Luiz de Souza

Risk factors for inadequate prenatal care use in the metropolitan area of Aracaju, Northeast Brazil.

BackgroundThe aim of prenatal care is to promote good maternal and foetal health and to identify risk factors for adverse pregnancy outcomes in an attempt to promptly manage and solve them. Although high prenatal care attendance is reported in most areas in Brazil, perinatal and neonatal mortalities are disproportionally high, raising doubts about the quality and performance of the care provided. The objective of the present study was to evaluate the adequacy of prenatal care use and the risk factors involved in inadequate prenatal care utilization in the metropolitan area of Aracaju, Northeast Brazil.MethodsA survey was carried out with puerperal women who delivered singleton liveborns in all four maternity hospitals of Aracaju. A total of 4552 singleton liveborns were studied. The Adequacy of Prenatal Care Utilization Index, modified according to the guidelines of the Prenatal Care and Birth Humanization Programme, was applied. Socioeconomic, demographic, biological, life style and health service factors were evaluated by multiple logistic regression. Results: Prenatal care coverage in Aracaju was high (98.3%), with a mean number of 6.24 visits. Prenatal care was considered to be adequate or intensive in 66.1% of cases, while 33.9% were considered to have inadequate usage. Age < 18 to 34 years at delivery, low maternal schooling, low family income, two or more previous deliveries, maternal smoking during pregnancy, having no partner and prenatal care obtained outside Aracaju were associated with inadequate prenatal care use. In contrast, private service attendance protected from inadequate prenatal care use.ConclusionPrenatal care coverage was high. However, a significant number of women still had inadequate prenatal care use. Socioeconomic inequalities, demographic factors and behavioural risk factors are still important factors associated with inadequate prenatal care use.

Prognostic factors in squamous cell carcinoma of the oral cavity

UNLABELLED Researchers have been looking for factors that can influence the prognosis of oral cancer, because its outcome is highly uncertain. AIM To evaluate variables that can impact the survival rate of patients with squamous-cell carcinoma of the oral cavity. MATERIAL AND METHODS Data analysis of 45 patients from January, 2001 to January, 2006. Survival rate curves have been estimated using the Kaplan-Meier method and they have been compared through the log-rank test and the Cox regression standard. STUDY DESIGN Retrospective analysis. RESULTS Total five-year survival rate was of 39% fpr these patients. Only the neck metastases (p=0.017), postoperative radiotherapy (p=0.056) and diseased margin(p=0.004) variables had statistic relevance. Survival rate was lower in patients with neck metastases, margins involved and those who underwent postoperative radiotherapy, in other words, those with the most aggressive tumors. After adjustment, radiotherapy did not prove to be statistically relevant. It is likely that the survival rate of 39% was due to the high number of patients with metastasis (52%) and because the samples were mostly of tongue and mouth floor diseases (82%), which are the hardest to control. CONCLUSION Neck metastases and diseased margins of oral cavity carcinomas are the prognostic factors that can most impact the survival rate.

Growth impairment of children with different types of lip and palate clefts in the first 2 years of life: a cross-sectional study

OBJECTIVE To analyze the differences in growth impairment according to sex in the 2 first years of life in children with three types of clefts. METHODS This was a cross-sectional study of 881 children (58.9% boys and 41.1% girls) with cleft lip and palate treated at the Craniofacial Anomaly Rehabilitation Hospital, (University of São Paulo, Bauru, SP), Brazil. Age ranged from 1 to 24 months. Three types of clefts were evaluated: isolated cleft lip (181/20.5%), isolated cleft palate (157/17.8%) and cleft lip + palate (543/61.6%). Weight and length measurements and data regarding breast-feeding and socioeconomic level were obtained. Children with weight and length below the 10th percentile of the NCHS reference were considered to have impaired growth. RESULTS Sample distribution according to cleft type and sex was similar to that observed in other epidemiological studies. Breast-feeding was more frequent in the isolated cleft lip group (45.9%) then in the isolated cleft palate (12.1%) or cleft lip + palate group (10.5%). Isolated cleft lip children showed less marked impairment of weight (23.8%) and length (19.3%) compared to the cleft lip + palate group (35.7% and 33.1%, respectively). In the latter group, the proportion of children with weight and length below the 10th percentile was very close to that of the isolated cleft palate group (34.4% and 38.9%). CONCLUSIONS The impairment in weight and length was more severe in cleft lip + palate and isolated cleft palate children and may be attributed to feeding difficulties compared to the isolated cleft lip group.

