Family Health Strategy and prevalence of anemia in women in an urban region of high Human Development Index / Estratégia de Saúde da Família e prevalência de anemia em mulheres de uma região urbana de alto Índice de Desenvolvimento Humano

INTRODUCTION: Iron deficiency anemia is a major public health problem. OBJECTIVE: To analyze the hemoglobin value and the prevalence of anemia in women in reproductive age, mothers of children enrolled in municipal day care centers in a municipality with a high Human Development Index, in the Southeast region of Brazil, and related factors, including being attended by the Family Health Strategy. METHOD: This is a cross-sectional study with a sample of 230 women between 15 and 49 years old. Data collection was performed through a form, addressing socioeconomic variables and maternal health. It was verified: weight, height and hemoglobin concentration dosage. : The prevalence of anemia in women was 9.6%, with an average hemoglobin concentration of 14.6 g / dL. In the bivariate analysis, the following variables were associated with anemia: age, having a disease, obstetric complications in the pregnancy of the studied child and, as a protective factor, being in the Family Health Strategy program. In the binary logistic analysis, only being met by the Family Health Strategy proved to be a significant protective effect against anemia (OR = 0.391, p <0.05). CONCLUSION: Although there is a slight prevalence of anemia, according to World Health Organization criteria, in urban areas with a high Human Development Index, well-conducted health care policies, the Family Health Strategy in particular can contribute to further reduce plus the prevalence of this condition in the health of women of reproductive age.

INTRODUÇÃO: Anemia ferropriva é um importante problema de saúde pública. OBJETIVO: Analisar o valor de hemoglobina e a prevalência de anemia em mulheres em idade reprodutiva, mães de filhos inscritos em creches municipais de um município com alto Índice de Desenvolvimento Humano, na região Sudeste, além de fatores a elas relacionados, incluindo serem atendidas pela Estratégia de Saúde da Família. MÉTODO: Trata-se de um estudo transversal com amostra constituída por 230 mulheres entre 15 e 49 anos de idade. A coleta de dados foi realizada por meio de formulário, abordando variáveis socioeconômicas e saúde materna. Verificaram-se: peso, estatura e dosagem da concentração da hemoglobina. RESULTADOS: A prevalência de anemia nas mulheres foi de 9,6%, com média de concentração da hemoglobina de 14,6g/dL. Na análise bivariada, mostraram associação com anemia as variáveis: idade, ter alguma doença, intercorrências obstétricas na gestação da criança estudada e, como fator de proteção, estar no programa Estratégia de Saúde da Família. Na análise binária logística, apenas ser atendida pela Estratégia de Saúde da Família demonstrou ser significante efeito protetor frente à anemia (OR=0,391, p<0,05). CONCLUSÃO: Apesar de haver uma prevalência leve de anemia, pelo critério da Organização Mundial da Saúde, em área urbana de alto Índice de Desenvolvimento Humano, políticas de atenção à saúde e bem conduzidas, a Estratégia de Saúde da Família em particular, podem contribuir para reduzir ainda mais a prevalência desse agravo na saúde das mulheres em idade reprodutiva.

Tri-Ponderal Mass Index: A Screening Tool for Risk of Central Fat Accumulation in Brazilian Preschool Children.

Background and Objectives: To verify the use of the tri-ponderalmass index (TMI) as a screening tool for risk of central fat accumulation in preschool children. Materials and Methods: An observational, analytical study was carried out on samples from children 2 to 5 years of age. The body mass index (BMI) and the tri-ponderalmass index (TMI: Weight/height3) were calculated. The waist circumference-to-height ratio (WHtR) was used to classify central fat accumulation risk. Preschoolers whose WHtRwas in the upper tertile of the sample were classified as at risk for central fat accumulation. A comparison of the two indicators (BMI and TMI) was made from the area under the receiver operator characteristics (ROC) curve (AUC) in the discrimination of the WHtR. Results: The sample used for analysis was 919 preschoolers. The mean age of the children was 3.9 years (SD = 0.7). The difference in AUC was 5% higher for TMI (p < 0.0001). In the individual analysis of the ROC curve of the TMI, favoring a higher sensitivity, the cutoff point of 14.0 kg/m3 showed a sensitivity of 99.3% (95% CI: 97.6-99.9). Conclusion: Considering WHtR as a marker of possible future metabolic risk among preschool children, TMI proved to be a useful tool, superior to BMI, in screening for risk of central fat accumulation in preschool children.

Nutritional Status Trends in Brazilian Preschoolers: A Cohort Study.

