Maria de Lurdes Zanolli

Características das mães adolescentes e de seus recém-nascidos e fatores de risco para a gravidez na adolescência em Campinas, SP, Brasil

OBJETIVOS: descrever o perfil das maes e seus recem-nascidos e apontar fatores de risco para gravidez na adolescencia. METODOS: estudo transversal que analisou os nascimentos de filhos de adolescentes ocorridos em Campinas, SP, Brasil em 2001. Identificou-se o perfil pelas caracteristicas sociodemograficas maternas, relacionadas as gestacoes, aos partos e recem-nascidos. Realizou-se teste de qui-quadrado e calcularam-se os odds ratio (OR) brutos. Para os OR ajustados, empregou-se modelo de regressao logistica. RESULTADOS: as adolescentes eram 17,8% das maes. Dessas, 48,4% tinham ate sete anos de estudo, 59,9% nao tinham companheiro, 87,6% nao trabalhavam, 46,0% viviam em regioes com baixas condicoes de vida; a maioria era primipara, 21,6% tinham um filho ou mais, 35,2% fizeram menos que sete consultas no pre-natal. Dos recem-nascidos, 7,5% nasceram prematuros, 36,2% por cesarea, 9,7% com baixo peso e 30,3% com peso insuficiente. Encontraram-se associacoes entre gravidez na adolescencia e mulheres sem companheiro (ORaj=2,63; IC95%=2,35-2,94), sem ocupacao (ORaj=3,29; IC95%=2,85-3,79), de regioes com baixas condicoes de vida (Noroeste [ORaj=1,30; IC95%=1,07-1,59] e Sudoeste [ORaj=1,22; IC95%=1,01-1,47]) e com pre-natal inadequado (ORaj=1,22; IC95%=1,09-1,38). CONCLUSOES: o perfil das maes adolescentes e dos seus partos e os fatores de risco para gravidez na adolescencia relacionaram-se principalmente com condicoes socioeconomicas desfavoraveis, sugerindo que as intervencoes requerem acoes intersetoriais.

Determinantes do baixo peso ao nascer a partir das Declarações de Nascidos Vivos

Este estudo teve como objetivos conhecer a distribuicao do peso de nascimento das criancas de Campinas (SP) e indicar fatores de risco para baixo peso. Realizou-se estudo transversal no qual foram utilizados dados das 14.444 Declaracoes de Nascidos Vivos de 2001. A variavel dependente foi o peso de nascimento, e as independentes as caracteristicas maternas, gestacionais, do parto e do recem-nascido. Na avaliacao da associacao entre variaveis empregou-se teste de qui-quadrado e calculou-se valores de odds ratio brutos (OR) e ajustados (ORaj). A media do peso de nascimento foi 3.142g, variando de 285 a 5.890g; 65,1% das criancas pesaram 3.000g ou mais, 25,7% entre 2.500 e 2.999g e 9,1% menos de 2.500g. Os determinantes para baixo peso em prematuros foram cesariana, gemelaridade, recem-nascidos femininos e os de mulheres com menos de sete consultas de pre-natal. Para criancas a termo os riscos foram gestacao dupla, tripla ou mais, filhos de mulheres com mais de 34 anos, das com ate sete anos de estudo, com oito a onze e das com menos de sete consultas de pre-natal. A distribuicao de peso de nascimento em Campinas foi inadequada e a proporcao de baixo peso foi mais que o dobro dos paises desenvolvidos. Os recem-nascidos prematuros que nasceram por cesariana, os prematuros e os a termo de gestacao multipla, os femininos, os de mulheres com pre-natal inadequado e os a termo daquelas com maior idade e baixa escolaridade apresentaram maior chance de nascer com baixo peso.