Clinical validation of impaired spirituality in patients with chronic renal disease

This study aimed to identify and validate the defining characteristics of the nursing diagnosis Impaired spirituality. The methodological framework proposed by Fehring for the clinical validation of nursing diagnosis was used. The investigation was carried out in a dialysis clinic and had as participants 120 patients with chronic renal disease. Data were collected by two expert nurses, through interviews. The prevalence of the nursing diagnosis Impaired spirituality in the sample was 27.5%. It was found that the most frequent defining characteristics were Expresses behavioral changes: rage, Inability to express creativity, Questions suffering and Expresses alienation. The clinical validation of Impaired spirituality contributed to refine this diagnosis. Its identification in patients with chronic renal disease undergoing dialysis treatment can offer alternatives for a safer and more effective intervention, aiming at the satisfaction of the spiritual needs of these patients.Este estudio tuvo por objetivo identificar y validar las caracteristicas definidoras del diagnostico de enfermeria espiritualidad perjudicada. Fue utilizado el marco metodologico propuesto por Fehring para validacion clinica del diagnostico de enfermeria. La investigacion se realizo en una clinica de hemodialisis y conto con la participacion de 120 pacientes con enfermedad renal cronica. Los datos fueron recolectados por dos enfermeros especialistas, por medio de entrevistas. La prevalencia del diagnostico de enfermeria espiritualidad perjudicada, en la muestra, fue de 27,5%. Se constato que las caracteristicas definidoras mas frecuentes fueron: expresa alteracion de comportamiento: rabia, es incapaz de expresar creatividad, cuestiona sufrimiento y expresa alienacion. La validacion clinica de espiritualidad perjudicada contribuyo para el refinamiento de ese diagnostico y su identificacion, en pacientes con enfermedad renal cronica en hemodialisis; este puede ofrecer alternativas para una intervencion mas segura y eficaz, con el objetivo de satisfacer las necesidades espirituales de esos pacientes.

Prejuízo no crescimento de crianças com diferentes tipos de fissura lábio-palatina nos 2 primeiros anos de idade. Um estudo transversal

OBJETIVO: Analisar as diferencas da restricao de crescimento ate o segundo ano de vida, com base no genero, entre criancas com tres tipos de fissuras. METODOS: Estudo transversal com 881 criancas (58,9% meninos e 41,1% meninas) com fissura labial e palatina do Hospital de Reabilitacao de Anomalias Craniofaciais, Universidade de Sao Paulo, Bauru (SP), Brasil, com idades entre 1 a 24 meses. Foram avaliados tres tipos de fissuras: fissura labial (181/20,5%), fissura palatina (157/17,8%) e fissura labial + palatina (543/61,6%). Foram obtidas as medidas de peso e comprimento e os dados acerca do aleitamento materno e do nivel socioeconomico. Criancas com peso e comprimento abaixo do percentil 10 da referencia NCHS foram consideradas como tendo restricao do crescimento. RESULTADOS: A distribuicao da amostra de acordo com o tipo de fissura e genero foi semelhante aquela observada em outros estudos epidemiologicos. O aleitamento materno foi mais frequente no grupo com fissura labial (45,9%) que nos grupos de fissura palatina (12,1%) ou de fissura labial + palatina (10,5%). Os lactentes com fissura labial mostraram menos comprometimento do peso (23,8%) e do comprimento (19,3%) comparados aqueles do grupo com fissura labial + palatina (35,7% e 33,1%, respectivamente), sendo que o ultimo grupo mostrou proporcoes de criancas com peso e comprimento inferiores ao percentil 10 muito proximas as do grupo com fissura palatina (34,4% e 38,9%). CONCLUSOES: O comprometimento do peso e comprimento e mais grave nos lactentes com fissura labial + palatina e com fissura palatina e pode ser atribuido principalmente as dificuldades de alimentacao, em comparacao ao grupo com fissura labial.

