La revista Journal of Human Growth and Development (anteriormente titulada Revista Brasileira de Crescimento e Desenvolvimento Humano) es una revista de libre acceso, revisada por colegas, que publica artículos originales de investigación y artículos de revisión en diversas áreas de las ciencias de la vida. La revista Journal of Human Growth and Development fue fundada en 1991 por el Profesor Arnaldo Augusto Franco de Siqueira. link: http://revistas.marilia.unesp.br/index.php/jhgd
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Delivery and postpartum care in Rio Branco in the northern state of Acre, Brazil: a population based survey
Introduction: Pregnancy can be associated with health risks for both the mother and infant, and specialised care during the pregnancy, delivery and puerperium periods can help reduce complications for the mother-infant binomial. Objective: To assess the demographic, social and reproductive aspects of delivery and the postpartum period in Rio Branco, Acre, Brazil. Methods: A population-based cross-sectional survey was conducted via an interview with 552 mothers with children aged 0 to 5 years between 2007 and 2008. Cluster sampling of the population was performed in two stages (census sectors and domiciles). Results: The majority of the 552 mothers were multiparous (79.6%). Around 70% of pregnancies occurred in teenage mothers. The proportion of caesarean section deliveries was 38.4% in mothers from urban zones and 28.5% in those from rural areas, and was higher in mothers who attended private clinics, who self-reported as being Caucasian, and who had a higher educational level. With regard to puerperal complications, mothers who underwent caesarean section had a higher prevalence of hypertension (71.1%) with an adjusted prevalence ratio of 3.90 (95% CI [2.00, 7.61]). Conclusions: The results revealed a high rate of teenage pregnancy, and arterial hypertension was the leading complication during the postpartum period experienced by women who had undergone caesarean section. These findings merit further attention, and should be used to improve the care provided to Rio Branco.
Derechos de autor 2018 Journal of Human Growth and Development
Juridical perspectives of interruption of pregnancy with zika virus infection regarding medical, emotional and social consequences
Uganda and isolated in humans in 1952 in the same country. Up to 2007 there were few cases of human infection in African and Asian countries. The first outbreak of the Zika virus occurred in Brazil in 2015, becoming a serious public health problem due to the increase in the number of cases of microcephaly in infected pregnant women. Objective: To describe the legal abortion at Zika virus infection during pregnancy regarding medical, emotional and social consequences. perspectives of abortion for the pregnant woman with Zika virus regarding the medical, emotional and social consequences. Methods: This is a documentary study based on documents about abortion and its outcomes in Brazil. Technical norms, textbooks, indexed articles of Scopus and PubMed, documents extracted from international human rights treaties and conventions, and legal documents on the subject were used. It was decided to direct the text based on the experiences of each theme on abortion and its outcomes in Brazil, with a synthesis of the current scenario. Results: Recognizing the exceptional nature of this situation, it is sought to confer an interpretation according to the Constitution and Article 128 of the Criminal Code, based on an analogical application, which seeks to protect the physical and mental health of women infected by the Zika virus. It is possible to qualify the practice of abortion in these circumstances as atypical conduct by the state of necessity, excluding the unlawfulness by comparing with articles 23, I and 24 of the Penal Code. Conclusion: Authorizing the termination of pregnancy after diagnosis of the virus Zika guarantees women the free exercise of their reproductive rights, which is not confused with state imposition of abortion or eugenic practice.
Knowledge and acceptance of HPV vaccine among adolescents, parents and health professionals: construct development for collection and database composition
Introduction: The human papillomavirus (HPV) is a prevalent viral infection in the sexually active population, which can be oncogenic and non-oncogenic. Educational efforts by health professionals, aimed at adolescents and their parents, help decision-making on human papillomavirus vaccination, benefiting the implantation process and vaccine coverage. Objective: To describe the data collection constructs about knowledge and acceptability of HPV vaccine among adolescents, parents and health professionals. Methods: Study of construct elaboration based on an empirical review of the literature with a qualitative focus on PubMed database, from 2007 to 2014, using the following keywords: Papillomaviridae AND Papillomavirus Vaccines AND Knowledge AND Community Health Services. A total of 31 questions were divided into six categories. In the internal validation, the final construct was applied in 390 subjects (adolescents, parents/guardians and health professionals) in the period of 2014. The proportion of assertive responses and respective 95% confidence interval (CI) were used to describe each question. Results: Three articles on the subject were found in the databases consulted that served as the basis for the elaboration of the questionnaire. There was a lower proportion of correct answers among adolescents about knowledge of HPV. Adolescents, parents, and carers showed a low proportion of correctness about the safety and efficacy of the vaccine. The three groups did not show any barriers to vaccine acceptability. Conclusion: The instrument was adequate to measure knowledge about HPV, its repercussions and its vaccine among adolescents, parents/guardians and health professionals, as well as measuring the acceptability of the human papillomavirus vaccine.
