Edson Theodoro dos Santos Neto

Políticas de saúde materna no Brasil: os nexos com indicadores de saúde materno-infantil

Desde o inicio do processo de medicalizacao diversos esforcos ocorreram para a perpetuacao da forca de trabalho. Uma das medidas para o exercicio do controle estatal foi a institucionalizacao do parto. Com isso, o entendimento sobre os processos fisiologicos e patologicos referentes a gestante, ao parto e ao recem-nascido avancou nos campos cientifico e tecnologico, permitindo a intervencao medica para melhoria das condicoes de saude materno-infantil. O presente estudo se propoe a identificar as principais legislacoes que fundamentaram a formulacao e a execucao de politicas publicas para a saude materno-infantil no Brasil, a partir da decada de 1980, alem de estabelecer as relacoes dessas politicas com indicadores de mortalidade materna e neonatal, no periodo de 1996 a 2005. Uma pesquisa documental foi realizada para identificar as principais legislacoes aprovadas e politicas implementadas pelo Ministerio da Saude relacionadas a saude materno-infantil; enquanto os dados referentes aos indicadores de saude foram coletados nas bases de dados do SINASC e SIM e disponibilizados on-line. Concluiu-se que as politicas publicas geradas no seio da sociedade pelos movimentos sociais na decada de 1980, apesar de seus limites, culminaram na consolidacao de diversas leis e programas de saude voltados a atencao materno-infantil e estas tiveram papel importante na organizacao dos sistemas e servicos de saude, de modo a refletir na melhoria dos indicadores de mortalidade neonatal nos anos 1990 e 2000. Entretanto, a persistencia dos elevados indices de mortalidade materna leva ao questionamento inevitavel de que as politicas de genero nao tem conseguido exito tao significativo.

O que os cartões de pré-natal das gestantes revelam sobre a assistência nos serviços do SUS da Região Metropolitana da Grande Vitória, Espírito Santo, Brasil?

This study aimed to assess the completeness of prenatal care information on the patients prenatal care cards, according to coverage by various public health services: Family Health Strategy (FHS), Community-Based Health Workers Program (CBHWP), and traditional Primary Care Units (PCU) in Greater Metropolitan Vitoria, Espirito Santo State, Brazil. In a cross-sectional study, 1,006 prenatal cards were randomly selected from postpartum women at maternity hospitals in the metropolitan area. Completeness of the cards was assessed according to the criteria proposed by Romero & Cunha, which measure the quality on a scale from excellent ( 50% incomplete cards). In general, completion of information on the cards was bad (> 20% incomplete), but cards were filled out better in the FHS than in the CBHWP and PCU, especially for tetanus vaccination (p = 0.016) and gestational weight (p = 0.039). In conclusion, the quality of prenatal care in the public health system in Greater Metropolitan Vitoria fails to meet the Brazilian national guidelines for maternal and child health.

Pacifier use as a risk factor for reduction in breastfeeding duration: a systematic review

This systematic review of literature proposes to establish whether pacifier use is a risk factor for a reduction in the duration of breastfeeding. A search of the Medline and Lilacs databases was carried out for articles published between 1996 and 2006 using the following descriptors: breastfeeding and pacifier. Articles were excluded if they: had no open access abstracts; did not contain estimators testing the degree of association between breastfeeding duration and pacifier use; involved a follow-up loss of greater than 20%; were written in languages other than Portuguese, English and Spanish; covered specific population categories, such as pre-term babies or mothers who experienced difficulty breastfeeding; or were based on information provided by the mother or a health care professional. Nineteen articles were chosen according to the criteria outlined above; of these, one was a randomized clinical trial, eleven were prospective cohort studies and seven were cross sectional studies. The review concludes that pacifier use is a risk factor for breastfeeding duration, although the performance mechanism remains obscure. Other risk factors relate to the children, their parents and the hospital care they receive regarding the early interruption of breastfeeding. There is a need to standardize the methodology for investigating the association between pacifier use and breastfeeding duration, in order to provide scientific knowledge on this subject.

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.

