Paulo Rogério Gallo

Avaliação antropométrica de pré-escolares do município de Mogi-Guaçú, São Paulo: subsídio para políticas públicas de saúde

OBJETIVOS: analisar o estado nutricional, atraves de avaliacao antropometrica, dos pre-escolares que frequentam Escolas Municipais de Educacao Infantil (EMEIs) de Mogi-Guacu, Sao Paulo, Brasil. METODOS: a partir de uma amostra por conglomerado, estimada pela equiprobabilidade, com participacao de 347 criancas de tres a sete anos de idade, matriculadas em nove EMEIs, das 38 existentes na pesquisa, foram tomadas medidas individuais de peso e estatura, complementadas por questionario com informacoes socioeconomicas familiares. As medidas foram controladas com o uso de escores z e comparadas com o referencial do Centro Nacional de Estatisticas da Saude dos Estados Unidos da America, e o indice de massa corporal. RESULTADOS: verificou-se um provavel deslocamento da media dos indices antropometricos para a direita da curva normal no tocante ao escore z dos indicadores peso/idade (+0,54; dp 1,48), altura/idade (+0,20; dp 1,02), IMC (+0,30; dp 1,13). CONCLUSOES: a caracterizacao da situacao nutricional das criancas matriculadas nas EMEIs nao aponta para risco de desnutricao proteico-energetica (DPE). Em contrapartida, observou-se, como problema, a presenca de sobrepeso e obesidade.

A humanização na saúde como instância libertadora

O texto discute a politica de Humanizacao em Saude do ponto de vista da logica que a sustenta, em particular como uma acao da singularidade dos atores implicados no processo de producao da Saude. A analise desenvolvida aponta para o fato de que as praticas de atencao a saude, quando de acordo com os cânones da logica utilitaria, refletem nao apenas uma ordem autoritaria, como produzem sujeitos cerceados, fragmentados e incapazes. A humanizacao em Saude e considerada uma possibilidade politica de se alterar essa logica e de instaurar, no interior das instituicoes, espacos de liberdade capazes de acolher, amparar, sustentar e dar significado a presenca e as acoes de profissionais de saude, gestores e pacientes, ao considerar suas dimensoes subjetivas e singulares.

Motivação de gestantes para o aleitamento materno

OBJECTIVE: The present study sought to discover the reasons for expectant mothers to breastfeed. METHODS: This was a qualitative study involving 164 expectant mothers attending prenatal care in two health centers of the city of Sao Paulo. Semi-structured interviews were done to collect data on the reasons to breastfeed. The information was organized in a spreadsheet to search for categories. RESULTS: The main identified categories regarded the childs and womans health and the benefits of breastfeeding and breast milk. The majority of the women (98.8%) regarded breastfeeding favorably. Benefit to the childs health was the reason mentioned most often (73.8%). CONCLUSION: Motivation to breastfeed was based on benefits to the childs health. Breastfeeding is valued regardless of the mothers will.

Nutritional status of pre-school children from low income families.

BackgroundWe evaluated growth and nutritional status of preschool children between 2 and 6 years old from low income families from 14 daycare centers.MethodsCross-sectional study with 1544 children from daycare centers of Santo Andre, Brazil. Body weight (W), height (H) and body mass index (BMI) were classified according to the 2000 National Center for Health Statistics (CDC/NCHS). Cutoff points for nutritional disorders: -2 z scores and 2.5 and 10 percentiles for malnutrition risk, 85 to 95 percentile for overweight and above BMI 95 percentile for obesity. Stepwise Forward Regression method was used including age, gender, birth weight, breastfeeding duration, age of mother at birth and period of time they attended the daycare center.ResultsChildren presented mean z scores of H, W and BMI above the median of the CDC/NCHS reference. Girls were taller and heavier than boys, while we observed similar BMI between both genders. The z scores tended to rise with age. A Pearson Coefficient of Correlation of 0.89 for W, 0.93 for H and 0.95 for BMI was documented indicating positive association of age with weight, height and BMI. The frequency of children below -2 z scores was lower than expected: 1.5% for W, 1.75% for H and 0% for BMI, which suggests that there were no malnourished children. The other extremity of the distribution evidenced prevalence of overweight and obesity of 16.8% and 10.8%, respectively.ConclusionLow income preschool children are in an advanced stage of nutritional transition with a high prevalence of overweight.