Evaluation of postural control in children and adolescents with down syndrome aged eight to twelve years old
Introduction: Down Syndrome is a genetic disorder caused by the presence of the third copy of chromosome 21 (total or partial). The syndrome occurs in approximately one out of every 700 – 1000 newborns per year. Objective:To analyze postural control (PC) of children and adolescents with Down Syndrome (DS) and to compare differences regarding age, sex, nutritional status, and physical activity (PA) levels. Methods: In this cross-sectional study, a convenience sample composed of 21 children and adolescents (9 girls) was categorized according to age: G1 (8 to 9 years old; n = 8), G2 (10 years old; n = 7), and G3 (11 to 12 years old; n = 6), Score-Z: eutrophic (n = 9) and overweight (n = 12), and PA level: practitioners (n = 7) and non-practitioners (n = 14). PC was assessed in the force platform (FP), in the standing position, with feet together during 30 seconds. The variables analyzed were the center of pressure area (COP) and the mean velocities of anteroposterior and mediolateral oscillation (VEL-AP and VEL-ML). Shapiro-Wilk test was used to test the normality of data. Kruskal-Wallis, Dunn’s, and Mann Whitney tests were performed to analyze associations with PC. Statistical significance was set at p<0.05. Results: The median COP, VEL-AP and VEL-ML were 3.55 [2.13 – 6.82] , 2.81 [2.32 – 3.16], and 2.98 [2.42 – 3.43], respectively. There were no differences in PC regarding sex, body mass index and PA level. The adolescents in G3 presented lower values of VEL-AP (G1=2,88 [2,82 – 3,21]; G2= 2,94 [2,35 – 3,39]; G3= 2,27 [2 – 2,3]) and VEL-ML (G1= 3,22 [3,14 – 3,68]; G2= 2,91 [2,52 – 3,63]; G3= 2,34 [2,1 – 2,39]). Conclusion: Sex, nutritional status, and PA level did not affect COP area and AP-VEL and ML-VEL. However, strategies were affected by age, as observed by differences in velocity, but did not affect the COP area.
Fatores sociodemográficos e excesso de peso em crianças participantes de programa governamental de distribuição de leite fortificado
Introdução: Estudos anteriores mostraram a efetividade do programa VIVALEITE para o ganho de peso de crianças menores de dois anos. Como o programa é efetivo, é possível que crianças ingressantes com peso próximo ao limite considerado adequado para idade o ultrapassem no decorrer de sua participação. Objetivo: Analisar a associação entre fatores sociodemográficos e excesso de peso em participantes do programa VIVALEITE. Método: Estudo de coorte com dados de 1.039 crianças de famílias de baixa renda do interior do Estado de São Paulo, ingressantes no programa com seis meses de idade e peso próximo ao limite superior de adequação, entre janeiro/2003 e setembro/2008. Investigou-se a proporção de crianças que ficam com excesso de peso durante a participação no programa e associações com as condições sociodemográficas de cada criança (amamentação aos seis meses, sexo, peso ao nascer) e dos respectivos responsáveis (condição conjugal, idade, situação de trabalho, escolaridade). A modelagem foi feita por meio de regressão logística multinível das variáveis socioeconômicas e o conjunto das idades de pesagem. O processamento foi feito com o pacote estatístico Stata 10.1. Resultados: Conforme análise multinível, a categoria sim da variável aleitamento materno aos seis meses (OR=0,29, p=0,000) e a categoria trabalha da variável situação de trabalho materno (OR=0,36, p=0,012) foram associadas significantemente ao excesso de peso das crianças. As demais variáveis não foram associadas estatisticamente a excesso de peso. Conclusão: Não amamentação aos seis meses e ausência de trabalho materno são fatores sociodemográficos positivamente associados ao excesso de peso das crianças participantes do programa.
programa de distribuição de leite fortificado
programas e políticas de nutrição e alimentação
Characteristics of medication use during lactation
Introdução: É inquestionável a importância do aleitamento materno. Seus benefícios abrangem o lactente, a nutriz, a família e a sociedade. A Organização Mundial de Saúde preconiza o aleitamento exclusivo até os seis meses de idade, o qual pode ser comprometido por alguns motivos, dentre eles o uso de medicamentos. Objetivo: Caracterizar os medicamentos utilizados por nutrizes, no que se refere a: categorias de risco; locais e responsáveis pela prescrição médica e orientações recebidas. Método: estudo transversal, retrospectivo, quantitativo. Os dados foram coletados na Estratégia de Saúde da Família (ESF) com 161 nutrizes nos anos de 2012 e 2013, por meio de questionário estruturado, contendo informações sobre o uso de medicamentos durante a lactação. Os dados foram apresentados em frequências absolutas e relativas, e comparados às variáveis selecionadas no estudo para verificação da existência de associação, utilizando-se o Teste do Qui-quadrado. Resultados: 55,9% das entrevistadas referiram uso de medicamentos, predominando os que atuam no Sistema hormonal, seguidos dos de uso sistêmico e cardivascular. O clínico geral foi o que mais prescreveu, seguido do ginecologista, na ESF. 64,4% das entrevistadas receberam algum tipo de orientação. A análise estatística demonstrou associação positiva entre categoria de risco e as variáveis especialidade médica (p=0,03) e local de atendimento (p=0,001). Conclusão: A classe de medicamento mais utilizada foi a dos anticoncepcionais. Todo medicamento classificado como contra indicado foi prescrito, na Atenção Primária, pelo clínico geral. Sendo assim, destaca-se a necessidade de profissionais qualificados em toda rede de atenção à saúde.
