Spatial distribution of domestic violence against women / Distribuição espacial da violência doméstica contra a mulher

INTRODUCTION: Violence against women is motivated by domination in power relations, including male over female violence, defined as violent action that can cause physical, sexual or mental injury or suffering, as well as intimidation, deprivation of rights to freedom or coercion carried out inside and outside the home. This aggravation has been growing more and more throughout the world, and deserves to be discussed and combated in the scope of public policies. OBJECTIVE: To analyse the spatial distribution of domestic violence against women in the municipality of João Pessoa, Paraíba, Brazil. METHODS: It is a quantitative cross-sectional study of the census type that analysed all the reported cases of domestic violence against women resident in the municipality, the study scenario, in the year 2017. The data source was of the secondary type, in the two Specialized Police Offices for Women's Affairs - DEAM, present in the municipality. RESULTS: We observed spatial patterns of domestic violence against women, as well as agglomerations throughout the capital, from the most affluent exclusive neighbourhoods to those living on the margins of society, proving that this violence has no class distinction. CONCLUSION: The study reached the proposed goal by analysing the spatial distribution of domestic violence in the research scenario based on spatial patterns.

INTRODUÇÃO: A violência contra a mulher é motivada por meio da dominação existente nas relações de poder, entre elas a masculina sobre a feminina, definida como ação violenta que possa gerar lesões ou sofrimentos no âmbito físico, sexual ou mental, além de intimidações, privações do direito à liberdade ou coerções realizadas dentro e fora de casa. Esse agravo vem crescendo cada vez mais no mundo inteiro, merecendo ser discutido e combatido no âmbito das políticas públicas. OBJETIVO: Analisar a distribuição espacial da violência doméstica contra a mulher no município de João Pessoa, Paraíba, Brasil. MÉTODO: Trata-se de um estudo quantitativo, transversal, do tipo censo, que analisou todos os casos denunciados de violência doméstica contra a mulher e que residissem no município, cenário do estudo, no ano de 2017. A fonte de dados foi do tipo secundária, nas duas Delegacias Especializadas de Atendimento da Mulher - DEAM, presentes no município. RESULTADOS: Observou-se padrões espaciais da violência doméstica contra a mulher, como também aglomerados por toda a capital, desde os bairros considerados mais nobres, até os que vivem à margem da sociedade, comprovando que essa violência não tem distinção de classe CONCLUSÃO: O estudo atingiu o objetivo proposto analisando a distribuição espacial da violência doméstica no cenário da pesquisa a partir dos padrões espaciais.

Microcephaly in north-east Brazil: a retrospective study on neonates born between 2012 and 2015.

OBJECTIVE: To assess the number of children born with microcephaly in the State of Paraíba, north-east Brazil. METHODS: We contacted 21 maternity centres belonging to a paediatric cardiology network, with access to information regarding more than 100 000 neonates born between 1 January 2012 and 31 December 2015. For 10% of these neonates, nurses were requested to retrieve head circumference measurements data from delivery-room books. We used three separate criteria to classify whether a neonate had microcephaly: (i) the Brazilian Ministry of Health proposed criterion: term neonates (gestational age ≥ 37 weeks) with a head circumference of less than 32 cm; (ii) Fenton curves: neonates with a head circumference of less than -3 standard deviation for age and gender; or (iii) the proportionality criterion: neonates with a head circumference of less than ((height/2))+10) ± 2. FINDINGS: Between 1 and 31 December 2015, nurses obtained data for 16 208 neonates. Depending on which criterion we used, the number of neonates with microcephaly varied from 678 to 1272 (4.2-8.2%). Two per cent (316) of the neonates fulfilled all three criteria. We observed temporal fluctuations of microcephaly prevalence from late 2012. CONCLUSION: The numbers of microcephaly reported here are much higher than the 6.4 per 10 000 live births reported by the Brazilian live birth information system. The results raise questions about the notification system, the appropriateness of the diagnostic criteria and future implications for the affected children and their families. More studies are needed to understand the epidemiology and the implications for the Brazilian health system.

