[Birth in Baby-Friendly Hospitals in Rio de Janeiro, Brazil: a protective factor for breastfeeding?]. / Nascer em Hospital Amigo da Criança no Rio de Janeiro, Brasil: um fator de proteção ao aleitamento materno?

This article aims to investigate the impact of the Baby-Friendly Hospital Initiative (BFHI) on exclusive breastfeeding (EBF). This was a cross-sectional study with 811 mothers of infants under five months of age, randomly selected at five health centers in Rio de Janeiro, Brazil. The exposure variable was hospital of birth, categorized in accredited hospitals (BFH), certified hospitals (CBFH), and hospitals without accreditation. The data were analyzed by complementary log-log transformation models, which capture cohort longitudinal experience (current status data). Even after adjusting the analysis for maternal socio-demographic, lifestyle, and psychological factors, health services use, and infants' age and health status, duration of EBF was longer in infants born in BFH and CBFH. The findings suggest the effectiveness of BFHI in maintaining EBF throughout the early months of life. To extend EBF through the first six months of life would require not only strengthening the BFHI but also developing and encouraging more actions in favor of breastfeeding, focusing on primary healthcare facilities.

Severe physical violence between intimate partners during pregnancy: a risk factor for early cessation of exclusive breast-feeding.

OBJECTIVE: To investigate the role of severe physical violence during pregnancy (SPVP) between intimate partners in early cessation of exclusive breast-feeding (EBF). DESIGN: A health services survey. The revised Conflict Tactics Scale was used to characterize SPVP; premature breast-feeding cessation was identified using a current status data approach, which was based on the information reported from food recall during the preceding 7 d. The cumulative hazard function was estimated by complementary log-log transformation models, which allowed the ensuing estimation of early breast-feeding cessation rates in different age groups and the ratio of rates of weaning between women exposed and not exposed to violence. SETTING: Five large public primary health-care facilities of Rio de Janeiro, Brazil. SUBJECTS: The sample comprised 811 randomly selected mothers of children under 5 months of age who were waiting to be consulted. RESULTS: SPVP is an independent risk factor of cessation of EBF since, after controlling for socio-economic, demographic, reproductive and lifestyle variables, women exposed to violence presented an incidence density that was 31% higher than those who were not exposed (hazard ratio = 1·30, 95% CI 1·01, 1·69). CONCLUSIONS: The findings corroborate the hypothesis that SPVP is an important risk factor for EBF. This indicates the need for incentives to adequately train health-care personnel in dealing with lactating women in order to gain a broader view of breast-feeding beyond the biological aspects of lactation, including the maternal psychological dimension.

Nascer em Hospital Amigo da Criança no Rio de Janeiro, Brasil: um fator de proteção ao aleitamento materno? / Birth in Baby-Friendly Hospitals in Rio de Janeiro, Brazil: a protective factor for breastfeeding?

Este artigo pretende avaliar o papel da Iniciativa Hospital Amigo da Criança (IHAC) na duração do aleitamento materno exclusivo (AME). Trata-se de estudo transversal, com população constituída de 811 mães de crianças menores de cinco meses de idade, selecionadas aleatoriamente em cinco unidades básicas de saúde (UBS) no Município do Rio de Janeiro, Brasil. A exposição de interesse central foi o local de nascimento da criança: Hospital Amigo da Criança (HAC), em vias de receber a titulação (EVHAC) e sem a titulação. Optou-se pelo modelo de análise de sobrevida log-log complementar, que recompõe a experiência longitudinal da coorte, caracterizando abordagem do tipo current status. Mesmo após o controle por variáveis sociodemográficas, relativas ao estilo de vida e aos aspectos psicossociais maternos, à utilização dos serviços de saúde, idade e saúde da criança, houve maior duração do AME em crianças nascidas em HAC e EVHAC. Os resultados sugerem a efetividade da IHAC na manutenção de AME nos primeiros meses de vida, reforçando a necessidade de ampliar sua cobertura para todo o território nacional.

