O objetivo desta revisão sistemática foi analisar os estudos que relacionam doença periodontal e nascimento prematuro e baixo peso, verificando o efeito da doença periodontal materna no desfecho da gestação. Foi realizada pesquisa nas seguintes bases de dados: PubMed, Scielo e LILACS até Dezembro de 2007. A revisão sistemática foi conduzida de forma a identificar os estudos capazes de preencher os critérios de inclusão, apresentando aspectos clínicos, microbiológicos e radiográficos da doença periodontal, assim como os desfechos da gestação, ou seja, nascimento prematuro e baixo peso. Foram então selecionados 35 (trinta e cinco) artigos, sendo 9 (nove) coorte, 16 (dezesseis) casos controles, e 10 (dez) ensaios clínicos. A associação entre a doença periodontal materna e o nascimento de bebê prematuro com baixo peso foi encontrada em 26 (vinte e seis) estudos: 7 (sete) coorte, 11 (onze) casos controles e 8 (oito) ensaios clínicos. Não foi possível realizar uma meta-análise devido à grande heterogeneidade entre os estudos, particularmente no que se refere aos métodos de mensuração da doença periodontal. Um melhor controle em relação aos fatores de confusão também permitiria uma confiança maior nos resultados e conclusões apresentadas. Ainda não é possível ter conclusões adequadas do real efeito da doença periodontal sobre os desfechos da gestação devido a limitações nas metodologias dos presentes estudos. Portanto, a evidência da relação da doença periodontal com o nascimento de bebê prematuro e baixo peso é limitada. Ainda existe a necessidade de novos e bem desenhados estudos observacionais e de intervenção, que possam confirmar o que até agora é visto apenas como uma possível associação, explorando a validade dessas possíveis associações em diferentes populações e controlando adequadamente as variáveis de confusão. / The objective of this systematic review was to analyse the studies that relate the periodontal disease and the preterm and low birth weight deliveries, assessing the effect of the maternal periodontal disease in the pregnancy outcome. A research was conducted in the following databases: PubMed, Scielo and LILACS until December 2007. The systematic review was undertaken to identify the researches that met the inclusion criterias, addresssing aspects of periodontal disease: clinical, radiographic, microbiological and immunological, and pregnancy outcomes, like preterm low birth weight as well. In that case, 35 (thirty five) studies were selected, 9 (nine) cohort, 16 (sixteen) case controls, and 10 (ten) clinical trials. The association between maternal periodontal disease and preterm low birth weight was found in 26 (twenty six) studies: 7 (seven) cohort, 11 (eleven) case controls and 8 (eight) clinical trials. A meta-analysis was not performed due to the extensive and clear heterogenity of the studies, particulary regarding the periodontal disease measures. An adequate control for confounders would permit results and conclusions more reliable. It is not possible to know the real effect of the periodontal disease in the pregnancy outcomes until now, because of the methodology limitations of the current studies. Therefore, the evidence of the relation of the periodontal disease with the preterm low birth weight is limited. There is a need for new and well designed observational and interventional studies to confirm, what so far is only a possible association, to explore the validity of the association in different populations, correctly control for confounders.

