Luciane Maria Oliveira Brito

Treinamento muscular inspiratório e exercícios respiratórios em crianças asmáticas

OBJECTIVE The aim of the present study was to evaluate the effects that inspiratory muscle training (IMT) and respiratory exercises have on muscle strength, peak expiratory flow (PEF) and severity variables in children with asthma. METHODS This was a randomized analytical study involving 50 children with asthma allocated to one of two groups: an IMT group, comprising 25 children submitted to IMT via an asthma education and treatment program; and a control group, comprising 25 children who were submitted only to monthly medical visits and education on asthma. The IMT was performed using a pressure threshold load of 40% of maximal inspiratory pressure (MIP). The results were evaluated using analysis of variance, the chi-square test and Fishers exact test, values of p > 0.05 being considered significant. RESULTS In the comparative analysis, pre- and post-intervention values of MIP, maximal expiratory pressure (MEP) and PEF increased significantly in the IMT group: MIP from -;48.32 +/- 5.706 to -;109.92 +/- 18.041 (p < 0.0001); MEP from 50.64 +/- 6.55 to 82.04 +/- 17.006 (p < 0.0001); and PEF from 173.6 +/- 50.817 to 312 +/- 54.848 (p < 0.0001). In the control group, however, there were no significant differences between the two time points in terms of MIP or MEP, although PEF increased from 188 +/- 43.97 to 208.80 +/- 44.283 (p < 0.0001). There was a significant improvement in the severity variables in the IMT group (p < 0.0001). CONCLUSIONS Programs involving IMT and respiratory exercises can increase mechanical efficiency of the respiratory muscles, as well as improving PEF and severity variables.

Aspects related to choice of type of delivery: a comparative study of two maternity hospitals in São Luís, State of Maranhão, Brazil

This study aimed to analyze aspects related to choice of type of delivery in two maternity hospitals, one public and the other private, in São Luís, Maranhão State, Brazil. This cross-sectional study compared 163 primiparous women in a public maternity hospital and 89 in a private hospital, with mean ages of 21.63 +/- 5.24 and 28.8 +/- 5.41 years, respectively. In the public hospital, 79.1% of the women reported preferring vaginal deliveries, while in the private hospital 67.4% of the women preferred cesareans (p < 0.0001). Cesareans were performed in 46% of the women in the public maternity hospital and 97.8% of those in the private hospital (p < 0.0001). Patient satisfaction was high for both modes of delivery, but the desire to repeat the same mode was reported more frequently by women with vaginal deliveries (71.6% vs. 41.3% in the public maternity hospital and 100% vs. 65.5% in the private). In the public maternity hospital, the cesarean subgroup included more white and higher-income women. The cesarean rate was thus high in both maternity hospitals and was significantly higher in the private hospital; the study also showed a preference for vaginal delivery in the public hospital and cesareans in the private.

Epidemiological evaluation of victims of spinal cord injury

OBJECTIVE to evaluate patients suffering from spinal cord injury METHODS A retrospective, cross-sectional study was conducted with 87 patients admitted to the university hospital of UFMA between January 2008 and June 2009. We assessed sex, age, compromised segment of the spine and cause of injury, subjecting these data to statistical analysis (chi-square test). RESULTS there was a significant prevalence of males (p <0.001), with 81.6% (71) cases, and age between 21 and 30 years of age (p <0.001), with 39.1% (34) of cases. The average age was 33.96 ± 13.56 years. The proportion of falls from height was significantly greater than the number of traffic (p <0.001) and motorcycle (p <0.001) accidents. The most compromised segment of the spine (p <0.001) was the thoracic (33), with 37.9% of cases. Traffic accidents appear in greater proportion among men (p = 0.014). The cervical spine was the most affected in males (p = 0.043). The thoracolumbar fractures were caused, to a greater extent, by falls from height (p = 0.003), whereas involvement of the thoracic spine was significantly higher (p = 0.016) in traffic accidents. CONCLUSION The group at higher risk of injury to the spinal cord is the young adult male. Although there is a difference between the sexes when correlated traffic accidents, falling from height is the main cause in both sexes.

