Risco reprodutivo e renda familiar: análise do perfil de gestantes

Validation and reproducibility of the International Study of Asthma and Allergies in Childhood (ISAAC) Written Atopic Eczema Questionnaire for telephone survey in children aged 6-7 years

BACKGROUND

The prevalence of atopic eczema is unknown in many countries. The International Study of Asthma and Allergies in Childhood (ISAAC) is an epidemiological landmark in the study of allergic diseases.

OBJECTIVE

To validate and assess the reproducibility of the ISAAC Written Atopic Eczema Questionnaire (WAEQ) for children aged between 6 and 7 years by telephone contact.

METHODS

Observational study through interviews with guardians of children aged 6 to 7 years using the ISAAC atopic eczema module questionnaire in three different phases separated by 2 weeks: telephone interviews in the first and third contacts and in-person interviews under supervision in the second contact. Reproducibility was estimated using the Kappa index and validation using the sensitivity and specificity coefficients.

RESULTS

Data from 88 children (32 from the atopic eczema group) were analyzed. Reproducibility showed almost perfect agreement for the questions "Recurrent pruritic lesions" and "Lesions in typical locations" (Kappa between 0.81-0.82), while a substantial agreement was observed for all other indicators (Kappa variation between 0.66 and 0.78). The validation showed high specificity (≥ 80.4%) and sensitivity (≥ 87.5%) for all questions, except those related to chronicity and medical diagnosis (34.4% and 40.6%, respectively).

STUDY LIMITATIONS

Non-random selection, no sample size calculation, participants from a tertiary hospital and study period coincident with the Coronavirus pandemic.

CONCLUSIONS

Our results showed that the ISAAC atopic eczema module questionnaire by telephone interviews has good reproducibility and high agreement with the clinical diagnosis of atopic eczema. It may be an appropriate alternative tool in epidemiological studies of childhood atopic eczema, especially in periods of social isolation.

Aspectos psicossociais da gestação de alto risco

A gestação de alto risco é caracterizada por ser um momento em que a vida ou a saúde da mãe e/ou do feto e/ou do recém-nascido está submetida a maiores chances de morte que a média da população considerada. O estudo objetivou apresentar dados sobre o perfil de gestantes de alto risco e identificar os aspectos psicossociais ligados à gravidez. A amostra foi composta por 74 mulheres grávidas em um hospital no município de Juiz de Fora, MG. Elas responderam ao PHQ-2, a EPSS, ao IDATE, ao ASSIST e a um questionário sociodemográfico e clínico. Foi possível observar a prevalência de sintomas de depressão, ansiedade, baixo suporte social e uso de substâncias na população avaliada. As análises confirmaram correlações entre características sociodemográficas, clínicas e aspetos psicossociais. Os resultados demonstram a relevância de se conhecer o perfil dessas mulheres para a melhora na elaboração de estratégias de suporte direcionadas ao enfrentamento de possíveis fatores que possam interferir no bom andamento da gestação.

Ciência & Saúde Coletiva - 25 years: contributions to pregnancy, delivery, and childhood studies

We reviewed the scientific production on maternal health and the health of children under ten years of age, published in Journal Ciência & Saúde Coletiva during the last 25 years, focusing on quantitative studies. The authors' characteristics, populations under study, thematic areas, and methodology are described. A total of 170 publications were identified and grouped into 12 major themes. Pregnancy, delivery, and puerperium were the subject of 47 studies, followed by child anthropometric assessments (29), breastfeeding (24), and mortality (13). The selected publications represented 3.5% of the total original papers published by the Journal since its creation in 1996 and about 5% of the publications in the 2015-2020 period. The primary data sources were health service records, information systems, and population surveys. The cross-sectional design was used in 113 of the 170 articles, and 70% covered only one municipality. The Southeast and Northeast Regions of Brazil were the target of most studies, and the North Region was the least represented. The publications reflect the complexity of maternal and child health themes, with a particular focus on the importance of the Unified Health System and showing how open access data can contribute to public health research.

