Lígia Braun Schermann

Determinantes biológicos e ambientais no desenvolvimento neuropsicomotor em uma amostra de crianças de Canoas/RS

Este estudo verificou a prevalencia de suspeita de atraso no desenvolvimento neuropsicomotor e possiveis associacoes a fatores ambientais e biologicos, bem como a competencia materna, em uma amostra de criancas de ate 6 anos residentes no municipio de Canoas/RS. As maes foi aplicado um questionario sobre fatores socioeconomicos e reprodutivos, condicoes da crianca ao nascer, patologia da crianca, estrutura familiar, atencao a crianca e componentes da competencia materna. Avaliou-se a suspeita de atraso no desenvolvimento neuropsicomotor via teste de Denver II. Visitaram-se quarenta clusters pelo processo de amostragem probabilistica por cluster na cidade de Canoas/RS. O delineamento do estudo foi analitico transversal. Segundo os resultados, ha prevalencia de suspeita de atraso no desenvolvimento neuropsicomotor de 27% (n=53) das 197 criancas avaliadas. A analise multivariada mostrou os seguintes fatores associados a suspeita de atraso no desenvolvimento: baixa renda familiar (or=9,3), gestacao materna com intervalo interpartal inferior a 18 meses (or=3,9) e maes sem o apoio dos pais da crianca (or= 7,0). Os resultados afirmam a importância de programas de geracao de renda, educacao em saude e planejamento familiar para a prevencao de atraso no desenvolvimento infantil.

Vínculos iniciais e desenvolvimento infantil: abordagem teórica em situação de nascimento de risco

O presente artigo traz consideracoes sobre o desenvolvimento nos primeiros anos de vida da crianca, contrapondo pontos importantes na teoria psicanalitica e na teoria das relacoes objetais, bem como enfocando autores da contemporaneidade. Sao abordados aspectos como a importância das primeiras relacoes, um breve historico das praticas de cuidados neonatais e a interacao mae-bebe em situacoes de nascimento de risco, especialmente em casos de nascimento pre-termo. Nestas situacoes, os processos de formacao dos vinculos iniciais e do apego podem apresentar dificuldades. Assim, faz-se uma reflexao sobre possiveis intervencoes de promocao e prevencao em saude coletiva dirigida as familias que estao com seus filhos internados em Unidade de Terapia Intensiva Neonatal, buscando uma melhor qualidade de vida para os envolvidos neste processo. Formulacoes que possam vir a prevenir o surgimento de transtornos gerais do desenvolvimento sao mencionadas, sugerindo-se que derivem em questoes a serem discutidas no âmbito da Saude Coletiva.

Diferentes Perspectivas na Análise da Interação Pais-Bebê/Criança

The study of corresponding levels of analysis in the parent-infant/child interaction may lead us to a common language and shared concepts, that in turn will hopefully aid in the prolific exchanges among researchers from various theoretical and methodological backgrounds. The authors of this article represent some of the most prominent research teams of Brazil engaged in the study of parent-infant/child interaction. Their various perspectives are presented, as are their points of agreement and disagreement, with the purpose of demonstrating both the complexity and the diversity of approaches to the parent-infant/child interactions and their role in development. Although there is no consensual definition of interaction, there is a tendency of the authors to consider the question of reciprocal actions, co-construction, and bidirectionality. Granting that there is a trend to focus on manifested behavior and interaction, there is also a clear awareness that implicit transactions and social representations must be studied through rigorous methodological procedures, insofar as they influence interactions. It is hoped that, as these discussions progress, the ideas proposed herein will be both improved and better disseminated.

Sensibilidade e aleitamento materno em díades com recém-nascidos de risco

The purpose of this study was to investigate the relation between the kinds of infants feeding (breastfeeding, complement and mixed) and the mother-infant interactional behaviors. The participants included 20 dyads of pre-term infant (Group I) who had needed intensive care, 14 dyads of full-term infant (Group II) who had needed intensive care, and 24 dyads of full-term health infants (Group III). The risk was considered by the neonatal intensive care needed. The mother-infant interaction was filmed at face-to-face situation and evaluated through Mother-Infant Interaction Protocol (Schermann et al. 1994) to assess the maternal behaviors, the infant behaviors and the dyads behaviors. Results showed that maternal sensitivity was very different between groups (p = 0.039); Group III (control group) had a better maternal sensitivity. Therefore maternal sensitivity is better in mothers of full-term health infants, than in mothers of pre-term infant and full-term infant who had needed intensive care. Breastfeeding is an important factor to promote a better maternal sensitivity.

