Transtornos do espectro autista: visão de discentes dos cursos de medicina e enfermagem de uma universidade pública / Autism spectrum disorders: students' view of medicine and nursing courses at a public university

Resumo O termo estigma é oriundo do grego, relacionado a identificação de pessoas através de marcação física. A literatura aponta quatro tipos de estigmas: púbico, institucional, autoestima e de cortesia. Pessoas com Transtornos do Espectro Autista são estigmatizadas em diversas culturas e sociedades. Este estudo descreve a visão sobre estigma em relação ao Transtorno do Espectro Autista entre estudantes dos cursos medicina e enfermagem. Estudo transversal, qualitativo, dados coletados por meio de dois grupos focais, um com estudantes de medicina, outro com enfermagem, de uma universidade pública, em Alagoas. Foi utilizado um roteiro com oito perguntas para discussão nos grupos focais. As falas foram gravadas, transcritas e analisadas no software IRAMUTEQ, embasada na análise de conteúdo. A Classificação Hierárquica Descendente apresentou cinco categorias relacionadas ao Transtorno, que foram: 1 - Abordagem da pessoa com o Transtorno; 2 - Vivência de Estigma; 3 - Segregação de Pessoas com Transtorno; 4 - Cuidado com a Pessoa com o Transtorno; e a Classe 5 - Desafios enfrentados pelas pessoas acometidas

Abstract The term stigma comes from Greek, being related to the identification of people through a physical mark, which can generate marginalization. The literature points out four types of stigmas: public, institutional, self-esteem, and courtesy. People with Autistic Spectrum Disorders are stigmatized in various cultures and societies. This study describes the view on stigma regarding Autistic Spectrum Disorder among undergraduate medical and nursing students. This is a cross-sectional study of a qualitative approach, whose data were collected through two focus groups, one with medical and another with nursing students, from a public university in Alagoas, Brazil. A script with eight questions for discussion in the focus groups was used. The speeches were recorded, transcribed, and analyzed with the IRAMUTEQ software, based on content analysis. The Descending Hierarchical Classification showed five categories related to the disorder, which were: 1 - Approach to the person with the disorder; 2 - Experience of Stigma; 3 - Segregation of People with Disorders; 4 - Care of the Person with the Disorder and Class; 5 - Challenges faced by the people affected.

Autism spectrum disorders: students' view of medicine and nursing courses at a public university. / Transtornos do espectro autista: visão de discentes dos cursos de medicina e enfermagem de uma universidade pública.

The term stigma comes from Greek, being related to the identification of people through a physical mark, which can generate marginalization. The literature points out four types of stigmas: public, institutional, self-esteem, and courtesy. People with Autistic Spectrum Disorders are stigmatized in various cultures and societies. This study describes the view on stigma regarding Autistic Spectrum Disorder among undergraduate medical and nursing students. This is a cross-sectional study of a qualitative approach, whose data were collected through two focus groups, one with medical and another with nursing students, from a public university in Alagoas, Brazil. A script with eight questions for discussion in the focus groups was used. The speeches were recorded, transcribed, and analyzed with the IRAMUTEQ software, based on content analysis. The Descending Hierarchical Classification showed five categories related to the disorder, which were: 1 - Approach to the person with the disorder; 2 - Experience of Stigma; 3 - Segregation of People with Disorders; 4 - Care of the Person with the Disorder and Class; 5 - Challenges faced by the people affected.

O termo estigma é oriundo do grego, relacionado a identificação de pessoas através de marcação física. A literatura aponta quatro tipos de estigmas: púbico, institucional, autoestima e de cortesia. Pessoas com Transtornos do Espectro Autista são estigmatizadas em diversas culturas e sociedades. Este estudo descreve a visão sobre estigma em relação ao Transtorno do Espectro Autista entre estudantes dos cursos medicina e enfermagem. Estudo transversal, qualitativo, dados coletados por meio de dois grupos focais, um com estudantes de medicina, outro com enfermagem, de uma universidade pública, em Alagoas. Foi utilizado um roteiro com oito perguntas para discussão nos grupos focais. As falas foram gravadas, transcritas e analisadas no software IRAMUTEQ, embasada na análise de conteúdo. A Classificação Hierárquica Descendente apresentou cinco categorias relacionadas ao Transtorno, que foram: 1 - Abordagem da pessoa com o Transtorno; 2 - Vivência de Estigma; 3 - Segregação de Pessoas com Transtorno; 4 - Cuidado com a Pessoa com o Transtorno; e a Classe 5 - Desafios enfrentados pelas pessoas acometidas.

Efficacy of school-based interventions for mental health problems in children and adolescents in low and middle-income countries: A systematic review and meta-analysis.