Background: Determining trends in the nutritional status of children may guide care prevention beyond this age in an effort to reduce the prevalence and incidence of overweight and/or obese children. The objective of this study is to evaluate the evolution of the nutritional status of preschool children in two moments, with an interval of 2 years. Methods: This is a cohort study of a random probabilistic sample of preschool children attending public schools within an urban area of high human development index city, in the hinterland of São Paulo state. In 2016, we reassessed the nutritional status of 351 preschoolers evaluated in 2014, comparing the prevalence of overweight according to BMI >1 z-score. Results: The prevalence of overweight was 31.05% (2014) and 31.06% (2016) and mean BMI z-scores were 0.58 and 0.57, respectively. The nutritional status classification of the preschool children showed almost no agreement between the two time points (κ = 0.053). Nevertheless, children with overweight in 2014 had a relative risk of 1.96 of being overweight or obese in 2016 (p = 0.0473). Conclusions: Prevalence of overweight among preschoolers was the same at 2 and 5 years of age, with no tendency to grow. Despite this, 2-year-old preschoolers with overweight present a twofold higher relative risk for excessive weight at 5 years of age. These changes of nutritional status at preschool age evince the great flexibility of their nutritional condition during this period of life.

Difficulties in the diagnosis and treatment of rare diseases according to the perceptions of patients, relatives and health care professionals.

OBJECTIVES: The aim of this study is to present a survey of vulnerabilities and to suggest approaches for the treatment of rare diseases according to the perceptions of a group of affected individuals, patient association representatives and health care professionals. METHODS: The focus group technique was used in interviews with patients and primary caregivers, patient support groups/non-governmental organizations, primary health care professionals and physician specialists. RESULTS: The transcript analysis focused on thematic units, which were tailored to each group and allowed comparisons in search of concordant views. Unanimity was observed in relation to the physical, emotional and social damage to the life standards of the affected individuals and their families as a result of illness. The Brazilian health system was unanimously classified as inadequate to respond to the needs of patients with rare diseases, and this inadequacy led to unpleasant experiences, such as the seemingly endless referrals among health services to reach a final diagnosis and develop a treatment plan. CONCLUSIONS: The complex set of health system requirements necessary to support the care of patients with rare diseases represents an obstacle to successfully meeting the needs of patients and their families. Therefore, it is important to develop specific public policies to create referral services, guarantee access to appropriate therapeutic modalities and incorporate technologies that promote research for developing new, affordable therapies.

Difficulties in the diagnosis and treatment of rare diseases according to the perceptions of patients, relatives and health care professionals

OBJECTIVES: The aim of this study is to present a survey of vulnerabilities and to suggest approaches for the treatment of rare diseases according to the perceptions of a group of affected individuals, patient association representatives and health care professionals. METHODS: The focus group technique was used in interviews with patients and primary caregivers, patient support groups/non-governmental organizations, primary health care professionals and physician specialists. RESULTS: The transcript analysis focused on thematic units, which were tailored to each group and allowed comparisons in search of concordant views. Unanimity was observed in relation to the physical, emotional and social damage to the life standards of the affected individuals and their families as a result of illness. The Brazilian health system was unanimously classified as inadequate to respond to the needs of patients with rare diseases, and this inadequacy led to unpleasant experiences, such as the seemingly endless referrals among health services to reach a final diagnosis and develop a treatment plan. CONCLUSIONS: The complex set of health system requirements necessary to support the care of patients with rare diseases represents an obstacle to successfully meeting the needs of patients and their families. Therefore, it is important to develop specific public policies to create referral services, guarantee access to appropriate therapeutic modalities and incorporate technologies that promote research for developing new, affordable therapies.

PEDIATRICIANS' REPRESENTATIONS ON DAIRY ALTERNATIVES WHEN WEANING IS UNAVOIDABLE. / REPRESENTAÇÕES DE PEDIATRAS ACERCA DAS ALTERNATIVAS DE ALIMENTOS LÁCTEOS DIANTE DO DESMAME INEVITÁVEL.

OBJECTIVE: To analyze pediatricians' representations on the nutritional alternatives that are adopted when weaning becomes inevitable. METHODS: This is a mixed cross-sectional analytical study with probabilistic sampling. Fifty-seven randomly selected pediatricians were interviewed with the use of a semi-structured script for thematic analysis. The technique of free evocations was used, and the terms were processed using software EVOC 2005. The thematic categories were established on software NVivo10, and their co-occurrence matrix was exported and analyzed in terms of their simple similarity hierarchy on software CHIC. RESULTS: In the pediatricians' representations, whole milk was cited as a foodstuff with high allergenic risk (35.1%) and nutritionally inappropriate, and they did not recommend its use if weaning occurred before 1 year of age. The infant formula, referred by 98.3% of the pediatricians as the best alternative at the moment of weaning, was cited by 38.1% of them owing to its nutritional adequacy. The points quoted as unfavorable to the use of the formula were the price, the possibility of causing allergy and the risk of the inadequate use of such a highly industrialized product. CONCLUSIONS: The pediatricians' representations show that they are sensitive to the importance of breast-feeding and at the same time, to the sociocultural difficulties inherent in the practice. Generally speaking, the interviewed pediatricians recommend the use of milk formulas, and not of whole cow's milk, if weaning occurs before the end of the first year of life.

