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2.
PLoS One ; 14(12): e0221691, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31887122

RESUMO

BACKGROUND: Globally, low birthweight (LBW) infants (<2.5 kilograms) contribute up to 80% of neonatal mortality. In Bangladesh, approximately 62% of all births occur at home and therefore, weighing newborns immediately after birth is not feasible. Thus, estimates of birthweight in Bangladesh are mostly obtained based on maternal perception of the newborn's birth size. Little is known about how birthweight is perceived in rural communities, and whether families associate birthweight with newborn's health status. Our objective was to explore families' perceptions of newborn's birthweight, and preventive and care practices for a LBW newborn in rural Bangladesh. METHODS: We conducted a qualitative study in two rural settings of Bangladesh, including 32 in-depth interviews (11 with pregnant women, 12 with recently delivered women, 4 with husbands whose wives were pregnant or had a recent birth, 5 with mothers-in-law whose daughters-in-law were pregnant or had a recent birth), 2 focus group discussions with husbands and 4 key-informant interviews with community health workers. We used thematic analysis to analyse the data. RESULTS: Most participants did not consider birthweight a priority for assessing a newborn's health status, although there was a desire for a healthy newborn. Recognition of different categories of birthweight was subjective and often included several physical descriptors including birth size of the newborn. LBW was not considered as a criterion of a newborn's illness unless the newborn appeared unwell. Maternal poor nutrition, inadequate diet in pregnancy, anaemia, illness during pregnancy, short stature, twin births and influence of supernatural spirit were identified as the major causes of LBW. Women's preventive practices for LBW or small newborns were predominantly constrained by a lack of awareness of birthweight and fear of caesarean section. As an effort to avoid caesarean section during birth, several women tended to perform potentially harmful practices in order to give birth to a small size newborn; such as avoiding nutritious food and eating less in pregnancy. Common practices to treat a LBW or small newborn who appeared ill included breastfeeding, feeding animal milk, feeding sugary water, feeding formula, oil massage, keeping the small newborn warm and seeking care from formal and informal care providers including a spiritual leader. Maternal lack of decision-making power, financial constraint, home birth and superstition were the major challenges to caring for a LBW newborn. CONCLUSION: Birthweight was not well-understood in the rural community, which highlighted substantial challenges to the prevention and care practices of LBW newborns. Community-level health education is needed to promote awareness related to the recognition of birthweight in rural settings.


Assuntos
Parto Domiciliar/ética , Saúde do Lactente/etnologia , Saúde do Lactente/tendências , Adulto , Bangladesh/epidemiologia , Peso ao Nascer , Cesárea , Feminino , Parto Domiciliar/tendências , Humanos , Renda , Lactente , Mortalidade Infantil , Recém-Nascido de Baixo Peso/fisiologia , Recém-Nascido , Mães/psicologia , Parto , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Gravidez , População Rural , Fatores Socioeconômicos
4.
Drug Saf ; 42(1): 1-12, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30246225

RESUMO

Information on the safety of medication use during pregnancy and breastfeeding is scarce, yet use of medication among pregnant and breastfeeding women is widespread. The pREGnant, the Dutch Pregnancy Drug Register, was set up to obtain insight into medication use among pregnant and breastfeeding women and potential effects on maternal and fetal/infant health. The systematically documented, good quality data on medication use during pregnancy and lactation in pREGnant will be used in signal detection, epidemiologic studies and counseling of healthcare providers and patients. The register has a prospective cohort design. The population is derived from pregnant women throughout the Netherlands. Data collection started in April 2014 and enrollment of women is continuous and is characterized by a relative high proportion of women born in the Netherlands with a high education compared with the general Dutch pregnant population. Data on current pregnancy, obstetric history, maternal lifestyle, health and medication use, delivery, and infant health are collected through web-based questionnaires completed by the participating women (three times during pregnancy and three times during the infant's first year of life). If permission is given, the self-reported data can be complemented with information retrieved from Perined, the perinatal registry of the Netherlands, and from obstetric and medical records, and/or pharmacy records. Here, we provide detailed information on the design of the pREGnant, the Dutch Pregnancy Drug Register, as well as descriptive information on characteristics of the participants so far. Currently, steps are being taken to implement the register on a large scale in the Netherlands.