Fingernails as a biomarker for dental fluorosis
Introduction: Biomarkers indicate levels of a particular chemical agent in the environment studied, which may be useful for monitoring health status, and nails may be major indicators of fluoride. Objective: To evaluate fluoride concentration in the fingernails of children as a biomarker for fluoride exposure. Methods: Twenty students were selected, aged 4-5 years old. Their nails were cut at 15 and 45 days (two collections), and the fluoride concentration in the nails was analyzed with the ion-specific electrode (Orion 9409) after rapid diffusion with HDMS. Results: The total fluoride mean of the samples was 3.68 μg F/g (sd 1.44), ranging from 1.39 μg F/g to 7.81 μg F/g. Eleven children (55%) brush their teeth three times a day, but only three children (15%) swallow toothpaste. Conclusion: There is a high prevalence of fluoride exposure in the fingernails of the children studied, presenting risk of developing dental fluorosis in permanent teeth.
Gender and violence: contributions to the debate
The term gender is defined as the social construction of sex, differentiating itself from the variable "sex" because this refers to the biological dimension of anatomical and physiological characterization of human beings, recognized as essential and innate in determining the distinctions between men and women. Gender violence is characterized as a phenomenon of multiple determinations that defines any act based on gender relations that result in physical and psychological harm or suffering. It refers to the hierarchy of power, desires of domination and annihilation of the other, and that can be used consciously sometimes in relationships as a mechanism for subordination of one person to the partner. Understanding how violence occurs from gender relations is essential in order for the phenomenon to be addressed. In this perspective, the Journal of Human Growth and Development has provided a wide debate on the subject, contributing to the decision making in regards to the fight against gender violence.
Validity and Reproducibility of a Food Frequency Questionnaire for Children
Introduction: A Quantitative Food Frequency Questionnaire (QUEFAC) was developed by Hinnig et al. (2010) to evaluate the usual food consumption of children 7 to 10 years old, since those developed for adults may overestimate the consumption of children. However, its validity and reproducibility must be tested to assert that the instrument has a recognized quality. Objective: To assess the reproducibility and validity of the QUEFAC to children aged 7 to 10 years. Methods: Reproducibility was tested with 89 children who responded to two QUEFAC's. Validity was tested with 167 children who responded to three 24-hour recalls (reference method) and one QUEFAC. For the evaluation, the paired t-tests, Wilcoxon, intraclass correlation coefficients, weighted Kappa and analysis of the Bland-Altman graphs were used. Results: For reproducibility, mean differences were observed for all nutrients investigated, correlation coefficients ranged from 0.12 to 0.54 and Kappa values from 0.01 to 0.39. For validity, mean differences for all nutrients were observed, except for energy and zinc, correlation coefficients ranged from 0 to 0.37, Kappa values from 0 to 0.27. Bland-Altman graphs showed a random distribution for most of the nutrients investigated. Conclusion: The QUEFAC was not valid for evaluation of usual food consumption of the last three months in children aged 7 to 10 years in São Paulo and presented moderate reproducibility for energy, protein, calcium, phosphorus, iron, potassium, magnesium and vitamin B2.
Maria do Rosário Dias de Oliveira Latorre
Portuguese translation and Brazilian cultural adaptation of the Assessment of Burden in Chronic Venous Disease questionnaire (ABC-V)
Introduction: The Assessment of Burden in Chronic Venous Disease questionnaire (ABC-V) is a valuable tool for assessing the impact that chronic venous disease (CVD) has on patients’ quality of life (QL). There was a need for a translated and adapted version suitable for use in the Brazilian population. CVD is becoming a public health issue as the incidence and prevalence are high. The ABC-V can be used to collect information on patients’ QL and thus the development of a Brazilian version that facilitates research into the CVD population. Objective: To provide translation and cultural validation of the Assessment of Burden in Chronic-Venous Disease (ABC-V) questionnaire for the Portuguese language. Methods: The ABC-V was translated into Portuguese by two bilingual translators working independently. The translators then created a consensus version, which was translated back into English by two native English speakers. Finally all the versions were analysed by a committee of with expertise in translation and the two cultures involved. The committee produced a draft Portuguese-language version which was tested in a pilot sample of between 30 and 40 people. The committee evaluated feedback from the pilot sample on the clarity and comprehensibility of the draft version. Results: The draft version was completed by 31 patients at the Chronic Venous Diseases Department of Padre Anchieta’s Teaching Hospital. With the analysis of the questionnaires used in the pre-test, it is possible to observe that in English, unlike Portuguese, verbs are often used in the passive tense. It also emerged that there was a need to use more colloquial terms and expressions so that the question would be easier to understand, whilst preserving the meaning of the original items. Changing the tone of the questionnaire in this way should make it more suitable for use with people from a wide range of socioeconomic levels, especially those with lower social status and less education. Because the questions are qualitative rather than quantitative they are more open to interpretation and elicit more subjective responses. This creates an additional difficulty in adapting the questionnaire for the Brazilian cultural context. The data from pilot-testing of the draft version was used to develop a translated and culturally adapted version of the ABC-V using the procedure described by Beaton et al. Conclusion: A translated and culturally adapted version of the ABC-V suitable for use in Brazil has been developed and can be used to evaluate changes in the QL of Brazilian patients with CVD.
