The influence of mode of delivery on neonatal and maternal short and longterm outcomes

OBJECTIVE: To evaluate the impact of mode of delivery on breastfeeding incentive practices and on neonatal and maternal short and long-term complications. METHODS: A cohort study was conducted between June 2015 and April 2016 with 768 puerperal women from 11 maternities in Sergipe, interviewed in the first 24 hours, 45–60 days and 6–8 months after delivery. Associations between breastfeeding incentive practices, neonatal and maternal, both short-term and late complications, and the exposure variables were evaluated by the relative risk (95%CI) and the Fisher exact test. RESULTS: The C-section newborns had less skin-to-skin contact immediately after delivery (intrapartum C-section: 0.18, 95%CI 0.1–0.31 and elective C-section: 0.36, 95%CI 0.27–0.47) and less breastfeeding within one hour of birth (intrapartum C-section: 0.43, 95%CI 0.29–0.63 and elective C-section: 0.44, 95%CI 0.33–0.59). Newborns from elective C-section were less frequently breastfed in the delivery room 0.42 (95%CI 0.2–0.88) and roomed-in less 0.85 (95%CI 0.77–0.95). Women submitted to intrapartum C-section had greater risk of early complications 1.3 (95%CI 1.04–1.64, p = 0.037) and sexual dysfunction 1.68 (95%CI 1.14–2.48, p = 0.027). The frequency of neonatal complications, urinary incontinence and depression according to the mode of delivery was similar. CONCLUSIONS: The C-section was negatively associated with breastfeeding incentive practices; in addition, C-section after labor increased the risk of early maternal complications and sexual dysfunction

Características maternas e da assistência pré-natal associadas à peregrinação no anteparto

OBJETIVO: Analisar as características maternas e da assistência pré-natal associadas à peregrinação no anteparto entre gestantes de um estado do Nordeste brasileiro. MÉTODOS: Estudo quantitativo e transversal, com abordagens descritiva e analítica, vinculado à pesquisa Nascer em Sergipe, realizada entre junho de 2015 e abril de 2016. Foram avaliadas 768 puérperas proporcionalmente distribuídas entre todas as maternidades do estado (n = 11). Os dados foram coletados por meio de entrevistas e consultas aos cartões de pré-natal. As associações entre a peregrinação no anteparto e as variáveis de exposição foram descritas em frequências absoluta e relativa, razões de chances brutas e ajustadas e seus respectivos intervalos de confiança. RESULTADOS: A peregrinação no anteparto foi referida por 29,4% (n = 226) das entrevistadas, a maioria das quais procurou atendimento em apenas um serviço antes do atual (87,6%; n = 198). Ressalta-se que a peregrinação no anteparto foi menos frequente entre as mulheres com idade ≥ 20 anos (OR = 0,50; IC95% 0,34–0,71), com alta escolaridade (OR = 0,42; IC95% 0,31–0,59), com trabalho remunerado (OR ajustada = 0,59; IC95% 0,41–0,82), orientadas durante o pré-natal sobre a maternidade de referência para o parto (OR ajustada = 0,88; IC95% 0,42–0,92) e que utilizaram o serviço privado para realização do pré-natal (OR ajustada = 0,44; IC95% 0,18–0,86) ou do parto (OR ajustada = 0,96; IC95% 0,66–0,98). Não foi observada evidência estatística de associação entre as características gestacionais e a ocorrência da peregrinação. CONCLUSÕES: A peregrinação no anteparto sofre interferência das características socioeconômicas maternas, da assistência pré-natal e do tipo de financiamento para o parto.OBJECTIVE: To analyze the maternal characteristics and type of prenatal care associated with peregrination before childbirth among pregnant women in a northeastern Brazilian state. METHODS: Quantitative and transversal study, with descriptive and analytical approaches, part of the Nascer em Sergipe research held between June 2015 and April 2016. A total of 768 puerperal women proportionally distributed across all maternities of the state (n = 11) were evaluated. Data were collected in interviews and from prenatal records. The associations between antepartum peregrination and the exposure variables were described in absolute and relative frequencies, crude and adjusted odds ratios and their respective confidence intervals. RESULTS: Antepartum peregrination was reported by 29.4% (n = 226) of the interviewees, most of whom sought care in a single service before the current one (87.6%; n = 198). It should be noted that antepartum peregrination was less frequent among women aged ≥ 20 years old (OR = 0.50; 95%CI 0.34–0.71), with high education level (OR = 0.42; 95%CI 0.31–0.59) and a paid job (adjusted OR = 0.59; 95%CI 0.41–0.82), who had been instructed during prenatal care about the referral maternity for childbirth (adjusted OR = 0.88; 95%CI 0.42–0.92), and who used the private service to receive prenatal (adjusted OR = 0.44; 95%CI 0.18–0.86) or childbirth (adjusted OR = 0.96; 95%CI 0.66–0.98) care. No statistical evidence of associations between gestational characteristics and the occurrence of peregrination was observed. CONCLUSIONS: Antepartum peregrination suffers interference from the mother’s socioeconomic characteristics, the type of prenatal care received and the source of funding for childbirth

