Antônio Augusto Moura da Silva

Early Growth and Neurologic Outcomes of Infants with Probable Congenital Zika Virus Syndrome

We report the early growth and neurologic findings of 48 infants in Brazil diagnosed with probable congenital Zika virus syndrome and followed to age 1–8 months. Most of these infants had microcephaly (86.7%) and craniofacial disproportion (95.8%). The clinical pattern included poor head growth with increasingly negative z-scores, pyramidal/extrapyramidal symptoms, and epilepsy.

Coverage and factors associated with not performing Pap smear screening tests in São Luís, Maranhão, Brazil

Com o objetivo de estimar a cobertura, a periodicidade, e identificar fatores associados a nao realizacao do exame preventivo de Papanicolau, 465 mulheres de 25 a 49 anos residentes no municipio de Sao Luis foram entrevistadas em 1998. Foi realizado inquerito domiciliar pelo metodo de amostragem por conglomerados em tres estagios. Na analise estatistica foram calculados intervalos de confianca de 95% corrigidos pelo desenho do estudo, e os odds ratio brutos e ajustados por regressao logistica. A cobertura do Papanicolaou pelo menos uma vez na vida foi de 82,4% (Intervalo de Confianca 95%, 76,6 - 87,0%), praticamente atingindo a cobertura minima necessaria de 85% para causar impacto epidemiologico na incidencia e mortalidade por câncer cervico-uterino. O intervalo entre a realizacao dos exames foi curto, pois 65,8% das mulheres repetiram o exame com ate um ano. Apos o ajuste para fatores de confundimento foram associados a nao realizacao do Papanicolaou: nao ter companheiro, ter cinco a oito anos de escolaridade, nao ter realizado consulta medica nos tres ultimos meses e morar em domicilio cujo chefe de familia tem ocupacao manual nao especializada. Ter tido de dois a quatro parceiros sexuais nos tres ultimos meses foi associado a menor risco de nao realizacao do preventivo. Em capital do Nordeste, a cobertura do exame preventivo de Papanicolaou foi semelhante a relatada em outros estudos nacionais. Entretanto, algumas mulheres realizaram citologias desnecessarias a intervalos curtos, implicando em desperdicio de recursos e dificultando o acesso aos grupos mais vulneraveis que apresentaram maiores riscos de nao testagem.

Saúde perinatal em Ribeirão Preto, SP, Brasil: a questão do método

Os autores apresentam a metodologia do planejamento, montagem, execucao empirica e um prototipo de analise de pesquisa em saude perinatal. No projeto foram estudados todos os partos hospitalares (resultando recem-nascidos vivos) no municipio de Ribeirao Preto, Brasil, no periodo de l de junho de 1978 a 31 de maio de 1979. O estudo foi feito atraves de entrevistas com todas as puerperas que deram o luz nos 8 hospitas-maternidades do municipio, e as informacoes obtidas referiam-se aos pais, a renda, a gestacao e ao parto, incluindo a atencao medica ao recem-nascido, ao obito da crianca (quando ocorresse), a etnia e a reproducao humana. Sao apresentados em detalhes, os passos para a execucao do projeto, bem como a conceituacao da classe social e sua operacionalizacao, ponto basico para o modelo de analise.

Increasing pre-term and low-birth-weight rates over time and their impact on infant mortality in south-east Brazil.

This study investigates the possible effects of pre-term births and low birth weight on infant mortality rates (IMRs) over a 15-year period in Ribeirão Preto, Brazil, based on surveys carried out in 1978/79 and 1994. The 1978/79 survey included 6750 births over a 12-month period and the 1994 survey 2846 births over a 4-month period. Infant deaths were retrieved monthly from the city register. Infant mortality rate decreased from 36.6 to 16.9 deaths per 1000 over 15 years. The decrease in IMR was larger in the 2500-2999 g group than in any other group. The observed falls in IMR were attributable to decreases in birth-weight-specific mortality rates. Likewise, there was a general decrease in IMR in mild, moderate and severe pre-term births. The incidence rate ratio of infant mortality between surveys was 0.46 (95% CI 0.34-0.63); it increased to 0.57 (95% CI 0.35-0.75) when adjusted for birth weight and other factors in the model and rose to 0.69 (95% CI 0.49-0.97) when adjusted for length of gestation and other variables. The increase in pre-term births and low birth weight may have had, at most, a marginal effect on the IMR. Progress in the care of newborns may have decreased the mortality risk, but even mild pre-term birth still has an impact on infant mortality. There is room for further improvement in IMR by tackling the high rates of pre-term birth.