Prevalência de colonização por estreptococos do grupo B em gestantes atendidas em maternidade pública da região Nordeste do Brasil

PURPOSE to assess the prevalence of group B streptococcus colonization (GBS) in pregnant women in prodrome or in labor. METHODS vaginal and rectal cultures were collected from 201 pregnant women, in the admission sector of a public maternity center in the northeast region of Brazil (São Luís, Maranhão). The samples obtained were inoculated in a Todd-Hewiths selective culture medium and after that they were sub-cultivated in blood-agar plates. The CAMP (Christie, Atkins, Munch-Petersen) test was used to identify GBS, which was then serologically confirmed by the BioMérieux Api 20 Strep kit microtest. GBS positive samples were submitted to an antibiotic sensitivity test. Sociodemographic variables, gynecological-obstetrical antecedents, and perinatal outcomes were studied. The Epi-Info 3.3.2 programs from World Health Organization and Statistical Package for Social Sciences 14.0 version were used for the statistical analysis. The prevalence ratio was used as risk measure, considering p<0.05 as significance level, and accepting 80% power. RESULTS the prevalence of SGB colonization in the mothers was 20.4%. There was no association between the sociodemographic variables or gynecological-obstetrical antecedents and a larger presence of SGB colonization. There were two cases of infectious outbreak among neonatal babies from colonized mothers, but hemocultures resulted negative. High resistance rates were found for the following antibiotics: clindamycin, 25.4%; erythromycin, 23.4% and ceftriaxone, 12.7%. CONCLUSIONS the prevalence of SGB colonization was high among the mothers, similar to what had been described in other studies. The elevated rates of antimicrobial resistance, especially to ceftriaxone indicate the need for further studies to determine the serology of this agent and of orientation protocols for rational use of antimicrobials.

O escore de risco ajustado para cirurgia em cardiopatias congênitas (RACHS-1) pode ser aplicado em nosso meio?

OBJECTIVE: The aim of this study was to evaluate the applicability of the RACHS-1 (Risk Adjustment in Congenital Heart Surgery) as a predictor of surgical mortality in a pediatric population of a public hospital of the Northeast of Brazil. METHODS: From June 2001 through June 2004, 145 patients undergone surgical treatment of CHD in our institution of whom 62% were female, and the mean age was 5.1 years. The RACHS-1 was used to classify the surgical procedures into categories of risk 1 to 6, and logistic regression analysis was used to identify the risk factors related to surgical death. RESULTS: Age, type of CHD, pulmonary flow, surgical procedure, pump time and cross clamp time were identified as a risk factor for postoperative mortality (p<0.001). There was a linear correlation between the categories of the RACHS-1 and the mortality rate; however, the observed mortality was greater than the predicted figures by that scoring system. CONCLUSION: Although the RACHS-1 is easily applicable, it can not be applicable in our scenario because it takes into account only the surgical procedure as a categorized variable, not considering others factors presented in our scenario that could interfere in the final surgical result.OBJECTIVE The aim of this study was to evaluate the applicability of the RACHS-1 (Risk Adjustment in Congenital Heart Surgery) as a predictor of surgical mortality in a pediatric population of a public hospital of the Northeast of Brazil. METHODS From June 2001 through June 2004, 145 patients undergone surgical treatment of CHD in our institution of whom 62% were female, and the mean age was 5.1 years. The RACHS-1 was used to classify the surgical procedures into categories of risk 1 to 6, and logistic regression analysis was used to identify the risk factors related to surgical death. RESULTS Age, type of CHD, pulmonary flow, surgical procedure, pump time and cross clamp time were identified as a risk factor for postoperative mortality (p<0.001). There was a linear correlation between the categories of the RACHS-1 and the mortality rate; however, the observed mortality was greater than the predicted figures by that scoring system. CONCLUSION Although the RACHS-1 is easily applicable, it can not be applicable in our scenario because it takes into account only the surgical procedure as a categorized variable, not considering others factors presented in our scenario that could interfere in the final surgical result.

