Professional who attended childbirth and breastfeeding in the first hour of life

OBJECTIVES

To investigate the association between the professionals who attended vaginal delivery and breastfeeding in the first hour of life.

METHODS

This is a cross-sectional study with data from the Nascer no Brasil (Born in Brazil) survey, conducted in the 2011-2012 period. Data from 8,466 puerperae were analyzed using a logistic regression model with a hierarchical approach.

RESULTS

The proportion of mothers who breastfed at birth was higher in deliveries attended by nurses (70%). A nurse-assisted delivery was 64% more likely to breastfeed in the first hour of life. Other factors associated with the outcome: residing in the North; age less than 35 years; multiparity; prenatal guidance on breastfeeding in the first hour of life; birth at Baby-Friendly Hospital; companion at birth; and female newborn.

CONCLUSIONS

Obstetrician nurse/nurse-assisted delivery was a significant independent factor associated with breastfeeding in the first hour of life, suggesting the importance of strengthening the role of the obstetrician nurse.

Life-threatening conditions at birth: an analysis of causes of death and survival estimate for under-five children in live birth cohorts

Despite the reduction in under-five mortality, the causes are still mostly avoidable, and survival may be compromised by life-threatening conditions at birth. The study estimated the burden of life-threatening conditions at birth, neonatal near miss, and mortality, with an emphasis on avoidable causes, as well as under-five survival in live birth cohorts. This was a retrospective cohort study of live birth in the city of Rio de Janeiro, Brazil (2012-2016). The databases from the Brazilian Information System on Live Births and the Brazilian Mortality Information System were linked. Pragmatic criteria were used to define life-threatening conditions and near miss. Deaths were classified according to the Brazilian list of causes of avoidable deaths. Morbidity and mortality and survival indicators were estimated (Kaplan-Meier). Of the 425,505 live birth , 2.2% presented life-threatening conditions at birth. The under-five, infant and neonatal mortality rates were 0.01, 0.06, and 14.97 per 1,000 person-days, respectively. Avoidable, unclearly avoidable, and ill-defined causes accounted respectively for 61%, 35%, and 4% of the deaths. The risk of death from avoidable causes attributable to life-threatening conditions at birth was 97.6%. Survival was lower in newborns with life-threatening conditions compared to those without life-threatening conditions. The pragmatic criteria for life-threatening conditions determined the profile of proportional mortality by causes of death according to the three groups of causes in the Brazilian list of causes of avoidable deaths. Life-threatening conditions at birth increases the risk of morbidity and mortality in under-five children and raises the discussion on vulnerability and the need for care for these children and social support for their families.

Deaths of women hospitalized for childbirth and abortion, and of their concept, in maternity wards of Brazilian public hospitals

The aim of this cross-sectional hospital-based study of 7,845 pregnancies was to analyze deaths of women hospitalized for childbirth and abortion, and fetal and neonatal deaths, in public hospitals in the cities of São Paulo, Rio de Janeiro and Niteroi (RJ), Brazil, in 2011. Outcomes of the pregnancies were: one maternal death, 498 abortions, 65 fetal deaths, 44 neonatal deaths and 7,291 infant survivors. Data were collected through interviews, medical records and the women's pregnancy records, and from the Mortality Information System (SIM). The study population was described and kappa coefficients of causes of death (from the SIM, and certified by research) and mortality health indicators were estimated. The maternal mortality ratio was 13.6 per 100,000 live births (LB), the fetal death rate was 8.8‰ births and the neonatal mortality rate was 6.0‰ LB. The drug most used to induce abortion was Misoprostol. The main causes of fetal and neonatal deaths were respiratory disorders and maternal factors. Congenital syphilis, diabetes and fetal death of unspecified cause were under-reported in the SIM. Kappa coefficients by chapter were 0.70 (neonatal deaths) and 0.54 (stillbirths). Good quality care in reproductive planning, prenatal care, during labor and at birth will result in prevention of deaths.

Pragmatic criteria of the definition of neonatal near miss: a comparative study

OBJECTIVE

The objective of this study was to test the validity of the pragmatic criteria of the definitions of neonatal near miss, extending them throughout the infant period, and to estimate the indicators of perinatal care in public maternity hospitals.

METHODS

A cohort of live births from six maternity hospitals in the municipalities of São Paulo, Niterói, and Rio de Janeiro, Brazil, was carried out in 2011. We carried out interviews and checked prenatal cards and medical records. We compared the pragmatic criteria (birth weight, gestational age, and 5’ Apgar score) of the definitions of near miss of Pileggi et al., Pileggi-Castro et al., Souza et al., and Silva et al. We calculated sensitivity, specificity (gold standard: infant mortality), percentage of deaths among newborns with life-threatening conditions, and rates of near miss, mortality, and severe outcomes per 1,000 live births.

RESULTS

A total 7,315 newborns were analyzed (completeness of information > 99%). The sensitivity of the definition of Pileggi-Castro et al. was higher, resulting in a higher number of cases of near miss, Souza et al. presented lower value, and Pileggi et al. and de Silva et al. presented intermediate values. There is an increase in sensitivity when the period goes from 0–6 to 0–27 days, and there is a decrease when it goes to 0–364 days. Specificities were high (≥ 97%) and above sensitivities (54% to 77%). One maternity hospital in São Paulo and one in Niterói presented, respectively, the lowest and highest rates of infant mortality, near miss, and frequency of births with life-threatening conditions, regardless of the definition.

CONCLUSIONS

The definitions of near miss based exclusively on pragmatic criteria are valid and can be used for monitoring purposes. Based on the perinatal literature, the cutoff points adopted by Silva et al. were more appropriate. Periodic studies could apply a more complete definition, incorporating clinical, laboratory, and management criteria, including congenital anomalies predictive of infant mortality.

Cognitive performance of premature infants: association between bronchopulmonary dysplasia and cognitive skills. Cross-sectional study

CONTEXT AND OBJECTIVE:

Children born prematurely often have worse cognitive performance than those born at term regarding skills such as memory, attention and processing speed. Bronchopulmonary dysplasia may compromise cognitive development. The aims here were: a) To describe the cognitive performance of preterm infants with very low birth weight; b) To investigate its association with bronchopul-monary dysplasia adjusted for sociodemographic, neonatal and post-neonatal factors.

DESIGN AND SETTING:

Cross-sectional study developed in a public tertiary-care hospital.

METHODS:

To evaluate cognition among 112 children, we applied an intelligence scale (Wechsler scale). The average scores for children with and without bronchopulmonary dysplasia were compared across the fve domains of the scale. Associations with bronchopulmonary dysplasia were investigated for domains that showed signifcant diferences between the two groups. Associations between exposure and outcome were estimated via multivariate logistic regression.

RESULTS:

There were no diferences in averages for the full-scale intelligence quotient, verbal intelligence quotient, performance intelligence quotient and general language composite domains. The processing speed quotient was the only domain that presented a signifcant diference between the two groups (P = 0.02). Among the children with bronchopulmonary dysplasia, low full-scale intelligence quotient was observed in 28.1%. In the multivariate analysis, bronchopulmonary dysplasia (odds ratio: 3.1; 95conf-dence interval: 1.1-8.7) remained associated with the outcome of processing speed quotient.