Fatores prognósticos no carcinoma espinocelular de cavidade oral

Devido a incerteza da evolucao do câncer oral e que os pesquisadores procuram fatores que possam influenciar no prognostico. OBJETIVO: Avaliar em pacientes com carcinoma espinocelular de cavidade oral variaveis que possam influenciar no tempo de sobrevida. MATERIAIS E METODOS: Analisados dados de 45 pacientes no periodo de Janeiro de 2001 a Janeiro de 2006. As curvas de sobrevida foram estimadas pelo metodo de Kaplan-Meier e para compara-las os testes de log-rank e o modelo de regressao de Cox. Desenho do Estudo: Analise retrospectiva. RESULTADOS: A sobrevida global foi de 39% em 5 anos. Apenas as variaveis, metastase cervical (p=0,017), radioterapia pos-operatoria (p=0,056) e margens comprometidas (p=0,004) tiveram significância estatistica. A sobrevida foi menor em pacientes: com metastase cervical; com margens comprometidas e os submetidos a radioterapia pos-operatoria, ou seja, nos tumores mais agressivos. Apos ajustamento, a radioterapia nao mostrou significância estatistica. Provavelmente a sobrevida de 39% seja pelo elevado numero de pacientes com metastase (52,2%) e pelo fato da amostra ser basicamente de cânceres de lingua e assoalho (82%), os de controle mais dificil. CONCLUSAO: A metastase cervical e o comprometimento das margens cirurgicas sao os fatores prognosticos no carcinoma de cavidade oral que influenciaram na sobrevida.

Growth of children with isolated Robin sequence treated by nasopharyngeal intubation: importance of a hypercaloric diet.

Objective To compare the growth curves (weight and length) of two groups of infants with isolated Robin sequence (RS) treated with nasopharyngeal intubation (NPI), one group receiving a hypercaloric diet and the other receiving a normal diet for age, and compare the growth rates and duration of NPI between the two groups. Design Prospective longitudinal study. Setting Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, Bauru, Brazil, 1998 to 2000. Patients Twenty-three children with isolated RS treated by prolonged NPI. Interventions Nine children received a milk formula supplemented with 5% to 7% glucose polymers and 3% to 5% medium chain triglycerides (group 1), and 14 children received a milk formula only (group 2). Weight and length were measured at birth and every month up to 6 months of life for the construction of weight and length growth curves. The time of use of the nasogastric tube, age at the beginning of NPI, and duration of NPI were also determined. Results No significant difference in length was observed between the two groups. The mean weight curves obtained for the two groups were below the 50th percentile of the National Center for Health Statistics, but weight gain was higher in group 1. The duration of NPI was shorter in this group. Conclusions The hypercaloric diet led to an improvement in nutritional status, which in turn contributed to improved respiratory conditions in isolated RS.

Is adolescent pregnancy a risk factor for low birth weight

OBJETIVO: Evaluar el embarazo en la adolescencia como factor de riesgo para bajo peso al nacer. METODOS: Estudio transversal incluido en una cohorte de puerperas y sus respectivos recien nacidos, en las cuatro maternidades de Aracaju, SE (Brasil), de marzo a julio de 2005. Se estudiaron 4.646 pares de madres/recien nacidos. Los datos se colectaron consecutivamente durante cuatro meses. Variables sociales, biologicas y asistenciales se obtuvieron por medio de cuestionario estandarizado. Se realizo regresion logistica multiple, con control de factores de confusion y de modificacion. RESULTADOS: Del total analizadas, 20,6% eran adolescentes (<20 anos). Las madres adolescentes presentaron peores condiciones socioeconomicas, reproductivas y resultados perinatales mas adversos, al compararse con otros grupos etarios. Se identificaron como factores de riesgo asociados al bajo peso al nacer, la ausencia de asistencia en el prenatal y tabaquismo en la gestacion. Se identifico interaccion de la edad materna con la situacion conyugal: madres adolescentes sin companero tuvieron mayores proporciones de bajo peso al nacer. CONCLUSIONES: La adolescencia se mostro como factor de riesgo para bajo peso al nacer entre las madres sin companero. Tabaquismo durante la gestacion y ausencia de asistencia prenatal se asocian al bajo peso al nacer.