AUTISM SPECTRUM DISORDER AND POSTNATAL FACTORS: A CASE-CONTROL STUDY IN BRAZIL

Objective:

To estimate the magnitude of the association between Autism Spectrum Disorder (ASD) and postnatal factors in a Brazilian population.

Methods:

A case-control study was performed with 253 individuals diagnosed with ASD and 886 individuals without signs of the disorder. A semi-structured questionnaire and the multiple logistic regression model were adopted in the data analysis. To estimate the magnitude of associations, the crude and adjusted Odds Ratio (OR) was used.

Results:

An association with the following factors was found: having been born with congenital malformation (OR 4.24; confidence interval of 95% - 95%CI 1.92-9.34), neonatal jaundice (OR 1.43; 95%CI 1.01-2.02), absence of crying at birth and seizure episode in childhood (OR 5.75; 95%CI 3.37-9.81). The magnitude of the association was higher in the children/adolescents who had two or more postnatal complications (OR 6.39; 95%CI 4.10-10.00).

Conclusions:

The findings of the present study suggest that malformation, neonatal jaundice, absence of crying at birth and seizure episodes in childhood are important factors to be considered when studying the etiology of ASD.

Social Representations of health care professionals on Acquired Immune Deficiency Syndrome

OBJECTIVE

To apprehend social representation of health care professionals on HIV/AIDS and to compare it with a subgroup of physicians.

METHOD

Qualitative research based on the Theory of Social Representations. Free associations for the term HIV/AIDS were collected from 73 workers of public services specialized in HIV/AIDS, in Salvador-Bahia. The results were analyzed in the EVOC software.

RESULTS

For all health professionals, HIV/AIDS is associated with "prejudice, care, disease and prevention", and for the subgroup of physicians it is associated with the term "prevention". Health professionals represented HIV/AIDS similarly to society in general and, due to their normative character, prescribed attitudes typical of health care professionals.

FINAL CONSIDERATIONS

The findings show that, despite the advances in the health area regarding the treatment of AIDS, prejudice still persists. It is important to strengthen interdisciplinary actions focused on discussions on this theme during training, favoring the comprehensiveness of the assistance.

Fatores assistenciais e gestacionais associados à anemia em nutrizes atendidas em um banco de leite humano

Resumo A anemia é um problema de saúde pública que acomete cerca de 30% das gestantes brasileiras, podendo acarretar efeitos deletérios à saúde e qualidade de vida do binômio mãe-filho. O objetivo deste artigo é avaliar os fatores assistenciais e gestacionais associados à anemia entre nutrizes atendidas em um banco de leite humano (BLH) de referência. Estudo transversal com dados secundários referentes a informações sociodemográficas e gestacionais de 12283 nutrizes no período de 2009 a 2012. Aplicaram-se os testes Kolmogorov-Smirnov e Qui-quadrado ou exato de Fisher. Estimaram-se as Razões de Prevalência (RP) e respectivos Intervalos de Confiança-IC95%, por meio da Regressão de Poisson com variância robusta. Identificou-se a prevalência de anemia em 29,2% da amostra, sendo maior entre as mães que não realizaram o pré-natal (RP = 3,84; IC95% 3,26-4,54); as que realizaram até 3 consultas pré-natais (RP = 1,92; IC95% 1,21-3,06) e aquelas que tiveram gestação múltipla (RP = 2,29; IC95% 1,25-4,19). Os resultados apontaram maior prevalência de anemia entre as mulheres que não realizaram o pré-natal apropriado e as que tiveram gestações múltiplas, destacando-se a importância da assistência à saúde como fator de prevenção à anemia e demais intercorrências gestacionais.

