Mental disorders in pregnancy and newborn conditions: longitudinal study with pregnant women attended in primary care

This study aimed to determine the presence and association of possible mental disorders diagnoses in primary care pregnant women and newborns' conditions. This is a longitudinal study with pregnant women (18-39 years), in the second and third trimesters of pregnancy, attended at primary care facilities in the metropolitan region of Sao Paulo (February to August/2014). The following tools were used: sociodemographic questionnaireMental Disorders in Primary Care Assessment tooland an interview with information and mother's perception of the behavior of newborns. Of the 300 pregnant women interviewed, 76 had possible diagnosis of mental disorders, 46 women had depression/dysthymia and 58 anxiety/panic symptoms. Low birth weight and prematurity was observed in 14 and 19 newborns, respectively, and there was no association with the probable diagnosis of mental disordersthe possible presence of mental disorders was associated with the mother's perception of newborns behavior. Pregnant women attended at low risk prenatal care showed relevant frequency of mental disordersthus, the identification of these changes during pregnancy can also contribute to a better understanding of the mother-and-child dynamics and in the quality of family care.O objetivo do estudo foi verificar a presença e a associação entre diagnósticos prováveis de transtornos mentais em gestantes da atenção básica e condições dos recém-nascidos. Estudo longitudinal com gestantes (18 a 39 anos), no segundo e terceiro trimestres da gravidez, assistidas na atenção básica da região Metropolitana de São Paulo (fevereiro a agosto/2014). Foram aplicados: questionário sociodemográfico, instrumento para Avaliação de Transtornos Mentais na Atenção Primária e entrevista sobre informações e percepção do comportamento do recém-nascido. Das 300 gestantes entrevistadas, 76 apresentaram diagnóstico provável de transtorno mental, sendo que 46 apresentavam sintomas de depressão/distimia e 58, ansiedade/pânico. Observou-se baixo peso ao nascer e prematuridade em 14 e 19 dos recém-nascidos, respectivamente, e não foi verificada associação com diagnósticos prováveis de transtorno mental; a presença destes associou-se com a percepção materna de alterações no comportamento do recém-nascido. Gestantes em acompanhamento de pré-natal de baixo risco apresentam frequência relevante de transtornos mentais, logo, a identificação dessas alterações na gestação pode colaborar para melhor compreensão da dinâmica do binômio mãe-filho e na qualidade na assistência à família.Univ Fed Sao Paulo, Escola Paulista Med, Dept Pediat, R Botucatu 598, BR-04023062 Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Dept Pediat, R Botucatu 598, BR-04023062 Sao Paulo, SP, BrazilWeb of Scienc

Adequacy of antenatal care and its relationship with low birth weight in Botucatu, São Paulo, Brazil: a case-control study

Background: Birth weight reflects gestational conditions and development during the fetal period. Low birth weight (LBW) may be associated with antenatal care (ANC) adequacy and quality. the purpose of this study was to analyze ANC adequacy and its relationship with LBW in the Unified Health System in Brazil.Methods: A case-control study was conducted in Botucatu, São Paulo, Brazil, 2004 to 2008. Data were collected from secondary sources (the Live Birth Certificate), and primary sources (the official medical records of pregnant women). the study population consisted of two groups, each with 860 newborns. the case group comprised newborns weighing less than 2,500 grams, while the control group comprised live newborns weighing greater than or equal to 2,500 grams. Adequacy of ANC was evaluated according to three measurements: 1. Adequacy of the number of ANC visits adjusted to gestational age; 2. Modified Kessner Index; and 3. Adequacy of ANC laboratory studies and exams summary measure according to parameters defined by the Ministry of Health in the Program for Prenatal and Birth Care Humanization.Results: Analyses revealed that LBW was associated with the number of ANC visits adjusted to gestational age (OR = 1.78, 95% CI 1.32-2.34) and the ANC laboratory studies and exams summary measure (OR = 4.13, 95% CI 1.36-12.51). According to the modified Kessner Index, 64.4% of antenatal visits in the LBW group were adequate, with no differences between groups.Conclusions: Our data corroborate the association between inadequate number of ANC visits, laboratory studies and exams, and increased risk of LBW newborns. No association was found between the modified Kessner Index as a measure of adequacy of ANC and LBW. This finding reveals the low indices of coverage for basic actions already well regulated in the Health System in Brazil. Despite the association found in the study, we cannot conclude that LBW would be prevented only by an adequate ANC, as LBW is associated with factors of complex and multifactorial etiology. the results could be used to plan monitoring measures and evaluate programs of health care assistance during pregnancy, at delivery and to newborns, focusing on reduced LBW rates.Dean's Office for Research Projects, (PROPE)UNESP - Paulista State UniversityUNESP, Paulista State Univ, Botucatu Med Sch, Dept Pediat, Botucatu, SP, BrazilUniversidade Federal de São Paulo, UNIFESP, Dept Pediat, São Paulo, BrazilUNESP, Paulista State Univ, Inst Biosci, Dept Biostat, Botucatu, SP, BrazilUniversidade Federal de São Paulo, UNIFESP, Dept Pediat, São Paulo, BrazilWeb of Scienc

