Postpartum issues' for expectant mothers and fathers

Objective: To investigate the postpartum psychosocial and infant care topics that women and men who attend preparation for parenthood classes have been thinking or worrying about during the pregnancy. Furthermore, to compare the rates of endorsement of such issues for women and men so that clinicians can use this information to help plan which topics to include in preparation for parenthood classes. Design: A survey of expectant parents attending preparation for parenthood classes at a local public hospital. Participants completed a 17- to 19-item postpartum issues checklist devised for the study. Setting: Preparation for parenthood classes conducted in a public hospital in South Western Sydney, Australia. Participants: People attending the session were in their 2nd to 3rd trimester, of low to middle socioeconomic status, and 95% were expecting their first child. Eighty-five percent of women were accompanied by their male partner at the session. Data are reported from 201 women and 182 men. Measure: A 17-item issues checklist was devised initially and later expanded to 19 items. The initial checklist covered three psychosocial issues: interpersonal, intrapersonal, and parental competency. The expanded checklist also included items on infant care issues. Participants rated each item as to the extent to which they had been thinking or worrying about it over the past few weeks. Results: More than half of the men and women had been thinking or worrying about their ability to cope as new parents; just less than half of both men and women endorsed the item regarding the effect having a baby would have on their relationship with their partner; approximately 40% of women had thought that they might get bored or lonely when at home with the baby, and an equal rate of men reported that their partner experiencing this sense of boredom or loneliness was an issue for them. There were few differences between the genders in the rate of endorsement on the issues checklist. Conclusion: That many of the issues on the checklist are prevalent in both women and men at this time in the pregnancy would suggest that these are topics that would be pertinent for inclusion at preparation for parenthood classes. Although the checklist is not exhaustive, the data reported give empirical justification for inclusion of these topics in such classes.

A survey of sodium hypochlorite use by general dental practitioners and endodontists in Australia

Background: Sodium hypochlorite is used commonly as an endodontic irrigant, but there are no published reports that provide details of its use. This survey sought to determine the percentage of Australian dentists who practiced endodontics, whether they used sodium hypochlorite for irrigation, and the manner of dilution, storage and dispensing sodium hypochlorite used by both dentists and endodontists. Methods: All Australian endodontists and a stratified random sample of 200 general dentists in Australia were surveyed to address the issues identified above. Results: Almost 98 per cent of dentists surveyed performed endodontic treatment. Among endodontists, nearly 94 per cent used sodium hypochlorite for irrigation compared with just under 75 per cent of general dentists: Sodium hypochlorite use by general dentists was more common in Victoria and South Australia than in other States. An infant sanitizer (Milton or Johnson's Antibacterial Solution) was used by just over 92 per cent of general practitioners and by more than 67 per cent of endodontists. All other respondents used domestic bleach. One hundred and sixty four of the respondents (80 per cent of endodontists and over 90 per cent of general dentists) used a 1 per cent w/v solution. Ten practitioners used a 4 per cent w/v solution, five used a 2 per cent w/v solution and four used a 1.5 per cent w/v solution. Eighty per cent of the practitioners who diluted their sodium hypochlorite before use, used demineralized water for this purpose. The remainder used tap water. Only four practitioners stored sodium hypochlorite in a manner which risked light exposure and loss of available chlorine content. Conclusions: Sodium hypochlorite is commonly used as an endodontic irrigant and Australian dentists generally stored the material correctly.

Immunoglobulins in saliva of preterm and full-term infants. A longitudinal study from 0-18 months of age

The aim of this longitudinal study was to determine salivary levels of total IgA, IgG and IgM in 84 preterm and 214 full-term infants, from birth to 18 months of age. Unstimulated whole saliva was collected from each infant at birth, and subsequently at 3-monthly intervals. Immunoglobulin levels were estimated using an ELISA technique. At birth, IgA was detected in 147/214 (69%) full-term infants but only 47/84 (56%) preterm infants (P

