Gleici Castro Perdoná

Fatores associados à violência física por parceiro íntimo em usuárias de serviços de saúde

OBJETIVO: Estimar a prevalencia de violencia por parceiro intimo contra mulheres e identificar fatores associados. METODOS: Estudo transversal com 504 mulheres de 15 a 49 anos, em cinco unidades basicas e distritais de saude em um municipio paulista em 2008. Foram realizadas entrevistas face a face com uso de questionario com 119 questoes, sobre informacoes sociodemograficas, saude reprodutiva, percepcao sobre papeis de genero no relacionamento conjugal e experiencia de violencia. Analises univariada e multipla por regressao logistica foram realizadas. RESULTADOS: Mais de um terco das mulheres sofreu violencia pelo parceiro intimo. Na analise multipla os fatores positivamente associados a violencia foram: morar em casa alugada, ter sofrido abuso sexual na infância, parceiro agredido fisicamente na infância, o uso de alcool pela entrevistada e pelo parceiro, uso de drogas e percepcao sobre o temperamento do parceiro. CONCLUSOES: As variaveis identificadas compuseram um modelo preditivo que pode ser utilizado para avaliar o risco de sofrer violencia pelo parceiro intimo.OBJECTIVE To estimate the prevalence of intimate partner violence against women and identify factors associated. METHODS Cross-sectional study comprising 504 women aged 15 to 49 years users of five primary care clinics in a municipality in the state of São Paulo, Southeastern Brazil, in 2008. Face-to-face interviews were carried out using a questionnaire consisting of 119 questions on sociodemographic information, reproductive health, perceptions of gender roles in the marital relationship and experience of violence. Univariate and multiple regression analyses were performed. RESULTS More than a third of the women reported intimate partner violence. In the multiple regression analysis factors predisposing to violence included living in rental housing, sexual abuse during childhood, the partners experience of physical violence during childhood, alcohol and drug use by the woman and her partner, and womans perception of her partners temperament. CONCLUSIONS The factors identified produced a predictive model that can be used to assess a womans risk of experiencing intimate partner violence.

A general hazard model for lifetime data in the presence of cure rate

Historically, the cure rate model has been used for modeling time-to-event data within which a significant proportion of patients are assumed to be cured of illnesses, including breast cancer, non-Hodgkin lymphoma, leukemia, prostate cancer, melanoma, and head and neck cancer. Perhaps the most popular type of cure rate model is the mixture model introduced by Berkson and Gage [1]. In this model, it is assumed that a certain proportion of the patients are cured, in the sense that they do not present the event of interest during a long period of time and can found to be immune to the cause of failure under study. In this paper, we propose a general hazard model which accommodates comprehensive families of cure rate models as particular cases, including the model proposed by Berkson and Gage. The maximum-likelihood-estimation procedure is discussed. A simulation study analyzes the coverage probabilities of the asymptotic confidence intervals for the parameters. A real data set on children exposed to HIV by vertical transmission illustrates the methodology.

HIV prevalence and risk factors in a Brazilian penitentiary

HIV infection among prison inmates shows one of the highest prevalence rates for specific population subgroups, reaching as high as 17% in Brazil and elsewhere in the world. The present study aimed to estimate HIV antibody prevalence and risk factors for infection in male inmates at the Ribeirão Preto Penitentiary, São Paulo State, Brazil, from May to August 2003. Using simple random sampling, 333 participants were selected, answered a standardized questionnaire, and had blood samples collected. Enzyme-linked immunosorbent assay (ELISA) and indirect immunofluorescence were used for HIV serological diagnosis. Overall HIV prevalence among inmates was 5.7% (95%CI: 3.2-8.2). All variables associated with HIV antibodies in the univariate analysis were submitted to unconditional multivariate logistic regression. Independent predictors of HIV infection were: total prison sentence less than five years and sharing needles and syringes.

Development of criteria for identifying neonatal near-miss cases: analysis of two WHO multicountry cross-sectional studies.

To develop and test markers of neonatal severe morbidity for the identification of neonatal near‐miss cases.

The development of a Simplified, Effective, Labour Monitoring-to-Action (SELMA) tool for Better Outcomes in Labour Difficulty (BOLD): study protocol