Prevalência de aleitamento materno exclusivo e fatores associados: estudo transversal com mães adolescentes de 14 a 16 anos em Porto Alegre, RS, Brasil

This is a cross-sectional study to verify the prevalence and associated factors related to exclusive breastfeeding in adolescent mothers between 14 and 16 years of age with 6-month-old or younger babies, born in Porto Alegre in the State of Rio Grande do Sul, Brazil, in 2009. The sample was based on 50% of the newborn babies from the population surveyed. A total of 341 adolescent mothers were interviewed in their homes. The variables considered as potential determinants of exclusive breastfeeding were social and demographic, pre- and post-natal assistance, emotional aspects of the mother, birth conditions and baby characteristics. Prevalence ratios (PR) were estimated by Poisson regression by means of hierarchical analysis. The prevalence of exclusive breastfeeding ranged from 47.8% in the first month of life up to 13.8% after six months and declined, on average, 24% for each month of life (RP = 0.76; CI95%: 0.68-0.85). Besides the babys age, the factors associated with exclusive breastfeeding were maternal education (PR=1.53; CII95%: 1.18-1.98) and multiple births (PR=1.57; CI95%:1.02-2.46), the latter observed in only 4.7% of the sample. Teenage mothers with higher schooling and with live children from earlier pregnancies manifested higher prevalence of exclusive breastfeeding.Os povos indigenas no Brasil vivenciam acelerado processo de transicao nutricional e epidemiologica, verificando-se a emergencia de doencas e agravos nao transmissiveis, como hipertensao arterial (HA). Realizou-se, em 2005, um estudo transversal para descrever os niveis tensionais em adultos (> 20 anos) indigenas Surui, Rondonia, e investigar sua relacao com o estado nutricional e o nivel socioeconomico (SSE). Foram visitadas 9 aldeias e avaliados 251 individuos (87,4% dos elegiveis). As medias de pressao arterial sistolica (PAS) e pressao arterial diastolica (PAD) foram maiores no sexo masculino e superiores as verificadas em 1988, com incremento na media da PAS de 7,9 mmHg e de 1,4 mmHg, em mulheres e homens, respectivamente. A PAS correlacionou-se positivamente com a razao cintura quadril (RCQ) em ambos os sexos, e com a idade, no sexo feminino. A PAD apresentou correlacoes estatisticamente significativas com todas as variaveis antropometricas, exceto com estatura e area muscular do braco. A prevalencia de HA foi de 2,8% (M: 2,4%; F: 3,1%). Essa prevalencia foi maior nos individuos > 40 anos, com perimetro da cintura (PC) ou RCQ elevados, sobretudo no grupo feminino e tambem no grupo de mais baixo de SSE. A HA e um problema de saude emergente entre os Surui, devendo receber atencao do sistema de saude e dos pesquisadores.

Prevalência e fatores associados à adesão de crianças na terapia antirretroviral em três centros urbanos do sul do Brasil

This study verified the prevalence and associated factors to the adhesion of children in Highly Active Antiretroviral Therapy (HAART), in three urban centers in Southern Brazil: Passo Fundo, Canoas and Cachoeira do Sul. The population of the study consisted of 44 children, between 18 months to 13 years old, in HAART. Data was collected by applying a socio-demographic questionnaire with the caregivers, aiming to know the childrens sex, age, schooling, treatment type and clinical state, as well as the caregivers income, age and schooling. Adhesion was considered when the effectiveness of the HAART was at least 95% of the prescribed regimen. The design of the study was analytical and transversal. Data analysis was performed by descriptive analysis (frequency, percentage) and bivariate analysis (chi-square test), crossing the outcome variable (adhesion to HAART) and the independent variables (sociodemographic, clinical state, treatment type, caregivers age and schooling). The results showed 82% of adhesion in the studied children. The bivariate analysis did not point out significant associations between adhesion and independent variables. A possible linear tendency to increase the adhesion as a function of the improvement of the physical state was observed.

