Sílvia Reis dos Santos

Vivências da maternidade na adolescência precoce

OBJECTIVE Although still scarcely studied in Brazil, motherhood in early adolescence among girls aged 10 to 14 years is mostly unwanted and it is an important public health issue. Most investigations are based on biomedical paradigms and few take into consideration the adolescents point of view. This study aimed to explore the different patterns of experiencing early motherhood from the adolescents own point of view. METHODS William Stephensons Q methodology was applied. The study population was selected from 2 public mother and child health units in Rio de Janeiro, Brazil, and comprised 20 adolescents who became pregnant at the age of 10 to 14 years and were followed up for a period of 6 to 24 months after giving birth. Q-sorts underwent factor analysis and then the factors were interpreted. RESULTS Four qualitatively and statistically (p<0.01) perception patterns were found. Two factors were well defined: Factor I - Satisfied with motherhood/ Dependent on the childs affection: motherhood is a positive and rich experience; and Factor II - Depressed/ Stressed out: motherhood is a negative and stressful experience. Other two potential factors need confirmation in further studies with a larger sample size. CONCLUSIONS It was observed that motherhoods experience is distinct and heterogeneous. For some adolescents, motherhood could be a rewarding experience

Evaluating mother-and-child health care in Brazil

OBJETIVO: Analisar e comparar os cuidados primarios prestados a populacao materno-infantil e contribuir para a avaliacao da assistencia integral a esse grupo. METODOS: Inquerito populacional realizado por entrevistas, no principal posto de vacinacao do Municipio de Teresopolis, RJ, no Dia Nacional de Vacinacao, que abrangeu questoes sobre utilizacao de servicos de saude e prestacao de cuidados primarios preventivos. RESULTADOS: Foram colhidas informacoes de 329 criancas e suas respectivas maes. Mais de 90% das criancas haviam comparecido a consulta pediatrica nos tres meses anteriores e quase todas possuiam o cartao da crianca, embora em 30% desses cartoes nao havia qualquer peso registrado no periodo. Observou-se associacao positiva entre consulta de puericultura e registro de peso no cartao da crianca (RP = 1,34; IC: 1,13-1,58; p = 0,0002). Cerca de 59% das maes compareceram a consulta de revisao de parto, mas 25% referiram nunca ter feito exame colpocitologico-oncotico e 36% nunca haviam realizado exame de mama. Observou-se associacao positiva entre a idade materna acima de 20 anos e a realizacao de algum exame colpocitologico-oncotico durante a vida reprodutiva (RP = 1,56; IC: 1,08-2,26; p = 0,03). Quase 70% das maes relataram uso de algum metodo anticoncepcional, principalmente pilula, condom e laqueadura tubaria. CONCLUSOES: Apesar de algumas limitacoes, os resultados sugerem a viabilidade da metodologia utilizada, permitindo a identificacao de deficiencias importantes na prestacao de cuidados primarios de saude para criancas e principalmente para maes.OBJECTIVE To describe and analyze primary health care provided to mother-and-child population in Teresópolis, state of Rio de Janeiro, Brazil. METHODS A population survey was performed at the main vaccination station on the local Vaccine National Day, to collect information about the use of health care services and preventive primary care. RESULTS Information was collected from 329 mothers and their children. More than 90% of children had at least one pediatric visit in the past three months. Almost all had their growth chart, but in 30% of them the childs weight was not registered. There was a positive association between having a routine visit and the registration of the childs weight in the card (RP = 1.34; IC: 1.13-1.58; p = 0.0002). Around 59% of the mothers had a medical visit after giving after birth; 25% said they had never had a Pap smear test before, and 36% never had a breast examination. There was a positive association between the mothers age being over 20 years and ever having a Pap smear test (RP = 1.56; IC: 1.08-2.26; p = 0.03). Almost 70% of the mothers referred the use of any contraception method, and the most common used were contraceptive pills, condoms and tubal ligation. CONCLUSIONS Despite some limitations, the results suggest a valid and useful methodology, which allows the identification of important needs in primary health care delivery to children and their mothers.OBJETIVO: Analisar e comparar os cuidados primarios prestados a populacao materno-infantil e contribuir para a avaliacao da assistencia integral a esse grupo. METODOS: Inquerito populacional realizado por entrevistas, no principal posto de vacinacao do Municipio de Teresopolis, RJ, no Dia Nacional de Vacinacao, que abrangeu questoes sobre utilizacao de servicos de saude e prestacao de cuidados primarios preventivos. RESULTADOS: Foram colhidas informacoes de 329 criancas e suas respectivas maes. Mais de 90% das criancas haviam comparecido a consulta pediatrica nos tres meses anteriores e quase todas possuiam o cartao da crianca, embora em 30% desses cartoes nao havia qualquer peso registrado no periodo. Observou-se associacao positiva entre consulta de puericultura e registro de peso no cartao da crianca (RP = 1,34; IC: 1,13-1,58; p = 0,0002). Cerca de 59% das maes compareceram a consulta de revisao de parto, mas 25% referiram nunca ter feito exame colpocitologico-oncotico e 36% nunca haviam realizado exame de mama. Observou-se associacao positiva entre a idade materna acima de 20 anos e a realizacao de algum exame colpocitologico-oncotico durante a vida reprodutiva (RP = 1,56; IC: 1,08-2,26; p = 0,03). Quase 70% das maes relataram uso de algum metodo anticoncepcional, principalmente pilula, condom e laqueadura tubaria. CONCLUSOES: Apesar de algumas limitacoes, os resultados sugerem a viabilidade da metodologia utilizada, permitindo a identificacao de deficiencias importantes na prestacao de cuidados primarios de saude para criancas e principalmente para maes.