Assuntos
Saúde do Lactente/tendências , Saúde Materna/tendências , Resultado da Gravidez/epidemiologia , Sistema de Registros , Inquéritos e Questionários , Adolescente , Adulto , Estudos de Coortes , Feminino , Seguimentos , Humanos , Países Baixos/epidemiologia , Gravidez , Estudos Prospectivos , Adulto Jovem
5.
Cien Saude Colet ; 23(6): 1915-1928, 2018 Jun.
Artigo em Português, Inglês | MEDLINE | ID: mdl-29972499

RESUMO

This study presents an overview of public sector interventions and progress made on the women's and child health front in Brazil between 1990 and 2015. We analyzed indicators of antenatal and labor and delivery care and maternal and infant health status using data from the Live Birth Information System and Mortality Information System, national surveys, published articles, and other sources. We also outline the main women's and child health policies and intersectoral poverty reduction programs. There was a sharp fall in fertility rates; the country achieved universal access to antenatal and labor and delivery care services; access to contraception and breastfeeding improved significantly; there was a reduction in hospital admissions due to abortion and in malnutrition. The rates of congenital syphilis, caesarean sections and preterm births remain excessive. Under-five mortality decreased by more than two-thirds, but less pronounced for the neonatal component. The maternal mortality ratio decreased from 143.2 to 59.7 per 100 000 live births. Despite worsening scores or levelling off across certain health indicators, the large majority improved markedly.


Assuntos
Saúde da Criança/tendências , Saúde do Lactente/tendências , Saúde Materna/tendências , Saúde Reprodutiva/tendências , Adolescente , Adulto , Brasil , Criança , Pré-Escolar , Assistência à Saúde/tendências , Feminino , Acesso aos Serviços de Saúde/tendências , Indicadores Básicos de Saúde , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Mortalidade Materna/tendências , Pessoa de Meia-Idade , Programas Nacionais de Saúde/organização & administração , Pobreza , Gravidez , Adulto Jovem
6.
Health Econ ; 27(8): 1319-1324, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29766619

RESUMO

Three recent studies have documented short- and long-run benefits of early-infancy health interventions in Norway, Sweden, and Denmark: Universal nurse home visiting (NHV) and well-baby center care decreased infant mortality and positively impacted long-run survival (DK, S), morbidity (DK, N), and educational and labor market outcomes (N). Using Danish conscription data, this paper examines intermediate outcomes to assess both potential mechanisms and the importance of selective survival for the long-run health effects of NHV. We do not find strong effects of NHV for young adult's height or obesity status, but we find that NHV increases treated individuals' probability of emigration. As emigrants in our sample are positively selected and as they are not part of the samples used in long-run analyses, this finding suggests that the established long-run health benefits of NHV may be lower bounds.


Assuntos
Visita Domiciliar , Saúde do Lactente/tendências , Mortalidade Infantil/tendências , Adulto , Dinamarca , Feminino , Humanos , Lactente , Recém-Nascido , Modelos Econômicos , Noruega , Enfermeiras de Saúde Comunitária , Obesidade , Fatores de Risco , Suécia , Adulto Jovem
7.
BMC Pregnancy Childbirth ; 18(1): 171, 2018 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-29769063

RESUMO

BACKGROUND: Early initiation of breastfeeding (EIBF) lowers the risk for all-cause mortality in babies, including those with low birth weight. However, rates of neonatal mortality and delayed initiation of breastfeeding remain high in most low- and middle-income countries. This study aimed to assess the trends and factors associated with EIBF in Namibia from 2000 to 2013. METHODS: An analysis of EIBF trends was conducted using data from three Namibia Demographic Health Surveys. The present sample included singleton children younger than 2-years from 2000 (n = 1655), 2006-2007 (n = 2152) and 2013 (n = 2062) surveys. Descriptive statistics were used to analyse respondents' demographic, socioeconomic and obstetric characteristics. Factors associated with EIBF were assessed using univariate analysis and further evaluated using multivariable logistic regression analysis. RESULTS: EIBF significantly decreased from 82.5% (confidence interval [CI]: 79.5-85.0) in 2000 to 74.9% (72.5-77.2) in 2013. Factors associated with EIBF in 2000 were urban residence (adjusted odds ratio 0.58, 95% CI: 0.36-0.93), poorer household wealth index (1.82, 1.05-3.17), lack of antenatal care (0.14, 0.03-0.81), small birth size (0.38, 0.24-0.63) and large birth size (0.51, 0.37-0.79). In 2013, factors associated with EIBF were maternal age of 15-19 years (2.28, 1.22-4.24), vaginal delivery (2.74, 1.90-3.93), married mothers (1.57, 1.16-2.14), delivery assistance from health professionals (3.67, 1.23-10.9) and birth order of fourth or above (1.52, 1.03-2.26). CONCLUSIONS: Namibia has experienced a declining trend in EIBF rates from 2000 to 2013. Factors associated with EIBF differed between 2000 and 2013. The present findings highlight the importance of continued commitment to addressing neonatal health challenges and strengthening implementation of interventions to increase EIBF in Namibia.