Background: Implementation of interventions to treat child and adolescent mental health problems in schools could help fill the mental health care gap in low- and middle-income countries (LMICs). Most of the evidence available come from systematic reviews on mental health prevention and promotion, and there is less evidence on treatment strategies that can be effectively delivered in schools. The aim of this review was to identify what school-based interventions have been tested to treat children and adolescents in LMICs, and how effective they are. Methods: We conducted a systematic review including seven electronic databases. The search was carried out in October 2022. We included randomised or non-randomised studies that evaluated school-based interventions for children or adolescents aged 6-18 years living in LMICs and who had, or were at risk of developing, one or more mental health problems. Results: We found 39 studies with 43 different pairwise comparisons, treatment for attention-deficit and hyperactivity (ADHD), anxiety, depression, and posttraumatic stress disorder (PTSD), Conduct disorder (CD). Pooled SMD were statistically significant and showed that, overall, interventions were superior to comparators for PTSD (SMD = 0.61; 95% CI = 0.37-0.86), not statistically significant for anxiety (SMD = 0.11; 95% CI = -0.13 to 0.36), ADHD (SMD = 0.36; 95% CI = -0.15 to 0.87), and for depression (SMD = 0.80; 95% CI = -0.47 to 2.07). For CD the sample size was very small, so the results are imprecise. Conclusion: A significant effect was found if we add up all interventions compared to control, suggesting that, overall, interventions delivered in the school environment are effective in reducing mental health problems among children and adolescents. Systematic review registration: [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=129376], identifier [CRD42019129376].

Suicidal ideation in mothers of asthmatic children and adolescents in a subspecialty outpatient practice / Ideação suicida em mães de crianças e adolescentes asmáticos em ambulatório especializado / Ideación suicida en madres de niños y adolescentes asmáticos en consulta externa de subespecialidad

We aimed to investigate prevalence and factors associated with Suicide ideation (SI) in mothers of asthmatic children. This cross-sectional study included 362 dyads of mothers and children with asthma aged 2 to 14 years who attended two pediatric outpatient clinics in Brazil. We assessed the presence of SI (Self-Report Questionnaire-20), the occurrence of stressful events and maternal social support. The prevalence of SI was 8.6%. Low maternal education, exposure to serious illness, and low perception of social support in its affective-social interaction dimension remained significantly associated with SI in the final model. Thus, life stressors, social support and low maternal education accounted for most of the variation in prevalence of maternal SI. There were no effects of child asthma severity on maternal SI in this study.

Nosso objetivo foi investigar a prevalência e os fatores associados à ideação suicida (IS) em mães de crianças asmáticas. Este estudo transversal incluiu 362 díades de mães e crianças com asma de 2 a 14 anos em dois ambulatórios pediátricos no Brasil. Avaliamos a presença de IS (Self-Report Questionnaire-20), a ocorrência de eventos estressantes e o suporte social materno. A prevalência de IS materna foi de 8,6%. Escolaridade materna inferior a oito anos, doença materna grave e a baixa percepção de suporte social em sua dimensão afetivo-social permaneceram significativamente associadas à IS no modelo final. Portanto, eventos estressores maternos, suporte social e baixa escolaridade materna foram os responsáveis pela maior parte da variação na prevalência de IS materna. Não houve efeitos da gravidade da asma infantil na IS materna neste estudo.

Este estudio investigo la prevalencia y los factores asociados com ideación suicida (IS) en madres de niños asmáticos. Participaron 362 díadas de madres y niños con asma de 2 a 14 años en dos clínicas pediátricas ambulatorias en Brasil. Evaluamos la presencia de IS (Self-Report Questionnaire-20), la ocurrencia de eventos estresantes y el apoyo social materno. La prevalencia de IS materno fue del 8,6%. La educación materna de menos de ocho años, la enfermedad materna grave y la baja percepción de apoyo social en su dimensión afectivo-social se mantuvieron significativamente asociadas con el SI en el modelo final. Entonces, los eventos de estrés materno, el apoyo social y la baja educación materna explicaron la mayor parte de la variación en la prevalencia materna de IS. No hubo efectos de la gravedad del asma infantil en el IS materno en este estudio.

Effectiveness of a resistance exercise program for lower limbs in chronic renal patients on hemodialysis: A randomized controlled trial.

