Maria Auxiliadora de Souza Mendes Gomes

Atencão humanizada ao recém-nascido de baixo peso - Método Canguru: a proposta brasileira

Este estudo contextualiza a experiencia brasileira na Atencao Humanizada ao Recem-Nascido de Baixo Peso-Metodo Canguru, resgatando aspectos ligados a origem do Metodo Canguru na Colombia e sua utilizacao em diferentes paises. Para sistematizar a experiencia partiu-se da leitura de fontes diversas que incluiram artigos, dissertacoes, teses e textos oficiais produzidos pelo Ministerio da Saude. A analise do processo de implantacao da Atencao Humanizada ao Recem-Nascido de Baixo Peso - Metodo Canguru pelo Ministerio da Saude nos permitiu mapear uma experiencia distinta da encontrada em paises que adotaram ou discutem o Metodo Canguru como estrategia de substituicao de tecnologia. Por outro lado, a experiencia brasileira tambem e mais ampla do que aquela encontrada nos paises desenvolvidos e se configura como estrategia de qualificacao do cuidado neonatal.

Conhecimentos e práticas dos profissionais de saúde sobre a "atenção humanizada ao recém-nascido de baixo peso - método canguru"

OBJECTIVE: to identify knowledge and practices related to Low Weight Newborn Humane Care - the Kangaroo Method by the medical and nursing staff in public maternity hospitals located in the city of Rio de Janeiro. METHOD: a cross cutting descriptive method performed by questionnaire application aiming at the management of eleven public maternity hospitals in the city of Rio de Janeiro, selected for the study, related to humane medical care for low weight newborns - the Kangaroo Method. One hundred and forty eight doctors and nurses working at these hospitals were interviewed. Of these, 116 professionals exclusively working in ICU answered specific questions related to care under the perspective of the Kangaroo Method. RESULTS: as for the strategies noted to minimize noise and luminosity, 39% of the professionals related prompt answer to alarms/careful equipment use and 88% referred to luminosity reduction in at least one period out of 24 hour. As for strategies to reduce pain/discomfort, 34% reported the use of non-feeding suction and 9% reported on the use of glucose. Eighty three percent reported clinical data as the main information relayed to parents during the first visit. Physical exam is a procedure where the mothers presence is allowed by 73% of the respondents. Fifty nine percent reported that clinical stability was the reason of allowing the mothers to hold the baby for the first time, but 30% will permit that only if the new born is stable with breathing support. CONCLUSION: notwithstanding theoretical knowledge on Humane Care, professionals still do not apply it fully in their clinical practice, which is suggestive that the scope of this type of neonatal care is still not totally accepted.

Assistência e mortalidade neonatal no setor público do Município do Rio de Janeiro, Brasil: uma análise do período 1994/2000

This article analyzes an intervention by the Rio de Janeiro Municipal Health Department (SMS-RJ), Brazil, to reduce the neonatal mortality rate (strategies for organizing and upgrading neonatal care in the municipal system, including an increase in the number of neonatal high-risk beds). We studied the trends in neonatal mortality rate (1995/2000), neonatal care provided in different public hospitals (1994/2000), and admissions profile and mortality in four neonatal intensive care units (NICUs) under the SMS-RJ (2000). There was a concentration of high-risk neonatal care in the municipal hospitals (an increase from 28.0% of the care provided for live premature neonates in 1994 to 67.0% in 2000) and a reduction in the neonatal mortality rate in units under the Unified National Health System (from 19.9 deaths per thousand live births in 1996 to 15.5 in 2000). There was no reduction in the prematurity and low birth weight rates among mothers residing in the municipality of Rio de Janeiro. Analysis of admissions to the NICUs showed a high proportion of neonates born to mothers from municipalities outside Rio de Janeiro, while 14.0% of the mothers had not received prenatal care, and the mortality rate among newborns with birth weight < 1.500g was 32.0%.