Assuntos
Aleitamento Materno/tendências , Saúde do Lactente/tendências , Mães/estatística & dados numéricos , Fatores de Tempo , Parto Obstétrico/estatística & dados numéricos , Demografia , Feminino , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Modelos Logísticos , Namíbia , Razão de Chances , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Fatores Socioeconômicos
8.
Aust J Gen Pract ; 47(4): 193-198, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29621858

RESUMO

BACKGROUND: Newborn babies are very vulnerable in their first weeks of life. Timely and appropriate management of neonatal conditions is paramount for health and developmental outcomes. OBJECTIVE: The aim of this article is to provide an overview of common neonatal presentations to general practice, and highlight significant conditions that may require referral to the emergency department and/or other specialist. DISCUSSION: Clinical history and examination are the most important tools in neonatal assessment. Babies often present with non-specific symptoms, but a thorough clinical assessment can identify the ‘unwell baby’ who requires immediate transfer to hospital. This includes babies with sepsis, moderate­to­severe dehydration or who are in acute cardiorespiratory compromise. A comprehensive neonatal assessment will also help to differentiate babies with significant conditions that may warrant further specialist input from those with normal neonatal development where parental support and reassurance may be sufficient.


Assuntos
Saúde do Lactente/tendências , Atenção Primária à Saúde/métodos , Comportamento Alimentar , Febre/diagnóstico , Febre/etiologia , Gastroenteropatias/diagnóstico , Gastroenteropatias/terapia , Humanos , Recém-Nascido , Anamnese/métodos , Atenção Primária à Saúde/tendências , Fenômenos Fisiológicos Respiratórios
9.
BMJ Open ; 8(3): e020578, 2018 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-29500215

RESUMO

OBJECTIVE: Instrumental vaginal delivery is associated with birth trauma to infant and obstetric trauma to mother. As caesarean delivery rates increased during the past decades, the rate of instrumental vaginal delivery declined. We examined concomitant temporal changes in the rates of severe birth trauma and maternal obstetric trauma. DESIGN: A retrospective observational study. SETTINGS AND PARTICIPANTS: All hospital singleton live births in Washington State, USA, 2004-2013, excluding breech delivery. Severe birth trauma (brain, nerve injury, fractures and other severe birth trauma) and obstetric trauma (third/fourth degree perineal lacerations, cervical/high vaginal lacerations) were identified from hospitalisation data. Pregnancy and delivery characteristics were obtained from birth certificates. Temporal trends were assessed by the Cochran-Armitage test. Logistic regression was used to obtain adjusted ORs (AORs) and 95% CI. RESULTS: Overall, 732 818 live births were included. The rate of severe birth trauma declined from 5.3 in 2004 to 4.5 per 1000 live births in 2013 (P<0.001). The decline was observed only in spontaneous vaginal delivery, the rates of fractures and other severe birth trauma declined by 5% and 4% per year, respectively (AOR: 0.95, 95% CI 0.94 to 0.97 and AOR: 0.96, 95% CI 0.93 to 0.99; respectively). The rate of third/fourth degree lacerations declined in spontaneous vaginal delivery from 3.5% to 2.3% (AOR: 0.95; 95% CI 0.94 to 0.95) and in vacuum delivery from 17.3% to 14.5% (AOR: 0.97, 95% CI 0.96 to 0.98). Among women with forceps delivery, these rates declined from 29.8% to 23.4% (AOR: 0.98, 95% CI 0.96 to 1.00). CONCLUSION: While the rates of fractures and other birth trauma declined among infants delivered by spontaneous vaginal delivery, the rate of birth trauma remained unchanged in instrumental vaginal delivery and caesarean delivery. Among mothers, the rates of severe perineal lacerations declined, except for women with forceps delivery.


