Orientador: Ana Maria Segall Correa / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-03T05:49:20Z (GMT). No. of bitstreams: 1 Patella_RoseineFortes_M.pdf: 21656384 bytes, checksum: a411b353da2b069b334fa693980d77d0 (MD5) Previous issue date: 2001 / Resumo: O objetivo deste estudo foi analisar o impacto da assistência oferecida pelo Programa de Vigilância para crianças nascidas sob risco (PRNR) sobre as intemações hospitalares e a mortalidade de crianças menores de um ano de idade em Santos/SP. Foi estudada uma coorte histórica retrospectiva de crianças expostas e não expostas ao Programa no período de 1"de Julho de 1997 até 30 de Junho de 1998. Dos 6554 bebês nascidos neste período, 1208 foram classificados como sob risco (RNRs). Foram então divididos em dois grupos: G.A. (acompanhados pelo PRNR = 675) e G.N.A. (não acompanhados pelo PRNR = 553). O seguimento foi delineado para controlar variáveis presumidas como fatores de confundimento como peso ao nascer, hospital de nascimento, localidade de residência e aleitamento ao seio além de outras variáveis psicossociais. Os RNRs do grupo G.A. foram então classificados em duas categorias de acordo com a assistência recebida. Foram considerados sob Assistência Adequada (ADEQ) os recém-nascidos que cumpriram três condições principais: - Ter realizado a primeira consulta médica e atividades de monitoramento em até 10 dias após o nascimento, ter recebido visita domiciliar (VD), e, pelo menos 7 consultas médicas durante o período de seguimento. Foram considerados sob Assistência Não Adequada (NADEQ) aqueles que não atingiram os critérios completos referidos. Foram encontrados 712 bebês no primeiro grupo e 496 no segundo. O risco relativo para intemação hospitalar considerando bebês não expostos ao programa (NADEQ) e os expostos (ADEQ) não foi estatisticamente significativo. Os Grupos GA e GNA foram diferentes ao considerar-se variáveis sociais. O primeiro (GA) mostrou freqüência mais alta de desemprego entre pais ou responsáveis e muitos moravam em localidades caracterizadas como as mais pobres na cidade. O risco relativo para intemação hospitalar no primeiro ano apontou para proteção para as crianças do G.N.A. O perfil de seguimento dos RNRs (G.A.) mostrou que 61,6% deles chegaram para a primeira consulta médica após dez dias; quase a metade (41,8%) compareceu a menos de sete consultas pediátricas; quase um terço deles (28,4%) nunca recebeu uma VD. Apesar da assistência oferecida pelo PRNR foram identificados 13 óbitos entre os RNRs da coorte estudada. Estudos adicionais seriam necessários para esclarecer melhor as características dos cuidados de saúde que deveriam ser oferecidos, em tais condições sociais, a recém-nascidos de alto risco no seu primeiro ano de vida / Abstract: The objective of this study was to analyze the impact of the assistance provided by the Surveillance Program for children bom at risk (PRNR) on hospital admissions and mortality of children under one year of age in Santos/SP. A historic retrospective cohort of children exposed and non-exposed to the program was studied from the 1st of July 1997 to the 30th of June 1998. From 6554 babies bom in this period, 1208 were classified as at risk (RNRs). They were then divided in two groups: G.A. (followed by the PRNR = 675) and G.N.A. (not followed by the PRNR = 553). The followup was designed to control for variables presumed to be confounders, like birth-weight, hospital of birth, neighborhood of residence, and breastfeeding, besides other mother's psychosocial variables. The RNRs of G.A. groups were then classified in two categories according to the assistance received. Adequate Assistance (ADEQ) was considered for those newboms who met tree main conditions: - first medical appointment and monitoring activity within 10 days afier birth, having received a home visit (VD), and, at least 7 medical consultations during the follow-up period. Non-Adequate Assistance (NADEQ) was assigned to those who did not meet the full ADEQ criteria. There were 712 babies in the first group and 496 in the second. The relative risk for hospital admission considering babies not exposed to the program (NADEQ) and those exposed (ADEQ) was not statistically significant. The GNA and GA groups were different considering social variables. This last group had higher frequency of unemployment among parents or family's responsible person and most of then were leaving in the neighborhood characterized as the poorest in the city. The relative risk for hospital admission in the first year of life pointed out to protection towards children of the G.N.A. The follow-up profile of the RNRs (G.A.) showed that 61,6% of them arrived after ten days at the 1st appointment, almost half (41,8%) attended less than seven pediatric consultations; almost a third of them (28,4%) never received a VD. Despite the assistance provided by the PRNR 13 deaths were acknowledged among RNRs in the study cohort. Further studies would be necessary to better clarify the characteristics of health care that should be offered, under such social conditions of the high-risk newbom in their first year of life / Mestrado / Saude Coletiva / Mestre em Saude Coletiva

