Vanda Maria Ferreira Simões

Características da gravidez na adolescência em São Luís, Maranhão

OBJECTIVE: To identify the main socioeconomic, demographic, anthropometric and behavioral characteristics, and pregnancy outcomes of adolescent pregnancy and to assess health services used by pregnant adolescents. METHODS: Data were collected from a cross-section of 2,429 deliveries by women residing in the municipality of Sao Luis, Brazil, of which 94% were hospital births. Women were categorized into six age groups. The two groups of teenagers (under 18 and 18-19 years) were compared to four groups of older women. Comparison was also made between the two teenage groups. The chi-square test was used to compare proportions and prevalence ratio was used as an effect measure. RESULTS: Of 2,429 women, 714 (29.4%) were adolescents. Their specific fertility coefficient was higher than in other regions of the country. Adolescents showed lower socioeconomic and reproductive conditions than older women and a higher proportion of inadequate prenatal care. The majority had no partner. They had the lowest percentages of caesarean section and smokers. CONCLUSIONS: Despite their equally unfavorable socioeconomic situation, 18-19 year-old adolescents had pregnancy outcomes comparable to the age group 25-29, whereas those under 18 had the highest proportions of low birth weight, preterm birth, and infant mortality rate. This suggests that biologic immaturity may be associated with adverse pregnancy outcomes.OBJETIVO: Identificar as principais caracteristicas socioeconomicas, demograficas, antropometricas e comportamentais, bem como os resultados perinatais da gravidez na adolescencia. Conhecer os tipos de servicos de saude utilizados pelas gestantes adolescentes. METODOS: A amostra de 2.429 partos de mulheres residentes em Sao Luis, MA, abrangeu 94% dos nascimentos hospitalares. As mulheres foram separadas em seis grupos de idade para melhor avaliacao do comportamento das variaveis entre os dois grupos de adolescentes (abaixo de 18 anos; 18 a 19 anos) e entre as adolescentes e as demais mulheres. O teste do qui-quadrado foi utilizado para a comparacao de proporcoes e a razao de prevalencias foi empregada como medida de efeito. RESULTADOS: Das 2.429 mulheres, 714 eram adolescentes (29,4%). Seu coeficiente especifico de fecundidade, 72,2 por mil, foi mais elevado que em outras regioes do Pais. As adolescentes apresentaram piores condicoes socioeconomicas e reprodutivas que as demais mulheres, maior proporcao de pre-natal inadequado (39,2%) e muitas nao tinham companheiro (34,5%). Por outro lado, tiveram menor proporcao de parto cesareo (23,0%) e de fumantes (3.5%). CONCLUSOES: Apesar da situacao socioeconomica igualmente desfavoravel, as adolescentes de 18 a 19 anos apresentaram resultados perinatais semelhantes as mulheres de 25 a 29 anos. Ja as menores de 18 anos tiveram maiores proporcoes de filhos com baixo peso ao nascer, prematuros e com maior risco de mortalidade infantil. Isto sugere que a imaturidade biologica possa estar associada a maiores taxas de prematuridade, baixo peso ao nascer e mortalidade infantil.OBJECTIVE To identify the main socioeconomic, demographic, anthropometric and behavioral characteristics, and pregnancy outcomes of adolescent pregnancy and to assess health services used by pregnant adolescents. METHODS Data were collected from a cross-section of 2,429 deliveries by women residing in the municipality of São Luís, Brazil, of which 94% were hospital births. Women were categorized into six age groups. The two groups of teenagers (under 18 and 18-19 years) were compared to four groups of older women. Comparison was also made between the two teenage groups. The chi-square test was used to compare proportions and prevalence ratio was used as an effect measure. RESULTS Of 2,429 women, 714 (29.4%) were adolescents. Their specific fertility coefficient was higher than in other regions of the country. Adolescents showed lower socioeconomic and reproductive conditions than older women and a higher proportion of inadequate prenatal care. The majority had no partner. They had the lowest percentages of caesarean section and smokers. CONCLUSIONS Despite their equally unfavorable socioeconomic situation, 18-19 year-old adolescents had pregnancy outcomes comparable to the age group 25-29, whereas those under 18 had the highest proportions of low birth weight, preterm birth, and infant mortality rate. This suggests that biologic immaturity may be associated with adverse pregnancy outcomes.