Assuntos
Parto Obstétrico/efeitos adversos , Saúde do Lactente/tendências , Saúde Materna/tendências , Complicações do Trabalho de Parto/epidemiologia , Ferimentos e Lesões/etiologia , Adolescente , Adulto , Traumatismos do Nascimento/epidemiologia , Cesárea , Parto Obstétrico/métodos , Parto Obstétrico/tendências , Feminino , Humanos , Recém-Nascido , Lacerações , Modelos Logísticos , Forceps Obstétrico , Períneo/lesões , Gravidez , Prevalência , Estudos Retrospectivos , Fatores de Risco , Vagina , Washington/epidemiologia , Ferimentos e Lesões/epidemiologia , Adulto Jovem
10.
BMC Pediatr ; 18(1): 32, 2018 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-29415674

RESUMO

BACKGROUND: Rapid economic and cultural transition in the United Arab Emirates has been accompanied by a rise in chronic disease. Early childhood is known to affect health outcomes in adulthood. This prospective longitudinal study examined the general health of Emirati infants born in a government maternity hospital in the Emirate of Abu Dhabi in October 2002. METHODS: One hundred twenty-five women, who had recently given birth, were interviewed as part of a larger study encompassing a wide range of cultural, social, and behavioural aspects of health. They were then re-interviewed at three (n = 94), six (n = 59) and 15 months postpartum (n = 52). Data are presented using univariate statistics. RESULTS: In this study seven infants (6%) were born prematurely and four infants (3%) were classified as small for gestational age, while 11 (9%) of the infants weighed less than 2500 g. Low birth weight infants (LBW) were significantly more likely to require treatment in the neonatal intensive care unit (OR = 30.83, p = 0.00). Iron supplementation during pregnancy was associated with fewer underweight infants (OR = 3.92, p = 0.042). No associations were found between infant birth weight and maternal age, age at marriage, consanguinity, education level, current maternal employment, parity, pre-existing anaemia or anaemia in pregnancy, diabetes, folic acid intake, multivitamin intake or infant gender. Maternally-reported infant health issues, vaccination, medication, breast-feeding and infant nutrition, and use of secure car seats are also reported. CONCLUSIONS: The health of infants at birth in this UAE sample showed improvements compared to previous studies. The proportion of LBW infants is decreasing and continuing improvements in health care in the UAE are having a positive impact on infant health.


Assuntos
Saúde do Lactente/tendências , Adolescente , Adulto , Países em Desenvolvimento , Feminino , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido Pequeno para a Idade Gestacional , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Gravidez , Complicações na Gravidez/epidemiologia , Estudos Prospectivos , Mudança Social , Emirados Árabes Unidos , Adulto Jovem
11.
Lancet ; 391(10129): 1538-1548, 2018 04 14.
Artigo em Inglês | MEDLINE | ID: mdl-29395268

RESUMO

Building upon the successes of Countdown to 2015, Countdown to 2030 aims to support the monitoring and measurement of women's, children's, and adolescents' health in the 81 countries that account for 95% of maternal and 90% of all child deaths worldwide. To achieve the Sustainable Development Goals by 2030, the rate of decline in prevalence of maternal and child mortality, stillbirths, and stunting among children younger than 5 years of age needs to accelerate considerably compared with progress since 2000. Such accelerations are only possible with a rapid scale-up of effective interventions to all population groups within countries (particularly in countries with the highest mortality and in those affected by conflict), supported by improvements in underlying socioeconomic conditions, including women's empowerment. Three main conclusions emerge from our analysis of intervention coverage, equity, and drivers of reproductive, maternal, newborn, and child health (RMNCH) in the 81 Countdown countries. First, even though strong progress was made in the coverage of many essential RMNCH interventions during the past decade, many countries are still a long way from universal coverage for most essential interventions. Furthermore, a growing body of evidence suggests that available services in many countries are of poor quality, limiting the potential effect on RMNCH outcomes. Second, within-country inequalities in intervention coverage are reducing in most countries (and are now almost non-existent in a few countries), but the pace is too slow. Third, health-sector (eg, weak country health systems) and non-health-sector drivers (eg, conflict settings) are major impediments to delivering high-quality services to all populations. Although more data for RMNCH interventions are available now, major data gaps still preclude the use of evidence to drive decision making and accountability. Countdown to 2030 is investing in improvements in measurement in several areas, such as quality of care and effective coverage, nutrition programmes, adolescent health, early childhood development, and evidence for conflict settings, and is prioritising its regional networks to enhance local analytic capacity and evidence for RMNCH.