OBJETIVO: Analisar as representações de pediatras sobre as alternativas alimentares adotadas quando o desmame se torna inevitável. MÉTODOS: Estudo transversal qualiquantitativo, analítico e com amostragem probabilística. Foram sorteados 57 pediatras, que participaram de uma entrevista com o uso de um roteiro semiestruturado para a análise temática. Foi utilizada a técnica de evocações livres, e os termos foram processados pelos softwares EVOC 2005. Estabeleceram-se as categorias temáticas no software NVivo 10, e sua matriz de coocorrência foi exportada e analisada pela hierarquia de similaridade simples no software CHIC. RESULTADOS: Nas representações dos pediatras, o leite integral foi evocado como um alimento com alto risco alergênico (35,1%) e nutricionalmente inadequado, e não se recomenda seu uso quando o desmame ocorre abaixo de 1 ano de idade. A fórmula infantil, referida por 98,3% dos pediatras como melhor opção no momento do desmame, foi evocada por 38,1%, em função de sua adequação de nutrientes. Os pontos desfavoráveis para o emprego da fórmula foram: o preço, a possibilidade de alergia e o risco da falta de critério na utilização de um produto altamente industrializado. CONCLUSÕES: As representações dos pediatras sugerem que eles estão sensíveis à importância do aleitamento materno e, ao mesmo tempo, às dificuldades socioculturais inerentes a essa prática. De modo geral, os pediatras entrevistados orientam o uso de fórmulas lácteas, e não o leite de vaca integral, se o desmame ocorre antes do fim do primeiro ano de vida.

REPRESENTAÇÕES DE PEDIATRAS ACERCA DAS ALTERNATIVAS DE ALIMENTOS LÁCTEOS DIANTE DO DESMAME INEVITÁVEL / PEDIATRICIANS’ REPRESENTATIONS ON DAIRY ALTERNATIVES WHEN WEANING IS UNAVOIDABLE

RESUMO Objetivo: Analisar as representações de pediatras sobre as alternativas alimentares adotadas quando o desmame se torna inevitável. Métodos: Estudo transversal qualiquantitativo, analítico e com amostragem probabilística. Foram sorteados 57 pediatras, que participaram de uma entrevista com o uso de um roteiro semiestruturado para a análise temática. Foi utilizada a técnica de evocações livres, e os termos foram processados pelos softwares EVOC 2005. Estabeleceram-se as categorias temáticas no software NVivo 10, e sua matriz de coocorrência foi exportada e analisada pela hierarquia de similaridade simples no software CHIC. Resultados: Nas representações dos pediatras, o leite integral foi evocado como um alimento com alto risco alergênico (35,1%) e nutricionalmente inadequado, e não se recomenda seu uso quando o desmame ocorre abaixo de 1 ano de idade. A fórmula infantil, referida por 98,3% dos pediatras como melhor opção no momento do desmame, foi evocada por 38,1%, em função de sua adequação de nutrientes. Os pontos desfavoráveis para o emprego da fórmula foram: o preço, a possibilidade de alergia e o risco da falta de critério na utilização de um produto altamente industrializado. Conclusões: As representações dos pediatras sugerem que eles estão sensíveis à importância do aleitamento materno e, ao mesmo tempo, às dificuldades socioculturais inerentes a essa prática. De modo geral, os pediatras entrevistados orientam o uso de fórmulas lácteas, e não o leite de vaca integral, se o desmame ocorre antes do fim do primeiro ano de vida.

ABSTRACT Objective: To analyze pediatricians’ representations on the nutritional alternatives that are adopted when weaning becomes inevitable. Methods: This is a mixed cross-sectional analytical study with probabilistic sampling. Fifty-seven randomly selected pediatricians were interviewed with the use of a semi-structured script for thematic analysis. The technique of free evocations was used, and the terms were processed using software EVOC 2005. The thematic categories were established on software NVivo10, and their co-occurrence matrix was exported and analyzed in terms of their simple similarity hierarchy on software CHIC. Results: In the pediatricians’ representations, whole milk was cited as a foodstuff with high allergenic risk (35.1%) and nutritionally inappropriate, and they did not recommend its use if weaning occurred before 1 year of age. The infant formula, referred by 98.3% of the pediatricians as the best alternative at the moment of weaning, was cited by 38.1% of them owing to its nutritional adequacy. The points quoted as unfavorable to the use of the formula were the price, the possibility of causing allergy and the risk of the inadequate use of such a highly industrialized product. Conclusions: The pediatricians’ representations show that they are sensitive to the importance of breast-feeding and at the same time, to the sociocultural difficulties inherent in the practice. Generally speaking, the interviewed pediatricians recommend the use of milk formulas, and not of whole cow’s milk, if weaning occurs before the end of the first year of life.

