Rosana Fiorini Puccini

Avaliação das práticas e conhecimentos de profissionais da atenção primária à saúde sobre vigilância do desenvolvimento infantil

O objetivo desta pesquisa foi avaliar os conhecimentos e praticas relacionados a vigilância do desenvolvimento da crianca de 160 profissionais que atuam na atencao primaria a saude, no Municipio de Belem, Para. Foram selecionados 40 medicos e 40 enfermeiros de Unidades Municipais de Saude (UMS), e 40 medicos e 40 enfermeiros do Programa da Familia Saudavel (PFS). Na avaliacao dos conhecimentos por meio da aplicacao de teste objetivo, o percentual de acerto foi de 63,7% para medicos das UMSs, 57,3% para medicos do PFS, 62,1% para os enfermeiros do PFS e 54,3% para enfermeiros das UMSs. Na avaliacao das praticas, apenas 21,8% das maes informaram que foram indagadas sobre o desenvolvimento dos seus filhos, 27,6% que o profissional perguntou ou observou o desenvolvimento da sua crianca e 14,4% que receberam orientacao sobre como estimula-las. Concluimos que medicos e enfermeiros da atencao primaria no Municipio de Belem apresentam deficiencias nos conhecimentos sobre desenvolvimento infantil e que a vigilância do desenvolvimento nao e realizada de forma satisfatoria, sendo necessarias sensibilizacao e capacitacao dos profissionais para esta pratica.

Metabolic syndrome among prepubertal Brazilian schoolchildren

This was a two-stage cross-sectional study that assessed metabolic syndrome and associated factors among prepubertal schoolchildren. In the first stage, nutritional status, blood pressure, personal (low birth weight) and family antecedents for cardiovascular disease (CVD) were collected. In the second stage, schoolchildren with at least one of these criteria participated: obesity, personal or family history. Metabolic syndrome (MS) was defined by ATP III and WHO definitions. Among 929 (6–10 year old) schoolchildren, 27.7% presented with overweight/obesity, 12.2% hypertension, and personal (9.4%) and family (35.3%) antecedents. 205 children finished the second stage. The frequencies of MS-ATP and MS-WHO were 9.3% and 1.9%. Among the obese, MS was present in 25.8% (ATP) and 5.2% (WHO). Children with normal weight presented: low HDL (23.6%), hyperglycaemia (3.6%), HOMA-IR (0.9%) and MS-ATP (0.9%). In conclusion, overweight/obesity was associated with metabolic syndrome in schoolchildren. It was found that children with normal weight with personal and/or family antecedents presented with HOMA-IR and MS-ATP.

Living conditions and receptive vocabulary of children aged two to five years

OBJECTIVE To assess the receptive vocabulary of children aged between two years and six months and five years and eleven months who were attending childcare centers and kindergarten schools. METHODS An analytical cross-sectional study was carried out in the municipality of Embu, Southeastern Brazil. The Peabody Picture Vocabulary Test and analysis of factors associated with childrens performance were applied. The sample consisted of 201 children of both genders, aged between two and six years. Statistical analysis was performed using multivariate analysis and logistic regression model. The dependent variable analyzed was test performance and the independent variables were childs age, mothers level of education and family socio-demographic characteristics. RESULTS It was observed that 44.3% of the children had performances in the test that were below what would be expected for their age. The factors associated with the best performances in the test were childs age (OR=2.4; 95% CI: 1.6-3.5) and mothers education level (OR= 3.2; 95% CI: 1.3-7.4). CONCLUSIONS Mothers education level is important for childs language development. Settings such as childcare and kindergarten schools are protective factors for child development in families of low income and education.

Eqüidade na atenção pré-natal e ao parto em área da Região Metropolitana de São Paulo, 1996

A cross-sectional study was conducted to evaluate prenatal and childbirth care interviewing mothers of infants in the municipality of Embu (Greater Metropolitan Sao Paulo) in 1996, according to four socioeconomic strata. A door-to-door survey included a probabilistic sample consisting of 483 infants. In all strata more than 90% of the mothers had received prenatal care, but with late access in stratum 4 (residents of favelas, or slums). Breast examination during prenatal care, reported by only 60.8% of the mothers, was the worst single indicator of quality of prenatal care in the municipality. The outcome indicator - first prenatal consultation after the first trimester and total number of consultations less than six - was associated with maternal age (less than 20 years), low per capita family income (less than one minimum wage), and lack of private health plan. As for deliveries, 97.7% occurred in hospital, of which 32.5% by cesarean section, with the latter more frequent in private health care facilities (63.2%). No population segments were identified as being excluded from the health care system, but some indicators suggest greater deficiencies in socioeconomic stratum 4. These results have supported local health system managers in redefining health measures for the municipality.