High-risk pregnancy: clinical-epidemiological profile of pregnant women attended at the prenatal service of the Public Maternity Hospital of Rio Branco, Acre

Abstract Objectives: to describe the clinical and epidemiological profile of the pregnant women treated at the high-risk prenatal service of the Public Maternity Hospital of Rio Branco, Acre Methods: a cross-sectional study of326pregnant women attended at the Rio Branco high risk prenatal outpatient clinic from April to May 2016. Interviews were conducted with a structured questionnaire. Results: the results showed that the mean age of women was 28 years old, schooling equal to or higher than high school (58.8%), married / stable union (81.7%), unemployed (50%); (26.4%), four or more pregnancies (32.8%), prenatal start with gestational age <12 weeks (69.3%), and 3 to 5 prenatal consultations (58%). The most frequent clinical antecedents were obesity (35%) and chronic hypertension (8%). The most frequent clinical and obstetric complications were urinary tract infection (39.9%), weight gain (30.4%), anemia (14%), threat of abortion (11%) and gestational hypertension (10.4%) Conclusions: knowledge about the clinical-epidemiological profile of high-risk pregnant women helps to create strategic health services instruments and, consequently, to reduce maternal mortality.

Transtorno do espectro do autismo e idade dos genitores: estudo de caso-controle no Brasil

O transtorno do espectro do autismo (TEA) tem se tornado um problema de saúde pública, com grande impacto familiar, social e econômico. O objetivo deste trabalho foi estimar a associação entre o TEA e a idade dos genitores no momento do parto. Realizou-se um estudo de caso-controle constituído por 243 indivíduos com o TEA (casos) e 886 neurotípicos (controles). Foi aplicado um questionário semiestruturado e realizada a regressão logística múltipla. Associações entre o TEA e as idades paterna (em anos) entre 25 e 34 (OR = 1,65; IC95%: 1,01-2,71), 35 e 44 (OR = 1,62; IC95%: 0,96-2,73) e ≥ 45 (OR = 2,44; IC95%: 1,14-5,00); e materna entre 25 e 34 (OR = 2,38; IC95%: 1,54-3,37) e ≥ 35 (OR = 2,09; IC95%: 1,29-3,39) foram significativas quando avaliadas em modelos independentes. Porém, quando incluídas em um mesmo modelo apenas as idades maternas entre 25 e 34 (OR = 2,27; IC95%: 1,45-3,55) e ≥ 35 (OR = 2,15; IC95%: 1,21-3,83) se mantiveram associadas. A magnitude da associação foi maior quando ambos os genitores apresentavam idades avançadas (OR = 4,87; IC95%: 1,71-13,80). Os resultados encontrados podem ter importantes implicações para a psiquiatria clínica e a saúde pública, pois a idade dos genitores, no momento do parto, tem aumentado. Deve-se enfatizar a prevenção da idade reprodutiva tardia e o rastreamento e o acompanhamento das crianças geradas por estes casais.

Exposure of tobacco farm working mothers to pesticides and the effects on the infants’ auditory health

ABSTRACT Objective: to check and compare female farm workers’ and female tobacco farm workers’ behavior related to the use of pesticides after the pregnancy diagnosis and their effect on the infants’ hearing. Methods: a cross-sectional analytical observational study developed with 59 female farming mothers. From these, 25 were tobacco farm workers (Group F) and 34 were farm workers for other crops (Group A - control). The results of the hearing screening of 59 infants, from both groups, were verified. The anamnesis to raise the risk factor indicators for hearing disabilities as well as the caption of Transient Evoked Otoacoustic Emissions (OAEs) was accomplished. Results: tobacco farming is directly related to the use of pesticides (p=0.0043); laundry of clothes worn to apply the pesticides is an indirect means of exposure/ contamination by pesticides and/or chemical substances (p=0.018); the association between pass/fail results and Hearing Disabilities Risk Indicators (HDRI) of infants in both groups (tobacco farm workers and other workers) did not show significant statistical differences. Conclusion: effects on the hearing health of infants of female tobacco farm workers and other farm workers exposed to pesticides were not found in this research. Further studies on this theme are suggested.

