Walter Fonseca

Características sócio-demográficas, reprodutivas e médicas de mulheres admitidas por aborto em hospital da Região Sul do Brasil

No Brasil, a inducao do aborto e legalmente permitida somente quando necessaria para salvar a vida da mulher ou quando a concepcao ocorreu de estupro. Apesar das restricoes legais, morais e religiosas, a inducao do aborto e amplamente praticada. Com o objetivo de identificar as caracteristicas do aborto incompleto nas mulheres admitidas na maternidade publica de Florianopolis, foram entrevistadas 620 mulheres, entre 1o de julho de 1993 e 30 de junho de 1994. Com base em dados coletados por meio de questionario estruturado, sao apresentadas caracteristicas socio-demograficas, reprodutivas e medicas dos abortos, classificados como certamente provocados, possivelmente provocados e espontâneos. Entre os 141 casos de aborto provocado, cerca de 50% das mulheres reportaram uso isolado do Cytotec® (misoprostol), ou deste associado a outro metodo abortivo. Os resultados revelam que na populacao estudada a inducao do aborto e pratica comum entre mulheres jovens, solteiras ou sem parceiro estavel, de bom nivel de escolaridade e nao usuarias de metodos anticonceptivos. Foi tambem registrada uma reducao do numero de complicacoes graves relacionadas ao aborto provocado admitido ao hospital.

Determinantes do aborto provocado entre mulheres admitidas em hospitais em localidade da região Nordeste do Brasil

Com o objetivo de identificar os determinantes do aborto provocado entre mulheres admitidas por complicacoes decorrentes dos abortos, nos hospitais-maternidades publicos em Fortaleza, CE (Brasil) foram entrevistadas 4.359 pacientes entre 1o de outubro de 1992 e 30 de setembro de 1993. Os dados foram coletados atraves de questionario estruturado. Sao apresentados os determinantes dos abortos provocados em 2.084 (48%) mulheres classificadas como tendo induzido aborto. Dois tercos (66%) das mulheres relataram a inducao do aborto com o uso isolado do Cytotec(R) (misoprostol) ou associado a outro meio abortivo. Os resultados indicam que, na populacao estudada, a inducao do aborto e pratica comum entre jovens, solteiras (ou que vivem sem um parceiro estavel), de baixa paridade, com escolaridade incipiente e nao-usuarias de metodos contraceptivos. Recomenda-se a realizacao de estudos que investiguem os conhecimentos relacionados a percepcoes, conceitos culturais do aborto, e as razoes por que mulheres pobres fracassam na adocao de metodos de planejamento familiar.

Comparing Pharmacokinetics of Amoxicillin Given Twice or Three Times per Day to Children Older than 3 Months with Pneumonia

ABSTRACT For children with ambulatory pneumonia, the World Health Organization (WHO) recommends oral amoxicillin (15 mg/kg of body weight/dose) thrice daily (t.i.d.) or oral cotrimoxazole (4 mg of trimethoprim/kg/dose) twice daily (b.i.d.). The more frequent amoxicillin dosing may lead to compliance problems. To compare the pharmacokinetics and levels of amoxicillin in plasma in the current WHO acute respiratory infection recommendations with the 25-mg/kg/dose b.i.d. regimen, we performed a two-group parallel study of 66 children ages 3 to 59 months with pneumonia. Amoxicillin was given orally at 25 mg/kg/dose b.i.d. or 15 mg/kg/dose t.i.d. Amoxicillin concentrations were determined by high-performance liquid chromatography after the first dose on days 1 and 3. After the first dose on day 1, the mean area under the concentration-time curve (AUC) for amoxicillin after the 25-mg/kg dose was 54.7 versus 24.9 μg · h/ml after the 15-mg/kg dose. After the first dose on day 3, the mean AUC was 44.1 versus 28.5 μg · h/ml. All but two children had plasma amoxicillin concentrations above 0.5 μg/ml for >50% of the dose interval on both days. Six children on day 1 and five children on day 3 had concentrations above 1.0 μg/ml for <50% of the dose interval. On day 1, 16 of 27 children in the b.i.d. group and 11 of 26 children in the t.i.d. group had concentrations that were above 2.0 μg/ml for <50% of the dose interval, and on day 3, 18 of 31 children in the b.i.d. group and 8 of 31 children in the t.i.d. group had concentrations that were above 2.0 μg/ml for <50% of the dose interval. Amoxicillin b.i.d. is a feasible alternative for t.i.d. dosing. To lengthen the time above the MIC at higher concentration levels, a 30- to 40-mg/kg/dose b.i.d. should be considered instead of the 25 mg/kg/dose used in this study.

