Abstract Objectives: a systematic review study with the objective of estimating the effect on the practice of the kangaroo method (KM) on the formation and strengthening of the mother-baby bond ...(MBB). Methods: independent searches were performed in three international databases in the United States National Library of Medicine - PubMed, Scientific Electronic Library Online - Scielo and Web of Science databases. Searches were made without limit on languages and year of publication. Results: the final selection consisted of 27 studies, 14 of a quantitative nature (nine clinical trials and five observational) and 13 qualitative. All qualitative articles and most quantitative ones (n=10) indicated the practice of the KM as favorable to the formation and strengthening of the MBB. Other quantitative studies did not show statistically significant differences in the comparisons made between groups. None of the 27 studies found unfavorable effects resulting from the practice of KM on the MBB. Conclusion: the results suggest that the KM favors the formation and strengthening of the MBB regardless of the weight and gestational age of the newborns or the place of measurement (hospital or residence). Thus, encouraging the execution of this biopsychosocial intervention of qualified and humanized care is recommended for the promotion of children’s health.
Resumo Objetivos: estudo de revisão sistemática com objetivo de estimar o efeito da prática do método canguru (MC) na formação e fortalecimento do vínculo mãe-bebê (VMB). Métodos: foram realizadas buscas independentes em três bases de dados internacionais nas bases de dados United States National Library of Medicine - PubMed, Scientific Electronic Library Online - Scielo e Web of Science. As buscas foram feitas sem limite para idioma e ano de publicação. Resultados: a seleção final foi composta por 27 estudos, 14 de caráter quantitativo (nove ensaios clínicos e cinco observacionais) e 13 qualitativos. Todos os artigos qualitativos e a maioria dos quantitativos (n=10) apontaram a prática do MC como favorável à formação e ao fortalecimento do VMB. Os demais estudos quantitativos não apresentaram diferenças estatisticamente significantes nas comparações realizadas entre grupos. Nenhum dos 27 estudos encontrou efeitos desfavoráveis resultantes da prática do MC sobre o VMB. Conclusão: os resultados sugerem que o MC favorece a formação e o fortalecimento do VMB independentemente do peso e idade gestacional dos recém-nascidos e do ambiente de medição (hospital ou domicílio). Assim, o incentivo a execução desta intervenção biopsicossocial de atenção qualificada e humanizada é recomendada para a promoção de saúde da criança.
Cardiovascular diseases are the main cause of mortality in the world, generating important socioeconomic and cultural impacts. Spirituality has been associated with the main risk factors for acute ...myocardial infarction, influencing lifestyle, and drug treatment compliance. Estimate the level of spiritual well-being and its association with coronary artery disease. We conducted a case–control study with 88 adults (42 cases and 46 controls) individually interviewed. Using a spiritual well-being scale and collecting socioeconomic and demographic information. We compared groups by Chi-square and Mann–Whitney tests. Friedman’s analysis of variance was used to evaluate the differences between the values assigned to the scale items in each group. Statistically, there was no significant difference between categories and levels of spiritual well-being in any of the groups. Both had high rates, driven by the high level of religious well-being. There was no difference between the rates attributed to the items on the subscale of religious well-being, in the case or control groups (
p
= 0.959 and
p
= 0.817). However, the existential well-being subscale revealed variability between the scores attributed to each item in both groups (
p
< 0.001). The results revealed a high level of spiritual well-being in the analyzed sample. There was no correlation between the levels of spiritual, religious, and existential well-being with coronary artery disease, possibly due to the reduced ability of the religious well-being subscale to discriminate between groups.
In high- and middle-income countries, mortality associated to congenital diaphragmatic hernia (CDH) is high and variable. In Brazil, data is scarce regarding the prevalence, mortality, and lethality ...of CDH. This study aimed to analyze, in São Paulo state of Brazil, the temporal trends of prevalence, neonatal mortality and lethality of CDH and identify the time to CDH-associated neonatal death.
Population-based study of all live births with gestational age ≥ 22 weeks, birthweight ≥400g, from mothers residing in São Paulo State, Brazil, during 2004-2015. CDH definition and its subgroups classification were based on ICD-10 codes reported in the death and/or live birth certificates. CDH-associated neonatal death was defined as death up to 27 days after birth of infants with CDH. CDH prevalence, neonatal mortality and lethality were calculated and their annual percent change (APC) with 95% confidence intervals (95%CI) was analyzed by Prais-Winsten. Kaplan-Meier estimator identified the time after birth that CDH-associated neonatal death occurred.
CDH prevalence was 1.67 per 10,000 live births, with a significant increase throughout the period (APC 2.55; 95%CI 1.30 to 3.83). CDH neonatal mortality also increased over the time (APC 2.09; 95%CI 0.27 to 3.94), while the lethality was 78.78% and remained stationary. For isolated CDH, CDH associated to non-chromosomal anomalies and CDH associated to chromosomal anomalies the lethality was, respectively, 72.25%, 91.06% and 97.96%, during the study period. For CDH as a whole and for all subgroups, 50% of deaths occurred within the first day after birth.