CONCLUSION:

Bronchopulmonary dysplasia was an independent risk factor for alteration of the processing speed quotient.

Neonatal near miss and mortality: factors associated with life-threatening conditions in newborns at six public maternity hospitals in Southeast Brazil

We aimed to evaluate factors associated with cases of neonatal near miss and neonatal deaths at six public maternity hospitals in São Paulo and Rio de Janeiro States, Brazil, in 2011. A prospective hospital-based birth cohort investigated these outcomes among live births with life-threatening conditions. Associations were tested using multinomial logistic regression models with hierarchical levels. High rates of near miss were observed for maternal syphilis (52.2‰ live births) and lack of prenatal care (80.8‰ live births). Maternal black skin color (OR = 1.9; 95%CI: 1.2-3.2), hemorrhage (OR = 2.2; 95%CI: 1.3-3.9), hypertension (OR = 3.0; 95%CI: 2.0-4.4), syphilis (OR = 3.3; 95%CI: 1.5-7.2), lack of prenatal care (OR = 5.6; 95%CI: 2.6-11.7), cesarean section and hospital, were associated with near miss; while hemorrhage (OR = 4.6; 95%CI: 1,8-11.3), lack of prenatal care (OR = 17.4; 95%CI: 6.5-46.8) and hospital, with death. Improvements in access to qualified care for pregnant women and newborns are necessary to reduce neonatal life-threatening conditions.

Itinerários de cuidados à saúde de mulheres com história de síndromes hipertensivas na gestação

O artigo teve como objetivo analisar itinerários de cuidados à saúde de mulheres com história de síndromes hipertensivas na gestação. O método foi o estudo de relatos orais, cujos resultados de 35 entrevistas foram agrupados em quatro categorias temáticas: compreensões de saúde e doença; percepções do risco; interações institucionais; e interações afetivo-familiares envolvidas na busca de cuidados. Múltiplas situações de vulnerabilidade afetam o itinerário de cuidados, incluindo dificuldades de acesso a serviços especializados e a relação com os profissionais de saúde. Saberes e práticas de saúde compartilhados na comunidade são recursos importantes na construção do cuidado, que também pode ser afetado, positiva ou negativamente, pelas dinâmicas de interação na rede afetivo-familiar e com o apoio social recebido.

Longitudinal assessment of the lung mechanics of very low birth weight preterm infants with and without bronchopulmonary dysplasia

CONTEXT AND OBJECTIVE

Prematurity has been correlated with altered lung mechanics. Some infants develop lung injury as a consequence of lung immaturity, invasive mechanical ventilation and exposure to oxygen, thus resulting in bronchopulmonary dysplasia. The aim here was to compare the lung mechanics of preterm infants with and without bronchopulmonary dysplasia during the first year of life.

DESIGN AND SETTING

Prospective cohort study in a tertiary-level hospital.

METHODS

This study included premature infants at a public hospital who underwent two pulmonary function tests: one at discharge and the other at the corrected age of 4 to 8 months. Tidal volume, lung compliance and lung resistance were measured. Statistical tests were used for comparisons between infants with and without bronchopulmonary dysplasia.

RESULTS

102 children with mean gestational age of 29 ± 2.0 weeks were studied; 17 with bronchopulmonary dysplasia. Lung compliance (0.84 ± 0.29 versus 1.28 ± 0.46; P < 0.001) and tidal volume (6.1 ± 0.94 versus 7.2 ± 1.43; P < 0.01) at discharge were significant lower in children with bronchopulmonary dysplasia than in those without the disease, but no differences were observed at the second test (compliance: 1.53 ± 0.77 versus 1.94 ± 1.01; P = 0.12; and tidal volume: 6.9 ± 1.4 versus 7.3 ± 1.6; P = 0.42).

CONCLUSION

Differences in lung mechanics were observed between infants with and without bronchopulmonary dysplasia at hospital discharge but these differences were no longer detected at the final follow-up. The lung mechanics of all the infants improved over this period of time.

Complicações do abortamento e assistência em maternidade pública integrada ao Programa Nacional Rede Cegonha

Objetivou-se descrever o perfil sociodemográfico, obstétrico e assistencial de todas as internações de abortamento em maio-agosto/2012, em emergência, em estudo transversal. Resultado: 20,5% eram adolescentes, 79,5% tinham mais de 20 anos de idade e 48,7% tinham a pele parda; 84,7% foram abortos não especificados e o tempo foi apropriado entre a classificação de risco e a internação em 36,6% dos casos. Há mudanças no perfil das complicações, com redução das infecções e aumento na porcentagem de adolescentes (20,5%). Na atenção diferenciada do Programa Rede Cegonha, a avaliação de risco acolheu 90% das mulheres em 30 minutos. O sub-registro do processo de abortamento persiste pela condição de ilegalidade e por dilemas ético-morais dos profissionais.

Smoking prevalence, reduction, and cessation during pregnancy and associated factors: a cross-sectional study in public maternities, Rio de Janeiro, Brazil

Background

Smoking epidemic in Brazilian women has later onset, smaller magnitude, and slower decreasing trend, compared to men. Among pregnant women, smoking has an additional deleterious effect. The purpose of this study was to analyze smoking prevalence during pregnancy and associated factors, and to describe the frequency of smoking reduction and cessation in public maternities of Rio de Janeiro State, southeastern Brazil, in 2011.

Methods

A cross-sectional study was conducted in two maternities located at public hospitals in two cities of the Rio de Janeiro state, Niterói (maternity A) and of Rio de Janeiro (maternity B). Data were gathered by interviews 12 hours after the delivery, and analyses of prenatal cards and medical records. Smoking prevalence according to maternal characteristics, adequacy of prenatal care, and proportions of smoking reduction and cessation during pregnancy were calculated. Factors associated to smoking during pregnancy were estimated by logistic regression analysis.

Results

Smoking prevalence at maternity A (24.8%, 95% CI: 21.1-29.0) and maternity B (17.9%, 95% CI: 15.8-20.1) were high. Prevalence rates were greater in women aged 20-34 years, mainly without partner, multiparous and brown or black skin color. Low education (OR = 2.14, 95% CI 1.21, 3.79) and multiparity (OR = 3.48, 95% CI 1.78, 6.81), at maternity A; adolescence (OR = 0.44, 95% CI 0.26, 0.75), black skin color (OR = 1.71, 95% CI 1.06, 2.74), low education (OR = 1.61, 95% CI 1.08, 2.40), and multiparity (OR = 1.58, 95% CI 1.03, 2.44), at maternity B, were associated with smoking in multivariable analysis. Adequacy of prenatal care and smoking prevalence showed an inverse association. More than half of the smokers kept the smoking habits during pregnancy. Reduction occurred mainly between the 1^st and 2^nd trimesters of pregnancy.