Maria Carolina Cozzi Pires de Oliveira Dias
Conception of the Right to Health of Mid-Level Technical Professionals of Unified Health System In Brazil
Introduction: The right to health, one of the achievements guaranteed by the Citizen Constitution promulgated in 1988, came in response to the citizens’ struggle for health reform in 1986. The guarantee of this right is established in the Unified Health System (SUS). Objective: To analyze the conception of the right to health of middle level proffesionals of SUS. Methods: Qualitative approach research, through 2 focus groups involving 9 graduates of a Health Technical School of the SUS in the north of Brazil, from the courses of clinical analysis, dental hygiene and nursing, working in the Unified Health System. Content analysis proposed by Bardin (2009), with the definition of 3 categories. Results: Three categories show the results obtained concluding concepts of health, the right to health and health conceptions; Health practices and access to care; and topics of training, health care and humanization. Conclusion: The participants of this study have a conception of the right to health directed to the legislation, their concepts of health approach elements of SUS policy, among others, promotion, prevention, humanization; their conceptions of health are strongly focused on the biomedical model centered on disease and medicine.
Health in School Program: From training processes to practice scenarios
Introduction: The Health in School Program (PSE) is an intersectoral policy between the ministries of health and education with the perspective of integral attention (prevention, promotion and attention) to the health of children, adolescents and young people in basic public education, within the framework of schools and basic health units. It has five structural components to be developed by professionals, who need ongoing training to reach their goals and goals. Objective: To analyse the training process of PSE health and education professionals. Methods: Qualitative research, based on the theoretical framework of Paulo Freire, whose epistemological categories were compiled by Ecco (reading of the world, significant themes, dialogue, curiosity and problematization). Collection of data was conducted through an interview with 45 professionals and analysed. Results: The reading of the world in relation to the training was permeated with doubts regarding the work with the adolescents. Regarding the significant themes, they expressed an interest in studying some content for the particularities of this publication. The dialogue was encouraged in the transfer of the information and determinations established by management. As for the curiosity, the professionals pointed out uncertainties about the continuity of the actions of the programme and reported learning needs that were not contemplated. The problematization was not evident in the speeches. Conclusion: There are gaps in the professional formation in the PSE for an action that considers the promotion of health in adolescents.
Mirna Neyara Alexandre de Sá Barreto Marinho
Intimate partner violence and severe maternal morbidity among pregnant and postpartum women in São Paulo, Brazil
This article investigates the association between intimate partner violence (IPV) during a current pregnancy and severe maternal morbidity (SMM) among pregnant and postpartum women cared for in public maternity centers located in São Paulo, Brazil. A total of 109 women who developed SMM were selected according to criteria adopted by the World Health Organization (WHO). Another 337 women who did not experience any clinical, laboratory or management intercurrences during a current pregnancy and postpartum were selected for the control group. The participants were submitted to a retrospective investigation of IPV using an instrument adapted from the WHO Multi-country Study on Women’s Health and Domestic Violence against Women, applied between November 2010 and June 2011. The relationship between the response variable (SMM) and the exposure variable (IPV) adjusted for the remaining independent variables was assessed through proportions, a chi-square test, a Fisher’s exact test, and multiple logistic regression. A prevalence of 12.6% (CI:9,5–15,7) for psychological violence, 7.6% (CI:5,1–10,1) for physical violence and 1.6% (CI:0,4–2,8) for sexual violence were observed during a current pregnancy in both the case and control groups. Although no statistical significance was found between IPV exposure during a current pregnancy and the occurrence of SMM (p>0,264), we identified factors associated with unfavorable socio-demographic and reproductive conditions in both the women exposed to IPV and those who developed SMM. Systematic monitoring of SMM and routine screening of IPV among pregnant women are important measures to reduce maternal morbidity and mortality and to qualify reproductive health care.
Funcionalidade e qualidade de vida de crianças com deficiência
Introdução: Professores da educação infantil são capazes de fornecer informações realistas acerca da funcionalidade e da qualidade de vida de crianças com deficiências incluídas nas classes regulares. Objetivo: Analisar a funcionalidade e a qualidade de vida de crianças com deficiência inseridas na educação infantil da rede pública de ensino de Capital do Sul do Brasil. Método: Foram selecionados professores de educação especial. professores de sala. professores de educação física. professores auxiliares de educação especial e auxiliares de sala de crianças com deficiência. entre dois e cinco anos de idade. que apresentam comprometimentos motores e estão inseridas na educação infantil da rede municipal de Florianópolis. Os instrumentos utilizados foram: Inventário de Avaliação Pediátrica de Incapacidade e o Questionário Pediátrico sobre Qualidade de Vida versão 4.0. além de uma ficha de identificação. Resultados: Houve semelhanças entre os relatos dos professores sobre funcionalidade e qualidade de vida das crianças. Conclusão: Há diferentes formações acadêmicas. categorias profissionais e carga horária de trabalho. porém os relatos destes professores apresentaram certa homogeneidade. indicando que estão tentos às tarefas educativas e de cuidados destas crianças. promovendo o processo de inclusão. o desenvolvimento infantil e o bem estar geral da criança.