Gravidez recorrente na adolescência e vulnerabilidade social no Rio de Janeiro (RJ, Brasil): uma análise de dados do Sistema de Nascidos Vivos

Repeated pregnancy (RP) among adolescents is seldom researched in Brazil, even tough the debate on the reproductive rights is important for this extract of population. A transversal study was developed with data from the Declaration of Live Births of adolescent mothers, living in Rio de Janeiro (RJ, Brazil), in 2005. The aim was to estimate the magnitude and features associated with RP. Prevalence ratios (PR) of RP, with 95% confidence interval (CI) for selected variables, were estimated through log-binomial multivariate regression. Among 12,168 adolescents, a RP prevalence of 29.1% was identified and the principal factors associated were: age 15-19 anos (PR=5.42; RI 95% 3.72-7.81); not doing prenatal consultation (RP=2.36; CI 95% 2.16-2.58); educational status<4anos (PR=1.48; CI 95% 1.25-1.76); housewife job (PR=1.8; CI 95% 1.57-2.15) or other (PR=1.9; CI 95%; 1.73-2.10). Giving birth by cesarean section and low birth weight were negatively associated to repeated pregnancy with RP equal to 0,94 (CI 95%; 0,86-0,99) and 0.69 (CI 95%; 0.62-0.77). The adolescents with RP had worst socioeconomic and assistance indicators than those on their first pregnancy. Specific social policies for adolescent mothers, in vulnerable situation, will enable them to have better conditions to exercise their reproductive rights.

Tendência temporal da amamentação na cidade do Rio de Janeiro: 1996-2006

OBJETIVO: Analisar a tendencia temporal da pratica de aleitamento materno (AM) e de aleitamento materno exclusivo (AME). METODOS: Foram analisados dados de sistema de monitoramento baseado em inqueritos realizados nos anos de 1996, 1998, 2000, 2003 e 2006 durante a Campanha Nacional de Imunizacao na cidade do Rio de Janeiro, RJ. A populacao de estudo foi constituida de 19.044 criancas menores de um ano de idade que compareceram aos postos de vacinacao. Para cada ano foi estudada uma amostra probabilistica por conglomerado (postos de vacinacao), auto-ponderada representativa da populacao de criancas menores de 12 meses ( 6 e em AME<6 foram observadas em todas as categorias de todas as variaveis sociodemograficas maternas. Para AME<6, a desvantagem observada em 1996 entre mulheres de menor escolaridade e em 1998 entre mulheres que trabalhavam nao foi completamente superada ate 2006. CONCLUSOES: O AM e o AME aumentaram no periodo estudado independentemente da faixa etaria da crianca e das caracteristicas sociodemograficas maternas. Nao foram totalmente superadas diferencas observadas entre mulheres em diferentes situacoes sociodemograficas.OBJECTIVE To analyze time trend in breast-feeding (BF) and exclusive breast-feeding (EBF). METHODS Data from a monitoring system, based on surveys conducted during the National Immunization Campaign in the city of Rio de Janeiro, Southeastern Brazil, in 1996, 1998, 2000, 2003 and 2006, were analyzed. Study population was comprised of 19,044 children younger than one year of age, who were present in vaccination stations. A probability cluster sample (vaccination stations), self-weighted and representative of the population of children younger than 12 months of age (<12), was studied for each year. A structured questionnaire with closed questions about the childs diet at the moment of the study and maternal sociodemographic characteristics was applied. The BF and EBF indicators proposed by the World Health Organization were adopted. RESULTS BF<12 increased from 61.3% to 73.4% between 1996 and 2006. Similar trend was observed in all age groups analyzed. EBF in children <4 and <6 months of age (EBF<6) increased from 18.8% to 42.4% and from 13.8% to 33.3%, respectively. Improvements in BF>6 and EBF<6 were found in all categories of all maternal sociodemographic variables. For EBF<6, the disadvantage observed in women with a lower level of education in 1996 and in women who worked in 1998 was not completely overcome by 2006. CONCLUSIONS BF and EBF increased in the period studied, independently from child age group and maternal socio-demographic characteristics. The differences found among women in distinct sociodemographic situations were not completely overcome.