Immunogenicity of a Whole-Cell Pertussis Vaccine with Low Lipopolysaccharide Content in Infants

ABSTRACT The lack of a clear correlation between the levels of antibody to pertussis antigens and protection against disease lends credence to the possibility that cell-mediated immunity provides primary protection against disease. This phase I comparative trial had the aim of comparing the in vitro cellular immune response and anti-pertussis toxin (anti-PT) immunoglobulin G (IgG) titers induced by a cellular pertussis vaccine with low lipopolysaccharide (LPS) content (wPlow vaccine) with those induced by the conventional whole-cell pertussis (wP) vaccine. A total of 234 infants were vaccinated at 2, 4, and 6 months with the conventional wP vaccine or the wPlow vaccine. Proliferation of CD3+ T cells was evaluated by flow cytometry after 6 days of peripheral blood mononuclear cell culture with stimulation with heat-killed Bordetella pertussis or phytohemagglutinin (PHA). CD3+, CD4+, CD8+, and T-cell receptor γδ-positive (γδ+) cells were identified in the gate of blast lymphocytes. Gamma interferon, tumor necrosis factor alpha, interleukin-4 (IL-4), and IL-10 levels in supernatants and serum anti-PT IgG levels were determined using enzyme-linked immunosorbent assay (ELISA). The net percentage of CD3+ blasts in cultures with B. pertussis in the group vaccinated with wP was higher than that in the group vaccinated with the wPlow vaccine (medians of 6.2% for the wP vaccine and 3.9% for the wPlow vaccine; P = 0.029). The frequencies of proliferating CD4+, CD8+, and γδ+ cells, cytokine concentrations in supernatants, and the geometric mean titers of anti-PT IgG were similar for the two vaccination groups. There was a significant difference between the T-cell subpopulations for B. pertussis and PHA cultures, with a higher percentage of γδ+ cells in the B. pertussis cultures (P < 0.001). The overall data did suggest that wP vaccination resulted in modestly better specific CD3+ cell proliferation, and γδ+ cell expansions were similar with the two vaccines.

Factors associated with insufficient birth weight

OBJECTIVE To identify risk factors for insufficient birth weight, in the Brazilian city of Campinas from the Live Birth Certificates. METHODS A cross-sectional study was conducted consulting data from 14,444 Live Birth Certificates from the year 2001. These newborn birth weights ranged from 285g to 5,890g (mean 3,142g), 65.1% of them weighted 3,000g or more, while 25.7% had insufficient weight. A sample of 12,779 term newborn from single pregnancies, with a birth weight > 2,500g was selected. Birth weight was the dependent variable and maternal, pregnancy, delivery and newborn characteristics were the independent variables. Association among variables was assessed by Chi-square test, crude odds-ratio (OR) was calculated. For adjusted odds-ratio (adjOR) values, a logistic regression model was used. RESULTS Results showed association between insufficient birth weight and newborn of the female gender (adjOR = 1.57 [95%CI 1.44 - 1.70]), birth from primiparous mothers (adjOR = 1.47 [95%CI 1.35 - 1.60]), inadequate prenatal care (adjOR = 1.42 [95%CI 1.29 - 1.58]) and vaginal delivery (adjOR = 1.23 [95%CI 1.13 - 1.34]). CONCLUSION The risk for insufficient birth weight was higher for female newborn, offspring of primiparous women, of women who had inadequate prenatal care and had vaginal delivery.

