Samuel Carvalho Dumith

Atividade física durante a gestação e associação com indicadores de saúde materno-infantil

OBJETIVO: Analisar fatores associados a pratica de atividade fisica durante a gestacao e sua relacao com indicadores de saude materno-infantil. METODOS: Estudo transversal realizado com todos os nascimentos ocorridos em maternidades no municipio de Rio Grande, RS, durante o ano de 2007 (N = 2.557). As informacoes foram obtidas por entrevista, por meio de um questionario pre-codificado aplicado as maes. Os desfechos de saude materno-infantil analisados foram: hospitalizacao durante a gravidez, parto por cesarea, prematuridade (idade gestacional menor de 37 semanas), baixo peso ao nascer (< 2.500 g) e morte fetal. RESULTADOS: Relataram ter praticado atividade fisica durante a gestacao 32,8% (IC95% 31,0;34,6) das maes. Os fatores associados a pratica de atividade fisica na gestacao, apos ajustes para possiveis confundidores, foram: idade materna (associacao inversa), escolaridade (associacao direta), ser primigesta, ter feito pre-natal, e ter recebido orientacao para a pratica de exercicios durante o pre-natal. Mulheres que praticaram atividade fisica durante a gestacao mostraram menor probabilidade de realizacao de cesariana e de terem filho natimorto. Nao houve associacao entre atividade fisica e parto prematuro, hospitalizacao e baixo peso ao nascer. CONCLUSOES: Apenas um terco das maes relatou ter praticado atividade fisica durante a gestacao. Esse comportamento foi mais frequente entre mulheres mais jovens, com maior escolaridade e que receberam orientacao. Mulheres que praticaram atividade fisica durante a gestacao realizaram menos cesarianas e tiveram menor ocorrencia de natimorto.OBJECTIVE To analyze factors associated with the practice of physical activity during pregnancy and its relationship to maternal and child health indicators. METHODS Cross-sectional study carried out with all births that occurred at maternity hospitals in the municipality of Rio Grande (Southern Brazil) during the year of 2007 (N = 2,557). Information was collected through interviews, by means of a pre-coded questionnaire administered to the mothers. The analyzed maternal and child health outcomes were: hospitalization during pregnancy, cesarean delivery, preterm birth (gestational age < 37 weeks), low birth weight (< 2500g), and fetal death. RESULTS A total of 32.8% of mothers (95%CI 31.0;34.6) reported having practiced physical activity during pregnancy. The factors associated with practice of physical activity during pregnancy, after adjusting for potential confounders, were: maternal age (inverse association), level of schooling (direct association), mothers first pregnancy, having received prenatal care, and having been instructed in physical activity during prenatal care. Women who practiced physical activity during pregnancy were less likely to deliver surgically and to have a stillbirth. There was no association between physical activity and preterm birth, hospitalization, and low birth weight. CONCLUSIONS Only one third of mothers reported having practiced physical activity during pregnancy. This behavior was more frequent among younger women with higher level of schooling who were advised during prenatal care. Women who practiced physical activity during pregnancy had fewer cesarean sections and lower occurrence of stillbirths.

Physical activity during pregnancy and its association with maternal and child health indicators

