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Farias DR, Anjos LAD, Freitas MBD, Berti TL, Andrade PG, Alves-Santos NH, Leite MA, Raymundo CE, Lacerda EMDA, Boccolini CS, Castro IRRD, Kac G, Vertulli Carneiro LB, Bertoni N, Normando P, Machado Schincaglia R. Malnutrition in mother-child dyads in the Brazilian National Survey on Child Nutrition (ENANI-2019). CAD SAUDE PUBLICA 2023; 39Suppl 2:e00085622. [PMID: 37792878 PMCID: PMC10552619 DOI: 10.1590/0102-311xen085622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 09/26/2022] [Accepted: 10/10/2022] [Indexed: 10/06/2023] Open
Abstract
Malnutrition affects billions of individuals worldwide and represents a global health challenge. This study aimed to determine the prevalence of malnutrition (undernutrition or overweight) among mother-child dyads in children under 5 years old in Brazil in 2019 and to estimate changes in this prevalence from 2006 to 2019. Individual-level data from the Brazilian National Survey on Child Nutrition (ENANI-2019) and the Brazilian National Survey of Demography and Health of Women and Children carried out in 2006 (PNDS 2006) were analyzed. Malnutrition outcomes in mother-child dyads included overweight mother and child, undernourished mother and child, and the double burden of malnutrition, i.e., overweight mother and child having any form of undernourishment (stunting, wasting, or underweight). Prevalence and 95% confidence intervals (95%CI) were estimated. Most women (58.2%) and 9.7% of the children were overweight, 6.9% were stunted, and 3.1% of mothers and 2.9% of the children were underweight. The prevalence of overweight in the mother-child dyad was 7.8% and was statistically higher in Southern Brazil (9.7%; 95%CI: 7.5; 11.9) than in the Central-West (5.4%; 95%CI: 4.3; 6.6). The prevalence of overweight mother and stunted child was 3.5%, with statistically significant difference between the extremes of the mother's education [0-7 vs. ≥ 12 years, 4.8% (95%CI: 3.2; 6.5) and 2.1%, (95%CI: 1.2; 3.0), respectively]. Overweight in the dyad increased from 5.2% to 7.8%, and the double burden of malnutrition increased from 2.7% to 5.2% since 2006. Malnutrition in Brazilian mother-child dyads seems to be a growing problem, and dyads with lower formal education, higher maternal age, and from the South Region of Brazil were more vulnerable.
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Affiliation(s)
- Dayana Rodrigues Farias
- Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Maiara Brusco de Freitas
- Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Talita Lelis Berti
- Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Pedro Gomes Andrade
- Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Nadya Helena Alves-Santos
- Instituto de Estudos em Saúde e Biológicas, Universidade Federal do Sul e Sudeste do Pará, Belém, Brasil
| | | | - Carlos Eduardo Raymundo
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Cristiano Siqueira Boccolini
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Gilberto Kac
- Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
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Freitas-Costa NC, Andrade P, Normando P, Salvatte Nunes KS, Raymundo CE, Ribeiro de Castro IR, Maria de Aquino Lacerda E, Farias DR, Kac G. Association of development quotient with nutritional status of vitamins B6, B12, and folate in 6-59-month-old children: Results from the Brazilian National Survey on Child Nutrition (ENANI-2019). Am J Clin Nutr 2023:S0002-9165(23)47384-4. [PMID: 37105522 DOI: 10.1016/j.ajcnut.2023.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/28/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Vitamins B6, B12, and folate are essential for the formation and maintenance of the human brain, but studies evaluating these vitamins with early childhood development (ECD) in children under five are limited and controversial. OBJECTIVE To evaluate the association between vitamins B6, B12, and folate concentrations/status and ECD. METHODS Data regarding 6,520 children aged 6-59 months (from the Brazilian National Survey on Child Nutrition [ENANI-2019]) were analyzed. ECD was assessed using the Survey of Well-being of Young Children's milestones questionnaire. Vitamin B6 concentration (nmol/L) was classified according to the tertile of the distribution and with the cutoff <20 nmol/L. Folate concentrations >45.3 nmol/L were classified as high, and vitamin B12 <150 pmol/L as deficient. The graded response model was used to estimate developmental age, and the developmental quotient (DQ) was calculated as the developmental age divided by chronological age. Multiple linear regression models were adjusted for confounders. RESULTS The DQ mean (95% confidence interval) for Brazilian children was 0.99 (0.97-1.01). Children aged 6-23 months (1.13 [1.10-1.16]) had a higher DQ mean than those aged 24-35 (0.99 [0.95-1.03]) and 36-59 months (0.89 [0.86-0.92]). Child age was inversely associated with DQ (β=-0.007; p<0.001). An interaction between child age and vitamin B12 deficiency in the DQ (β=-0.005; p<0.001) indicated that, in children aged 36-59 months, the DQ was markedly lower in children with B12 deficiency than in those without B12 deficiency. Vitamin B6 concentrations were directly associated with the DQ (β=0.0004; p=0.031) among children aged 24-59 months in the adjusted model. No association was observed between folate status and DQ. CONCLUSIONS In Brazil, the DQ is lower among older children, and those with vitamin B12 deficiency. Vitamin B6 status was directly associated with the DQ in children aged 24-59 months.
