Claudia Regina Lindgren Alves

Qualidade do preenchimento da Caderneta de Saúde da Criança e fatores associados

The Child Health Record (CHR) is an essential document for childrens health care activities. A cross-sectional study was performed with simple random sampling, aimed at analyzing factors related to quality of data completion on the CHR. Interviews and direct verification of 365 CHRs from 9 health districts in Belo Horizonte, Minas Gerais State, Brazil, were performed. A scoring system was created to classify the CHRs in terms of quality of data completion and to relate them to explanatory variables. Odds ratios were calculated by logistic regression. Completion of the 20 scoring items varied from 3.1% (use of iron supplements) to 99.7% (date of birth). Factors associated with worse scores were: children > 12 months old (OR = 1.77), mothers with < or = 6 years of schooling (OR = 1.97), children not treated by general practitioners (OR = 3.18), and mothers who had not received explanations on the CHR while in the maternity ward (OR = 1.77). The results show poor use of the CHR and emphasize the need for on-going efforts to train health professionals and prepare health services for their important role in the promotion of childrens health.

Fatores de risco para o desmame entre usuárias de uma unidade básica de saúde de Belo Horizonte, Minas Gerais, Brasil, entre 1980 e 2004

This study was a comparative analysis of factors affecting duration of breastfeeding among users of the Sao Marcos primary care clinic in Belo Horizonte, Minas Gerais State, Brazil, in 1980, 1986, 1992, 1998, and 2004. Five retrospective longitudinal studies (historical cohorts) were performed with the same questionnaire, and 790 mothers of children less than 24 months of age were interviewed. The statistical analysis was conducted year-by-year using the Kaplan-Meier method and Cox model. From 1980 to 2004, conditions significantly associated with risk of weaning were: primiparity; difficulty in postpartum breastfeeding; belief in ideal breastfeeding duration of less than six months; start of breastfeeding after discharge from the maternity hospital, non-recognition of the advantages of breastfeeding for the child; and unfavorable, unknown, or indifferent paternal opinion concerning breastfeeding. In four of the five studies, difficulty in breastfeeding (RR: 1.70-3.97) and belief in ideal breastfeeding duration of less than six months (RR: 1.67-3.27) were risk factors for weaning. Median duration of breastfeeding was five months in 1980 and 11 months in 2004.

Review articleEffect of preterm birth on motor development, behavior, and school performance of school‐age children: a systematic reviewEfeito do nascimento prematuro no desenvolvimento motor, comportamento e desempenho de crianças em idade escolar: revisão sistemática☆☆☆

OBJECTIVES to examine and synthesize the available knowledge in the literature about the effects of preterm birth on the development of school-age children. SOURCES this was a systematic review of studies published in the past ten years indexed in MEDLINE/Pubmed, MEDLINE/BVS; LILACS/BVS; IBECS/BVS; Cochrane/BVS, CINAHL, Web of Science, Scopus, and PsycNET in three languages (Portuguese, Spanish, and English). Observational and experimental studies that assessed motor development and/or behavior and/or academic performance and whose target-population consisted of preterm children aged 8 to 10 years were included. Article quality was assessed by the Strengthening the reporting of observational studies in epidemiology (STROBE) and Physiotherapy Evidence Database (PEDro) scales; articles that did not achieve a score of 80% or more were excluded. SUMMARY OF FINDINGS the electronic search identified 3,153 articles, of which 33 were included based on the eligibility criteria. Only four studies found no effect of prematurity on the outcomes (two articles on behavior, one on motor performance and one on academic performance). Among the outcomes of interest, behavior was the most searched (20 articles, 61%), followed by academic performance (16 articles, 48%) and motor impairment (11 articles, 33%). CONCLUSION premature infants are more susceptible to motor development, behavior and academic performance impairment when compared to term infants. These types of impairments, whose effects are manifested in the long term, can be prevented through early parental guidance, monitoring by specialized professionals, and interventions.Objectives to examine and synthesize the available knowledge in the literature about the effects of preterm birth on the development of school‐age children.

