Factors Associated with Height Catch-Up and Catch-Down Growth Among Schoolchildren

In developed countries, children with intrauterine growth restriction (IUGR) or born preterm (PT) tend to achieve catch-up growth. There is little information about height catch-up in developing countries and about height catch-down in both developed and developing countries. We studied the effect of IUGR and PT birth on height catch-up and catch-down growth of children from two cohorts of liveborn singletons. Data from 1,463 children was collected at birth and at school age in Ribeirão Preto (RP), a more developed city, and in São Luís (SL), a less developed city. A change in z-score between schoolchild height z-score and birth length z-score≥0.67 was considered catch-up; a change in z-score≤−0.67 indicated catch-down growth. The explanatory variables were: appropriate weight for gestational age/PT birth in four categories: term children without IUGR (normal), IUGR only (term with IUGR), PT only (preterm without IUGR) and preterm with IUGR; infant's sex; maternal parity, age, schooling and marital status; occupation of family head; family income and neonatal ponderal index (PI). The risk ratio for catch-up and catch-down was estimated by multinomial logistic regression for each city. In RP, preterms without IUGR (RR = 4.13) and thin children (PI<10th percentile, RR = 14.39) had a higher risk of catch-down; catch-up was higher among terms with IUGR (RR = 5.53), preterms with IUGR (RR = 5.36) and children born to primiparous mothers (RR = 1.83). In SL, catch-down was higher among preterms without IUGR (RR = 5.19), girls (RR = 1.52) and children from low-income families (RR = 2.74); the lowest risk of catch-down (RR = 0.27) and the highest risk of catch-up (RR = 3.77) were observed among terms with IUGR. In both cities, terms with IUGR presented height catch-up growth whereas preterms with IUGR only had height catch-up growth in the more affluent setting. Preterms without IUGR presented height catch-down growth, suggesting that a better socioeconomic situation facilitates height catch-up and prevents height catch-down growth

Prevalence of non-communicable diseases in Brazilian children: follow-up at school age of two Brazilian birth cohorts of the 1990's

<p>Abstract</p> <p>Background</p> <p>Few cohort studies have been conducted in low and middle-income countries to investigate non-communicable diseases among school-aged children. This article aims to describe the methodology of two birth cohorts, started in 1994 in Ribeirão Preto (RP), a more developed city, and in 1997/98 in São Luís (SL), a less developed town.</p> <p>Methods</p> <p>Prevalences of some non-communicable diseases during the first follow-up of these cohorts were estimated and compared. Data on singleton live births were obtained at birth (2858 in RP and 2443 in SL). The follow-up at school age was conducted in RP in 2004/05, when the children were 9-11 years old and in SL in 2005/06, when the children were 7-9 years old. Follow-up rates were 68.7% in RP (790 included) and 72.7% in SL (673 participants). The groups of low (<2500 g) and high (≥ 4250 g) birthweight were oversampled and estimates were corrected by weighting.</p> <p>Results</p> <p>In the more developed city there was a higher percentage of non-nutritive sucking habits (69.1% vs 47.9%), lifetime bottle use (89.6% vs 68.3%), higher prevalence of primary headache in the last 15 days (27.9% vs 13.0%), higher positive skin tests for allergens (44.3% vs 25.3%) and higher prevalence of overweight (18.2% vs 3.6%), obesity (9.5% vs 1.8%) and hypertension (10.9% vs 4.6%). In the less developed city there was a larger percentage of children with below average cognitive function (28.9% vs 12.2%), mental health problems (47.4% vs 38.4%), depression (21.6% vs 6.0%) and underweight (5.8% vs 3.6%). There was no difference in the prevalence of bruxism, recurrent abdominal pain, asthma and bronchial hyperresponsiveness between cities.</p> <p>Conclusions</p> <p>Some non-communicable diseases were highly prevalent, especially in the more developed city. Some high rates suggest that the burden of non-communicable diseases will be high in the future, especially mental health problems.</p

Staff workload and adverse events during mechanical ventilation in neonatal intensive care units

