Juliana Sousa Soares de Araújo

Microcephaly in north-east Brazil: a retrospective study on neonates born between 2012 and 2015

Abstract Objective To assess the number of children born with microcephaly in the State of Paraíba, north-east Brazil. Methods We contacted 21 maternity centres belonging to a paediatric cardiology network, with access to information regarding more than 100 000 neonates born between 1 January 2012 and 31 December 2015. For 10% of these neonates, nurses were requested to retrieve head circumference measurements data from delivery-room books. We used three separate criteria to classify whether a neonate had microcephaly: (i) the Brazilian Ministry of Health proposed criterion: term neonates (gestational age ≥ 37 weeks) with a head circumference of less than 32 cm; (ii) Fenton curves: neonates with a head circumference of less than −3 standard deviation for age and gender; or (iii) the proportionality criterion: neonates with a head circumference of less than ((height/2))+10) ± 2. Findings Between 1 and 31 December 2015, nurses obtained data for 16 208 neonates. Depending on which criterion we used, the number of neonates with microcephaly varied from 678 to 1272 (4.2–8.2%). Two per cent (316) of the neonates fulfilled all three criteria. We observed temporal fluctuations of microcephaly prevalence from late 2012. Conclusion The numbers of microcephaly reported here are much higher than the 6.4 per 10 000 live births reported by the Brazilian live birth information system. The results raise questions about the notification system, the appropriateness of the diagnostic criteria and future implications for the affected children and their families. More studies are needed to understand the epidemiology and the implications for the Brazilian health system.

A telemedicine network for remote paediatric cardiology services in north-east Brazil

Abstract Problem Providing health care for children with congenital heart diseases remains a major challenge in low- and middle-income countries. Approach In October 2011, the Government of Paraíba, Brazil, established a paediatric cardiology network in partnership with the nongovernmental organization Círculo do Coração. A cardiology team supervised all network activities, using the Internet to keep in contact with remote health facilities. The network developed protocols for screening heart defects. Echocardiograms were performed by physicians under direct online supervision of a cardiologist; alternatively, a video recording of the examination was subsequently reviewed by a cardiologist. Cardiovascular surgeons came to a paediatric hospital in the state capital once a week to perform heart surgeries. Local setting Until 2011, the State of Paraíba had no structured programme to care for children with heart disease. This often resulted in missed or late diagnosis, with adverse health consequences for the children. Relevant changes From 2012 to 2014, 73 751 babies were screened for heart defects and 857 abnormalities were identified. Detection of congenital heart diseases increased from 4.09 to 11.62 per 1000 live births (P < 0.001). Over 6000 consultations and echocardiograms were supervised via the Internet. Time to diagnosis, transfers and hospital stays were greatly reduced. A total of 330 operations were carried out with 6.7% (22/330) mortality. Lessons learnt Access to an echocardiography machine with remote supervision by a cardiologist improves the detection of congenital heart disease by neonatologists; virtual outpatient clinics facilitate clinical management; the use of Internet technology with simple screening techniques allows resources to be allocated more efficiently.

Controle pressórico e adesão/ vínculo em hipertensos usuários da atenção primária à saúde.

This is a population-based, descriptive, and analytic study conducted with a randomized and probabilistic sample comprising 340 hypertensive individuals representative of the Family Health Strategy (FHS) Service in Joio Pessoa, PB, Brazil. The present study corresponds to the first part of a cohort started in 2008. The instrument used was an adaptation of the Primary Care Assessment Tool revalidated in Brazil. Logistic regression was used to investigate the associations between blood pressure (BP) control, sociodemographic variables, and an indicator of adherence/ attachment. Among the 340 hypertensive participants, 32.6% were followed up at the FHS, and 89.1% exhibited satisfactory adherence/ attachment. The older adults were more likely to control BP, which suggests a more accurate self-care perception and greater adherence to treatment. The present study highlights the problem posed by the control of hypertension by means of the assessment of services. We expected the present model to be applied at other locations to generate parameters to compare different municipalities.