Perspectiva de alimentação infantil obtida com gestantes atendidas em centros de saúde na cidade de São Paulo

OBJECTIVES: to obtain information from pregnant women on how they planned to feed their infants during the first year of life. METHODS: cross sectional study of the data obtained through structured questionnaires, filled by means of individual interviews with 164 pregnant women assisted by prenatal clinics in Outpatient Centers in the city of Sao Paulo. Statistical Chi- Square test was used to determine association between age, school level, parity and knowledge on the variety of fruits, vegetables and meats available. RESULTS: all women knew at least one type of fruit and vegetable while 20% of the women did not intend to offer vegetables. Significant statistical results between age, school level, parity and knowledge on the variety of fruits and vegetables available were not determined. The most rejected food, according to the mothers were fish (85.4%) and liver (82.3%). Many myths were determined related to the iron content of food. CONCLUSIONS: the intention of offering food to children under six months old was frequent. The value of discussing the transition of infant feeding during prenatal care was determined as well.

Narrative interviews: an important resource in qualitative research

Objetivo Este estudio es un aporte metodologico en que se explica y destaca el alcance y la fertilidad de la entrevista narrativa en la investigacion cualitativa. Metodo Describir el metodo de la narrativa en la investigacion cualitativa. Resultados El metodo de investigacion cualitativa se caracteriza por abordar las cuestiones relacionadas con las singularidades del campo y de las personas encuestadas, siendo las entrevistas narrativas un metodo potente para uso de los investigadores que toman posesion de ella. Permiten que la profundizacion de la investigacion, la combinacion de historias de vida con los contextos socio-historicos e la comprension de los sentidos que producen cambios en las creencias y valores que motivan y justifican las acciones de los posibles informantes. Conclusion El uso de la narrativa se presenta un recurso de investigacion ventajosa en la investigacion cualitativa, la narrativa es una forma tradicional de comunicacion cuyo objetivo es servir contenido a partir de la que se pueden transmitir las experiencias subjetivas.Objetives This methodological study explain and emphasize the extent and fertility of the narrative interview in qualitative research. Methods To describe the narrative method within the qualitative research. Results The qualitative research method is characterized by addressing issues related to the singularities of the field and individuals investigated, being the narrative interviews a powerful method for use by researchers who aggregate it. They allow the deepening of research, the combination of life stories with socio-historical contexts, making the understanding of the senses that produce changes in the beliefs and values that motivate and justify the actions of possible informants. Conclusion The use of narrative is an advantageous investigative resource in qualitative research, in which the narrative is a traditional form of communication whose purpose is to serve content from which the subjective experiences can be transmitted.

Declarações de nascidos mortos no município de São Paulo: avaliação descritiva do preenchimento

OBJECTIVES: to study the information contained in Stillbirth Registers (SBRs) in the Municipality of Sao Paulo. METHODS: the adequacy of the filling out of SBR forms was assessed on the basis of the SBRs (6722) made available by the FSEADE (Foundation for Statistical Data Analysis System), using a Data Completion Index (DCI), making it possible to compare the three years studied (2001-3). Variables relating to the mother and the fetus were included where the DCI was greater than 10%. Education, parity, place of residence, birth type, for the mother and weight, gestational age and underlying cause of death, for the fetus. RESULTS: the absolute stillbirth component changed little in the first two of the three years, falling slightly in the third. The variable most frequently registered was sex (98%), followed by place of residence (82.9%) and parity (70%). The data least often registered were those relating to the mothers age and schooling, 20.0% and 16.7%, respectively. The underlying cause was recorded in 46.7%, fetal weight in 37% and type of birth in 25.3%. CONCLUSIONS: the data demonstrate that the difficulty encountered in incorporating this health indicator into the traditional set of indicators is in part due to the inadequacy of the data provided on the SBR form.