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Affiliation(s)
- Nathalia Cristina Freitas-Costa
- Nutritional Epidemiology Observatory, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Pedro Andrade
- Institute of Applied Economic Research, Rio de Janeiro, Brazil
| | - Paula Normando
- Nutritional Epidemiology Observatory, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Keronlainy Silva Salvatte Nunes
- Nutritional Epidemiology Observatory, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carlos Eduardo Raymundo
- Institute of Collective Health, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Elisa Maria de Aquino Lacerda
- Nutritional Epidemiology Observatory, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Dayana Rodrigues Farias
- Nutritional Epidemiology Observatory, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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Oliveira MC, de Araujo Eleuterio T, de Andrade Corrêa AB, da Silva LDR, Rodrigues RC, de Oliveira BA, Martins MM, Raymundo CE, de Andrade Medronho R. Correction to: Factors associated with death in confirmed cases of COVID-19 in the state of Rio de Janeiro. BMC Infect Dis 2021; 21:728. [PMID: 34340676 PMCID: PMC8327052 DOI: 10.1186/s12879-021-06410-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
| | - Tatiana de Araujo Eleuterio
- Instituto de Estudos em Saúde Pública / Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Faculdade de Enfermagem, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Lucas Dalsenter Romano da Silva
- Departamento de Medicina Preventiva, Instituto de Estudos em Saúde Pública / Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Marlos Melo Martins
- Department of Child Neurology, Martagão Gesteira Institute of Childcare and Pediatrics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carlos Eduardo Raymundo
- Instituto de Estudos em Saúde Pública / Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Roberto de Andrade Medronho
- Instituto de Estudos em Saúde Pública / Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Cini Oliveira M, de Araujo Eleuterio T, de Andrade Corrêa AB, da Silva LDR, Rodrigues RC, de Oliveira BA, Martins MM, Raymundo CE, de Andrade Medronho R. Fatores associados ao óbito em casos confirmados de COVID-19 no estado do Rio de Janeiro. BMC Infect Dis 2021; 21:687. [PMID: 34271868 PMCID: PMC8283387 DOI: 10.1186/s12879-021-06384-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 06/17/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND COVID-19 can occur asymptomatically, as influenza-like illness, or as more severe forms, which characterize severe acute respiratory syndrome (SARS). Its mortality rate is higher in individuals over 80 years of age and in people with comorbidities, so these constitute the risk group for severe forms of the disease. We analyzed the factors associated with death in confirmed cases of COVID-19 in the state of Rio de Janeiro. This cross-sectional study evaluated the association between individual demographic, clinical, and epidemiological variables and the outcome (death) using data from the Unified Health System information systems. METHODS We used the extreme boosting gradient (XGBoost) model to analyze the data, which uses decision trees weighted by the estimation difficulty. To evaluate the relevance of each independent variable, we used the SHapley Additive exPlanations (SHAP) metric. From the probabilities generated by the XGBoost model, we transformed the data to the logarithm of odds to estimate the odds ratio for each independent variable. RESULTS This study showed that older individuals of black race/skin color with heart disease or diabetes who had dyspnea or fever were more likely to die. CONCLUSIONS The early identification of patients who may progress to a more severe form of the disease can help improve the clinical management of patients with COVID-19 and is thus essential to reduce the lethality of the disease.