Common infectious diseases and skin test anergy in children from an urban slum in Northeast Brazil

BACKGROUND Acute respiratory infection (ARI), diarrheal disease (DD) and infective dermatitis (ID) are important causes of morbidity in children under five, in Northeast Brazil. OBJECTIVES (a) to evaluate the morbidity of ARI, DD and ID; and (b) to determine their association with cellular immunity in poor urban children from Fortaleza, Brazil. MATERIALS AND METHODS A prospective cohort study. At enrollment, multipuncture skin-tests (Multitest CMI) were performed and interpreted according to standard procedures. Children were followed for infectious diseases by weekly home visits. RESULTS Seventy-one children aged 6 to 21 months were recruited in an ongoing cohort of newborns. A mean of 39 (6 to 63) home visits per child were made, which detected 184.5 symptomatic days per child-year of observation. ARI was present in 62% of the days of illness (6,378 out of 10,221), DD in 23% (2,296 days), ID in 6% (597) and other infections in 4% (373). Episodes per child-year were: 10 for ARI, 7 for DD and 1 for ID. Twelve (17%) out of 71 children were anergic. The incidences of ARI, DD and ID were similar in responsive versus anergic children. The mean duration of ID in anergy was 8.5 days, while it was 4.3 in the responsive group (P=0.007). Anergy was independent of age, sex and nutritional status. CONCLUSIONS A high incidence of ARI and DD was found in these poor urban children. Skin-test responsiveness was not related to malnutrition, nor to morbidity due to ARI and DD, however anergic children had a longer duration of infective dermatitis.

Uso da aspiração manual a vácuo na redução do custo e duração de internamentos por aborto incompleto em Fortaleza, CE, Brasil