Enzyme replacement therapy with idursulfase for mucopolysaccharidosis type ii (hunter syndrome)

Background Mucopolysaccharidosis II, also known as Hunter syndrome, is a rare, X-linked disease caused by a deficiency of the lysosomal enzyme iduronate-2-sulfatase, which catalyses a step in the catabolism of glycosaminoglycans. The glycosaminoglycans accumulate within tissues affecting multiple organs and physiologic systems. The clinical manifestations include neurologic involvement, severe airways obstruction, skeletal deformities and cardiomyopathy. The disease has a variable age of onset and variable rate of progression. In those with severe disease, death usually occurs in the second decade of life, whereas those individuals with less severe disease may survive into adulthood. Enzyme replacement therapy with intravenous infusions of idursulfase has emerged as a new treatment for mucopolysaccharidosis type II. This is an update of a previously published version of this review. Objectives To evaluate the effectiveness and safety of enzyme replacement therapy with idursulfase compared to other interventions, placebo or no intervention, for treating mucopolysaccharidosis type II. Search methods We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Trials Register (date of last search 23 November 2015). We also searched Embase, PubMed and the Literature Latino-Americana e do Caribe em Ciencias da Saude (LILACS) (date of last search 28 November 2015). Selection criteria Randomised and quasi-randomised controlled trials of enzyme replacement therapy with idursulfase compared to no intervention, placebo or other options (e.g. behavioral strategies, transplantation). Data collection and analysis Two authors independently screened the trials identified, appraised quality of papers and extracted data. Main results One study (96 male participants) met the inclusion criteria, although the primary outcome of this review -z score for height and weight, was not assessed in the study. This trial was considered to be of overall good quality. Following 53 weeks of treatment, participants in the weekly idursulfase 0.5 mg/kg group demonstrated a significant improvement rate compared with placebo for the primary outcome: distance walked in sixminutes on the basis of the sum of ranks of change from baseline, mean difference 37.00 (95% confidence interval 6.52 to 67.48). The every-other-week idursulfase 0.5 mg/kg group also showed an improvement, which was not significant compared with placebo, mean difference 23.00 (95% confidence interval -4.49 to 50.49). After 53 weeks, there was no statistical significance difference in per cent predicted forced vital capacity between the three groups and absolute forced vital capacity was significantly increased from baseline in the weekly dosing group compared to placebo, mean difference 0.16 (95% confidence interval CI 0.05 to 0.27). No difference was observed between the every-other-week idursulfase 0.5 mg/kg group and placebo. In addition, liver and spleen volumes and urine glycosaminoglycan excretion were significantly reduced from baseline by both idursulfase dosing regimens. Idursulfase was generally well tolerated, but infusion reactions did occur. Idursulfase antibodies were detected in 31.7% of participants at the end of the study and they were related to a smaller reduction in urine glycosaminoglycan levels. Authors' conclusions The current evidence is limited. While the randomised clinical trial identified was considered to be of good quality, it failed to describe important outcomes. It has been demonstrated that enzyme replacement therapy with idursulfase is effective in relation to functional capacity (distance walked in six minutes and forced vital capacity), liver and spleen volumes and urine glycosaminoglycan excretion in people with mucopolysaccharidosis type II compared with placebo. There is no available evidence in the included study and in the literature on outcomes such as improvement in growth, sleep apnoea, cardiac function, quality of life and mortality. More studies are needed to obtain more information on the long-term effectiveness and safety of enzyme replacement therapy.National Institute for Health Research, UKNational Institute for Health ResearchEmergency Medicine and Evidence Based Medicine, Universidade Federal de São Paulo, São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilDepartment of Public Health, Universidade do Estado do Pará, Belém, BrazilDepartment of Urology,Universidade Federal de São Paulo, São Paulo, BrazilEmergency Medicine and Evidence Based Medicine, Universidade Federal de São Paulo, Rua Borges Lagoa 564 Cj 64, BR-04038000 Sao Paulo, SP, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilDepartment of Urology,Universidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc

Birth Weight and Its Relationship with the Cardiac Autonomic Balance in Healthy Children