Drug resistance in the sexually transmitted protozoan Trichomonas vaginalis

Trichomoniasis is the most common, sexually transmitted infection. It is caused by the flagellated protozoan parasite Trichomonas vaginalis. Symptoms include vaginitis and infections have been associated with preterm delivery, low birth weight and increased infant mortality, as well as predisposing to HIV/AIDS and cervical cancer. Trichomoniasis has the highest prevalence and incidence of any sexually transmitted infection. The 5-nitroimidazole drugs, of which metronidazole is the most prescribed, are the only approved, effective drugs to treat trichomoniasis. Resistance against metronidazole is frequently reported and cross-resistance among the family of 5-nitroimidazole drugs is common, leaving no alternative for treatment, with some cases remaining unresolved. The mechanism of metronidazole resistance in T. vaginalis from treatment failures is not well understood, unlike resistance which is developed in the laboratory under increasing metronidazole pressure. In the latter situation, hydrogenosomal function which is involved in activation of the prodrug, metronidazole, is down-regulated. Reversion to sensitivity is incomplete after removal of drug pressure in the highly resistant parasites while clinically resistant strains, so far analysed, maintain their resistance levels in the absence of drug pressure. Although anaerobic resistance has been regarded as a laboratory induced phenomenon, it clearly has been demonstrated in clinical isolates. Pursuit of both approaches will allow dissection of the underlying mechanisms. Many alternative drugs and treatments have been tested in vivo in cases of refractory trichomoniasis, as well as in vitro with some successes including the broad spectrum anti-parasitic drug nitazoxanide. Drug resistance incidence in T. vaginalis appears to be on the increase and improved surveillance of treatment failures is urged.

Printed advice on initiating and maintaining breastfeeding in mid-20th-century Queensland

This article, which is part of a larger historical study of infant-feeding advice received by mothers in Queensland, Australia, identifies and examines print materials that were used by mothers, or that influenced other texts, during the postwar period from 1945 to 1965. The texts are described within the context of their environmental influences and the medical knowledge and research of the time to assess what effect, if any, these latter materials had on the established system of infant-feeding advice. Two innovations that were employed are the use of interviews to identify the most-used texts and the comparison of popular advice books with medical journal material.

Centile reference for total energy expenditure in infants from 1 to 12 months

Background: A knowledge of energy expenditure in infancy is required for the estimation of recommended daily amounts of food energy, for designing artificial infant feeds, and as a reference standard for studies of energy metabolism in disease states. Objectives: The objectives of this study were to construct centile reference charts for total energy expenditure (TEE) in infants across the first year of life. Methods: Repeated measures of TEE using the doubly labeled water technique were made in 162 infants at 1.5, 3, 6, 9 and 12 months. In total, 322 TEE measurements were obtained. The LMS method with maximum penalized likelihood was used to construct the centile reference charts. Centiles were constructed for TEE expressed as MJ/day and also expressed relative to body weight (BW) and fat-free mass (FFM). Results: TEE increased with age and was 1.40,1.86, 2.64, 3.07 and 3.65 MJ/day at 1.5, 3, 6, 9 and 12 months, respectively. The standard deviations were 0.43, 0.47, 0.52, 0.66 and 0.88, respectively. TEE in MJ/kg increased from 0.29 to 0.36 and in MJ/day/kg FFM from 0.36 to 0.48. Conclusions: We have presented centile reference charts for TEE expressed as MJ/day and expressed relative to BW and FFM in infants across the first year of life. There was a wide variation or biological scatter in TEE values seen at all ages. We suggest that these centile charts may be used to assess and possibly quantify abnormal energy metabolism in disease states in infants.

Emergence of joint attention: Relationships between gaze following, social referencing, imitation, and naming in infancy

The authors investigated the extent to which the joint-attention behaviors of gaze following, social referencing, and object-directed imitation were related to each other and to infants vocabulary development in a sample of 60 infants between the ages of 8 and 14 months. Joint-attention skills and vocabulary development were assessed in a laboratory setting. Split-half reliability analyses on the joint-attention measures indicated that the tasks reliably assessed infants' capabilities. In the main analysis, no significant correlations were found among the joint-attention behaviors except for a significant relationship between gaze following and the number of names in infants' productive vocabularies. The overall pattern of results did not replicate results of previous studies (e.g., M. Carpenter, K. Nagell, & M. Tomasello, 1998) that found relationships between various emerging joint-attention behaviors.