Hantavirus infection in Anajatuba, Maranhao, Brazil.

In 2000, the first outbreak of hantavirus pulmonary syndrome was recognized in the Brazilian Amazon (Maranhão State). An epidemiologic study identified a 13.3% prevalence of hantavirus-specific immunoglobulin G. The analysis of risk factors suggests that persons are occupationally exposed to infected rodents in the crop fields.

Avaliação do conhecimento sobre hemoterapia e segurança transfusional de profissionais de enfermagem

The risks involved in blood and blood component transfusion can be caused by inadequate procedures and mistakes or omissions by professionals responsible for transfusion. The present study aims at evaluating the level of knowledge on this issue and about the adequacy of the transfusional practices of nurses at a large university hospital in the State of Sao Paulo, Brazil. The study was conducted during an in-service training course on hemotherapy. A data collection instrument was applied before and after the training, when the professionals were asked about their knowledge of transfusion practices. Study participants were nurses and nursing assistants, all of whom were responsible for transfusion procedures. More than half the participants felt that they were given little information or were badly informed about transfusions. A large portion of the professionals mentioned that the signs and symptoms of transfusion reactions are not explained to patients. Many participants reported inadequate blood warming procedures. The evaluation of the knowledge showed significant defects in the education of these nursing professionals.

Risk Factors for Intrauterine Growth Restriction: A Comparison between Two Brazilian Cities

In Brazil, similar intrauterine growth restriction (IUGR) rates were observed between cities with distinct levels of socioeconomic development, challenging the current knowledge that higher rates of IUGR would necessarily be observed in poorer areas than in wealthier ones. Ribeirão Preto, a city located in the most developed area in Brazil, showed an IUGR rate of 18% in 1994, whereas this rate was 18.5% in 1997/1998 in São Luís, located in one of the poorest areas in the country. The objective of this study was to compare risk factors for IUGR in these two cities and to identify factors that are responsible for this unexpected lack of difference between the rates. Using data from two birth cohorts, including 2839 neonates who were from Ribeirão Preto and born in 1994 and 2439 neonates who were from São Luís and born in 1997/1998, a multivariable analysis was conducted to assess changes in the risk for IUGR in the poorer city compared with the wealthier one in a combined model, adjusting for some risk factors for IUGR. The wealthier city showed higher rates of maternal smoking, attendance in the private sector, and obstetric interventions than the less developed one. Differences in maternal smoking and obstetric interventions were possibly responsible for the similarity of the rates between cities. It seems that early detection of IUGR followed by cesarean section in the wealthier city is associated with increased low birth weight and IUGR rates but reduced stillbirth and infant mortality rates.

Cesarean section and increased body mass index in school children: two cohort studies from distinct socioeconomic background areas in Brazil