Risk factors associated with developmental abnormalities among high-risk children attended at a multidisciplinary clinic

CONTEXT AND OBJECTIVE Knowledge of risk factors associated with child development disorders is essential for delivering high-quality childcare. The objective here was to evaluate the relationships between risk factors and occurrences of developmental abnormalities among children attended at a reference clinic for children at risk of developmental abnormalities. DESIGN AND SETTING Retrospective study at a multidisciplinary reference center, Embu, São Paulo. METHODS All cases followed up for more than three months between 1995 and 2003 were reviewed. The risk factors assessed were low birth weight, gestational age, length of stay in neonatal ward, perinatal asphyxia, mothers age < 18 years, congenital infections, malformations and low mothers education level. Developmental abnormalities were defined according to developmental tests and assessments by the clinics professionals. The statistical analysis consisted of the chi-squared test for comparing categorical variables and a logistic regression model for multivariate analysis. RESULTS 211 children were followed up for more than three months. Developmental abnormalities occurred in 111 (52.6%). Univariate analysis showed significant relationships between developmental abnormality and low birth weight, perinatal asphyxia, length of stay > 5 days, prematurity and mothers age 18 years and older. Low birth weight, history of perinatal asphyxia and mothers age continued to be significant in multivariate analysis. CONCLUSIONS Special attention must be paid to the development of low birth weight infants and/or infants with histories of neonatal complications. Low birth weight is easily assessed and should be considered to be an important marker when defining guidelines for following up child development.

Fatores associados à internação hospitalar de crianças menores de cinco anos, São Paulo, SP

OBJECTIVE In developing countries acute respiratory infection (ARI) is the leading cause of hospitalization among children under five years of age. Their underprivileged life conditions and restricted access to health care services are important determining factors. The objective of the study was to assess hospital morbidity and to identify factors associated to hospitalization of children under five years of age. METHODS A data set derived from a cross-sectional study on health conditions of children under five years of age in the city of Embu, a county located in the metropolitan region of Sao Paulo, Brazil, was used. The inclusion criteria were one child per family (random selection). The exclusion criteria were missing data on any study variable. The sample size was 893 children. Data was collected using household interviews with mother or caretaker. Statistical analysis was performed using logistic regression models to identify factors associated with hospitalization. RESULTS/CONCLUSIONS Sixty-five (7.7%) children were hospitalized. Of them, 41.5% were admitted with a respiratory tract disease, mainly due to an ARI (27.7 %). Factors associated to hospitalization included: low birth weight; perinatal problems; chronic illness; death of a sibling under the age of five; grandmother as day caretaker; living in overcrowded places, and mothers higher educational level.Objective In developing countries acute respiratory infection (ARI) is the leading cause of hospitalization among children under five years of age. Their underprivileged life conditions and restricted access to health care services are important determining factors. The objective of the study was to assess hospital morbidity and to identify factors associated to hospitalization of children under five years of age. Methods A data set derived from a cross-sectional study on health conditions of children under five years of age in the city of Embu, a county located in the metropolitan region of Sao

Constipação em lactentes: influência do tipo de aleitamento e da ingestão de fibra alimentar

OBJECTIVE To study the relationship between breast-feeding, dietary fiber intake and constipation in infants. METHODS The study population consisted of 275 infants consecutively enrolled in two Primary Care Clinic in the city of Embu, in the Great São Paulo. The feeding pattern were classified in predominantly breast-feeding, partially breast and cows milk feeding and artificial feeding. Constipation was defined by the elimination of hard stool associated with one of the following: painful or difficult defecation, hard or round cracked stools and less than three defecations a week. False constipation was defined by the elimination of soft stools without pain or difficulty but with less than three defecations a week. RESULTS Constipation was found in 25.1% (69/275). False constipation was found only in the first semester of life in 5.1% of 159 infants. The prevalence of constipation was higher between 6 and 24 months (38.8%, 45/116) than in the first semester of life (15.1%, p=0.000). A model of logistic regression demonstrated that infants under artificial feeding were 4.53 times more liable to develop constipation than infants who were predominantly breastfed. The daily dietary fiber intake (g/day) was similar (p=0.57) among the constipated (median=9.0 g; 25th and 75th percentiles: 6.9-13.1 g) and non-constipated (median=8.8 g; 25th and 75th percentiles: 6.1-12.9 g). CONCLUSIONS Dietary fiber intake was similar in constipated and non-constipated infants. Breast-feeding serves as a protection factor against the development of constipation in the first semester of life.

