Adauto Emmerich Oliveira

Adequação do processo da assistência pré-natal segundo os critérios do Programa de Humanização do Pré-natal e Nascimento e Rede Cegonha

PURPOSE To evaluate the adequacy of the process of prenatal care according to the parameters of the Program for the Humanization of Prenatal Care (PHPN) and of the procedures provided by the Stork Network of Unified Health System (SUS) in the microregion of Espirito Santo state, Brazil. METHODS A cross-sectional study was conducted in 2012-2013 by interviewing and analyzing the records of 742 women during the postpartum period and of their newborns in 7 hospitals in the region chosen for the research. The information was collected, processed and analyzed by the χ² and Fishers exact test to determine the difference in proportion between the criteria adopted by the PHPN and the Stork Network and the place of residence, family income and type of coverage of prenatal service. The level of significance was set at 5%. RESULTS The parameters showing the lowest adequacy rate were quick tests and repeated exams, with frequencies around 10 and 30%, respectively, in addition to educational activities (57.9%) and tetanus immunization (58.7%). In contrast, risk management (92.6%) and the fasting plasma glucose test (91.3%) showed the best results. Adequacy was 7.4% for the PHPN, 0.4% for the Stork Network, with respect to the parameters of normal risk pregnancies, and 0 for high risk pregnancies. There was a significant difference between puerperae according to housing location regarding the execution of serology for syphilis (VDRL), anti-HIV and repeated fasting glucose tests, and monthly income influenced the execution of blood type/Rh factor tests, VDRL, hematocrit and anti-HIV test. CONCLUSION Prenatal care in the SUS proved to be inadequate regarding the procedures required by the PHPN and Stork Network in the micro-region of a state in southeastern Brazil, especially for women of lower income, PACS users and residents of rural areas.

Association between food consumption in the first months of life and socioeconomic status: a longitudinal study

OBJETIVO: Objetivou-se descrever a qualidade do consumo alimentar de criancas a partir da inclusao da alimentacao complementar liquida e semi-solida, nos primeiros meses de vida, alem de determinar as associacoes entre as praticas alimentares e as condicoes socioeconomicas. METODOS: O grupo inicial constituiu-se por 86 bebes com idades de 0 a 3 meses, selecionados em areas de abrangencia de tres Unidades Basicas de Saude do Municipio de Vitoria (ES). Realizaram-se sete visitas domiciliares, coletando-se dados sobre as caracteristicas maternas, o padrao de dieta adotado pelas maes e os habitos de succao da crianca. Os testes de Qui-quadrado foram aplicados e analises de regressao logistica foram realizadas para mensurar as associacoes. RESULTADOS: Aproximadamente 50% iniciaram alimentacao complementar por mamadeira ate os tres meses de vida, enquanto a alimentacao complementar semi-solida ate os seis meses de vida ocorreu em 75% das criancas. Os modelos de regressao logistica mostraram que a ausencia de participacao paterna na renda familiar configura-se como risco para o consumo de feijao (OR=3,9: IC 95%= 1,2-12,6). A renda maior ou igual a dois salarios minimos torna-se potencialmente fator de protecao para o consumo de frutas (OR=0,4: IC 95% 0,14-1,15). CONCLUSAO: Os percentuais de consumo alimentar revelaram a predominância de um padrao inadequado a faixa etaria de menores de dois anos. O grau de instrucao da mae e a participacao direta do pai na renda da familia parecem influenciar nas escolhas de alguns alimentos, como frutas e feijao. Entretanto, nao explicam completamente as praticas alimentares infantis nos primeiros meses de vida, sinalizando que outras questoes mais complexas podem estar envolvidas.OBJECTIVE: This paper aims to describe the quality of the feeding practices of infants from the moment liquids and semi-solid foods are introduced into their diets and to determine associations between feeding practices and socioeconomic status. METHODS: The initial population consisted of 86 infants aged 0 to 3 months; they were selected from 3 Public Primary Healthcare Units of the city of Vitoria. Seven visits were made to the childrens homes to collect descriptive data on the mother, house, eating habits and sucking habits. Chi-square tests were applied and logistic regression analysis was performed to measure the associations. RESULTS: Approximately 50% of the children were given bottles before age 3 months, while semi-solid foods were given to 75% of the infants aged 6 months or less. Logistic regression models showed that the lack of paternal contribution to the familys income is a risk factor for the consumption of beans (OR =3.9; CI - 95% =1.2-12.6). Family income equal to or above two minimum wages was likely to promote fruit consumption (OR =0.4: CI - 95%=0.14-1.15). CONCLUSION: Food variety percentages revealed that most children under two years of age were not being fed properly. The mothers education level and contribution of the father to family income seem to influence the consumption of certain foods, such as fruits and beans. However, they do not fully explain the feeding practices found in the first months of life, showing that other more complex issues may be involved.