Conclusion

Smoking prevalence during pregnancy was higher for multiparous and less educated women. Population and individual strategies for smoking prevention and control must include actions specific for women, especially during the reproductive period.

Comparison of childbirth care models in public hospitals, Brazil

OBJECTIVE

To compare collaborative and traditional childbirth care models.

METHODS

Cross-sectional study with 655 primiparous women in four public health system hospitals in Belo Horizonte, MG, Southeastern Brazil, in 2011 (333 women for the collaborative model and 322 for the traditional model, including those with induced or premature labor). Data were collected using interviews and medical records. The Chi-square test was used to compare the outcomes and multivariate logistic regression to determine the association between the model and the interventions used.

RESULTS

Paid work and schooling showed significant differences in distribution between the models. Oxytocin (50.2% collaborative model and 65.5% traditional model; p < 0.001), amniotomy (54.3% collaborative model and 65.9% traditional model; p = 0.012) and episiotomy (collaborative model 16.1% and traditional model 85.2%; p < 0.001) were less used in the collaborative model with increased application of non-pharmacological pain relief (85.0% collaborative model and 78.9% traditional model; p = 0.042). The association between the collaborative model and the reduction in the use of oxytocin, artificial rupture of membranes and episiotomy remained after adjustment for confounding. The care model was not associated with complications in newborns or mothers neither with the use of spinal or epidural analgesia.

CONCLUSIONS

The results suggest that collaborative model may reduce interventions performed in labor care with similar perinatal outcomes.

Aconselhamento sobre o teste rápido anti-HIV em parturientes

Introdução: O aconselhamento pré e pós-teste anti-HIV é preconizado pelo Ministério da Saúde, e constitui-se em ferramenta para a reflexão e tomada de decisão conjunta. Objetivos: Verificar a proporção de parturientes que receberam aconselhamento por ocasião da submissão ao teste rápido anti-HIV e analisar os fatores associados ao não recebimento de aconselhamento por estas parturientes. Método: Estudo transversal conduzido nos cinco “Hospitais Amigos da Criança” do Sistema de Gestação de Alto Risco do município do Rio de Janeiro. A população do estudo foram 955 mães submetidas ao teste rápido anti-HIV internadas em alojamento conjunto entre 11 de setembro e 11 de dezembro de 2006. Foram aplicados questionários às mães e coletados dados do laboratório e do prontuário materno. Para análise das variáveis associadas ao não recebimento de aconselhamento utilizou-se a regressão multivariada binomial. Resultados: Foram submetidas ao teste rápido anti-HIV 28,5% das parturientes. Destas, apenas 26,9% foram aconselhadas. Os fatores associados ao não aconselhamento foram: escolaridade materna inferior a 8 anos de estudo (RP = 1,36; IC 95%: 1,15-1,62), realização de 0 a 3 consultas de pré-natal (RP = 0,73; IC 95%: 0,59-0,90) e parto em hospitais com menos de 50% das parturientes submetidas ao teste-rápido anti-HIV (RP = 1,65; IC 95%: 1,40-1,96). Conclusões: As mulheres em situação socialmente desfavorável não foram alvo de aconselhamento, e apenas o baixo número de consultas pré-natais mostrou-se um fator de proteção contra o não aconselhamento. O aconselhamento foi pouco praticado por ocasião da realização do teste rápido anti-HIV, sinalizando que este teste vem sendo realizado sem o consentimento das mulheres, de modo imperativo.

Associação entre as orientações pré-natais em aleitamento materno e a satisfação com o apoio para amamentar

OBJETIVOS: analisar a associação entre orientações pré-natais em aleitamento materno e a satisfação das gestantes com o apoio recebido para amamentar. MÉTODOS: estudo transversal realizado no município do Rio de Janeiro, Brasil, com amostra representativa de 461 gestantes acompanhadas nos 15 hospitais com mais de 1000 partos/ano do Sistema Único de Saúde. Sete desses hospitais eram credenciados na Iniciativa Hospital Amigo da Criança e oito não. As razões de prevalência (RP) da satisfação foram obtidas por modelo de regressão de Poisson com variância robusta, segundo modelo hierarquizado. RESULTADOS: ficaram satisfeitas com o apoio recebido para amamentar 62,0% das gestantes. As variáveis associadas ao desfecho na análise múltipla foram ter recebido orientação sobre como amamentar (RP=1,77; IC95%: 1,38-2,28), ter recebido orientação sobre livre demanda (RP=1,52; IC95%: 1,22-1,88), ter recebido orientação sobre não uso de mamadeira e outros leites (RP=1,35; IC95%: 1,15-1,58) e a qualidade do acompanhamento pré-natal segundo a percepção da gestante (RP=1,22; IC95%: 1,08-1,38). CONCLUSÕES: a satisfação da gestante com o apoio recebido para amamentar não variou segundo as características sociodemográficas da mulher, porém se associou a orientações pré-natais sobre aleitamento materno, ressaltando a importância da qualidade da assistência.

Sexualidade, reprodução e saúde: experiências de adolescentes que vivem em município do interior de pequeno porte

O objetivo deste artigo é escrever experiências de adolescentes escolares de ambos os sexos, de um município do interior do Rio de Janeiro, referentes à vida afetivo-sexual, à reprodução e à saúde sexual e reprodutiva. Estudo transversal com 200 adolescentes de escolas públicas de Silva Jardim, de 15 a 19 anos, com aplicação de questionário estruturado. A iniciação sexual das meninas ocorreu entre 15 e 19 anos e dos meninos entre 12 a 14 anos. Eles se iniciaram com parceiros de 12 a 19 anos e elas com parceiros mais velhos. Meninas receberam mais informações sobre relações sexuais do que meninos e conversaram mais com parceiros sobre prevenção de gravidez na ocasião da iniciação sexual. Fontes de informações sobre sexualidade e contracepção são principalmente os pais. A farmácia é o principal local de aquisição de contraceptivos. Informações sobre doenças sexualmente transmissíveis provêm principalmente da escola. A comparação desses resultados com os de outros estudos com adolescentes escolares de grandes centros urbanos e populações que incluem jovens fora da escola evidencia aproximações e distanciamentos entre suas experiências. Fatores relacionados ao contexto sociocultural e institucional de pequenos municípios, diferenciais de gênero e escolaridade ajudam a compreendê-las.

[Sexuality, reproduction and health: experiences of adolescent students living in a small city of the interior]

This article aims to describe experiences of school adolescents of both sexes, living in a small city in the interior of the State of Rio de Janeiro, concerning affective-sexual life and sexual and reproductive health. A cross-sectional study was conducted with a structured questionnaire among 200 adolescents aged between 15 and 19 from public schools in Silva Jardim,. The girls' sexual initiation occurred between 15 and 19 and boys between 12 and 14. Boys started with partners from 12 to 19 years of age and girls with older partners. Girls received more information about sex than boys and talked more with partners about preventing pregnancy at the time of sexual initiation. Sources of information about sexuality and contraception are mainly from parents, with the pharmacy being the main location for the purchase of contraceptives. Information about sexually transmitted diseases is mainly received at school. The comparison of these results with those of other studies with adolescent students in large urban centers and populations that include youths outside school demonstrates similarities and dissimilarities between their experiences. Factors related to the socio-cultural and institutional context of small municipalities, gender and education help to understand them.

