Características das gestações, partos e recém-nascidos da região metropolitana de Aracaju, Sergipe, Brasil

Prevalence and Risk Factors for Dysphonia in Preschoolers at Five Years Old in a Capital City in the Northeast of Brazil

GOALS

Identifying the prevalence and risk factors of childhood dysphonia in children turning 5 years old; and assess the link with the interactional, behavioral, sociodemographic, economic, and biological indicators METHOD: Analytical, transversal, nested within a birth cohort 5 years after its creation. Original cohort biologic data were recovered from the previous database. The current demographic and personal data were acquired from the official health institutions where the individuals were found. We managed to find 371 preschoolers, both sexes, enrolled in 141 public and private schools. Face-to-face interviews were performed with mothers regarding maternal and child health and biological, sociodemographic, economic, interactional-affective, and behavioral indicators. Speech therapists used the Consensus of Auditory-Perceptual Evaluation of Voice authorized for Portuguese for the perceptual-auditory judgment of children's voices. Bivariate and multivariate analyzes of the data were performed. A significance level of 5% (P < 0.05) was considered in all analyses.

RESULTS

The prevalence of mild-moderate general dysphonia occurred in 26.4% of the preschoolers assessed with tense, rough, and breathy voice quality; low pitch; strong loudness and laryngeal resonance. There was a contrast between preschoolers with dysphonia, calm temperament, and family income of up to three minimum wages and those without these characteristics. We also have noted that a greater chance of dysphonia occurred in preschoolers with a calm temperament, family income of up to three minimum wages, nocturnal bruxism up to 3 years old and who did not use a pacifier.

CONCLUSION

There was a high prevalence of dysphonia at 5 years old. Biological indicators have an impact on voice, while interactional, behavioral, sociodemographic, and economic indicators have a higher impact. There is a great need for investments in prevention, promotion, and vocal treatment to minimize negative socio-educational impacts and provide higher quality of life for children at greater risk for dysphonia.

Relationship between the type of delivery and the epidemiological profile of prenatal and perinatal assistance in a municipality of Minas Gerais

Abstract Objectives: to describe the profile of prenatal and perinatal health by correlating it with sociodemographic and clinical conditions, verifying the effectiveness of health actions. Methods: quantitative, descriptive and retrospective research using data from the Live Birth Information System (Sinasc) of the municipality of Patos de Minas in the period of 2011 to 2015. Results: between 2011 and 2014 there was a reduction in the rate of vaginal births and a slight increase in 2015, however, the rates of cesarean delivery were higher than recommended by the Ministry of Health. In both types of delivery, most pregnant women attended seven or more prenatal consultations, however, this rate was significantly higher for pregnant women who underwent cesarean section. Maternal age > 35 years was also related to cesarean delivery, however, there was no significant relationship between type of delivery, the gestation time, birth weight and occurrence of maternal death. Conclusions: during the analyzed period there were more cesarean sections in relation to vaginal deliveries, with no significant change in the number of maternal deaths. A significant association was found between the highest number of prenatal consultations and maternal age > 35 years in pregnant women who underwent caesarean section. Verification of these associations can help in reorienting health practices in the region.

“Revés de um parto”: relatos de mulheres que perderam o filho no período neonatal

Resumo: O objetivo deste estudo foi compreender como as mães interpretam e explicam a morte de seus filhos no período neonatal. Trata-se de uma pesquisa de abordagem qualitativa. Foram utilizadas entrevistas semiestruturadas com 15 mulheres residentes no Município de São Luís, Maranhão, Brasil, cujos recém-nascidos morreram no período de julho de 2012 a julho de 2014. A coleta de dados foi realizada entre 1º de abril e 29 de agosto de 2014. As entrevistas incluíram perguntas acerca do trabalho de parto, parto, nascimento e puerpério. Foi realizada análise de conteúdo na modalidade temática. A partir da fala das entrevistadas, foram evidenciadas fragilidades na rede de assistência. Para muitas, o atendimento recebido esteve relacionado a eventos que levaram à morte dos filhos. Foram identificados como núcleos de sentido a demora no atendimento e a negligência na maternidade, que evidenciaram um contexto de violência obstétrica sofrida pelas mulheres. Fica evidente a importância de criação de estratégias para promover e assegurar o cuidado humanizado no atendimento ao parto e nascimento. Deve-se buscar o fortalecimento de políticas públicas integralizadas que contemplem as demandas de atenção à saúde da mulher e da criança.