INTRODUCTION: Physical inactivity in hemodialysis patients is associated with increased mortality. The objective of this study was evaluated the effect of an intradialytic resistance exercise program on chronic kidney disease (CKD) patients on hemodialysis. METHODS: One hundred seven patients were included in the study. They were aged 18-60 years, of both sexes, had undergone hemodialysis treatment for at least 1 year, sedentary. Patients were randomly divided into two groups: stretching (STG) and resistance exercise (REG). Intervention programs were performed for 8 weeks, three times a week. The evaluations were performed before and after the training programs. The primary outcome was functional capacity using the 6-minute walk test (6MWT). Secondary outcomes were peripheral muscle strength, respiratory muscle strength, spirometric respiratory function, and laboratory data. FINDINGS: Comparisons between groups revealed the following clinically relevant results in favor of REG: lower limb muscle strength (mean difference [MD] = -1.99, 95% confidence interval [CI] = -2.77 to -1.21; d = -0.53), distance walked in the 6MWT (MD = -26.27, 95% CI = -45.40 to -7.14; d = -0.46), creatinine (MD = -1.52, 95% CI = -2.49 to -0.54; d = -0.66), and calcium (MD = -0.44, 95% CI = -0.78 to -0.10; d = -0.49). DISCUSSION: CKD patients on hemodialysis have reduced functional capacity compared to healthy sedentary individuals. In turn, this reduction appears to be associated with a lower survival rate and affects the performance of their daily living activities. Thus, resistance exercise performed in the intradialytic phase is an effective therapeutic strategy for CKD patients, mainly because it increases functional capacity and lower limb muscle strength.

Retrospective clinical and epidemiological analysis of scorpionism at a referral hospital for the treatment of accidents by venomous animals in Alagoas State, Northeast Brazil, 2007-2017.

Scorpionism has a high incidence rate in Brazil. It is considered a serious public health problem mainly in tropical and subtropical regions around the world. The number of scorpion accidents have increased over the years and the highest frequencies have been reported mainly in the Brazilian Northeast region. Therefore, in this study we report a retrospective clinical and epidemiological analysis of scorpion stings from 2007 to 2017 in Alagoas State, Northeast Brazil, at a referral hospital for assistance and treatment of accidents by venomous animals. During the analyzed period, the referral hospital treated 27,988 cases, and an increase in the number of cases has taken place over the years. The highest frequency of scorpion stings was observed in females, and the age range most affected was from 20 to 29 years old. The most stung body site was the foot, followed by finger, toe or hand. Regarding the severity, most severe cases were reported in children up to 4 years old (69.4%) and 50% of the total cases treated with serotherapy corresponded to patients in this age range. Interestingly, it was also found that the occurrence of systemic manifestations and the severity of the cases were significantly associated with pediatric patients. In this way, this study highlights the scorpionism as an environmental public health problem in Alagoas State, Northeast Brazil, as well as the need to intensify the epidemiological surveillance and educational campaigns to prevent and control scorpion accidents throughout the year.

Maternal common mental disorder over time and asthma control: The role of social support.

BACKGROUND: Despite therapeutic advances, asthma prevalence remains high. Psychosocial factors, including maternal mental disorders, may be involved. This study aims to evaluate the association of maternal common mental disorders (CMDs) and their change over time with asthma morbidity in the child and to observe the effect of social support on this association. METHODS: This prospective study involved 189 dyads of mothers and their asthmatic children aged between 2 and 14 years, assisted in specialized outpatient clinics. We measured the association of maternal CMD evolution (absent, maintained, or improved over time) with asthma control and visits to the emergency department (ED) due to asthma attacks through Poisson regression analysis. We further stratified the sample according to social support levels to identify a possible effect of this variable on the association of maternal psychological symptoms with asthma morbidity. RESULTS: Compared with mothers who maintained CMD over time, maternal CMD absence had a protective effect on the occurrence of visits to the ED (RR: 0.45; 95% CI: 0.26-0.79) and maternal CMD improvement was associated with lower risk of uncontrolled asthma in the child (RR: 0.60; 95% CI: 0.37-0.97). There was a stronger association of maternal CMD improvement with asthma control in the child only for the stratum of mothers with high social support in its three dimensions (affective-social interaction, emotional-informational, and material dimensions). CONCLUSIONS: Maternal CMD absence and improvement over the study period were protective factors for uncontrolled asthma in the child, mainly in the presence of high social support.

Effective/cost effective interventions of child mental health problems in low- and middle-income countries (LAMIC): Systematic review.