Risk factors for cognitive impairment in school-age children born preterm: application of a hierarchical model

The purpose was to analyze factors associated with cognitive impairment in very low birth weight (VLBW) children born preterm. A prospective cohort of 65 VLBW children was assessed at the age of eight years using the Wechsler Intelligence Scale for Children. A model for the relationship of variables with the cognitive impairment outcome attributed hierarchical levels: distal (socioeconomic variables), intermediate I and II (perinatal and neonatal variables, post-neonatal variables) and proximal (child health and psychosocial stimulation). A multivariate logistic regression was performed. In the multivariate hierarchical logistic regression, the maternal education (OR=0.77, 95%CI 0.63-0.94) and number of prenatal visits (OR=0.73, 95%CI 0.54-0.99) showed a protective association, but the male (OR=7.3, 95%CI 1.54-35.3) was associated with worse results. The VLBW children cognitive performance in the age of eight years benefits from more educated mothers, better prenatal care, and the baby gender as female.

[Predictors of unawareness of HIV serostatus among women submitted to the rapid HIV test at admittance for delivery]

This article aims to analyze factors associated with unawareness of prenatal HIV serostatus at admittance for delivery. A cross-sectional study was performed in 2006 in "Friends of Children" Hospitals from the High-risk Pregnancy System, belonging to the Unified Health System, in Rio de Janeiro City. Data were collected through interviews applied to 873 rooming-in mothers submitted to a rapid HIV test at the hospital. Prevalence ratios (PR) of the lack of HIV serologic status were estimated by Poisson regression with robust variance, controlled by maternal and familiar socio-demographic characteristics, pregnancy and prenatal care. Prevalence of unawareness of HIV status was 32.2%. Mothers with low educational level, low-income, more than one relationship in the last year, enrolling late in prenatal care, and low number of prenatal visits were more likely to have unknown HIV status. The main predictor for unawareness of HIV serostatus at hospital admittance was the low number of prenatal visits. It is recommended that coverage of HIV testing during prenatal care be broadened with timely delivery of results, improving early access of pregnant women and increasing the number of prenatal visits, focusing on clients with low socio-economic level.

Preditores do desconhecimento do status sorológico de HIV entre puérperas submetidas ao teste rápido anti-HIV na internação para o parto

O objetivo deste artigo é analisar fatores associados ao desconhecimento do status sorológico de HIV do pré-natal na internação ao parto. Estudo transversal realizado em 2006 em Hospitais Amigos da Criança do Sistema de Gestação de Alto Risco do SUS no município do Rio de Janeiro. Foram entrevistadas no alojamento conjunto 873 mães submetidas ao teste rápido anti-HIV no hospital. Razões de prevalência (RP) do desconhecimento do status de HIV foram obtidas por regressão de Poisson com variância robusta, com ajuste por características sociodemográficas maternas e familiares, da gravidez e de assistência pré-natal. A prevalência de status ignorado de HIV foi 32,2%. Baixa escolaridade materna, baixa renda materna, ter tido mais de um relacionamento no último ano, início tardio do pré-natal e baixo número de consultas pré-natais mostraram-se associados ao desfecho. O mais importante preditor do desconhecimento do status de HIV na internação para o parto foi o baixo número de consultas pré-natais. Recomenda-se a expansão da cobertura da testagem anti-HIV no pré-natal e a entrega de resultados em tempo hábil, com captação precoce da gestante e incremento no número de consultas, enfocando a clientela de baixo nível socioeconômico.

Avaliação da implantação da iniciativa hospital amigo da criança no Rio de Janeiro, Brasil

OBJETIVOS: avaliar a implantação da Iniciativa Hospital Amigo da Criança no Rio de Janeiro. MÉTODOS: pesquisa avaliativa realizada em 2009, com sete hospitais credenciados (HAC) e oito não (HNC), do SUS. Avaliação de estrutura (Passos 1 e 2) realizada por observação e entrevista a 215 profissionais. Avaliações de processo (Passos 3 a 10) e resultado compreenderam entrevista em amostra representativa de 461 gestantes, 687 mães em alojamento conjunto e 148 mães com recém-nascido em unidade neonatal. O grau de implantação foi avaliado segundo o cumprimento de cada passo e de parâmetros compreendidos nestes passos. A correlação entre grau de implantação e desfechos foi analisada por meio de regressão linear: aleitamento materno (AM) na primeira hora, AM exclusivo (AME) e satisfação das mulheres com o apoio recebido. RESULTADOS: os graus de implantação variaram de 9 a 5 passos (90,6% a 70,1% dos parâmetros) cumpridos nos HAC e de 5 a 1 passo (76,1% a 43,9% dos parâmetros) nos HNC. Foi encontrada correlação linear significativa entre o grau de implantação, expresso em passos e parâmetros, respectivamente, e o AM na primeira hora (r=0,78 e r=0,74), o AME (r=0,72 e r=0,69), e a satisfação (r=0,69 e r=0,73). CONCLUSÕES: ambas as formas de avaliação mostraram-se consistentes com os resultados. Os HAC apresentaram um desempenho superior aos HNC, sendo necessário um investimento na sustentabilidade desta iniciativa.

Desempenho mental de bebês pré-termo de muito baixo peso ao nascer: avaliação da estabilidade nos dois primeiros anos de vida e fatores associados ao desempenho mental

O objetivo do estudo foi investigar a estabilidade do desempenho mental de bebês prematuros de muito baixo peso ao nascer ao longo dos dois primeiros anos de vida e identificar os fatores associados ao seu desempenho mental. Estudo de coorte com 109 crianças. A Escala Mental da Bayley Scales of Infant Development - Second Edition foi aplicada aos 6, aos 12 e entre 18-24 meses de idade corrigida. A estabilidade dos escores entre as avaliações foi investigada através de análise de variância para medidas repetidas. A associação entre as características neonatais e sociais no desenvolvimento mental foi verificada por análise multivariada através de regressão linear, considerando como desfechos os Índices de Desenvolvimento Mental aos 6 meses, 12 meses e entre 18-24 meses de idade corrigida. A média do Índice de Desenvolvimento Mental aos 6 meses foi 83,4 (DP: 12,4), aos 12 meses foi 86,4 (DP: 13,9) e aos 18-24 meses foi 73,4 (DP: 14,5). Observou-se uma diminuição significativa de 13 pontos no escore aos 18-24 meses de idade corrigida. O Índice de Desenvolvimento Mental não apresentou estabilidade ao longo dos dois primeiros anos de vida nesta população de prematuros, exceto para as crianças que tiveram pneumonia neonatal, cujo desempenho foi insatisfatório em todas as avaliações. Dos fatores de risco investigados, apenas o sexo masculino e a pneumonia neonatal estiveram associados aos desfechos.

