Silvia Wanick Sarinho

Risk factors for neonatal death in Recife: a case-control study

OBJECTIVE: Neonatal mortality is the main cause of infant mortality in the city of Recife. The objective of the present study was to determine the major risk factors for neonatal death in Recife in 1995. METHODS: This is a case control study. Information was obtained from the mortality and live birth databases after validation of the data set, between January and December 1995. A sample of 456 cases and 2,280 controls was obtained after using the linkage technique between the two data sets. The difference in proportion was analyzed by the chi square test. The odds ratio was calculated as a risk measure, with a 95% confidence interval. The logistic regression technique was used to adjust potential confounding factors. RESULTS: 212 deaths (46.6%) occurred in the first 24 hours of life. We found that 358 (79.7%) of the cases presented low birth weight, with a 46-fold higher risk of death (CI =33.8-59.0 P 2,500g. The major risk factors observed in the logistic regression analyses of the measure, listed in descending order, were: birth weight < 1,500g (OR= 49.6 CI= 22.6-108.7 P < 0.001), 5-minute Apgar score < 7 (OR = 44.1 CI= 25.1-77.2 P < 0.001), birth weight between 1,500 and 2,500g (OR= 8.2 CI= 4.8-14.0 P < 0.001), gestational age < 37 weeks (OR= 4.3 CI= 2.6-7.1 P < 0.001). CONCLUSIONS: Among the studied variables, birth weight, gestational age, and Apgar score should be considered the main risk factors for the surveillance of neonatal death.

Quality of information analysis on basic causes of neonatal deaths recorded in the Mortality Information System: a study in Maceió, Alagoas State, Brazil, 2001-2002

Analysis of the quality of information on basic causes of neonatal deaths in Brazil is crucially important, since it allows one to estimate how many deaths are avoidable and provide support for policies to decrease neonatal mortality. The current study aimed to evaluate the reliability and validity of the Mortality Information System (MIS) for discriminating between basic causes of neonatal deaths and defining percentages of reducible causes. The basic causes of early neonatal deaths in hospitals in Maceió, Alagoas State, were analyzed, and the causes recorded in medical records were compared to the MIS data in order to measure reliability and validity. The modified SEADE Foundation and Wigglesworth classifications were compared to analyze the capacity for reduction of neonatal mortality. Maternal causes predominated in the medical records, as compared to respiratory disorders on the death certificates and in the MIS. The percentage of avoidable deaths may be much higher than observed from the MIS, due to imprecision in completing death certificates. Based on the MIS, the greatest problems are in early diagnosis and treatment of neonatal causes. However, the results show that the most pressing problems relate to failures in prenatal care and lack of control of diseases.

Ecological correlation among prevalence of asthma symptoms, rhinoconjunctivitis and atopic eczema with notifications of tuberculosis and measles in the Brazilian population

This study aims to assess the relationship among incidence of tuberculosis and measles, in the general population, within the year of birth and the prevalence of asthma, rhinoconjunctivitis and atopic eczema in teenagers from different Brazilian cities enrolled in the International Study of Asthma and Allergies in Childhood (ISAAC) phases I and III. Positive answers to the questions: ‘Have you had wheezing or whistling in the chest in the past 12 months?’, ‘In the past 12 months, has this nose problem been accompanied by itchy‐watery eyes?’ and ‘Has this itchy rash at any time affected any of the following places: the folds of the elbows, behind the knees, in front of the ankles, under the buttocks, or around the neck, ears or eyes?’ identified the teenagers with asthma, rhinoconjunctivitis, and atopic eczema, respectively. The incidence of tuberculosis and measles, in the general population, observed in the year of birth of the enrolled teenagers (1981/82 and 1988/89) were obtained from governmental agencies: National Foundation of Health (FUNASA) and Brazilian Institute of Geography and Statistics (IBGE). They were compared with the prevalence of asthma, rhinoconjunctivitis and atopic eczema reported in both ISAAC phases I and III. Although we observed reduction of the incidence of tuberculosis and measles in the general population in all cities, the prevalence of asthma, rhinoconjunctivitis and atopic eczema remained stable in most of the centers. In Pernambuco and Paraná, there has been a significant increase in the prevalence of rhinoconjunctivitis. These data do not corroborate the findings of an inverse relationship between the prevalence of atopic diseases and the decreasing incidence of tuberculosis and measles.