Alterações de fala em escolares na cidade de Belo Horizonte

Purpose: To describe speech disorders in students from 1st to 4th grades, and to investigate possible associations between these disorders and stomatognathic system and auditory processing disorders. Methods: Cross-sectional study with stratified random sample composed of 288 students, calculated based on an universe of 1,189 children enrolled in public schools from the area covered by a health center in Belo Horizonte. The median age was 8.9 years, and 49.7% were male. Assessment used a stomatognathic system protocol adapted from the Myofunctional Evaluation Guidelines, the Phonology task of the ABFW – Child Language Test, and a simplified auditory processing evaluation. Data were statistically analyzed. Results: From the subjects studied, 31.9% had speech disorder. From these, 18% presented phonetic deviation, 9.7% phonological deviation, and 4.2% phonetic and phonological deviation. Linguistic variation was observed in 38.5% of the children. There was a higher proportion of children with phonetic deviation in 1st grade, and a higher proportion of children younger than 8 years old with both phonetic and phonological deviations. Phonetic deviation was associated to stomatognathic system disorder, and phonological deviation was associated to auditory processing disorder. Conclusion: The prevalence of speech disorders in 1st to 4th grade students is considered high. Moreover, these disorders are associated to other Speech-Language Pathology and Audiology alterations, which suggest that one disorder may be a consequence of the other, indicating the need for early diagnosis and intervention.

Caderneta de Saúde da Criança: avaliação do preenchimento dos dados sobre gravidez, parto e recém-nascido

OBJECTIVE: Evaluate pregnancy, birth and neonatal data filling of the Childs Health Record (CHR) and study mothers perception about the function of this tool in Belo Horizonte, Minas Gerais, Brazil. METHODS: This was a cross-sectional descriptive study of 797 CHR of infants born between April and December 2005 and delivered to their mothers soon after birth. A written protocol was used to assess the first pages of the CHR and mothers were asked two questions. Each CHR item was classified as correctly, incorrectly or not filled in. RESULTS: The name of the child was not in the CHR in 44%. The first prenatal visit and the number of prenatal visits were absent in respectively 40 and 31% of the records. The type of birth was not recorded in 15% of the CHR, as well as the gestational age in 24% and the Apgar score at five minutes in 23%. The newborns weight, length and head circumference were not informed in 9, 10 and 15%, respectively. The slot with the orientation to take the newborn to the first pediatric visit on the 5th day of life was blank in 75%. Only 32% of the mothers received information about the CHR at the maternity ward. To 313 mothers, the CHR was important to record follow-up of growth and/or development of their child. CONCLUSIONS: An important lack of information was noted in the CHR. Efforts should be directed to improve the quality of information in order to enhance childrens health promotion.

Anemia entre pré-escolares - um problema de saúde pública em Belo Horizonte, Brasil

O artigo tem por objetivo determinar a prevalencia de anemia em criancas matriculadas em creches da regional Centro-Sul de Belo Horizonte (MG), identificando fatores biologicos e socioeconomicos associados. Estudo transversal descritivo realizado em 18 creches. Foram avaliadas 373 criancas com base em amostragem estratificada por instituicao participante. A hemoglobina (Hb) serica foi determinada por puncao capilar e leitura em β-hemoglobinometro, adotando-se pontos de corte para anemia de Hb < 11,0g/dL para criancas de seis a 60 meses e Hb < 11,5g/dL para aquelas com idade superior, preconizados pela OMS. O estado nutricional foi definido por afericao do peso e altura e confeccao dos indices Peso/Idade (P/I), Estatura/Idade (E/I) e IMC/Idade (IMC/I). Entre os participantes 54% eram meninas. A media de idade foi de 38,1 ± 6,2 meses. A prevalencia global de anemia foi de 38,3%, sendo superior nas criancas com idade inferior ou igual a 24 meses (56,1%). Encontrou-se associacao significativa entre anemia e os fatores menor idade da crianca, menor idade materna e baixa renda familiar. O estudo mostrou que anemia em criancas de creches de Belo Horizonte constitui relevante problema de saude publica, sinalizando a necessidade de se implantar acoes especificas para mitigacao dos riscos por ele apontados.

Abordagem pedagógica e diversificação dos cenários de ensino médico: projetos selecionados pelo PROMED

Este trabalho analisa as principais propostas de abordagem pedagogica e diversificacao de cenarios do processo de ensino apresentadas pelas escolas selecionadas pelo Programa de Incentivo a Mudancas Curriculares nas Escolas de Medicina (Promed), instituido em 2002 pelos ministerios da Saude e da Educacao. Foi realizada pesquisa documental, utilizando-se roteiro com base no termo de referencia do programa para a leitura dos projetos. Verificou-se que todas as escolas selecionadas ja se encontravam em processo de mudanca curricular por ocasiao do edital Promed. Embora buscassem alcancar os objetivos apresentados pelo programa, os projetos selecionados apontaram diferentes caminhos para sua realizacao. Conhecer essas propostas e a maneira como se articularam entre si e com o objetivo final do Promed e de capital importância para os educadores da area de saude envolvidos com mudancas curriculares em suas instituicoes, bem como para os gestores dessa area que vem apresentando suas demandas em consonância com as necessidades de saude da populacao