INTRODUÇÃO: A sobrevida de recém-nascidos (RN) com peso de nascimento cada vez menor tem aumentado nos últimos anos. A prematuridade é a principal causa de morbidade e mortalidade neonatal, tornando as crianças vulneráveis. Desta forma, a prematuridade extrema e suas consequências provavelmente podem possam influenciar a QVRS no primeiro ano de vida de recém-nascidos de muito baixo peso, por meio de seus efeitos sobre o meio social e dinâmica familiar. OBJETIVO: Avaliar a qualidade de vida relacionada à saúde de recém- nascidos prematuros de muito baixo peso no primeiro ano após o termo, utilizando o instrumento TNO-AZL Preschool Children Quality of Life Questionnaire. MÉTODOS: Desenvolveu-se estudo de coorte, com 89 recém-nascidos prematuros de muito baixo peso, egressos de Unidades de Terapia Intensiva Neonatal nos anos de 2011-2012. Foram colhidos os dados referentes às características do RN e evolução perinatal a partir do prontuário e aplicado o instrumento TAPQOL aos 8 e 12 meses pós termo. Os recém-nascidos incluídos foram divididos em dois grupos, de acordo com a mediana do escore obtido aos 12 meses pós Termo, sendo Grupo I aqueles com escores menores ou iguais à mediana e Grupo II, os que obtiveram escores maiores. O Cálculo da amostra considerou alfa=5%, beta=80% e nível de significância de 5%. RESULTADOS: Houve um aumento (p < 0,001) da pontuação total do TAPQOL entre 8 e 12 meses pós T no período. As medianas do TAPQOL nos dois grupos e nas duas idades avaliadas alcançaram qualificação boa, com escores variando entre 73,21 a 96,13. Na evolução dos domínios, o Grupo I apresentou aumento das pontuações nos domínios condições de saúde (p=0,021) e humor( < 0,001), e redução no domínio comportamento (0,003), sem modificação no apetite e qualidade do sono. No Grupo II, houve aumento significativo nas pontuações relativas às condições de saúde (p=0,003) e humor (< 0,001) e a manutenção da pontuação máxima nos domínios qualidade do sono e apetite; o comportamento reduziu (< 0,001) a pontuação obtida nesse período. A confiabilidade do TAPQOL pelo teste Alfa de Cronbach aos 8 e 12 meses foi considerada aceitável(0,7). CONCLUSÃO: A QVRS evoluiu com melhora no período, sendo considerada boa. Dentre os domínios, as condições de saúde evoluíram positivamente, acompanhada da qualidade do sono, apetite e humor, com piora do comportamento / INTRODUCTION: The survival of newborns (NB) with progressively lower birth weights has increased in recent years. Preterm birth is the leading cause of neonatal morbidity and mortality, which has created vulnerable children. Thus, extreme prematurity and its consequences may influence health-related quality of life (HRQoL) in the first year of life of these infants through their effects on social and family dynamics. OBJECTIVE: Evaluate the health-related quality of life of preterm infants with very low weight in the first year after birth, using the TNO-AZL Preschool Children Quality of Life Questionnaire (TAPQOL). METHODS: This study used a cohort design that included 89 preterm neonates with very low birth weights, discharged of Neonatal Intensive Care Units in the years 2011-2012. Data were collected from neonatal unit medical records concerning the characteristics of the NBs and the perinatal outcomes; the TAPQOL was used at 8 and 12 months post term. In the data analysis, NBs included in the study were divided into two groups according to the median score obtained at 12 months post term; Group I included those with scores lower or equal to the median scores and Group II included those who obtained scores higher than the median. The sample size calculation considering alfa = 5%, beta = 80% and a significance level of 5 %. RESULTS : There was an increase (p < 0.001) for total score TAPQOL between 8 and 12 months post term in the period . The median TAPQOL in both groups and at both ages tested achieved good qualification, with scores ranging from 73.21 to 96.13 . In the evolution of domains , Group I showed higher scores in the health status (p = 0.021) and mood (< 0.001) , and reduced behavior (0.003) , with no change in appetite and sleep quality . In Group II , there was a significant increase in scores related to health status (p = 0.003) and mood (< 0.001) and maintaining the highest score in the areas of quality sleep and appetite ; behavior reduced (< 0.001) scores obtained in this period . The reliability of TAPQOL by Cronbach\'s alpha test at 8 and 12 months was considered acceptable (0.7). CONCLUSION: HRQOL evolved with improvement in the period being considered good. Among the areas the health positive developments, together with the sleep quality, appetite and mood, behavior worsened