Mothers' conceptions about excess weight in infancy and the nutritional status of their children.

OBJECTIVE: To analyze maternal conceptions about excess weight in infancy and the nutritional status of their preschool-aged children. METHODS: A mixed, exploratory study was performed using semi-structured interviews. Two study groups were defined: a group of 16 mothers of children with excess weight and a group of 15 mothers of eutrophic children. The interviews were submitted to content analysis using CHIC software (Classification Hiérarchique Implicative et Cohésitive¯). RESULTS: The mothers of children with excess weight tended to conceive thin children as malnourished, while those of normal weight children emphasized the influence of family and genetics as determinants of a child's nutritional status. Although there was a certain consensus among the mothers that an unhealthy diet contributes to the risk of a child developing excess weight, the concept of genetics as a determinant of a child's nutritional status was also present in the dialogue from the mothers of both groups. This result indicates a lack of clarity regarding the influence of eating behavior and family lifestyle on weight gain and the formation of a child's eating habits. Both groups indicated that the mother has a decisive role in the eating habits of her child; however, the mothers of children with excess weight did not seem to take ownership of this concept when addressing the care of their own children. CONCLUSION: Differences in conceptions, including taking ownership of care, may contribute to the development of excess weight in preschool-aged children.

Mothers' conceptions about excess weight in infancy and the nutritional status of their children

OBJECTIVE: To analyze maternal conceptions about excess weight in infancy and the nutritional status of their preschool-aged children. METHODS: A mixed, exploratory study was performed using semi-structured interviews. Two study groups were defined: a group of 16 mothers of children with excess weight and a group of 15 mothers of eutrophic children. The interviews were submitted to content analysis using CHIC software (Classification Hiérarchique Implicative et Cohésitive¯). RESULTS: The mothers of children with excess weight tended to conceive thin children as malnourished, while those of normal weight children emphasized the influence of family and genetics as determinants of a child’s nutritional status. Although there was a certain consensus among the mothers that an unhealthy diet contributes to the risk of a child developing excess weight, the concept of genetics as a determinant of a child’s nutritional status was also present in the dialogue from the mothers of both groups. This result indicates a lack of clarity regarding the influence of eating behavior and family lifestyle on weight gain and the formation of a child’s eating habits. Both groups indicated that the mother has a decisive role in the eating habits of her child; however, the mothers of children with excess weight did not seem to take ownership of this concept when addressing the care of their own children. CONCLUSION: Differences in conceptions, including taking ownership of care, may contribute to the development of excess weight in preschool-aged children.

In the context of a daycare center: nursing and their representations of child care as an educational act / En el contexto de la guardería: enfermería y sus representaciones de cuidado infantil como un acto educativo / No contexto da creche: a enfermagem e suas representações do cuidado à criança como ato educativo

This study aimed to analyze the social representations in the professionals of technical staff, who work with children at USP daycare centers. Eight professionals of the nursing field underwent a semi-structured interview. The interviews were recorded and transcribed in their entirety and the content of the discourse was subjected to thematic-categorical analysis. The categories were transformed into variables and processed by the software Classification Hiérarchique Classificatoire et Cohésitive (CHIC®) and analyzed by the hierarchical similarity tree. The results indicate that actions to promote health are reported as educational and transformative, in which health care gains new meaning through contextualized conceptions in the field of child education. We conclude that professionals attribute new meanings to their practices in the health care environment of daycare centers as their representations shifts from the logic of the biomedical field to a logic of educational care. In this sense, they perceive themselves as being challenged to establish an interaction with the children in terms of their activities related to the promotion of health and in an educational act.

El objetivo de la investigación estudio fue analizar las representaciones sociales de los técnicos profesionales que trabajan en los centro de atención infantil de la Universidad de São Paulo (USP). Ocho profesionales de enfermería fueron entrevistados mediante un semi-estructurada guión. Las entrevistas fueron grabadas y transcritas y sometidas al análisis de contenido temático-categorial. Las categorías se transformaron en variables procesadas por hiérarchique Classificatoire et Cohesiva software Clasificación (CHIC®) y analizados por similitud árbol jerárquico (clúster de múltiples niveles). Los resultados indican que las acciones sobre promoción de la salud se reportan como educativo y transformador, en que la atención de la salud adquiere nuevos significados a través de concepciones contextualizadas en el campo de la educación infantil. Llegamos a la conclusión de que los profesionales atribuyen nuevos significados a sus prácticas en el ámbito sanitario de los centro de atención infantil sus representaciones turnos desde la lógica del campo de la biomedicina a la lógica de la atención educativa. En este sentido, los propios que perciben al ser desafiados a establecerse una interacción con los niños en términos de sus actividades relacionadas con la promoción de la salud y en un acto educativo.