Assuntos
Saúde Global/tendências , Cobertura Universal do Seguro de Saúde/tendências , Saúde da Criança/estatística & dados numéricos , Saúde da Criança/tendências , Conservação dos Recursos Naturais/tendências , Saúde Global/estatística & dados numéricos , Equidade em Saúde/estatística & dados numéricos , Equidade em Saúde/tendências , Humanos , Saúde do Lactente/estatística & dados numéricos , Saúde do Lactente/tendências , Saúde Materna/estatística & dados numéricos , Saúde Materna/tendências , Mortalidade/tendências , Estado Nutricional , Saúde Reprodutiva/estatística & dados numéricos , Saúde Reprodutiva/tendências , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos
12.
Lancet ; 391(10129): 1493-1512, 2018 04 14.
Artigo em Inglês | MEDLINE | ID: mdl-29395272

RESUMO

BACKGROUND: The Millennium Development Goal (MDG) period saw dramatic gains in health goals MDG 4 and MDG 5 for improving child and maternal health. However, many Muslim countries in the south Asian, Middle Eastern, and African regions lagged behind. In this study, we aimed to evaluate the status of, progress in, and key determinants of reproductive, maternal, newborn, child, and adolescent health in Muslim majority countries (MMCs). The specific objectives were to understand the current status and progress in reproductive, maternal, newborn, child, and adolescent health in MMCs, and the determinants of child survival among the least developed countries among the MMCs; to explore differences in outcomes and the key contextual determinants of health between MMCs and non-MMCs; and to understand the health service coverage and contextual determinants that differ between best and poor or moderate performing MMCs. METHODS: In this country-level ecological study, we examined data from between 1990 and 2015 from multiple publicly available data repositories. We examined 47 MMCs, of which 26 were among the 75 high-burden Countdown to 2015 countries. These 26 MMCs were compared with 48 non-Muslim Countdown countries. We also examined characteristics of the eight best performing MMCs that had accelerated improvement in child survival (ie, that reached their MDG 4 targets). We estimated adolescent, maternal, under-5, and newborn mortality, and stillbirths, and the causes of death, essential interventions coverage, and contextual determinants for all MMCs and comparative groups using standardised methods. We also did a hierarchical multivariable analysis of determinants of under-5 mortality and newborn mortality in low-income and middle-income MMCs. FINDINGS: Despite notable reductions between 1990 and 2015, MMCs compared with a global esimate of all countries including MMCs had higher mortality rates, and MMCs relative to non-MMCs within Countdown countries also performed worse. Coverage of essential interventions across the continuum of care was on average lower among MMCs, especially for indicators of reproductive health, prenatal care, delivery, and labour, and childhood vaccines. Outcomes within MMCs for mortality and many reproductive, maternal, newborn, child, and adolescent health indicators varied considerably. Structural and contextual factors, especially state governance, conflict, and women and girl's empowerment indicators, were significantly worse in MMCs compared with non-MMCs within the high-burden Countdown countries, and were shown to be strongly associated with child and newborn mortality within low-income and middle-income MMCs. In adjusted hierarchical models, among other factors, under-5 mortality in MMCs increased with more refugees originating from a country (ß=23·67, p=0·0116), and decreased with better political stability or absence of terrorism (ß=-0·99, p=0·0285), greater political rights or government effectiveness (ß=-1·17, p<0·0001), improvements in log gross national income per capita (ß=-4·44, p<0·0001), higher total adult literacy (ß=-1·69, p<0·0001), higher female adult literacy (ß=-0·97, p<0·0001), and greater female to male enrolment in secondary school (ß=-16·1, p<0·0001). The best performing MMCs were Azerbaijan, Bangladesh, Egypt, Indonesia, Kyrgyzstan, Morocco, Niger, and Senegal, which had higher coverage of family planning interventions and newborn or child vaccinations, and excelled in many of the above contextual determinants when compared with moderate or poorly performing MMCs. INTERPRETATION: The status and progress in reproductive, maternal, newborn, child, and adolescent health is heterogeneous among MMCs, with little indication that religion and its practice affects outcomes systemically. Some Islamic countries such as Niger and Bangladesh have made great progress, despite poverty. Key findings from this study have policy and programmatic implications that could be prioritised by national heads of state and policy makers, development partners, funders, and the Organization of the Islamic Cooperation to scale up and improve these health outcomes in Muslim countries in the post-2015 era. FUNDING: US Fund for UNICEF under the Countdown to 2015 for Maternal, Newborn, and Child Survival, the Centre for Global Child Health, Hospital for Sick Children, and the Aga Khan University.


