Maria Bethânia da Costa Chein

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.

Clinical and laboratory profile of children living with vertically transmitted HIV/AIDS in a city in northeastern Brazily

INTRODUCTION Vertical transmission constitutes the main route for child infection by the HIV-1 virus (human immune deficiency virus). This study aimed to investigate the clinical and laboratory evolution of children with vertically transmitted HIV/AIDS. METHODS This was a retrospective descriptive study based on data gathered from the medical records of all the children who were seen at a specialized care unit between January 1998 and June 2006. RESULTS Eighty children who met the inclusion criteria were evaluated. In the cases 56 (70%) of the children, their mothers were diagnosed as HIV-positive after childbirth. The delivery was vaginal for 44 (55%) of the children. Fifty-six children (70%) were breastfed by their mothers for periods ranging from one to more than 12 months. Failure to use or incomplete use of the ACTG 076 protocol was documented in 63 (78.5%) of the cases. CONCLUSIONS The findings from our study are a cause for considerable concern and show failures of medical care for mothers and children, particularly with regard to prevention of transmission.

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.

Rastreamento do câncer do colo do útero no Estado do Maranhão, Brasil

The scope of the study was to analyze the screening for cervical cancer in the state of Maranhao using secondary data from the Cervical Cancer Information System (SISCOLO). A retrospective descriptive study was conducted using secondary data from 139505 cytopathology exams recorded in SISCOLO in Maranhao in 2011. The variables: age, education, adequacy of material, represented epithelia, microbiology and cellular changes detected in Pap smear tests were selected. The age group between 25 to 29 years and incomplete basic schooling were the most frequent findings. The most common microbiological agents detected were bacilli (52.8%), cocci (45.5%) and Lactobacillus sp (32.6%). Inflammation was the most common benign cellular alteration (86.3%). Low-grade intraepithelial lesions were the most prevalent atypical findings in squamous cells (0.6%), followed by high-grade squamous intraepithelial lesions (0.2%). Squamous cell carcinoma was observed in 0.003% and 0.006% for adenocarcinoma. SISCOLO proved a useful tool for studying aspects related to cancer screening of the cervix, which can orient actions to reduce the incidence and mortality from this cancer.

Prevalence and conditions associated with chronic pelvic pain in women from São Luís, Brazil

The objective of the present study was to estimate the prevalence of chronic pelvic pain in the community of São Luís, capital of the State of Maranhão, Northeastern Brazil, and to identify independent conditions associated with it. A cross-sectional study was conducted, including a sample of 1470 women older than 14 years predominantly served by the public health system. The interviews were held in the subjects home by trained interviewers not affiliated with the public health services of the municipality. The homes were visited at random according to the city map and the prevalence of the condition was estimated. To identify the associated conditions, the significant variables (P=0.10) were selected and entered in a multivariate analysis model. Data are reported as odds ratio and 95% confidence interval, with the level of significance set at 0.05. The prevalence of chronic pelvic pain was 19.0%. The independent conditions associated with this diagnosis were: dyspareunia (OR=3.94), premenopausal status (OR=2.95), depressive symptoms (OR=2.33), dysmenorrhea (OR=1.77), smoking (OR=1.72), irregular menstrual flow (OR=1.62), and irritative bladder symptoms (OR=1.90). The prevalence of chronic pelvic pain in Sao Luís is high and is associated with the conditions cited above. Guidelines based on prevention and/or early identification of risk factors may reduce the prevalence of chronic pelvic pain in São Luís, Brazil.