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Affiliation(s)
| | - Tatiana de Araujo Eleuterio
- Instituto de Estudos em Saúde Pública / Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
- Faculdade de Enfermagem, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Lucas Dalsenter Romano da Silva
- Departamento de Medicina Preventiva, Instituto de Estudos em Saúde Pública / Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | | | - Marlos Melo Martins
- Department of Child Neurology, Martagão Gesteira Institute of Childcare and Pediatrics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carlos Eduardo Raymundo
- Instituto de Estudos em Saúde Pública / Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Roberto de Andrade Medronho
- Instituto de Estudos em Saúde Pública / Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
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Raymundo CE, de Andrade Medronho R. Association between socio-environmental factors, coverage by family health teams, and rainfall in the spatial distribution of Zika virus infection in the city of Rio de Janeiro, Brazil, in 2015 and 2016. BMC Public Health 2021; 21:1199. [PMID: 34162338 PMCID: PMC8220830 DOI: 10.1186/s12889-021-11249-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 06/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Zika virus (ZIKV) infection caused outbreak in Brazil, in 2015 and 2016. Disorganized urban growth, facilitates the concentration of numerous susceptible and infected individuals. It is useful to understand the mechanisms that can favor the increase in ZIKV incidence, such as areas with wide socioeconomic and environmental diversity. Therefore, the study analyzed the spatial distribution of ZIKV in the city of Rio de Janeiro, Brazil, in 2015 and 2016, and associations between the incidence per 1000 inhabitants and socio-environmental factors. METHODS The census tracts were used as the analytical units reported ZIKV cases among the city's inhabitants. Local Empirical Bayesian method was used to control the incidence rates' instability effect. The spatial autocorrelation was verified with Moran's Index and local indicators of spatial association (LISA). Spearman correlation matrix was used to indicate possible collinearity. The Ordinary Least Squares (OLS), Spatial Lag Model (SAR), and Spatial Error Model (CAR) were used to analyze the relationship between ZIKV and socio-environmental factors. RESULTS The SAR model exhibited the best parameters: R2 = 0.44, Log-likelihood = - 7482, Akaike Information Criterion (AIC) = 14,980. In this model, mean income between 1 and 2 minimum wages was possible risk factors for Zika occurrence in the localities. Household conditions related to adequate water supply and the existence of public sewage disposal were associated with lower ZIKV cumulative incidence, suggesting possible protective factors against the occurrence of ZIKV in the localities. The presence of the Family Health Strategy in the census tracts was positively associated with the ZIKV cumulative incidence. However, the results show that mean income less than 1 minimum wage were negatively associated with higher ZIKV cumulative incidence. CONCLUSION The results demonstrate the importance of socio-environmental variables in the dynamics of ZIKV transmission and the relevance for the development of control strategies.
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Affiliation(s)
- Carlos Eduardo Raymundo
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, State of Rio de Janeiro, Brazil.
- Present address: s/n - Próximo a Prefeitura Universitária da UFRJ Rio de Janeiro, Avenida Horácio Macedo, Rio de Janeiro, State of Rio de Janeiro, 21941598, Brazil.
| | - Roberto de Andrade Medronho
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, State of Rio de Janeiro, Brazil
- Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, State of Rio de Janeiro, Brazil
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Raymundo CE, Oliveira MC, Eleuterio TDA, André SR, da Silva MG, Queiroz ERDS, Medronho RDA. Spatial analysis of COVID-19 incidence and the sociodemographic context in Brazil. PLoS One 2021; 16:e0247794. [PMID: 33647044 PMCID: PMC7920392 DOI: 10.1371/journal.pone.0247794] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/12/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Identified in December 2019 in the city of Wuhan, China, the outbreak of COVID-19 spread throughout the world and its impacts affect different populations differently, where countries with high levels of social and economic inequality such as Brazil gain prominence, for understanding of the vulnerability factors associated with the disease. Given this scenario, in the absence of a vaccine or safe and effective antiviral treatment for COVID-19, nonpharmacological measures are essential for prevention and control of the disease. However, many of these measures are not feasible for millions of individuals who live in territories with increased social vulnerability. The study aims to analyze the spatial distribution of COVID-19 incidence in Brazil's municipalities (counties) and investigate its association with sociodemographic determinants to better understand the social context and the epidemic's spread in the country. METHODS This is an analytical ecological study using data from various sources. The study period was February 25 to September 26, 2020. Data analysis used global regression models: ordinary least squares (OLS), spatial autoregressive model (SAR), and conditional autoregressive model (CAR) and the local regression model called multiscale geographically weighted regression (MGWR). FINDINGS The higher the GINI index, the higher the incidence of the disease at the municipal level. Likewise, the higher the nurse ratio per 1,000 inhabitants in the municipalities, the higher the COVID-19 incidence. Meanwhile, the proportional mortality ratio was inversely associated with incidence of the disease. DISCUSSION Social inequality increased the risk of COVID-19 in the municipalities. Better social development of the municipalities was associated with lower risk of the disease. Greater access to health services improved the diagnosis and notification of the disease and was associated with more cases in the municipalities. Despite universal susceptibility to COVID-19, populations with increased social vulnerability were more exposed to risk of the illness.