Assuntos
Saúde do Adolescente/tendências , Saúde da Criança/tendências , Saúde do Lactente/tendências , Islamismo , Saúde Materna/tendências , Religião e Medicina , Adolescente , Saúde do Adolescente/estatística & dados numéricos , Adulto , Criança , Saúde da Criança/estatística & dados numéricos , Mortalidade da Criança/tendências , Assistência à Saúde/normas , Assistência à Saúde/tendências , Feminino , Humanos , Lactente , Saúde do Lactente/estatística & dados numéricos , Mortalidade Infantil/tendências , Recém-Nascido , Masculino , Saúde Materna/estatística & dados numéricos , Serviços de Saúde Materna/normas , Serviços de Saúde Materna/tendências , Mortalidade Materna/tendências , Indicadores de Qualidade em Assistência à Saúde , Fatores Socioeconômicos
13.
J Obstet Gynecol Neonatal Nurs ; 47(2): 245-253, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28736265

RESUMO

The unprecedented scale of the 2014-2015 Ebola virus outbreak in West Africa and the recent emergence and rapid spread of Zika virus infection and resultant neonatal sequelae show that the geographic range, spread, and effect of emerging infections are unpredictable. Lessons learned from analyzing the response of an academic medical center to care for pregnant women with suspected or confirmed Ebola virus disease can help health care professionals address future threats from emerging infections.


Assuntos
Doenças Transmissíveis Emergentes/prevenção & controle , Surtos de Doenças/prevenção & controle , Saúde Global , Doença pelo Vírus Ebola/prevenção & controle , Infecção por Zika virus/prevenção & controle , Centros Médicos Acadêmicos , Controle de Doenças Transmissíveis/métodos , Feminino , Pessoal de Saúde/educação , Doença pelo Vírus Ebola/epidemiologia , Humanos , Saúde do Lactente/tendências , Recém-Nascido , Assistência Perinatal/métodos , Gravidez , Medição de Risco , Infecção por Zika virus/epidemiologia
14.
JAMA Netw Open ; 1(7): e184145, 2018 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-30646341

RESUMO

Importance: With increasing prevalence of atopic dermatitis (AD) and its manifestation in most countries, together with the supporting evidence of the progression to other atopic phenotypes, AD has developed into a worldwide public health concern. The presence of the disease of has increased since the 1950s, but some recent studies suggest a stationary or decreasing trend. Objective: To analyze a nationwide health register based on prescription data to determine the incidence rate (IR) of AD in an entire pediatric population. Design, Setting, and Participants: All children resident in Norway younger than 6 years from January 1, 2009, through December 31, 2015, were included in this cohort study. Medical diagnoses and disease-specific medications were used as a proxy for identifying children with AD in this population-based prescription registry study. The prescription study was terminated in 2016. The total number of 295 286 disease-specific prescriptions was analyzed from August 2016 through December 2017. The hypothesis was formulated before, during, and after the data collection. Main Outcomes and Measures: All children with a medical diagnosis of AD or eczema based on at least 2 prescriptions of topical corticosteroids or at least 1 prescription of topical calcineurin inhibitors. Incidence rates per person-year (PY) and IR ratios were calculated. Results: A total of 295 286 disease-specific prescriptions were dispensed to 122 470 children, of whom 63 460 had AD and 56 009 (88.3%) had reimbursed prescriptions and associated AD diagnoses. The annual Norwegian study population (aged <6 years) increased from 357 451 children in 2009 to 373 954 in 2015. The overall IR increased from 0.028 per PY (95% CI, 0.028-0.029 per PY) in 2009 to 0.034 per PY (95% CI, 0.033-0.035 per PY) in 2014. For children younger than 1 year, the IR increased from 0.052 per PY (95% CI, 0.050-0.053 PY) in 2009 to 0.073 per PY (95% CI, 0.071-0.075 per PY) in 2014. In this age group, the IR was 53% higher in boys compared with girls (IR ratio, 1.53; 95% CI, 1.49-1.57; P < .001). The incidence proportion before the age of 6 years was 17.4% (95% CI, 17.2%-17.7%). The primary seasons for the onset of AD were winter and spring. Conclusions and Relevance: This nationwide study suggests an increase in the IR of pediatric AD, especially among children younger than 1 year. This study's findings suggest that increase occurred with a higher IR during winter and spring seasons. Atopic dermatitis had an earlier onset in boys than in girls. During the study period, more than 1 in 6 children younger than 6 years had, at some point, been affected by AD.