Changes in perinatal health in two birth cohorts (1997/1998 and 2010) in São Luís, Maranhão State, Brazil

The objective of this study was to analyze changes in perinatal health in two birth cohorts started in 1997/1998 and 2010, respectively, in São Luís, Maranhão State, Brazil. A total of 2,493 live born infants were included in 1997/1998 and 5,166 in 2010. Low birth weight (LBW) rate did not change (8.5% in 1997/1998 and 8.6% in 2010). Preterm birth (PTB) rate also remained stable (13.2% in 1997/1998 and 13% in 2010). Teenage deliveries and births to single mothers decreased. Maternal schooling and prenatal care coverage increased. Intrauterine growth restriction (IUGR) decreased from 13.3% to 10.6% (p < 0.001). The perinatal mortality rate decreased from 36.6 to 20.7 per 1,000 (p < 0.001) and the infant mortality rate (IMR) dropped from 28.5 to 12.8 per 1,000 (p < 0.001). The cesarean rate increased from 34.1% to 47.5% (p < 0.001). In conclusion, despite favorable changes in socio-demographic, behavioral, and health service factors and decreasing rates of IUGR and perinatal and infant mortality, LBW and PTB remained stable, while the cesarean rate increased.

A DECISÃO PELA VIA DE PARTO NO BRASIL: TEMAS E TENDÊNCIAS NA PRODUÇÃO DA SAÚDE COLETIVA

O artigo estuda a produção de conhecimento no campo da saúde coletiva sobre a "decisão" relacionada à via de parto. Trata-se de um estudo de revisão integrativa da literatura que discute usos, potencialidades e limites dessa categoria nas análises sobre a prática da cesariana no Brasil. Utilizou-se uma combinação de técnicas de análise temática e de discurso. Considera-se que a literatura sobre cesariana no Brasil tem avançado ao sair do foco estreito de escolha individual para uma contextualização mais profunda. Acredita-se, porém, que a literatura ainda precisa progredir, pois há poucas discussões de questões socioculturais, políticas, econômicas e sobre o papel das tecnologias médicas e não médicas.

Stomatognathic evaluation at five years of age in children born premature and at term

BACKGROUND

The high frequency of alterations of the stomatognathic system associated with premature birth may suggest that prematurity is an important risk factor in the development of this system. Prematurity has an incidence between 6-11% of births and is associated with factors such as genetic, maternal conditions (obstetric problems, nutritional status, infections) and antenatal care. In addition, undesirable situations, such as changes in enamel and the development of the skeletal structure, also appears to be associated with prematurity. This study aimed to look for changes in the stomatognathic system at five years of age associated with premature birth.

METHODS

We estimated the prevalence of developmental disorders of the stomatognathic system in the primary dentition of preschool children at five years of age. Changes in preterm infants (n = 32) compared with term born (n = 381) were evaluated . Clinical examinations and questionnaire with sociodemographic and health of mothers and children information. Gestational age, birth weight, head circumference, Apgar score and mechanical ventilation, were collected from the medical records to birth records. The explanatory variable was preterm (<37 weeks gestational age).

RESULTS

RESULTS

Prevalence of 7.7% of preterm infants was found. Of these, 40.6% had atresic palate, 56.2% malocclusion and 21.8% enamel hypoplasia. Forty (9.6%) children were not breastfed at the breast, and 26 (65.0%) had some type of malocclusion, showing association between not breastfeeding with an abnormal development of the stomatognathic system. The group of preterm infants showed five times more changes in head circumference and three times more mechanical ventilation use at birth. Change in head circumference at birth and mechanical ventilation has a significant association between groups of preterm and term infants.

CONCLUSIONS

Mechanical ventilation at birth directly contributed to an increased risk of developmental disorders of the stomatognathic system in preterm infants, especially dental hypoplasia. Non-breastfed children had a higher risk of developing malocclusion. Alterations in head circumference were related effective on dental malocclusion. The results suggest that changes in the stomatognathic system are influenced by premature birth and points to the imperative need of using methods of preventive.

[Prevalence of preterm birth according to birth weight group: a systematic review]

OBJECTIVE

To estimate the prevalence of preterm birth by categories of birth weight, and to obtain an equation to correct the estimates.

METHODS

Systematic review of the Brazilian literature published from 1990 to 2012, to identify studies with primary collection of data on birth weight and gestational age. Twelve studies were selected and contributed for tabulations of preterm prevalence according to 100 g birth weight categories. These results were combined using sex-specific fractional polynomial equations and the resulting curves were compared with results from the Live Birth Information System for the years 2000, 2005, 2010 and 2011.

RESULTS

For all birth weight categories, preterm prevalence estimates based on primary studies had a higher prevalence than those of the the Live Birth Information System. The prevalence reported by the Live Birth Information System was of 7.2% in 2010, about 38.0% lower than the estimated prevalence of 11.7% obtained with the correctional equation.