INTRODUCAO: O uso de aspiracao a vacuo (AV) no tratamento do aborto incompleto e pratica bastante difundida em paises desenvolvidos. Varios estudos nesses paises indicam que o uso da tecnica de aspiracao manual a vacuo (AMV) pode conservar recursos do sistema de saude e melhorar a qualidade do tratamento do aborto. No Brasil, o uso da AMV e procedimento de rotina nos hospitais e clinicas privados. Entretanto, na maioria dos hospitais da rede publica e utilizada somente a tecnica de dilatacao e curetagem (D&C). METODOLOGIA: Foram utilizados metodos de avaliacao rapida para estimar a variacao do custo medio do tratamento e duracao da estadia hospitalar, em um grupo de 30 pacientes admitidas com aborto incompleto em hospital publico de Fortaleza, CE (Brasil). Participantes foram alocadas, randomicamente, em um dos dois grupos de tratamento investigados (AMV ou D&C). RESULTADOS E CONCLUSOES: Os resultados sugerem que o uso da AMV, em substituicao a D&C, no tratamento do aborto incompleto, pode reduzir em ate 41% o custo medio do tratamento e em 77% o tempo medio de hospitalizacao. Recomenda-se a realizacao de estudos confirmatorios, como tambem que se aprofunde os conhecimentos sobre a percepcao do aborto e seu tratamento por parte do pessoal de saude e da populacao feminina.INTRODUCAO: O uso de aspiracao a vacuo (AV) no tratamento do aborto incompleto e pratica bastante difundida em paises desenvolvidos. Varios estudos nesses paises indicam que o uso da tecnica de aspiracao manual a vacuo (AMV) pode conservar recursos do sistema de saude e melhorar a qualidade do tratamento do aborto. No Brasil, o uso da AMV e procedimento de rotina nos hospitais e clinicas privados. Entretanto, na maioria dos hospitais da rede publica e utilizada somente a tecnica de dilatacao e curetagem (D&C). METODOLOGIA: Foram utilizados metodos de avaliacao rapida para estimar a variacao do custo medio do tratamento e duracao da estadia hospitalar, em um grupo de 30 pacientes admitidas com aborto incompleto em hospital publico de Fortaleza, CE (Brasil). Participantes foram alocadas, randomicamente, em um dos dois grupos de tratamento investigados (AMV ou D&C). RESULTADOS E CONCLUSOES: Os resultados sugerem que o uso da AMV, em substituicao a D&C, no tratamento do aborto incompleto, pode reduzir em ate 41% o custo medio do tratamento e em 77% o tempo medio de hospitalizacao. Recomenda-se a realizacao de estudos confirmatorios, como tambem que se aprofunde os conhecimentos sobre a percepcao do aborto e seu tratamento por parte do pessoal de saude e da populacao feminina.INTRODUCTION In most developed countries vacuum aspiration has been shown to be safer and less costly than sharp curettage (SC) for uterine evacuation. In many of the developing countries, including Brazil, sharp curettage (SC) is the most commonly used technique for treating cases of incomplete abortion admitted to hospital. The procedure often involves light to heavy sedation for pain control and an overnight hospital stay for patient recuperation and monitoring. Two hypotheses are examined: the first, that the use of manual vacuum aspiration (MVA)--a variation of the vacuum aspiration, would be less costly than SC for the treatment of cases of incomplete abortion admitted to hospital; and the second, that the treatment of incomplete abortion with MVA would substantially reduce the length of hospital stay. METHODOLOGY Thirty women with diagnosis of first trimester incomplete abortion