Malaria infection is a major cause of morbidity and mortality in tropical countries, and particularly in Mozambique. Recently substantial resources have been used to reduce the burden of malaria in Mozambique. These include the distribution of insecticide treated bed-nets, indoor residual insecticide spraying, access to artemisinin-based combination treatment (ACT), and intermittent preventive treatment of pregnant women with sulfadoxine-pyrimetamine (SP-IPTp). The most important benefit of SP-IPTp in malaria endemic areas has been the increase in birth weight, thus increasing the probability of child survival. The SP-IPTp policy was based on evidence of its effectiveness in areas of high intensity malaria transmission. The effect of SP-IPTp has been less evident in the presence of high coverage with insecticide treated bed-nets. It is not know whether reducing the risk of malaria through effective vector control using indoor residual insecticide spraying and large-scale deployment of ACTs has a similar effect in reducing the impact of SP-IPTp on birth weight. At the same time, increasing resistance of SP could be compromising the effect of SP-IPTp on birth weight, as could co-infection with HIV. The aim of this study was to determine if the effect of SP-IPTp on reduction in risk of low birth weight is modified by Plasmodium falciparum malaria prevalence. This retrospective antenatal record review, analyzed 20867 antenatal records from 2005 to 2007 from public health facilities in Maputo and Gaza provinces, southern Mozambique. One or two doses of SP-IPTp does not have any effect on reducing the risk of low birth weight, while women who had at least three doses of SP-IPTp had a 15% lower risk of their babies being born with low birth weigh compared with fewer doses, (OR=0.85; 95% CI 0.73 – 1.00; p=0.053). The risk of babies being born with low birth weight was reduced by 28% when both malaria prevalence and dhfr / dhps mutation prevalence are low, (OR=0.72; 95% CI 0.51 – 1.00), but this effect was no longer significant with higher malaria prevalence and or mutation prevalence. SP-IPTp has an effect on reducing low birth weight with three or more doses, and in areas where malaria prevalence and mutation prevalence are low.  Copyright / Dissertation (MSc)--University of Pretoria, 2013. / Clinical Epidemiology / unrestricted

Background: Adolescent female depressive symptomatology is an unrecognized mood disorder that impairs health in adolescence or adulthood. However, the long-term effects of pre-pregnancy depressive symptoms on birth outcomes in adulthood have not been given adequate empirical assessments. Method: In this study, we assessed the relationship between the life time duration of depressive symptoms over a 14-year period and birth outcomes (LBW and PTB) among a sample of 6023 female respondents who took part in the National Longitudinal Study of Adolescent to Adult Health (Add Health). We used the generalized estimating equation (GEE) models to assess these relationships. Results: Exposure to elevated depressive symptoms in late adolescence, but not in adulthood, was associated with increased odds of LBW by more than 2-fold in early and young adulthoods (adjusted odds ratio [aOR] = 2.19; 95% confidence interval, CI: 1.56, 3.08). Depressive symptoms in early adulthood were independently associated with increased odds of PTB and were higher for black mothers. Maternal race modified the relationship between consistent reporting of depressive symptoms in adolescence and LBW or PTB in adulthood. Conclusion: This study provides compelling evidence that effects of elevated depressive symptomatology on LBW or PTB appear to be linked to a specific development period in adolescence. National policies to address social inequalities and stratification particularly in health at all stages of human development, will provide an important step in reducing depressive symptoms prior to early adulthood and in pregnancy and childbirth.

No description available.