RISCO REPRODUTIVO EM GESTANTES PORTADORAS DE CARDIOPATIA: O MUNDO VIVIDO DIRECIONANDO O CUIDADO EM SAÚDE

RESUMO Objetivo: compreender o significado de gestar para mulheres portadoras de cardiopatia; desvelar sentidos da mundanidade do ser-aí-mulher em risco reprodutivo no vivido/vivência da gestação de alto risco por cardiopatia. Método: pesquisa qualitativa sustentada na fenomenologia Heideggeriana. Foram entrevistadas 17 mulheres entre os meses de julho a dezembro de 2014 que gestaram com cardiopatia em instituição de referência para risco materno. Resultados: o movimento analítico hermenêutico permitiu a emersão das Unidades de Significação: saber do risco e tanto planejar quanto não saber como evitar, e se surpreender ao se descobrir grávida; falar como se sentiu física e emocionalmente na gestação; sentir-se segura pela rotina de acompanhamento pré-natal. Os sentidos desvelados apontaram para a fragilidade dos saberes das participantes acerca do risco reprodutivo. Conclusão: o enfermeiro e a equipe de saúde devem considerar em sua prática clínica o cuidado intersubjetivo que favorece a integralidade da atenção à saúde. As discussões sobre o risco percebido por parte da gestante devem se integrar à condução do pré-natal suscitando um impacto positivo na saúde da mulher. Considera-se a fenomenologia de Martin Heidegger como referencial que permite alcançar resultados de pesquisas qualitativas no campo epistemológico de interesse acerca da essência humana por meio das experiências vividas.

O conceito de vulnerabilidade e seu caráter biossocial

Um dos exercícios teóricos da Saúde Pública diz respeito à necessária e contínua tarefa de se discutirem os conceitos nos quais se ancoram suas práticas. Uma análise crítica sobre os usos do conceito de vulnerabilidade em saúde, com base em uma revisão sistemática, serve de suporte para uma discussão sobre seu conteúdo, alcances e limites, no sentido de fortalecer a potencialidade teórica e prática do conceito e o diálogo entre as distintas áreas de conhecimento implicadas. O conceito de vulnerabilidade apresenta alta capacidade heurística e aplicação diferenciada. Neste artigo, ele é caracterizado com base em complexos processos de fragilização biossocial que exprimem, de maneira inextrincável, valores biológicos, existenciais e sociais. Esta perspectiva considera vulnerabilidade como dimensão ontológica constitutiva e constituinte da vida humana, que reclama distintos e complexos sistemas de segurança.

[Obstetric Nurses: contributions to the objectives of the Millennium Development Goals]

OBJECTIVE

To characterize and analyze assistance to labor and delivery performed by residents in Obstetric Nursing.

METHOD

Quantitative and retrospective study of 189 normal births attended by residents in Obstetric Nursing in the period between July 2013 and June 2014 in a maternity hospital located in the countryside of Rio Grande do Sul. Data collection took place by gathering information from medical records and the analysis was performed using descriptive statistics.

RESULTS

It was found the wide use of non-invasive and non-pharmacological pain relief and freedom of position during labor. It is noteworthy that 55.6% of women have not undergone any obstetric intervention.

CONCLUSIONS

It was possible to identify that the Nursing Residency Program allows the reduction of obstetrical interventions, reflecting directly in the improvement of maternal health.

Association between congenital malformation and neonatal and maternal variables in neonatal units of a Northeast Brazilian city

Congenital malformations occur due to genetic, environmental, and mixed factors or unknown causes. This study aimed to investigate the existence of a relationship between the type of congenital malformation and maternal and neonatal variables. This prospective, quantitative study was conducted in three public neonatal units in Fortaleza, Ceará, Brazil. Data were collected from the medical records of 159 malformed neonates and analyzed using the Chi-square test (χ2), significance level of 5% (p<0.05). The majority of the newborns were male, 85 (53%), 91 (57%) born full-term, and 82 (52%) weighed between 2500g and 3999g. Malformations of the central nervous and musculoskeletal systems exceeded the other categories. Variables such as gender, gestational age, birth weight, drug use, maternal age, family income, education level, and number of children showed statistically significant associations with the categories of malformations (p<0.05). Maternal and neonatal factors have close relationships with the type of malformation, with these data providing support for neonatal nursing care.