were randomly allocated to the SC or MVA group. Rapid-assessment data collection techniques were used to identify factors that contributed to cost reduction and hospital stay. RESULTS AND CONCLUSION The results of the study show that, overall, patients treated for incomplete abortion with MVA spent 77% less time in the hospital and consumed 41% fewer resources than similarly diagnosed patients treated with SC. Recommendations are made as to the need of certain changes in patient management. Particularly necessary is information regarding cultural perception and concepts of abortion treatment.INTRODUCTION: In most developed countries vacuum aspiration has been shown to be safer and less costly than sharp curettage (SC) for uterine evacuation. In many of the developing countries, including Brazil, sharp curettage (SC) is the most commonly used technique for treating cases of incomplete abortion admitted to hospital. The procedure often involves light to heavy sedation for pain control and an overnight hospital stay for patient recuperation and monitoring. Two hypotheses are examined: the first, that the use of manual vacuum aspiration (MVA) - a variation of the vacuum aspiration, would be less costly than SC for the treatment of cases of incomplete abortion admitted to hospital; and the second, that the treatment of incomplete abortion with MVA would substantially reduce the length of hospital stay. METHODOLOGY: Thirty women with diagnosis of first trimester incomplete abortion were randomly allocated to the SC or MVA group. Rapid-assessment data collection techniques were used to identify factors that contributed to cost reduction and hospital stay. RESULTS AND CONCLUSION: The results of the study show that, overall, patients treated for incomplete abortion with MVA spent 77% less time in the hospital and consumed 41% fewer resources than similarly diagnosed patients treated with SC. Recommendations are made as to the need of certain changes in patient management. Particularly necessary is information regarding cultural perception and concepts of abortion treatment.

[Risk factors of stillbirths in Fortaleza-Brazil: a case-control study].

Stillbirths are a common event in areas where reproductive health care is poorly delivered, such as the Northeast region of Brazil. This case-control study aimed to identify risk factors associated to foetal deaths occurred in a major obstetric facility of Fortaleza, 1.7 million inhabitants, Northeastern Brazil. 125 stillborn foetus over 20 weeks of gestation (cases) were compared to 250 healthy newborns (controls), in relation to socioeconomic, reproductive, behavioral and morbidity characteristics of their mothers. Crude and adjusted Odds Ratios were then calculated. After adjustment for confounders, the following characteristics of the mother remained as risk factors for stillbirths, with OR statistically significant at the 95% level: attending <5 antenatal consultations during pregnancy (OR=3.30; CI=1.92 - 5.07 ), illiterate mother (OR=3.30; CI=1.84 - 5.92 ), mothers age above 19 (OR=2.73; CI=1.42 - 5.24 ), monthly family income of 1 minimum wage or less (OR=2.12; CI=1.03 - 4.35 ) and severe illnesses or complication during pregnancy (OR=1.75; CI=1.01 - 3.03 ). Inadequate attendance to antenatal care consultations was the risk factor most strongly associated to stillbirths. Similarly, it was the condition most amenable to change in a short term, among those identified as risk factors.