This article aims to investigate the impact of the Baby-Friendly Hospital Initiative (BFHI) on exclusive breastfeeding (EBF). This was a cross-sectional study with 811 mothers of infants under five months of age, randomly selected at five health centers in Rio de Janeiro, Brazil. The exposure variable was hospital of birth, categorized in accredited hospitals (BFH), certified hospitals (CBFH), and hospitals without accreditation. The data were analyzed by complementary log-log transformation models, which capture cohort longitudinal experience (current status data). Even after adjusting the analysis for maternal socio-demographic, lifestyle, and psychological factors, health services use, and infants' age and health status, duration of EBF was longer in infants born in BFH and CBFH. The findings suggest the effectiveness of BFHI in maintaining EBF throughout the early months of life. To extend EBF through the first six months of life would require not only strengthening the BFHI but also developing and encouraging more actions in favor of breastfeeding, focusing on primary healthcare facilities.

Postpartum depression according to time frames and sub-groups: a survey in primary health care settings in Rio de Janeiro, Brazil.

This study aimed at estimating the prevalence of postpartum depression (PPD) according to postpartum periods and sub-groups in public primary health care settings in Rio de Janeiro, Brazil. A cross-sectional survey was carried out in five primary health care units and included 811 participants randomly selected among mothers of children up to five postpartum months. Women were classified as depressed and given scores on Edinburgh Postnatal Depression Scale (EPDS) above 11. The overall estimate of PPD was 24.3% (95% CI, 21.4-27.4). However, estimates were not homogeneous during the first 5 months postpartum (p value = 0.002). There was a peak of depressive symptoms around 3 months postpartum, when 128 women (37.5%, 95% CI, 29.1-46.5) disclosed scores above 11 on EPDS. Regarding the magnitude of PPD according to some maternal and partners' characteristics, it was consistently higher among women with low schooling, without a steady partner, and whose partners misused alcohol or used illicit drugs. The prevalence of PPD among women attending primary health care units in Rio de Janeiro seems to be higher than general estimates of 10-15%, especially among mothers with low schooling and that receive little (if any) support from partners. Also, the "burden" of PPD may be even higher around 3 months postpartum. These results are particularly relevant for public health policies. Evaluation of maternal mental health should be extended at least until 3 to 4 months postpartum, and mothers presenting a high-risk profile deserve special attention.

Severe acute obstetric morbidity (near-miss): a review of the relative use of its diagnostic indicators.

OBJECTIVE: To assess the most commonly employed diagnostic indicators of severe maternal morbidity (obstetric near-miss). METHODS: Review of the literature from January 1989 to August 2008. RESULTS: Fifty-one manuscripts met the eligibility criteria, and 96 indicators were utilized at least once. Admission to intensive care unit (n = 28 studies) was the indicator most frequently utilized, followed by eclampsia and hemorrhage (n = 27), blood transfusion (n = 26) and emergent hysterectomy (n = 24). CONCLUSION: Considering these findings, a trial version of a 13-item instrument for diagnosing obstetric near-miss is proposed. It includes the indicators eclampsia, severe hypertension, pulmonary edema, cardiac arrest, obstetrical hemorrhage, uterine rupture, admission to intensive care unit, emergent hysterectomy, blood transfusion, anesthetic accidents, urea >15 mmol/l or creatinine >400 mmol/l, oliguria (<400 ml/24 h) and coma. Further studies should focus on consensual definitions for these indicators and evaluate the psychometric proprieties of this trial version.

[The Hospital Information System of the Brazilian National Unified Health System: a preliminary evaluation of performance in monitoring RhD hemolytic disease of the newborn]. / Sistema de informações hospitalares do sistema único de saúde (SIH-SUS): uma avaliação preliminar do seu desempenho no monitoramento da doença hemolítica perinatal Rh(D).