AIDS in childhood: cardiac involvement with and without triple combination antiretroviral therapy

OBJECTIVE To describe the prevalence of cardiac abnormalities in the echocardiogram of children with AIDS followed up in a reference service at 18+/-6 months of AIDS confirmed diagnosis. METHODS A cross-section study with a cohort after 18+/-6 months of AIDS diagnosis. The study included a total of 93 children with a confirmed diagnosis of AIDS with vertical transmission, with no malignancies and who underwent echocardiogram (echo) during cardiologic evaluation. Cardiac abnormalities were assessed in patients who were not treated (G1) and patients who were treated (G2) with combination antiretroviral therapy. RESULTS When diagnosed with AIDS, the children were on average 3.07 years old and 50.50% were female. The combination regimen with antiretroviral agents was used by 47 patients (G2). Cardiac involvement was present in 40 children (43.00%). The presence of left ventricular dysfunction (G1: 39.10%; G2: 10.60%) and the isolated enlargement of left ventricle (G1: 6.60%; G2: 14.90%) were the most frequent findings. We observed a significant association between the groups without and with combination antiretroviral therapy asregards the presence of left ventricular dysfunction (PR= 3.42; [1.41-8.26]; p = 0.02) and malnutrition (PR = 1.79; [1.00-3.20]; p = 0.04). CONCLUSION Cardiac involvement was frequent in children with AIDS and left ventricular dysfunction was the most common abnormality on echocardiogram. There was a statistically significant difference between the groups with and without triple combination treatment as regards the presence of left ventricular dysfunction and malnutrition.

Addiction Medicine and Continuing Medical Education

Addictive disorders are one of the most common problems encountered by primary care physicians. In the last decades there has been a significant effort by organizations, universities, and private foundations to increase the teaching of alcohol and drug abuse issues to medical students, residents and practitioners. Still, up to now, the subject has not been presented appropriately at either the undergraduate or graduate medical education level and the majority of physicians in practice have not been adequately instructed in addiction medicine. This article reviews the literature on addictive disorders and medical education, exploring issues concerning continuing medical education (CME) in particular. The authors discuss the problems relative to this subject and the educational techniques and methods most appropriate to changing attitudes and behaviors of physicians. They also design an approach to a CME program on addictive disorders for primary care physicians that incorporates multiple teaching/learning methodologies.

Adaptação e aplicabilidade do componente "maus-tratos" à estratégia da Atenção Integrada às Doenças Prevalentes na Infância no Brasil

OBJETIVOS: descrever o processo de adaptacao ao contexto brasileiro e da aplicabilidade do conteudo do modulo de maus-tratos no âmbito da estrategia Atencao Integrada as Doencas Prevalentes na Infância (AIDPI), a partir do original proposto pela Organizacao Pan-Americana da Saude. METODOS: O protocolo original foi traduzido para o portugues, retro-traduzido e revisado de forma independente. Foram incorporados aspectos relativos a legislacao, contexto de saude e organizacao dos servicos brasileiros. O material foi discutido por especialistas de diferentes areas ate obter consenso a respeito de compreensao e correspondencia sobre os conceitos e os instrumentos propostos. A versao preliminar foi testada com grupo de monitores da estrategia AIDPI. Sugestoes foram incorporadas ao texto. O modulo final foi aplicado com sucesso em treinamento para monitores em AIDPI na Regiao Nordeste. RESULTADOS: o material mostrou-se util, claro e coerente. A classificacao de gravidade para maus tratos psicologicos e negligencia, alem de textos com orientacoes aos profissionais e pais sobre o desenvolvimento psicomotor e emocional normais da crianca foram incluidos. CONCLUSOES: A incorporacao desse modulo de maus-tratos em treinamentos formais na estrategia AIDPI pode preencher uma lacuna na educacao do profissional de saude na atencao primaria, onde problemas relacionados a violencia contra a crianca sao frequentes.

Integrated care of childhood disease in Brazil: Mothers' response to the recommendations of health workers: Mothers' response to IMCI recommendations

Aim: To describe the process of follow‐up in primary care facilities where the Integrated Management of Childhood Illness (IMCI) strategy was implemented. IMCI was developed by WHO and UNICEF as an integrated approach to manage sick children under 5 y of age and aims to reduce mortality and morbidity. Methods: From August 2001 to February 2002, 229 sick children who had a health condition included in the IMCI case management guidelines were seen in six family healthcare facilities in Brazil. We analysed the care provided to 153 children who were recommended for a 2‐ or 5‐d follow‐up visit. Children who did not return were visited and assessed at home. Results: Only 87 children (56.9%) timely returned for follow‐up: 70 had improved, eight presented the same health conditions, five were worse and four had a new problem. The main reasons given for not returning for follow‐up were: the child had improved (35.1%) and other family priorities (47.4%). Home visits showed that, although most children had improved (n=49), some had a new health problem and one child was sick enough to be referred. Prescription of antibiotics was associated with increased probability of returning for a follow‐up visit (RR =1.64 [1.22–2.20], p=0.001).