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Affiliation(s)
- Carlos Eduardo Raymundo
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, State of Rio de Janeiro, Brazil
| | - Marcella Cini Oliveira
- Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, State of Rio de Janeiro, Brazil
| | - Tatiana de Araujo Eleuterio
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, State of Rio de Janeiro, Brazil
- Departamento de Enfermagem em Saúde Pública, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, State of Rio de Janeiro, Brazil
| | - Suzana Rosa André
- Escola de Enfermagem Anna Nery, Universidade Federal do Rio de Janeiro, Rio de Janeiro, State of Rio de Janeiro, Brazil
| | - Marcele Gonçalves da Silva
- Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, State of Rio de Janeiro, Brazil
| | - Eny Regina da Silva Queiroz
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, State of Rio de Janeiro, Brazil
| | - Roberto de Andrade Medronho
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, State of Rio de Janeiro, Brazil
- Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, State of Rio de Janeiro, Brazil
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Martins MM, Alves da Cunha AJL, Robaina JR, Raymundo CE, Barbosa AP, Medronho RDA. Fetal, neonatal, and infant outcomes associated with maternal Zika virus infection during pregnancy: A systematic review and meta-analysis. PLoS One 2021; 16:e0246643. [PMID: 33606729 PMCID: PMC7894820 DOI: 10.1371/journal.pone.0246643] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/22/2021] [Indexed: 12/16/2022] Open
Abstract
The occurrence of fetal and neonatal disorders in pregnant women with Zika virus infection in the literature is not consistent. This study aims to estimate the prevalence rate of these disorders in fetuses/neonates of pregnant women with confirmed or probable infection by Zika virus. A systematic review with meta-analysis was conducted in November 2020. Cohort studies that contained primary data on the prevalence of unfavorable outcomes in fetuses or neonates of women with confirmed or probable Zika virus infection during pregnancy were included. A total of 21 cohort studies were included, with a total of 35,568 pregnant women. The meta-analysis showed that central nervous system abnormalities had the highest prevalence ratio of 0.06 (95% CI 0.03-0.09). Intracranial calcifications had a prevalence ratio of 0.01 (95% CI 0.01-0.02), and ventriculomegaly 0.01 (95% CI 0.01-0.02). The prevalence ratio of microcephaly was 0.03 (95% CI 0.02-0.05), fetal loss (miscarriage and stillbirth) was 0.04 (95% CI 0.02-0.06), Small for Gestational Age was 0.04 (95% CI 0.00-0,09), Low Birth Weight was 0.05 (95% CI 0.03-0.08) and Prematurity was 0.07 (95% CI 0.04-0.10). The positivity in RT-PCR for ZIKV performed in neonates born to infected mothers during pregnancy was 0.25 (95% CI 0.06-0.44). We also performed the meta-analysis of meta-analysis for microcephaly with the prevalence ratios from other two previously systematic reviews: 0.03 (95% CI 0.00-0.25). Our results contribute to measuring the impact of Zika virus infection during pregnancy on children's health. The continuous knowledge of this magnitude is essential for the implementation development of health initiatives and programs, in addition to promoting disease prevention, especially in the development of a vaccine for Zika virus. PROSPERO protocol registration: http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42019125543.
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Affiliation(s)
- Marlos Melo Martins
- Department of Pediatrics, Martagão Gesteira Institute of Childcare and Pediatrics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail:
| | | | | | - Carlos Eduardo Raymundo
- Department of Pediatrics, Instituto D’Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil
| | - Arnaldo Prata Barbosa
- Department of Pediatrics, Instituto D’Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil
| | - Roberto de Andrade Medronho
- Department of Epidemiology and Public Health, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Passos VMDA, Raymundo CE, Bezerra FF, Faerstein E. Diabetes and hypertension are associated with lowered cognitive performance among middle-aged Brazilian adults: cross-sectional analyses nested in the longitudinal Pró-Saúde study. SAO PAULO MED J 2021; 139:46-52. [PMID: 33656123 PMCID: PMC9632506 DOI: 10.1590/1516-3180.2020.0269.r1.30102020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/30/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cardiovascular risk factors are frequently associated with lowered cognitive performance among elderly people, but rarely among middle-aged adults. OBJECTIVES To investigate associations between cardiovascular risk factors (age, physical inactivity, smoking, alcohol use, hypertension and diabetes) and lower cognitive performance among middle-aged (45-64 years) Brazilian adults. DESIGN AND SETTING Cross-sectional study nested within the Pró-Saúde cohort. From 2,876 baseline study participants (1999), we randomly selected 488 participants and gave them validated and standardized cognitive tests (2012). METHODS We used multiple linear and logistic regression analyses to detect associations of cardiovascular risk factors with crude scores in cognitive tests on memory (word test) and executive function (verbal fluency tests), and with overall cognitive performance scores, respectively. RESULTS All cognitive test scores presented statistically significant inverse associations with age and direct associations with education. There was no association between lower cognitive performance and smoking or alcohol use. In both 1999 and 2012, after adjusting for sex, age and schooling, being physically active was inversely associated with lower performance regarding late memory. For individuals with diabetes in 1999, there was an association with lower performance regarding executive function, while there was a borderline association for those reporting it only in 2012. Having a diagnosis of hypertension since 1999 was associated with lower performance regarding both memory and executive functions, while reporting hypertension in 2012 was associated with lower performance regarding executive function. CONCLUSIONS Aging, low schooling and cardiovascular risk factors may represent life course disadvantages associated with cognitive decline even among middle-aged Brazilian adults.