Sa??de materno infantil no Brasil: evolu????o e programas desenvolvidos pelo Minist??rio da Sa??de

Trata-se de uma revis??o de literatura com o objetivo de descrever a evolu????o da aten????o ?? sa??de materno infantil no Brasil desde o Estado Novo at?? os dias atuais. O levantamento de dados foi realizado em livros, sites do Minist??rio da Sa??de, Legisla????es do Di??rio Oficial e artigos das bases de dados Biblioteca Virtual em Sa??de (BVS/Bireme), Medline e Scientific Eletronic Library (Scielo). As pol??ticas p??blicas de sa??de materno infantil foram definidas seguindo desde os princ??pios meramente reprodutivos at?? aqueles mais amplos, voltados para garantir uma melhor condi????o de sa??de e de vida. Nas ??ltimas d??cadas, com o aux??lio do governo e da sociedade, houve uma progress??o no atendimento da sa??de da mulher e da crian??a. No entanto, conclui-se que, apesar da evolu????o observada, o grande desafio ainda se encontra na redu????o da morbimortalidade materna, neonatal e infantil.

O desenho da criança de cinco anos : investigando/refletindo as formas produzidas a partir de imagem da arte

O desenho infantil comprova significados e sentidos estabelecidos historicamente e revela experiências comuns da criança pensar e idealizar o mundo. Diante dessa constatação, o cerne desta pesquisa é investigar e refletir sobre as nuances no desenho da criança de cinco anos quando apresentadas às imagens de arte, analisando e compreendendo como ela se expressa verbal e graficamente diante de informações mediadas pelo professor de arte, quando manifestam suas experiências individuais e/ou em grupo, representando suas vivências e apropriando-se da linguagem artística, e assim constituindo-se como autoras. Para sustentar a pesquisa, adotamos os princípios da pesquisa qualitativa utilizando como recurso a observação participante em sala de aula, que vem ao encontro às nossas propostas por oportunizar o registro de dados in locus, potencializando assim, a estratégia da produção de dados. Os sujeitos dessa pesquisa são vinte e uma crianças de cinco anos que frequentaram o Grupo Cinco, do Centro de Educação Infantil Criarte/Ufes. A pesquisa buscou entender o desenho infantil como expressão intrínseca da criança, que, oportunizado por ações que colaboram para esse fazer, dará significados ao objeto, que, associado a sua história, sua vivência, possivelmente contribuirá para a formação artística e imagética da criança, significando sua expressão e criação. Trazemos para esse estudo conceitos do desenho infantil, bem como questões que abarcam todo o processo de elaboração e maturação do desenho, fundamentados nas pesquisas de Rosa Iavelberg, Analice Pilar, César Cola, Arno Stern e Viktor Lowenfeld, dentre outros, os quais possibilitaram nossa análise a partir do desenho e da fala das crianças. As reflexões apresentadas procuram contribuir para compreendermos o processo de diálogo, envolvimento e representação gráfica das crianças com as imagens de arte.

Interação mãe-bebê e uso de chupeta no contexto do nascimento pré-termo : cultura, representações sociais e processos proximais

Objetivo: Investigar a avaliação de mães de recém-nascidos pré-termo (RNPT) egressos de unidades de terapia intensiva neonatal (UTIN) quanto à interação mãe-bebê e uso de chupeta nos primeiros dois anos. Método: O planejamento do estudo longitudinal foi baseado na Teoria Bioecológica do Desenvolvimento Humano, com foco nos processos proximais (PP), utilizando entrevistas gravadas com 62 mães de RNPT no contexto da UTIN e 33 aos seis, 12, 18 e 24 meses de idade do bebê, considerando Grupo-A (chupeta) e Grupo-B (não usou chupeta). Resultados: A vivência em UTIN foi considerada evento impactante na vida das mães, mas expectativas futuras para a relação mãe-bebê foram positivas. A tentativa de oferta da chupeta foi 96,2% e seu uso aos seis meses foi 50% (n=52), significativamente associado com prematuridade pela relação peso/idade-gestacional (p-valor=0,044), dificuldades para estabelecer aleitamento materno exclusivo (AME) (p=0,012) e primiparidade (p=0,02). Apresentaram relação com menor frequência de chupeta: AME ≥3 meses (p=0,026) e tempo de aleitamento materno ≥6 meses. A chupeta configurou-se como uma das representações sociais sobre objetos de bebê, elaboradas pelas participantes aos 12 meses de idade do bebê. Características de temperamento calmo/tranquilo da mãe foram mais frequentes no Grupo-A e o temperamento nervoso/agitado/irritado no Grupo-B (p-valor=0,041). No Grupo-A predominou o temperamento do bebê calmo/fácil-de-cuidar/independente, enquanto no Grupo-B as características de temperamento agitado/bagunceiro/teimoso/agressivo (p-valor=0,026), associado também à necessidade de várias tentativas de oferta da chupeta (p-valor=0,006). No Grupo-A, o número de pessoas para apoio social foi uma ou duas (77,8%), enquanto no Grupo-B foram três a sete (66,7%), p-valor=0,001. A contribuição da chupeta como auxiliar nos PP foi indiferente para mães que controlavam o hábito, enquanto o uso irrestrito facilitava a resolução do choro, liberando a mãe para outras tarefas, atuando como limitador dos PP. A análise da evolução e complexidade dos PP demonstrou não haver interferência pelo uso da chupeta, tendo sido mais efetivos quando as mães tinham maior escolaridade e nas classes econômicas A e B. Conclusão: Aspectos culturais influenciaram na oferta da chupeta, mas sua aceitação ocorreu principalmente em RNPT pequeno para idade gestacional, diante das dificuldades para AME, menor extensão do apoio social e temperamento do bebê calmo/fácil-de-cuidar/independente, também associado à aceitação mais fácil da chupeta. O uso irrestrito da chupeta demonstrou atuar como limitador dos processos proximais.

