Thesis (M.S.)--University of Michigan, 1987. / "A research report submitted in partial fulfillment of the requirents for the degree ..."

Thesis (M.S.)--University of Michigan, 1979.

Thesis (M.S.P.H.)--University of Michigan, 1940.

Thesis (M.S.)--University of Michigan, 1989.

Thesis equivalent (M.P.H.)--University of Michigan, 1947.

Thesis (M.S.)--University of Michigan, 1989.

Thesis (M.S.)--University of Michigan, 1979.

Introdução: O período neonatal é uma época de adaptação em que as reações patológicas e fisiológicas às vezes se confundem, sendo as alterações cutâneas comuns neste período. A frequência dessas manifestações tem sido estudada por diversos autores e difere entre os distintos grupos raciais. Na literatura médica, dados recentes mostram que 57 a 99% dos recém-nascidos (RN) apresentam algum achado dermatológico. Métodos: Foram selecionados de forma aleatória aproximadamente 25% dos nascidos vivos nas três maiores maternidades de Porto Alegre, de junho de 2011 a julho de 2012, para serem submetidos ao exame dermatológico realizado por dermatologistas. Resultados: Um total de 2878 neonatos foram examinados em datas mensalmente sorteadas através de um programa estatístico. A maioria dos neonatos eram da raça branca, 95,4% tinham até 48 horas de vida no momento do exame, 50,9% eram do sexo masculino, 54,9% nasceram por parto vaginal e 92,5% das mães realizaram o pré-natal. Dos RN examinados, 96% apresentavam algum achado dermatológico (IC 95%: 95,3-96,6); destes, 89,6% tinham lesões cutâneas transitórias neonatal (IC: 88% a 91%), 40% marca congênita (IC: 38% a 42%), 24,5% tinham alguma pustulose benigna neonatal (IC: 23% a 27%), 1,4% malformação cutânea (IC: 1% a 2%), 3% lesões secundárias ao trauma - incluindo arranhadura (IC: 2 a 4%) e 0,1% doença infecciosa. O achado dermatológico mais frequente foi o lanugo, observado em 40,9% dos RN (IC: 39% a 43%), seguido pela hiperplasia de glândulas sebáceas (35,3% - IC: 34% a 37%), melanocitose dérmica (23,1% - IC: 22% a 25%), eritema tóxico neonatal (21% - IC: 19% a 22%), eritema da pele (19,7% - IC: 18 a 21%), hiperpigmentação da genitália (18,9% - IC: 17% a 20%), mancha salmão (18,8% - IC: 17% a 20%), edema palpebral (17,2% - IC: 16% a 19%), cistos de mília (16,4% - IC 15% a 18%), descamação da pele (12,5% - IC: 11% a 14%), hipertrofia da genitália (11,4% - IC: 10% a 13%), xerose cutânea (10,7% - IC: 10% a 12%). Foi encontrada ainda uma prevalência de 3,4% de melanose pustulosa transitória neonatal (IC: 3% a 4%), 2,2% de mancha mongólica aberrante, 1,2% de nevo congênito, 0,7% de hemangioma ou precursor de hemangioma, 0,5% de pólipo anexial, 0,3% nevo sebáceo e 0,3% de bolhas de sucção. A presença ou não de afecções cutâneas neonatais foi semelhante nas diferentes estações do ano, porém alguns achados foram mais prevalentes em determinada época do ano. Conclusões: Os achados dermatológicos são frequentes em RN e alguns foram mais comuns do que o esperado. Evidenciando a importância do conhecimento das características da pele do bebê durante o período neonatal. A etnia do neonato e os fatores de risco gestacional influenciam na presença de achados dermatológicos neonatais. Enquanto outras características do neonato, como a idade gestacional e o gênero; bem como e as estações do ano podem influenciar na presença de determinadas lesões cutâneas no RN. / Introduction: Skin changes are common during the neonatal period due to physiological and environmental adjustments and to some pathological reactions. The frequency of these events differs among different regions and ethnicities. Recent data show that 57-99% of newborns (NB) have skin alterations. Methods: This study aims to evaluate skin changes in children born in the 3 three major maternities in Porto Alegre, Brazil, from June 2011 to July 2012. Results: A total of 2878 of the neonates were examined in monthly-randomized dates. The majory were Caucasian, 95,4% during the first 48h of life, 50,9% male, 54,9% born by vaginal delivery and 92.5% of the mothers received prenatal care. From the examined NB, 96% had some dermatologic finding (IC 95%: 95,3-96,6): 89.6% transient neonatal skin conditions (IC: 88% a 91%), 40% congenital birthmarks (IC: 38% a 42%), 24.5% had some benign neonatal pustulosis (IC: 23% a 27%), 1.4% had cutaneous malformations (IC: 1% a 2%), 3% of secondary trauma injuries – including scratch and 0.1% any infection. The most prevalent dermatologic findings were: lanugo (40.9% of the NB - IC: 39% a 43%), sebaceous hyperplasia (35,3% - IC: 34% a 37%), dermal melanocytosis (23,1% - IC: 22% a 25%), neonatal toxic erythema (21% - IC: 19% a 22%), erythema (19,7% - IC: 18 a 21%), genital hyperpigmentation (18,9% - IC: 17% a 20%), salmon patch (18,8% - IC: 17% a 20%), eyelid edema (17,2% - IC: 16% a 19%), milia (16,4% - IC 15% a 18%), desquamation (12,5% - IC: 11% a 14%), hypertrophy of the genitalia (11,4% - IC: 10% a 13%), skin xerosis (10,7% - IC: 10% a 12%). Other findings were transient neonatal pustular melanosis (3.4% - IC: 3% a 4%), aberrant Mongolian spot (2.2%), congenital nevi (1.2%), hemangioma or its precursors (0.7%), adnexal polyps (0.5%), naevus sebaceous (0.3%) and suction blisters (0.3%). Neonatal skin lesions occur with similar frequency in the different seasons (p=0.092), but some findings are more prevalent in certain time of the year. Conclusions: This study showed that skin changes are very frequent in neonates and some disorders are more common than expected. Prove the importance of a good knowledge of the NB skin. The ethnicity of the NB and the gestational risk factors influenced the presence of neonatal dermatological findings. While others neonatal characteristics, such as gestational age and NB gender, as well as the seasons can influence the presence of specific neonatal lesions skin.