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Affiliation(s)
- Valéria Maria de Azeredo Passos
- MD, PhD. Associate Professor, Postgraduate Program on Health Science, Faculdade de Ciências Médicas de Minas Gerais (FCMMG), Belo Horizonte (MG), Brazil.
| | - Carlos Eduardo Raymundo
- IT, MSc. Doctoral Student, Instituto de Estudos em Saúde Coletiva (IESC), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro (RJ), Brazil.
| | - Flávia Fioruci Bezerra
- RD, DSc. Associate Professor, Institute of Nutrition, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro (RJ), Brazil.
| | - Eduardo Faerstein
- MD, PhD. Associate Professor, Institute of Social Medicine, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro (RJ), Brazil.
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Prata-Barbosa A, Lima-Setta F, Santos GRD, Lanziotti VS, de Castro REV, de Souza DC, Raymundo CE, de Oliveira FRC, de Lima LFP, Tonial CT, Colleti J, Bellinat APN, Lorenzo VB, Zeitel RDS, Pulcheri L, Costa FCMD, La Torre FPF, Figueiredo EADN, Silva TPD, Riveiro PM, Mota ICFD, Brandão IB, de Azevedo ZMA, Gregory SC, Boedo FRO, de Carvalho RN, Castro NADASR, Genu DHS, Foronda FAK, Cunha AJLA, de Magalhães-Barbosa MC. Pediatric patients with COVID-19 admitted to intensive care units in Brazil: a prospective multicenter study. J Pediatr (Rio J) 2020; 96:582-592. [PMID: 32781034 PMCID: PMC7402103 DOI: 10.1016/j.jped.2020.07.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/19/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To describe the clinical characteristics of children and adolescents admitted to intensive care with confirmed COVID-19. METHOD Prospective, multicenter, observational study, in 19 pediatric intensive care units. Patients aged 1 month to 19 years admitted consecutively (March-May 2020) were included. Demographic, clinical-epidemiological features, treatment, and outcomes were collected. Subgroups were compared according to comorbidities, age < 1 year, and need for invasive mechanical ventilation. A multivariable logistic regression model was used for predictors of severity. RESULTS Seventy-nine patients were included (ten with multisystemic inflammatory syndrome). Median age 4 years; 54% male (multisystemic inflammatory syndrome, 80%); 41% had comorbidities (multisystemic inflammatory syndrome, 20%). Fever (76%), cough (51%), and tachypnea (50%) were common in both groups. Severe symptoms, gastrointestinal symptoms, and higher inflammatory markers were more frequent in multisystemic inflammatory syndrome. Interstitial lung infiltrates were common in both groups, but pleural effusion was more prevalent in the multisystemic inflammatory syndrome group (43% vs. 14%). Invasive mechanical ventilation was used in 18% (median 7.5 days); antibiotics, oseltamivir, and corticosteroids were used in 76%, 43%, and 23%, respectively, but not hydroxychloroquine. The median pediatric intensive care unit length-of-stay was five days; there were two deaths (3%) in the non- multisystemic inflammatory syndrome group. Patients with comorbidities were older and comorbidities were independently associated with the need for invasive mechanical ventilation (OR 5.5; 95% CI, 1.43-21.12; p = 0.01). CONCLUSIONS In Brazilian pediatric intensive care units, COVID-19 had low mortality, age less than 1 year was not associated with a worse prognosis, and patients with multisystemic inflammatory syndrome had more severe symptoms, higher inflammatory biomarkers, and a greater predominance of males, but only comorbidities and chronic diseases were independent predictors of severity.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - José Colleti
- Hospital Assunção, São Bernardo do Campo, SP, Brazil
| | | | | | - Raquel de Seixas Zeitel
- Universidade do Estado do Rio de Janeiro (UERJ), Hospital Pedro Ernesto, Rio de Janeiro, RJ, Brazil
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Magalhães-Barbosa MCD, Prata-Barbosa A, Raymundo CE, Cunha AJLAD, Lopes CDS. VALIDADE E CONFIABILIDADE DE UM NOVO SISTEMA DE CLASSIFICAÇÃO DE RISCO PARA EMERGÊNCIAS PEDIÁTRICAS: CLARIPED. Rev paul pediatr 2018; 36:398-406. [PMID: 30540107 PMCID: PMC6322794 DOI: 10.1590/1984-0462/;2018;36;4;00017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 09/24/2017] [Indexed: 05/30/2023]
Abstract
Objective: To assess the validity and reliability of a triage system for pediatric
emergency care (CLARIPED) developed in Brazil. Methods: Validity phase: prospective observational study with children aged 0 to 15
years who consecutively visited the pediatric emergency department (ED) of a
tertiary hospital from July 2 to 18, 2013. We evaluated the association of
urgency levels with clinical outcomes (resource utilization, ED admission
rate, hospitalization rate, and ED length of stay); and compared the
CLARIPED performance to a reference standard. Inter-rater reliability phase:
a convenience sample of patients who visited the pediatric ED between April
and July 2013 was consecutively and independently double triaged by two
nurses, and the quadratic weighted kappa was estimated. Results: In the validity phase, the distribution of urgency levels in 1,416 visits
was the following: 0.0% red (emergency); 5.9% orange (high urgency); 40.5%
yellow (urgency); 50.6% green (low urgency); and 3.0% blue (no urgency). The
percentage of patients who used two or more resources decreased from the
orange level to the yellow, green, and blue levels (81%, 49%, 22%, and 2%,
respectively, p<0.0001), as did the ED admission rate,
ED length of stay, and hospitalization rate. The sensitivity to identify
patients with high urgency level was 0.89 (confidence interval of 95%
[95%CI] 0.78-0.95), and the undertriage rate was 7.4%. The inter-rater
reliability in 191patients classified by two nurses was substantial
(kw2=0.75; 95%CI 0.74-0.79). Conclusions: The CLARIPED system showed good validity and substantial reliability for
triage in a pediatric emergency department.