Impact of Telemedicine in the Screening for Congenital Heart Disease in a Center from Northeast Brazil.

OBJECTIVES: To describe the incidence of congenital heart disease before and after the establishment of a telemedicine screening program, in a reference center from Northeast Brazil. METHODS: This is a descriptive, retrospective and comparative study based on the institutional data from a reference center in perinatology for a period of 16 years. Institutional data were collected from a 16-year period (2001-15). Data were divided into two periods: prior to (2001-11) and after (2012-15) the establishment of a telemedicine screening program. RESULTS: After the implementation of the screening process, almost all kinds of heart disease showed a significant increase in their incidence (p < 0.05). With this, the incidence of major heart diseases approached those specified in developed regions. CONCLUSION: The implementation of a screening process model for congenital heart diseases can change the context of patients with congenital heart diseases in poor regions.

A telemedicine network for remote paediatric cardiology services in north-east Brazil.

PROBLEM: Providing health care for children with congenital heart diseases remains a major challenge in low- and middle-income countries. APPROACH: In October 2011, the Government of Paraíba, Brazil, established a paediatric cardiology network in partnership with the nongovernmental organization Círculo do Coração. A cardiology team supervised all network activities, using the Internet to keep in contact with remote health facilities. The network developed protocols for screening heart defects. Echocardiograms were performed by physicians under direct online supervision of a cardiologist; alternatively, a video recording of the examination was subsequently reviewed by a cardiologist. Cardiovascular surgeons came to a paediatric hospital in the state capital once a week to perform heart surgeries. LOCAL SETTING: Until 2011, the State of Paraíba had no structured programme to care for children with heart disease. This often resulted in missed or late diagnosis, with adverse health consequences for the children. RELEVANT CHANGES: From 2012 to 2014, 73,751 babies were screened for heart defects and 857 abnormalities were identified. Detection of congenital heart diseases increased from 4.09 to 11.62 per 1000 live births (P < 0.001). Over 6000 consultations and echocardiograms were supervised via the Internet. Time to diagnosis, transfers and hospital stays were greatly reduced. A total of 330 operations were carried out with 6.7% (22/330) mortality. LESSONS LEARNT: Access to an echocardiography machine with remote supervision by a cardiologist improves the detection of congenital heart disease by neonatologists; virtual outpatient clinics facilitate clinical management; the use of Internet technology with simple screening techniques allows resources to be allocated more efficiently.

Busca ativa por cardiopatias congênitas é factível? Experiência em oito cidades Brasileiras / Active search for congenital heart disease is possible? Experience from eight brazilian cities

Fundamentos: As cardiopatias congênitas são causa de alta morbimortalidade na faixa etária pediátrica. Em regiões em desenvolvimento, a falta de diagnóstico precoce pode acarretar a piora do quadro; uma busca ativa por cardiopatias congênitas pode colaborar na resolução dessa situação.Objetivo: Descrever os principais achados de uma busca ativa por cardiopatias na infância, realizada em oito cidades brasileiras do estado da Paraíba. Métodos: Estudo realizado em oito cidades brasileiras do estado da Paraíba. A busca ativa compreendeu duas fases. Na primeira, os centros de saúde locais realizaram a triagem de crianças com sintomas ou história clínica de doenças cardiovasculares. Na segunda fase, realizada uma consulta clínica com posterior realização de ecocardiograma para identificação de cardiopatias. As frequências obtidas foram analisadas. Variáveis categóricas foram comparadas utilizando-se o teste do qui-quadrado. Resultados: Atendidas 440 crianças. Destas, 192 (43,63%) apresentaram alterações ao ecocardiograma. As presenças de sopro e da síndrome de Down mostraram correlação significativa (p<0,05) com a cardiopatia congênita. A maioria dos casos era de cardiopatia congênita por shunt (64,1%), seguida pelos defeitos valvares (12,5%) e pelas cardiopatias obstrutivas acianogênicas (8,3%). Conclusão: A busca ativa realizada foi capaz de identificar um número expressivo de cardiopatias congênitas na infância, não reconhecidas previamente, e inserir esses pacientes nos serviços de saúde para o tratamento adequado, garantindo-lhes melhor qualidade de vida.