Several studies indicate that the fetal environment plays a significant role in the development of cardiometabolic disease later in life. However, a few studies present conflicting data about the correlation between birth weight and the impairment of cardiac autonomic modulation. The purpose of the present study was to provide further knowledge to elucidate this contradictory relationship. One hundred children aged 5 and 14 years had anthropometric parameters, body composition and blood pressure levels determined. Heart rate variability (HRV) was evaluated by heart rate monitoring, including measurements of both the time and frequency domains. The results showed inverse correlation between the HRV parameters with BMI (RMSSD: P = 0.047; PNN50: P = 0.021; HF: P = 0.041), systolic (RMSSD: P = 0.023; PNN50: P = 0.032) and diastolic (PNN50: P = 0.030) blood pressure levels. On the other hand, there were consistent positive correlations between the HRV parameters and birth weight (RMSSD: P = 0.001; PNN50: P = 0.001; HF: P = 0.002). To determine the effect of birth weight on HRV parameters, we perform multivariate linear regression analysis adjusted for potentially confounding factors (prematurity, gender, age, BMI, physical activity index and SBP levels). These findings were preserved even after adjusting for these confounders. Our results suggested that impaired cardiac autonomic modulation characterized by a reduction in the parasympathetic activity occurs in children with low birth weight. One possible interpretation for these data is that a vagal withdrawal, rather than a sympathetic overactivity, could precede the development of hypertension and other cardiometabolic diseases in children with low birth weight. However, long-term studies should be performed to investigate this possibility.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Univ Fed Sao Paulo, Div Nephrol, Sao Paulo, BrazilUniv Fed Alagoas, Dept Nutr, Alagoas, BrazilUniv Fed Sao Paulo, Dept Pediat, Sao Paulo, BrazilUniv Fed Sao Paulo, Div Nephrol, Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Pediat, Sao Paulo, BrazilFAPESP: 2013/03139-0Web of Scienc

Prevalence of malnutrition among children in Embu, São Paulo State, Brazil, 1996-1997

This paper focused on the nutritional profile of children in the municipality of Embu, São Paulo State, Brazil, in 1996-1997, to identify vulnerable population segments that require specific action by health services. The sample consisted of 320 children £ 5 years of age distributed into four socioeconomic strata. The indices were expressed as z-scores: weight/age (W/A), height/age (H/A), and weight/height (W/H) to analyze the nutritional status, and the reference for normality was the NCHS curve. In all population strata and age groups, the height/age index was the most frequently affected, while the weight/height index had the fewest deficits. No statistically significant differences were observed in children's nutritional status between the four population strata or between the different age groups. Children with low birth weight showed the highest prevalence of deficits in all indices. In the municipality, the frequency of deficits were: H/A< 2z: 7.1%, W/H< 2z: 0.2%, and W/A< 2z: 2.9%. Height deficit can be used as an early warning, considering that loss observed over the course of years has future consequences.O presente trabalho teve como objetivo descrever o perfil nutricional de crianças residentes no Município de Embu, São Paulo, Brasil, em 1996-1997, visando a identificar segmentos populacionais mais vulneráveis que demandassem atuação específica dos serviços de saúde. A amostra consistiu em 320 crianças de zero a cinco anos, distribuídas em quatro estratos de condições de vida. Considerou-se os índices expressos em z escores: P/I, E/I e P/E, para avaliação antropométrica e a curva NCHS como referência. Em todos os estratos e em todas as faixas de idade, o índice E/I foi o mais freqüentemente comprometido e o P/E apresentou menores freqüências de déficits. Não se observaram diferenças estatisticamente significantes entre os quatro estratos e entre as faixas de idade. As crianças nascidas com baixo peso apresentaram maiores prevalências de déficits, considerando-se todos os índices. As freqüências de déficits para o município foram: P/I < 2z: 2,9%, E/I < 2z: 7,1% e P/E < 2z : 0,2%. O déficit estatural pode servir como alerta, considerando que perdas ao longo dos anos têm reflexos no futuro.Universidade Federal de São Paulo (UNIFESP) Departamento de PediatriaUniversidade de São Paulo Faculdade de Saúde Pública Departamento de EpidemiologiaUNIFESP, Depto. de PediatriaSciEL

Salud del niño: factores de riesgo aplicados en programas de atención básica a la salud