Adoption of manual vacuum aspiration for treatment of incomplete abortion reduces costs and duration of patient's hospital stay in an urban area of Northeastern Brazil

INTRODUCAO: O uso de aspiracao a vacuo (AV) no tratamento do aborto incompleto e pratica bastante difundida em paises desenvolvidos. Varios estudos nesses paises indicam que o uso da tecnica de aspiracao manual a vacuo (AMV) pode conservar recursos do sistema de saude e melhorar a qualidade do tratamento do aborto. No Brasil, o uso da AMV e procedimento de rotina nos hospitais e clinicas privados. Entretanto, na maioria dos hospitais da rede publica e utilizada somente a tecnica de dilatacao e curetagem (D&C). METODOLOGIA: Foram utilizados metodos de avaliacao rapida para estimar a variacao do custo medio do tratamento e duracao da estadia hospitalar, em um grupo de 30 pacientes admitidas com aborto incompleto em hospital publico de Fortaleza, CE (Brasil). Participantes foram alocadas, randomicamente, em um dos dois grupos de tratamento investigados (AMV ou D&C). RESULTADOS E CONCLUSOES: Os resultados sugerem que o uso da AMV, em substituicao a D&C, no tratamento do aborto incompleto, pode reduzir em ate 41% o custo medio do tratamento e em 77% o tempo medio de hospitalizacao. Recomenda-se a realizacao de estudos confirmatorios, como tambem que se aprofunde os conhecimentos sobre a percepcao do aborto e seu tratamento por parte do pessoal de saude e da populacao feminina.INTRODUCAO: O uso de aspiracao a vacuo (AV) no tratamento do aborto incompleto e pratica bastante difundida em paises desenvolvidos. Varios estudos nesses paises indicam que o uso da tecnica de aspiracao manual a vacuo (AMV) pode conservar recursos do sistema de saude e melhorar a qualidade do tratamento do aborto. No Brasil, o uso da AMV e procedimento de rotina nos hospitais e clinicas privados. Entretanto, na maioria dos hospitais da rede publica e utilizada somente a tecnica de dilatacao e curetagem (D&C). METODOLOGIA: Foram utilizados metodos de avaliacao rapida para estimar a variacao do custo medio do tratamento e duracao da estadia hospitalar, em um grupo de 30 pacientes admitidas com aborto incompleto em hospital publico de Fortaleza, CE (Brasil). Participantes foram alocadas, randomicamente, em um dos dois grupos de tratamento investigados (AMV ou D&C). RESULTADOS E CONCLUSOES: Os resultados sugerem que o uso da AMV, em substituicao a D&C, no tratamento do aborto incompleto, pode reduzir em ate 41% o custo medio do tratamento e em 77% o tempo medio de hospitalizacao. Recomenda-se a realizacao de estudos confirmatorios, como tambem que se aprofunde os conhecimentos sobre a percepcao do aborto e seu tratamento por parte do pessoal de saude e da populacao feminina.INTRODUCTION In most developed countries vacuum aspiration has been shown to be safer and less costly than sharp curettage (SC) for uterine evacuation. In many of the developing countries, including Brazil, sharp curettage (SC) is the most commonly used technique for treating cases of incomplete abortion admitted to hospital. The procedure often involves light to heavy sedation for pain control and an overnight hospital stay for patient recuperation and monitoring. Two hypotheses are examined: the first, that the use of manual vacuum aspiration (MVA)--a variation of the vacuum aspiration, would be less costly than SC for the treatment of cases of incomplete abortion admitted to hospital; and the second, that the treatment of incomplete abortion with MVA would substantially reduce the length of hospital stay. METHODOLOGY Thirty women with diagnosis of first trimester incomplete abortion were randomly allocated to the SC or MVA group. Rapid-assessment data collection techniques were used to identify factors that contributed to cost reduction and hospital stay. RESULTS AND CONCLUSION The results of the study show that, overall, patients treated for incomplete abortion with MVA spent 77% less time in the hospital and consumed 41% fewer resources than similarly diagnosed patients treated with SC. Recommendations are made as to the need of certain changes in patient management. Particularly necessary is information regarding cultural perception and concepts of abortion treatment.INTRODUCTION: In most developed countries vacuum aspiration has been shown to be safer and less costly than sharp curettage (SC) for uterine evacuation. In many of the developing countries, including Brazil, sharp curettage (SC) is the most commonly used technique for treating cases of incomplete abortion admitted to hospital. The procedure often involves light to heavy sedation for pain control and an overnight hospital stay for patient recuperation and monitoring. Two hypotheses are examined: the first, that the use of manual vacuum aspiration (MVA) - a variation of the vacuum aspiration, would be less costly than SC for the treatment of cases of incomplete abortion admitted to hospital; and the second, that the treatment of incomplete abortion with MVA would substantially reduce the length of hospital stay. METHODOLOGY: Thirty women with diagnosis of first trimester incomplete abortion were randomly allocated to the SC or MVA group. Rapid-assessment data collection techniques were used to identify factors that contributed to cost reduction and hospital stay. RESULTS AND CONCLUSION: The results of the study show that, overall, patients treated for incomplete abortion with MVA spent 77% less time in the hospital and consumed 41% fewer resources than similarly diagnosed patients treated with SC. Recommendations are made as to the need of certain changes in patient management. Particularly necessary is information regarding cultural perception and concepts of abortion treatment.