Assuntos
Saúde da Criança/tendências , Dermatite Atópica/epidemiologia , Eczema/epidemiologia , Saúde do Lactente/tendências , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Inibidores de Calcineurina/administração & dosagem , Inibidores de Calcineurina/uso terapêutico , Criança , Pré-Escolar , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Incidência , Lactente , Masculino , Noruega/epidemiologia , Sistema de Registros , Estações do Ano , Fatores Sexuais
15.
Public Health Nutr ; 21(5): 868-876, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29183408

RESUMO

OBJECTIVE: Anaemia is the main nutritional deficiency in Brazil, and a prevention and control programme (National Program for Iron Supplementation) has been developed since 2005. Studies on the temporal evolution of anaemia prevalence contribute to assessment of the effectiveness of the actions undertaken. The present study aimed to identify the prevalence and temporal trend of anaemia in children. DESIGN: Study based on two cross-sectional household surveys carried out in 2005 and 2015. Anaemia was defined as Hb<11 g/dl (HemoCue®). Trend analysis was performed using the prevalence ratio (PR), calculated by Poisson regression with a robust adjustment of the variance. Differences were significant when P<0·05 in both crude analyses and those adjusted for possible confounding factors (e.g. socio-economic, demographic and health variables). SETTING: Alagoas, Brazil. SUBJECTS: In total, 666 and 782 children in the first and second Alagoas State Health and Nutrition Survey, respectively (probabilistic samples). RESULTS: In 2005 and 2015, anaemia prevalence was 45·1 and 27·4 %, respectively (-39·1 %; PR=0·61; 95 % CI 0·52, 0·70). In both surveys, children aged ≤24 months were more affected (P24 months (67·2 v. 40·7 %; 27·0 v. 19·3 %, respectively). CONCLUSIONS: The prevalence of anaemia reduced significantly in the evaluated period. Thus, it may no longer be a severe public health problem but can instead be considered a problem of moderate magnitude. It remains, however, above the level considered acceptable according to WHO criteria. These results justify the implementation of prevention and control actions.


Assuntos
Anemia/epidemiologia , Estado Nutricional , Adulto , Anemia Ferropriva/epidemiologia , Brasil/epidemiologia , Saúde da Criança/tendências , Pré-Escolar , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Saúde do Lactente/tendências , Masculino , Prevalência , Características de Residência , Adulto Jovem
17.
J Policy Anal Manage ; 36(4): 748-72, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28991421

RESUMO

Early term birth is defined as birth at 37 or 38 weeks gestation. While infants born early term are not considered premature, the medical literature suggests that they have an increased risk of serious adverse health outcomes compared to infants born at term (39 or 40 weeks). Despite these known harms, we document a rise in early term births in the United States from 1989 to the mid-2000s, followed by a decline in recent years. We posit that the recent decline in early term births has been driven by changes in medical practice advocated by the American College of Obstetricians and Gynecologists, programs such as the March of Dimes' "Worth the Wait" campaign, and by Medicaid policy. We first show that this pattern cannot be attributed to changes in the demographic composition of mothers, and provide some evidence that efforts to reduce early term elective deliveries (EEDs) through Medicaid policy were effective. We next exploit county-level variation in the timing of these changes in medical practice to examine the effect of early term inductions (our proxy for EEDs) on infant and maternal health. We find that early term inductions lower birth weights and increase the risks of precipitous labor, birth injury, and required ventilation. Our results suggest that reductions in early term inductions can explain about one-third of the overall increase in birth weights between 2010 and 2013 for births at 37 weeks gestation and above.