Neck circumference as screening measure for identifying adolescents with overweight and obesity

Objective: To study the neck circumference (NC) cut-off points for identifying excess body weight levels in adolescents from age between 12-17 years. Methods: Cross-sectional study was conducted using the data from a Brazilian multicentric project called Study of Cardiovascular Risks in Adolescents – ERICA, which included adolescents with age between 12-17 years’ residents in two Brazilian cities from the Northeast part of Brazil. Anthropometric measurements and blood pressure data were collected from the adolescent’s sample. The mean average in between the adolescents’ groups was compared using the Mann-Whitney. The correlation was estimated by Spearman correlation coeffi cient to evaluate the association between the NC and other anthropometric variables like age, waist circumference (WC), body mass index (BMI) and blood pressure. The ROC curve was used to analyze the predictive validation of NC as well as to determine the cut-off point of overweight and obesity identifi cation among the adolescents. Results: This study comprised 1474 adolescents with a mean age of 14.59 ± 1.57 years, in which 55.3% were female. It was found a positive correlation between NC and WC; NC and BMI. The cutoff point for overweight according to the NC for male adolescents aged 12 to 14 years was equivalent to 34.1 cm and for females 32.05 cm. The adolescent male aged 15 to 17 years group the cutoff point was 36.85 cm and for women 32,95 cm. The cutoffs points for obesity according to the NC for male adolescents aged 12 to 14 years was 34.9 cm and for females 33.85 cm. In the age group 15-17 years, the cutoff point for obesity for males was 38.4 cm and for females 35.85 cm. Conclusions: The neck circumference represented significant correlation among waist circumference and body mass index well stablished indicators of adiposity and can identify adolescents with high body mass index

Ansiedade e Depressão na Morbidade Materna Grave e Near Miss

To verify the prevalence of anxiety and depression in women with severe maternal morbidity (near miss), a cross-sectional cohort study was conducted, with 549 women. The Beck Depression Inventory (BDI) and the Anxiety Inventory (BAI) were used. For the statistical analysis, the Pearson chi-square test and the U-Mann-Whitney test besides Odds Ratio and their 95% confidence intervals. There was a higher prevalence and a greater chance of developing anxiety and depression in the SAMM/NM, as well as the positive and significant relationship between both. We consider association from the psychological point of view as a serious and shocking factor in the mental health of women.Com o objetivo de verificar a prevalência da ansiedade e depressão em mulheres com morbidade materna grave (near miss), foi realizado estudo de coorte transversal, com 549 mulheres. Para tanto, foram utilizados o Inventário de Beck de Depressão (BDI) e o Inventário de Ansiedade (BAI). Na análise estatística, aplicaram-se o teste do qui-quadrado de Pearson e o U-Mann-Whitney, além de Razões de Chances brutas e seus Intervalos com 95% de confiança. Houve maior prevalência e maior chance de desenvolver a ansiedade e depressão na MMG/NM, bem como a relação positiva e significativa entre ambos. Considera-se a associação do ponto de vista psicológico, como um fator grave e impactante na saúde mental da mulher