O estudo teve como objetivo analisar as representações sociais dos profissionais das equipes técnicas que trabalham nas creches da Universidade de São Paulo (USP). Foram entrevistados oito profissionais da área de enfermagem com o uso de um roteiro semiestruturado. As entrevistas foram gravadas e transcritas na íntegra e o conteúdo submetido à análise de conteúdo temático-categorial. As categorias foram transformadas em variáveis, processadas pelo software Classification Hiérarchique Classificatoire et Cohésitive (CHIC®) e analisadas pela árvore hierárquica de similaridade (cluster multinível). Os resultados indicam que as ações acerca da promoção à saúde são relatadas como educativas e transformadoras, em que o cuidado em saúde ganha novos significados por meio de concepções contextualizadas no campo da educação infantil. Conclui-se que os profissionais ressignificam suas práticas de cuidado em saúde no ambiente das creches em que as representações transitam da lógica biomédica do cuidar para uma lógica educativa do cuidado. Neste sentido, se percebem desafiados na interação que estabelecem com as crianças acerca de sua atuação vinculada à promoção da saúde e ao ato de educar.

Narrative interviews: an important resource in qualitative research / Entrevistas narrativas: un recurso importante en la investigación cualitativa / Entrevistas narrativas: um importante recurso em pesquisa qualitativa

Objetives This methodological study explain and emphasize the extent and fertility of the narrative interview in qualitative research. Methods To describe the narrative method within the qualitative research. Results The qualitative research method is characterized by addressing issues related to the singularities of the field and individuals investigated, being the narrative interviews a powerful method for use by researchers who aggregate it. They allow the deepening of research, the combination of life stories with socio-historical contexts, making the understanding of the senses that produce changes in the beliefs and values that motivate and justify the actions of possible informants. Conclusion The use of narrative is an advantageous investigative resource in qualitative research, in which the narrative is a traditional form of communication whose purpose is to serve content from which the subjective experiences can be transmitted. .

Objetivo Este estudio es un aporte metodológico en que se explica y destaca el alcance y la fertilidad de la entrevista narrativa en la investigación cualitativa. Método Describir el método de la narrativa en la investigación cualitativa. Resultados El método de investigación cualitativa se caracteriza por abordar las cuestiones relacionadas con las singularidades del campo y de las personas encuestadas, siendo las entrevistas narrativas un método potente para uso de los investigadores que toman posesión de ella. Permiten que la profundización de la investigación, la combinación de historias de vida con los contextos socio-históricos e la comprensión de los sentidos que producen cambios en las creencias y valores que motivan y justifican las acciones de los posibles informantes. Conclusion El uso de la narrativa se presenta un recurso de investigación ventajosa en la investigación cualitativa, la narrativa es una forma tradicional de comunicación cuyo objetivo es servir contenido a partir de la que se pueden transmitir las experiencias subjetivas. .

Objetivo Este trabalho consiste numa contribuição metodológica em que se explicitam e se enfatizam o alcance e a fecundidade da entrevista narrativa no âmbito da investigação de natureza qualitativa. Método Descrever o método da narrativa no âmbito da investigação qualitativa. Resultados O método qualitativo de pesquisa caracteriza-se por abordar questões relacionadas às singularidades do campo e dos indivíduos pesquisados, sendo as entrevistas narrativas um método potente para uso dos investigadores que dele se apropriam. Elas permitem o aprofundamento das investigações, a combinação de histórias de vida com contextos sócio–históricos, tornando possível a compreensão dos sentidos que produzem mudanças nas crenças e valores que motivam e justificam as ações dos informantes. Conclusão As narrativas mostram-se muito úteis em estudos de abordagem qualitativa, uma vez que a narratividade é uma forma artesanal de comunicação cujo objetivo é veicular conteúdos a partir dos quais as experiências subjetivas podem ser transmitidas. .

In the context of a daycare center: nursing and their representations of child care as an educational act.

This study aimed to analyze the social representations in the professionals of technical staff, who work with children at USP daycare centers. Eight professionals of the nursing field underwent a semi-structured interview. The interviews were recorded and transcribed in their entirety and the content of the discourse was subjected to thematic-categorical analysis. The categories were transformed into variables and processed by the software Classification Hiérarchique Classificatoire et Cohésitive (CHIC®) and analyzed by the hierarchical similarity tree. The results indicate that actions to promote health are reported as educational and transformative, in which health care gains new meaning through contextualized conceptions in the field of child education. We conclude that professionals attribute new meanings to their practices in the health care environment of daycare centers as their representations shifts from the logic of the biomedical field to a logic of educational care. In this sense, they perceive themselves as being challenged to establish an interaction with the children in terms of their activities related to the promotion of health and in an educational act.