Obesidade e fatores de risco cardiovascular em estudantes de Sorocaba, SP

OBJETIVO: Verificar a prevalencia de obesidade, hipertensao arterial sistemica (HAS), aumento de cintura e acanthosis nigricans em estudantes da cidade paulistana de Sorocaba em 2009, associando aos fatores de risco. METODOS: Amostra probabilistica com 680 criancas (7-11 anos) de 13 escolas municipais de Sorocaba. Um questionario avaliou a pratica de atividade fisica, tempo com televisao, videogame e computador (TV/VG/PC), antecedentes do aluno e dos pais para hipertensao arterial, doenca renal e cardiaca e nivel economico. Foram realizadas medidas de peso, altura, cintura, pressao arterial (PA) e verificado acanthosis nigricans. Determinou-se a prevalencia de alteracao nutricional, HAS, aumento da cintura e acanthosis nigricans. Para a associacao do indice de massa corporea (IMC) IMC > P85 e da PA > P90 com outras variaveis, empregou-se o teste do qui-quadrado ou exato de Fisher (p P85 foi 22,1% [IC 95%: 19,0-25,3%], de PA > P90 10,9% [IC 95%: 8,6-13,5%], aumento da cintura 15,4% [IC 95%: 12,9-17,9%] e acanthosis nigricans 3,8% [IC 95%: 2,6-5,6%]. Foi encontrada associacao do excesso de peso com antecedentes do pai (RCP: 1,76; IC 95%:1,05-2,95; p = 0,02) em ambas as analises. A elevacao de PA associou-se ao sexo feminino (RCP: 1,90; IC 95%:1,12-3,23; p = 0,010), ao maior tempo na TV/VG/PC (RCP: 1,82; IC 95%:1,00-3,36; p = 0,030), a presenca de acanthosis nigricans (RCP: 8,18; IC 95%:3,37-19,80; p < 0,00), a obesidade (RCP: 4,09; IC 95%:2,416,94; p < 0,00) e a cintura (RCP: 4,83; IC 95%:2,77-8,41; p < 0,00). Apos analise multivariada, permaneceram como fatores associados o sexo feminino (RCP ajustada = 2,15; IC 95%:1,17-3,93) e a obesidade (RCP ajustada = 9,51; IC 95%: 4,77-18,97). CONCLUSAO: A prevalencia de excesso de peso, HAS, aumento da cintura e acanthosis nigricans foi relevante, o que justifica a realizacao dessas medidas.

Implante Coclear em Crianças: A Visão dos Pais

The objective of this study was to analyze the point of view of parents in relation to the cochlear implant, their level of information concerning the implant, its risks and benefits, and their expectations towards their childrens future. Ten parents of deaf children candidate for the cochlear implant at Unicamps Clinical Hospital were interviewed. Based on a qualitative approach, a content analysis showed that the majority of parents seek the cure for deafness, and consequently, the acquisition of speech with the cochlear implant. For these families, the cochlear implant is seen both as the solution to their childrens deafness and as a path for a better future. It has been evidenced that during the acquisition of knowledge about the implant, parents experienced anxiety and anguish when faced with the risks and benefits of the procedure, and the need to choose between performing and not performing the cochlear implant.

Obesity and cardiovascular risk factors in school children from Sorocaba, SP.

OBJECTIVE To verify the prevalence of obesity, systemic arterial hypertension (SAH), waist circumference and acanthosis nigricans (AN) in school children from Sorocaba, in 2009 and associate them with risk factors. METHODS A probabilistic sample study was carried out with 680 children (7-11 years) from 13 public schools from the city of Sorocaba, SP. A questionnaire containing questions on physical activity, time spent watching television, playing with video games and computers (TV/VG/PC), student and parental antecedents of arterial hypertension, renal or cardiac disease, and economic level was applied. On physical examination, weight, height, waist circumference (WC) and blood pressure (BP) were measured; presence of AN was observed. The prevalence of nutritional disorders, SAH, WC increase and presence of AN were calculated. To associate body mass index (BMI) > P85 and BP > P90 with the other variables, chi square or Fishers exact test (significance p < 0.05) and crude and adjusted prevalence odds ratio (POR) were used. RESULTS The prevalence of BMI > P85 was 22.1% [95% CI: 19.0-25.3%], of BP > P90 10.9% [95% CI: 8.6- 13.5%], increased WC 15.4% [95% CI: 12.9-17.9%] and AN 3.8% [95% CI: 2.6-5.6%]. Paternal antecedents were associated with weight excess in both analysis (POR: 1.76; 95% CI: 1.05-2.95; p = 0.02). High blood pressure was associated with female sex (POR: 1.90; 95% CI: 1.12-3.23; p = 0.01), more time spent with TV/VG/PC (POR: 1.82; 95% CI: 1.00-3.36; p = 0.03), AN (POR: 8.18; 95% CI: 3.37-19.80; p < 0.00), obesity (POR: 4.09; 95% CI: 2.41-6.94; p < 0.00) and WC (POR: 4.83; 95% CI: 2.77-8.41; p < 0.00). After the multivariate analysis, the female sex (adjusted POR = 2.15; 95% CI: 1.17-3.93) and obesity (adjusted POR = 9.51; 95% CI: 4.77-18.97) remained. CONCLUSION The prevalence of weight excess, SAH, increased WC and AN in these school children was relevant. This fact justifies the use of these measurements.