ERICA: prevalence of asthma in Brazilian adolescents

OBJECTIVE: To describe the prevalence of asthma and physician-diagnosed asthma in Brazilian adolescents. METHODS: Cross-sectional, national, school-based study with adolescents from 12 to 17 years old, participants in the Study of Cardiovascular Risks in Adolescents (ERICA). The study stratified the sample by region and grouped according to schools and classes with representativeness to the set of cities with more than 100,000 inhabitants of the Country, macro-regions, capitals, and Federal District. A questionnaire collected data through a self-filled in method. We calculated the prevalences and their confidence intervals of 95% (95% CI) according to sex, age group, type of school and skin color. RESULTS: Between 2013 and 2014, 74,589 adolescents were evaluated, 55.3% of the female sex. The total prevalence of active asthma was of 13.1% (95% CI 12.1-13.9), being higher in girls (14.8%; 95% CI 13.7-16.0) when compared to boys (11.2%; 95% CI 10.3-12.2) in all geographical strata examined. It was also higher between students of private schools (15.9%; 95% CI 14.2-17.7) when compared to public ones (12.4%; 95% CI 11.4-13.4). It was higher in the Southeast region (14.5%; 95% CI 12.9-16.1), and in the city of Sao Paulo (16.7%; 95% CI 14.7-18.7). The lowest prevalence was observed in North region (9.7%; 95% CI 9.7-10.5), and in Teresina (6.3%; 95% CI 4.9-7.7). The prevalence of physician-diagnosed asthma was of 8.7% (95% CI 8.2-9.1); higher in the North region (13.5%; 95% CI 12.7-14.2), and in Porto Alegre (19.8%; 95% CI 17.5-22.3). It was lower in the Midwest (6.9%; 95% CI 6.0-7.8), and in Cuiaba (4.8%; 95% CI 3.8-5.9). We found no significant difference in the expression of this rate between the sexes, as well as in other variables evaluated by the study. CONCLUSIONS: The prevalence of asthma in Brazilian adolescents is high. Rates of active asthma and physician-diagnosed asthma vary widely in different regions and capitals evaluated by the ERICA. These results may assist in the preparation of preventive programs and policies on health and a better understanding of the factors associated with asthma in this age group.Department of Science and Technology of the Science, Technology and Strategic Inputs Secretariat from the Brazilian Ministry of Health (Decit/SCTIE/MS)Health Sector Fund (CT-Saude) of the Ministry of Science, Technology and Innovation (MCTI)Research Incentive Fund of the Hospital de Clinicas de Porto AlegreUniv Estado Rio de Janeiro, Fac Ciencias Med, Dept Pediat, BR-20550011 Rio De Janeiro, RJ, BrazilUniv Fed Sergipe, Dept Med, Aracaju, SE, BrazilUniv Fed Sao Paulo, Dept Pediat, Disciplina Alergia Imunol Clin & Reumatol, Sao Paulo, SP, BrazilUniv Estado Rio de Janeiro, Fac Ciencias Med, Dept Med Interna, BR-20550011 Rio De Janeiro, RJ, BrazilUniv Estado Rio de Janeiro, Fac Ciencias Med, Programa Posgrad Ciencias Med, BR-20550011 Rio De Janeiro, RJ, BrazilUniv Estado Rio de Janeiro, Inst Nutr, Dept Nutr Aplicada, BR-20550011 Rio De Janeiro, RJ, BrazilFundacao Inst Brasileiro Geog & Estat, Escola Nacl Ciencias Estat, Rio De Janeiro, RJ, BrazilUniv Estado Rio de Janeiro, Fac Ciencias Med, Nucleo Estudos Saude Adolescente, BR-20550011 Rio De Janeiro, RJ, BrazilUniv Fed Sao Paulo, Dept Pediat, Disciplina Alergia Imunol Clin & Reumatol, Sao Paulo, SP, BrazilMCTI: FINEP - 01090421CNPq: 565037/2010-2Research Incentive Fund of the Hospital de Clinicas de Porto Alegre FIPE-HCPA: 405.009/2012-7Web of Scienc