Analysis models for variables associated with breastfeeding duration

OBJECTIVE To analyze the factors associated with breastfeeding duration by two statistical models. METHODS A population-based cohort study was conducted with 86 mothers and newborns from two areas primary covered by the National Health System, with high rates of infant mortality in Vitória, Espírito Santo, Brazil. During 30 months, 67 (78%) children and mothers were visited seven times at home by trained interviewers, who filled out survey forms. Data on food and sucking habits, socioeconomic and maternal characteristics were collected. Variables were analyzed by Cox regression models, considering duration of breastfeeding as the dependent variable, and logistic regression (dependent variables, was the presence of a breastfeeding child in different post-natal ages). RESULTS In the logistic regression model, the pacifier sucking (adjusted Odds Ratio: 3.4; 95%CI 1.2-9.55) and bottle feeding (adjusted Odds Ratio: 4.4; 95%CI 1.6-12.1) increased the chance of weaning a child before one year of age. Variables associated to breastfeeding duration in the Cox regression model were: pacifier sucking (adjusted Hazard Ratio 2.0; 95%CI 1.2-3.3) and bottle feeding (adjusted Hazard Ratio 2.0; 95%CI 1.2-3.5). However, protective factors (maternal age and family income) differed between both models. CONCLUSIONS Risk and protective factors associated with cessation of breastfeeding may be analyzed by different models of statistical regression. Cox Regression Models are adequate to analyze such factors in longitudinal studies.

Associação entre doença periodontal e aterosclerose subclínica: uma revisão sistemática

The association between periodontal disease and the development of atherosclerosis has been studied. The systematic review of literature aims to evaluate the association between periodontal disease and subclinical atherosclerosis. A literature search of the PubMed, Scopus, LILACS, BBO, Cochrane Library and Scielo bibliographic databases was conducted using the following descriptors: periodontal disease, periodontitis, carotid, and therosclerosis. Articles were excluded if they: presented abstracts written in languages other than Portuguese, English and Spanish; experimental studies; did not contain data testing the degree of association between periodontal disease and subclinical atherosclerosis; did measure the extent of periodontal disease by parameters other than the clinical examination; did not measure the carotid artery intima-media wall thickness by ultrasonography; and covered specific population groups. The studies design, measurement protocols and reported data were compared. A total of 63 papers identified only 10 studies that met the inclusion criteria: 1 longitudinal study, 6 cross-sectional, and 3 case control studies. There was a wide heterogeneity between the studies regarding the methods of measuring periodontal disease and atherosclerosis outcomes. The conclusion is that periodontal infections are strongly associated with the development of subclinical atherosclerosis, however the mechanisms involved on the pathogenic process remain unknown.A associacao entre doenca periodontal e o desenvolvimento de aterosclerose tem sido pesquisada. Esta revisao sistematica da literatura se propoe a verificar a associacao entre a doenca periodontal e a aterosclerose subclinica. A pesquisa utilizou as bases de dados: PubMed, Scopus, LILACS, BBO, Biblioteca Cochrane e Scielo com os termos: doenca periodontal, periodontite, carotida e aterosclerose. Foram excluidos artigos: que apresentaram resumos escritos em idiomas diferentes do portugues, ingles e espanhol; com abordagem laboratorial em modelos experimentais; sem descricao ou referencia a estimadores de associacao entre doenca periodontal e aterosclerose subclinica; pesquisas que realizaram a medida da doenca periodontal por parâmetros diferentes de exames clinicos; pesquisas que nao analisaram a espessura da intima media da arteria carotida atraves de exame de ultrassom; e que abordassem grupos especificos. Foram comparados os desenhos de estudo, protocolos de medida e os dados relatados. De um total de 63 referencias, apenas 10 artigos contemplavam todos os criterios de inclusao, distribuidos em: 1 estudo longitudinal, 6 transversais e 3 casos controles. Observou-se uma heterogeneidade entre os estudos em relacao ao metodo de mensuracao da doenca periodontal e os desfechos da aterosclerose. Concluiu-se que infeccoes periodontais sao fortemente associadas ao desenvolvimento da aterosclerose subclinica, entretanto os mecanismos envolvidos no processo patogenico ainda permanecem desconhecidos.