Concordância entre informações do Cartão da Gestante e da memória materna sobre assistência pré-natal

This cross-sectional study aimed to verify agreement between information given by mothers after delivery and data recorded on Pregnant Cards about antenatal care under the Brazilian Unified National Health System in the Metropolitan Region of Vitoria, Espirito Santo State, Brazil. The study considered a population of 1,035 postpartum mothers interviewed in eight hospitals, where the cards were copied. The representativeness of the sample was guaranteedby stratification according to the proportion of births. Kappa and McNemar tests were carried out with the collected and processed information. Agreement levels regarding antenatal care were predominantly poor (kappa < 0.20). Mothers tend to: overestimate the number of antenatal visits (McNemar = 51.73; p-value = 0.001); affirm diseases during pregnancy, such as diabetes, anemia, hypertension and urinary infections; report the performance of laboratory tests; report the carrying out of clinical examinations. Results suggest the need to reflect on the type of data used for planning and implementing maternal and child public health polices, since data varies depending on the information source.

Acesso à assistência odontológica no acompanhamento pré-natal

This study sought to evaluate the self-perceived response to dental care during prenatal assistance in the Unified Health System (SUS) in the Metropolitan Region of Vitoria, Espirito Santo, Brazil. 1032 postpartum women were interviewed and 1006 prenatal records copied. Postpartum womens self-perceived response was measured by the Oral Health Index Profile-14. When an impact was identified, dental care rendered in educational, preventive and curative terms was considered adequate. When there was no impact, assistance was considered adequate in educational and preventive terms. The Chi-square test revealed an association between prenatal care and dental care. Oral health impact on quality of life was 14.7%. Dental care received by mothers in educational terms was rated at 41.3%, while in preventive terms it was 21% and in curative terms it was 16.6%. Six or more prenatal appointments coupled with educational activities was closely associated with adequate dental care (p < 0.05). Access to dental care is facilitated when pregnant women attend health services and become involved in educational activities during the prenatal period. Consequently, educational measures appear to indicate an improvement in prenatal care in the SUS.

O processo de trabalho do técnico em saúde bucal e suas relações com a equipe de saúde bucal na Região Metropolitana da Grande Vitória, Espírito Santo, Brasil

O objetivo deste estudo e analisar a compreensao dos cirurgioes-dentistas (CDs) sobre o processo de trabalho e as relacoes da equipe de saude com os Tecnicos em Saude Bucal (TSBs). Em cinco municipios da Regiao Metropolitana da Grande Vitoria (RMGV), Espirito Santo (ES), Brasil, foram selecionados 18 sujeitos, a partir de uma amostra probabilistica de 217 CDs que atuavam no Sistema Unico de Saude (SUS). Os sujeitos foram entrevistados a partir de um roteiro-guia semiestruturado, do qual constavam temas relacionados a organizacao do trabalho na saude bucal; as atribuicoes e responsabilidades do TSB; a relacao entre o cirurgiao-dentista e o TSB; a relacao com a equipe de saude e autonomia do TSB. Os dados foram analisados a partir da Analise de Conteudo sugerida por Bardin. Constatou-se que os CDs valorizam a importância da participacao dos TSBs na reorganizacao do trabalho odontologico e a construcao de uma relacao de parceria e cooperacao. Contudo, os CDs reconhecem que a relacao com os TSBs e prejudicada pela desinformacao sobre o processo de trabalho. Alem disso, os CDs demonstram receios quanto a possibilidade de os TSBs tornarem-se dentistas praticos e tomarem seu espaco no mercado de trabalho. Tambem ha preocupacoes sobre a responsabilizacao legal dos CDs sobre atividades desenvolvidas pelos TSBs.

Access to prenatal care: assessment of the adequacy of different indices

This study aimed to compare the evaluation of adequate access to prenatal care according to different indices. Data to construct the indices were obtained from 1,006 patient interviews, prenatal cards, and medical charts for postpartum women who had been admitted for childbirth at maternity hospitals in Greater Metropolitan Vitória, Espírito Santo State, Brazil, from April to September 2010. The various indices for the evaluation of prenatal care were compared to the Kotelchuck index (1994) as the standard reference. Prevalence rates for adequacy were calculated, as were agreement, sensitivity, specificity, predictive values, accuracy, and likelihood ratios. The Takeda index showed the highest prevalence of adequacy (55.8%). The highest agreement was between the indices proposed by Villar et al. and Rosen et al. (adjusted kappa = 0.84). The study concludes that the Carvalho & Novaes index and the Brazilian Ministry of Health index are relevant for assessing adequate access to prenatal care.