This study aimed to evaluate the adequacy of the Hospital Information System of the National Unified Health System (SIH-SUS) in identifying cases of RhD hemolytic disease of the newborn (HDN) at the Fernandes Figueira Institute (IFF/FIOCRUZ) from 1998 to 2003. Neonatal records, data from the Medical Archives, and AIH (Hospital Admissions Authorization Form) data consolidated in the SIH-SUS were analyzed. Cases were identified according to the following fields: principal diagnosis, secondary diagnosis, and procedure performed. During the period studied, 194 cases of HDN were diagnosed. The Medical Archives registered 148 newborns with HDN, however only 147 AIHs were issued and 145 consolidated in the SIH-SUS. Among these 145 cases, 84 cited HDN as the principal diagnosis, while secondary diagnosis identified 38 additional cases and the procedures performed failed to identify any further cases. Thus, the SIH-SUS identified only 122 (62.9%) of the 194 cases of HDN treated at the IFF/FIOCRUZ. Although it is necessary to evaluate other units, the SIH-SUS does not appear to be reliable for monitoring HDN. Additional studies are essential for employing secondary administrative data in the context of epidemiological surveillance.

Sistema de informações hospitalares do sistema único de saúde (SIH-SUS): uma avaliação preliminar do seu desempenho no monitoramento da doença hemolítica perinatal Rh(D) / The Hospital Information System of the Brazilian National Unified Health System: a preliminary evaluation of performance in monitoring RhD hemolytic disease of the newborn

Considerando a utilização de bases administrativas na vigilância epidemiológica, propõe-se aqui avaliar a adequação do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH-SUS) na identificação dos casos de doença hemolítica perinatal ocorridos no Instituto Fernandes Figueira, Fundação Oswaldo Cruz (IFF/FIOCRUZ), entre 1998 e 2003. Foram analisadas informações disponibilizadas pelo Serviço Neonatal, pelo Arquivo Médico e os dados da Autorização de Internação Hospitalar (AIH) consolidados no SIH-SUS. A identificação dos casos de doença hemolítica perinatal se deu através dos campos Diagnóstico Primário, Diagnóstico Secundário e Procedimento Realizado. Nesse período, 194 neonatos foram diagnosticados com doença hemolítica perinatal. No Arquivo Médico, 148 casos foram registrados, porém apenas 147 AIHs foram emitidas e 145 consolidadas no SIH-SUS. Entre essas, 84 AIHs arrolavam a doença hemolítica perinatal como Diagnóstico Primário; considerando também o Diagnóstico Secundário, mais 38 casos foram identificados; e nenhum caso adicional foi recuperado pelo Procedimento Realizado. Assim, o SIH-SUS identificou apenas 122 (62,9 por cento) dos 194 neonatos com doença hemolítica perinatal assistidos no IFF/FIOCRUZ. Mesmo que ainda requerendo uma reavaliação em outros hospitais, a utilização do SIH-SUS no monitoramento da doença hemolítica perinatal não parece recomendável. Estudos ancilares são necessários quando do emprego de dados secundários nesse contexto.

This study aimed to evaluate the adequacy of the Hospital Information System of the National Unified Health System (SIH-SUS) in identifying cases of RhD hemolytic disease of the newborn (HDN) at the Fernandes Figueira Institute (IFF/FIOCRUZ) from 1998 to 2003. Neonatal records, data from the Medical Archives, and AIH (Hospital Admissions Authorization Form) data consolidated in the SIH-SUS were analyzed. Cases were identified according to the following fields: principal diagnosis, secondary diagnosis, and procedure performed. During the period studied, 194 cases of HDN were diagnosed. The Medical Archives registered 148 newborns with HDN, however only 147 AIHs were issued and 145 consolidated in the SIH-SUS. Among these 145 cases, 84 cited HDN as the principal diagnosis, while secondary diagnosis identified 38 additional cases and the procedures performed failed to identify any further cases. Thus, the SIH-SUS identified only 122 (62.9 percent) of the 194 cases of HDN treated at the IFF/FIOCRUZ. Although it is necessary to evaluate other units, the SIH-SUS does not appear to be reliable for monitoring HDN. Additional studies are essential for employing secondary administrative data in the context of epidemiological surveillance.