BACKGROUND: This systematic review protocol aims to examine the evidence of effectiveness and cost-effectiveness of interventions for children and adolescents with, or at risk of developing mental disorders in low- and middle-income countries (LAMICs). METHODS: We will search Medline Ovid, EMBASE Ovid, PsycINFO Ovid, CINAHL, LILACS, BDENF and IBECS. We will include randomised and non-randomised controlled trials, economic modelling studies and economic evaluations. Participants are 6 to 18 year-old children and adolescents who live in a LAMIC and who present with, or are at high risk of developing, one or more of the conditions: depression, anxiety, behavioural disorders, eating disorders, psychosis, substance abuse, autism and intellectual disabilities as defined by the DSM-V. Interventions which address suicide, self-harm will also be included, if identified during the extraction process. We will include in person or e-health interventions which have some evidence of effectiveness (in relation to clinical and/or functional outcomes) and which have been delivered to young people in LAMICs. We will consider a wide range of delivery channels (e.g., in person, web-based or virtual, phone), different practitioners (healthcare practitioners, teachers, lay health care providers) and sectors (i.e., primary, secondary and tertiary health care, education, guardianship councils). In the pilot of screening procedures, 5% of all references will be screened by two reviewers. Divergences will be resolved by one expert in mental health research. Reviewers will be retrained afterwards to ensure reliability. The remaining 95% will be screened by one reviewer. Covidence web-based tool will be used to perform screening of references and full text paper, and data extraction. RESULTS: The protocol of this systematic review will be disseminated in a peer-reviewed journal and presented at relevant conferences. The results will be presented descriptively and, if possible, meta-analysis will be conducted. Ethical approval is not needed for anonymised secondary data. CONCLUSION: the systematic review could help health specialists and other professionals to identify evidence-based strategies to deal with child and adolescents with mental health conditions.

Disability due to maternal common mental disorders (CMDs) as a risk factor for chronic childhood malnutrition: cross-sectional study / Incapacidade decorrente de transtornos mentais comuns (TMC) maternos como fator de risco para desnutrição crônica infantil: estudo transversal

ABSTRACT: CONTEXT AND OBJECTIVE: The disability associated with maternal common mental disorders (CMDs) is among the possible explanations for the association between chronic childhood malnutrition and CMDs. CMDs may impair the mother's ability to perform her role, particularly in deprived environments. The present study aimed to evaluate whether disability relating to CMDs could be part of the pathway of the association between childhood malnutrition and maternal CMDs. DESIGN AND SETTING: Cross-sectional study conducted in two institutions: one for malnourished children and another for eutrophic children living in a low-income community in the state of Alagoas, Brazil. METHOD: The cases consisted of 55 malnourished children aged from 12 to 60 months who were attending a nutritional rehabilitation center, with height-for-age z-scores < 2. The controls were 70 eutrophic children of the same age who were attending a day care center in the same area as the cases. The Self-Report Questionnaire made it possible to identify likely cases of maternal CMD. The Sheehan Disability Scale enabled evaluation of the associated disability. RESULTS: Chronic childhood malnutrition was significantly associated with maternal disability relating to CMDs (OR = 2.28; 95% CI: 1.02-5.1). The best logistic regression model using chronic childhood malnutrition as the dependent variable included the following independent variables: higher number of people living in the household; absence of the biological father from the household; and maternal disability relating to CMDs. CONCLUSIONS: If confirmed, the association between chronic childhood malnutrition and maternal disability relating to CMDs may be useful in helping to identify the causal chain between childhood malnutrition and maternal CMDs and to indicate environmental risk factors associated with chronic childhood malnutrition.

RESUMO: CONTEXTO E OBJETIVO: A incapacidade associada aos transtornos mentais comuns (TMCs) maternos está entre as explicações possíveis para a associação entre a desnutrição infantil crônica e os TMCs. Os TMCs podem comprometer a capacidade materna de desempenhar seu papel, especialmente em ambientes precários. O presente estudo objetivou avaliar se a incapacidade relacionada com TMCs pode fazer parte do processo de associação entre a desnutrição infantil e TMCs maternos. DESENHO E LOCALIZAÇÃO: Estudo transversal realizado em duas instituições, uma para crianças desnutridas e outra para crianças eutróficas vivendo em uma comunidade de baixa renda no estado de Alagoas, Brasil. METODOLOGIA: Casos foram 55 crianças desnutridas de 12 a 60 meses atendidas num centro de recuperação nutricional com escore z da idade para altura < 2. Controles foram 70 crianças eutróficas da mesma idade que frequentavam uma creche na mesma área do que os casos. O "Self-Report Questionnaire" permitiu identificar casos prováveis de TMCs maternos; a "Sheehan Disability Scale" possibilitou a avaliação de incapacidade associada. RESULTADOS: A desnutrição crônica infantil e a incapacidade maternal relacionada ao TMCs mostraram-se associados (OR = 2.28, IC 95% 1.02-5.1). O melhor modelo de regressão logística utilizando desnutrição crônica infantil como variável dependente incluiu um maior número de residentes na casa, ausência do pai biológico na residência e incapacidade materna relacionada ao TMCs como variáveis independentes. CONCLUSÕES: Se confirmada, a associação entre desnutrição crônica infantil e incapacidade materna relacionada a TMCs pode ser útil para ajudar a identificar a cadeia causal entre a desnutrição infantil e os TMCs maternos e indicar fatores de risco ambientais associados com a desnutrição crônica infantil.

Disability due to maternal common mental disorders (CMDs) as a risk factor for chronic childhood malnutrition: cross-sectional study.