Estrutura de maternidades do Sistema Único de Saúde do Rio de Janeiro: desafio à qualidade do cuidado à saúde

OBJECTIVES: to evaluate the structure of Brazilian National Health Service (SUS) maternity hospitals in the State of Rio de Janeiro. METHODS: a normative cross-sectional evaluation was carried out of selected SUS maternity hospitals in the year 2005. Sixty-seven maternity hospitals were selected as a sample for reasons of convenience. Hospitals were observed and interviews conducted with health service managers and health workers. Various aspects of the structure of these services were examined, taking as a point of reference the norms provided by the Ministry of Health and outlined in the literature. These aspects included: installations, equipment, health team, training of health workers and availability of clinical guidelines. RESULTS: the presence of the structural requirements under evaluation varied according to the level of complexity, being less frequently found in maternity hospitals undertaking lower complexity procedures. The physical structure, availability of clinical guidelines and the presence of trained health workers in these services were more adequate than the training offered. CONCLUSIONS: there is a need to invest more in professional training, to extend the availability of clinical guidelines, and to improve the physical structure of hospitals as a way of providing better quality perinatal care in conformity with national regulations.

Dependência crônica de ventilação pulmonar mecânica na assistência pediátrica: um debate necessário para o SUS

People with prolonged dependence on mechanical ventilation require permanent care and the use of equipment that can result in longer term hospital internment. This can lead to difficulty of access for patients with acute injuries, as well as personal difficulties and stress with reduced quality of life for their families or caregivers due to such longer hospital internment. This critical review of publications dealing with dependence on mechanical ventilation among children and adolescents aimed at making information organized in a systematic manner available in order to support discussion on the subject. It should be borne in mind that changes in epidemiological profile and growing technological access determine needs such as intensive therapy hospital beds and complex home care for chronic patients, which still have limits of supply and regulatory restrictions in the Brazilian public health system.Pessoas com dependencia prolongada de ventilacao pulmonar mecânica necessitam de cuidados permanentes e de equipamentos, que podem alongar muito a permanencia hospitalar, determinando uma dificuldade de acesso para pacientes com agravos agudos, assim como transtornos pessoais com limitacao da qualidade de vida de seus familiares ou cuidadores, devido aos longos periodos de internacao. Esta revisao critica de publicacoes sobre dependencia de ventilacao pulmonar mecânica em criancas e adolescentes objetivou disponibilizar informacoes organizadas de modo sistematico, a fim de subsidiar o debate sobre o tema, considerando que as mudancas de perfil epidemiologico e o crescente acesso tecnologico determinam necessidades como leitos de terapia intensiva e complexa assistencia domiciliar para pacientes cronicos, ainda com limites de oferta e regulacao no sistema publico de saude brasileiro.

Perfil dos pacientes internados em serviços de pediatria no município do Rio de Janeiro: mudamos?

Apesar das alteracoes observadas nos ultimos anos no adoecimento e na mortalidade na infância com marcada reducao das internacoes por doencas infecto-contagiosas, existem poucos estudos que apresentem o perfil clinico e demografico das internacoes pediatricas em nosso meio. O estudo teve como objetivo identificar as caracteristicas e os procedimentos diagnosticos e terapeuticos das internacoes pediatricas em hospitais do sistema publico de saude no municipio do Rio de Janeiro. Quanto ao metodo, foi realizado estudo retrospectivo desenvolvido em quatro hospitais publicos no Rio de Janeiro, em amostra constituida de 170 internacoes ocorridas nas enfermarias de pediatria no periodo de janeiro a dezembro de 2008. As informacoes obtidas evidenciaram elevada frequencia de criancas portadoras de doencas cronicas (47.6%) no conjunto das internacoes estudadas. Os servicos tambem apresentaram elevado percentual de pacientes com historico de reinternacao (35.3%). A analise por unidade mostrou que, entre os quatro servicos estudados, apenas um apresentou menor proporcao de criancas portadoras de doencas cronicas e menor frequencia de reinternacoes. Nas outras tres unidades hospitalares, em mais da metade do grupo estudado, as causas de internacoes encontradas estavam ligadas as doencas cronicas. Os resultados confirmam a necessidade de organizacao dos servicos pediatricos no sentido de estarem preparados, com estrutura e processos de cuidado adequados, para o manejo, tratamento e acompanhamento do paciente portador de doenca cronica.