[The association between diabetes mellitus and lower urinary tract dysfunctions in women assisted in a reference service]

PURPOSE

to describe lower urinary tract dysfunctions and clinical demographic characteristics of patients with urinary symptoms. This study assessed the prevalence of diabetes mellitus and urodynamic changes in these women.

METHODS

We conducted a cross-sectional, retrospective study on 578 women. The prevalence of diabetes mellitus and urodynamic diagnoses was assessed in patients with lower urinary tract dysfunctions, with their respective 95% confidence intervals. The prevalence ratios of urodynamic alterations were calculated according to the diabetes mellitus diagnoses.

RESULTS

Seventy-seven patients (13.3%) had diabetes and type 2 diabetes was predominant (96.1%). Stress urinary incontinence was the most frequent urodynamic diagnosis (39%) in diabetic patients, followed by detrusor overactivity (23.4%). The prevalence of urodynamic alterations was associated with diabetes (PR=1.31; 95%CI=1.17-1.48). Changes in detrusor contractility (over- or underactivity) were diagnosed in 42.8% diabetic patients and in 31.5% non-diabetic patients.

CONCLUSIONS

Diabetic women had a greater prevalence of urodynamic alterations than the non-diabetic ones. There was no association between diabetes mellitus and detrusor contractility alterations (p=0.80).

Transcranial sonography as a diagnostic tool for Parkinson's disease: a pilot study in the city of Rio de Janeiro, Brazil

In Brazil there is no systematic study on Transcranial Sonography (TCS), a neuroimaging method that depicts echogenic deep brain structures using ultrasound. OBJECTIVE: To establish the percentage of subjects with permissive temporal windows and to address the ability of TCS of the substantia nigra (SN) to distinguish parkinsonian patients in a Brazilian sample. METHOD: We performed TCS using the Acuson X300 (Siemens, Germany) in 37 individuals: 23 with Parkinson's disease (PD) and 14 healthy controls. RESULTS: 10.8% of subjects had insufficient temporal acoustic bone windows. SN echogenic areas were larger in patients (mean±SD, 0.31±0.08cm²) compared to controls (mean±SD, 0.17±0.02cm²). TCS accurately identified 88.2% of PD patients. CONCLUSION: A large proportion of Brazilians seem to be eligible for TCS. An expressive number of PD patients could be diagnosed by TCS based on an expanded SN echogenic area. However, the current data is preliminary and must be corroborated by larger studies.

Características da assistência ao trabalho de parto e parto em três modelos de atenção no SUS, no Município de Belo Horizonte, Minas Gerais, Brasil

Estudo transversal com 831 gestantes, de risco habitual, sobre o manejo do trabalho de parto num Centro de Parto Normal (CPN), num hospital vencedor do título "Galba de Araújo" (HG) e numa maternidade com modelo assistencial prevalente (HP). O uso da ocitocina no CPN foi de 27,9%, no HG 59,5% e no HP 40,1%, enquanto a amniotomia foi realizada em 67,6%, 73,6% e 82,2% das mulheres, respectivamente. A realização da episiotomia foi menor nas modalidades com incorporação de práticas humanizadas: 7,2% no CPN e 14,8% no HG versus 54,9% no HP. A prática de oferta liberal no HG resultou numa taxa de analgesia superior (54,4%) à do HP (7,7%). O percentual de internação dos recém-nascidos e o de parto a fórceps foram mais altas no HP, mas não houve diferenças para o índice de Apgar e para a taxa de cesárea. Os resultados sugerem resistência ao uso seletivo de intervenções em todos os modelos assistenciais, embora favoreçam o CPN como estratégia no controle das intervenções durante o trabalho de parto e parto nas gestantes de risco habitual sem prejuízos para as mulheres e os recém-nascidos.

[Epidemiological and nutritional characteristics of pregnant HIV-infected women]

PURPOSE

To describe the epidemiological profile and nutritional status of pregnant women infected with human immunodeficiency virus (HIV) and its effect on the nutritional status of these women during pregnancy.

METHODS

A retrospective cohort study was conducted on 121 pregnant women with HIV infection, single fetus pregnancies, who received prenatal care and delivered at a referral unit for HIV-infected pregnant women during the period from 1997 to 2007. Outcomes of the study were the initial and final nutritional status as measured by body mass index, weight gain, anemia (hemoglobin <11 g/dL) and low birth weight. Bivariate analysis investigated the association of these outcomes with socio-demographic, clinical-care and dietary characteristics. We estimated the relative risks (RR) with 95% confidence intervals (CI).

RESULTS

At the beginning of pregnancy, 11.0% of the women were underweight, and in late pregnancy, the prevalence was 29.3%. Low educational level, urinary infection and worm infestation were associated with low gestational weight in late pregnancy. The percentage of insufficient weight gain was 47.5%, with well-nourished pregnant women (RR=3.3 95%CI 1.3-8.1) and women with no companion (RR=1.5 95%CI 1.1-2.2) having a higher risk for this outcome. The prevalences of overweight at the beginning and at the end of pregnancy were 26.8 and 29.4, respectively. There was a significant prevalence of anemia (61.0%).

CONCLUSIONS

The high percentage of negative nutritional outcomes identified at this referral service with multidisciplinary care for pregnant women living with HIV reveals the need to establish more effective strategies to deal with the complex context of HIV.

[Non-Governmental Organizations in the area of Child Healthcare - review of the literature]

The second half of the twentieth century saw the emergence of organizations that reflected the mobilization of civil society for more effective participation in questions in the public interest and of a social nature. These became known as non-governmental organizations (NGOs) and they assumed their place as partners with public and private sectors to develop actions in different areas, including healthcare. Based on a review of the literature, the scope of this paper was to assess the status of scientific knowledge on the participation of NGOs in child healthcare and, by identifying and classifying their activities, establish if they are in line with the agenda of the field. Analysis of the publications took into consideration where the authors were from, the journal in question, the origins and area of activity of the NGOs and the source of the funds applied to the projects implemented. The nature of activities varied with the degree of development of the region where the NGOs operated and the themes, partnership between government and private sector agencies, sustainability and impact of actions on the favored communities were the main topics highlighted by the authors. The conclusion reached was that the performance of NGOs in child health is in the early stages and is a knowledge field to be explored.