OBJETIVO: Analisar fatores associados a pratica de atividade fisica durante a gestacao e sua relacao com indicadores de saude materno-infantil. METODOS: Estudo transversal realizado com todos os nascimentos ocorridos em maternidades no municipio de Rio Grande, RS, durante o ano de 2007 (N = 2.557). As informacoes foram obtidas por entrevista, por meio de um questionario pre-codificado aplicado as maes. Os desfechos de saude materno-infantil analisados foram: hospitalizacao durante a gravidez, parto por cesarea, prematuridade (idade gestacional menor de 37 semanas), baixo peso ao nascer (< 2.500 g) e morte fetal. RESULTADOS: Relataram ter praticado atividade fisica durante a gestacao 32,8% (IC95% 31,0;34,6) das maes. Os fatores associados a pratica de atividade fisica na gestacao, apos ajustes para possiveis confundidores, foram: idade materna (associacao inversa), escolaridade (associacao direta), ser primigesta, ter feito pre-natal, e ter recebido orientacao para a pratica de exercicios durante o pre-natal. Mulheres que praticaram atividade fisica durante a gestacao mostraram menor probabilidade de realizacao de cesariana e de terem filho natimorto. Nao houve associacao entre atividade fisica e parto prematuro, hospitalizacao e baixo peso ao nascer. CONCLUSOES: Apenas um terco das maes relatou ter praticado atividade fisica durante a gestacao. Esse comportamento foi mais frequente entre mulheres mais jovens, com maior escolaridade e que receberam orientacao. Mulheres que praticaram atividade fisica durante a gestacao realizaram menos cesarianas e tiveram menor ocorrencia de natimorto.OBJECTIVE To analyze factors associated with the practice of physical activity during pregnancy and its relationship to maternal and child health indicators. METHODS Cross-sectional study carried out with all births that occurred at maternity hospitals in the municipality of Rio Grande (Southern Brazil) during the year of 2007 (N = 2,557). Information was collected through interviews, by means of a pre-coded questionnaire administered to the mothers. The analyzed maternal and child health outcomes were: hospitalization during pregnancy, cesarean delivery, preterm birth (gestational age < 37 weeks), low birth weight (< 2500g), and fetal death. RESULTS A total of 32.8% of mothers (95%CI 31.0;34.6) reported having practiced physical activity during pregnancy. The factors associated with practice of physical activity during pregnancy, after adjusting for potential confounders, were: maternal age (inverse association), level of schooling (direct association), mothers first pregnancy, having received prenatal care, and having been instructed in physical activity during prenatal care. Women who practiced physical activity during pregnancy were less likely to deliver surgically and to have a stillbirth. There was no association between physical activity and preterm birth, hospitalization, and low birth weight. CONCLUSIONS Only one third of mothers reported having practiced physical activity during pregnancy. This behavior was more frequent among younger women with higher level of schooling who were advised during prenatal care. Women who practiced physical activity during pregnancy had fewer cesarean sections and lower occurrence of stillbirths.

Aggregation of the four main risk factors to non-communicable diseases among adolescents

OBJECTIVE It was to investigate the cluster of four main risk behaviors (smoking, alcohol, physical inactivity and low consumption of fruits and vegetables) related to chronic diseases from Northeastern Brazil. METHODS Cross-sectional study with a representative sample (n = 600) of high school students from public schools in Caruaru, Pernambuco, Brazil. The cluster was evaluated by comparing the observed prevalence expected in all the possibilities of coupling between the behaviors. The logistic regression analysis was performed by grouping three or four behaviors, after adjusting for independent variables. RESULTS With the exception of smoking, other risk behaviors had prevalence rates above 20%. Only 0.3% (95%CI 0.1 - 1.3) of the students presented the four risk behaviors simultaneously, while 15.3% (95%CI 12.3 - 18.2) did not present anyone. Risk behaviors tended to cluster, particularly smoking and alcohol consumption, being more pronounced among boys, and physical inactivity and low consumption of fruits and vegetables among girls (p < 0.05). Regression analysis indicated that, among the independent variables, those students who do not have physical education classes were 2.1 times more likely to have three or more risk behaviors added. CONCLUSIONS The results of this study allow us to establish the prevalence of risk behaviors in cluster, which may have important implications for health policies and practices. It is suggested that educational and health actions are tested in schools, and physical education classes can be an important context for intervention.

Prevalence and factors associated with stunting and excess weight in children aged 0-5 years from the Brazilian semi-arid region☆

OBJECTIVE To analyze the prevalence of excess weight and low height, and identify associated factors among children younger than five years. METHODS Cross-census study. A total of 1,640 children from two municipalities in Piauí, Brazil were included. RESULTS The prevalence of low height was 10.9% (95% CI: 9.3 to 12.4), inversely associated with mothers younger age and low level of education, lower socioeconomic status, mothers who had fewer than six prenatal consultations, and households that had more than one child younger than 5 years. Excess weight prevalence was 19.1% (95% CI: 17.2 to 21.0), and remained inversely associated with lower maternal age, low maternal education, and cesarean delivery. Stunting was greater in children aged between 12 and 23 months, while excess weight decreased with age. CONCLUSIONS It is noteworthy that the stunting rate, although decreasing, is still high, while the prevalence of excess weight, even in this very poor area, already exceeds the expected percentage for a population with better socioeconomic level.