Blood pressure control and adherence/attachment in hypertensive users of Primary Healthcare

This is a population-based, descriptive, and analytic study conducted with a randomized and probabilistic sample comprising 340 hypertensive individuals representative of the Family Health Strategy (FHS) Service in Joio Pessoa, PB, Brazil. The present study corresponds to the first part of a cohort started in 2008. The instrument used was an adaptation of the Primary Care Assessment Tool revalidated in Brazil. Logistic regression was used to investigate the associations between blood pressure (BP) control, sociodemographic variables, and an indicator of adherence/ attachment. Among the 340 hypertensive participants, 32.6% were followed up at the FHS, and 89.1% exhibited satisfactory adherence/ attachment. The older adults were more likely to control BP, which suggests a more accurate self-care perception and greater adherence to treatment. The present study highlights the problem posed by the control of hypertension by means of the assessment of services. We expected the present model to be applied at other locations to generate parameters to compare different municipalities.

Impact of a virtual clinic in a paediatric cardiology network on northeast Brazil

Introduction. Congenital heart diseases (CHD) affect approximately 1% of live births and is an important cause of neonatal morbidity and mortality. Despite that, there is a shortage of paediatric cardiologists in Brazil, mainly in the northern and northeastern regions. In this context, the implementation of virtual outpatient clinics with the aid of different telemedicine resources may help in the care of children with heart defects. Methods. Patients under 18 years of age treated in virtual outpatient clinics between January 2013 and May 2014 were selected. They were divided into 2 groups: those who had and those who had not undergone a screening process for CHD in the neonatal period. Clinical and demographic characteristics were collected for further statistical analysis. Results. A total of 653 children and teenagers were treated in the virtual outpatient clinics. From these, 229 had undergone a neonatal screening process. Fewer abnormalities were observed on the physical examination of the screened patients. Conclusion. The implementation of pediatric cardiology virtual outpatient clinics can have a positive impact in the care provided to people in areas with lack of skilled professionals.

Analysis of changes in maternal and child health policy in a capital of northeastern Brazil. Dilemmas and challenges for care

Background The care to women’s health in pregnancy, childbirth and puerperium has being changing with the development of Brazil’s health policies. To discuss the implementation of the changes in perinatal care policy in a capital of the Northeast, analyzing the changes in the care and in organization of health services. Methods We used a qualitative approach with data collection between May and December 2015, with weekly visits in a Maternity, document review of municipal government, semi-structured interviews with users of the service, municipal managers, local managers of the federal government, professionals and managers of a municipal maternity. We conducted a focus group with volunteer doula. Findings Prenatal stands out difficulties in accessing some routine tests in primary care. It is still in the design phase to build a normal delivery centers in the city. Realize humanization of care initiatives as the introduction risk classification and the volunteer doulas program in a maternity, despite being hegemonic traditional obstetric model. There is no state regulation obstetric reflecting in the demand for care of parturient in obstetric emergency. Conclusions We perceive an incipient implementation of some key aspects of the perinatal care policy in the city, however, also identified several experiments in the routine of services pointing to the qualification of humanized care during labor and childbirth. keywords: Health Evaluation; Delivery of Health Care, Integrated; Maternal and Child Health; Perinatal Care; Humanization of Assistance.

Control de presion arterial y adhesion/vinculo en hipertensos pacientes de la Atencion Primaria de Salud

This is a population-based, descriptive, and analytic study conducted with a randomized and probabilistic sample comprising 340 hypertensive individuals representative of the Family Health Strategy (FHS) Service in Joio Pessoa, PB, Brazil. The present study corresponds to the first part of a cohort started in 2008. The instrument used was an adaptation of the Primary Care Assessment Tool revalidated in Brazil. Logistic regression was used to investigate the associations between blood pressure (BP) control, sociodemographic variables, and an indicator of adherence/ attachment. Among the 340 hypertensive participants, 32.6% were followed up at the FHS, and 89.1% exhibited satisfactory adherence/ attachment. The older adults were more likely to control BP, which suggests a more accurate self-care perception and greater adherence to treatment. The present study highlights the problem posed by the control of hypertension by means of the assessment of services. We expected the present model to be applied at other locations to generate parameters to compare different municipalities.