Avaliação do desenvolvimento neuropsicomotor em crianças na rede básica de saúde utilizando o teste de Denver II: identificação de fatores de risco materno

Alterations in the neuropsychomotor development of children are not rare and can manifest themselves with varying intensity at different stages of their development. In this context, maternal risk factors may contribute to the appearance of these alterations. A number of studies have reported that neuropsychomotor development diagnosis is not an easy task, especially in the basic public health network. Diagnosis requires effective, low-cost, and easy - to-apply procedures. The Denver Developmental Screening Test, first published in 1967, is currently used in several countries. It has been revised and renamed as the Denver II Test and meets the aforementioned criteria. Accordingly, the aim of this study was to apply the Denver II Test in order to verify the prevalence of suspected neuropsychomotor development delay in children between the ages of 0 and 12 months and correlate it with the following maternal risk factors: family income, schooling, age at pregnancy, drug use during pregnancy, gestational age, gestational problems, type of delivery and the desire to have children. For data collection, performed during the first 6 months of 2004, a clinical assessment was made of 398 children selected by pediatricians and the nursing team of each public health unit. Later, the parents or guardians were asked to complete a structured questionnaire to determine possible risk indicators of neuropsychomotor development delay. Finally the Denver II Developmental Screening Test (DDST) was applied. The data were analyzed together, using Statistical Package for Social Science (SPSS) software, version 6.1. The confidence interval was set at 95%. The Denver II Test yielded normal and questionable results. This suggests compromised neuropsychomotor development in the children examined and deserves further investigation. The correlation of the results with preestablished maternal risk variables (family income, mother s schooling, age at pregnancy, drug use during the pregnancy and gestational age) was strongly significant. The other maternal risk variables (gestational problems, type of delivery and desire to have children) were not significant. Using an adjusted logistic regression model, we obtained the estimate of the greater likelihood of a child having suspected neuropsychomotor development delay: a mother with _75 4 years of schooling, chronological age less than 20 years and a drug user during pregnancy. This study produced two manuscripts, one published in Acta Cirúrgica Brasileira , in which an analysis was performed of children with suspected neuropsychomotor development delay in the city of Natal, Brazil. The other paper (to be published) analyzed the magnitude of the independent variable maternal schooling associated to neuropsychomotor development delay, every 3 months during the first twelve months of life of the children selected.. The results of the present study reinforce the multifactorial characteristic of development and the cumulative effect of maternal risk factors, and show the need for a regional policy that promotes low-cost programs for the community, involving children at risk of neuropsychomotor development delay. Moreover, they suggest the need for better qualified health professionals in terms of monitoring child development. This was an inter- and multidisciplinary study with the integrated participation of doctors, nurses, nursing assistants and professionals from other areas, such as statisticians and information technology professionals, who met all the requirements of the Postgraduate Program in Health Sciences of the Federal University of Rio Grande do Norte

Síndrome da fragilidade e fatores associados em idosos comunitários do município de Santa Cruz RN

The frailty in the elderly is characterized by decreased physiological reserves, and is associated with increased risk of disability and high vulnerability to morbidity and mortality. This study is part of a multicentric project on Frailty in Elderly Brazilians (REDE FIBRA). Aims: to investigate characteristics, prevalence and associated factors related to frailty. Metodology: We interviewed 391 elderly patients aged 65 years, selected randomly. Data collection was performed using a multidimensional questionnaire containing information about socio-demographic and clinical variables. To characterize the frail elderly, was considered the phenotype proposed by Fried. Data were analyzed using descriptive statistics, bivariate analysis (χ ²) and binary logistic regression. Results: The prevalence of frailty was 17.1%. In the final model of multivariate analysis, was obtained as factors associated with frailty: advanced chronological age (p <0.001), have comorbidity (p <0.035), show dependence on performing basic activities of daily living (p <0.010) and instrumental (p <0.003) and have poor perception of health status (p <0030). Conclusions: The factors associated with frailty suggest a predictive model helping to understand the syndrome, guiding actions that minimize adverse effects on the aging process

Reavaliação de critérios estruturais na hidrogeologia de terrenos cristalinos, com ênfase na neotectônica e sensoriamento remoto

Hydrogeological prospecting in Northeast Brazil and in other crystalline terrains has been developed on the basis of structural and regional geology concepts that date back to the 50-60 decades and, as such, demand a natural re-evaluation and update. In this kind of terrain, the percolation and accumulation of ground water are controlled by fractures and other types of discontinuities, such as foliations and geological contacts that, through weathering, impart porosity and permeability to the rocks, allowing water flow and storage. Several factors should be considered in the process of locating water wells, as discussed in the literature. Among these, the kind of structures, fracture geometry (including aperture and connectivity) and their geological and chronological context. It is important to correlate fracture systems with the regional neotectonic framework. Fractures at low angle (sub parallel) with the principal stress axis (s1) are those which tend to open (actually they work as tension joints) and, in principle, would present major hydric potential; in the opposite side, fractures at high angle to s1 would behave as closed by a compressional component. Fractures diagonal to the compression and tension axes correspond to shear fractures and, due to their connectivity with second fractures, are also important in terms of hydric potential. Uplift followed by terrain denudation leads to decompression and a general tendency to open (aided by weathering processes) fractures and other rock discontinuities, at different orientations. Low angle fractures, formed in this context, are equally important to increase connectivity, collection of water and recharge of the aquifer systems. In a general way, an opening component (neotectonic or by terrain decompression) and several models to increase fracture connectivity correlate with a greater hydric potential of these structures. Together with parallel research, this thesis addresses models of ground water occurrence in crystalline terrains, either improving well established concepts like the (Riacho-Fenda model), but also stressing other possibilities, like the role of alluvium and paleo-regoliths (the Calha Elúvio-Aluvionar model) and of strongly altered, permo-porous zones placed at variable depths below the present surface, flanking several types of discontinuities, especially interconnected fracture arrays (the Bolsões de Intemperismo model). Different methodological approaches are also discussed in order to improve success rates in the location of water wells in crystalline terrains. In this methodological review, a number of case studies were selected in the eastern domain of the State of Rio Grande do Norte, involving the localities of Santa Cruz, Santo Antônio, Serrinha, Nova Cruz, Montanhas, Lagoa de Pedras and Lagoa Salgada. Besides the neotectonic analysis of brittle structures, this Thesis addresses the validation of remote sensing as a tool for ground water prospecting. Several techniques were tested in order to detect and select areas with higher potential for ground water accumulation, using Landsat 5-TM and RADARSAT images, besides conventional aerial photos. A number of filters were tested to emphasize lineaments in the images, improving their discrimination, to identify areas with higher overburden humidity, which could reflect subsurface water accumulation, as well as alluvium and other sedimentary covers that might act as recharge zones. The work started with a regional analysis with the orbital images, followed by analysis of aerial photos, up to a detailed structural study of rock exposures in the terrain. This last step involved the analysis of outcrops surrounding wells (in a ray of approximately 10 to 100 m) with distinct productivities, including dry examples. At the level required for detail, it was not possible to accomplish a statistical approach using the available well data catalogs, which lack the desired specific information. The methodology worked out in this Thesis must undergo a testing phase through location of new water wells. An increase in the success rates as desired will led to a further consolidation step with wider divulgation of the methodology to private companies and governmental agencies involved in ground water prospecting in crystalline terrains