Organizações Não Governamentais na área da Saúde da Criança - revisão da literatura

A segunda metade do século vinte assistiu ao crescimento de entidades que refletiam a mobilização da sociedade civil para uma participação mais efetiva nas questões de interesse público e de cunho social. Desta forma surgiram as organizações não governamentais (ONG) que ganharam espaço como parceiros dos setores públicos e privados para a atuação em diferentes áreas, entre elas a saúde. Baseado em uma revisão da literatura, este trabalho teve como objetivo conhecer o status do conhecimento científico sobre a participação das ONG na saúde da criança e a partir da identificação e classificação de suas atividades, observar se esta atuação tem se compatibilizado com a agenda desse campo. A análise das publicações considerou a procedência dos autores, o periódico, os objetivos, a origem e o local de atuação das ONG e a procedência dos recursos aplicados nos projetos desenvolvidos. A natureza das atividades variou de acordo com o grau de desenvolvimento da região onde as ONG atuavam e os temas, parceria entre órgãos de governo e terceiro setor, sustentabilidade e impacto das ações nas comunidades beneficiárias foram os principais tópicos destacados pelos autores. Concluiu-se que as questões estão apenas se esboçando e que o impacto das intervenções das ONG na área da saúde da criança é um campo de conhecimento a ser explorado.

Desenvolvimento cognitivo de prematuros à idade escolar: proposta de modelo hierarquizado para investigação dos fatores de risco

O déficit cognitivo é a sequela do neurodesenvolvimento mais prevalente na população de prematuros de muito baixo peso. Poucos são os trabalhos nacionais sobre o desenvolvimento desta população na idade escolar. Este estudo propõe uma discussão teórica sobre os fatores determinantes do desenvolvimento cognitivo na idade escolar de prematuros de muito baixo peso ao nascer, utilizando o modelo hierarquizado de análise. Neste modelo, fatores biológicos e ambientais se relacionariam em diversos níveis: distal, intermediário e proximal, resultando em alterações no desenvolvimento cognitivo. Pretende-se, desta forma, aprofundar a questão das mediações possíveis das variáveis e suas inter-relações e consequentes eventos que podem levar ao desfecho. Para a seleção dos fatores de risco foi realizada uma revisão da literatura sobre fatores associados a resultados cognitivos desfavoráveis. Pressupõe-se que o melhor conhecimento das inter-relações destes fatores auxiliaria na prevenção e intervenção mais adequada nesta população, aumentando suas chances de inclusão escolar e social.

A computed tomography scoring system to assess pulmonary disease among premature infants

CONTEXT AND OBJECTIVE

High-resolution computed tomography (HRCT) is considered to be the best method for detailed pulmonary evaluation. The aim here was to describe a scoring system based on abnormalities identified on HRCT among premature infants, and measure the predictive validity of the score in relation to respiratory morbidity during the first year of life.

DESIGN AND SETTING

Prospective cohort study in Instituto Fernandes Figueira, Fundação Oswaldo Cruz.

METHODS

Scoring system based on HRCT abnormalities among premature newborns. The affected lung area was quantified according to the number of compromised lobes, in addition to bilateral pulmonary involvement. Two radiologists applied the score to 86 HRCT scans. Intraobserver and interobserver agreement were analyzed. The score properties were calculated in relation to predictions of respiratory morbidity during the first year of life.

RESULTS

Most of the patients (85%) presented abnormalities on HRCT, and among these, 56.2% presented respiratory morbidity during the first year of life. Scores ranged from zero to 12. There was good agreement between observers (intraclass correlation coefficient, ICC = 0.86, confidence interval, CI: 0.64-0.83). The predictive scores were as follows: positive predictive value 81.8%, negative predictive value 56.3%, sensitivity 39.1%, and specificity 90.0%.

CONCLUSION

The scoring system is reproducible, easy to apply and allows HRCT comparisons among premature infants, by identifying patients with greater likelihood of respiratory morbidity during the first year of life. Its use will enable HRCT comparisons among premature infants with different risk factors for respiratory morbidity.

Avaliação da implementação da assistência ao planejamento reprodutivo em três municípios do Estado do Rio de Janeiro entre 2005 e 2007

OBJETIVOS: avaliar a implementação das ações de assistência ao planejamento reprodutivo (PR) em três municípios fluminenses e os aspectos contextuais. MÉTODOS: pesquisa avaliativa realizada entre 2005-2007. Foram realizadas entrevistas com gestores e profissionais de saúde, observação de serviços e análise de documentos. Para análise do grau de implementação do programa foi desenvolvida matriz de avaliação com três componentes - assistência, educação e gerenciamento - e estabelecidos padrões e critérios. Fontes orais e documentais possibilitaram análise do contexto de implementação. RESULTADOS: a implementação do PR no município metropolitano está avançada e nos municípios do interior é incipiente. Atividades educativas apresentaram maior conformidade com critérios do que atividades clínico-assistenciais. Irregularidade de métodos contraceptivos, problemas na oferta de contracepção cirúrgica, ausência de atenção à infertilidade e à saúde reprodutiva masculina foram aspectos frágeis. Existem equipes multiprofissionais, mas há necessidade de capacitação. No município metropolitano, o gerenciamento do programa é ponto forte, mas nos demais é débil. CONCLUSÕES: o grau de implementação da assistência ao PR se relacionou com desigualdades geopolíticas entre os municípios e aspectos do contexto institucional do SUS - pouca integração da rede assistencial e regionalização limitada. O estudo pode contribuir para institucionalização da prática de monitoramento e avaliação das ações de assistência ao planejamento reprodutivo.

Bronchopulmonary dysplasia as a predictor factor for motor alteration at 6 months corrected age in premature infants

OBJECTIVE: The study aimed to assess bronchopulmonary dysplasia (BPD) as a predisposing factor for alteration in the psychomotor development index (PDI) in premature infants and verify the incidence of neuromotor alterations at 6 months corrected age. METHOD: This was a prospective cohort study that followed the neuromotor development of 152 very low birth weight premature infants, with psychomotor development index as the outcome. The study used the Bayley Scale of Infant Development at 6 months corrected age, and neurological examination. RESULTS: Incidence of BPD was 13.2% (n=20). Logistic regression analysis showed an association between BPD and altered psychomotor development index (OR 3.98; 95%CI: 1.04-15.1) after adjusting for confounding variables. Neurological examination was altered in 67.1% of the 152 infants. CONCLUSION: Bronchopulmonary dysplasia acted as an independent predisposing factor for alteration in the psychomotor development index in premature infants at 6 months corrected age.

Intra and interobserver reliability of the interpretation of high-resolution computed tomography on the lungs of premature infants

CONTEXT AND OBJECTIVE

High-resolution computed tomography (HRCT) of the lungs is more sensitive than radiographs for evaluating pulmonary disease, but little has been described about HRCT interpretation during the neonatal period or shortly afterwards. The aim here was to evaluate the reliability of the interpretation of HRCT among very low birth weight premature infants (VLBWPI; < 1500 g).

DESIGN AND SETTING

Cross-sectional study on intra and interobserver reliability of HRCT on VLBWPI.

METHODS

86 VLBWPI underwent HRCT. Two pediatric radiologists analyzed the HRCT images. The reliability was measured by the proportion of agreement, kappa coefficient (KC) and positive and negative agreement indices.