Early Growth and Neurologic Outcomes of Infants with Probable Congenital Zika Virus Syndrome

We report the early growth and neurologic findings of 48 infants in Brazil diagnosed with probable congenital Zika virus syndrome and followed to age 1–8 months. Most of these infants had microcephaly (86.7%) and craniofacial disproportion (95.8%). The clinical pattern included poor head growth with increasingly negative z-scores, pyramidal/extrapyramidal symptoms, and epilepsy.

Carga de trabalho de profissionais da saúde e eventos adversos durante ventilação mecânica em unidades de terapia intensiva neonatal

Objective:To investigate a possible association between the intensity of staff workload and intermediate adverse events, such as accidental extubation, obstruction of the endotracheal tube, and accidental disconnection of the ventilator circuit, during neonatal mechanical ventilation in high-risk neonatal units. Method:This prospective cohort study analyzed data of 543 newborns from public neonatal intensive care units (NICUs) in the city of Sao Luis, state of Maranhao, Northeastern Brazil, for 6 months, during which 136 newborns were submitted to mechanical ventilation in 1,108 shifts and were observed a total of 4,554 times. Results: Adverse events occurred 117 times during this period. The associations between workload and adverse events were analyzed by means of generalized estimating equations. The adjustment variables were: birth weight, gender, maternity unit, Clinical Risk Index for Babies score, and care demand, the latter measured by the Northern Neonatal Network Scale. The larger the number of newborns classified by care demand (NCCD) per nurse and nursing technician, the more likely the occurrence of intermediate adverse events linked to mechanical ventilation. A number of NCCD > 22 per nurse (relative risk [RR] = 2.86) and > 4.8 per auxiliary nurse (RR = 3.41) was associated with a higher prevalence of intermediate adverse events. Conclusions: The workload of NICU professionals seems to interfere with the intermediate results of neonatal care and thus should be taken into consideration when evaluating NICU outcomesOBJECTIVE To investigate a possible association between the intensity of staff workload and intermediate adverse events, such as accidental extubation, obstruction of the endotracheal tube, and accidental disconnection of the ventilator circuit, during neonatal mechanical ventilation in high-risk neonatal units. METHOD This prospective cohort study analyzed data of 543 newborns from public neonatal intensive care units (NICUs) in the city of São Luís, state of Maranhão, Northeastern Brazil, for 6 months, during which 136 newborns were submitted to mechanical ventilation in 1,108 shifts and were observed a total of 4,554 times. RESULTS Adverse events occurred 117 times during this period. The associations between workload and adverse events were analyzed by means of generalized estimating equations. The adjustment variables were: birth weight, gender, maternity unit, Clinical Risk Index for Babies score, and care demand, the latter measured by the Northern Neonatal Network Scale. The larger the number of newborns classified by care demand (NCCD) per nurse and nursing technician, the more likely the occurrence of intermediate adverse events linked to mechanical ventilation. A number of NCCD > 22 per nurse (relative risk [RR] = 2.86) and > 4.8 per auxiliary nurse (RR = 3.41) was associated with a higher prevalence of intermediate adverse events. CONCLUSIONS The workload of NICU professionals seems to interfere with the intermediate results of neonatal care and thus should be taken into consideration when evaluating NICU outcomes.