During a 12-year period in São Paulo State, Brazil, CDH prevalence and neonatal mortality showed a significant increase, while lethality remained stable, yet very high, compared to rates reported in high income countries.
Background
This study aimed to identify main factors associated with child and adolescent access to chronic kidney disease (CKD) treatment in Brazil.
Methods
Multi-center cross-sectional study ...conducted in eight pediatric nephrology centers across all Brazilian geographic regions. Information was collected on characteristics associated with referral and treatment of patients with CKD. The following outcomes were analyzed as follows: (1) age at first consultation, and (2) time elapsed between referral and treatment at the specialized service.
Results
Three hundred thirty-five children were assessed. Variables associated with age at first consultation were as follows: CAKUT (HR=1.7; 95%CI 1.3–2.2,
p
<0.01); private health plan (HR=1.54; 95%CI 1.06–2.23,
p
=0.02); modified Medical Outcomes Study Social Support Survey mMOS-SS score (HR=1.02; 95%CI 1.00–1.03,
p
=0.024); maternal age (HR=0.96; 95%CI 0.95–0.97,
p
<0.01); and number of siblings in the household (HR=0.86; 95%CI 0.79–0.83,
p
<0.01). Significant variables associated with time elapsed between referral and treatment at the specialized service were as follows: each additional occupant sharing the household (HR=0.94; 95%CI:0.89–0.99,
p
=0.02), residing in the Northeast (HR=0.81; 95%CI:0.67–0.98,
p
=0.03) and having someone to take them to the physician (HR=1.36; 95%CI 1.07–1.74,
p
=0.01). The median time interval between patient referral and treatment by the service was 11 days (IQR 10–31).
Conclusion
There are potentially modifiable factors hampering access of children with CKD to specialized treatment. The importance of the role of social support for the two outcomes should serve as an alert for health managers and professionals to consider this aspect throughout all steps of the care process of children with CKD.
To estimate trends in mortality rate and average age of death, and identify sociodemographic factors associated with early death in patients with sickle cell disease (SCD).
An ecological and ...cross-sectional study was conducted using data from the Mortality Information System. All deaths of patients residing in the state of São Paulo from 1996 to 2015 with at least one International Disease Code for SCD in any field of the death certificate were included. Simple linear regression was used to estimate trends. The Log-rank test and multiple Cox regression were used to identify factors associated with early death.
The age-standardized mortality rate per million inhabitants increased by 0.080 per year (R2=0.761; p<0.001). When the events were stratified by age at death, the increase was 0.108 per year for those occurring at age 20 years or older, (R2=0.789; p<0.001) and 0.023 per year for those occurring before age 20 years old (R2=0.188; p=0.056). The average age at death increased by 0.617 years (7.4 months) per year (R2=0.835; p<0.001). Sociodemographic factors associated with early death identified were male gender (hazard ratio - HR=1.30), white race (HR=1.16), death occurring in the hospital (HR=1.29), and living in the Greater São Paulo (HR=1.13).
The mortality rate and the average age of death in patients with SCD have increased over the last two decades. Sociodemographic factors such as gender, race, place of occurrence, and residence were found to be associated with early death.
Infant mortality rate is a measure of population health and neonatal mortality account for great proportion of these deaths. Underdevelopment might be associated to higher neonatal mortality risk due ...to assistant related factors. Spatial and temporal distribution of mortality help identifying and developing strategies for interventions.
To investigate the cluster areas of asphyxia-associated neonatal mortality and to explore its association with per capita gross domestic product (GDP) in São Paulo State (SP), Brazil.
Ecological study including live births residents in SP from 2004-2013. Neonatal deaths (0-27 days) with perinatal asphyxia were defined as intrauterine hypoxia, birth asphyxia or meconium aspiration syndrome written in any line of the Death Certificate. Geoprocessing analytical approach included detection of first order effects through quintiles and spatial moving average maps, followed by second order effects by global and local spatial autocorrelation (Moran and LISA, respectively) before and after smoothing with local Bayesian estimates. Finally, Spearman correlation was applied between asphyxia-associated neonatal mortality and mean per capita GDP rates for the municipalities with significant LISA.
There were 6,713 asphyxia-associated neonatal deaths among 5,949,267 live births (rate: 1.13/1000) in SP. Spatial moving average maps showed a non-random distribution among municipalities, with presence of clusters (I = 0.048; p = 0.023). LISA map identified clusters of asphyxia-associated neonatal mortality in the south, southeast and northwest. After applying local Bayes estimates, clusters were more pronounced (I = 0.589; p = 0.001). There was a partial overlap of the areas of higher asphyxia-associated neonatal mortality and lower mean per capita GDP.