BackgroundRecent studies have raised controversy regarding the association between cesarean section and later obesity in the offspring. The purpose of this study was to assess the association of cesarean section with increased body mass index (BMI) and obesity in school children from two Brazilian cities with distinct socioeconomic backgrounds.MethodsTwo birth cohorts respectively born in 1994 in Ribeirao Preto, a wealthy city in Southeast, and in 1997/98 in Sao Luis, a less wealthy city in Northeast of Brasil, were evaluated. After birth, 2,846 pairs of mothers-newborns were evaluated in Ribeirao Preto and 2,542 in Sao Luis. In 2004/05, 790 children aged 10/11xa0years were randomly reassessed in Ribeirao Preto and 673 at 7/9xa0years in Sao Luis. Information on type of delivery, maternal and child characteristics, socioeconomic position and anthropometric measurements were collected after birth and at school age. Obesity was defined as BMIu2009≥u200995th percentile at school age.ResultsObesity rate was 13.0% in Ribeirao Preto and 2.1% in Sao Luis. Cesarean section was associated with obesity and remained significant after adjustment only in Ribeirao Preto [ORu2009=u20091.74 (95% CI: 1.04; 2.92)]. The association between cesarean section and BMI remained significant after adjustment for maternal schooling, maternal smoking during pregnancy, duration of breastfeeding, gender, birth weight and gestational age, type of school and, only in Sao Luis, pre-pregnancy maternal weight. In Ribeirao Preto children born by cesarean section had BMI 0.31xa0kg/m2 (95%CI: 0.11; 0.51) higher than those born by vaginal delivery. In Sao Luis BMI of children born by cesarean section was 0.28xa0kg/m2 higher (95%CI: 0.08; 0.49) than those born by vaginal delivery.ConclusionA positive association between cesarean section and increased BMI z-score was demonstrated in areas with different socioeconomic status in a middle-income Country.

Avaliação dos resultados neonatais do método canguru no Brasil

OBJECTIVE: To evaluate the results of the kangaroo mother method in Brazil. METHODS: A prospective cohort study comparing 16 units that have or do not have the second phase of the kangaroo mother method: eight were national centers of excellence for the kangaroo mother method (study group) and eight were part of the Brazilian Neonatal Research Network (control group). A total of 985 newborn infants with birth weights of 500 to 1,749 g were enrolled. Multivariate analyses employed multiple linear regression and Poisson regression with robust adjustment. RESULTS: The adjusted analysis (controlled for birth weight, gestational age, Score for Neonatal Acute Physiology Perinatal Extension II, Neonatal Therapeutic Intervention Scoring System, and maternal age and educational level) demonstrated that mean length of hospital stay (p = 0.14) and intercurrent clinical conditions in the intermediate or kangaroo unit were equal for both groups. Weight (p = 0.012), length (p = 0.039) and head circumference (p = 0.006) at 36 weeks corrected gestational age were all lower at the kangaroo units. The kangaroo units exhibited superior performance in relation to exclusive breastfeeding at discharge (69.2 vs. 23.8%, p = 0.022). CONCLUSIONS: The evidence suggests that the humanization strategy adopted by the Brazilian Ministry of Health is a safe alternative to conventional treatment and a good strategy for promoting breastfeeding.

Water-contact patterns and risk factors for Schistosoma mansoni infection in a rural village of Northeast Brazil

Schistosomiasis mansoni in the Serrano village, municipality of Cururupu, state of Maranhão, Brazil, is a widely spread disease. The PECE (Program for the Control of Schistosomiasis), undertaken since 1979 has reduced the prevalence of S. mansoni infection and the hepatosplenic form of the disease. Nevertheless piped water is available in 84% of the households, prevalence remains above 20%. In order to identify other risk factors responsible for the persistence of high prevalence levels, a cross-sectional survey was carried out in a systematic sample of 294 people of varying ages. Socioeconomic, environmental and demographic variables, and water contact patterns were investigated. Fecal samples were collected and analyzed by the Kato-Katz technique. Prevalence of S. mansoni infection was 24.1%, higher among males (35.5%) and between 10-19 years of age (36.6%). The risk factors identified in the univariable analysis were water contacts for vegetable extraction (Risk Ratio--RR = 2.92), crossing streams (RR = 2.55), bathing (RR = 2.35), fishing (RR = 2.19), hunting (RR = 2.17), cattle breeding (RR = 2.04), manioc culture (RR = 1.90) and leisure (RR = 1.56). After controlling for confounding variables by proportional hazards model the risks remained higher for males, vegetable extraction, bathing in rivers and water contact in rivers or in periodically inundated parts of riverine woodland (swamplands).