Concordância entre informações do Cartão da Gestante e do recordatório materno entre puérperas de uma cidade brasileira de médio porte

Prenatal care is a key indicator of the quality of health services. The current study aimed to evaluate the correlation between data from prenatal care cards and maternal recall in the city of Rio Grande, Rio Grande do Sul State, Brazil. The cross-sectional study included all mothers from 2010 who had received prenatal care. Interviews were conducted with a pre-coded questionnaire in the maternity hospital. Of the 2,288 mothers interviewed, 1,228 (53.7%) had the prenatal care card with them and thus comprised the group for comparison. The analysis used kappa correlation and confidence interval. The variables six or more prenatal visits, clinical breast and gynecological examination, two blood tests, VDRL, HIV serology, urine test, and tetanus vaccination showed statistically significant differences between annotated and maternal recall data (p ≤ 0.001). Adequacy of prenatal care based on the guidelines of the Program for Humanization of Prenatal Care (PHPN) was 23.9% according to information provided by the patients and 4.4% according to information recorded on the prenatal cards (p ≤ 0.001). The prenatal care card showed underreporting, which limited the quality assessment of prenatal care.A assistencia pre-natal e um indicativo da qualidade dos servicos de saude. Esse estudo objetivou avaliar a concordância entre os dados do pre-natal da memoria materna e do cartao da gestante no Municipio do Rio Grande, Rio Grande do Sul, Brasil. Estudo transversal incluindo todas puerperas do ano de 2010 que realizaram pre-natal. As entrevistas e a coleta dos dados do cartao ocorreram nas maternidades. Das 2.288 puerperas entrevistadas, 1.228 (53,7%) portavam o cartao da gestante, sendo a comparacao realizada nesse grupo. A analise foi feita utilizando-se o teste de concordância kappa e o intervalo de confianca. A realizacao de seis ou mais consultas de pre-natal, exame das mamas e ginecologico, dois exames de sangue, VDRL, anti-HIV, urina e a vacinacao antitetânica demonstraram diferenca estatistica entre os dados referidos e anotados (p ≤ 0,001). A adequacao do pre-natal pelo indice do Programa de Humanizacao do Pre-Natal (PHPN) nos dados referidos foi de 23,9% e de 4,4% nos dados anotados (p ≤ 0,001). Observamos um sub-registro no cartao da gestante, o qual influenciou negativamente na avaliacao da qualidade do pre-natal.

Conhecimento sobre a transmissão de HIV/AIDS entre adolescentes com 11 anos de idade do Sul do Brasil

OBJECTIVE To investigate the effect of demographic, socioeconomic, educational and family variables on HIV/AIDS knowledge among adolescents aged 11 years. METHODS 3,949 adolescents born in Pelotas (Brazil). HIV/AIDS knowledge was assessed through a self-administered questionnaire and measured through five questions about HIV transmission: heterosexual intercourse, homosexual intercourse, needle sharing, open-mouth kissing and hugging someone with AIDS. All the analyses were adjusted based on a hierarchical model, using Poisson regression with robust adjustment of variance. RESULTS Prevalence of wrong answers to the examined questions were 17.2% for heterosexual transmission, 44.1% for homosexual intercourse, 34.9% for needle sharing, 25.6% for kiss on the mouth and 16.2% for hugging someone with AIDS. In adjusted analysis, lower knowledge levels were more prevalent among boys, adolescents with lower socioeconomic status and with less maternal education level, among those who had not talked about sex with mother and without sexual education lessons at school. Knowledge was not associated with school type (public or private), skin color or talk about sex with father. CONCLUSION Providing information to adolescents is essential to improve knowledge about HIV and other sexually transmitted infections, especially among young males, with lower socioeconomic status and with lower maternal education level. Public policies aimed to reducing HIV infection should consider maternal and school relevance to improve knowledge on adolescents.

Iron supplementation among pregnant women: results from a population-based survey study

OBJECTIVES To measure the prevalence and risk factors associated with iron supplementation among pregnant women in the municipality of Rio Grande, Southern Brazil. METHODS All mothers living in this municipality who had children in 2007 were surveyed for demographic, socioeconomic and health care received during pregnancy and childbirth. The statistical analysis consisted of Poisson regression with robust adjustment of variance, and the measure of effect was prevalence ratio (PR). RESULTS Among the 2,557 mothers interviewed (99% of total), 59% were supplemented with iron during pregnancy period. After adjusting for various confounding factors, a higher PR to iron supplementation was observed among teenagers, women with black skin color, primigravidae, who had six or more antenatal visits, who performed prenatal care in public sector and received vitamin during pregnancy. CONCLUSION There is a clear need to increase the iron supplementation coverage of all pregnant women, especially among those currently considered with low gestational risk.