Estado nutricional de crianças do baixo Amazonas: concordância entre três critérios de classificação
Introdução: A avaliação do estado nutricional é fundamental na infância, pois a desnutrição, o sobrepeso e a obesidade são estágios indicativos de desequilíbrios que podem influenciar o adequado desenvolvimento infantil e interferir nos processos de saúde/doença. Objetivo: Determinar a concordância entre três métodos de avaliação do estado nutricional de crianças de 2 a 6 anos de idade da região do Baixo Amazonas, Brasil. Método: Estudo exploratório, epidemiológico com desenho transversal de base escolar realizado em 2014 com crianças do Ensino Infantil da cidade de Parintins. Foi avaliado o estado nutricional, pelo índice de massa corporal, segundo três critérios de avaliação: Conde e Monteiro, Cole et al. e Organização Mundial da Saúde (OMS). Aplicaram-se testes descritivos e de associação para análise do comportamento das variáveis e o coeficiente de Kappa para investigar a concordância dos resultados entre os três critérios. Resultados: Participaram da pesquisa 1.387 crianças (714 meninos) com idade média de 5 anos. Os meninos apresentaram maior prevalência de sobrepeso em relação às meninas pela classificação da OMS, em contrapartida maior proporção de meninas com baixo peso, segundo o critério nacional. Os melhores níveis de concordância foram para o sexo feminino e o protocolo nacional apresentou satisfatória concordância com os protocolos de uso internacional, com destaque para o proposto pela OMS. Conclusão: Desse modo, conclui-se que houve concordância entre os critérios de avaliação do estado nutricional em crianças do Baixo Amazonas.
Tomada de decisão clínica frente ao diagnóstico e tratamento de lesões em esmalte dentário
Introdução: O tecido que recobre a coroa dos dentes é o esmalte dentário, que promove proteção e revestimento. Trata-se de tecido mineralizado e sensível às variações do ambiente em sua formação, sendo que não sofre remodelação ao longo de seu ciclo de vida. Objetivo: Avaliar a escolha mais adequada do diagnóstico e opções de tratamento de lesões de esmalte dentário pelos docentes e discentes do curso de Odontologia. Método: Estudo quantitativo descritivo, cuja amostra foi composta por 98 discentes matriculados nas disciplinas de Clínicas Odontológicas do IV ao VIII nível e por 23 docentes. O instrumento de coleta dos dados foi um questionário composto por fotografias de quatro casos clínicos, cujos dentes apresentavam diferentes lesões em esmalte dentário: hipoplasia do esmalte dentário, fluorose dentária, amelogênese imperfeita e cárie dentária. Resultados: Dos 98 discentes, o acerto predominante foi o da fluorose dentária, onde 93,9% acertaram o diagnóstico. Enquanto o acerto predominante em relação ao tratamento foi o das lesões de cárie, onde 86,7% optaram por restauração direta. Dos 23 docentes, o acerto predominante frente ao diagnóstico foi de lesão de cárie, 100% acertaram o diagnóstico, enquanto o tratamento foi o de restauração direta no caso de hipoplasia, onde 95,7% fizeram essa opção de tratamento. Conclusão: Ambos os grupos apesentaram dificuldade na tomada de decisão de tratamento nos dentes com amelogênese imperfeita e com fluorose dentária leve. Os discentes relataram possuir dificuldade no diagnóstico diferencial na prática clínica frente às diferentes lesões que acometem os tecidos dentários, além de terem pouco conhecimento sobre o diagnóstico das lesões abordadas.
Impacto do tipo de parto sobre a mobilidade Toracoabdominal de recém-nascidos
Introdução: Nos recém-nascidos de parto cesáreo, ocorre menor compressão torácica e pouca quantidade de líquido é drenada por ação da gravidade, o que diminui, transitoriamente, a mobilidade toracoabdominal. Objetivo: O objetivo do estudo é avaliar o impacto do tipo de parto na mobilidade torácica e abdominal em recém-nascidos. Método: Trata-se de um estudo transversal com recém-nascidos de idade gestacional entre 37 a 41 semanas, de ambos os sexos, com até 72 horas de vida, respirando em ar ambiente e nascidos de parto normal ou parto cesáreo. A mobilidade torácica e abdominal foram avaliadas pela videogrametria por meio do Software MATLAB e considerada, em unidades métricas (cm2), como a diferença da maior e menor expansibilidade toracoabdominal para cada ciclo respiratório. Resultados: Foram inclusos 26 recém-nascidos 11 do sexo masculino e 50% nascidos de parto cesáreo. A idade gestacional média foi de 39 ± 0,9 sem e tinham 28 ± 18 horas de vida. A mobilidade, diferença entre a maior e menor expansibilidade, da área torácica no parto vaginal e cesáreo foi 6 ± 3 cm2 e 7 ± 5 cm2 e da área abdominal foi de 29±22 cm2 e 21± 14 cm2, respectivamente. Esta diferença não foi estatisticamente significante entre os dois tipos de parto para a área torácica, mas mostrou-se diferente estatisticamente para a área abdominal (p = 0,01). E para os recém-nascidos de parto cesáreo, quanto maior a frequência respiratória, menor a mobilidade abdominal (r= -0,57; p = 0,02). Conclusão: Os dados indicam que o tipo de parto parece influenciar a mobilidade abdominal e a frequência respiratória. Na amostra estudada os recém-nascidos de parto cesáreo apresentaram menor mobilidade abdominal.