CONTEXT AND OBJECTIVE: The disability associated with maternal common mental disorders (CMDs) is among the possible explanations for the association between chronic childhood malnutrition and CMDs. CMDs may impair the mother's ability to perform her role, particularly in deprived environments. The present study aimed to evaluate whether disability relating to CMDs could be part of the pathway of the association between childhood malnutrition and maternal CMDs. DESIGN AND SETTING: Cross-sectional study conducted in two institutions: one for malnourished children and another for eutrophic children living in a low-income community in the state of Alagoas, Brazil. METHOD: The cases consisted of 55 malnourished children aged from 12 to 60 months who were attending a nutritional rehabilitation center, with height-for-age z-scores < 2. The controls were 70 eutrophic children of the same age who were attending a day care center in the same area as the cases. The Self-Report Questionnaire made it possible to identify likely cases of maternal CMD. The Sheehan Disability Scale enabled evaluation of the associated disability. RESULTS: Chronic childhood malnutrition was significantly associated with maternal disability relating to CMDs (OR = 2.28; 95% CI: 1.02-5.1). The best logistic regression model using chronic childhood malnutrition as the dependent variable included the following independent variables: higher number of people living in the household; absence of the biological father from the household; and maternal disability relating to CMDs. CONCLUSIONS: If confirmed, the association between chronic childhood malnutrition and maternal disability relating to CMDs may be useful in helping to identify the causal chain between childhood malnutrition and maternal CMDs and to indicate environmental risk factors associated with chronic childhood malnutrition.

[Factors associated with neurodevelopment in children 6-18 months of age in public daycare centers in João Pessoa, Paraíba State, Brazil]. / Fatores associados ao desenvolvimento neuropsicomotor em crianças de 6-18 meses de vida inseridas em creches públicas do Município de João Pessoa, Paraíba, Brasil.

This study aimed to determine the prevalence of altered neurodevelopment in children in public daycare centers in João Pessoa, Paraíba State, Brazil, and to analyze factors associated with child development. A cross-sectional study was conducted in a sample of children 6 to 18 months of age enrolled in daycare. Child development was assessed by the Denver II Screening Test. Biological, riables were studied with a questionnaire and form. Associations were adjusted using logistic regression. Altered development was present in 52.7% of the children and was associated with age > 12 months (OR = 4.3), vaginal delivery (OR = 4.4), neonatal phototherapy (OR = 7.9), and daycare centers not supported by the Family Health Strategy (OR = 2.9). The findings suggest that child development reflects the family's conditions and the care received from educational and healthcare services.

Fatores associados ao desenvolvimento neuropsicomotor em crianças de 6-18 meses de vida inseridas em creches públicas do Município de João Pessoa, Paraíba, Brasil / Factors associated with neurodevelopment in children 6-18 months of age in public daycare centers in João Pessoa, Paraíba State, Brazil / Los factores asociados con el desarrollo neurológico en los niños de 6-18 meses presentes en guarderías públicas de la ciudad de João Pessoa, Paraíba, Brasil

O estudo objetivou verificar a prevalência de alteração no desenvolvimento neuropsicomotor em lactentes inseridos nas creches públicas de João Pessoa, Paraíba, Brasil, e analisar fatores associados ao desenvolvimento infantil. Realizou-se um estudo seccional com o censo de crianças entre 6 e 18 meses de vida inseridas nas creches. O desenvolvimento infantil foi avaliado pelo Teste de Triagem de Denver II. Variáveis de natureza biológica, materna, social, demográfica e relativas à creche foram investigadas através de questionário e formulário. As associações foram ajustadas por regressão logística. A prevalência de alteração no desenvolvimento foi 52,7%. Associou-se à alteração no desenvolvimento a criança ter mais que 12 meses de idade (RC = 4,3), o parto vaginal (RC = 4,4), a fototerapia (RC = 7,9) e a creche não ter apoio da Estratégia Saúde da Família (RC = 2,9). Os achados sugerem que o desenvolvimento infantil é o reflexo das condições familiares, bem como da assistência recebida pelos serviços de educação e saúde.

This study aimed to determine the prevalence of altered neurodevelopment in children in public daycare centers in João Pessoa, Paraíba State, Brazil, and to analyze factors associated with child development. A cross-sectional study was conducted in a sample of children 6 to 18 months of age enrolled in daycare. Child development was assessed by the Denver II Screening Test. Biological, riables were studied with a questionnaire and form. Associations were adjusted using logistic regression. Altered development was present in 52.7% of the children and was associated with age > 12 months (OR = 4.3), vaginal delivery (OR = 4.4), neonatal phototherapy (OR = 7.9), and daycare centers not supported by the Family Health Strategy (OR = 2.9). The findings suggest that child development reflects the family’s conditions and the care received from educational and healthcare services.