INTRODUÇÃO: O baixo peso ao nascer representa fator de risco importante para a morbidade e mortalidade neonatal e infantil, sendo acompanhado por prematuridade, retardo de crescimento intra-uterino, ou ambos os fatores. OBJETIVO: Estudar as características maternas, perinatais, ambientais, econômicas, evolução ponderoestatural e alimentação das crianças nascidas com baixo peso e sua interação no aumento da morbidade durante o primeiro ano de vida. MÉTODOS: Estudo de coorte retrospectivo realizado na cidade de Sobral, Ceará, no período de três anos (2005 a 2007) onde foram incluídas 261 crianças nascidas com baixo peso (BP) e acompanhadas pelo Programa de Saúde da Família. Foi utilizado a Base de Dados do Sistema de Informações de Nascidos Vivos e revisão de prontuários hospitalares e ambulatoriais destas crianças para coleta de dados, quantificação e causa das consultas e internações. Para análise das variáveis foram realizadas distribuições de freqüência, Odds Ratio (OR), respectivos intervalos de confiança (95%) e significância estatística das associações. A análise final de associação utilizou modelo de regressão multivariado para avaliar os fatores de risco relacionados com o aumento da morbidade. RESULTADOS: Entre as 261 crianças estudadas, a média da idade materna foi de 24 anos, sendo que 29,12% das mães eram adolescentes. Cerca de 41,76 % das mães eram solteiras e 31,42% casadas ou com união estável, e 24,14% eram sem escolaridade. Quanto às características perinatais, 52,11% das crianças nasceram de parto vaginal, 52,49% pré-termos; 55,56% eram do sexo feminino, 98,08% das crianças obtiveram Apgar de 5 minutos maior que 6. O peso médio de nascimento foi de 2140 g, sendo que 72,03% das crianças nasceram com peso entre 2000 e 2500 g. Houve incremento do escore-z de peso até os quatro meses de idade cronológica para crianças nascidas a termo e idade gestacional corrigida para os pré-termo em cerca de 87% das crianças e 45% do escore-z do comprimento. O índice de aleitamento materno exclusivo foi de 26,05% e 8,43% até os 4 e 6 meses de idade respectivamente. Observou-se que 13,97% das crianças residiam em casa de taipa, 36,49% dos domicílios utilizavam fogão a lenha e 36,11% viviam com renda familiar inferior a um salário mínimo. Quanto a morbidade, as 261 crianças nascidas com baixo peso realizaram 1103 consultas por motivo de doença no Programa de Saúde de Família, tendo como causa principal infecções respiratórias agudas. Ocorreram 469 consultas ocorreram em emergência pediátrica e 156 internações hospitalares, principalmente no período neonatal. Foram identificados como fatores de risco para maior morbidade: a) Interrupção do aleitamento materno exclusivo antes dos quatro meses o qual esteve associado a presença de consulta em emergência (OR 3,07; p<0,001); b) Idade gestacional e peso de nascimento baixos, com maior probabilidade de internação no período neonatal (OR 6,26; p<0,001); c) Prematuridade e a ausência de recuperação de peso até os 4 meses estiveram associados a internação por pneumonia, diarréia aguda e outros motivos (OR 5,15 e 0,65; p = 0,036 e 0,013, respectivamente). As demais variáveis não tiveram relação com a morbidade estudada. CONCLUSÃO: A prematuridade, a interrupção do aleitamento materno exclusivo antes dos quatro meses e a ausência do incremento de peso estiveram associadas a maior morbidade nas crianças de baixo peso ao nascer. Nesta população atendida pelo PSF, as características maternas, ambientais e econômicas não estiveram associadas à maior morbidade / BACKGROUND: Low birth weight represents an important risk factor for neonatal and infant morbidity and mortality, accompanied by prematurity, intrauterine growth restriction, or both. OBJECTIVE: To study maternal, perinatal, environmental, economic characteristics, growth and feeding of children with low birth weight and their interaction in the increased morbidity during the first year of life. METHODS: A retrospective cohort study conducted in the city of Sobral, Ceará, in the period of three years (2005-2007) which included 261 children with low birth weight (LBW) and followed by the Family Health Program. We used the database of the Sistema de Informação de Nascidos Vivos (SINASC) and review data collection of hospital and ambulatory records of these children, quantification and causes of emergency room visits and hospitalizations. For analysis of the variables, were used frequency distributions, odds ratio (OR), confidence intervals (95%) and statistical significance of associations. The final analysis of association used logistic regression analysis to assess the risk factors associated with increased morbidity. RESULTS: Among 261 children studied, the average