Prevalencia e fatores associados a desnutricao e ao excesso de peso em menores de cinco anos nos seis maiores municipios do Maranhao

Prevalences of malnutrition and overweight among children under five years and its association with socioeconomic, demographic and health indicators were estimated for the six largest municipalities of Maranhao, in 2006/2007. By means of a household survey, a sample of 1214 children under five years of age was randomly selected. Two-stage cluster sampling was used, representing the six municipalities of Maranhao with over one hundred thousand inhabitants. Standardized questionnaire was administered to mothers or guardians and trained personnel measured weight and height or length. For classification of malnutrition cutoff points of +2 z score, following World Health Organization guidelines. By weight-for-age malnutrition prevalence was 4.5, by length/height-for-age 8.5% were stunted and by the weight-for-length/height 3.9% were malnourished (wasting), while 6.7% were overweight. Children of families headed by women had lower prevalence of malnutrition (prevalence ratio=0.4). Socioeconomic variables were not associated with malnutrition or overweight. Participation in money transfer programs from the government was not associated with malnutrition or overweight. The prevalence of malnutrition was low, but being overweight was more prevalent than malnutrition. Social inequality was not detected in relation to malnutrition in children under five years of age, suggesting a favorable trend towards greater equity.

Associação de gravidez na adolescência e prematuridade

PURPOSE To analyze the association of pregnancy in adolescence and prematurity. METHODS The study included all the patients who delivered at a teaching hospital in Maranhão State, from July to December 2006. The patients were divided into two groups: adolescents (10 to 19 years old) and adults (20 to 34 years old). The variables studied were: educational level, marital status, number of prenatal visits, gestational age at the onset of prenatal care, duration of gestation, delivery route and birth weight. Statistical analysis was performed using the Epi-Info software, version 3.4.1, and the associations between variables were analyzed by the odds ratio (OR), with a 95% confidence interval (CI). Models of logistic regression were also used. The level of significance adopted was 0.05. RESULTS The study evaluated 1,978 patients. The frequency of deliveries in adolescents was 25.4%. This group presented low educational level, no mates, low number of prenatal visits, late onset of prenatal care, low birth weight and prematurity. In the analysis of prematurity as the outcome variable, there was a clear association with low number of prenatal visits (OR 3.0; 95%CI 2.2-4.0) and late onset of prenatal care (OR 1.9; 95%CI 1.3-2.6) and low educational level (OR 1.9; 95%CI 1.4-2.5) related to adolescence (OR 1.5; 95%CI 1.1-1.9). The incidence of caesarean delivery was significantly lower among adolescents (33.3%) than among adults (49.4%), with a lower association with pre-eclampsia and cephalo-pelvic disproportion. CONCLUSIONS Pregnancy in adolescence was associated with late onset of prenatal care and low number of visits, as well as low educational level, low birth weight, prematurity and a lower incidence of cephalo-pelvic disproportion and pre-eclampsia.

A protocol to identify non-classical risk factors for preterm births: the Brazilian Ribeirão Preto and São Luís prenatal cohort (BRISA)

BackgroundPreterm birth is the main cause of morbidity and mortality during the perinatal period. Classical risk factors are held responsible for only 1/3 of preterm births and no current intervention has produced an appreciable reduction of this event. It is necessary to explore new hypotheses and mechanisms of causality by using an integrated approach, collaboration among research groups and less fragmented theoretical-methodological approaches in order to detect new risk factors and to formulate more effective intervention strategies.MethodsThe study will be conducted on a convenience cohort of Brazilian pregnant women recruited at public and private prenatal health services. A total of 1500 pregnant women in São Luís, and 1500 in Ribeirão Preto, will be invited for an interview and for the collection of biological specimens from the 22nd to the 25th week of gestational age (GA). At the time of delivery they will be reinterviewed. GA will be determined using an algorithm based on two criteria: date of last menstruation (DLM) and obstetric ultrasound (OUS) performed at less than 20 weeks of GA. Illicit drug consumption during pregnancy will be determined using a self-applied questionnaire and the following instruments will be used: perceived stress scale, Beck anxiety scale, screening for depression of the Center of Epidemiological Studies (CES-D), experiences of racial discrimination, social network and social support scale of the Medical Outcomes Study and violence (Abuse Assessment Screening and violence questionnaire of the WHO). Bacterial vaginosis, urinary tract infection and periodontal disease will also be identified. Neuroendocrine, immunoinflammatory and medical intervention hypotheses will be tested. The occurrence of elective cesarean section in the absence of labor will be used as a marker of medical intervention.ConclusionPsychosocial, genetic and infectious mechanisms will be selected, since there are indications that they influence preterm birth (PTB). The studies will be conducted in two Brazilian cities with discrepant socioeconomic conditions. The expectation is to identify risk factors for PTB having a greater predictive power than classically studied factors. The final objective is to propose more effective interventions for the reduction of PTB, which, after being tested, might subsidize health policies.

