Saúde materno-infantil e nutrição de crianças Kaiowá e Guaraní, Área Indígena de Caarapó, Mato Grosso do Sul, Brasil

Este trabalho teve como proposta estudar o estado nutricional de crianças indígenas e conhecer condições de saúde materno-infantil. Trata-se de um estudo transversal, com uma amostra de 137 crianças de zero a 59 meses de idade, das comunidades Kaiowá e Guaraní, Área Indígena de Caarapó, Mato Grosso do Sul, Brasil. Foram realizadas entrevistas com a aplicação de um questionário sobre as condições de saúde materno-infantil. A avaliação nutricional foi obtida por meio de medidas antropométricas (peso e estatura). Verificou-se que 19,7% das mães não realizaram o pré-natal e 53,3% tiveram parto domiciliar. A ocorrência de desnutrição para o índice peso/idade foi de 18,2% e para o índice altura/idade foi de 34,1%. A proporção de crianças desnutridas quando separadas por sexo, faixa etária e escolaridade materna não apresentou diferença estatisticamente significante para ambos os índices. Este estudo evidenciou elevada ocorrência de desnutrição infantil e uma preocupante situação de saúde materno-infantil.

Saúde materno-infantil: visão crítica dos determinantes e dos programas assistenciais

Discute-se a determinação social da saúde materno-infantil nas Américas, a partir de inúmeras publicações e recomendações oficiais. Observou-se que nem todos os estudos valorizam apropriadamente as variáveis sociais e que muitos deles as consideram no mesmo nível de importância das variáveis biológicas. Como conseqüência, a compreensão final dos achados fica prejudicada e as conclusões e recomendações extraídas ficam longe de tocar a raiz dos problemas. Diferentes variáveis sociais (como escolaridade materna ou assistência médica) encontram-se freqüentemente associadas com variáveis biológicas (como peso ao nascer ou estado nutricional). Esta associação, no entanto, pode não representar uma relação causai, mas tão somente a ocorrência simultânea de características pertencentes a uma única classe social. Reitera-se a necessidade de estudos que reconheçam as classes sociais e analisem os resultados sobre saúde materno-infantil em relação às mesmas. Estes estudos provavelmente evidenciarão a importância social da saúde materno-infantil e evitarão as habituais diretrizes e recomendações restritas ao plano puramente técnico.

Avaliação da atenção à saúde da criança no contexto da Saúde da Família no município de Teixeiras, Minas Gerais (MG, Brasil)

Este estudo tem como objetivo analisar a atenção à saúde da criança pelo Programa de Saúde da Família (PSF) do município de Teixeiras, MG, Brasil. Foi aplicado um questionário a 161 mães de crianças menores de dois anos. Utilizou-se um sistema de escores específicos para análise das dimensões de estrutura, processo e resultado e seus respectivos atributos, classificando o município nos cenários incipiente, intermediário e avançado. Configurou-se, na síntese, um cenário intermediário (49,6%) para o PSF, caracterizado por uma atenção à saúde da criança fragmentada, mas com avanços na organização da atenção para este grupo. Foram consideradas incipientes as instalações físicas, a qualidade do cuidado no controle da diarréia e das infecções respiratórias, a participação comunitária e a intersetorialidade. Os avanços estiveram relacionados ao acolhimento realizado pelo programa, no entanto, as atividades preventivas e promocionais do PSF demonstram que o programa surge como um suporte do hospital e mais um local de atendimento médico. A atuação do PSF na atenção a saúde das crianças distancia-se da proposta de reorientação do modelo assistencial hegemônico, pela qual foi criado, dificultando estratégias na prevenção de doenças e na promoção da saúde.

Caracterização de idosos internados em enfermaria de pronto-socorro quanto à vulnerabilidade social e programática

O aumento da população idosa acarretará grandes transformações socioeconômicas, repercutindo diretamente no setor saúde. O estudo objetivou caracterizar idosos hospitalizados quanto aos aspectos de vulnerabilidade social e programática. Trata-se de estudo quantitativo, realizado na Enfermaria de Adultos do Pronto-Socorro do Hospital das Clínicas de Botucatu - UNESP. Os dados foram coletados no período de maio a outubro de 2009, por meio de entrevistas e de informações constantes nos prontuários. A amostra foi constituída por 71 sujeitos, a média de idade foi de 74,30 anos, a maioria dos indivíduos reside com algum familiar e possui vínculo com um serviço de saúde, mas apenas oito frequentam alguma associação comunitária ou outro recurso de lazer social. Urge que o cuidado integralizado seja uma realidade no atendimento ao idoso, utilizando uma abordagem individual centrada na pessoa, e não na doença, atentando para suas vulnerabilidades e respeitando sua autonomia e dignidade.