Uterine leiomyoma: understanding the impact of symptoms on womens' lives.

BackgroundMost women report negative experience about the symptoms of uterine leiomyoma (UL) in their lives, such as abnormal uterine bleeding and pelvic pain. Many studies have been conducted about efficacy of UL treatment, but little research has been performed about womens health related quality of life (HRQL).MethodsThis is a semi-structured, descriptive, observational, qualitative study that was performed during eight months. Focus group (FG) interviews were performed with women attending at a tertiary hospital in Brazil, who were consecutively included in the study. Seventy women with symptomatic UL were recruited to this study. FG duration was one hour with mediators with 5-6 women at each group. Collected data from discussions was processed according to thematic analysis and stored at a qualitative software.ResultsWomen were negatively influenced by the presence of symptomatic UL. The major themes that were noticed during analysis were: beliefs and attitudes towards UL; limitation to social and professional activities; sensation of fear/unfairness/discouragement towards the symptoms and adverse effects during treatment with GnRH analogs.ConclusionsSymptomatic UL has a negative impact on womens HRQL. Health providers should consider such impact when counseling women on their treatment options, since it may have an important influence in these patients’ decision-making process. While current pharmacological treatments may improve disease specific outcomes, such as bleeding intensity and tumor volume, they fail on actually improving quality of life.

Caracterização da cobertura do pré-natal no Estado do Maranhão, Brasil

El objetivo de este estudio fue caracterizar la cobertura de atencion prenatal en el Estado de Maranhao. Un estudio de base poblacional en 30 municipios del Estado de Maranhao, con 2.075 mujeres en edad fertil, con el embarazo anterior, entre julio de 2008 enero de 2009. Los resultados mostraron que las unidade de salud de la familia fueron responsables de un 45,9% de la atencion de la mujer embarazada y que el 46,8% indicaron que hacian seis o mas visitas a la atencion prenatal durante su ultimo embarazo y el 64,6% comenzo la atencion prenatal sigue siendo en el 1er trimestre. La cobertura de atencion prenatal fue de 85,6%, sin embargo, cuando se considera la cobertura de atencion prenatal adecuada, esto fue un 43,4%, de acuerdo con las recomendaciones del Ministerio de Salud (Brasil). Aunque la cobertura de atencion prenatal por encima del 80%, menos de la mitad se considera satisfactoria, con una brecha en la calidad de la atencion primaria.The purpose of the study was to characterize the coverage of prenatal care in the State of Maranhão. A population-based study, descriptive in 30 municipalities of the State of Maranhão, with 2075 women of childbearing age, with previous pregnancy, from July 2008 to Januray 2009. The results demonstrated that the units of family health accounted for 45.9% of the care of pregnant women and that 46.8% reported carrying out consultations six or more prenatal care during last pregnancy and 64.6% started prenatal in the first three months of pregnancy. The coverage of prenatal care, without regard to adequacy, was 85.6%, however, when considering the coverage of adequate prenatal as established by Brazilian Health Ministry was 43.4%. Although coverage of prenatal above 80%, less than half is considered adequate, showing a gap in primary care quality.

