Lúcia Maria Horta de Figueiredo Goulart

Triagem auditiva em hospital público de Belo Horizonte, Minas Gerais, Brasil: deficiência auditiva e seus fatores de risco em neonatos e lactentes

The objective of this study was to estimate the prevalence of hearing impairment in children in a public hospital in Belo Horizonte, Minas Gerais, Brazil, and to investigate the association with risk factors described in the literature. This study was cross-sectional and retrospective and analyzed 798 newborns and infants evaluated in the Universal Neonatal Hearing Screening Program from June 2002 to December 2003. The risk factors established by the Joint Committee on Infant Hearing in 1994 and Azevedo in 1996 were studied, besides prematurity. Prevalence of hearing impairment was 1.8% (15 cases). A multivariate logistic regression analysis was used to verify associations between risk factors and hearing impairment, showing a significant statistical association (p < 0.05) between hearing loss and suspicion of hearing loss by relatives, hyperbilirubinemia (serum level requiring exchange transfusion), ototoxic drugs, and low birth weight. A significant prevalence of hearing impairment in neonates and infants was confirmed. Attention should thus be focused on risk factors for hearing impairment, using hearing programs that ensure prevention, early detection, and intervention.

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.

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.

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

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.

Curricular transformations in medical school: an exploration of the promotion of change in Brazil

Curricular transformation is complex and involves many interrelated and influential factors. The idiosyncratic nature of the time‐frame in which curricular change takes place makes it difficult to study these factors systematically. In 2002, the Brazilian government established the Programme of Incentives for Curricular Changes in Medical Schools (PROMED). Nineteen schools participated in the programme and were given resources to finance curricular reforms in an effort to align their course structures with the tenets of the government proposal. This study analyses reforms in coursework among the schools in this cohort in an effort to better understand the impact of such incentive programmes and factors that might influence the degree of impact across institutions.

Alimentação complementar em crianças no segundo ano de vida

OBJETIVO: Estudar as praticas alimentares de criancas no segundo ano de vida, comparando as que estao em aleitamento materno complementado com aquelas desmamadas antes dos 12 meses de vida. METODOS: Estudo transversal envolvendo criancas de 12 a 24 meses da area de abrangencia de um servico de atencao primaria de Belo Horizonte, Minas Gerais. As maes foram entrevistadas sobre as praticas de alimentacao de seus filhos. Foram comparadas as praticas alimentares das criancas em aleitamento materno complementado com aquelas desmamadas antes dos 12 meses de vida por meio dos testes qui-quadrado ou exato de Fisher, t de Student e Kruskal-Wallis, com nivel de significância de 5%. RESULTADOS: Foram avaliadas 118 criancas com idade media de 16,8±4,0 meses, sendo que 35% delas ainda eram amamentadas e 15,3% mantiveram aleitamento exclusivo por seis meses. Nas criancas amamentadas, a duracao mediana do aleitamento exclusivo foi de quatro meses e, nas desmamadas, dois meses (p=0,13). Em ambos os grupos houve introducao precoce de alimentos complementares, elevado consumo de alimentos industrializados, alta prevalencia de consumo diario de oleos ou gorduras (90,7%) e baixo consumo de frutas (38,1%). CONCLUSOES: Os resultados sinalizam praticas alimentares inadequadas nos lactentes, independentemente do consumo recomendado de leite materno, denotando a necessidade de aprimoramento e integracao das acoes de promocao do aleitamento materno e alimentacao saudavel nos servicos de atencao primaria a saude.

Avaliação da Ação de Vigilância à Morbi-mortalidade Infantil na periferia de Belo Horizonte, Minas Gerais

OBJECTIVES: to assess the Infant Morbidity and Mortality Surveillance Action implemented at the Sao Marcos Public Healthcare Center (HC) and to determine the association - low birth weight newborns (LBWN), illiterate and/or adolescent mothers - and variables, such as growth and breastfeeding. METHODS: prospective cohort analytical study. Infants at risk, born from January 1996 to December 1998, were compared with controls. Following a 12-month period growth and breast-feeding duration were analyzed. RESULTS: 199 infants at risk were identified. 131 infants at risk and 88 controls were followed up. There was no difference in breast-feeding duration between the groups. By the end of the follow-up period, the LBWN presented lower weight and height values (p < 0,01). There were 17 deaths, most of them in the neonatal period. The relative death risk for LBWN in the first year was 69,81. CONCLUSIONS: the Action represented a development in implementing strategies to identify, bring in and follow up children at risk. However, efforts must be made through an earlier and broader initiative primarily targeted at LBWN.