Narrative interviews: an important resource in qualitative research.

Objetives This methodological study explain and emphasize the extent and fertility of the narrative interview in qualitative research. Methods To describe the narrative method within the qualitative research. Results The qualitative research method is characterized by addressing issues related to the singularities of the field and individuals investigated, being the narrative interviews a powerful method for use by researchers who aggregate it. They allow the deepening of research, the combination of life stories with socio-historical contexts, making the understanding of the senses that produce changes in the beliefs and values that motivate and justify the actions of possible informants. Conclusion The use of narrative is an advantageous investigative resource in qualitative research, in which the narrative is a traditional form of communication whose purpose is to serve content from which the subjective experiences can be transmitted.

Motor development of Brazilian breastfeeding infants in socially unfavorable condition of life

The early years of life are of essential importance for child development and growth. The child's development in a social vulnerability and unfavorable life condition can be injured, and that early detection of disorders is fundamental for healthy development. PURPOSE: To assessment the Alberta Infant Motor Scale as an assessment tool to identify early of disorders in infants until 18 months. METHODS: This is an observational, cross-sectional study undertaken in "educational program for the growth and development promotion" at the health unit administered by reference hospital of Health Public System, in Paraisópolis community, São Paulo. The sample (n=71) was composed for infants less than 18 months of age, eutrophic, low biological risk at birth; singleton, full-term births, weight at birth between 2,000g e" and d" 4,500g and no associated congenital neurological, cardiac or orthopedic pathologies at the clinical exam. RESULTS: This study presented the greatest prevalence of delay motor neuromotor when compared with the AIMS reference population. First, 8.5% of the breastfeeding infants are classified as being mdA and 7.0% are classified as dmS and secondly that, although the category mdT contains 84.5% of the children, the median of the z-score has shifted from the central point of the normal standardized distribution, only 33.7% of the children, i.e., 24 in 71, being equal to or above Z=0 (p<0.05). CONCLUSION: The use of AIMS was efficient, practice, low cost and quick applies. Plus a quick view of motor milestone presents by infant. Features that became possible take decision by health team...(AU)

Os primeiros anos de vida são de importância essencial para o desenvolvimento infantil. O desenvolvimento neurosensoriomotor de crianças, vivendo em condição de pobreza, pode ser prejudicado, sendo a detecção precoce de anormalidades essencial para um desenvolvimento saudável. OBJETIVO: Avaliar o uso da AIMS como instrumento de avaliação para detecção precoce de anormalidades. MÉTODO: Trata-se de um estudo descritivo, do tipo transversal, realizado com lactentes brasileiros matriculados no "Programa educativo de promoção do crescimento e desenvolvimento", do ambulatório de uma unidade de saúde gerenciada por um Hospital de referência do Sistema Público de Saúde, na Comunidade de Paraisópolis, São Paulo. A amostra (n = 71) foi composta por lactentes menores de 18 meses, eutróficos, de baixo risco biológico ao nascimento, nascidos de parto único, termo, peso ao nascer entre 2.000g e 4.500g, sem associação com patologias congênitas neurológicas, cardíacas ou ortopédicas no exame clinico. RESULTADOS: Este estudo apresenta prevalência de atraso motor quando comparado com a população de referencia da AIMS. Primeiro, 8,5% dos lactentes foram classificados como mdA e 7% como dmS, além da categoria mdT conter 84,5% dos lactentes, a media do escore Z tem modificado o ponto central da distribuição padronizada, apenas 33,7% do grupo, isto e, 24 em 71, estão igual ou acima do Z = 0 (p < 0.05). CONCLUSÃO: A utilização da AIMS neste estudo foi eficiente na avaliação do desenvolvimento motor, prática, de baixo custo e rápida aplicação. Forneceu rápida visualização da posição do lactente. Característica que permite tomada de decisões oportunas pelos profissionais que integram as equipes de saúde...(AU)

Motor development of Brazilian breastfeeding infants in socially unfavorable condition of life