El objetivo del estudio fue determinar la prevalencia de desarrollo neurológico alterado en los bebés presentes en guarderías públicas en João Pessoa, Paraíba, Brasil, y analizar los factores asociados con el desarrollo del niño. Se realizó un estudio transversal con el censo de los niños entre 6 y 18 meses de vida que se encontraban siendo cuidados en guarderías. El desarrollo se evaluó mediante la Prueba de Detección de Denver II. Variables biológicas, maternas, sociales, demográficos y relacionadas con el cuidado de niños se investigaron mediante un cuestionario. Las asociaciones se ajustaron mediante regresión logística. La prevalencia de un desarrollo anormal fue de un 52,7%. Asociado a un cambio en el desarrollo de los niños que tienen más de 12 meses de edad (OR = 4,3), parto vaginal (OR = 4,4), fototerapia (OR = 7,9) y no contar con el apoyo de una guardería en el ámbito de estrategia de salud familiar (OR = 2,9). Los resultados sugieren que el desarrollo infantil es un reflejo de las condiciones de la familia y el cuidado que recibe servicios de educación y salud.

Depression in hemodialysis patients: the role of dialysis shift.

OBJECTIVE: Depression is the most important neuropsychiatric complication in chronic kidney disease because it reduces quality of life and increases mortality. Evidence demonstrating the association between dialysis shift and depression is lacking; thus, obtaining such evidence was the main objective of this study. METHOD: This cross-sectional study included patients attending a hemodialysis program. Depression was diagnosed using Beck's Depression Inventory. Excessive daytime sleepiness was evaluated using the Epworth Sleepiness Scale. RESULTS: A total of 96 patients were enrolled (55 males, age 48±14 years). Depression and excessive daytime sleepiness were observed in 42.7% and 49% of the patients, respectively. When comparing variables among the three dialysis shifts, there were no differences in age, dialysis vintage, employment status, excessive daytime sleepiness, hemoglobin, phosphorus levels, or albumin levels. Patients in the morning shift were more likely to live in rural areas (p<0.0001), although patients in rural areas did not have a higher prevalence of depression (p = 0.30). Patients with depression were more likely to be dialyzed during the morning shift (p = 0.008). Independent risk factors for depression were age (p<0.03), lower levels of hemoglobin (p<0.01) and phosphorus (p<0.01), and dialysis during the morning shift (p = 0.0009). The hospitalization risk of depressive patients was 4.5 times higher than that of nondepressive patients (p<0.008). CONCLUSION: These data suggest that depression is associated with dialysis shift, higher levels of phosphorus, and lower levels of hemoglobin. The results highlight the need for randomized trials to determine whether this association occurs by chance or whether circadian rhythm disorders may play a role.

Depression in hemodialysis patients: the role of dialysis shift

OBJECTIVE: Depression is the most important neuropsychiatric complication in chronic kidney disease because it reduces quality of life and increases mortality. Evidence demonstrating the association between dialysis shift and depression is lacking; thus, obtaining such evidence was the main objective of this study. METHOD: This cross-sectional study included patients attending a hemodialysis program. Depression was diagnosed using Beck's Depression Inventory. Excessive daytime sleepiness was evaluated using the Epworth Sleepiness Scale. RESULTS: A total of 96 patients were enrolled (55 males, age 48±14 years). Depression and excessive daytime sleepiness were observed in 42.7% and 49% of the patients, respectively. When comparing variables among the three dialysis shifts, there were no differences in age, dialysis vintage, employment status, excessive daytime sleepiness, hemoglobin, phosphorus levels, or albumin levels. Patients in the morning shift were more likely to live in rural areas (p<0.0001), although patients in rural areas did not have a higher prevalence of depression (p = 0.30). Patients with depression were more likely to be dialyzed during the morning shift (p = 0.008). Independent risk factors for depression were age (p<0.03), lower levels of hemoglobin (p<0.01) and phosphorus (p<0.01), and dialysis during the morning shift (p = 0.0009). The hospitalization risk of depressive patients was 4.5 times higher than that of nondepressive patients (p<0.008). CONCLUSION: These data suggest that depression is associated with dialysis shift, higher levels of phosphorus, and lower levels of hemoglobin. The results highlight the need for randomized trials to determine whether this association occurs by chance or whether circadian rhythm disorders may play a role. .