Importance of lipid accumulation product index as a marker of CVD risk in PCOS women

BackgroundThe polycystic ovary syndrome (PCOS) is considered the most common endocrine disease during the womans reproductive life, with prevalence ranging from 5 to 10 % of women of reproductive age. There is a paucity of studies regarding the use of the lipid accumulation product (LAP) as a risk marker for the development of cardiovascular disease (CVD).MethodsA cross-sectional study was conducted on 78 women aged 18 to 42 years seen at University Hospital of Maranhão, with a diagnosis of polycystic ovary syndrome according to the Rotterdam criteria. The following variables of interest were recorded on a protocol form: sociodemographic and behavioral data, body mass index, waist circumference, fasting glucose, total cholesterol, triglycerides, low density lipoprotein cholesterol, high-density lipoprotein cholesterol, and systolic and diastolic blood pressure.ResultsLogistic regression showed that, except for HDL, all cardiovascular risk markers presented a higher chance of being altered when the lipid accumulation product was above the cut off value of 37.9 cm.mmol/L.ConclusionThe lipid accumulation product seems to be sufficient to indicate a risk of cardiovascular diseases in women with polycystic ovary syndrome.

Depressão em mulheres climatéricas: análise de mulheres atendidas ambulatorialmente em um hospital universitário no Maranhão

Introduction: The climacteric is a transition period between reproductive and non-reproductive ages that leads to biopsychossocial changes in women who experience it. However, association between a larger prevalence of depression in this period is still controversial. The objective of this study was to assess the prevalence of depression in climacteric women receiving care at a university hospital in a Northeastern Brazilian municipality and to identify associated factors. Method: A prospective, analytic study of 70 climacteric women was performed. Diagnosis of depression was performed according to the International Classification of Diseases diagnostic criteria through a minimal 3-month follow-up period. The following variables were investigated: educational level, marital status, personal income, Hamilton Depression Rating Scale, presence and intensity of climacteric symptoms, menopause (natural or surgical), financial dependence on the partner, family history of depression, previous history of postpartum depression, depressive episodes, premenstrual dysphoric disorder, sexual function disorders, and positive or negative attitudes toward menopause. Results: A percentage of 34.3% of the patients had depression, and 70.8% were classified as mild intensity according to Hamilton scale. There was no statistically significant association between socioeconomic variables, reduced sex drive and family history of depression and presence of depression. Conversely, presence of vasomotor symptoms (p = 0.03), insomnia (p < 0.001), menopause (p = 0.05), history of postpartum depression (p = 0.04), premenstrual dysphoric disorder (p = 0.05), and negative attitude toward menopause (p = 0.001) were statistically associated with depression. Conclusions: There was a high prevalence of depression in assessed women. Multiple factors (impact of menopause, psychiatric history and personal impressions of menopause) are responsible for its occurrence.

Perfil cognitivo em idosas de dois serviços públicos em São Luís - MA

CONTEXTO: Este estudo procurou estabelecer, sob o ponto de vista descritivo, o nivel de cognicao e variaveis sociodemograficas associadas em mulheres da setima a nona decada, em dois servicos publicos, na cidade de Sao Luis (MA). OBJETIVOS: Estudar o nivel de cognicao pelo Miniexame do Estado Mental (MMSE) e variaveis sociodemograficas associadas em mulheres da setima a nona decada, em dois servicos publicos, na cidade de Sao Luis (MA). METODOS: Durante quatro meses um questionario com as variaveis sociodemograficas e o Miniexame do Estado Mental (MMSE) foram aplicados em pacientes ambulatoriais. As voluntarias foram avaliadas nos ambulatorios de Neurologia do Hospital Universitario Presidente Dutra e do Hospital Estadual Carlos Macieira. RESULTADOS: Oitenta pacientes foram avaliadas - 31,2% foram classificadas com transtorno cognitivo ao MEEM; 71,4% destas tinham entre 81 e 85 anos. Transtorno cognitivo estava presente em 65% das pacientes com nivel educacional inferior a sete anos. Em relacao ao nivel de renda e cognicao, foi observado que 30,4% das pacientes que apresentavam nivel de renda menor que um a dois salarios minimos eram classificadas com transtorno cognitivo. Das 33 voluntarias que tinham cuidador direto, 57,6% apresentavam transtorno cognitivo. CONCLUSOES: O estudo torna-se de relevância, pois permite se atentar para o problema na regiao e serve de estimulo para estudos metodologicos mais complexos, visando promover a saude publica mental do idoso.