Will artificial intelligence be a blessing or concern in assistive robots for play?
The recent advances and popularity of artificial intelligence (AI) offer exciting possibilities to improve technology but they also raise concerns. In this paper, we use our research to present the potential benefits of using AI in assistive technology for children with disabilities to access play, and examine potential ethical concerns surrounding data required by AI algorithms. Since play is a key factor in child well-being and cognitive development, secondary disabilities may arise as a consequence of motor impairments. Assistive robots for augmentative manipulation can be instrumental in providing children with physical disabilities play opportunities, but we need to take a principled and user-centered approach to technical innovations.
Sociocultural aspects of health and disease and their pragmatic impact
Introduction: Several factors are involved in the health–disease process and important points are related to sociocultural aspects that need to be known and interpreted to understand a more general framework that involves health. Objective:To analyse the sociocultural aspects related to the health and disease process. Methods:This is a reflexive review study. Thematic categories were established for the development and discussion of results according to the analysis of Bardin. Results: Sociocultural aspects influence the health of the population based on creation of work in the field of public health. Conclusion: Many aspects are involved in the health–disease process. All impact in some way on some context in public health and therefore should be analysed and considered.
Introduction: Human beings go through history in search of the plenitude and perfection of the human body. The actors have changed and the scene has changed, and likewise the sociocultural context, the tastes and interpretations, and the meaning have changed, yet the search for the ideal body remains. Objective: A critical-reflexive approach is proposed regarding the standard of the body throughout the historical trajectory, as well as its cultural representativeness and the meaning attributed to it. Methods: This is a critical-reflexive dissertation based on existing literature. We have used the: MEDLINE, LILACS, Scientific Electronic Library - SciELO and Bireme databases; as well as Google Scholar and grey literature. The preparation of the manuscript followed the norms of literature reviews, and nearly attained the qualitative approach. Results: One must consider the relationship that the media establishes with the body, impelling a relentless search for a standardized reflection in the mirror, seen as beauty; the culture of purchasing power regarding the female body, of discrimination, of violence, and of indifference. It reveals a discussion of aspects that are important and fundamental to understand the body in its totality, not only as an organic structure, but also as something complex and subjective that suffers constant influences from the environment to which it is exposed and from the time and society in which it is inserted. Conclusion: It may be concluded that the body has always been in a prominent position in the civilizations of the numerous historical periods mankind has lived through, and regardless of when, there has always been a corporal stereotype to be followed, cultivated and worshiped, and the search for this conquest continues in current days.
Descriptions of Perceived Quality of Life of Residents from a Quilombo in North Brazil
The study aimed to describe the perceptions regarding the quality of life of Quilombola community in the municipality of Santa Tereza, Tocantins, Brazil. A descriptive cross-sectional study was conducted with children in the Quilombola community. To evaluate the children's quality of life, the questionnaire named Vie Enfant Imagé's Autoquestionnaire Qualité was used, composed of four factors: Autonomy, Leisure, Function, and Family. To evaluate the quality of life in adults, the World Health Organization Quality of Life assessment was used. The program used was Stata version 11.0. Regarding the quality of life of the children according to gender, the girls presented a mean of 11.0 in the Function factor, in the Family, Leisure, and Autonomy factor, presented with a mean of 12.3, 8.2 and 4.8, respectively. For boys, the Function factor had a mean of 11.0, the Family factor of 12.0, and the Leisure and Autonomy factors of 7.6 and 5.6, in this sequence. Among the adults, the men had lower values in the Physical domain with a mean of 13.7, the women had lower averages in the Physical and Environmental domains, with values equal to 13.8. In the general scores, the male sex obtained higher value when compared to the female sex, 14.0 and 13.6, respectively. The study showed that among the children, the Family factor had higher mean values, followed by the Function, Leisure, and Autonomy factors, respectively. When studying adults, the domain with the best score was Social Relations, on the other hand, the Physical domain presented the worst score for men and women. However, investigations carried out regarding the quality of life in quilombolas represent a still low number, making it difficult to understand the possibilities of improving the quality of life in this population.
Introduction: The lifestyle of quilombola communities has changed due to extra community influence, thus affecting their environmental and behavioral factors related to the Metabolic Syndrome (MS). However, little is known about the influence of MS on the Quality of Life (QoL) of quilombola residents. Objective: We aimed to study the association between MS and QoL in quilombola communities in northern Tocantins, Brazil. Methods: The QoL of 147 adults from five quilombola communities from Tocantins was assessed using the WHOQOL-BREF instrument. Blood pressure, abdominal perimeter, fasting blood glucose, triglycerides and HDL-cholesterol were measured, and the presence of MS was defined as the alteration of at least three of these clinical aspects. The association of the clinical components and the SM presence with the Quality of Life was evaluated by Student’s t-test for independent samples. Results: We observed that in the total population, an altered abdominal perimeter had an inverse association with both the Physical (15.2 vs. 14.0, p=0.002) and General QoL domains (14.4 vs. 14.0, p=0.045), and MS was inversely associated with the Physical domain (14.9 vs. 14.0, p=0.030). When stratified by sex, the altered abdominal perimeters in men were inversely associated with the Physical (16.5 vs. 14.4, p<0.001), Environmental (14.0 vs. 12.6, p=0.020) and General domains (15.5 vs. 14.0, p<0.001). MS had an inverse association with the Physical (15.8 vs. 14.4, p=0.026) and General domains (14.8 vs. 14.0 p= 0.042) in men. In women there was no association between any risk factor studied and QoL domain. Conclusions: The status of MS was negatively associated with the quality of life of the male population, highlighting the abdominal perimeter, which influences the Physical and General domains of QoL, but in the female population the MS does not interfere in the perception of QoL. Understanding the relationship between chronic diseases and QoL in quilombola communities is necessary to reduce health inequalities in historically vulnerable communities.
