1995 e 2007, a quantidade de atendimentos oferecidos pelos estabelecimentos municipais cresceu 278,7%. CONCLUSÕES: Observou-se que a oferta de atendimento fisioterápico ambulatorial pelo SUS ainda é pequena e geograficamente desigual, embora regiões menos desenvolvidas apresentem um maior crescimento no CoA. O SUS remunera inadequadamente os serviços prestados em fisioterapia e ainda o faz, em grande parte, por meio de convênios com estabelecimentos privados.

OBJECTIVE: Describe the ambulatory physical therapy treatments provided by the Unified Health System (SUS) in Brazil with regard to their geographical distribution, costs, types of procedure, and types of provider. METHODS: Data from the SUS Information Technology Department (DATASUS) were utilized, drawing from the period from 1995 to 2008, which included the quantity and the value of the procedures approved for payment by the Secretariats of Health and the quantity and value of the procedures presented for payment. The treatment coefficients (CoA) were calculated by dividing the number of treatments in a particular year and region by the estimated population of that region in that year. RESULTS: The CoA in Brazil in 2008 was 0.19 and the North and Center-West regions presented the lowest coefficients (0.13 and 0.10, respectively). Between 1995 and 2007 there was an increase in the national treatment coefficient of 33.7%, with the North region showing the largest increase, 143.8%; the Center-West 62.1%, and the Northeast 56.1%. Treatment for motor disorders was the most widely performed procedure (61.8%), and the values of payments approved were lower than those presented by the managers of the services in 2008 (10.4%). Private for-profit establishments provided 44.5% of the physical therapy treatments paid for by the SUS in 2008. Municipal establishments accounted for 26.6% of the treatments, and federal establishments for only 0.9%. Between 1995 and 2007, the quantity of treatments offered by municipal establishments increased 278.7%. CONCLUSIONS: It was observed that the provision of ambulatory physical therapy treatment by the SUS remains small and geographically unequal, although lessdeveloped regions showed a larger increase in the CoA. The SUS remunerates inadequately the physical therapy services provided and continues to do so, in large part, by means of agreements with private establishments.

Este estudo tem por objetivo verificar a prevalência de obesidade e sua associação com diabetes melito (DM) e dores articulares na população idosa residente em São Carlos, SP. Foram avaliadas 227 idosas (média de idade 69,6±6,8 anos) e 172 idosos (69,4±6,7 anos) quanto ao índice de massa corporal (IMC) e questionados quanto à presença de diabetes e dor articular. Os dados foram tratados estatisticamente. Os resultados mostram que 73,6% das idosas e 66,9% dos idosos apresentavam sobrepeso ou eram obesos. As médias de IMC foram maiores nos indivíduos com idade inferior a 75 anos. Entre as mulheres da amostra foi encontrada associação entre a presença de DM, dores no pé, tornozelo e joelho e a condição"obesa". No grupo masculino, a condição obeso só apresentou associação com a presença de DM. Foi pois constatada associação entre obesidade e presença de DM. Mulheres idosas apresentam maior prevalência de obesidade e associação entre dores articulares e excesso de peso corporal.

The aim of this study was to assess prevalence of obesity and its association with diabetes mellitus (DM) and joint pain among elderly dwellers in the city of São Carlos, SP, Brazil. A total of 399 aged people - 227 women (mean age 69.6±6.8) and 172 men (mean age 69.4±6.7) - were assessed as to body mass index (BMI) and were questioned whether they had diabetes and joint pain. Data were statistically analysed. Results showed that 73.6% of the women and 66.9% of the men were overweight or obese; BMI values were higher in subjects aged under 75. Among women, associations were found between the obese condition, presence of diabetes, and foot, ankle and knee pain. In the male group, the obese condition presented association only with presence of diabetes. An association was hence found between obesity and DM. Prevalence of obesity was greater in elderly women, who also presented association between joint pain and high BMI values.