OBJECTIVE:To compare the frequency of risk factors in children attending basic health units (UBS) in two periods (1988-1989 and 2005-2006) and to analyze the association of these factors with malnutrition, hospitalization and death. METHODS: A retrospective study using a quantitative approach with a random cohort sample (n = 414) of children under one year of age, enrolled in two UBS of Embu (SP) in 2005-2006. Independent variables: high risk and presence of risk factors. Outcomes: unfavorable weight gain, malnutrition, hospitalization and death. Statistics: Chi-square and Odds Ratio. RESULTS: In 2005-2006, we found: a higher frequency of neonatal complications and adolescent mothers; lower rates of malnutrition or death of a sibling 2z (17.9%); hospitalizations (21.8%); no deaths. Low birth weight was associated with hospitalization (OR = 4.04, 95% : 1,35-12, 04). CONCLUSIONS: Low birth weight remains an important risk factor and the proportion of overweight / obesity indicates a need for redirection of child health activities.OBJETIVO: comparar las frecuencias de los factores de riesgo en niños matriculados en unidades básicas de salud (UBS) en dos períodos (1988-1989 y 2005-2006) y analizar la asociación de esos factores con desnutrición, internamiento y óbito. MÉTODOS: Estudio de abordaje cuantitativo, tipo cohorte retrospectivo con muestra probabilística (n=414) de niños menores de un año matriculados en dos UBSs de Embu (SP), en 2005-2006. Las variables independientes: alto riesgo y presencia de factores de riesgo. Desenlace: evolución ponderal desfavorable, déficit nutricional, internamiento, óbito. Estadística: Chi-Cuadrado y Odds Ratio. RESULTADOS: en 2005-2006, se verificó: mayor frecuencia de variaciones neonatales y madres adolescentes; menor frecuencia de desnutrición u óbito de hermano 2z (17,9%); internamientos (21,8%); ningún óbito. Bajo peso al nacer se asoció al internamiento (OR=4,04;IC95%:1,35-12,04). CONCLUSIONES: Bajo peso al nacer permanece, como un importante factor de riesgo y la proporción de sobrepeso/obesidad indica la necesidad de redireccionamiento de las acciones de salud del niño.OBJETIVO: comparar as frequências dos fatores de risco em crianças matriculadas em unidades básicas de saúde (UBS) em dois períodos (1988-1989 e 2005-2006) e analisar a associação desses fatores com desnutrição, internação e óbito. MÉTODOS:Estudo de abordagem quantitativa, tipo coorte retrospectiva com amostra probabilística (n=414) de crianças menores de um ano matriculadas em duas UBSs do Embu (SP), em 2005-2006. Variáveis independentes: alto risco e presença de fatores de risco. Desfechos: evolução ponderal desfavorável, déficit nutricional, internação, óbito. Estatística: Qui-Quadrado e Odds Ratio. RESULTADOS: em 2005-2006, verificou-se: maior frequência de intercorrências neonatais e mães adolescentes; menor freqüência de desnutrição ou óbito de irmão 2z (17,9%); internações (21,8%); nenhum óbito. Baixo peso ao nascer associou-se à internação (OR=4,04;IC95%:1,35-12,04). CONCLUSÕES: Baixo peso ao nascer permanece, como importante fator de risco e a proporção de sobrepeso/obesidade indica necessidade de redirecionamento das ações de saúde da criança.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Atention to children and adolescents with short stature: the experience in an interdisciplinary clinic

Objetivo: Descrever a experiencia de um ambulatorio interdisciplinar para atendimento de criancas e adolescentes com baixa estatura. Metodos: Estudo descritivo de 152 pacientes acompanhados no ambulatorio Crescer - Departamento de Pediatria UNIFESP (Pediatria geral/comunitaria, Endocrinologia, Genetica e Nutricao). Criterios de inclusao: criancas acima de dois anos de idade com estatura para idade menor que o percentil 5, segundo curva do NCHS. Resultados: Cerca de 80 por cento dos pacientes eram procedentes de ambulatorios do Hospital São Paulo; a media de comparecimentos foi de 4,8 consultas, sendo que 15,1 por cento dos pacientes compareceram somente a primeira consulta. A idade de inclusao variou de dois a 15 anos, sendo a maioria (63,2 por cento) do sexo masculino. Observou-se a relacao peso para estatura menor que 90 por cento em 36,2 por cento das criancas e indice de massa corporea menor que o percentil 5 em 17,2 por cento dos adolescentes. Quanto ao peso ao nascer, 31,1 por cento dos pacientes nasceram com baixo peso. A asma foi a doenca associada mais comumente referida (32,2 por cento). Em 77,8 por cento dos casos, a estatura observada encontrava-se dentro do canal familiar e 52,8 por cento das maes dos pacientes apresentaram estatura abaixo do P5 da curva do NCHS. Dentre os 99 pacientes com periodo de seguimento superior a seis meses, 17,2 por cento apresentaram velocidade de crescimento inadequada. O diagnostico etiologico preponderante da baixa estatura foi familiar/constitucional em 58,6 por cento dos casos, 9,1 por cento com etiologia genetica e 2 por cento hormonal. Em 14,1 por cento dos pacientes a principal causa para a baixa estatura foi o retardo de crescimento intra-uterino. Conclusao: O atendimento da baixa estatura deve ser iniciado e, na quase totalidade dos casos, acompanhado pelo pediatra geral, com a observacao das causas mais frequentemente apontadas e dos exames necessarios para a consolidacao do diagnosticoBV UNIFESP: Teses e dissertaçõe