The early years of life are of essential importance for child development and growth. The child's development in a social vulnerability and unfavorable life condition can be injured, and that early detection of disorders is fundamental for healthy development. PURPOSE: To assessment the Alberta Infant Motor Scale as an assessment tool to identify early of disorders in infants until 18 months. METHODS: This is an observational, cross-sectional study undertaken in "educational program for the growth and development promotion" at the health unit administered by reference hospital of Health Public System, in Paraisópolis community, São Paulo. The sample (n=71) was composed for infants less than 18 months of age, eutrophic, low biological risk at birth; singleton, full-term births, weight at birth between 2,000g e" and d" 4,500g and no associated congenital neurological, cardiac or orthopedic pathologies at the clinical exam. RESULTS: This study presented the greatest prevalence of delay motor neuromotor when compared with the AIMS reference population. First, 8.5% of the breastfeeding infants are classified as being mdA and 7.0% are classified as dmS and secondly that, although the category mdT contains 84.5% of the children, the median of the z-score has shifted from the central point of the normal standardized distribution, only 33.7% of the children, i.e., 24 in 71, being equal to or above Z=0 (p<0.05). CONCLUSION: The use of AIMS was efficient, practice, low cost and quick applies. Plus a quick view of motor milestone presents by infant. Features that became possible take decision by health team...

Os primeiros anos de vida são de importância essencial para o desenvolvimento infantil. O desenvolvimento neurosensoriomotor de crianças, vivendo em condição de pobreza, pode ser prejudicado, sendo a detecção precoce de anormalidades essencial para um desenvolvimento saudável. OBJETIVO: Avaliar o uso da AIMS como instrumento de avaliação para detecção precoce de anormalidades. MÉTODO: Trata-se de um estudo descritivo, do tipo transversal, realizado com lactentes brasileiros matriculados no "Programa educativo de promoção do crescimento e desenvolvimento", do ambulatório de uma unidade de saúde gerenciada por um Hospital de referência do Sistema Público de Saúde, na Comunidade de Paraisópolis, São Paulo. A amostra (n = 71) foi composta por lactentes menores de 18 meses, eutróficos, de baixo risco biológico ao nascimento, nascidos de parto único, termo, peso ao nascer entre 2.000g e 4.500g, sem associação com patologias congênitas neurológicas, cardíacas ou ortopédicas no exame clinico. RESULTADOS: Este estudo apresenta prevalência de atraso motor quando comparado com a população de referencia da AIMS. Primeiro, 8,5% dos lactentes foram classificados como mdA e 7% como dmS, além da categoria mdT conter 84,5% dos lactentes, a media do escore Z tem modificado o ponto central da distribuição padronizada, apenas 33,7% do grupo, isto e, 24 em 71, estão igual ou acima do Z = 0 (p < 0.05). CONCLUSÃO: A utilização da AIMS neste estudo foi eficiente na avaliação do desenvolvimento motor, prática, de baixo custo e rápida aplicação. Forneceu rápida visualização da posição do lactente. Característica que permite tomada de decisões oportunas pelos profissionais que integram as equipes de saúde...

Infant mortality in Cabinda, Angola: challenge to health public policies / Mortes infantis em Cabinda, Angola: desafio para as politicas publicas de saude

OBJECTIVE: To critically discuss, describe and analyze the data on infant mortality provided by public health services of Cabinda, Angola. METHOD: The deaths of children aged less than one year old in 2007 and 2008 were analyzed in the Cabinda province. Provincial hospital records and those of the WHO office were used due to the limited quality and availability of official information. RESULTS: In 2007, 11,734 children were born, and 366 of them died in their first year of life: 113 on the first day, 87 by the 28th day and 166 in the remaining 337 days. In 2008, 13,441 children were born and 275 died; 109 died on the first day and 69 by the 28th day. Malaria was the main cause of death (one out of three). Pneumonia was the second cause in 2007 and the third in 2008, presenting consistent reduction, from 65 to 40 deaths. Cases of diarrhea from 2007 (9.83%) decreased to 3.27% in 2008. Tetanus accounted for about 5% of all deaths. Perinatal causes increased in proportion, particularly neonatal asphyxia (17.75% in 2007 and 26.90% in 2008) and prematurity (13.38% in 2007 and 17.45% in 2008). CONCLUSIONS: Improvements in the quality of prenatal care, attendance during delivery and to new born risk, would reduce infant mortality. The lack of sanitation, inadequate water supply and poor access to health services played an important role as determinants of infant mortality observed in Cabinda. This study highlights the need to reorganize the civil registration system. .