Análise sociolinguística da aprendizagem dos clíticos de 3º pessoa por crianças do 4º ano do ensino fundamental

Diversas pesquisas apontam um contínuo desuso dos clíticos de 3ª pessoa (lhe, o, a, os, as e suas variantes) na modalidade oral do Português Brasileiro (PB), sendo substituídos pelo pronome reto, pelo objeto nulo ou pela repetição do sintagma a que eles fazem referência. Por outro lado, os clíticos de 3ª pessoa aparecem comumente em textos escritos veiculados pela mídia, bem como nos estilos mais formais da língua falada, o que faz com que esses elementos constem dos programas da disciplina Língua Portuguesa, nas escolas brasileiras. Dessa feita, esta pesquisa tem por objetivo descrever esse processo de aprendizagem do ponto de vista linguístico e social, procurando investigar como as crianças interpretam o uso dessas formas – e, por conseguinte, da variedade padrão da língua –, e se e/ou como a escola favorece a aprendizagem dessas formas. Para respondermos a essas perguntas, procedemos a uma pesquisa sociolinguística, que analisa os fatores linguísticos e sociais que poderiam influenciar essa aprendizagem. Para tanto, os clíticos de 3ª pessoa foram trabalhados gradualmente durante um ano letivo. Assim, o corpus desta pesquisa compõe-se de textos escritos livremente e de testes de compreensão – que visava verificar a compreensão dos clíticos presentes em textos infantis – e de desempenho – que consistia na substituição de expressões pelos clíticos adequados. Os dados foram colhidos em uma turma de 4º ano do Ensino Fundamental durante 10 meses letivos, numa escola pública de Belo Horizonte, Minas Gerais, cujos alunos pertencem a diferentes níveis socioeconômicos. Os resultados obtidos revelam que: i) o contexto em que o clítico é inserido contribui significativamente para a sua compreensão; ii) com relação aos fatores extralinguísticos, os alunos, independentemente de sua origem social e sexo/gênero, apresentam dificuldades em compreender os clíticos; entretanto, há uma leve tendência de um melhor aproveitamento quanto aos meninos da classe socioeconômica favorecida

The population of Brazil

In 1970 the population of Brazil with 94,508,554 inhabitants was extreme youth, since 42.67% was composed of children under 14 years old. In that year the proportion of female was 50.2%. The population density increased from 1.17 inhabitants /km² in 1872 to 11.18 in 1970, and in this last year the range was 1.03 in the North region and 43.90 in the South-East region. The urban population increased from 31.24% in 1940 to 55.98% in 1970 and for the first time the rural population was smaller than the urban population. In 1950 concerning with marital status 39% of the population 15 years old and over was single and 54% married. In 1970 this rate was respectively 35.4% and 56.6%. The population economically inactive increased from 49.17% in 1940 to 52.24% in 1970. The literacy ratio increased from 43% in 1940, to 48% in 1950 and 68.04% in 1970. The crude birth rate was 43/1000 live births in 1950 and fell to 37.7/1000 in 1970. The fertility rate decreased from 179.3/1000 women (15-49 years old} to 156.7/1000 in 1960/70. The crude death rate decreased from 20.60/1000 inhabitants in 1940/50 to 9.4/1000 in 1960/70. The infant mortality rate still remains high: 171/1000 live births in 1940/50 and 170/1000 in 1971. Concerning with the size of the cities, 8 in 1940 had 100,000 or more inhabitants and in 1970 this number increased to 94 cities. The population growth increased from 2.38% in 1940/50, to 2.99% in 1950/60 and 2.83% in 1960./70. Brazil is the first country in population size in Latin America and the eighth in the world. Concerning his area, Brazil is the fifth country in size.