Out-patient drug treatment of pneumonia among children under two years of age in Fortaleza, Brazil

Results are reported from a study on drug use in treatment of children with pneumonia in a pediatric hospital in the city of Fortaleza, Northeastern Brazil. There were 171 out-patients; prescription details were obtained for 149. The most commonly prescribed antimicrobial drug was procaine penicillin, accounting for 33% of antimicrobial prescriptions, followed by benzathine penicillin (31%), ampicillin or amoxicillin (12%), and cotrimoxazole (8%). Benzathine penicillin was frequently given with other drugs, but was the sole antimicrobial agent for 31 children. Compliance with antimicrobial treatment was 52% overall and was higher for the injectables. Prescription patterns varied from child to child, and children were often prescribed more than one antimicrobial in the same or repeat prescriptions; combining this information with compliance, 81 (54%) of the children were estimated to have received 5 or more days of appropriate antimicrobial treatment for pneumonia. This percentage is not high, and five days were often reached after using more than one antimicrobial and after repeat visits. The authors concluded that the need remains for simple antimicrobial regimes, attractive to comply with, that can be expected to be consistently used. Other drugs were chiefly analgesics and bronchodilators.

Revista de Saúde Pública

INTRODUCAO: O uso de aspiracao a vacuo (AV) no tratamento do aborto incompleto e pratica bastante difundida em paises desenvolvidos. Varios estudos nesses paises indicam que o uso da tecnica de aspiracao manual a vacuo (AMV) pode conservar recursos do sistema de saude e melhorar a qualidade do tratamento do aborto. No Brasil, o uso da AMV e procedimento de rotina nos hospitais e clinicas privados. Entretanto, na maioria dos hospitais da rede publica e utilizada somente a tecnica de dilatacao e curetagem (D&C). METODOLOGIA: Foram utilizados metodos de avaliacao rapida para estimar a variacao do custo medio do tratamento e duracao da estadia hospitalar, em um grupo de 30 pacientes admitidas com aborto incompleto em hospital publico de Fortaleza, CE (Brasil). Participantes foram alocadas, randomicamente, em um dos dois grupos de tratamento investigados (AMV ou D&C). RESULTADOS E CONCLUSOES: Os resultados sugerem que o uso da AMV, em substituicao a D&C, no tratamento do aborto incompleto, pode reduzir em ate 41% o custo medio do tratamento e em 77% o tempo medio de hospitalizacao. Recomenda-se a realizacao de estudos confirmatorios, como tambem que se aprofunde os conhecimentos sobre a percepcao do aborto e seu tratamento por parte do pessoal de saude e da populacao feminina.INTRODUCAO: O uso de aspiracao a vacuo (AV) no tratamento do aborto incompleto e pratica bastante difundida em paises desenvolvidos. Varios estudos nesses paises indicam que o uso da tecnica de aspiracao manual a vacuo (AMV) pode conservar recursos do sistema de saude e melhorar a qualidade do tratamento do aborto. No Brasil, o uso da AMV e procedimento de rotina nos hospitais e clinicas privados. Entretanto, na maioria dos hospitais da rede publica e utilizada somente a tecnica de dilatacao e curetagem (D&C). METODOLOGIA: Foram utilizados metodos de avaliacao rapida para estimar a variacao do custo medio do tratamento e duracao da estadia hospitalar, em um grupo de 30 pacientes admitidas com aborto incompleto em hospital publico de Fortaleza, CE (Brasil). Participantes foram alocadas, randomicamente, em um dos dois grupos de tratamento investigados (AMV ou D&C). RESULTADOS E CONCLUSOES: Os resultados sugerem que o uso da AMV, em substituicao a D&C, no tratamento do aborto incompleto, pode reduzir em ate 41% o custo medio do tratamento e em 77% o tempo medio de hospitalizacao. Recomenda-se a realizacao de estudos confirmatorios, como tambem que se aprofunde os conhecimentos sobre a percepcao do aborto e seu tratamento por parte do pessoal de saude e da populacao feminina.INTRODUCTION In most developed countries vacuum aspiration has been shown to be safer and less costly than sharp curettage (SC) for uterine evacuation. In many of the developing countries, including Brazil, sharp curettage (SC) is the most commonly used technique for treating cases of incomplete abortion admitted to hospital. The procedure often involves light to heavy sedation for pain control and an overnight hospital stay for patient recuperation and monitoring. Two hypotheses are examined: the first, that the use of manual vacuum aspiration (MVA)--a variation of the vacuum aspiration, would be less costly than SC for the treatment of cases of incomplete abortion admitted to hospital; and the second, that the treatment of incomplete abortion with MVA would substantially reduce the length of hospital stay. METHODOLOGY Thirty women with diagnosis of first trimester incomplete abortion were randomly allocated to the SC or MVA group. Rapid-assessment data collection techniques were used to identify factors that contributed to cost reduction and hospital stay. RESULTS AND CONCLUSION The results of the study show that, overall, patients treated for incomplete abortion with MVA spent 77% less time in the hospital and consumed 41% fewer resources than similarly diagnosed patients treated with SC. Recommendations are made as to the need of certain changes in patient management. Particularly necessary is information regarding cultural perception and concepts of abortion treatment.INTRODUCTION: In most developed countries vacuum aspiration has been shown to be safer and less costly than sharp curettage (SC) for uterine evacuation. In many of the developing countries, including Brazil, sharp curettage (SC) is the most commonly used technique for treating cases of incomplete abortion admitted to hospital. The procedure often involves light to heavy sedation for pain control and an overnight hospital stay for patient recuperation and monitoring. Two hypotheses are examined: the first, that the use of manual vacuum aspiration (MVA) - a variation of the vacuum aspiration, would be less costly than SC for the treatment of cases of incomplete abortion admitted to hospital; and the second, that the treatment of incomplete abortion with MVA would substantially reduce the length of hospital stay. METHODOLOGY: Thirty women with diagnosis of first trimester incomplete abortion were randomly allocated to the SC or MVA group. Rapid-assessment data collection techniques were used to identify factors that contributed to cost reduction and hospital stay. RESULTS AND CONCLUSION: The results of the study show that, overall, patients treated for incomplete abortion with MVA spent 77% less time in the hospital and consumed 41% fewer resources than similarly diagnosed patients treated with SC. Recommendations are made as to the need of certain changes in patient management. Particularly necessary is information regarding cultural perception and concepts of abortion treatment.