maternal age was 24 years, and 29.12% of mothers were teenagers. Approximately 41.76% were single mothers and 31.42% were married or with a stable union, and 24.14% were uneducated. Regarding perinatal characteristics, 52.11% were born vaginally, 52.49% were preterm, 55.56% were female and 98.08% of the children had Apgar 5 minutes greater than 6. The average birth weight was 2140 g, and 72.03% of children born weighing between 2000 and 2500 g. There was catch up in weight to four months of chronological age for children born at term and corrected gestational age for preterm at around 87% and 45% in height. The rate of exclusive breastfeeding was 26.05% and 8.43% to 4 and 6 months of age respectively. It was observed that 13.97% of children lived in wattle and daub house, 36.49% of households used wood stoves, and 36.11% lived with less than one minimum wage. As for morbidity, the 261 children born with low birth weight were 1103 visits due to illness in the Family Health Program, with the main cause was acute respiratory infections. There were 469 emergency visits and 156 pediatric emergency hospital admissions, especially in the neonatal period. Were identified as risk factors for increased morbidity: a) interruption of exclusive breastfeeding before 4 months which was associated with the presence of emergency consultation (OR 3.07, p <0.001), b) low gestational age and birth weight, with a greater likelihood of hospitalization in the neonatal period (OR 6.26, p <0.001), c) Prematurity and the no catch up in weight at to 4 months of age were associated with hospitalization for pneumonia, diarrhea and other reasons (OR 5, 15 and 0.65, p = 0.036 and 0.013, respectively). The other variables were not associated with morbidity study. CONCLUSION: Prematurity, interruption of exclusive breastfeeding before four months and no catch up growth were associated with greater morbidity in children with low birthweight. In the population served by the PSF, maternal characteristics, environmental and economic were not associated with increased morbidity

Introdução: A fungemia no período neonatal é uma complicação grave principalmente entre recém-nascidos de muito baixo peso (RN MBP). O maior conhecimento dos fatores de risco associados possibilita o desenvolvimento de estratégias para prevenir sua ocorrência. Objetivos: 1) descrever a incidência de sepse fúngica e identificar as espécies de fungo; 2) analisar os fatores de risco exploratóriamente nessa população. Métodos: Estudo prospectivo observacional de uma coorte de RN MBP admitidos em Unidade de Terapia Intensiva Neonatal de um hospital terciário no período de 25 meses, de 01 de junho de 2005 a 30 de junho de 2007. Foram excluídos aqueles com idade igual ou inferior a 72 horas de vida. Criou-se um banco de dados dividindo a amostra em cinco grupos, baseados na primeira hemocultura positiva: sem infecção; sepse com hemocultura negativa; sepse por bactéria gram-positiva; sepse por bactéria gram-negativa; sepse fúngica. Para análise estatística, foram utilizados: teste do qui-quadrado de Pearson, teste não paramétrico de Kruskal-Wallis e um modelo de regressão logística multinomial para as medidas quantitativas e as categorizadas. Resultados: Foram incluídos no estudo 187 recém-nascidos, dos quais 110 (58,8%) evoluiram com sepse neonatal tardia, sendo 13 casos de sepse fúngica (7%). A taxa de mortalidade foi 69,2%. As espécies de fungo identificadas foram C.albicans (50%), C. parapsilosis (41,7%) e C. não albicans (8,3%). Os fatores de risco encontrados na comparação, entre o grupo com fungemia e o restante da amostra foram: peso de nascimento (PN), idade gestacional (IG), exposição a cateter venoso central (CVC), nutrição parenteral prolongada (NPP), jejum (JJ), ventilação pulmonar mecânica (VPM), exposição a vancomicina, cefepime, meropenem e amicacina. A análise estatística mostrou que: a cada incremento de 10 gramas no PN, o risco de fungemia diminuiu em 3%; a cada dia de CVC, o risco aumentou em 8,1%; a cada dia de VPM, o risco aumentou em 11,1%. Após a categorização das variáveis, observou-se que: o PN 1000 g aumentou o risco para fungemia 23 vezes; a VPM 14 dias, aumentou 36 vezes o risco para fungemia; cada dia de CVC no RN com PN 1000 g aumentou o risco de infecção fúngica em 9,3%. Conclusões: A incidência de sepse fúngica em RNMBP foi de 7%; as espécies de fungo identificadas foram C.albicans, C.parapsilosis e C. não albicans, com mortalidade de 69,2%. O PN 1000 g e a duração da ventilação mecânica 14 dias aumentaram 23 e 36 vezes o risco de sepse fúngica, respectivamente. Cada dia de CVC no RN 1000 g aumentou o risco de infecção fúngica em 9,3%. A maior proporção de recém-nascidos que permaneceu