Atenção humanizada ao recém-nascido de baixo-peso. Método Canguru e cuidado centrado na família: correspondências e especificidades

Este artigo apresenta a Atencao Humanizada ao Recem-Nascido de Baixo-Peso - Metodo Canguru - como uma diretriz clinica na assistencia neonatal, e busca tracar um paralelo com outro importante componente do cuidado infantil descrito na literatura internacional: o cuidado centrado na familia. O artigo propoe que a Atencao Humanizada ao Recem-Nascido de Baixo-Peso - Metodo Canguru seja vista como uma boa pratica e seja considerada tambem no campo das tecnologias em saude.

Time trend in breast-feeding in the city of Rio de Janeiro, Southeastern Brazil: 1996-2006

OBJETIVO: Analisar a tendencia temporal da pratica de aleitamento materno (AM) e de aleitamento materno exclusivo (AME). METODOS: Foram analisados dados de sistema de monitoramento baseado em inqueritos realizados nos anos de 1996, 1998, 2000, 2003 e 2006 durante a Campanha Nacional de Imunizacao na cidade do Rio de Janeiro, RJ. A populacao de estudo foi constituida de 19.044 criancas menores de um ano de idade que compareceram aos postos de vacinacao. Para cada ano foi estudada uma amostra probabilistica por conglomerado (postos de vacinacao), auto-ponderada representativa da populacao de criancas menores de 12 meses ( 6 e em AME<6 foram observadas em todas as categorias de todas as variaveis sociodemograficas maternas. Para AME<6, a desvantagem observada em 1996 entre mulheres de menor escolaridade e em 1998 entre mulheres que trabalhavam nao foi completamente superada ate 2006. CONCLUSOES: O AM e o AME aumentaram no periodo estudado independentemente da faixa etaria da crianca e das caracteristicas sociodemograficas maternas. Nao foram totalmente superadas diferencas observadas entre mulheres em diferentes situacoes sociodemograficas.OBJECTIVE To analyze time trend in breast-feeding (BF) and exclusive breast-feeding (EBF). METHODS Data from a monitoring system, based on surveys conducted during the National Immunization Campaign in the city of Rio de Janeiro, Southeastern Brazil, in 1996, 1998, 2000, 2003 and 2006, were analyzed. Study population was comprised of 19,044 children younger than one year of age, who were present in vaccination stations. A probability cluster sample (vaccination stations), self-weighted and representative of the population of children younger than 12 months of age (<12), was studied for each year. A structured questionnaire with closed questions about the childs diet at the moment of the study and maternal sociodemographic characteristics was applied. The BF and EBF indicators proposed by the World Health Organization were adopted. RESULTS BF<12 increased from 61.3% to 73.4% between 1996 and 2006. Similar trend was observed in all age groups analyzed. EBF in children <4 and <6 months of age (EBF<6) increased from 18.8% to 42.4% and from 13.8% to 33.3%, respectively. Improvements in BF>6 and EBF<6 were found in all categories of all maternal sociodemographic variables. For EBF<6, the disadvantage observed in women with a lower level of education in 1996 and in women who worked in 1998 was not completely overcome by 2006. CONCLUSIONS BF and EBF increased in the period studied, independently from child age group and maternal socio-demographic characteristics. The differences found among women in distinct sociodemographic situations were not completely overcome.