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Canela LNP, Magalhães-Barbosa MCD, Raymundo CE, Carney S, Siqueira MM, Prata-Barbosa A, Cunha AJLAD. Viral detection profile in children with severe acute respiratory infection. Braz J Infect Dis 2018; 22:402-411. [PMID: 30365924 PMCID: PMC7138071 DOI: 10.1016/j.bjid.2018.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 09/03/2018] [Accepted: 09/06/2018] [Indexed: 01/15/2023] Open
Abstract
Objectives The role of viral co-detection in children with severe acute respiratory infection is not clear. We described the viral detection profile and its association with clinical characteristics in children admitted to the Pediatric Intensive Care Unit (PICU) during the 2009 influenza A(H1N1) pandemic. Method Longitudinal observational retrospective study, with patients aged 0–18 years, admitted to 11 PICUs in Rio de Janeiro, with suspected H1N1 infection, from June to November, 2009. The results of respiratory samples which were sent to the Laboratory of Fiocruz/RJ and clinical data extracted from specific forms were analyzed. Results Of 71 samples, 38% tested positive for H1N1 virus. Of the 63 samples tested for other viruses, 58 were positive: influenza H1N1 (43.1% of positive samples), rhinovirus/enterovirus (41.4%), respiratory syncytial vírus (12.1%), human metapneumovirus (12.1%), adenovirus (6.9%), and bocavirus (3.5%). Viral codetection occured in 22.4% of the cases. H1N1-positive patients were of a higher median age, had higher frequency of fever, cough and tachypnea, and decreased leukometry when compared to H1N1-negative patients. There was no difference in relation to severity outcomes (number of organic dysfunctions, use of mechanical ventilation or amines, hospital/PICU length of stay or death). Comparing the groups with mono-detection and co-dection of any virus, no difference was found regarding the association with any clinical variable. Conclusions Other viruses can be implicated in SARI in children. The role of viral codetection has not yet been completely elucidated.
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Affiliation(s)
| | | | | | - Sharon Carney
- Fundação Oswaldo Cruz (Fiocruz), Laboratório de Vírus Respiratórios e do Sarampo, Rio de Janeiro, RJ, Brazil
| | - Marilda Mendonca Siqueira
- Fundação Oswaldo Cruz (Fiocruz), Laboratório de Vírus Respiratórios e do Sarampo, Rio de Janeiro, RJ, Brazil
| | - Arnaldo Prata-Barbosa
- Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, RJ, Brazil; Universidade Federal do Rio de Janeiro (UFRJ), Faculdade de Medicina, Departamento de Pediatria, Rio de Janeiro, RJ, Brazil
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de Magalhães-Barbosa MC, Prata-Barbosa A, Robaina JR, Raymundo CE, Lima-Setta F, Antonio José Ledo Alves da Cunha. Prevalence of microcephaly in eight south-eastern and midwestern Brazilian neonatal intensive care units: 2011-2015. Arch Dis Child 2017; 102:728-734. [PMID: 28302630 DOI: 10.1136/archdischild-2016-311541] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 02/05/2017] [Accepted: 02/10/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To describe the prevalence of microcephaly in infants admitted to the neonatal intensive care units (NICUs) in eight private hospitals in south-eastern and midwestern Brazil, from 2011 to 2015. DESIGN Observational, cross-sectional study in a cohort of neonates. SETTING Eight private NICUs situated in the cities of Rio de Janeiro (RJ), São Paulo (SP) and Federal District of Brasilia (FDB). PATIENTS Neonates up to 7 days of age and >23 weeks of gestational age. MAIN OUTCOME MEASURES Primary outcomes were the annual prevalence of microcephaly and severe microcephaly, both overall and in subgroups according to gestational age, type of microcephaly (proportional or disproportional) and the NICU's location in RJ, SP or FDB. RESULTS In this cohort of 8275 neonates admitted to eight private NICUs, the overall prevalence of microcephaly was 5.6% (95% CI 5.1% to 6.1%) and severe microcephaly, 1.5% (95% CI 1.2% to 1.7%). There was no annual variation in these overall estimates (p=0.48 and p=0.99, respectively), nor in the studied subgroups. Microcephaly prevalence was higher in extremely premature and term newborns (7.7% and 7.2%; p<0.001, respectively). Disproportional microcephaly was much more common than proportional microcephaly (prevalence 5.0% vs 0.6%; p<0.001). CONCLUSIONS The prevalence of microcephaly showed little variation from 2011 to 2015 in these south-eastern and midwestern Brazilian NICUs, suggesting that the impact of the Zika epidemic in neonates that occurred mainly in the north-eastern region in 2015 did not yet affect the infants of those regions during the studied period. These prevalence results can serve as a reference for comparisons with any future Zika outbreaks in the same or similar populations from these regions.