O programa de saúde bucal para crianças pré-escolares em Araraquara-SP-O desempenho em 1988.

This paper reports the composition change of the dmf-teeth index, outcome from dental health program for the 3 to 6 year old pre-school children population, enrolled in kindergartens in Araraquara-SP, in 1988. The program performance promotes a major contribution of the f component to the dmf-teeth index.

Determinantes da evolução do peso e altura em crianças de 3 meses a 6 anos assistidas em creche: Análise por modelo linear não hierarquizado em ensaio quase-experimental

Objective. To assess factors determining growth in a group of children between 3 months and 6 years old enrolled in a public municipal (i.e., government-supported, not private) day-care center, in comparison to a group of children with similar characteristics but who were not enrolled in the center. Methods. A quasi-experimental study was designed to observe 444 children aged 3 to 72 months from a low-income neighborhood in the city of Sorocaba, in the state of São Paulo, Brazil. Two groups were studied: 164 children enrolled in a local municipal day-care center (intervention group) and 280 not receiving care at the center (nonintervention, comparison group) but instead being cared for at home. Both groups were seen four times over a period of 16 months. At each observation session, the children's weight and height were measured. Information was also collected on the mother's sociodemographic characteristics and the illnesses she had suffered as well as the child's weight and other health characteristics at birth, the child's illnesses in the 15 days before each observation, and any hospitalizations. Results. The children in both groups were from low-income families, with 65% of the families having an average monthly income below US$ 100; 80% of the mothers had received 8 years of schooling or less. Multivariate linear regression analysis showed that at the first observation (just before enrollment in the day-care center), birth weight was the only factor that explained the nutritional differences between the two groups. Subsequent analyses showed that being in day care was the factor that best explained the differences between the groups, especially in terms of the adequacy of weight for age, after controlling for birthweight, sex, age at the beginning of the study, and illnesses in the 15 days before an observation session. The nutritional impact of the intervention was significant as early as 3 months after being enrolled in day care. Conclusions. The nutritional benefits of the care provided at the center outweighed the negative effects sometimes seen in such centers, such as the greater morbidity that children in day-care centers often experience in comparison to children receiving care at home.

Dentistry for babies: Why do parents seek dental care?

This study investigated what are the main reasons that led parents to enroll children in a clinic for infants. This was studied by consulting 1368 records during the period from July 1996 to August 2001. The predominant reason for enrolling was orientation/prevention followed by other and treatment. This study demonstrated that a program for children from the first year of life encourages parents to have a new vision of dentistry.

Effect of fortification of drinking water with iron plus ascorbic acid or with ascorbic acid alone on hemoglobin values and anthropometric indicators in preschool children in day-care centers in Southeast Brazil

Background. Iron-deficiency anemia currently is the most frequently occurring nutritional disorder worldwide. Previous Brazilian studies have demonstrated that drinking water fortified with iron and ascorbic acid is an adequate vehicle for improving the iron supply for children frequenting day-care centers. Objective. The objective of this study was to clarify the role of ascorbic acid as a vehicle for improving iron intake in children in day-care centers in Brazil. Methods. A six-month study was conducted on 150 children frequenting six day-care centers divided into two groups of three day-care centers by drawing lots: the iron-C group (3 day-care centers, n = 74), which used water fortified with 10 mg elemental iron and 100 mg ascorbic acid per liter, and the comparison group (3 day-care centers, n = 76), which used water containing only 100 mg ascorbic acid per liter. Anthropometric measurements and determinations of capillary hemoglobin were performed at the beginning of the study and after six months of intervention. The food offered at the day-care centers was also analyzed. Results. The fo od offered at the day-care center was found to be deficient in ascorbic acid, poor in heme iron, and adequate in non-heme iron. Supplementation with fortified drinking water resulted in a decrease in the prevalence of anemia and an increase in mean hemoglobin levels associated with height gain in both groups. Conclusions. Fortification of drinking water with iron has previously demonstrated effectiveness in increasing iron supplies. This simple strategy was confirmed in the present study. The present study also demonstrated that for populations receiving an abundant supply of non-heme iron, it is possible to control anemia in a simple, safe, and inexpensive manner by adding ascorbic acid to drinking water. © 2005, The United Nations University.