Qualidade dos dados sobre óbitos neonatais precoces

OBJECTIVE To investigate the quality of official neonatal death data in Maceió, Alagoas. METHOD A descriptive study was conducted on early neonatal deaths in hospitals between January 1, 2001, and December 31, 2002, to compare data entry in the Death Certificate (DC) and Mortality Information System (MIS) with a standardized form filled out with data of medical files from the mothers and newborn. The frequency with which the following variables failed to be recorded in the DC and SIM was studied: type of death, address, age of mother, gender, birth weight, and delivery type, age at death and gestational age. MIS reliability was verified using simple concordance, sensitivity and Kappa indicator. RESULTS MIS recorded 451 deaths, of which 50 were excluded. Mothers age was omitted from MIS in 44.1% of cases. 85.7% to 100% of the variables not filled in for the DC were recovered from the medical files. There was good concordance between DC and medical files for type of delivery, weight and age. Birth weight and age of mother presented the least concordance between medical files and MIS. MIS presented 69.2% sensitivity for weight and 36.3% for age of mother, thus demonstrating little capability to correctly supply information to generate perinatal health indicators. CONCLUSION Because of incomplete filling out, quality of the DC becomes precarious and makes the MIS inadequate, even though it covers 100% of neonatal deaths in Maceió. Inefficiency of the system is increased by failure of MIS technicians to correct errors found and input all the information available.

Quality Assessment of Neonatal Transport performed by the Mobile Emergency Medical Services (SAMU)

OBJECTIVE To assess the quality of neonatal transport performed by the Mobile Emergency Medical Services (Serviço de Atendimento Móvel de Urgência [SAMU]). METHODS This was a cross-sectional before-and-after observational study. The study was carried out from March to August of 2013 using a validated instrument, the Transport Risk Index of Physiologic Stability (TRIPS), to assess the characteristics of the newborn, medical and mechanical complications (equipment and ambulance), and stability of newborns before and after transport. Tests were conducted with 95% confidence level. Numerical variables are represented by measures of central tendency and dispersion. Categorical variables were compared by Fishers exact test. In the comparison of variables between the groups, the Students t-test was used for variables with normal distribution, Fisher exact test, when appropriate, and the Mann-Whitney test, for non-normal distribution. RESULTS 33 newborns were transported from low-risk units to neonatal intensive care units. Male gender (57.6%) and full-term gestational age (63.6%) were more prevalent. Birth weight<2,500g was found in 39.4% of newborns. Respiratory failure accounted for 42.4% of the requests. The mean transport time was 58 minutes without medical or mechanical complications. The TRIPS score worsened in 15% of neonates; in this group of infants, the mean initial temperature of 36.46±0.19 decreased significantly to 36.08±0.22 (p=0.041). CONCLUSION The transport performed by the SAMU was adequate for most newborns. The oscillation in body temperature was the only significant variable for the alteration in the TRIPS score.

Exercise-induced bronchospasm in a hot and dry region: study of asthmatic, rhinitistic and asymptomatic adolescents

ABSTRACT Background: Exercise-induced bronchospasm (EIB) is the bronchial narrowing that occurs after intense exercise in a significant number of asthmatics and in some non-asthmatics. This study aims to evaluate the occurrence of EIB in adolescents with asthma, rhinitis and respiratory asymptomatics in a hot and dry climate. Research design and methods: This is a cross-sectional study based on an epidemiological study that evaluated the prevalence of asthma in schoolchildren in a semi-arid zone of Brazil. The EIB was defined as a reduction in forced expiratory volume in first second (FEV1) greater than 10%. Results: A total of 114 individuals participated in the study (36.8% male), of whom 54 were asymptomatic, 30 asthmatic and 30 with rhinitis. Asthmatics presented a higher proportion of EIB in comparison to rhinitis and asymptomatics (46.7% vs. 13.3% and 7.4%, p = 0.001) and none of the individuals had severe EIB (ΔFEV1 ≥ 50%). Conclusions: A large proportion of the asthmatics selected from the community for the clinical study had EIB. Among participants with rhinitis, EIB was found in slightly more than 10%, while in the asymptomatics the frequency was slightly more than 5%. This study presents an important aspect in individuals living in hot and dry climates.

Lower prevalence and greater severity of asthma in hot and dry climate

OBJECTIVE To estimate asthma prevalence, severity, and associated factors in adolescents who live in a low relative humidity environment. METHODS In this cross-sectional study, adolescents aged 13-14 years from the city of Petrolina located in the Brazilian semiarid region answered the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. The possible explanatory variables of the study were gender, family income, mothers education, smokers in the household, parental history of asthma, personal history of allergic rhinitis or atopic dermatitis, and physical activity level. Poisson regression analysis was used to assess the association between asthma and the explanatory variables. RESULTS A total of 1591 adolescents participated in the study, of whom 49.7% were male. The prevalence of active asthma, severe asthma, and physician-diagnosed asthma were 14.0%, 10.4%, and 17.8%, respectively. Adolescents with asthma missed more school days than their peers (33 vs. 22 days/year; p<0.03). Associated factors that remained significant after adjustment were history of asthma in parents (PR=2.65, p<0.001) and personal diagnosis of allergic rhinitis (PR=1.96, p<0.001) and/or atopic dermatitis (PR=2.18, p<0.001). CONCLUSION Asthma prevalence in this low-humidity environment was lower, but more severe than those reported in other Brazilian cities. The dry climate might hamper disease control and this may have contributed to the higher school absenteeism observed. The association of asthma with allergic rhinitis and atopic dermatitis as well as a history of asthma in parents suggests that atopy is an important risk factor for asthma in this population.