ERICA: prevalência de asma em adolescentes brasileiros

OBJETIVO Descrever a prevalência de asma ativa e de diagnóstico médico de asma em adolescentes brasileiros. MÉTODOS Estudo transversal, nacional, de base escolar com adolescentes de 12 a 17 anos, participantes do Estudo de Riscos Cardiovasculares em adolescentes (ERICA). A amostra foi estratificada por região e conglomerada por escolas e turmas com representatividade para o conjunto de municípios com mais de 100 mil habitantes do País, macrorregiões, capitais e Distrito Federal. Os dados foram coletados em questionário autopreenchível. Foram calculadas as prevalências e respectivos intervalos de confiança de 95% (IC95%) segundo sexo, faixa etária, tipo de escola e cor da pele. RESULTADOS Entre 2013 e 2014 foram avaliados 74.589 adolescentes, 55,3% do sexo feminino. A prevalência total de asma ativa foi 13,1% (IC95% 12,1-13,9), sendo superior nas meninas (14,8%; IC95% 13,7-16,0) em relação aos meninos (11,2%; IC95% 10,3-12,2) em todos estratos geográficos analisados, e também entre os alunos da rede privada (15,9%; IC95% 14,2-17,7) em relação aos de escolas públicas (12,4%; IC95% 11,4-13,4). Foi mais elevada na região Sudeste (14,5%; IC95% 12,9-16,1) e na cidade de São Paulo (16,7%; IC95% 14,7-18,7). A menor prevalência foi observada na região Norte (9,7%; IC95% 9,7-10,5) e em Teresina (6,3%; IC95% 4,9-7,7). A prevalência de diagnóstico médico de asma foi 8,7% (IC95% 8,2-9,1); mais elevada na região Norte (13,5%; IC95% 12,7-14,2) e em Porto Alegre (19,8%; IC95% 17,5-22,3) e mais baixa no Centro-Oeste (6,9%; IC95% 6,0-7,8) e em Cuiabá (4,8%; IC95% 3,8-5,9). Não ocorreu diferença significativa na expressão desta taxa entre os sexos, assim como nas outras variáveis avaliadas pelo estudo. CONCLUSÕES A prevalência de asma em adolescentes brasileiros é alta. As taxas de asma ativa e de diagnóstico médico variam amplamente nas diferentes regiões e capitais avaliadas pelo ERICA. Estes resultados poderão auxiliar na elaboração de programas preventivos e de políticas de saúde e no melhor entendimento sobre os fatores associados à asma nessa faixa etária.OBJECTIVE To describe the prevalence of asthma and physician-diagnosed asthma in Brazilian adolescents. METHODS Cross-sectional, national, school-based study with adolescents from 12 to 17 years old, participants in the Study of Cardiovascular Risks in Adolescents (ERICA). The study stratified the sample by region and grouped according to schools and classes with representativeness to the set of cities with more than 100,000 inhabitants of the Country, macro-regions, capitals, and Federal District. A questionnaire collected data through a self-filled in method. We calculated the prevalences and their confidence intervals of 95% (95%CI) according to sex, age group, type of school and skin color. RESULTS Between 2013 and 2014, 74,589 adolescents were evaluated, 55.3% of the female sex. The total prevalence of active asthma was of 13.1% (95%CI 12.1-13.9), being higher in girls (14.8%; 95%CI 13.7-16.0) when compared to boys (11.2%; 95%CI 10.3-12.2) in all geographical strata examined. It was also higher between students of private schools (15.9%; 95%CI 14.2-17.7) when compared to public ones (12.4%; 95%CI 11.4-13.4). It was higher in the Southeast region (14.5%; 95%CI 12.9-16.1), and in the city of Sao Paulo (16.7%; 95%CI 14.7-18.7). The lowest prevalence was observed in North region (9.7%; 95%CI 9.7-10.5), and in Teresina (6.3%; 95%CI 4.9-7.7). The prevalence of physician-diagnosed asthma was of 8.7% (95%CI 8.2-9.1); higher in the North region (13.5%; 95%CI 12.7-14.2), and in Porto Alegre (19.8%; 95%CI 17.5-22.3). It was lower in the Midwest (6.9%; 95%CI 6.0-7.8), and in Cuiaba (4.8%; 95%CI 3.8-5.9). We found no significant difference in the expression of this rate between the sexes, as well as in other variables evaluated by the study. CONCLUSIONS The prevalence of asthma in Brazilian adolescents is high. Rates of active asthma and physician-diagnosed asthma vary widely in different regions and capitals evaluated by the ERICA. These results may assist in the preparation of preventive programs and policies on health and a better understanding of the factors associated with asthma in this age group