Citopatológico de colo uterino entre gestantes no Sul do Brasil: um estudo transversal de base populacional

PURPOSE To determine the prevalence and risk factors associated with failure of voluntary screening for cervical cancer during the gestational period in Rio Grande, Rio Grande do Sul State, Southern Brazil. METHODS Previously trained interviewers applied a standardized questionnaire in the maternity to all mothers from this municipality who had delivered from January 1st to December 31st 2010 to obtain information about the demographic characteristics of the pregnant women, family socioeconomic status, and prenatal care received. The χ² test was used to compare proportions and Poisson regression with robust adjustment of variance was used in the multivariate analysis. RESULTS Among the 2,288 respondents, 33% were not submitted to the Pap smear during pregnancy. Two thirds of these women stated that they were not aware of the need to perform it, 18% were not screened out of fear or shame, and the rest for other reasons. After adjustment, the highest prevalence ratios (PR) for noncompliance with the Pap smear occurred among young women (PR=1.5; 95%CI 1.25 - 1.80), with lower educational level (PR=1.5; 95%CI 1.12 - 2.12), who were living without a partner (PR=1.4; 95%CI 1.24 - 1.62), smokers (PR=1.2; 95%CI 1.07 - 1.39), who did not plan the current pregnancy (PR=1.3; 95%CI 1,21 - 1.61), who had attended less than six medical visits during the prenatal period (PR=1.4; 95%CI 1.32 - 1.69) and among users of oral contraceptives (PR=1.2; 95%CI 1.04 - 1.38). CONCLUSIONS The higher the risk for uterine cervical cancer, the less likely a pregnant woman is to undergo a Pap smear. This definitely contributed to the increased morbidity and mortality from this disease in this setting.

Text Messaging (SMS) Helping Cancer Care in Patients Undergoing Chemotherapy Treatment: a Pilot Study

Cancer treatment is an extremely stressful life experience that is accompanied by a range of psychological, social, physical, and practical difficulties. Cancer patients need to receive information that helps them to better understand the disease, assists them in decision-making, and helps them deal with treatment. Patients are interested in receiving such information. The degree of satisfaction with the information received has been associated with positive health outcomes, specifically regarding quality of life, severity of side effects, and psychological well-being. This study investigates a method of guiding cancer patients, in relation to outpatient chemotherapy treatment, using SMS (short message service) text messaging. A smartphone application called cHEmotHErApp was developed, and its primary function is to send out SMS text messages with guidance for self-care and emotional support for oncology patients undergoing chemotherapy. Thus, the main objective of this study is to evaluate the acceptance and perception of patients of the receipt of these SMS messages, as well as to evaluate the possible benefits reported by the participants. Adult patients diagnosed with cancer, who started the first outpatient chemotherapy treatment scheme between August and November 2016 at the School Hospital (HE) of the Federal University of Pelotas (UFPel), were invited to participate in this pilot study. In total, 14 cancer patients were adherent to this study. Each of these patients received a daily text message on their cell phone with some guidance on encouraging self-care and emotional support. Patients reported that, because of the SMS text messages they received, they felt more confident in their treatment, felt more supported and encouraged, and that the text messages facilitated self-care. In addition, patients reported that the SMS text messages they received helped them to take better care of themselves and to continue further treatment.

Diet and body fat in adolescence and early adulthood: a systematic review of longitudinal studies

Adipose tissue is a vital component of the human body, but in excess, it represents a risk to health. According to the World Health Organization, one of the main factors determining excessive body adiposity is the dietary habit. This systematic review investigated longitudinal studies that assessed the association between diet and body fat in adolescents and young adults. Twenty-one relevant papers published between 2001 and 2015 were selected. The most used method for estimating body fat was the body mass index (15 studies). Diet was most commonly assessed by estimating the consumption of food groups (cereals, milk and dairy products) and specific foods (sugar-sweetened beverages, soft drinks, fast foods, milk, etc.). Ten studies found a direct association between diet and quantity of body fat. During adolescence, adhering to a dietary pattern characterized by high consumption of energy-dense food, fast foods, sugar-sweetened beverages and soft drinks, as well as low fiber intake, appears to contribute to an increase in body fat in early adulthood. The findings of the present study suggest that the frequent consumption of unhealthy foods and food groups (higher energy density and lower nutrient content) in adolescence is associated with higher quantity of body fat in early adulthood.