Proposta de utilização da técnica de contagem como preditor da capacidade vital lenta em indivíduos hospitalizados

PURPOSE:to evaluate if there is a correlation between the slow vital capacity and the maximum phonation time by technique of counting numbers and if it is possible from the maximum phonation time estimate the slow vital capacity in hospitalized individuals.METHODS:it is a cross-sectional study, crossover and choice of techniques (technique of numerical count and spirometry) were performed randomly (simple draw). The slow vital capacity was measured by spirometry and maximum phonation time was assessed using the technique of counting numbers.RESULTS:participated in the research 221 hospitalized patients. A positive correlation was observed between the Slow vital capacity and maximum phonation time evaluated on an absolute (r = 0.75; p <0.001) and relative (r = 0.76; p <0.001). From the simple linear regression of the data, were verified equations of the lines analyzed absolutely, Slow vital capacity = 55 Technique of numerical count + 735 (r2= 0,56; p < 0,0001) and relative Slow vital capacity = 0,84 Technique of numerical count + 14 (r2= 0,57; p < 0,0001).CONCLUSIONS:the results obtained in this study showed a good correlation between the techniques evaluated, possible to estimate the Slow vital capacity from the technique of counting numbers in hospitalized individuals.

Adaptation of the MABC-2 Test (Age Band 2) for children with low vision

BACKGROUND The tools used to assess motor performance in children with low vision often have no validity and reliability data concerning this population and use non-standardized modifications. Adaptations of these tools could help to identify motor problems and mitigate their effects. AIM To assess aspects of validity and reliability in an adaptation of the Movement ABC-2 Test (MABC-2) for children with low vision. METHODS AND PROCEDURES The research was undertaken in two stages: 1) application of the original MABC-2 to 10 children with low vision, adaptation and pilot test; 2) administration and re-administration of the adapted MABC-2 in 30 children with low vision. Inter-rater reliability and test-retest reliability were assessed with an intraclass correlation coefficient and Kappa index; internal consistency was assessed with Cronbachs alpha. OUTCOMES AND RESULTS Substantial to almost perfect inter-rater reliability was found between the component standard scores and a reasonable to excellent concordance rate in the classification of movement difficulty. The adapted tool has moderate internal consistency. CONCLUSIONS AND IMPLICATIONS The adapted MABC-2 Test has improved the assessment of motor performance in children with low vision.

Descrição da atividade física e da jornada de trabalho na qualidade de vida de profissionais de terapia intensiva: Comparação entre um grande centro urbano e uma cidade do interior brasileiro

O objetivo deste estudo foi comparar a qualidade de vida dos diversos profissionais que trabalham em terapia intensiva considerando o nivel de atividade fisica, a jornada de trabalho e o local de residencia. Trata-se de um estudo transversal realizado em quatro Unidades de Terapia Intensiva de uma capital brasileira e em tres de uma regiao interiorana do sertao brasileiro. O nivel de atividade fisica foi avaliado pelo IPAQ versao curta e a qualidade de vida foi analisada mediante o questionario SF-36, ambos aplicados em forma de entrevista. Participaram do estudo 280 profissionais medicos, enfermeiros, fisioterapeutas e tecnicos de enfermagem. Embora tenha sido observado que a maior parte dos profissionais apresentou elevada jornada de trabalho, este fator nao influenciou na qualidade de vida. Os individuos ativos apresentaram melhores escores nos dominios referentes a limitacao por aspectos fisicos (p = 0,010); aspecto social (p = 0,043) e saude mental (p = 0,014). Profissionais com elevada jornada de trabalho e que se mantinham ativos apresentaram melhor escore do dominio capacidade vital em relacao aos individuos inativos (p = 0,028). Os profissionais residentes no interior apresentaram maior escore para o dominio saude mental (p = 0,034). O nivel de atividade fisica foi a variavel que mais influenciou nos escores de qualidade de vida e garantiu aos profissionais que trabalham em regime elevado melhor escore no dominio capacidade vital.