A brief exploration of resilience and child development is presented. The concepts of resilience and ‘risk competence’ are elaborated on along with some of the practice implications of these with respect to child care and wellbeing. Questions are raised regarding managing childhood risks while at the same time enabling children to become capable in assessing and handling risks themselves.
Introduction: Human dignity, as coined by the Universal Declaration of Human Rights (UDHR / 1948), is an expression social solidarity, which should cement the relations between people. Human dignity is the foundation of all rights, such as freedom, equality, justice and peace in the world, and in Brazil, human dignity was deemed a fundamental pillar of the country’s post-1988 constitutional order. Objective: This article seeks to a deeper investigation about the social nature of human dignity and its definition over time. Methods: This is an exploratory research meant to unpack the concepts of "human dignity", "bioethics", "human rights" and "constitution". After describing the conceptual evolution of human dignity and the facts relevant to its conceptual formation in world history - as a normative standard and a legal rule -, we address the Universal Declaration of Human Rights (UDHR/1948), the Declaration of Helsinki (DH/1964), the Universal Declaration on Bioethics and Human Rights (UDBHR/2005), and the definition adopted in the Constitution of the Federative Republic of Brazil (CFRB/1988). The study was carried out without temporal limitation, and included a review of referenced books, legal doctrines, as well as articles and books in the SciELO database. Results and discussion: The findings ratify that human dignity is the foundation of all rights, including those of freedom, equality, justice and peace in the world, and must also guide the rights and duties of social regulation. Human dignity has changed from a criterion of power attributed to the social position of individuals to a value of the right to freedom, which now goes beyond the right of freedom and is the basis of modern constitutional democracy, which makes possible the realization of solidarity, as well as the duty and purpose of the state and the community. The will of the subject, of society, of the science and of the state, as well as the rules of domination and regulation, must have a limit on human dignity, and human dignity is not just fundamental right, in the sense of the Constitution, and must prevail over the exclusive will of science, the State and society. Therefore, in the making of power decisions and in realization of possible innovations of science involving human beings, human dignity demands the explicit consideration of respect and promotion of it. Conclusion: Human dignity is enshrined in Brazilian constitutional law, as well as in bioethics and in human rights, and it constitutes all the fundamental rights of the human person. It is not merely a rule of autonomy and liberty, and it is an obligatory and non-derogable precept in the making of power decisions, a true main foundation of constitutional democracies.
There is enough evidence to show the importance of the first 1000 days of life for child survival and development, and the next 8000 days for a child to reach adulthood. Yet discrimination, place of residence, socio-economic status, and inequalities within and between countries contribute to earlier mortality and significant morbidities for mothers and their children, particularly in settings with limited resources. Therefore, many children and adolescents and their families were left behind. JHGD has been raising public health issues related to inequalities and right to health. In this issue, articles generate debate around human dignity and health disparities. Several articles discuss a verity of health issues particularly in Amazon and Northeast region. School health was also discussed in this issue. Three studies were conducted in schools in Rio Grande do Sul, Brazil. Research indicate that many children and adolescents are left behind. We are missing many opportunities to bridge the gap of inequality. Actions need to be taken now to make sure no one is left behind.
Health Disparities: Challenges, Opportunities, and What You Can Do About It
Racial disparities in health outcomes, access to health care, insurance coverage, and quality of care in the United States have existed for many years. The Development and implementation of effective strategies to reduce or eliminate health disparities are hindered by our inability to accurately assess the extent and types of health disparities due to the limited availability of race/ethnicity-specific information, the limited reliability of existing data and information, and the increasing diversity of the American population. Variations in racial and ethnic classification used to collect data hinders the ability to obtain reliable and accurate health-indicator rates and in some instances cause bias in estimating the race/ethnicity-specific health measures. In 1978, The Office of Management and Budget (OMB) issued "Directive 15" titled "Race and Ethnic Standards for Federal Statistics and Administrative Reporting" and provided a set of clear guidelines for classifying people by race and ethnicity. Access to health care, behavioral and psychosocial factors as well as cultural differences contribute to the racial and ethnic variations that exist in a person’s health. To help eliminate health disparities, we must ensure equal access to health care services as well as quality of care. Health care providers must become culturally competent and understand the differences that exist among the people they serve in order to eliminate disparities. Enhancement of data collection systems is essential for developing and implementing interventions targeted to deal with population-specific problems. Developing comprehensive and multi-level programs to eliminate healthcare disparities requires coordination and collaboration between the public (Local, state and federal health departments), private (Health Insurance companies, private health care providers), and professional (Physicians, nurses, pharmacists, laboratories, etc) sectors.