Abstract Identifying Data Needs to Support the Public Health Program of First Care Background: First Care (FC) is a Georgia (GA) public health (PH) program funded by Title V Block Grant, whose main purpose is to provide collaborative skilled PH services for infants with LBW and VLBW (low and very low birth weight) as well as those considered at high risk for illness and disabilities. Purpose: 1. Describe current health outcomes of GA infants less than one years of age. * Current baselines of IMR (infant mortality rate), preterm, very low birth weight (VLBW) and low birth weight (LBW) births 2. Use data to inform FC program in order to improve overall health outcomes in LBW, VLBW and preterm infants less than 1 years of age in GA as well as IMR. * Identifying common diagnoses and reasons for the hospitalization of infants less than one. Methods: Several online secondary data sources containing GA birth outcomes were evaluated. These sources were used to produce most current or 2008, GA and national profiles on health outcomes such as IMR, preterm, LBW and VLBW births. SAS was used to evaluate OHIP (Office of Health Information and Policy) hospital discharges in 2008 to determine common diagnosis affecting GA children under 1 years of age. Results: National comparisons of health outcomes revealed that GA consistently ranks below the national average for IMR, preterm, VLBW, and LBW births. GA’s poor health outcomes are also seen when compared to Healthy People 2010 objectives. A comparison of GA public health districts (PHD) health outcomes demonstrates lagging indicators mainly in the southern and midsection (central section) of GA. This study also revealed racial disparities indicating Blacks falling behind in all health outcomes when compared to Whites and Hispanics. Statistical analysis of hospital discharges showed that the top 25 discharges reflect common conditions that affect high-risk infants such as preterm, VLBW and LBW infants. Higher rates of morbidity were found in the southern and central PHDs of GA. Conclusion: The purpose for FC is to provide current data baselines on health outcomes of GA infants less than one year of age, as well as information regarding current hospitalizations. Current results are only preliminary findings underscoring the need for continued research. By emphasizing their need for monitoring will allow FC to focus on this critical role that will only grow with an expanding population in GA.

O Câncer colorretal (CCR) é um problema de saúde importante devido a sua incidência e mortalidade elevadas. O rastreamento e o diagnóstico precoce são a principal estratégia para diminuir a mortalidade pelo CCR. A colonoscopia convencional (CC), constitui o melhor método para o diagnóstico precoce do CCR e para o diagnóstico e tratamento das lesões precurssoras. Entretanto a CC apresenta taxas de falha de detecção não desprezíveis. A colonoscopia com magnificação de imagem (CM), vem sendo utilizada com o intuito de melhorar a performance da CC. A sua principal vantagem é a possibilidade de diferenciar lesões neoplásicas de não-neoplásicas, de maneira que apenas lesões neoplásicas seriam retiradas, diminuindo custos e riscos relacionados ao rastreamento por colonoscopia. O objetivo deste estudo é determinar a acurácia da CM para o diagnóstico diferencial entre lesões neoplásicas e não-neoplásicas do intestino grosso por meio da comparação entre o diagnóstico endoscópico e o fornecido pelo exame histopatológico convencional. Entre abril de 2002 e outubro de 2003, cento e vinte pacientes foram incluídos no estudo, tendo-se encontrado 200 lesões. Todas as lesões foram classificadas endoscopicamente através da CM com alta magnificação (até 200X), associada a cromoscopia com índigo carmim, de acordo com a classificação proposta por Kudo, e em seguida excisadas ou biopsiadas para estudo histopatológico. A acurácia da determinação do diagnóstico diferencial endoscópico em relação à histopatologia entre lesões neoplásicas e não-neoplásicas foi de 78,5%. A diferença da CM em relação ao exame histopatológico foi estatisticamente significativa (p<0,0001). Conclui-se que, no atual estágio de desenvolvimento, a CM, pela sua acurácia, não permite excluir o exame histopatológico para o diagnóstico diferencial entre as lesões neoplásicas e não-neoplásicas do intestino grosso. / Bacterial meningitis in the neonatal period is a severe disease, associated to elevated mortality and sequelae in around 12 to 29% of the survivors. Newborns whose birth weight is < 2,500g have a 3-fold increase in the risk of acquiring meningitis when compared to those whose weight is > or = 