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Affiliation(s)
| | - Arnaldo Prata-Barbosa
- Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, Rio de Janeiro, Brazil.,Instituto de Puericultura e Pediatria Martagão Gesteira-Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Fernanda Lima-Setta
- Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, Rio de Janeiro, Brazil.,Instituto Fernandes Figueira da Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
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Magalhães-Barbosa MCD, Prata-Barbosa A, Robaina JR, Raymundo CE, Lima-Setta F, Cunha AJLAD. New trends of the microcephaly and Zika virus outbreak in Brazil, July 2016-December 2016. Travel Med Infect Dis 2017; 16:52-57. [PMID: 28342826 DOI: 10.1016/j.tmaid.2017.03.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 03/19/2017] [Accepted: 03/21/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Maria Clara de Magalhães-Barbosa
- Instituto D'Or de Pesquisa e Ensino (IDOR), Departamento de Pediatria, Rua Diniz Cordeiro 30, Botafogo, Rio de Janeiro, Rio de Janeiro, 22281-100, Brazil.
| | - Arnaldo Prata-Barbosa
- Instituto D'Or de Pesquisa e Ensino (IDOR), Departamento de Pediatria, Rua Diniz Cordeiro 30, Botafogo, Rio de Janeiro, Rio de Janeiro, 22281-100, Brazil; Faculdade de Medicina da Universidade Federal do Rio de Janeiro, Departamento de Pediatria, Cidade Universitária, Rua Bruno Lobo, nº 50, Rio de Janeiro, 21941-612, Brazil.
| | - Jaqueline Rodrigues Robaina
- Instituto D'Or de Pesquisa e Ensino (IDOR), Departamento de Pediatria, Rua Diniz Cordeiro 30, Botafogo, Rio de Janeiro, Rio de Janeiro, 22281-100, Brazil.
| | - Carlos Eduardo Raymundo
- Instituto D'Or de Pesquisa e Ensino (IDOR), Departamento de Pediatria, Rua Diniz Cordeiro 30, Botafogo, Rio de Janeiro, Rio de Janeiro, 22281-100, Brazil.
| | - Fernanda Lima-Setta
- Instituto D'Or de Pesquisa e Ensino (IDOR), Departamento de Pediatria, Rua Diniz Cordeiro 30, Botafogo, Rio de Janeiro, Rio de Janeiro, 22281-100, Brazil.
| | - Antonio José Ledo Alves da Cunha
- Faculdade de Medicina da Universidade Federal do Rio de Janeiro, Departamento de Pediatria, Rua Bruno Lobo, nº 50, Cidade Universitária, Rio de Janeiro, 21941-612, Brazil.