The influence of sucking habits on occlusion development in the first 36 months

OBJECTIVE: The objective of this study was to identify the influence of sucking habits on the occlusal characteristics of the deciduous dentition. METHODS: The initial sample consisted of 86 infants, aged 0 to 3 months. Seven home visits were performed, when and information on breastfeeding practice, nutritive and non-nutritive sucking habits, mouth breathing and dentition development was collected. From the first sample, impressions of the dental arches were obtained from 58 children at the age of 36 months (+2.51SD). Dental casts were obtained and two examiners, trained and calibrated by the Kappa and Pearson Correlation tests, measured several parameters of dental occlusion, such as arch length, depth, and width. RESULTS: The results showed that bottle feeding before 6 months was associated to an increased mandibular intermolar width (p=0.01). Pacifier use before 6 months was statistically associated to a reduction of the maxillary intercanine (p=0.03) and intermolar (p=0.03) width. In addition to these findings, the increased molar depth of the maxillary arch was associated to loss of lip closure before the age of 12 months (p= 0.03). CONCLUSION: According to these results, it could be concluded that sucking habits interfere with the determination of some deciduous occlusal characteristics: pacifier sucking limits lateral-lateral maxillary growth, bottle feeding favors lateral-lateral mandibular growth and open bite development, and the lack of lip closure favors the anteroposterior maxillary growth.

Mothers' memory about breastfeeding and sucking habits in the first months of life for their children

Objective: To validate the information of mothers’ memory about breastfeeding and sucking habits in the first months of their children’s life. Methods: A cohort study followed 86 children for 36 months from birth. In the initial moment, zero to three months-old infants were assessed about breastfeeding, sucking habits and semisolid food introduction. Nearly six years after the initial study, 53 mothers of these children were re-interviewed regarding their recall about breastfeeding, sucking habits and semisolid food introduction. Kappa, McNemar, Student’s t, and intraclass correlation tests were used to verify the association between previous and current maternal memory. Results: Disagreement between previous and current maternal memory was found regarding thumb-sucking (McNemar; p=0.001) and pacifier use (McNemar; p=0.009). In addition, mothers in the current interview report older ages for introducing bottle feed (Student’s t; p=0.043) and semisolid food (Student’s t; p=0.001). However, memory about duration of breastfeeding presented high intraclass correlation coefficient (ρ=0.923; p=0.001). Conclusions: Maternal information about duration of breastfeeding and age of pacifier withdraw is valid for use in retrospective studies. Introduction of bottle feeding, pacifier and semisolid foods during the first six months of life may suffer a recordatory bias.OBJETIVO: Validar las informaciones de la memoria materna sobre amamantacion y habitos de succion los primeros meses de la vida de sus hijos, en Vitoria, Espirito Santo (Brasil). METODOS: Estudio de cohorte que siguio, durante 36 meses, a 86 ninos con edad inicial de cero a tres meses para evaluar los desenlaces sobre: amamantacion, habitos de succion e inicio de la alimentacion semi-solida. Aproximadamente seis anos despues del estudio inicial, 53 madres de esos ninos fueron re-entrevistados respecto a los habitos alimentares y de succion de sus hijos. Pruebas de Kappa, McNemar, t de Student y correlacion intraclase fueron utilizadas para probar la relacion entre la memoria materna anterior y actual. RESULTADOS: La memoria materna anterior y actual discordo sobre las practicas de succion de dedo (McNemar; p=0,001) y de chupete (McNemar; p=0,009) por sus hijos. Ademas, la memoria materna actual relato edades mas tardias para el inicio del biberon (t de Student; p=0,043) y de la alimentacion semi-solida (t de Student; p=0,001). Sin embargo, presento un alto coeficiente de correlacion intraclase cuando la informacion recordada fue el tiempo de amamantacion (r=0,923; p=0,001). CONCLUSIONES: Informaciones maternas sobre el tiempo de amamantacion y sobre la edad de termino del habito de succion del chupete son validas para uso en estudios retrospectivos. Con menor nivel de validez, se puede utilizar las informaciones sobre la succion de chupete y de biberon en los primeros seis meses de vida, sumadas a la edad de la introduccion del uso de biberon por las madres