Suspicion of Obstructive Sleep Apnea by Berlin Questionnaire predicts events in patients with Acute Coronary Syndrome

FUNDAMENTO: De um ponto de vista mecanistico, a apneia obstrutiva do sono (SAOS) pode causar disturbios extras a homeostase cardiovascular na presenca de sindrome coronariana aguda (SCA). OBJETIVO: Investigar se um diagnostico clinico padronizado de SAOS, em pacientes com SCA, prediz o risco de eventos cardiovasculares durante hospitalizacao. METODOS: Em um estudo de coorte prospectivo, um grupo de 200 pacientes com diagnostico de SCA estabelecido entre Setembro de 2005 e Novembro de 2007, foram estratificados pelo Questionario de Berlim (QB) para o risco de SAOS (alto ou baixo risco). Foi testado se o subgrupo de alto risco para SAOS apresenta maior tendencia a eventos cardiovasculares. O endpoint primario avaliado foi um desfecho composto de morte cardiovascular, eventos cardiacos isquemicos recorrentes, edema pulmonar agudo e acidente vascular cerebral durante a hospitalizacao. RESULTADOS: Noventa e quatro (47%) dos pacientes identificados pelo QB apresentavam suspeita de SAOS. Alto risco para SAOS estava associado com uma mortalidade mais elevada, embora sem diferenca estatistica (4,25% vs 0,94%; p=0,189), mas com uma estatisticamente significante maior incidencia de desfecho composto de eventos cardiovasculares (18,08% vs 6,6%; p=0,016). No modelo de regressao logistica, os preditores multivariados de desfecho composto de eventos cardiovasculares foram idade (OR = 1,048; IC95%: 1,008 a 1,090; p=0,019), fracao de ejecao do VE (OR = 0,954; IC95%: 0,920 a 0,989; p=0,010), e risco mais elevado de SAOS (OR = 3,657; IC95%: 1,216 a 10,996; p=0,021). CONCLUSAO: O uso de um questionario simples e validado (QB) para identificar pacientes com risco mais elevado de SAOS pode ajudar a prever o desfecho cardiovascular durante a hospitalizacao. Alem disso, nossos dados sugerem que SAOS e muito comum em pacientes com SCA.BACKGROUND From a mechanistic standpoint, obstructive sleep apnea (OSA) may further disturb cardiovascular homeostasis in the setting of acute coronary syndrome (ACS). OBJECTIVE We sought to investigate if a standardized clinical diagnosis of OSA, in acute coronary syndrome patients, predicts the risk of cardiovascular events during hospitalization. METHODS In a prospective cohort study, a group of 200 patients diagnosed with ACS between September 2005 and November 2007 were stratified by the Berlin Questionnaire (BQ) regarding the risk for OSA (high or low risk). We tested if the subgroup of high risk for OSA was prone to a higher frequency of cardiovascular events. The primary endpoint evaluated was a composite outcome of cardiovascular death, recurrent cardiac ischemic events, acute pulmonary edema and stroke during hospitalization. RESULTS Ninety four (47%) patients assessed by the BQ were likely to have OSA. High risk for OSA was associated with a non-significant higher mortality (4.25% vs 0.94%; p=0.189), but a significant higher incidence of composite cardiovascular events (18.08% vs 6.6%; p=0.016). In the logistic regression model, multivariate predictors of composite cardiovascular events were age (OR= 1.048; 95% CI 1.008 to 1.090; p=0.019), left ventricular ejection fraction (OR= 0.954; 95% CI 0.920 to 0.989; p=0.010), and higher risk for OSA (OR= 3.657; 95% CI 1.216 to 10.996; p=0.021). CONCLUSION The use of a simple and validated questionnaire (BQ) to identify patients with higher risk for OSA may help in the prediction of cardiovascular outcome during hospitalization. Moreover, our data suggests that OSA is very common in patients with ACS.

Longitudinal study of the growth of infants with isolated Robin sequence considered being severe cases

Aim: To study the growth of infants with isolated Robin sequence (IRS) considered being severe cases during the first 6 months of life.