Mortalidade infantil e classificação de sua evitabilidade por cor ou raça em Mato Grosso do Sul / Child mortality and classification of its preventability by skin color or ethnicity in Mato Grosso do Sul, Brazil

Resumo Estudo epidemiológico que objetivou analisar os óbitos infantis em menores de um ano e seus critérios de evitabilidade por cor ou raça, em Mato Grosso do Sul, de 2005 a 2013, a partir dos Sistemas de Informações sobre Mortalidade e sobre Nascidos Vivos. Elaborou-se o coeficiente de mortalidade infantil anual e a descrição dos óbitos por componentes e por grupo de causas evitáveis, mal definidas e não evitáveis para os três triênios. Observou-se declínio do coeficiente de mortalidade infantil para todas as categorias de cor ou raça, com predomínio para as crianças pardas e pretas. O componente Neonatal precoce apresentou maior percentual de óbitos para todas as categorias, com exceção da indígena que registrou predomínio no componente Pós-neonatal. Os óbitos ocorreram, majoritariamente, por causas evitáveis e não foram homogêneos entre as categorias de cor ou raça. Os óbitos por causas mal definidas predominaram entre as crianças indígenas e pardas. A investigação dos óbitos apontou diferenças nos componentes de mortalidade e nas causas evitáveis segundo recorte étnico racial, o que poderá contribuir para o direcionamento de políticas públicas que qualifiquem a rede assistencial materno-infantil, sobretudo para as minorias étnicas.

Abstract The epidemiological study aimed to investigate the mortality of children under one year and the classification of preventability by skin color or ethnicity in Mato Grosso do Sul state in the period 2005-2013 retrieved from the Mortality and Live Births Information Systems. The annual child mortality coefficient and the description of deaths by components and by group of preventable, ill-defined and non-preventable causes for the three triennia were elaborated. The child mortality coefficient declined for all skin color or ethnicity categories, with a predominance of brown and black children. The early neonatal component had higher mortality rates for all categories, except for the indigenous population, which recorded predominance of the post-neonatal component. Deaths were mainly due to preventable causes, and they were not homogeneous among skin color or ethnicity categories. Deaths from ill-defined causes predominated among indigenous and brown children. The investigation of deaths pointed to differences in the components of mortality and preventable causes according to racial and ethnic contour, which could contribute to the direction of public policies that qualify the mother and child care network, especially for ethnic minorities.

Teste do pezinho: condições materno-fetais que podem interferir no exame em recém-nascidos atendidos na unidade de terapia intensiva / Heel prick test: maternal-fetal conditions that may have an effect on the test results in newborns admitted to the intensive care unit

RESUMO Objetivo: Descrever as características do teste do pezinho dos neonatos atendidos na unidade de terapia intensiva de um hospital universitário, bem como verificar se existiam condições maternas e fetais que pudessem interferir no resultado desse exame. Métodos: Estudo retrospectivo longitudinal de abordagem quantitativa que avaliou 240 prontuários médicos. Os dados coletados foram submetidos à análise estatística descritiva. Resultados: Houve predomínio de gestantes com idades entre 20 a 34 anos, com Ensino Médio completo e que realizaram mais de seis consultas pré-natais. As intercorrências ou patologias maternas ocorreram em 60% das mães, e a maioria (67,5%) não apresentou nenhuma condição que pudesse interferir no resultado do teste do pezinho. A maioria dos neonatos era prematura e exibiu baixo peso ao nascimento. Cerca de 90% dos neonatos exibiram condições que poderiam influenciar no exame, principalmente prematuridade, nutrição parenteral e transfusão sanguínea. Dos 240 neonatos, 25% apresentaram resultado alterado no teste do pezinho, sobretudo para fibrose cística e hiperplasia adrenal congênita. Conclusão: Existem condições maternas e neonatais que podem interferir no teste do pezinho e, nesse sentido, sua investigação é imprescindível, visando direcionar ações que promovam a saúde materno-infantil e consolidem a triagem neonatal nessa população.