Caracterização da fala de crianças de 4 a 6 anos de creches públicas

OBJETIVO: caracterizar a fala de criancas de 4 a 6 anos de duas creches publicas de Belo Horizonte e classifica-la segundo dois criterios de referencia nacional. METODO: foram avaliadas 60 criancas em relacao a fala. Foram realizadas analises relativas ao inventario fonetico, segundo a ordem de ocorrencia proposta por dois autores, e a associacao entre as classificacoes. RESULTADOS: a prevalencia de inadequacoes de fala encontrada foi alta nas duas creches, sendo que 45% e 53,3% das criancas foram consideradas com fala inadequada segundo as classificacoes 1 e 2 respectivamente. Houve boa concordância entre as duas classificacoes (coeficiente de Kappa = 0,768). Nao houve associacao com significância estatistica entre os sexos e as idades. As alteracoes de fala mais prevalentes foram presenca assistematica e substituicao, os unicos fonemas com 100% de ocorrencia na amostra total de criancas avaliadas foram /t, k, m, n, ŋ/ , os de menor ocorrencia foram, o arquifonema /R/ (30%) o fonema /ſ/ (63,3%) e /l/ (68,3%) em encotro consonantal. CONCLUSAO: na faixa etaria de 4 a 6 anos as criancas ainda produzem varios fonemas de maneira assistematica, ocorrendo alteracoes como substituicoes e omissoes. Deve-se levar em conta fatores que podem ter influenciado os resultados, como local da pesquisa, classe economica e caracteristicas individuais. Outros estudos sobre a aquisicao fonologica sao necessarios, contribuindo para programas de intervencao precoce e acoes preventivas em ambientes escolares.

Otorrinolaringologia pediátrica no Sistema Público de Saúde de Belo Horizonte

ABSTRACT OBJECTIVE: To assess the suitability of referral from primary to secondary care in pediatric Otolaryngology. METHODS: The study was performed in the city of Belo Horizonte, in the state of Minas Gerais, from March 2004 to May 2005. A total of 408 pre-school children referred from primary care to secondary care in the department of Otolaryngology presenting with otitis, tonsillitis, sinusitis, allergic rhinitis, and tonsillar/adenoidal hypertrophy was assessed. The studied variables were: agreement between diagnoses in primary and secondary care; waiting time for doctor’s appointment; follow-up, and professional (pediatrician or family physician) that examined children in primary care. Agreement of diagnoses was assessed using kappa statistics. RESULTS: Patients were fi ve years old on average, 214 (52.5%) were boys, mean waiting time for appointment was 3.7 months. Diagnoses in primary and secondary care were respectively: otitis (44%, 49%), tonsillar/adenoidal hypertrophy (22%, 33%), tonsillitis (18%, 23%), sinusitis (13%, 21%), allergic rhinitis (3%, 33%). Agreement analysis of kappa was 0.15 for otitis with effusion, 0.35 for recurrent otitis, 0.04 for tonsillar/adenoidal hypertrophy, 0.43 for tonsillitis, 0.05 for allergic rhinitis, and 0.2 for sinusitis. Diagnoses in primary care referred to secondary care were in agreement when given either by pediatrician or family physician.

Mudanças curriculares: principais dificuldades na Implementação do PROMED

This study aims to discuss the difficulties faced by medical schools in the implementation of curricular changes, within the context of the Incentive Program for Curricular Changes for Medical Schools - PROMED. Interviews were conducted with heads of medicine courses and local SUS managers, as well as focus groups with students and teachers. The main limiting factors are related to teachers, students, educational institutions, SUS services/management and the conditions established in the PROMED Rules. Regarding the teachers, there was resistance to the proposed changes, insufficient teacher training and lack of knowledge about the Pedagogical Project of their own institution. Among students, the main barriers were related to practice in Primary Health Care settings and to restrictions regarding the training of physicians of a generalist profile. The conditions inadequacy of the Basic Health Units, as a teaching scenario, was the main difficulty related to services/management. The study shows the diversity and complexity of the obstacles faced by medical schools in implementing their projects for curricular change. This requires joint efforts of actors and institutions involved in the realization of the proposed change.