OBJETIVO: Discutir criticamente, descrever e analisar os dados e óbitos infantis disponibilizados pelos serviços públicos da província de Cabinda, Angola. MÉTODO: Foram estudados óbitos de menores de um ano de idade, em 2007 e 2008, da província de Cabinda. Utilizaram-se os registros do hospital provincial e do escritório provincial da Organização Mundial da Saúde (OMS) de Cabinda, considerando as dificuldades e limitantes da qualidade e disponibilidade das informações locais. RESULTADOS: Em 2007, nasceram 11.734 crianças; destas, 366 morreram no primeiro ano de vida: 113 no primeiro dia e 87 até o 28º e 166 nos 337 dias restantes Em 2008, nasceram 13.441 e morreram 275 crianças; destas, 109 crianças no primeiro dia de vida e 69 até o 28º dia de vida. A malária destaca-se como principal causa de morte (uma a cada três). A pneumonia, segunda causa em 2007 e terceira em 2008, com expressiva redução de 65 para 40 óbitos, respectivamente. As diarreias de 2007 (9,83%) diminuíram em 2008 (3,27%). O tétano responde por cerca de 5% das mortes. As causas perinatais aumentaram de proporção, particularmente a asfixia neonatal (17,75% em 2007 e 26,90% em 2008) e a prematuridade (13,38% em 2007 e 17,45% em 2008). CONCLUSÕES: Melhorias na qualidade de assistência pré-natal, ao parto e ao recém-nascido de risco poderiam reduzir a mortalidade infantil. A falta de saneamento básico, condições inadequadas de abastecimento de água e acesso aos serviços de saúde revelaram ter papel importante como condicionantes da elevada mortalidade infantil observada em Cabinda. Evidencia-se a necessidade de reorganizar o sistema de registro civil. .

Motor development of infants exposed to maternal human immunodeficiency virus (HIV) but not infected.

BACKGROUND: To assess the motor development of infants exposed to maternal human immunodeficiency virus (HIV). METHODS: Thirty infants were assessed in the period from November 2009 to March 2010 at the AIDS Reference and Training Centre, in São Paulo, Brazil. The assessment instrument used in the research was the Alberta Infant Motor Scale (AIMS). All 30 infants used the antiretroviral drug properly for 42 consecutive days, in accordance with the protocol of the World Health Organization. RESULTS: Out of the total number of infants, 27 (90%) had proper motor performance and 3 (10%) presented motor delay, according to the AIMS. DISCUSSION: This study demonstrated that only 10% of the assessed group had developmental delay and no relation with environmental variables was detected, such as maternal level of education, social and economic issues, maternal practices, attendance at the day care center, and drug use during pregnancy. It is important to emphasize the necessity of studies with a larger number of participants.

Verbal and visual stimulation effects on rectus femoris and biceps femoris muscles during isometric and concentric.

BACKGROUND: Coactivation may be both desirable (injury prevention) or undesirable (strength measurement). In this context, different styles of muscle strength stimulus have being investigated. In this study we evaluated the effects of verbal and visual stimulation on rectus femoris and biceps femoris muscles contraction during isometric and concentric. METHODS: We investigated 13 men (age =23.1 ± 3.8 years old; body mass =75.6 ± 9.1 kg; height =1.8 ± 0.07 m). We used the isokinetic dynamometer BIODEX device and an electromyographic (EMG) system. We evaluated the maximum isometric and isokinetic knee extension and flexion at 60°/s. The following conditions were evaluated: without visual nor verbal command (control); verbal command; visual command and; verbal and visual command. In relation to the concentric contraction, the volunteers performed five reciprocal and continuous contractions at 60°/s. With respect to isometric contractions it was made three contractions of five seconds for flexion and extension in a period of one minute. RESULTS: We found that the peak torque during isometric flexion was higher in the subjects in the VVC condition (p > 0.05). In relation to muscle coactivation, the subjects presented higher values at the control condition (p > 0.05). CONCLUSION: We suggest that this type of stimulus is effective for the lower limbs.

Infant mortality in Cabinda, Angola: challenge to health public policies.

OBJECTIVE: To critically discuss, describe and analyze the data on infant mortality provided by public health services of Cabinda, Angola. METHOD: The deaths of children aged less than one year old in 2007 and 2008 were analyzed in the Cabinda province. Provincial hospital records and those of the WHO office were used due to the limited quality and availability of official information. RESULTS: In 2007, 11,734 children were born, and 366 of them died in their first year of life: 113 on the first day, 87 by the 28th day and 166 in the remaining 337 days. In 2008, 13,441 children were born and 275 died; 109 died on the first day and 69 by the 28th day. Malaria was the main cause of death (one out of three). Pneumonia was the second cause in 2007 and the third in 2008, presenting consistent reduction, from 65 to 40 deaths. Cases of diarrhea from 2007 (9.83%) decreased to 3.27% in 2008. Tetanus accounted for about 5% of all deaths. Perinatal causes increased in proportion, particularly neonatal asphyxia (17.75% in 2007 and 26.90% in 2008) and prematurity (13.38% in 2007 and 17.45% in 2008). CONCLUSIONS: Improvements in the quality of prenatal care, attendance during delivery and to new born risk, would reduce infant mortality. The lack of sanitation, inadequate water supply and poor access to health services played an important role as determinants of infant mortality observed in Cabinda. This study highlights the need to reorganize the civil registration system.