Spatial analysis identified cluster areas of high asphyxia-associated neonatal mortality and low per capita GDP rates, with a significant negative correlation. This optimized, structured, and hierarchical approach to identify high-risk areas of cause-specific neonatal mortality may be helpful for guiding public health efforts to decrease neonatal mortality.
This study aimed to estimate the prevalence of psychoactive substance use by adolescents from public schools. This is a cross-sectional study that used a random sample of adolescents from five public ...schools located in a municipality in the central-west region of the São Paulo Metropolitan Area, Brazil. Information on demographic, socioeconomic, and drug use was collected using self-report questionnaires. The sample consisted of 1,460 students, 716 (49%) males, aged 10-19 years (13.19±2.04 years). The prevalence of psychoactive substance use in the last month was 51% for analgesics; 48.8% for alcohol; 37.3% for tobacco; 30.8% for tranquilizers; 23.1% for marijuana; 22.6% for anabolic steroids; 21.6% for ecstasy; 15.3% for amphetamines/stimulants; 13.4% for phencyclidine; 12.9% for cocaine/crack; 12.6% for inhalants/solvents; 11.5% for opiates; 11.4% for hallucinogens; and 16.2% for other unclassified drugs. Elementary and middle school students were more likely to consume tobacco (OR = 2.306; 95%CI: 1.733-3.068; p < 0.001), and male students were more likely to consume any type of substance. We identified a high use of psychoactive substances among this study participants, with a higher prevalence among male students.
To identify the prevalence and factors associated with the consumption of ultra-processed foods by Brazilian adolescents.
The sample was representative of adolescents and participants in the ...cross-sectional population-based study National Survey of School Health, 2015 edition (PeNSE-2015). A self-administered questionnaire was used for data collection. The variable weekly consumption of ultra-processed foods was considered, and consumption more than seven times a week was considered excessive. Descriptive and inferential analyses of demographic, socioeconomic, behavioral and environmental characteristics potentially associated with the outcome were performed. Poisson's multiple regression model was adjusted to control for confounding factors.
The prevalence of excessive consumption of ultra-processed foods among 16,324 adolescents in Brazil was 75.4%. Nine factors independently associated with this outcome were identified: age under 15 years (RR 1.08; p<0.001), daily sitting time greater than four hours (RR 1.13; p<0.001), eating while watching TV or studying more than four days a week (RR 1.09; p<0.001), daily TV time greater than three hours (RR 1.08; p<0.001), breakfast frequency less than four days a week (RR 1,03; p=0.001), having a cell phone (RR 1.12; p<0.001), absent maternal education (RR 0.88; p<0.001), being enrolled in a private school (RR 1.05; p=0.002) located in the urban area (RR 1.13; p=0.002).
The results express the multifactorial characteristic of excessive consumption of ultra-processed foods and suggest the need for the development and implementation of health policies to guide the consumption of these foods and the importance of adopting healthy behaviors for this population group in both school and home environments.
There are few reports in the literature estimating the epidemiologic characteristics of pediatric chronic dialysis. These patients have impaired physical growth, high number of comorbidities and ...great need for continuous attention of specialized services with high demand for complex and costly procedures.
The aim of this study was to estimate the incidence and prevalence rates and describe the characteristics of children and adolescents undergoing chronic dialysis treatment in a Brazilian demographic health survey.
A cross-sectional study was performed in a representative sample of dialysis centers (nc = 239) that was established from the 2011 Brazilian Nephrology Society Census (Nc = 708). We collected data encompassing the five Brazilian macro-regions. We analyzed the data from all patients under 19 years of age. The sample population consisted of 643 children and adolescents who were on chronic dialysis program anytime in 2012. Data collection was carried out in the dialysis services by means of patients' records reviews and personal interviews with the centers' leaders.
We estimated that there were a total of 1,283 pediatric patients on chronic dialysis treatment in Brazil, resulting in a prevalence of 20.0 cases per million age-related population (pmarp) (95% CI: 14.8-25.3) and an incidence of 6.6 cases pmarp in 2012 (95% CI: 4.8-8.4). The South region had the highest prevalence and incidence rates of patients under dialysis therapy, 27.7 (95% CI: 7.3-48.1) and 11.0 (95% CI: 2.8-19.3) cases pmarp, respectively; the lowest prevalence and incidence rates were found in the North-Midwest region, 13.8 (95% CI: 6.2-21.4), and in the Northeast region, 3.8 (95% CI: 1.4-6.3) cases pmarp, respectively.
Brazil has an overall low prevalence of children on chronic dialysis treatment, figuring near the rates from others countries with same socioeconomic profile. There are substantial differences among regions related to pediatric chronic dialysis treatment. Joint strategies aiming to reduce inequities and improving access to treatment and adequacy of services across the Brazilian regions are necessary to provide an appropriate care setting for this population group.
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