CONCLUSIONS

Information reported by the Live Birth Information System on preterm prevalence does not reflect the true magnitude of the problem in Brazil, and should not be used without the correction factors proposed in the present analyses.

Fatores materno-infantis associados à diástase dos músculos retos do abdome no puerpério imediato

Objetivos: comparar a distância entre os músculos retos do abdome (MRA) e a prevalência da diástase (DMRA) nas regiões supra-umbilical e infraumbilical de primíparas e multíparas no pós-parto imediato e verificar quais fatores materno-infantis podem estar associados. Métodos: estudo transversal, incluindo 115 primíparas e 154 multíparas. Avaliou-se a DMRA 4,5 cm acima e abaixo da cicatriz umbilical. Correlacionouse com idade materna, índice de massa corporal (IMC), idade gestacional, peso, estatura, perímetro cefálico e torácico do recém-nascido (RN). Utilizouse test t de Student, correlação de Pearson, quiquadrado e regressão logística múltipla, p<0,05. Resultados: a distância entre os MRA supraumbilical foi 3,04 (±1,68) e 3,35 (±1,19) cm nas primíparas e multíparas. A prevalência da DMRA supra-umbilical foi 74,8% e 76,6% e, infra-umbilical 40,0% e 54,5%. Nos dois grupos observou-se correlação positiva da distância entre os MRA supraumbilical com idade materna, IMC e infra-umbilical. O IMC e peso do RN foram fatores associados à DMRA supra-umbilical na primíparas e a idade materna nas multíparas. Conclusões: independente da paridade, a distância entre os MRA e prevalência da DMRA foram maiores na região supra-umbilical e, correlacionou-se com idade materna, IMC e infra-umbilical. Nas primíparas os fatores associados foram IMC e peso do RN e nas multíparas, a idade materna.

Is adolescent pregnancy a risk factor for low birth weight?

OBJECTIVE

The objective of this study was to evaluate whether adolescent pregnancy is a risk factor for low birth weight (LBW) babies.

METHODS

This was a cross-sectional study of mothers and their newborns from a birth cohort in Aracaju, Northeastern Brazil. Data were collected consecutively from March to July 2005. Information collected included socioeconomic, biological and reproductive aspects of the mothers, using a standardized questionnaire. The impact of early pregnancy on birth weight was evaluated by multiple logistic regression.

RESULTS

We studied 4,746 pairs of mothers and their babies. Of these, 20.6% were adolescents (< 20 years of age). Adolescent mothers had worse socioeconomic and reproductive conditions and perinatal outcomes when compared to other age groups. Having no prenatal care and smoking during pregnancy were the risk factors associated with low birth weight. Adolescent pregnancy, when linked to marital status "without partner", was associated with an increased proportion of low birth weight babies.

CONCLUSIONS

Adolescence was a risk factor for LBW only for mothers without partners. Smoking during pregnancy and lack of prenatal care were considered to be independent risk factors for LBW.

Birth prevalence and characteristics of congenital toxoplasmosis in Sergipe, North-east Brazil

OBJECTIVES

To estimate, by neonatal screening, the birth prevalence of congenital toxoplasmosis among live-born infants in Sergipe state, Brazil, and to investigate the clinical features of affected infants.

METHODS

Dried blood spot specimens obtained from 15 204 neonates were assayed for the presence of anti-T. gondii IgM antibodies. Duplicate retesting was done in infants with positive and borderline results. Confirmatory testing in peripheral blood samples consisted of testing for anti-T. gondii IgG and IgM in infants and mothers. Those with possible congenital toxoplasmosis were evaluated and followed up to a median age of 20 months. Congenital infection was confirmed in the presence of persisting anti-T. gondii IgG antibodies beyond 12 months of age. All infants with confirmed infection were treated with pyrimethamine, sulfadiazine and folinic acid for 1 year.

RESULTS

  Fifty-three infants had detectable IgM in dried blood spot specimens. Confirmatory testing was reactive in 39/50, of which, 38 completed follow-up. Six of 15 204 newborns were diagnosed with congenital toxoplasmosis, resulting in an estimated birth prevalence of four per 10 000 [CI 95% 1.4-8.0]. Four infants (67%) showed signs of congenital toxoplasmosis in their first year of life; three (75%) had retinochoroidal scars, and one had cerebral calcifications. Two infants remained asymptomatic until 20 months of age.

CONCLUSIONS

The birth prevalence of congenital toxoplasmosis is high in the Brazilian state of Sergipe, with most of the infants showing ocular lesions. Preventive measures are strongly warranted.