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Magalhães-Barbosa MCD, Prata-Barbosa A, Robaina JR, Raymundo CE, Lima-Setta F, Cunha AJLAD. Trends of the microcephaly and Zika virus outbreak in Brazil, January-July 2016. Travel Med Infect Dis 2016; 14:458-463. [PMID: 27702683 DOI: 10.1016/j.tmaid.2016.09.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 09/09/2016] [Accepted: 09/13/2016] [Indexed: 10/20/2022]
Abstract
In the last two months, there have been indications that the Zika virus epidemic is on the decline in Brazil. We reviewed the surveillance data published by the Brazilian Ministry of Health to assess trends of microcephaly and neurological abnormalities suggestive of congenital infection, as well as Zika virus disease in Brazil as a whole and its various regions. From November 2015 to July 2016, 8301 cases of microcephaly were reported in Brazil, mainly in the Northeast region. The number of newly reported cases is declining throughout the country, except in the Southeast region. The numbers of cases that remain under investigation still represent 37.7% of all reported cases in early July. Meanwhile, from January to June, 2016, 165,241 cases of Zika virus disease were reported in Brazil. The state of Rio de Janeiro (Southeast) experienced the third highest incidence, lagging behind only the states of Bahia (Northeast) and Mato Grosso (Midwest). In early June, the number of new Zika virus cases showed a marked decline in all of the regions, except the North. Although the Zika epidemic seems to be diminishing, continued monitoring and surveillance of reported microcephaly and neurological abnormality cases is essential, and investigation efforts need to be vastly improved, as some states still reported high incidences of Zika disease in the first half of 2016.
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Affiliation(s)
- Maria Clara de Magalhães-Barbosa
- Instituto D'Or de Pesquisa e Ensino (IDOR), Departamento de Pediatria, Rua Diniz Cordeiro 30, Botafogo, Rio de Janeiro, Rio de Janeiro, 22281-100, Brazil.
| | - Arnaldo Prata-Barbosa
- Instituto D'Or de Pesquisa e Ensino (IDOR), Departamento de Pediatria, Rua Diniz Cordeiro 30, Botafogo, Rio de Janeiro, Rio de Janeiro, 22281-100, Brazil; Faculdade de Medicina da Universidade Federal do Rio de Janeiro, Departamento de Pediatria, Rua Bruno Lobo, n° 50, Cidade Universitária, Rio de Janeiro, Rio de Janeiro, 21941-612, Brazil.
| | - Jaqueline Rodrigues Robaina
- Instituto D'Or de Pesquisa e Ensino (IDOR), Departamento de Pediatria, Rua Diniz Cordeiro 30, Botafogo, Rio de Janeiro, Rio de Janeiro, 22281-100, Brazil.
| | - Carlos Eduardo Raymundo
- Instituto D'Or de Pesquisa e Ensino (IDOR), Departamento de Pediatria, Rua Diniz Cordeiro 30, Botafogo, Rio de Janeiro, Rio de Janeiro, 22281-100, Brazil.
| | - Fernanda Lima-Setta
- Instituto D'Or de Pesquisa e Ensino (IDOR), Departamento de Pediatria, Rua Diniz Cordeiro 30, Botafogo, Rio de Janeiro, Rio de Janeiro, 22281-100, Brazil.
| | - Antonio José Ledo Alves da Cunha
- Faculdade de Medicina da Universidade Federal do Rio de Janeiro, Departamento de Pediatria, Rua Bruno Lobo, n° 50, Cidade Universitária, Rio de Janeiro, Rio de Janeiro, 21941-612, Brazil.
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Magalhães MDC, Raymundo CE, Bustamante-Teixeira MT. Morbidade materna extremamente grave a partir dos registros de internação hospitalar do Sistema Único de Saúde: algoritmo para identificação dos casos. Rev Bras Saude Mater Infant 2013. [DOI: 10.1590/s1519-38292013000100002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVOS: identificar os códigos de procedimentos constantes no Sistema de Informação Hospitalar - Sistema Único de Saúde (SIH-SUS) considerados como Morbidade Materna Extremamente Grave (MMEG) e construir um algoritmo para o manejo/preparação da base de dados de Autorização de Internação Hospitalar visando a captura dos casos de MMEG neste banco de dados. MÉTODOS: utilizaram-se os dados do SIH-SUS fornecidos pela Secretaria de Saúde de Juiz de Fora e referem se as internações ocorridas no SUS no período de 2006-2007. Foram selecionadas todas as internações cujo diagnóstico principal compreendia todo o capítulo XV da Classificação Internacional de Doenças (CID10) - Complicações da gravidez, aborto, parto e puerpério e/ou internações em que procedimentos obstétricos foram realizados. Para identificação dos procedimentos no SIH-SUS, considerados como MMEG, adotaram-se os critérios propostos pela Organização Mundial da Saúde. O algoritmo foi desenvolvido no software Microsoft Access. RESULTADOS: foram capturados 326 casos de MMEG entre as 8620 mulheres selecionadas, perfazendo uma taxa de 37,8/1000 mulheres. Os procedimentos mais frequentes foram transfusão de hemoderivados, "permanência a maior" e pré-eclampsia grave/eclâmpsia, com prevalências de 15,7/1000, 9,5/1000 e 8,2/1000, respectivamente. CONCLUSÕES: o algoritmo utilizado pode otimizar o uso do SIH-SUS para a captação dos casos de MMEG e gerar informações para os serviços de vigilância da morbimortalidade materna e avaliação de cuidados obstétricos.
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