2,500; among those with very low birth weight (< 1,500g), the risk increases 17-fold. Objectives: General: to describe the clinical picture and the complications of bacterial meningitis in two groups of newborns, considered according to birth weight (< 2,500g or > or = 2,500g). Specific: to describe and compare the etiological agents, the frequency of neurological signs and symptoms and complications, mortality rate and duration of treatment in both groups. Methods: Observational study of 87 newborns with bacterial meningitis, admitted at the Neonatal Intensive Care Unit (NICU) of Instituto da Criança of Hospital das Clínicas of the University of São Paulo School of Medicine, during an 11-year period (January 1994 to December 2004). The data were obtained through the analysis of hospital files. Statistical analysis was carried out with Fisher\'s exact test and the non-parametric Mann Whitney test. Results: Bacteria were identified in the cerebrospinal fluid (CSF) of 39% of the patients, with 50% of them being Gram-positive and 50%, Gram-negative. Most neonates presented unspecific signs and symptoms: fever (63.2%), irritability (31%), and lethargy (26.4%). The neurological findings occurred in 35.3% of the cases. Complications occurred in 48.2% of the neonates, and were mainly seizures (23%), intracranial hemorrhage (14.9%) and hydrocephalus (13.8%) with a mortality rate of 11.5%. At the comparison between clinical evolution and birth weight, associations between weight > or = 2,500g and seizures (p=0.047), weight > or = 2,500g and concave fontanel (p=0.019), bacteria in the CSF and complications (p=0.008) and bacteria in the CSF and death (p=0.043) were observed. Conclusions: The etiological agents most often identified in the CSF were enterobacteria (41%), followed by B Streptococcus (17.5%), non-B Streptococcus (17.5%), Staphylococcus aureus (11.7%), Neisseria meningitidis (8.8%) and Enterococcus faecalis (3.0%), with no statistical difference between the type of bacteria and birth weight. The predominant signs and symptoms were unspecific, with neurological findings in 35% of the cases. The higher frequency of neurological signs and symptoms in newborns with birth weight > or = 2,500g suggest a higher degree of central nervous system maturity in these infants. Although the mortality was lower than that observed in previous studies at the same Service, the frequency of complications was high, regardless of birth weight. The presence of bacteria in the CSF was associated to a higher frequency of seizures and mortality. The need for prolonged treatment in newborns with low birth weight suggests higher disease severity in this group of neonates.

No description available.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-12-15T14:26:56Z No. of bitstreams: 1 hericasilvadutra.pdf: 3223242 bytes, checksum: 250a7a107719f5970fd463ae5025faf6 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-12-15T14:39:16Z (GMT) No. of bitstreams: 1 hericasilvadutra.pdf: 3223242 bytes, checksum: 250a7a107719f5970fd463ae5025faf6 (MD5) / Made available in DSpace on 2016-12-15T14:39:16Z (GMT). No. of bitstreams: 1 hericasilvadutra.pdf: 3223242 bytes, checksum: 250a7a107719f5970fd463ae5025faf6 (MD5) Previous issue date: 2010-03-19 / Um aumento na sobrevida de recém-nascidos cada vez mais imaturos tem sido observado em consequência dos avanços em neonatologia. Crianças de muito baixo peso ao nascer (MBPN) e extremo baixo peso ao nascer (EBPN) podem apresentar como desfechos complicações a curto e longo prazo devido à assistência intensiva no período neonatal, o que pode determinar alterações em sua qualidade de vida (QV). Os objetivos foram avaliar a QV de crianças nascidas MBPN e EBPN a partir da utilização de questionário validado; descrever domínios incluídos no instrumento e estabelecer um perfil de satisfação da criança a partir do autorrelato e da perspectiva de seus responsáveis. Foram avaliadas 40 crianças e 45 responsáveis selecionados a partir dos dados do serviço de follow-up do HU-UFJF. A QV foi avaliada a partir do AUQUEI. Outros dados de interesse foram obtidos a partir de avaliação dos prontuários e inquérito direto ao responsável pela criança. A idade das crianças variou de 3 a 7 anos. O peso médio, ao nascer, foi 1173,13 (± 222,84). A idade gestacional variou de 24 a 33 semanas (29,40 ± 2,08). A QV média na avaliação das crianças foi de 49,75 (± 5,973) e na avaliação dos responsáveis 49,24 (± 6,675). A correlação entre os escores totais de crianças e responsáveis obteve intensidade de nível razoável (Correlação de Pearson = 0,391 / p = 0,013). Entretanto, a classificação final