Submitted by Santos Bárbara ([email protected]) on 2015-01-08T11:35:48Z No. of bitstreams: 1 Carga de trabalho de profissionais da saúde e eventos adversos durante ventilação mecânica em unidades....pdf: 265224 bytes, checksum: a86721d23466bc07539fc7295ee3fee4 (MD5)Approved for entry into archive by Santos Bárbara ([email protected]) on 2015-01-08T11:36:06Z (GMT) No. of bitstreams: 1 Carga de trabalho de profissionais da saúde e eventos adversos durante ventilação mecânica em unidades....pdf: 265224 bytes, checksum: a86721d23466bc07539fc7295ee3fee4 (MD5)Approved for entry into archive by Santos Bárbara ([email protected]) on 2015-01-08T11:57:55Z (GMT) No. of bitstreams: 1 Carga de trabalho de profissionais da saúde e eventos adversos durante ventilação mecânica em unidades....pdf: 265224 bytes, checksum: a86721d23466bc07539fc7295ee3fee4 (MD5)Made available in DSpace on 2015-01-08T11:57:55Z (GMT). No. of bitstreams: 1 Carga de trabalho de profissionais da saúde e eventos adversos durante ventilação mecânica em unidades....pdf: 265224 bytes, checksum: a86721d23466bc07539fc7295ee3fee4 (MD5) Previous issue date: 2011Universidade Federal do Maranhão. Departamento de Medicina III. São Luís, MA, Brasil.Universidade Federal do Maranhão. Departamento de Saúde Pública. São Luís, MA, Brasil.Fundação Oswaldo Cruz. Instituto Fernandes Figueira. Departamento de Neonatologia. Rio de Janeiro, RJ, Brasil.Universidade Federal do Maranhão. Departamento de Saúde Pública. São Luís, MA, Brasil.Universidade Federal do Maranhão. Departamento de Medicina I. São Luís, MA, Brasil.Universidade Federal do Maranhão. Departamento de Saúde Pública. São Luís, MA, Brasil.Objetivo: Investigar uma possível associação entre a carga de tra-balho de profissionais da saúde e eventos adversos intermediários, tais como extubação acidental, obstrução do tubo endotraqueal e desconexão acidental do circuito do ventilador, durante ventilação mecânica neonatal em unidades neonatais de alto risco. Método: Este estudo de coorte prospectiva analisou os dados refe-rentes a 543 recém-nascidos de unidades de terapia intensiva neonatal (UTINs) de São Luís (MA) por 6 meses, durante os quais 136 recém-nascidos foram submetidos a ventilação mecânica em 1.108 turnos e foram observados 4.554 vezes. Resultados:Ocorreram eventos adversos 117 vezes durante esse período. As associações entre carga de trabalho e eventos adversos foram analisadas por meio de equações de estimação generalizada. As variáveis de ajuste foram: peso de nascimento, gênero, maternidade estudada, pontuação no índice de risco clínico para bebês (clinical risk index for babies) e demanda de cuidados, determinada pela escala desenvolvida pela Northern Neonatal Network. Quanto maior o número de recém-nas-cidos classificados de acordo com a demanda de cuidados (RCDCs) por enfermeiro e técnico em enfermagem, maior a probabilidade da ocorrência de eventos adversos intermediários relacionados à ventilação mecânica. Um número de RCDCs > 22 por enfermeiro [risco relativo (RR) = 2,86] e > 4,8 por enfermeiro auxiliar (RR = 3,41) esteve associado a uma maior prevalência de eventos adversos intermediários. Conclusões: A carga de trabalho dos profissionais de UTINs parece interferir nos resultados intermediários do cuidado neonatal e, portanto, deve ser levada em conta na avaliação dos desfechos na UTIN.Objective:To investigate a possible association between the intensity of staff workload and intermediate adverse events, such as accidental extubation, obstruction of the endotracheal tube, and accidental disconnection of the ventilator circuit, during neonatal mechanical ventilation in high-risk neonatal units. Method:This prospective cohort study analyzed data of 543 newborns from public neonatal intensive care units (NICUs) in the city of São Luís, state of Maranhão, Northeastern Brazil, for 6 months, during which 136 newborns were submitted to mechanical ventilation in 1,108 shifts and were observed a total of 4,554 times. Results: Adverse events occurred 117 times during this period. The associations between workload and adverse events were analyzed by means of generalized estimating equations. The adjustment variables were: birth weight, gender, maternity unit, Clinical Risk Index for Babies score, and care demand, the latter measured by the Northern Neonatal Network Scale. The larger the number of newborns classified by care demand (NCCD) per nurse and nursing technician, the more likely the occurrence of intermediate adverse events linked to mechanical ventilation. A number of NCCD > 22 per nurse (relative risk [RR] = 2.86) and > 4.8 per auxiliary nurse (RR = 3.41) was associated with a higher prevalence of intermediate adverse events. Conclusions: The workload of NICU professionals seems to interfere with the intermediate results of neonatal care and thus should be taken into consideration when evaluating NICU outcome

Frequency (weighted percentage) and non-adjusted risk ratio for the change in height z-score (catch-up and catch-down growth) according to birth variables. Ribeirão Preto, 1994/2004–05.

*<p>RR- risk ratio;</p>**<p>CI – confidence interval;</p>***<p>normal: term children without IUGR – intrauterine growth restriction;</p>****<p>p value excluding missing data and calculated by the chi-square test.</p

Mean z-score for birth length and for height at school age and difference between these means by preterm birth/IUGR status. Ribeirão Preto, 1994/2004–05 and São Luís, 1997–98/2005–06.

*<p>difference between birth length z-score and height at school age;</p>**<p>CI – confidence interval;</p>***<p>normal: term children without IUGR – intrauterine growth restriction;</p>****<p>Calculated by ANOVA.</p

Initial sample, eligible for follow-up, number and percentage followed-up in the 1994 Ribeirão Preto and 1997/98 São Luís birth cohorts.

*<p>P value calculated by the chi-square test.</p

Adjusted risk ratio for the changes in z-score for height (catch-up and catch-down growth) according to birth variables. São Luís, 1997–98/2005–06.

*<p>RR- risk ratio;</p>**<p>CI – confidence interval;</p>***<p>normal: term children without IUGR – intrauterine growth restriction;</p