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Patel M.M.,Centers for Disease Control and Prevention | Lopez-Collada V.R.,National Center for Child and Adolescent Health | Bulhoes M.M.,Centers for Disease Control and Prevention | De Oliveira L.H.,Pan American Health Organization | And 32 more authors.
New England Journal of Medicine

Background: Because postlicensure surveillance determined that a previous rotavirus vaccine, RotaShield, caused intussusception in 1 of every 10,000 recipients, we assessed the association of the new monovalent rotavirus vaccine (RV1) with intussusception after routine immunization of infants in Mexico and Brazil. Methods: We used case-series and case-control methods to assess the association between RV1 and intussusception. Infants with intussusception were identified through active surveillance at 69 hospitals (16 in Mexico and 53 in Brazil), and age-matched infants from the same neighborhood were enrolled as controls. Vaccination dates were verified by a review of vaccination cards or clinic records. Results: We enrolled 615 case patients (285 in Mexico and 330 in Brazil) and 2050 controls. An increased risk of intussusception 1 to 7 days after the first dose of RV1 was identified among infants in Mexico with the use of both the case-series method (incidence ratio, 5.3; 95% confidence interval [CI], 3.0 to 9.3) and the case-control method (odds ratio, 5.8; 95% CI, 2.6 to 13.0). No significant risk was found after the first dose among infants in Brazil, but an increased risk, albeit smaller than that seen after the first dose in Mexico - an increase by a factor of 1.9 to 2.6 - was seen 1 to 7 days after the second dose. A combined annual excess of 96 cases of intussusception in Mexico (approximately 1 per 51,000 infants) and in Brazil (approximately 1 per 68,000 infants) and of 5 deaths due to intussusception was attributable to RV1. However, RV1 prevented approximately 80,000 hospitalizations and 1300 deaths from diarrhea each year in these two countries. Conclusions: RV1 was associated with a short-term risk of intussusception in approximately 1 of every 51,000 to 68,000 vaccinated infants. The absolute number of deaths and hospitalizations averted because of vaccination far exceeded the number of intussusception cases that may have been associated with vaccination. (Funded in part by the GAVI Alliance and the U.S. Department of Health and Human Services.) Copyright © 2011 Massachusetts Medical Society. Source

Francisco P.M.S.B.,University of Campinas | de Azevedo Barros M.B.,University of Campinas | Segri N.J.,University of Sao Paulo | Cesar C.L.G.,University of Sao Paulo | Alves M.C.G.P.,Secretaria de Estado da Saude de Sao Paulo
Cadernos de Saude Publica

The study assesses differences in socio-demographic, lifestyle, and health-related characteristics among adults with and without residential telephone lines using data from a health survey in Campinas, São Paulo State, Brazil, (2008-2009), through a population-based cross-sectional survey that included 2,637 adults (18 years and older). Descriptive statistics, chi-square tests, prevalence, and 95% confidence intervals were used in the analysis. Estimates were also made of the bias associated with non-coverage of the population without telephones before and after adjusting for post-stratification. The impact of bias on the confidence intervals was assessed by the bias ratio. Some 76% of respondents owned residential telephone lines. Except for marital status, differences were observed in socio-demographic data according to ownership of residential telephones. After post-stratification adjustment, there was a decrease in bias estimates for variables associated with ownership of telephone lines. However, except for osteoporosis, post-stratification adjustment was insufficient to correct the non-coverage bias. Source

Mendes T.A.B.,University of Sao Paulo | Goldbaum M.,University of Sao Paulo | Segri N.J.,University of Sao Paulo | de Azevedo Barros M.B.,University of Campinas | And 3 more authors.
Cadernos de Saude Publica

This study analyzes factors associated with diabetes prevalence according to demographic and socioeconomic variables, health status, and lifestyle among 872 elderly living in the city of São Paulo, Brazil, in addition to health services utilization and control measures and practices. Reported diabetes prevalence among the elderly was 17.9%, a higher rate than in the adult population. The highest diabetes rates in elderly individuals were associated with: bad or very bad self-rated health, never having consumed alcohol or having stopped drinking, widowhood, and at least one hospitalization in the previous 12 months, independently of age. Among the elderly, 69.9% routinely sought out health services due to their diabetes, and 96.1% received treatment at the services they turned to. There is a lack of information, knowledge, and use of control measures for diabetes among the elderly. Health policies focusing on professional training and family orientation are needed to promote lifestyle changes among the elderly. Source

Francisco P.M.S.B.,University of Campinas | Belon A.P.,University of Campinas | Barros M.B.A.,University of Campinas | Carandina L.,Sao Paulo State University | And 3 more authors.
Cadernos de Saude Publica

The aim of the study was to assess the prevalence of self-reported diabetes in the elderly, identifying associated factors, knowledge, and practices related to treatment options. This was a cross-sectional population-based study with stratified clustered two-stage sampling in six municipalities in the State of São Paulo, Brazil. Among the 1,949 elderly, 15.4% presented self-reported diabetes. Body mass index and exercising were statistically associated with diabetes. There was a significant difference between diabetics and non-diabetics in terms of self-rated health, hospitalization, self-reported illness in the previous two weeks, and report of the following diseases: hypertension, anemia, chronic kidney disease, and heart disease. In terms of per capita family income, there was no difference in regular medical visits, participation in discussion groups, and control practices. The findings show the need for behavior changes to prevent and control diabetes and its complications. Educational interventions are needed to expand the coverage of diabetes care. Source

Zaitune M.P.A.,University of Campinas | Barros M.B.A.,University of Campinas | Cesar C.L.G.,University of Sao Paulo | Carandina L.,Sao Paulo State University | And 2 more authors.
Cadernos de Saude Publica

The purpose of this study was to measure the prevalence of global and leisure-time physical activity and associated factors in the elderly. This was a population-based cross-sectional study covering a multiple-stage sample of 1,950 subjects 60 years or older living in areas of São Paulo State, Brazil. Prevalence of global physical activity (assessed through the short version of the International Physical Activity Questionnaire - IPAQ) was 73.9%, and prevalence of leisure-time physical activity was 28.4%. The results highlight the differences between factors associated with global and leisure-time physical activities. The social groups most prone to overall sedentary lifestyle and especially to lack of leisure-time physical activity should be the main targets of health policies aimed at promoting healthier lifestyles. Source

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