Significant global health attention and promotion has been focused on hand washing with soap due to the clear benefits observed in promoting and ensuring child health. However, the measurement and evaluation of hand washing behaviours remains complex. The Sanitation, Hygiene Education and Water Supply in Bangladesh Programme (SHEWA-B) is a large project being implemented by the Government of Bangladesh and UNICEF. This research assessed methodological issues of measuring hand washing behaviours through comparison of structured observation and responses to cross-sectional survey measures (spot-check observation, selfreported hand washing and a hand washing demonstration) and discusses the suitability of indicators. Focus group discussions with fieldworkers were also conducted. The results of this study indicate that hand washing behaviours were over-reported compared with structured observation findings. This implies that current estimates of hand washing from large scale surveys, for example, Demographic and Health Surveys (DHS) are also likely to be overestimates. In about 1000 households, approximately 1% or less of female caregivers were observed to wash their hands with soap or ash before preparing food, before eating, and 3% before feeding a child. Hand washing with soap was higher for defecation related events with approximately 29% of female caregivers using soap two thirds or more of the time after cleaning a child’s anus/disposing of a child’s stools and 38% used soap two-thirds or more of the time after defecation. Soap was observed at the hand washing location in about 50% of the households but actual practice was much lower. Reported knowledge was high; approximately 90% identified the important times for hand washing as being before eating and after defecation and approximately 50% identified before preparing food and after cleaning/changing a baby. The measurement of hand washing is complex and there has been limited research into the validity of different measurement methods. This research used an epidemiological style approach using the concepts of screening/diagnostic testing and calculation of kappa statistics to assess validity. In conclusion, this research demonstrates that self report hand washing measures are subject to over reporting. Structured observation provides useful information on directly observed hand washing behaviours and the frequency of behaviours. Spot check methods of soap and hand washing locations also provide more optimistic data than observations and can be used as an alternative to structured observation. In addition, the use of questions on the 24 hour recall of soap and other self report questions on knowledge and the availability of spare soap demonstrate potential for use as potential indicators as an alternative to structured observation. Further validation of measurement methods is required in different country settings.

This thesis explores the pathways through which individual and household factors are associated with temporal changes in child nutritional status. In this study the concept of nutrition deprivation is used in two ways: firstly as indicated by the child's anthropometric measures, and secondly in terms of food consumption. The thesis also explores how nutritional deprivation is linked with economic deprivation. The main objectives of the study are: to examine the physical growth trajectories of children, to investigate the household's economic and nutritional (food) deprivations, to explore the determinants of child malnutrition, and finally to investigate the relationship between temporal changes in the poverty status of households and temporal changes in child nutritional status. The study uses the Pakistan Panel Data collected by the International Food Policy Research Institute (IFPRI) from 1986-89, covering four rural districts of Pakistan. The study employs a comprehensive child health framework to establish the mechanism of child nutritional status by linking the various factors at child, household and community levels. This framework specifies poverty as the root cause of malnutrition. The basic need absolute poverty approach is used to work out the incidence and the dynamic nature of poverty. Various statistical modelling techniques for analysing the longitudinal data are used in this study. For example, to study the height and weight growth traectories of children a growth curve modelling technique is employed, and to study the determinants of child malnutrition a three-level hierarchical linear model for longitudinal data is used. The predicted average growth velocities indicate a slower growth during first year of child's life in comparison with the usual growth velocities amongst the normal children. However, in a particular cohort of children some evidence of growth acceleration is found during the third year of a child's life after a growth deceleration during the second year. Child level factors, such as breastfeeding and the incidence of diarrhoea and morbidity, are found to explain most of the variability in child nutritional status. The results reveal dissimilarities in nutritional status between children in a household. The results also indicate associations between poverty and stunting while chronic poverty is found to be associated with wasting. The results indicate that caloric and protein consumption amongst the study households was notably high. However, food consumption patterns mostly revolve around the staple food, and even in the top expenditure quintile this pattern remains persistent.