Dores recorrentes na infância e adolescência

OBJECTIVE: to perform a bibliographic review of recurrent pain in children and adolescents, focusing on differential diagnosis and management of such patients. SOURCES OF DATA: search of Medline and Lilacs databases, covering the last four and ten years, respectively. Classical studies and texts related to the matter were also included. SUMMARY OF THE FINDINGS: studies carried out in different parts of the world demonstrate that the most frequent kinds of recurrent pain in children and adolescents are abdominal pain, headache, and limb pain. The occurrence of organic etiology is low, observed in 5% to 10% of the cases. Among the well defined organic etiology, no predominance is observed. The main advances regarding the pathophysiology of recurrent pain in its main localizations were analyzed. Guidelines for the diagnostic and therapeutic approach of the most common infantile diseases related to recurrent pain are presented. CONCLUSIONS: recurrent pain in children and adolescents is very common and determines significant demand on healthcare services. Defined etiology is only presented by 5% to 10% of patients. Anamnesis, physical examination and follow-up are extremely important instruments for dealing with such patients.

Desigualdades sociais e uso de serviços de saúde: evidências de análise estratificada

OBJETIVO: Identificar os grupos populacionais nao alcancados pelo programa local de saude materno-infantil, buscando caracterizar os possiveis pontos de exclusao, com vistas ao estudo de intervencoes capazes de ampliar o acesso e a utilizacao das principais acoes de saude oferecidas pelo programa. METODOS: Estudou-se uma amostra de 465 menores de um ano residentes no Municipio de Embu, SP (Brasil). A analise estatistica, orientada pela hipotese que esperava maior disponibilidade de planos de saude entre as familias que nao usavam o programa local de saude infantil, consistiu em analises de associacao estratificadas que buscaram detectar heterogeneidade entre os quatro estratos de familias e no interior deles, definidos segundo diferentes padroes de condicoes de vida. RESULTADOS: Apesar de apenas 85,4% das criancas estudadas serem matriculadas nas unidades basicas de saude, 91,2 % eram assistidas pelas principais acoes de saude. No estrato 3, onde reside a populacao periferica, estao concentradas as criancas nao alcancadas pelo programa. O estudo de diferencas dentro dos estratos revelou que tambem no estrato 3 encontra-se a possibilidade de que algumas familias estejam usando convenios ou planos de saude como alternativa ao programa local de saude. Os resultados apontam ainda que a populacao com piores condicoes de vida (favelas) dispoe do sistema publico do municipio como unica alternativa para cuidar de sua saude. CONCLUSOES: E na populacao residente na periferia do municipio que se concentram as criancas nao assistidas pelo programa local de saude infantil e existe maior heterogeneidade entre as familias quanto a disponibilidade de outros recursos para os cuidados de saude de suas criancas.

Blood pressure levels in childhood: probing the relative importance of birth weight and current size

Several studies have reported data supporting the idea that an impaired intrauterine environment that deprives the fetus of optimal nutrient delivery results in the predisposition of the fetus to experience cardiovascular and metabolic dysfunction in later life. However, contradictory data still exist. Our purpose was to investigate the effects of both birth weight and weight gain on the risk for high blood pressure levels in 6- to 10-year-old children. This cross-sectional study included 739 children divided into quartiles of birth weight. The mean values of both systolic and diastolic pressure were significantly different between quartiles of birth weight, with increasing blood pressure values as the birth weight decreased (P < 0.001). Covariance analysis adjusting for gender, prematurity, and body mass index (BMI) showed that both systolic and diastolic pressure remained greater in the lowest than in the highest birth weight quartile. Separating those with low and normal birth weight demonstrated that the risk of childhood hypertension was significantly higher among children with low birth weight and current obesity (odds ratio [OR]: 5.0, confidence interval [CI]: 3.3 to 16.1; P = 0.023). The inverse association between birth weight and blood pressure levels appears to be programmed during fetal life, while weight gain during childhood adds to this risk.