Correlação entre o índice de massa corporal e a prega cutânea tricipital em crianças da cidade de Paulínia, São Paulo, SP

UNLABELLED Body mass index (BMI) has been considered a criterion to define and analyse obesity in adults and children. BACKGROUND the purpose of this study was to evaluate the correlation between BMI and triceps skinfold (TSF). METHODS there were studied 4,236 children (3.1-10.9y); 48.3%M:51.6%F, from four studies made in Paul nia, SP-Brazil. Height, weight and TSF (Holtain caliper) were measured. For each children BMI was calculated and transformed in SDS, according to North American data (Frisancho, 1993). Multiple linear regression analysis (stepwise) was used for the whole population and in three groups according to BMI: A) SDS < or = -1.0; B) -1.0 < SDS< 1.0) SDS(3) 1.0. Data were processed with SPSS software. RESULTS in group A, the TSF (7.8 +/- 2.3) variability was lower when compared with the groups B (10.1 +/- 4.0) and C (17.8 +/- 6.2). In multiple linear regression with the whole population, R = 0.478 for TSF. In groups B and C, R = 0.364 and 0.368 respectively for TSF, and in group A it was only 0.032. CONCLUSIONS these observations demonstrated a height correlation between BMI and TSF in children with obesity risk (group C). Therefore, we conclude that, in Brazil BMI can be used for childrens research of obesity in population studies, instead of TSF.

Gêmeos monozigóticos: revelações do discurso familiar

PURPOSE: Families with monozygotic twin children have some typical practices which begin in early pregnancy and persist during the childhood, including wearing the same clothes and colors, choosing phonetically similar names and offering the same food and sleeping patterns. The purpose of this study was to follow-up, prospectively, one family with identical twins, analyzing the influence of assumptions and social practices expressed in their discourse on the language development and the construction process of each childs identity, from the diagnosis of monozygotic twin pregnancy. METHODS: The study is based on the naturalist/observational approach, the historic-cultural perspective and the indiciary paradigm. Eight interviews were video recorded every three months since the diagnosis of identical twin pregnancy in one family, and information regarding the following categories were analyzed: the announcement of pregnancy, choice of names, clothes, family interaction, general routine, language and identity of each child. RESULTS: All analyzed categories were referred by the family during the interviews, and revealed their difficulty in assimilating the presence of two different children, who end up being seen as one child. CONCLUSION: The social aspects that come along with the similarities of monozygotic twins are remarkable enough to overcome and change its influence on these childrens processes of language and identity development. The Speech-Language Pathology has an important role to support these families in the context of their beliefs and values, so that the intervention, when necessary, is effective.

Violência doméstica e risco para problemas de saúde mental em crianças e adolescentes

A literatura demonstra que sofrer violencia domestica na infância e juventude e um risco para o desenvolvimento das psicopatologias. Este estudo utilizou o Strenghts and Difficulties Questionnarie(SDQ) e encontrou prevalencia de 65,5% de possibilidades de problemas de saude mental em criancas e adolescentes (4-16 anos), vitimas de violencia domestica, acompanhados em Servicos de Referencia, todos residentes em um municipio brasileiro. O resultado encontrado foi considerado elevado, se comparado a populacao geral. A violencia domestica foi observada como fator de risco para problemas de saude mental nas criancas e adolescentes estudados, agravada pelo uso preocupante de bebida alcoolica pelo responsavel, ou este estar fora do processo produtivo. Nao foram encontrados fatores de protecao efetivos, principalmente em relacao a rede de protecao. Esses resultados sinalizam a necessidade de implementacao de mecanismos que avaliem a efetividade de programas especificos nas areas de saude mental e violencia domestica.