Saúde mental materna e desnutrição crônica infantil: o papel do suporte social / Salud menal materna y desnutrición crónica infantil: el papel del apoyo social / Maternal mental health and chronic malnutrition for children: the role of social support

Investigar o papel do suporte social na condição de transtorno mental comum (TMC) em mães de crianças com desnutrição crônica. Estudo caso-controle feito em uma comunidade de baixa renda. O suporte social foi avaliado com o Medical Outcomes Study Questions - Social Support Survey e o TMC, com o Self-Reporting Questionnaire, além de variáveis sociodemográficas e o índice altura-idade (-2 desvios padrão) na determinação do estado nutricional. Utilizou-se: o teste do χ2, Odds Ratio com intervalo de confiança de 95% e o teste t de Student (p<0,05). A amostra foi de 125 duplas mãe-criança, com 55 casos (desnutridos) e 70 controles (eutróficos). Na análise univariada, o suporte social global não se associou com a desnutrição infantil; já o TMC, a ausência do marido ou companheiro no mercado de trabalho, residir com mais de quatro pessoas e ausência do pai biológico apresentaram medidas de risco significativas. Entre as dimensões do Medical Outcomes Study Questions - Social Support Survey, a interação social positiva diferiu significativamente entre os grupos. A categoria interação social positiva parece ampliar nas mães a concepção do cuidado adequado com a prole. Contudo, ainda restam lacunas a serem preenchidas.

To investigate the role of social support in the condition of common mental disorders (CMD) in mothers of children with chronic malnutrition. Case-control study carried out in a low-income community. Social support was assessed with the Medical Outcomes Study - Social Support Survey Questions, and the TMC was evaluated with the Self-Reporting Questionnaire, besides socio-demographic variables and the index height-age (-2 standard deviations) in determining the nutritional status. In this study, χ2 test, Odds Ratio with confidence interval of 95% and the Student's t-test (p<0.05) were used. The sample consisted of 125 mother-child pairs (55 cases ­ malnourished children; 70 controls ­ eutrophic ones). In univariate analysis, overall social support was not associated with child malnutrition; CMD, the absence of the husband or partner in the labor market, living with more than four people and the absence of biological father showed significant risk measures. Among the dimensions of the Medical Outcomes Study - Social Support Survey Questions, positive social interaction differed significantly between groups. The positive social interaction category seems to enlarge the mothers' concept of proper care with the offspring. However, there are still gaps to be fulfilled.

Investigar el papel del apoyo social en la condición de trastorno mental común (TMC) en madres de niños con desnutrición crónica. Estudio caso-control realizado en una comunidad de baja renta. El apoyo social fue evaluado con Medical Outcomes Study Questions - Social Support Survey y el TMC, con el Self-Reporting Questionnaire, además de las variables sociodemográficas y el índice de altura-edad (-2 desviaciones estándar) en la determinación del estado nutricional. Se utilizaron: el test del χ2, Odds Ratio con un intervalo de confianza del 95% y el test t (p<0,05). La muestra fue de 125 parejas madre-niño, con 55 casos (desnutridos) y 70 controles (eutróficos). En el análisis univariado, el apoyo social global no se asoció con la desnutrición infantil; mientras que el TMC, la ausencia de un esposo o pareja en el mercado laboral, vivir con más de cuatro personas y la ausencia del padre biológico presentaron medidas significativas de riesgo. Entre las dimensiones del Medical Outcomes Study Questions - Social Support Survey, la interacción social positiva fue diferente significativamente entre los grupos. La categoría interacción social positiva parece ampliar en las madres la concepción de la atención adecuada de la prole. Sin embargo, sigue habiendo huecos a rellenar.

Qualidade da atenção à saúde da criança na estratégia saúde da família / Quality of child health care in the family health strategy

Objetivo: verificar a qualidade da atenção à saúde da criança pelas equipes da Estratégia Saúde da Família (ESF) em Capital do Nordeste do Brasil. Método: trata-se de um estudo transversal, descritivo, com abordagem quantitativa, realizado durante o ano de 2010, por meio de inquérito com os profissionais médicos e enfermeiros de 66 equipes da ESF de Maceió-AL, estratificadas por tempo de funcionamento em anos. Utilizou-se parte do instrumento de auto-avaliação denominado Avaliação para Melhoria da Qualidade da Estratégia Saúde da Família(AMQ) do Ministério da Saúde, especificamente as questões referentes às ações e atividades realizadas no campo de atenção à“saúde da criança”, dentro da dimensão “atenção à saúde”. Resultados: os padrões elementares de qualidade foram encontrados em 84,1 por cento das ações realizadas. Os padrões considerados avançados apresentaram o menor percentual de conformidade entre todas as equipes (47,7 por cento). Quanto ao tempo de implantação da ESF, as equipes com menos de quatro anos tenderam a relatar melhores padrões de qualidade. Conclusões: os achados sugerem que as ações de saúde da criança estão sendo realizadas em melhor conformidade nas equipes com menos tempo de implantação, e que a grande maioria das equipes ainda estão atendendo a padrões considerados menos avançados em termos de qualidade.(AU)