em jejum por tempo igual ou superior a sete dias ocorreu no grupo com sepse fúngica (92,3%). / Introduction: Fungemia is a severe complication on neonatal period among very low birth weight infants (VLBW). A better understanding of the risk factors involved could help improving prevention strategies of its occurrence. Objectives: 1) To describe the incidence of fungal sepsis and to recognize the fungal species involved 2) To analyse the risk factors among this population. Methods: Data were collected prospectively over a 25 months period from 1st june 2005 to 30 june 2007 to asses risk factors among VLBW infants admitted at the Neonatal Intensive Care Unit of a tertiary hospital. All newborns with 72 hours of life or less were excluded from the study. Patients were divided in five groups, based on the first positive blood culture: without sepsis; sepsis with negative blood culture; Gram-positive bacterial sepsis; Gram-negative bacterial sepsis and fungal sepsis. For statistical analyses the Pearson test, the Kruskal-Wallis test and a logistic regression model were used. Results: 187 newborns were included in the study: 110 (58,8%) had late-onset sepsis; 13 (7%) had fungal sepsis. Rate of mortality was 69,2%. The fungal species identified were: C.albicans (50%), C. parapsilosis (41,7%) and one non identified Candida (8,3%). The risk factors identified at the comparison between the fungal sepsis group and the group without fungal sepsis were: birth weight (BW), gestational age (GA), central venous catheter, parenteral nutrition, fasting, mechanical ventilation, exposure to vancomycine, cefepime, meropenem, and amikacine. Further statistical analyses have shown: for each increasing of 10 grams in BW, the risk of fungemia diminished 3%; each day of central venous catheter, increased this risk in 8,1%; each day of mechanical ventilation increased this risk in 11,1%. The analyses of the categorized variables have shown: BW 1000 g increased the risk of fungemia 23 times; mechanical ventilation 14 days increased the risk 36 times; each day of central venous catheter increased the risk of fungemia in 9,3%. Conclusions: The incidence of fungal sepsis in VLBW infant was 7%; the fungal species identified were C.albicans, C.parapsilosis and one non identified Candida. The mortality rate was 69,2%. BW 1000 g and mechanical ventilation during 14 days or more increased the risk of fungemia 23 and 36 times, respectively. Each day of central venous catheter increased the risk of fungemia in 9,3%. 92,3% of the newborns with fungal sepsis were submitted to fasting for seven days or more, the biggest proportion found.

Thesis (MA. (Clinical Psychology)) -- University of Limpopo, 2004. / Refer to the document

<p>This secondary analysis aimed to develop dietary scores to assess the dietary intake of pregnant women in the West Coast/ Winelands region and determine the association with LBW. Further to determine the association between the dietary scores and maternal socioeconomic and socio-demographic characteristics and maternal smoking and/or alcohol consumption during pregnancy.</p>

No description available.

Despite substantial evidence linking improved pregnancy outcomes with receipt of prenatal care and recent improvements in prenatal care utilization, specific subpopulations continue to receive late prenatal care and experience adverse birth outcomes. This study will use the Health Belief Model and the Intersectionality Framework to examine the timing of prenatal care utilization, prenatal care compliance, and adverse birth outcomes within a group of low-income, black women in the South. Black women have worst rates of late prenatal care utilization and compliance than any other racial group. This late prenatal care utilization and compliance leads to adverse birth outcomes. A secondary data analysis was conducted using binary logistic regression and OLS regression to examine agency factors, structural factor, and risk health behavior in predicting timing of prenatal care utilization and compliance. In addition, this study also examines timing of prenatal care utilization and compliances and its effects on preterm birth and low birth weight. The results show that family size and knowledge/attitude significantly influences timing of prenatal care. Prenatal care compliance is influenced by church social support and low birth weight is influenced by private insurance. The results of this study show that although much is known in comparing different racial groups, more investigation is needed to explain why low income black women still experience less prenatal care use and compliance and worse adverse birth outcomes than any other racial group in the United States.