Interação Mãe-Criança e Problemas de Comportamento Infantil em Crianças com Hipotireoidismo Congênito

The present study intended to find out whether there are differences in mother-child interaction as well as to detect childhood behavior problems in ten children suffering from congenital hypothyroidism (HC), who had received early treatment, in comparison with a group of ten healthy children. When the children were between four¾six years of age the interaction was videotaped during a free play situation and was assessed according to the Play Observational Scheme and Emotion Rating (POSER). The mothers answered the Child Behavior Checklist 4/18 (CBCL). No significant differences were found in mother-infant interaction measures, or on the child behavior problems. The lack of significant difference between the groups attests for the importance of early treatment in children with HC, which facilitates the quality mother-infant interaction and soften behavior problems in children.

Maternidade na adolescência: indicadores emocionais negativos e fatores associados em mães de 14 a 16 anos em Porto Alegre, RS, Brasil

The prevalence of negative emotional indicators and associated factors in 430 adolescent mothers between 14 to 16 years of age in Porto Alegre in the State of Rio Grande do Sul was detected. Socio-demographic variables, social and family relationships, reproductive aspects, abuse and violence were studied. The prevalence rate (PR) was obtained by Poisson regression using hierarchical analyses. The prevalence of intense psychological distress was 32.6%, and it was associated with low social class, grade repetition, bad relationship with the mother, lack of acceptance of the pregnancy by the father, and lack of family support during pregnancy. The prevalence of negative self-esteem was 15.4%, and it was associated with the bad relationship with the mother and not having a person to confide in. Little or no expectation for the future was found in 7.5% of the adolescents and was associated with grade repetition, nurturing by the biological mother, early sexual initiation, and the occurrence of physical abuse. The high prevalence of psychological distress found in the adolescent mothers of this study deserves special attention from the public policies in health in order to include qualified professionals to manage the emotional aspects of early motherhood.

Fatores associados à iniciação sexual em mães de 14 a 16 anos em Porto Alegre/RS, Brasil

This study analyzed the factors associated with first sexual intercourse among 427 mothers with 14-16 years of age from Porto Alegre (RS), Brazil. Data on adolescent socio-demographic status (skin color, religion and schooling gap) and reproductive aspects (age at menarche, age at first sexual intercourse, partnership in first sexual intercourse and partners age) were collected through household survey. Data analysis was performed using bivariate and multivariate analysis through Poisson regression with robust variance. Among adolescents with early first sexual intercourse (up to 14 years), 77.4% had menarche at up to 12 years of age and 16.4% had casual partners in the first sexual intercourse. These variables were associated with the outcome and showed that early menarche (OR=1.26; CI 95%:1.04-1.52) and casual partner at first sexual intercourse (OR=1.28; CI 95%:1.09-1.49) increase by respectively 26% and 28% the prevalence of early first sexual intercourse. This study highlights the need to strengthen health programs and policies already implemented, such as the School Health Program, as well as reinforces that parents and teachers need to be oriented in an integrated manner in order to facilitate dialogue with adolescents and provide adequate counseling.Resumo O presente estudo analisou os fatores associados a iniciacao sexual em 427 maes de 14 a 16 anos de Porto Alegre/RS/Brasil. Foram coletados dados referentes a condicao sociodemografica das adolescentes (cor da pele, religiao e defasagem escolar) e dimensao reprodutiva (idade na menarca, idade na iniciacao sexual, tipo de parceria na iniciacao sexual e idade do parceiro) atraves de inquerito domiciliar. A avaliacao dos dados foi realizada com o uso de analise bivariada e multivariada atraves de regressao de Poisson com variância robusta. Entre as adolescentes com iniciacao sexual precoce (ate os 14 anos), 77,4% tiveram menarca ate os 12 anos e o parceiro na iniciacao sexual foi casual em 16,4% dos casos. Essas variaveis foram associadas ao desfecho e mostram que menarca precoce (RP=1,26; IC95%:1,04-1,52) e parceiro casual na iniciacao sexual (RP=1,28; IC95%:1,09-1,49) aumentam em, respectivamente, 26% e 28% a prevalencia da iniciacao sexual precoce. Este estudo evidencia a necessidade de fortalecer os programas e politicas de saude ja implantados, como o Programa Saude do Escolar, e reforca que pais e professores precisam ser orientados de maneira integrada com o fim de facilitar o dialogo com as adolescentes e promover um aconselhamento adequado.