Assuntos
Saúde do Lactente/estatística & dados numéricos , Recém-Nascido de Baixo Peso , Recém-Nascido Prematuro , Saúde Materna/estatística & dados numéricos , Trabalho de Parto Prematuro/prevenção & controle , Nascimento Prematuro/prevenção & controle , Feminino , Previsões , Política de Saúde , Humanos , Saúde do Lactente/tendências , Recém-Nascido , Trabalho de Parto Induzido/efeitos adversos , Saúde Materna/tendências , Medicaid , Gravidez , Governo Estadual , Estados Unidos
18.
J Policy Anal Manage ; 36(4): 773-89, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28991422

RESUMO

Transit buses are an integral part of urban life. They reduce externalities generated from private vehicles and increase geographic mobility. However, unlike most private vehicles in the United States, they use diesel fuel and emit higher amounts of toxic pollutants. The U.S. Environmental Protection Agency set emission standards for transit buses starting in 1988 that have been continually updated, but their public health and economic impacts are unclear due to scarce emissions data. I construct a novel panel dataset for the New York City (NYC) Transit bus fleet between 1990 and 2009 and examine the impact of bus pollution on infant health by using bus vintage as a proxy for emissions. I exploit the variation in vintage as older buses are retired and replaced with newer, lower-emitting buses forced to adhere to stricter emission standards. I then assign maternal exposure to bus vintage at the census block level. Findings suggest that maternal exposure to the oldest, unregulated buses is associated with modest reductions in birth weight and gestational age relative to newer buses that abide by emissions policies. I then conduct a back-of-the-envelope cost-benefit calculation and find net economic benefits of $53.3 million resulting from improved emission standards for the 2009 birth cohort in NYC. Since the treatment in this study clearly maps to federal emissions policies, these results are the first to provide credible evidence that transit bus emission standards had a positive effect on infant health.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Poluentes Atmosféricos/normas , Poluição do Ar/efeitos adversos , Saúde do Lactente/estatística & dados numéricos , Veículos Automotores/normas , Óxidos de Nitrogênio/efeitos adversos , Emissões de Veículos , Índice de Apgar , Peso ao Nascer , Idade Gestacional , Humanos , Lactente , Saúde do Lactente/tendências , Cidade de Nova Iorque , Transportes/normas , Estados Unidos
19.
Soc Sci Med ; 186: 78-86, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28599141

RESUMO

Naturally-occurring Yellow Dust outbreaks, which are produced by winds flowing to Korea from China and Mongolia, create air pollution. Although there is a seasonal pattern of this phenomenon, there exists substantial variation in its timing, strength, and location from year to year. To warn residents about air pollution in general, and about these dust storms in particular, Korean authorities issue different types of public alerts. Using birth certificate data on more than 1.5 million babies born between 2003 and 2011, we investigate the impact of air pollution, and the avoidance behavior triggered by pollution alerts on various birth outcomes. We show that air pollution rises during Yellow Dust outbreaks and that exposure to air pollution during pregnancy has a significant negative impact on birth weight, the gestation weeks of the baby, and the propensity of the baby being born low weight. Public alerts about air quality during pregnancy help mitigate the adverse effect of pollution on fetal health. The results provide evidence for the effectiveness of pollution alert systems in promoting public health. They also underline the importance of taking into account individuals' avoidance behavior when estimating the impact of air quality on birth outcomes. We show that when the preventive effect of public health warnings is not accounted for, the estimated relationship between air pollution and infant health is reduced by more than fifty percent. In summary, air pollution has a deteriorating impact on newborns' health, and public alerts that warn individuals about increased air pollution help alleviate the negative impact.


Assuntos
Poluição do Ar/efeitos adversos , Saúde do Lactente/tendências , Poluição do Ar/análise , China , Poeira/análise , Monitoramento Ambiental/métodos , Feminino , Humanos , Lactente , Saúde do Lactente/etnologia , Recém-Nascido , Exposição Materna/efeitos adversos , Análise de Regressão , República da Coreia/etnologia , Estações do Ano
20.
Worldviews Evid Based Nurs ; 14(5): 422-423, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28281336

RESUMO

This column shares the best evidence-based strategies and innovative ideas on how to facilitate the learning and implementation of EBP principles and processes by clinicians as well as nursing and interprofessional students. Guidelines for submission are available at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1741-6787.


Assuntos
Prática Clínica Baseada em Evidências/métodos , Guias como Assunto/normas , Síndrome de Abstinência Neonatal/enfermagem , Enfermeiras e Enfermeiros/normas , Cuidados de Enfermagem/normas , Prática Clínica Baseada em Evidências/educação , Humanos , Saúde do Lactente/tendências , Recém-Nascido , Tempo de Internação , Meio-Oeste dos Estados Unidos , Inquéritos e Questionários
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