Background: Congenital heart defects are the cause of high morbidity and mortality in pediatric patients. In developing regions, the lack of early diagnosis may lead to worsening of the condition; an active search for congenital heart diseases can assist in resolving this situation. Objective: To describe the key findings of an active search for heart diseases in childhood, held in eight Brazilian cities in the state of Paraíba. Methods: A study conducted in eight Brazilian cities in the state of Paraíba. The active search included two phases. In the first, local health centers screened children with symptoms or a history of cardiovascular diseases. In the second phase, a clinical consultation with echocardiogram to identify diseases was conducted. The frequencies were then analyzed. Categorical variables were compared using the chi-square test. Results: 440 children were assisted. Of these, 192 (43.63%) had abnormalities on echocardiogram. The presence of heart sounds and Down’s syndrome showed a significant correlation (p <0.05) with the congenital heart disease. Most cases were congenital heart disease by shunt (64.1%), followed by valve defects (12.5%) and acyanogenic obstructive heart diseases (8.3%). Conclusion: The active search conducted was able to identify a significant number of congenital heart diseases in childhood not previously recognized and inserting these patients in health services for appropriate treatment, thus ensuring them a better quality of life.

Cardiopatia congênita no nordeste brasileiro: 10 anos consecutivos registrados no Estado da Paraíba, Brasil / Congenital heart disease in northeast Brazil: 10 consecutive years of records in Paraiba State, Brazil

Fundamentos: Diferentes índices de incidência das cardiopatias congênitas são descritos na literatura dependendo da idade da população analisada e dos tipos de malformações incluídas. No Brasil, notadamente nas regiões norte e nordeste, não existem dados sobre a real incidência de cardiopatias congênitas. Objetivo: Descrever o perfil das cardiopatias congênitas (CC) num serviço público de referência do estado da Paraíba, Brasil. Métodos: Estudo descritivo e retrospectivo baseado em dados institucionais referentes ao Estudo Colaborativo Latino-Americano de Malformações Congênitas (ECLAMC), coletados entre janeiro 2001 e dezembro 2011. As variáveis estudadas foram: peso ao nascer, idade gestacional, sexo, município de origem, tipo de cardiopatia, faixa etária e escolaridade dos pais, história de malformações na família, consanguinidade e antecedentes familiares. Resultados: Dos 70 857 nascimentos consecutivos analisados, o diagnóstico de CC foi relatado em 290, e o tipo do defeito foi determinado em 232. Destas, 37,8 % eram cardiopatias de shunt esquerdo-direito, 9,1 % obstrutivas acianogênicas, 5,6 % obstrutivas cianogênicas e 10,3 % cardiopatias complexas. A cardiopatia foi achado isolado em 81,0 % dos casos. Conclusão: A incidência de CC nesta série foi inferior àquela relatada na literatura. Isto provavelmente reflete a dificuldade para a realização do diagnóstico precoce.

Background: Different congenital heart disease rates are described in the literature, depending on the age of the population studied and the types of malformations included. In Brazil, especially in the North and Northeast, there are no data on actual congenital heart disease rates. Objective: To describe the profile of congenital heart diseases (CHD) observed in a government-run reference facility in Paraíba State, Northeast Brazil. Methods: A descriptive retrospective study based on institutional data drawn from the Collaborative Latin American Study of Congenital Malformations (ECLAMC) compiled between January 2001 and December 2011. The variables analyzed were: birthweight, gestational age, gender, birthplace (municipality), type of congenital heart defect, age and education levels of parents, family history of congenital defects, consanguinity and family precedents. Results: Through an analysis of 70,857 consecutive births, 290 diagnoses of CHD were reported, with defect types established for 232 of them: 37.8% left-to-right shunt lesions, 9.1% acyanotic obstructive lesions, 5.6% cyanotic obstructive and 10.3% complex congenital heart diseases. Heart defects were an isolated finding in 81% of cases. Conclusion: The CHD rate in this series was below that reported in the literature, probably reflecting difficulties is establishing early diagnoses.