BACKGROUND: The social causation of preterm birth remains elusive, without an adequate explanatory framework. Thus, this study proposed and evaluated a conceptual model of the social determinants of perinatal health for the understanding of perinatal health disparities. METHODS: A prospective cohort study was conducted with pregnant women between 20 and 35 weeks gestation who were participating in two Healthy Start programs in Central Florida, from July 2011-August 2013. Perinatal health was operationalized based on gestational age, birth weight, and healthy start infant risk screen score. The predictors were: early life adversity, social position, maternal health-related quality of life, maternal stress, racism and discrimination, lack of social support, father involvement during pregnancy, intimate partner violence, and adverse maternal behaviors. Data collection consisted of a self-administered survey and birth outcome data was obtained from Healthy Start administrative databases. The statistical framework was structural equation modeling. RESULTS: The study sample was racially and ethnically diverse (N, Hispanics=72; N, non-Hispanic blacks=61; and N, non-Hispanic whites=48). The majority of mothers in this study were single or not married (cumulative 76%), US born (74.6%), and with English speaking preference (74.6%). The sample tended to cluster in low income groups (cumulative 58% less than $25,000 annual household income) and with education levels of less than high school (79.6%). A greater proportion of Hispanic mothers were married (66.7%) compared to non-Hispanic blacks (34.4%) and non-Hispanic whites (47.9%). Only 41.7% had completed high school, compared to 63.9% non-Hispanic blacks and 64.6% non-Hispanic whites. Nearly all non-Hispanic blacks and non-Hispanic whites were born in the US, compared to only 43.1% Hispanic mothers. Only 40% of non-Hispanic blacks reported on currently living with the baby's father at the time of the survey, compared to 66.2% for Hispanic mothers, and 58.3% for non-Hispanic whites. Furthermore, non-Hispanic blacks reported a greater proportion of discriminatory experiences in daily situations (mean = 4.74), compared to the other groups (mean for Hispanics was 2.14, and mean for non-Hispanic whites was 1.95). Non-Hispanic whites reported the greater proportion of daily alcohol use (mean 3.8 beverages per month), compared to other groups (Hispanic mean was 0.69, and non-Hispanic blacks mean was 1.68). Non-Hispanic white mothers also presented a higher mean of adverse childhood experiences before 18 years of life (mean = 3.4), compared to other groups (mean for Hispanics was 1.63, mean for non-Hispanic blacks was 2.48). With the exception of the confirmatory factor analysis for intimate partner violence (low correlations with common factor), all other confirmatory factor analyses demonstrated an acceptable Chi-square to degrees of freedom ratio (<6), and the RMSEA was less than 0.08 (minimum for acceptance). Thus, structural equation models were estimated subsequently. The first model was a model of direct effects between social position and perinatal health (hypothesis 1: direct effects), which demonstrated a good fit as indicated by X2/DF ratio of 1.4 (Chi-Square = 19, DF =13) and a RMSEA of 0.05. However, the direct effect of social position was very small and non-significant (Beta=-.02, p-value =.76), supporting the conclusion that a simple direct effect of social position on perinatal health was not found in this population. The second model explored indirect effects of social position through intermediate factors (hypothesis 2: indirect effects), which demonstrated a good fit to the data, as indicated by a Chi-square/df ratio = 1.45 and RMSEA=.05. Social support was a statistically significant mediator between social position (Beta=0.284, p<0.05) and perinatal health (Beta=0.22, p<0.05). The third model incorporated adverse childhood experiences as predictor of social position effects. Adverse childhood experiences were significantly associated with social position (Beta=.363, p<0.05) and moderated the effects of social position on social support and perinatal health. In the presence of adverse childhood experiences, the social position was significantly associated to maternal health-related quality of life (Beta=-0.226, p<0.05) and maladaptive maternal behaviors (Beta=0.654, p<0.05). CONCLUSION: This study demonstrated synergistic effects of social determinants of health. Controlling for all factors considered, social support was significantly associated with perinatal health, which presents implications for strengthening prenatal programs that provide support to pregnant women. Findings need to be replicated in larger studies with the US general population. Policy makers and researchers need to pay greater attention to the role of early life adversity on perinatal health outcomes.

<p>This secondary analysis aimed to develop dietary scores to assess the dietary intake of pregnant women in the West Coast/ Winelands region and determine the association with LBW. Further to determine the association between the dietary scores and maternal socioeconomic and socio-demographic characteristics and maternal smoking and/or alcohol consumption during pregnancy.</p>