Mortality problems in Brazil and in Germany: past-present-future. Learning from each other?

This article was written by a Swiss-German historical demographer after having visited different Brazilian Universities in 1984 as a guest-professor. It aims at promoting a real dialog between developed and developing countries, commencing the discussion with the question: Can we learn from each other? An affirmative answer is given, but not in the superficial manner in which the discussion partners simply want to give each other some "good advice" or in which the one declares his country's own development to be the solely valid standard. Three points are emphasized: 1. Using infant mortality in S. Paulo from 1908 to 1983 as an example, it is shown that Brazil has at its disposal excellent, highly varied research literature that is unjustifiably unknown to us (in Europe) for the most part. Brazil by no means needs our tutoring lessons as regards the causal relationships; rather, we could learn two things from Brazil about this. For one, it becomes clear that our almost exclusively medical-biological view is inappropriate for passing a judgment on the present-day problems in Brazil and that any conclusions so derived are thus only transferable to a limited extent. For another, we need to reinterpret the history of infant mortality in our own countries up to the past few decades in a much more encompassing "Brazilian" sense. 2. A fruitful dialog can only take place if both partners frankly present their problems. For this reason, the article refers with much emprasis to our present problems in dealing with death and dying - problems arising near the end of the demographic and epidemiologic transitions: the superanuation of the population, chronic-incurable illnesses as the main causes of death, the manifold dependencies of more and more elderly and really old people at the end of a long life. Brazil seems to be catching up to us in this and will be confronted with these problems sooner or later. A far-sighted discussion already at this time seems thus to be useful. 3. The article, however, does not want to conclude with the rather depressing state of affairs of problems alternatingly superseding each other. Despite the caution which definitely has a place when prognoses are being made on the basis of extrapolations from historical findings, the foreseeable development especially of the epidemiologic transition in the direction of a rectangular survival curve does nevertheless provide good reason for being rather optimistic towards the future: first in regards to the development in our own countries, but then - assuming that the present similar tendencies of development are stuck to - also in regard to Brazil.

Nutritional factors in milk from Brazilian mothers delivering small for gestational age neonates

The composition of breast milk from brazilian mothers delivering low birthweight infants and its adequacy as a source of nutrients for this group has not yet been fully elucidated. A total of 209 milk samples from 66 women were analysed. The mothers were divided into three groups: G1, mothers delivering term babies of low birthweight (TSGA, n=16); G2, mothers delivering preterm babies of appropriate birthweight (PTAGA, n=20); G3, mothers delivering term babies of appropriate birthweight (TAGA, n=30). The following factors were analysed: osmolarity, total proteins and protein fractions, creamatocrit, sodium, potassium, calcium and magnesium. Milk samples were collected 48 h and 7, 15, 30 and 60 days after delivery. The groups did not differ significantly in terms of osmolarity, total proteins and fractions, creamatocrit, calcium, magnesium or potassium throughout the study period. Sodium levels were higher in all samples from mothers of TSGA infants and in samples from mothers of PTAGA infants on the 7th, 15th and 30th days than in milk from the TAGA group. The authors consider the needs of the low birthweight and TAGA infants and that these high sodium levels may be necessary for growth of low birthweight infants.

Maternal neurotic symptoms and infants' risk of developing persistent diarrhoea

A previously calculated predictive model for health risk selects infants who suffer 4-5 times more morbidity than their unselected peers. Preliminary results suggested that this risk is related to maternal neurotic symptomatology. To evaluate this hypothesis, 52 consecutive mothers whose infants had a positive predictive score (Group 1) and 52 in whom this was negative (Group 2) were evaluated by means of Goldberg's General Health Questionnaire (GHQ - 30). A total of 41.9% and 20.5% of the mothers in Groups 1 and 2, respectively, scored above 11 points in GHQ-30, established as the cut off point. It is concluded that among poor urban families in Santiago mothers of infants with high risk of persistent diarrhoea have increased frequency of detectable neurotic symptoms. New programs aimed at this type of infant should include psychological support for their mothers.