OBJECTIVE: to verify the quality of child health care in the Family Health Strategy (FHS) in a state capital of Northeastern Brazil. METHODS: a descriptive study using a quantitative approach was carried out in 2010 with 66 primary care (PC) teams represented by their doctors and nurses. The survey used part of the Evaluation for Quality Improvement of the Family Health Strategy² (AMQ), a self-rating instrument of the Brazilian Ministry of Health which evaluates the FHS actions and services and classifies them by the following quality-based standards of care: Elementary, undergoing development, Consolidated, Good or Advanced. RESULTS: 84.1% of the FHS-teams rated themselves as providing "Elementary" actions and services, and 47.7% of them considered that they provided "Advanced" ones. The health teams with less than four years of implementation rated themselves better. CONCLUSION: these findings suggest that most of the FHC-teams are providing care with an elementary standard of quality, and indicate that better quality child care is apparently delivered with by teams with less time of implementation.(AU)

Qualidade da atenção à saúde da criança na estratégia saúde da família / Quality of child health care in the family health strategy

Objetivo: verificar a qualidade da atenção à saúde da criança pelas equipes da Estratégia Saúde da Família (ESF) em Capital do Nordeste do Brasil. Método: trata-se de um estudo transversal, descritivo, com abordagem quantitativa, realizado durante o ano de 2010, por meio de inquérito com os profissionais médicos e enfermeiros de 66 equipes da ESF de Maceió-AL, estratificadas por tempo de funcionamento em anos. Utilizou-se parte do instrumento de auto-avaliação denominado Avaliação para Melhoria da Qualidade da Estratégia Saúde da Família(AMQ) do Ministério da Saúde, especificamente as questões referentes às ações e atividades realizadas no campo de atenção à“saúde da criança”, dentro da dimensão “atenção à saúde”. Resultados: os padrões elementares de qualidade foram encontrados em 84,1 por cento das ações realizadas. Os padrões considerados avançados apresentaram o menor percentual de conformidade entre todas as equipes (47,7 por cento). Quanto ao tempo de implantação da ESF, as equipes com menos de quatro anos tenderam a relatar melhores padrões de qualidade. Conclusões: os achados sugerem que as ações de saúde da criança estão sendo realizadas em melhor conformidade nas equipes com menos tempo de implantação, e que a grande maioria das equipes ainda estão atendendo a padrões considerados menos avançados em termos de qualidade.

OBJECTIVE: to verify the quality of child health care in the Family Health Strategy (FHS) in a state capital of Northeastern Brazil. METHODS: a descriptive study using a quantitative approach was carried out in 2010 with 66 primary care (PC) teams represented by their doctors and nurses. The survey used part of the Evaluation for Quality Improvement of the Family Health Strategy² (AMQ), a self-rating instrument of the Brazilian Ministry of Health which evaluates the FHS actions and services and classifies them by the following quality-based standards of care: Elementary, undergoing development, Consolidated, Good or Advanced. RESULTS: 84.1% of the FHS-teams rated themselves as providing "Elementary" actions and services, and 47.7% of them considered that they provided "Advanced" ones. The health teams with less than four years of implementation rated themselves better. CONCLUSION: these findings suggest that most of the FHC-teams are providing care with an elementary standard of quality, and indicate that better quality child care is apparently delivered with by teams with less time of implementation.

Qualidade da atenção à saúde da criança na estratégia saúde da família / Quality of child health care in the family health strategy

Objetivo: verificar a qualidade da atenção à saúde da criança pelas equipes da Estratégia Saúde da Família (ESF) em Capital do Nordeste do Brasil. Método: trata-se de um estudo transversal, descritivo, com abordagem quantitativa, realizado durante o ano de 2010, por meio de inquérito com os profissionais médicos e enfermeiros de 66 equipes da ESF de Maceió-AL, estratificadas por tempo de funcionamento em anos. Utilizou-se parte do instrumento de auto-avaliação denominado Avaliação para Melhoria da Qualidade da Estratégia Saúde da Família(AMQ) do Ministério da Saúde, especificamente as questões referentes às ações e atividades realizadas no campo de atenção àôsaúde da criançaö, dentro da dimensão ôatenção à saúdeö. Resultados: os padrões elementares de qualidade foram encontrados em 84,1 por cento das ações realizadas. Os padrões considerados avançados apresentaram o menor percentual de conformidade entre todas as equipes (47,7 por cento). Quanto ao tempo de implantação da ESF, as equipes com menos de quatro anos tenderam a relatar melhores padrões de qualidade. Conclusões: os achados sugerem que as ações de saúde da criança estão sendo realizadas em melhor conformidade nas equipes com menos tempo de implantação, e que a grande maioria das equipes ainda estão atendendo a padrões considerados menos avançados em termos de qualidade.(AU)

Violência intrafamiliar e desnutrição crônica infantil: estudo caso-controle / Intrafamily violence and chronic infantile malnutrition: control case study

Não foi detectada diferença significativa nos níveis de violência contra a criança e contra a mulher comparando as famílias de crianças desnutridas e de eutróficas.