Introduction: Adolescence is a period of transition, between childhood and adulthood marked by biological, psychological and social changes. These changes characterize the situations of vulnerability to which these individuals are exposed. Objective: The aim of this study was to examine the association between alcohol consumption and involvement in physical violence among adolescent students in the city of Olinda, Pernambuco, Brazil. Methods: This was a pilot, cross-sectional, study conducted with adolescents enrolled in high school. The Youth Risk Behavior Survey questionnaire was applied in the classroom and questions were taken from the modules on alcohol consumption, violence and socioeconomic data. Analysis of associations was performed using the Chi-square test, or Fisher’s exact test when the Chi-square parameters were not met. Results: Involvement in physical altercations was associated with male gender (p = 0.001), alcohol consumption in the last 30 days (p = 0.019), binge drinking (p = 0.022) and higher maternal education (p = 0.037). Conclusion: There was an association between the consumption of alcohol by adolescents and physical violence. These results are an indication of the vulnerability to which this population is exposed and is a warning of the need for further studies to investigate this issue.
Introduction: Epidemiological information on poisonings by venomous animals is fundamental in order to elaborate proposals for educational campaigns for prevention of poisonings, and may contribute to the improvement of the care of patients admitted to health facilities. Objective: Thus, the objective is to analyze the epidemiological profile of spider and scorpion poisoning in the Upper Juruá region, Western Amazonia, Brazil, from 2012 to 2017. Methods: Epidemiological data were obtained from the records of SINAN (Information System of Notifiable Diseases) in the Epidemiological Surveillance Sector of the Juruá Regional Hospital located in Cruzeiro do Sul. Results: There were 207 cases of accidents with arachnids, predominantly stinging by scorpions (148 cases, 71.9%), in the Regional Epidemiological Surveillance Sector of the Juruá Regional Hospital located in Cruzeiro do Sul. The average morbidity coefficient during the study period was 12 cases per 100,000 inhabitants for spider bites and 29.28 for scorpion stings. There was no correlation between spider and scorpion incidents with rainfall over the months during the study period. Conclusion: The average incidence of spider and scorpion incidents in the Upper Juruá region is one of the highest recorded for the Brazilian Amazon and is higher than the averages for Brazil, the Northern region and the state of Acre. Incidents with spiders and scorpions were not correlated with rainfall, and other factors associated with species biology or with human activities related to the temporal distribution, therefore there could be a risk of an arachnid incident throughout the year.
Introduction: Heart rate variability (HRV) can be assessed from RR-intervals. These are derived from an electrocardiographic PQRST-signature and can deviate in a chaotic or irregular manner. In the past, techniques from statistical physics have allowed researchers to study such systems. Objective: This study planned to assess the heart rate dynamics in young obese subjects by nonlinear metrics to heart rate variability. Methods: 86 subjects were split equally according to status. Heart rate was recorded with the subjects resting in a dorsal (prone) position for 30 minutes. The complexity of the RR-intervals was assessed by five Entropies, Detrended Fluctuation Analysis, Higuchi and Katz’s fractal dimensions Following inconclusive tests of normality we calculated the One-Way Analysis of Variance, Kruskal-Wallis, and the Effect Sizes by Cohen’s d significances. Results: It was established that Shannon, Renyi and Tsallis Entropies and the Higuchi and Katz・s fractal dimensions could significantly discriminate the two groups. The three entropies were higher in obese youths, suggesting less predictable sets of RR intervals (p<0.0001; d≈1.0). Whilst the Higuchi (p<0.003; d≈0.76) and Katz・s (p≈0.02; d≈0.57) fractal dimensions were lower in obese youths. Conclusion: As with chaotic globals an increase in response was detected by three measures of entropy in young obese. This is counter to the decreasing response detected by fractal dimensions. Chaotic globals and entropies are more dependable than fractal dimensions when assessing the responses to obesity.
Introduction: Chagas disease (CD), also known as American Trypanosomiasis, is an infectious parasitic disease caused by the etiologic agent Trypanosoma cruzi. It is considered endemic in the low-income population and is classified by the WHO as a neglected tropical disease. In the state of Acre, there is almost no scientific data regarding the epidemiology of CD, even though the first autochthonous case was registered in the 1980s. Objective: To analyze the epidemiological panorama of the transmission of Chagas disease in the State of Acre, Brazil, from 2009 to 2016. Methods: A survey of the occurrence of Chagas disease in the State of Acre was performed using public domain secondary data from the Brazil’s Notifiable Diseases Information System of SUS (publicly funded health care system), and from the SUS Database of the Health Surveillance Foundation of the State of Acre. Data were collected from the following variables: gender, age group, form of contagion, distribution by region and municipality, perimeter and seasonality. Result: Forty-two cases of CD were confirmed, with an increase of more than 300% from 2015 to 2016 and a frequency coefficient of 3.06 cases per 100,000 people, and in the Tarauacá/Envira region, the probability of a person contracting CD was 600% higher than the state mean. Conclusion: We found that in the state of Acre, in the period from 2009 to 2016, most cases of CD occurred in 2016, in the Tarauacá/Envira region, mainly in the municipality of Feijó, in the rural zone, from July to October, in the age group of 0 to 30 years, being the oral form the main route of transmission and presenting no statistical difference between men and women.