BackgroundThe partograph is currently the main tool available to support decision-making of health professionals during labour. However, the rate of appropriate use of the partograph is disappointingly low. Apart from limitations that are associated with partograph use, evidence of positive impact on labour-related health outcomes is lacking. The main goal of this study is to develop a Simplified, Effective, Labour Monitoring-to-Action (SELMA) tool. The primary objectives are: to identify the essential elements of intrapartum monitoring that trigger the decision to use interventions aimed at preventing poor labour outcomes; to develop a simplified, monitoring-to-action algorithm for labour management; and to compare the diagnostic performance of SELMA and partograph algorithms as tools to identify women who are likely to develop poor labour-related outcomes.Methods/DesignA prospective cohort study will be conducted in eight health facilities in Nigeria and Uganda (four facilities from each country). All women admitted for vaginal birth will comprise the study population (estimated sample size: 7,812 women). Data will be collected on maternal characteristics on admission, labour events and pregnancy outcomes by trained research assistants at the participating health facilities. Prediction models will be developed to identify women at risk of intrapartum-related perinatal death or morbidity (primary outcomes) throughout the course of labour. These predictions models will be used to assemble a decision-support tool that will be able to suggest the best course of action to avert adverse outcomes during the course of labour. To develop this set of prediction models, we will use up-to-date techniques of prognostic research, including identification of important predictors, assigning of relative weights to each predictor, estimation of the predictive performance of the model through calibration and discrimination, and determination of its potential for application using internal validation techniques.DiscussionThis research offers an opportunity to revisit the theoretical basis of the partograph. It is envisioned that the final product would help providers overcome the challenging tasks of promptly interpreting complex labour information and deriving appropriate clinical actions, and thus increase efficiency of the care process, enhance providers’ competence and ultimately improve labour outcomes.Please see related articles ‘http://dx.doi.org/10.1186/s12978-015-0027-6’ and ‘http://dx.doi.org/10.1186/s12978-015-0028-5’.

Soroprevalência da infecção pelo vírus da Hepatite B em uma prisão brasileira

Esta pesquisa objetivou estimar a prevalencia do marcador do HBV e seus fatores de risco na populacao masculina carceraria da Penitenciaria de Ribeirao Preto - SP, Brasil. De 1.030 presidiarios, foram sorteados 333 participantes, os quais foram submetidos a aplicacao de um questionario e a coleta de sangue, no periodo de maio a agosto de 2003. Para diagnostico de exposicao ao HBV foi utilizado o ensaio imunoabsorvente de ligacao de enzimas (ELISA) para deteccao dos marcadores HBsAg, anti-HBsAg e anti-HBc total. A prevalencia total de infeccao pelo HBV nos presidiarios foi de 19,5% (IC95%: 15,2 - 23,8). A media de idade dos participantes foi de 30,1 anos. Na analise univariada, a infeccao pelo HBV esteve associada a idade acima de 30 anos (p<0,001), uso previo de drogas injetaveis (p<0,001) e compartilhamento de agulhas previo (p<0,001). Em um modelo multivariado, de regressao logistica, a infeccao pelo HBV foi associada a idade acima de 30 anos (OR = 3,3: IC95%: 1,8 - 6.1) e uso previo de droga injetavel (OR = 2,7; IC95%: 1.9 - 6.4). Infeccao pelo HBV nas prisoes representa grave problema de saude publica, principalmente relacionado a idade acima de 30 anos e uso previo de drogas injetaveis.

Dietary polyunsaturated fatty acid intake during late pregnancy affects fatty acid composition of mature breast milk

OBJECTIVE The aim of this study was to investigate how maternal polyunsaturated fatty acid intake at different periods during pregnancy affects the composition of polyunsaturated fatty acids in mature human milk. METHODS A prospective study was conducted involving 45 pregnant women, aged between 18 and 35 y, who had full-term pregnancies and practiced exclusive or predominant breast-feeding. Mature breast milk samples were collected after the 5th postpartum week by manual expression; fatty acid composition was determined by gas chromatography. Fatty acid intake during pregnancy and puerperium was estimated through multiple 24-h dietary recalls. Linear regression models, adjusted by postpartum body mass index and deattenuated, were used to determine associations between estimated fatty acids in maternal diet during each trimester of pregnancy and fatty acid content in mature human milk. RESULTS A positive association was identified between maternal intake of eicosapentaenoic acid (β, 1.873; 95% confidence interval [CI], 0.545, 3.203) and docosahexaenoic acid (β, 0.464; 95% CI, 0.212-0.714) during the third trimester of pregnancy, as well as the maternal dietary ω-3 to ω-6 ratio (β, 0.093; 95% CI, 0.016-0.170) during the second and third trimesters and postpartum period, with these fatty acids content in mature breast milk. CONCLUSIONS The maternal dietary docosahexaenoic acid and eicosapentaenoic acid content during late pregnancy may affect the fatty acid composition of mature breast milk. Additionally, the maternal dietary intake of ω-3 to ω-6 fatty acid ratio, during late pregnancy and the postpartum period, can affect the polyunsaturated fatty acid composition of breast milk.