Are mental health problems and depression associated with bruxism in children

OBJECTIVES Previous studies have found an association between bruxism and emotional and behavioral problems in children, but reported data are inconsistent. The objective of this study was to estimate the prevalence of bruxism, and of its components clenching and grinding, and its associations with mental problems and depression. METHODS Data from two Brazilian birth cohorts were analyzed: one from 869 children in Ribeirão Preto - RP (São Paulo), a more developed city, and the other from 805 children in São Luís - SL (Maranhão). Current bruxism - evaluated by means of a questionnaire applied to the parents/persons responsible for the children - was defined when the habit of tooth clenching during daytime and/or tooth grinding at night still persisted until the time of the assessment. Additionally, the lifetime prevalence of clenching during daytime only and grinding at night only was also evaluated. Mental health problems were investigated using the Strength and Difficulties Questionnaire (SDQ) and depression using the Childrens Depression Inventory (CDI). Analyses were carried out for each city: with the SDQ subscales (emotional symptoms, conduct problems, peer problems, attention/hyperactivity disorder), with the total score (sum of the subscales), and with the CDI. These analyses were performed considering different response variables: bruxism, clenching only, and grinding only. The risks were estimated using a Poisson regression model. Statistical inferences were based on 95% confidence intervals (95% CI). RESULTS There was a high prevalence of current bruxism: 28.7% in RP and 30.0% in SL. The prevalence of clenching was 20.3% in RP and 18.8% in SL, and grinding was found in 35.7% of the children in RP and 39.1% in SL. Multivariable analysis showed a significant association of bruxism with emotional symptoms and total SDQ score in both cities. When analyzed separately, teeth clenching was associated with emotional symptoms, peer problems, and total SDQ score; grinding was significantly associated with emotional symptoms and total SDQ score in RP and SL. Female sex appeared as a protective factor for bruxism, and for clenching and grinding in RP. Furthermore, maternal employment outside the home and white skin color of children were associated with increased prevalence of teeth clenching in SL. CONCLUSIONS Mental health problems were associated with bruxism, with teeth clenching only and grinding at night only. No association was detected between depression and bruxism, neither clenching nor grinding. But it is necessary to be cautious regarding the inferences from some of our results.

Prevalence of non-communicable diseases in Brazilian children: follow-up at school age of two Brazilian birth cohorts of the 1990's