Representações sociais sobre o acesso e o cuidado pré-natal no Sistema Único de Saúde da Região Metropolitana da Grande Vitória, Espírito Santo

As representacoes sociais das puerperas sobre o acesso ao cuidado pre-natal destacam aspectos relacionados as barreiras de acesso e as formas de sua superacao. O objetivo deste trabalho foi analisar o acesso ao cuidado pre-natal a partir das representacoes sociais de usuarias do Sistema Unico de Saude. A partir de 1.035 puerperas, selecionaram-se 24 puerperas da Regiao Metropolitana da Grande Vitoria, Espirito Santo: um grupo de 14 puerperas que realizou mais de seis consultas de pre-natal e um grupo de 10 puerperas que realizou nenhuma ou ate tres consultas. Entrevistas individuais abordaram qualitativamente questoes sobre o acesso aos servicos de saude, segundo as dimensoes disponibilidade, capacidade de pagar e aceitabilidade. A analise de conteudo tematica revelou situacoes de acesso satisfatorio, mas tambem a existencia de barreiras de acesso geografico, organizacionais, indisponibilidade de recursos materiais e humanos, custos diretos e indiretos para a obtencao do cuidado e expectativas nao atendidas sobre os procedimentos e os aspectos mais subjetivos, resultados semelhantes nos dois grupos estudados. As diferencas na capacidade de enfrentamento desses obstaculos foram determinantes para o acesso adequado ao cuidado pre-natal. Considera-se que incluir as representacoes sociais das gestantes na avaliacao do cuidado pre-natal facilita a adocao de medidas que assegurem a melhoria do acesso.

Memória das mães sobre amamentação e hábitos de sucção nos primeiros meses da vida de seus filho

Objective: To validate the information of mothers’ memory about breastfeeding and sucking habits in the first months of their children’s life. Methods: A cohort study followed 86 children for 36 months from birth. In the initial moment, zero to three months-old infants were assessed about breastfeeding, sucking habits and semisolid food introduction. Nearly six years after the initial study, 53 mothers of these children were re-interviewed regarding their recall about breastfeeding, sucking habits and semisolid food introduction. Kappa, McNemar, Student’s t, and intraclass correlation tests were used to verify the association between previous and current maternal memory. Results: Disagreement between previous and current maternal memory was found regarding thumb-sucking (McNemar; p=0.001) and pacifier use (McNemar; p=0.009). In addition, mothers in the current interview report older ages for introducing bottle feed (Student’s t; p=0.043) and semisolid food (Student’s t; p=0.001). However, memory about duration of breastfeeding presented high intraclass correlation coefficient (ρ=0.923; p=0.001). Conclusions: Maternal information about duration of breastfeeding and age of pacifier withdraw is valid for use in retrospective studies. Introduction of bottle feeding, pacifier and semisolid foods during the first six months of life may suffer a recordatory bias.OBJETIVO: Validar las informaciones de la memoria materna sobre amamantacion y habitos de succion los primeros meses de la vida de sus hijos, en Vitoria, Espirito Santo (Brasil). METODOS: Estudio de cohorte que siguio, durante 36 meses, a 86 ninos con edad inicial de cero a tres meses para evaluar los desenlaces sobre: amamantacion, habitos de succion e inicio de la alimentacion semi-solida. Aproximadamente seis anos despues del estudio inicial, 53 madres de esos ninos fueron re-entrevistados respecto a los habitos alimentares y de succion de sus hijos. Pruebas de Kappa, McNemar, t de Student y correlacion intraclase fueron utilizadas para probar la relacion entre la memoria materna anterior y actual. RESULTADOS: La memoria materna anterior y actual discordo sobre las practicas de succion de dedo (McNemar; p=0,001) y de chupete (McNemar; p=0,009) por sus hijos. Ademas, la memoria materna actual relato edades mas tardias para el inicio del biberon (t de Student; p=0,043) y de la alimentacion semi-solida (t de Student; p=0,001). Sin embargo, presento un alto coeficiente de correlacion intraclase cuando la informacion recordada fue el tiempo de amamantacion (r=0,923; p=0,001). CONCLUSIONES: Informaciones maternas sobre el tiempo de amamantacion y sobre la edad de termino del habito de succion del chupete son validas para uso en estudios retrospectivos. Con menor nivel de validez, se puede utilizar las informaciones sobre la succion de chupete y de biberon en los primeros seis meses de vida, sumadas a la edad de la introduccion del uso de biberon por las madres