RESULTS

For radiologist A, the intraobserver reliability KC was 0.79 (confidence interval, CI: 0.54-1.00) for normal/abnormal examinations; for each abnormality on CT, KC ranged from 0.05 to 1.00. For radiologist B, the intraobserver reliability KC was 0.79 (CI: 0.54-1.00) for normal/abnormal examinations; for each abnormality on CT, KC ranged from 0.37 to 0.83. The interobserver agreement was 88% for normal/abnormal examinations and KC was 0.71 (CI: 0.5- 0.93); for most abnormal findings, KC ranged from 0.51-0.67.

CONCLUSION

For normal/abnormal examinations, the intra and interobserver agreements were substantial. For most of the imaging findings, the intraobserver agreement ranged from moderate to substantial. Our data demonstrate that in clinical practice, there is no reason for more than one tomographic image evaluator, provided that this person is well trained in VLBWPI HRCT interpretation. Analysis by different observers should be reserved for research and for difficult cases in clinical contexts.

[Cognitive function in menopausal women evaluated with the Mini-Mental State Examination and Word-List Memory Test]

There is little research in Brazil on cognition and menopause, despite the high frequency of neuropsychiatric complaints in this phase of women's life. The authors present a cross-sectional study aimed at describing the scores by 156 menopausal women on the Mini-Mental State Examination (MMSE) and the Word-List Memory Test (WLMT). The mean score on the MMSE was 25.86 points (SD = 2.67), similar to other studies, except for better performance by illiterate women; scores on the sub-items 'attention and calculation' and 'immediate recall' showed lower values. In the WLMT, the mean was also consistent with the literature (M = 18.83 words; SD = 3.82). The only significant associations with score were for schooling in both tests and arterial hypertension in the WLMT. The authors conclude that cognitive performance in these menopausal women is similar to that of other Brazilian samples, corroborating the wider range of scores among individuals with lower schooling. Complaints pertaining to memory in middle-aged women may be related to decreased attention.

Resultado do teste rápido anti-HIV após o parto: uma ameaça à amamentação ao nascimento

OBJETIVO: Analisar fatores associados à não-amamentação na primeira hora de vida, sobretudo a influência do momento do resultado do teste rápido anti-HIV. MÉTODOS: Estudo de coorte, sendo o ponto inicial a submissão ao teste rápido e o final a primeira mamada do bebê. A população estudada incluiu 944 parturientes submetidas ao teste rápido anti-HIV, com resultado negativo, em 2006, nos cinco hospitais amigos da criança do Sistema de Gestação de Alto Risco no município do Rio de Janeiro, RJ. Entrevistadoras treinadas obtiveram dados do laboratório e do prontuário e no pós-parto aplicaram questionário para entrevista às mães. O modelo multinível foi adotado para analisar a influência de características sociodemográficas, de assistência pré-natal e ao parto sobre a não-amamentação na primeira hora de vida. RESULTADOS: Dentre as participantes, apenas 15,6% receberam seu resultado antes do parto, 30,8% depois do parto e 53,6% ainda desconheciam o resultado ao ser entrevistada. A prevalência de não-amamentação na primeira hora de vida foi de 52,5% (IC 95%: 49,3;55,8). Após ajuste, o recebimento do resultado do teste rápido após o parto dobrou o risco da não-amamentação na primeira hora de vida (RR=2,06; IC 95%: 1,55;2,75). Outros fatores de risco foram: cor não branca, renda materna de um salário mínimo ou menos, parto cesáreo, mãe não querer amamentar o bebê ao nascimento e mãe referir que a equipe hospitalar não a escutava. O desconhecimento da realização do teste rápido anti-HIV pela mãe se mostrou como fator de proteção. CONCLUSÕES: O principal fator de risco para a não-amamentação na primeira hora de vida foi o recebimento do resultado do teste rápido após o parto. O teste anti-HIV deve ser amplamente disponibilizado no pré-natal e o teste rápido deve ser realizado sob indicação, na admissão, com busca ativa e pronta comunicação do resultado à mulher.

Fatores associados à morbidade respiratória entre 12 e 36 meses de vida de crianças nascidas de muito baixo peso oriundas de uma UTI neonatal pública

O objetivo do estudo foi estimar a morbidade respiratória entre 12 e 36 meses em crianças prematuras e identificar os fatores associados. A população compreendeu 84 crianças de uma coorte de prematuros de muito baixo peso. O desfecho foi a taxa de incidência de morbidade respiratória. A associação entre as variáveis independentes e morbidade respiratória foi verificada por modelo linear generalizado. Entre 12 e 24 meses, 56,3% das crianças apresentaram morbidade respiratória. Entre 24 e 36 meses, 38,1% das crianças foram acometidas. As variáveis associadas à morbidade respiratória foram: displasia broncopulmonar (RT = 1,9; IC95%: 1,2-2,9), complacência pulmonar alterada (RT = 1,6; IC95%: 1,1-2,2), pneumonia neonatal (RT = 2,8; IC95%: 2,0-4,0), persistência do canal arterial (RT = 1,6; IC95%: 1,1-2,4) e morbidade respiratória no primeiro ano de vida (RT = 1,8; IC95%: 1,3-2,6). A incidência de morbidade respiratória entre 12 e 36 meses se manteve elevada neste grupo de crianças de alto risco, o que reforça a necessidade de acompanhamento e de intervenções efetivas na prevenção do adoecimento e na melhora da qualidade de vida destas crianças e suas famílias.

Predictive factors for neuromotor abnormalities at the corrected age of 12 months in very low birth weight premature infants

BACKGROUND: The increase in survival of premature newborns has sparked growing interest in the prediction of their long-term neurodevelopment. OBJECTIVE: To estimate the incidence of neuromotor abnormalities at the corrected age of 12 months and to identify the predictive factors associated with altered neuromotor development in very low birth weight premature infants. METHOD: Cohort study. The sample included 100 premature infants. The outcome was neuromotor development at 12 months classified by Bayley Scale (PDI) and neurological assessment (tonus, reflexes, posture). A multivariate logistic regression model was constructed. Neonatal variables and neuromotor abnormalities up to 6 months of corrected age were selected by bivariate analysis. RESULTS: Mean birth weight was 1126g (SD: 240). Abnormal neuromotor development was presented in 60 children at 12 months corrected age. CONCLUSION: According to the model, patients with a diagnosis including bronchopulmonary dysplasia, hypertonia of lower extremities, truncal hypotonia showed a 94.0% probability of neuromotor involvement at 12 months.

Incidence of cervical intraepithelial lesions in a population of adolescents treated in public health services in Rio de Janeiro, Brazil

This study aimed to estimate the incidence and types of cervical cytopathological findings in adolescents who were treated in public health services between 1993 and 2006. This is a cohort study, with the following inclusion criteria: < 20 years of age, sexually-active, without cervical lesions upon entry into the study or sexually active < 1 year. The data were collected from 403 adolescents' medical records. Incidence density of cytopathological alterations was estimated and the actuarial method was used to calculate the 5-year incidence during follow-up after sexual initiation. In the first year of sexual activity, the incidence of cervical lesions was 24.1%. The incidence decreased to 3-8% over the following 4 years. The incidence density was 4.7 cases per 100 persons per year. The first abnormal cytological diagnosis showed atypical squamous cells of undetermined significance (ASCUS) in 5.5% (22) of patients, low-grade squamous intra-epithelial lesions (LSIL) in 28% (113), and high-grade squamous intraepithelial lesions (HSIL) in 3% (12). Eight (67%) cases of HSIL occurred during the first year of sexual activity. The incidence of cytopathological findings at beginning of sexual life is high, suggesting the importance of including sexually-active adolescents in cervical cancer prevention programs.