BackgroundFew cohort studies have been conducted in low and middle-income countries to investigate non-communicable diseases among school-aged children. This article aims to describe the methodology of two birth cohorts, started in 1994 in Ribeirão Preto (RP), a more developed city, and in 1997/98 in São Luís (SL), a less developed town.MethodsPrevalences of some non-communicable diseases during the first follow-up of these cohorts were estimated and compared. Data on singleton live births were obtained at birth (2858 in RP and 2443 in SL). The follow-up at school age was conducted in RP in 2004/05, when the children were 9-11 years old and in SL in 2005/06, when the children were 7-9 years old. Follow-up rates were 68.7% in RP (790 included) and 72.7% in SL (673 participants). The groups of low (<2500 g) and high (≥ 4250 g) birthweight were oversampled and estimates were corrected by weighting.ResultsIn the more developed city there was a higher percentage of non-nutritive sucking habits (69.1% vs 47.9%), lifetime bottle use (89.6% vs 68.3%), higher prevalence of primary headache in the last 15 days (27.9% vs 13.0%), higher positive skin tests for allergens (44.3% vs 25.3%) and higher prevalence of overweight (18.2% vs 3.6%), obesity (9.5% vs 1.8%) and hypertension (10.9% vs 4.6%). In the less developed city there was a larger percentage of children with below average cognitive function (28.9% vs 12.2%), mental health problems (47.4% vs 38.4%), depression (21.6% vs 6.0%) and underweight (5.8% vs 3.6%). There was no difference in the prevalence of bruxism, recurrent abdominal pain, asthma and bronchial hyperresponsiveness between cities.ConclusionsSome non-communicable diseases were highly prevalent, especially in the more developed city. Some high rates suggest that the burden of non-communicable diseases will be high in the future, especially mental health problems.

Mental health and physical inactivity during pregnancy: a cross-sectional study nested in the BRISA cohort study

The aim of this study was to investigate the association between mental health and physical inactivity in 1,447 pregnant women in the second trimester of pregnancy. Subjects answered the short version of the International Physical Activity Questionnaire. Symptoms of depression and anxiety, and stress levels were assessed using the Center for Epidemiological Studies Depression Scale, the Beck Anxiety Inventory and the Perceived Stress Scale, respectively. The rate of physical inactivity was low (39.8%). The prevalence rates of symptoms of severe depression and severe levels of anxiety were 28.8% and 16.9%, respectively. The average perceived stress score was 24.9. An association was found between physical inactivity and not living with a partner (OR = 1.28), having a manual occupation (OR = 0.71) and, unexpectedly, normal and low levels of anxiety (OR = 1.46 and OR = 1.44, respectively). No association was observed between physical inactivity and symptoms of severe depression and perceived stress. It is plausible to assume that the majority of physical activity practiced by these women was attributable to housework or occupation which may in turn be associated with high levels of anxiety.

Secular trends in the rate of low birth weight in Brazilian State Capitals in the period 1996 to 2010

Epidemias de malaria ocorrem anualmente nos municipios da Regiao Amazonica, Brasil, no entanto os servicos de saude nao adotam, de maneira sistematica, instrumentos para deteccao e contencao oportunas desses eventos. O objetivo foi caracterizar as epidemias de malaria na regiao segundo duracao, especie de Plasmodium e vulnerabilidade das populacoes. Foi avaliado um sistema de monitoramento automatizado da incidencia da malaria, com base no diagrama de controle segundo quartis, para identificar as epidemias da doenca. Em 2010, ocorreram epidemias em 338 (41,9%) municipios da regiao. Houve epidemias por P. falciparum e por P. vivax, separadamente, e tambem por ambas as especies. Epidemias com duracao de um a quatro meses ocorreram em 58,3% dos municipios epidemicos; de cinco a oito meses, em 24,3%; e de nove a 12 meses, em 17,4%. O monitoramento automatizado da variacao da incidencia da malaria podera contribuir para deteccao precoce das epidemias e melhorar o seu controle oportuno.Malaria epidemics occur annually in various municipalities (counties) in the Brazilian Amazon. However, health services do not systematically adopt tools to detect and promptly control these events. This article aimed to characterize malaria epidemics in the Brazilian Amazon Region based on their duration, the Plasmodium species involved, and the populations degree of vulnerability. An automatic malaria incidence monitoring system based on quartiles was assessed for prompt identification of malaria epidemics. In 2010, epidemics were identified in 338 (41.9%) of the counties in the Brazilian Amazon. P. falciparum and P. vivax epidemics were detected, both singly and in combination. Epidemics lasted from 1 to 4 months in 58.3% of the counties, 5 to 8 months in 34.5%, and 9 to 12 months in 17.4%. Systematic monitoring of malaria incidence could contribute to early detection of epidemics and improve the effectiveness of control measures.