Rest energy expenditure is decreased during the acute as compared to the recovery phase of sepsis in newborns

BackgroundLittle is known with respect to the metabolic response and the requirements of infected newborns. Moreover, the nutritional needs and particularly the energy metabolism of newborns with sepsis are controversial matter. In this investigation we aimed to evaluate the rest energy expenditure (REE) of newborns with bacterial sepsis during the acute and the recovery phases.MethodsWe studied nineteen neonates (27.3 ± 17.2 days old) with bacterial sepsis during the acute phase and recovery of their illness. REE was determined by indirect calorimetry and VO2 and VCO2 measured by gas chromatography.ResultsREE significantly increased from 49.4 ± 13.1 kcal/kg/day during the acute to 68.3 ± 10.9 kcal/kg/day during recovery phase of sepsis (P < 0.01). Similarly, VO2 (7.4 ± 1.9 vs 10 ± 1.5 ml/kg/min) and VCO2 (5.1 ± 1.7 vs 7.4 ± 1.5 ml/kg/min) were also increased during the course of the disease (P < 0.01).ConclusionREE was increased during recovery compared to the sepsis phase. REE of septic newborns should be calculated on individualized basis, bearing in mind their metabolic capabilities.

Infant mortality in Cabinda, Angola: challenge to health public policies

OBJECTIVE To critically discuss, describe and analyze the data on infant mortality provided by public health services of Cabinda, Angola. METHOD The deaths of children aged less than one year old in 2007 and 2008 were analyzed in the Cabinda province. Provincial hospital records and those of the WHO office were used due to the limited quality and availability of official information. RESULTS In 2007, 11,734 children were born, and 366 of them died in their first year of life: 113 on the first day, 87 by the 28th day and 166 in the remaining 337 days. In 2008, 13,441 children were born and 275 died; 109 died on the first day and 69 by the 28th day. Malaria was the main cause of death (one out of three). Pneumonia was the second cause in 2007 and the third in 2008, presenting consistent reduction, from 65 to 40 deaths. Cases of diarrhea from 2007 (9.83%) decreased to 3.27% in 2008. Tetanus accounted for about 5% of all deaths. Perinatal causes increased in proportion, particularly neonatal asphyxia (17.75% in 2007 and 26.90% in 2008) and prematurity (13.38% in 2007 and 17.45% in 2008). CONCLUSIONS Improvements in the quality of prenatal care, attendance during delivery and to new born risk, would reduce infant mortality. The lack of sanitation, inadequate water supply and poor access to health services played an important role as determinants of infant mortality observed in Cabinda. This study highlights the need to reorganize the civil registration system.

Motor development of infants exposed to maternal human immunodeficiency virus (HIV) but not infected.

Background To assess the motor development of infants exposed to maternal human immunodeficiency virus (HIV). Methods Thirty infants were assessed in the period from November 2009 to March 2010 at the AIDS Reference and Training Centre, in São Paulo, Brazil. The assessment instrument used in the research was the Alberta Infant Motor Scale (AIMS). All 30 infants used the antiretroviral drug properly for 42 consecutive days, in accordance with the protocol of the World Health Organization. Results Out of the total number of infants, 27 (90%) had proper motor performance and 3 (10%) presented motor delay, according to the AIMS. Discussion This study demonstrated that only 10% of the assessed group had developmental delay and no relation with environmental variables was detected, such as maternal level of education, social and economic issues, maternal practices, attendance at the day care center, and drug use during pregnancy. It is important to emphasize the necessity of studies with a larger number of participants.