Clinical outcome and risk factors related to extended-spectrum beta-lactamase-producing Klebsiella spp. infection among hospitalized patients

Over the past two decades, nosocomial infections caused by extended-spectrum beta-lactamase (ESBL)-producing Klebsiella spp. have become a major problem all around the world. This situation is of concern because there are limited antimicrobial options to treat patients infected with these pathogens, and also because this kind of resistance can spread to a wide variety of Gram-negative bacilli. Our objectives were to evaluate among in-patients at a public university tertiary-care hospital with documented infection due to Klebsiella spp., which were the risk factors (cross-sectional analysis) and the clinical impact (prospective cohort) associated with an ESBL-producing strain. Study subjects were all patients admitted at the study hospital between April 2002 and October 2003, with a clinically and microbiologically confirmed infection caused by Klebsiella spp. at any body site, except infections restricted to the urinary tract. Of the 104 patients studied, 47 were infected with an ESBL-producing strain and 57 with a non-ESBL-producing strain. Independent risk factors associated with infection with an ESBL-producing strain were young age, exposure to mechanical ventilation, central venous catheter, use of any antimicrobial agent, and particularly use of a 4th generation cephalosporin or a quinolone. Length of stay was significant longer for patients infected with ESBL-producing strains than for those infected with non-ESBL-producing strains, although fatality rate was not significantly affected by ESBL-production in this cohort. In fact, mechanical ventilation and bacteremia were the only variables within dependent association with death detected in this investigation.

Medidas da dinâmica respiratória em crianças de quatro a dez anos

BACKGROUND: respiratory dynamics measurements are frequently used in the speech-language pathology practice, but few are the scientific data for children. AIM: to study the respiratory dynamics in children with nasal breathing. METHOD: the study was performed with a stratified random sample of 106 nasal breathing children, male and female, from schools of the city of Marilia-SP, with ages between four and ten years. The following measurements were obtained: vital capacity (VC) in both standing and sitting positions, with and without nasal occlusion; maximum phonation time (MPT) of sustained vowels and consonants and also of speech when counting numbers. RESULTS: the mean values for VC in the standing position with and without nasal occlusion were of 1515.56ml and 1538.67ml respectively and for the sitting position of 1524ml and 1539.15ml respectively. MPT of vowels in seconds were: /a/ = 8.32, /i/ = 8.61 and /u/ = 8.42; of consonants: /s/ = 6.64 and /z/ = 7.65; and when counting numbers: 7.76. It was observed that the mean values of these measurements progressively increased according to age. There was a statistically significant difference (p<0.05) not only for the MPT of vowels but also for the MPT of consonants in older children, i.e. between 4 and 10 year olds, 4 and 9 year olds and 4 and 8 year olds. There was no significant statistical difference for the VC values in consecutive age groups. There was a strong association between VC and the childs physical development. CONCLUSION: this study presented respiratory dynamics measurements in children that can be used for the speech-language diagnosis and therapy. Other studies should be developed in order to bring additional information on the subject.

Factors associated with intimate partner physical violence among health service users

OBJETIVO: Estimar a prevalencia de violencia por parceiro intimo contra mulheres e identificar fatores associados. METODOS: Estudo transversal com 504 mulheres de 15 a 49 anos, em cinco unidades basicas e distritais de saude em um municipio paulista em 2008. Foram realizadas entrevistas face a face com uso de questionario com 119 questoes, sobre informacoes sociodemograficas, saude reprodutiva, percepcao sobre papeis de genero no relacionamento conjugal e experiencia de violencia. Analises univariada e multipla por regressao logistica foram realizadas. RESULTADOS: Mais de um terco das mulheres sofreu violencia pelo parceiro intimo. Na analise multipla os fatores positivamente associados a violencia foram: morar em casa alugada, ter sofrido abuso sexual na infância, parceiro agredido fisicamente na infância, o uso de alcool pela entrevistada e pelo parceiro, uso de drogas e percepcao sobre o temperamento do parceiro. CONCLUSOES: As variaveis identificadas compuseram um modelo preditivo que pode ser utilizado para avaliar o risco de sofrer violencia pelo parceiro intimo.OBJECTIVE To estimate the prevalence of intimate partner violence against women and identify factors associated. METHODS Cross-sectional study comprising 504 women aged 15 to 49 years users of five primary care clinics in a municipality in the state of São Paulo, Southeastern Brazil, in 2008. Face-to-face interviews were carried out using a questionnaire consisting of 119 questions on sociodemographic information, reproductive health, perceptions of gender roles in the marital relationship and experience of violence. Univariate and multiple regression analyses were performed. RESULTS More than a third of the women reported intimate partner violence. In the multiple regression analysis factors predisposing to violence included living in rental housing, sexual abuse during childhood, the partners experience of physical violence during childhood, alcohol and drug use by the woman and her partner, and womans perception of her partners temperament. CONCLUSIONS The factors identified produced a predictive model that can be used to assess a womans risk of experiencing intimate partner violence.