da QV (prejudicada x satisfatória), obteve concordância pobre (índice de Kappa = 0,143 / p = 0,457). A QV de crianças nascidas MBPN e EBPN foi considerada satisfatória na perspectiva delas mesmas e de seus responsáveis. A concordância entre os escores das crianças e seus pais foi alta. Entretanto a classificação em QV satisfatória e prejudicada teve concordância pobre, o que reforça a importância de valorizar o auto-relato de crianças e adicionar a perspectiva dos pais na avaliação da QV. O domínio lazer foi considerado o componente mais importante da QV na infância pelas crianças e responsáveis. / An increase in the number of more immature newborn survivors has been observed due to neonatology advances. Children born very low birth weight (VLBW) and extremity low birth weight (ELBW) can present as outcomes complications at short and long time, due to intensive care assistance in the neonatal period, what can determine alterations in their quality of life (QoL). This study aims: to evaluate the QoL of children born VLBW and ELBW using a validated questionnaire; to describe domains included in the instrument and to establish a satisfaction profile of the child using self-report and parent proxy-report. 40 children and 45 parents were selected from data at the follow-up service of the HU-UFJF. The QoL was evaluated using the AUQUEI. Other interest data had been collected from follow-up records and direct inquiry to the responsible one for the child. The age of the children varied from 3 to 7 years. The average birth weight was 1173,13g (± 222,84). The gestacional age varied from 24 to 33 weeks (29,40 ± 2,08). The QoL score in the self-report was 49,75 (± 5,973) and in the proxy-report was 49,24 (± 6,675). The correlation between the total scores of children and parents has got intensity of reasonable level (Correlation of Pearson = 0,391 / p = 0,013). However, the QoL final classification (damaged x satisfactory), got poor agreement between them (index of Kappa = 0,143 / p = 0,457). The QoL of children born VLBW and ELBW was considered satisfactory in the self-report and proxy-report. The total scores agreement between them were high, however the classification in satisfactory / damged QoL had poor agreement, what strengthens the importance to evaluate the self-report and to add the proxyreport of the QoL. The domain leisure was considered the most important component of the QoL in childhood by self and proxy-report.

O Câncer colorretal (CCR) é um problema de saúde importante devido a sua incidência e mortalidade elevadas. O rastreamento e o diagnóstico precoce são a principal estratégia para diminuir a mortalidade pelo CCR. A colonoscopia convencional (CC), constitui o melhor método para o diagnóstico precoce do CCR e para o diagnóstico e tratamento das lesões precurssoras. Entretanto a CC apresenta taxas de falha de detecção não desprezíveis. A colonoscopia com magnificação de imagem (CM), vem sendo utilizada com o intuito de melhorar a performance da CC. A sua principal vantagem é a possibilidade de diferenciar lesões neoplásicas de não-neoplásicas, de maneira que apenas lesões neoplásicas seriam retiradas, diminuindo custos e riscos relacionados ao rastreamento por colonoscopia. O objetivo deste estudo é determinar a acurácia da CM para o diagnóstico diferencial entre lesões neoplásicas e não-neoplásicas do intestino grosso por meio da comparação entre o diagnóstico endoscópico e o fornecido pelo exame histopatológico convencional. Entre abril de 2002 e outubro de 2003, cento e vinte pacientes foram incluídos no estudo, tendo-se encontrado 200 lesões. Todas as lesões foram classificadas endoscopicamente através da CM com alta magnificação (até 200X), associada a cromoscopia com índigo carmim, de acordo com a classificação proposta por Kudo, e em seguida excisadas ou biopsiadas para estudo histopatológico. A acurácia da determinação do diagnóstico diferencial endoscópico em relação à histopatologia entre lesões neoplásicas e não-neoplásicas foi de 78,5%. A diferença da CM em relação ao exame histopatológico foi estatisticamente significativa (p<0,0001). Conclui-se que, no atual estágio de desenvolvimento, a CM, pela sua acurácia, não permite excluir o exame histopatológico para o diagnóstico diferencial entre as lesões neoplásicas e não-neoplásicas do intestino grosso. / Bacterial meningitis in the neonatal period is a severe disease, associated to elevated mortality and sequelae in around 12 to 29% of the survivors. Newborns whose birth weight is < 2,500g have a 3-fold increase in the risk of acquiring meningitis when compared to those whose weight is > or = 2,500; among