Avaliação da assistência pré-natal e puerperal desenvolvidas em região do interior do Estado de São Paulo em 2005

Objectives: to evaluate the structure and process of the prenatal and puerperal care given by Direção Regional de Saúde (DIR) XI, at the city of Botucatu, State of São Paulo, Brazil. Methods: an evaluation of resources and activities developed during prenatal and puerperal care in twenty municipalities comprising DIR XI which had adhered the Prenatal and Birth Humanization Program until 2003. Interviews with city managers and analysis of 385 sampled patient charts taking into account recommendations by the Health Department. Results: structure analysis showed that caregiving was centered on medical work; basic equipment and instruments were available; 85.2% of patients began prenatal care with up to 120 days of pregnancy, and 75.9% had at least six prenatal consultations. The active search for absentees and strategies for early prenatal care initiation were observed in 30% and 50% of the municipalities, respectively. Process indicators showed that 3.6% of women had six prenatal consultations, one puerperal consultation, all basic exams and tetanus immunization. Recording of gestational age, arterial blood pressure and weight was of approximately 90%; 58.7% of the women underwent childbirth review and 31.5% were vaccinated. Conclusions: the performance of the set of activities is a challenge to prenatal care at DIR XI.

The flower workshop in psychosocial rehabilitation: A pilot study

We report a pilot study with the Flower Workshop, a new modality of psychosocial rehabilitation group activity. Cognitive performance in schizophrenia and other mental conditions can be impaired depending on the tasks to be executed and their respective social context. The vulnerability of these individuals can be reduced by means of cognitive and socio-affective facilitation. We conducted a pilot study to introduce the Flower Workshop in a public Mental Health Service in the city of Ribeirao Preto (Sao Paulo-Brasil) with 12 participants during 18 months (2002-2003). With cognitive and socio-affective facilitation, participants were able to construct vases and make flower arrangements successfully.

Summit of the Americas 1994-2009: selected indicators

Includes bibliography

Qualidade de vida de crianças e adolescentes asmáticos: Sua relação com estratégias de enfrentamento materno

Objective: To evaluate the quality of life of asthmatic children and adolescents, its relation with sociodemographic and clinical variables, and maternal coping strategies. Methods: Cross-sectional study in which children and adolescents with asthma answered a quality of life questionnaire, and their mothers did the same with a coping scale. Results: Out of the 42 children and adolescents investigated, 74% were classified as having mild/severe persistent asthma; 19%, mild persistent asthma; and 7%, intermittent asthma. A total of 69% of the participants showed impaired quality of life with mean scores ranging between 4.7 and 3.5, with greater harm in the domain of symptoms (score=3.6). There was a significant association between maternal schooling and the general index of quality of life, whereas maternal coping strategies were not associated with the severity of asthma. A large number of strategies used by mothers to cope with their children's crises were related to the management of stressors or to religious practices, and the latter presented negative correlation with the children's quality of life general index, showing that mothers whose children had worse quality of life used more religious coping. Conclusions: Asthmatic children, particularly those with moderate/severe persistent asthma, showed significant alterations as to quality of life. The high percentage of mothers using religious strategies, particularly in face of more severe clinical conditions, seem to indicate that they feel powerless to act, thus requiring concrete and useful orientation to low income families.

Prevalência de sobrepeso/obesidade e nível econômico de escolares

Objective: To associate the nutritional status of elementary schoolchildren with their gender, age group, and economic status based on a cross-sectional study carried out at public schools in the municipality of Cruzeiro do Oeste, Southern Brazil. Methods: The study was performed in 2010 including 939 schoolchildren aged six to ten years-old. The economical status of the families was classified based on a socioeconomic ranking questionnaire (Brazilian Association of Survey Companies), and the body mass index was calculated. Data were analyzed by descriptive statistics, and differences between independent groups were verified by Mann-Whitney and Kruskal-Wallis tests, while possible associations were verified by the chi-square test, being significant p<0.05. Results: The prevalence of obesity in the sample was 8.0%, and overweight, 16.4%. No association was found between the socioeconomic and nutritional status or between the nutritional status and gender. Conclusions: A high prevalence of overweight and obesity was found in this study, indicating that children of both genders are affected regardless of their economical status and age.

Adaptação transcultural do questionário para avaliação das atitudes dos pais com relação a saúde bucal dos filhos

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Programa Saúde da Família: analisando a prática do enfermeiro

Pós-graduação em Enfermagem (mestrado profissional) - FMB