Mortalidade por Neoplasias relacionadas à cavidade bucal no Espírito Santo de 2001 a 2010

As neoplasias relacionadas a cavidade bucal constitui-se em relevante preocupacao para o setor saude no mundo pela expressiva incidencia e mortalidade. Objetivo: O presente estudo avaliou a mortalidade por Neoplasias relacionadas a cavidade bucal no Estado do Espirito Santo (ES) no periodo de 2001 a 2010, segundo sexo, faixa etaria, raca/cor e escolaridade. Me- todos: Foi realizado um estudo agregado descritivo, baseado em dados registrados no Departamento de Informatica do Sistema Unico de Saude. Resultados: Nesse periodo, observou-se que ocorreram 1.209 mortes por Neoplasias relacionadas a cavidade bucal no ES, tendo sido 959 obitos para o sexo masculino (79,3%) e 250 para o sexo feminino (20,7%). A frequencia de obitos por Neoplasias relacionadas a cavidade bucal esteve concentrada na faixa etaria de 50 a 79 anos. A populacao branca foi a que mais morreu por Neoplasias relacionadas a cavidade bucal no ES, com cerca de 45% dos obitos, seguida pela populacao parda, que representou cerca de 30% dos obitos. A maioria dos obitos, cerca de 30%, ocorreu na populacao analfabeta ou com o ensino fundamental incompleto (0 a 3 anos de estudo). A Regiao Metropolitana concentrou o maior percentual de todos os obitos de 2001 a 2010, cerca de 58%. Conclusao: Concluiu-se neste estudo que, no periodo analisado, a mortalidade por Neoplasias relacionadas a cavidade bucal no ES foi maior entre pessoas do sexo masculino, brancas, de baixa escolaridade, na faixa etaria entre 50 e 79 anos, e residentes de regioes urbanizadas...(AU)

Modelos de análise dos fatores associados à duração do aleitamento materno

OBJECTIVE To analyze the factors associated with breastfeeding duration by two statistical models. METHODS A population-based cohort study was conducted with 86 mothers and newborns from two areas primary covered by the National Health System, with high rates of infant mortality in Vitória, Espírito Santo, Brazil. During 30 months, 67 (78%) children and mothers were visited seven times at home by trained interviewers, who filled out survey forms. Data on food and sucking habits, socioeconomic and maternal characteristics were collected. Variables were analyzed by Cox regression models, considering duration of breastfeeding as the dependent variable, and logistic regression (dependent variables, was the presence of a breastfeeding child in different post-natal ages). RESULTS In the logistic regression model, the pacifier sucking (adjusted Odds Ratio: 3.4; 95%CI 1.2-9.55) and bottle feeding (adjusted Odds Ratio: 4.4; 95%CI 1.6-12.1) increased the chance of weaning a child before one year of age. Variables associated to breastfeeding duration in the Cox regression model were: pacifier sucking (adjusted Hazard Ratio 2.0; 95%CI 1.2-3.3) and bottle feeding (adjusted Hazard Ratio 2.0; 95%CI 1.2-3.5). However, protective factors (maternal age and family income) differed between both models. CONCLUSIONS Risk and protective factors associated with cessation of breastfeeding may be analyzed by different models of statistical regression. Cox Regression Models are adequate to analyze such factors in longitudinal studies.

Modelo de análisis de los factores asociados a la duración de la lactancia materna

OBJECTIVE To analyze the factors associated with breastfeeding duration by two statistical models. METHODS A population-based cohort study was conducted with 86 mothers and newborns from two areas primary covered by the National Health System, with high rates of infant mortality in Vitória, Espírito Santo, Brazil. During 30 months, 67 (78%) children and mothers were visited seven times at home by trained interviewers, who filled out survey forms. Data on food and sucking habits, socioeconomic and maternal characteristics were collected. Variables were analyzed by Cox regression models, considering duration of breastfeeding as the dependent variable, and logistic regression (dependent variables, was the presence of a breastfeeding child in different post-natal ages). RESULTS In the logistic regression model, the pacifier sucking (adjusted Odds Ratio: 3.4; 95%CI 1.2-9.55) and bottle feeding (adjusted Odds Ratio: 4.4; 95%CI 1.6-12.1) increased the chance of weaning a child before one year of age. Variables associated to breastfeeding duration in the Cox regression model were: pacifier sucking (adjusted Hazard Ratio 2.0; 95%CI 1.2-3.3) and bottle feeding (adjusted Hazard Ratio 2.0; 95%CI 1.2-3.5). However, protective factors (maternal age and family income) differed between both models. CONCLUSIONS Risk and protective factors associated with cessation of breastfeeding may be analyzed by different models of statistical regression. Cox Regression Models are adequate to analyze such factors in longitudinal studies.