Cervical stenosis following electrosurgical conization

CONTEXT AND OBJECTIVE

Cervical stenosis is a postoperative complication of procedures for treating preinvasive lesions of the cervix and takes on particular importance due to the clinical repercussions associated with it. Furthermore, it causes limitations in relation to cytological and colposcopic follow-up. The aim here was to assess the incidence of cervical stenosis among a cohort of patients who underwent electrosurgical conization and to identify possible prognostic factors associated with its occurrence.

DESIGN AND SETTING

Retrospective study at Gynecology and Obstetrics Department, Instituto Fernandes Figueira, Rio de Janeiro.

METHODS

This was an observational study among a cohort of patients who underwent electrosurgical conization of the uterine cervix. The possible predictive variables were analyzed as bivariate means between the groups with and without stenosis. We also calculated the incidence density rate ratio for cervical stenosis in relation to each possible predictive variable and the respective confidence intervals (95%). Levels of 5% were considered significant.

RESULTS

274 patients who underwent electrosurgical conization of the uterine cervix with a minimum follow-up period of six months were included. The crude incidence of cervical stenosis was 7.66% and the incidence density was 3.3/1,000 patients-month.

CONCLUSIONS

We did not find associations between the variables for stenosis. However, we observed borderline significance levels relating to hemorrhagic complications before and after the operation (p = 0.089).

Utilização de serviços de reabilitação pelas crianças e adolescentes dependentes de tecnologia de um hospital materno-infantil no Rio de Janeiro, Brasil

O objetivo deste estudo é caracterizar descritivamente a dependência tecnológica e a utilização de serviços de reabilitação pela população de crianças e adolescentes de um hospital materno-infantil do Rio de Janeiro, Brasil. O estudo transversal descreveu as características demográficas da criança e sócio-econômicas do cuidador e família, como também o tipo de dependência tecnológica e a utilização de serviços de reabilitação. A população do estudo é composta de pré-escolares (56,3%), do sexo masculino (58,3%), residentes na região metropolitana do Estado do Rio de Janeiro (89,6%). São oriundos de famílias com rendimentos mensais até dois salários mínimos (70,9%), cuidados sobretudo por suas mãe (93,8%), que possuem escolaridade menor ou igual ao ensino fundamental (54,2%) e não trabalham (89,6%). Dos entrevistados, um total de 22,9% depende de três tipos diferentes de tecnologias, sendo o suporte medicamentoso (87,5%) a mais utilizada. O tratamento de reabilitação é financiado preponderantemente pelo Sistema Único de Saúde (SUS) e instituições filantrópicas, sendo o fisioterapeuta motor (60,4%) o profissional de maior demanda nesse tratamento. O hospital estudado concentra todos os atendimentos médicos especializados e a maior parte dos tratamentos em reabilitação.

Cholelithiasis and biliary sludge in Downs syndrome patients

CONTEXT AND OBJECTIVE

Although studies have demonstrated increased frequency of gallbladder abnormalities among Downs syndrome (DS) patients in some countries, there is only one paper on this subject in the Brazilian literature. The aim of this study was to demonstrate the prevalence, clinical characteristics and evolution of lithiasis and biliary sludge among DS patients in a maternity and childrens hospital in Rio de Janeiro.

DESIGN AND SETTING

This was a cross-sectional study followed by a retrospective cohort study on all individuals with an ultrasound diagnosis of gallbladder abnormalities.

METHODS

547 DS patients (53.2% male, 46.8% female) attending the Instituto Fernandes Figueira in 2001 underwent abdominal ultrasound examination at ages of between one day and three years (mean: five months). Clinical and ultrasound data were analyzed.

RESULTS

In 50 patients (9.1%), the ultrasound demonstrated gallbladder abnormalities (6.9% lithiasis and 2.1% biliary sludge). Spontaneous resolution was observed in 66.7% of the patients with biliary sludge and 28.9% with lithiasis. Cholecystectomy was carried out on 26.3% of the patients with gallstones.

CONCLUSION

The results from this study and comparison with the literature suggest that DS patients are at risk of developing lithiasis and biliary sludge and should be monitored throughout the neonatal period, even if there are no known risk factors for gallstone formation. Most frequently, these gallbladder abnormalities occur without symptoms and spontaneously resolve in most non-symptomatic patients. DS patients should be monitored with serial abdominal ultrasound, and cholecystectomy is indicated for symptomatic cases or when cholecystitis is present.

Pre-invasive cervical disease and uterine cervical cancer in Brazilian adolescents: prevalence and related factors

The objective was to describe the prevalence and factors associated with uterine cervical cancer (CA) and high-grade squamous intraepithelial lesions (HSIL) in adolescents. A cross-sectional study was carried out with 702 sexually active adolescents treated at a general hospital in Rio de Janeiro, Brazil, from 1993 to 2002. Screening was performed by cytopathology and colposcopy and confirmation by biopsy. Exposure variables were socio-demographic characteristics and those related to reproductive health, habits, and sexual behavior. Adjusted odds ratios were estimated using multivariate logistic regression analysis. Based on histopathology, the prevalence of HSIL/CA was 3% (95%CI: 1.8-4.6). There was one case of invasive cancer. With each additional pregnancy, the odds of HSIL/CA increased by 2.2 (95%CI: 1.1-4.4). Age was also associated with this outcome, doubling the odds of acquiring this degree of disease with each year of age (OR = 2.0; 95%CI: 1.2-3.4). The prevalence of lesions suggests the importance of including sexually active adolescent females in cervical cancer screening programs aimed at early detection and treatment of these lesions.

Escala de apoio social aplicada a uma população de gestantes: confiabilidade teste-reteste e estrutura de concordância dos itens

A associação entre apoio social e desfechos relacionados à saúde tem sido objeto de interesse de pesquisadores. O objetivo desse artigo foi avaliar a confiabilidade e estrutura de concordância da escala de apoio social. A confiabilidade teste-reteste foi investigada num grupo de gestantes de maternidade pública (n = 65) por intermédio do coeficiente de correlação intraclasse (CCIC) e kappa ponderado (kw2). Avaliou-se a estrutura de concordância pelos modelos log-lineares. O CCIC da escala foi 0,90 e kw² variou entre 0,23 e 0,70. Modelos com melhores ajustes foram o de concordância diagonal mais associação linear por linear e de semi-independência. Considerou-se a escala um instrumento capaz de medir, de maneira confiável, o apoio social entre gestantes de baixa renda.