OBJETIVO: Verificar os efeitos de um programa de atividade física sobre a força de preensão manual de idosos depressivos e não depressivos. MÉTODO: Foram avaliados 85 idosos (30 mulheres depressivas e 39 não depressivas, e quatro homens depressivos e 12 homens não depressivos) com média de idade de 65,59 (±8,26), participantes de um programa de atividade física desenvolvido para idosos com duração de um ano. Foram feitas quatro avaliações da força de preensão manual nesse período, sendo uma antes do início do programa, duas no meio e uma no final. A análise dos dados foi feita por meio da Análise de Variâncias, Teste de Tukey e Teste t. RESULTADOS: Não foram encontradas diferenças significativas entre as quatro avaliações quanto à força do grupo total e dos subgrupos. Também não foram encontradas diferenças significativas entre mulheres depressivas e não depressivas, nem entre homens depressivos e homens não depressivos, em nenhuma das quatro avaliações. CONCLUSÕES: O programa de atividade física avaliado não foi capaz de aumentar a força de preensão manual dos idosos depressivos e nem dos não depressivos e parece não haver associação entre essa condição e a força.

OBJECTIVE: To assess the effect of an activity program on the hand grip strength of depressed and non-depressed elderly people. METHODS: We evaluated 85 older people (30 depressed women and 39 non-depressed women, and four depressed men and 12 non-depressed men) with a mean age of 65.59 (±8.26) years, who participated in an activity program developed for older people and lasting one year. In this period, four hand grip strength assessments were held: one at the beginning of the program, two during the program and one at the end. Data analysis was performed using Analysis of Variances, Tukey's test and t test. RESULTS: We did not find any significant differences among the four evaluations in terms of strength in the total group and in the subgroups. Moreover, there were no significant differences between the depressed women and the non-depressed women, or between the depressed men and the non-depressed men, in any one of the four evaluations. CONCLUSIONS: The activity program evaluated was incapable of increasing the hand grip strength of the depressed and non-depressed older people and it appears there is no association between such condition and strength.

OBJETIVO: Identificar a ocorrência de quedas em idosos institucionalizados no Município de São Carlos (SP), descrever os fatores determinantes e verificar sua associação com a força de preensão manual. MÉTODOS: Participaram do estudo 61 idosos institucionalizados (31 homens e 30 mulheres) que foram avaliados quanto à força de preensão manual e entrevistados quanto a eventos de queda e possíveis fatores determinantes. RESULTADOS: Verificou-se que 54,1% haviam sofrido pelo menos uma queda no ano que antecedeu a entrevista e que a incapacidade de assistir televisão possui correlação significativa com o índice de quedas (p=0,05), ao contrário das demais atividades funcionais estudadas (deambular, tomar banho e sentar sem auxílio), dor e doenças. Foram encontradas diferenças estatisticamente significantes entre as médias de idade dos idosos que já haviam caído (76,76 anos, ±9,17) e dos que não haviam caído (71,05 anos, ±8,67); e entre as médias de força de preensão manual de idosos que já haviam caído (19,37 kgf, ±8,92) e dos que não haviam caído (25,45 kgf, ±12,14). A análise de variância não mostrou diferença no número de quedas sofridas entre homens e mulheres. CONCLUSÕES: Houve alta incidência de quedas em idosos institucionalizados no município estudado, sendo que os idosos com menor força de preensão manual, os mais velhos e os incapazes de assistir televisão se mostraram mais propensos a sofrer quedas.

OBJECTIVE: To identify the occurrence of falls among institutionalized elderly in São Carlos City, to describe its determining factors and to verify its relationship with handgrip strength. METHODS: 61 elderly subjects (31 men and 30 women) took part of the study, being assessed regarding handgrip strength and interviewed regarding falls and possible factors for its occurrence. RESULTS: It was found that 54.1% of the elderly had fallen at least once in the 12 months preceding the study. The disability of watching television presented a significant correlation with falls (p=0.05), in contrast to other functional activities studied (walk, take shower and seat independently), pain and diseases. Statistically significant differences were found between the mean age of the elderly who had fallen (76.76 years, ±9.17) and those who hadn’t fallen (71.05 years, ±8.67); and among grip strength of those who had fallen (19.37 kgf, ±8.92) compared to the ones who hadn’t fallen (25.45 kgf, ±12.14). The variance analysis didn’t show differences in the number of falls between men and women. CONCLUSIONS: The incidence of falls among institutionalized elderly in São Carlos City is high and the individuals who were more likely to suffer falls were the older and weaker ones, as well as those unable to watch television.