those with very low birth weight (< 1,500g), the risk increases 17-fold. Objectives: General: to describe the clinical picture and the complications of bacterial meningitis in two groups of newborns, considered according to birth weight (< 2,500g or > or = 2,500g). Specific: to describe and compare the etiological agents, the frequency of neurological signs and symptoms and complications, mortality rate and duration of treatment in both groups. Methods: Observational study of 87 newborns with bacterial meningitis, admitted at the Neonatal Intensive Care Unit (NICU) of Instituto da Criança of Hospital das Clínicas of the University of São Paulo School of Medicine, during an 11-year period (January 1994 to December 2004). The data were obtained through the analysis of hospital files. Statistical analysis was carried out with Fisher\'s exact test and the non-parametric Mann Whitney test. Results: Bacteria were identified in the cerebrospinal fluid (CSF) of 39% of the patients, with 50% of them being Gram-positive and 50%, Gram-negative. Most neonates presented unspecific signs and symptoms: fever (63.2%), irritability (31%), and lethargy (26.4%). The neurological findings occurred in 35.3% of the cases. Complications occurred in 48.2% of the neonates, and were mainly seizures (23%), intracranial hemorrhage (14.9%) and hydrocephalus (13.8%) with a mortality rate of 11.5%. At the comparison between clinical evolution and birth weight, associations between weight > or = 2,500g and seizures (p=0.047), weight > or = 2,500g and concave fontanel (p=0.019), bacteria in the CSF and complications (p=0.008) and bacteria in the CSF and death (p=0.043) were observed. Conclusions: The etiological agents most often identified in the CSF were enterobacteria (41%), followed by B Streptococcus (17.5%), non-B Streptococcus (17.5%), Staphylococcus aureus (11.7%), Neisseria meningitidis (8.8%) and Enterococcus faecalis (3.0%), with no statistical difference between the type of bacteria and birth weight. The predominant signs and symptoms were unspecific, with neurological findings in 35% of the cases. The higher frequency of neurological signs and symptoms in newborns with birth weight > or = 2,500g suggest a higher degree of central nervous system maturity in these infants. Although the mortality was lower than that observed in previous studies at the same Service, the frequency of complications was high, regardless of birth weight. The presence of bacteria in the CSF was associated to a higher frequency of seizures and mortality. The need for prolonged treatment in newborns with low birth weight suggests higher disease severity in this group of neonates.

Advances in neonatal nursing and medical interventions have made it possible for the very low birth weight (VLBW) infant to survive. However, it is now time to recognize the intangible costs, emotional stress, marital stress, grief, pain, sorrow, and the disruption of the role transition to parenthood. To facilitate progress in the area of neonatal nursing, systematic efforts were undertaken to examine and describe parental adaptation to the VLBW infant and potential risk for parenting problems after hospital discharge. The purpose of this study was to describe parents' method of adaptation to the problems of caring for a VLBW infant at home. Specifically this study was designed to identify: (1) What strategies parents employed during the adaptation process. (2) What resources parents combined with their strategies of adaptation. (3) What situations promoted or inhibited parental adaptation. The informants consisted of parents of VLBW infants (<1500 grams) following hospital discharge. The number of subjects for this study was 14. An exploratory design was used to conduct this study. Each subject was involved in three interview sessions, one months, three months, and five months following hospital discharge of their VLBW infant. Data were sampled theoretically, as guided by the emergent theory. The constant comparative method was used for data analysis. A basic social process, Creating Paths, was identified as the core category of the theory. Creating Paths is the continuous process experienced by parents living with a VLBW infant the first five months after hospital discharge. The process consists of three stages: Gathering, Emerging, and Affirming. Results of this investigation provide a beginning theoretical foundation for assessing the adaptation process of parents with VLBW infants the first five months at home. Neonatal nurses can utilize the model to provide anticipatory guidance and support to benefit parents and their VLBW infant.