ABSTRACT Objective: To describe the characteristics of the heel prick test in newborns admitted to the intensive care unit of a university hospital as well as to determine whether maternal and fetal conditions could have affected the results of this test. Methods: Retrospective longitudinal study with a quantitative approach that evaluated 240 medical records. The data collected were analyzed by descriptive statistical analysis. Results: There was a predominance of pregnant women aged 20 to 34 years who had a complete secondary education and who had more than six prenatal care visits. Maternal complications or pathologies occurred in 60% of the mothers, and most (67.5%) did not present any condition that could have affected the heel prick test results. Most newborns were premature and exhibited low birth weight. Approximately 90% of newborns exhibited conditions that could have influenced the test, especially prematurity, parenteral nutrition and blood transfusion. Of the 240 newborns, 25% had abnormal heel prick test results, especially for cystic fibrosis and congenital adrenal hyperplasia. Conclusion: There are maternal and neonatal conditions that can affect heel prick test results, and therefore, their investigation is essential, aiming to guide measures that promote mother and child health and consolidate neonatal screening in this population.

Serviços de Saúde Materna como estratégia biopolítica de disciplinamento dos corpos em Cuba / Maternal health services in Cuba - a biopolitical strategy for disciplining pregnant women' bodies / Servicios de Salud Maternal como estrategia biopolítica de disciplinamiento de los cuerpos en Cuba

A saúde materno-infantil se apresenta como uma das áreas prioritárias na atenção à saúde em Cuba. O presente artigo tem como objetivo analisar os serviços de saúde materna (chamados em Cuba de Hogares Maternos) - onde as mulheres são internadas para receberem cuidados médicos pelo tempo necessário nas situações de risco ou complicações na gestação - enquanto uma estratégia biopolítica. Nesse sentido, buscamos problematizar a utilização dessa estratégia de docilização e disciplinamento das gestantes, ao mesmo tempo em que reconhecemos ser esta uma potente estratégia de governo para preservação da vida em Cuba.(AU)

Maternal and child health is a healthcare priority in Cuba. This article analyzes the provision of maternal health services in Cuba's Hogares Maternos (maternity homes), where mothers are admitted in cases of high-risk pregnancy or complications. We problematize the docilization and disciplining of pregnant women, while at the same time recognizing that this process as a powerful strategy for preserving life in Cuba.(AU)

La salud materno-infantil se presenta como una de las áreas prioritarias en la atención de la salud en Cuba. El objetivo del presente artículo es analizar los servicios de salud maternal (que en Cuba se denominan Hogares Maternos) - en donde las mujeres son ingresadas para recibir cuidados médicos durante el tiempo que sea necesario en las situaciones de riesgo o de complicaciones durante el embarazo - como estrategia biopolítica. En ese sentido, buscamos problematizar la utilización de esa estrategia de docilización y disciplinamiento de las embarazadas, al mismo tiempo en que reconocemos que esta es una potente estrategia de gobierno para la preservación de la vida en Cuba.(AU)

Risco gestacional e fatores associados em mulheres atendidas pela rede pública de saúde / Riesgo gestacional y factores asociados en mujeres atendidas por la red pública de salud / Gestational risk and associated factors in women cared by the public health network

RESUMO Objetivou-se classificar e estimar os fatores associados ao risco gestacional em mulheres atendidas para o parto pelo Sistema Único de Saúde (SUS). Estudo transversal com entrevista e consulta ao cartão da gestante e ao prontuário hospitalar de 607 puérperas residentes em município do Estado do Paraná, Brasil. O risco gestacional foi classificado segundo critérios do programa Rede Mãe Paranaense - RMP e a associação com características maternas foi realizada por meio de análise de regressão logística. Das puérperas, 50,9% tiveram gravidez classificada como de risco habitual, 5,8% risco intermediário e 43,3% alto risco. Para classificação do risco, o tabagismo (12,7%), a raça negra (11,4%), os distúrbios hipertensivos (9,6%) e a infecção do trato urinário de repetição (8,4%) foram as condições mais frequentes. A reação paterna negativa à gestação (ORaj=1,71), o IMC pré-gestacional elevado (ORaj=1,67) e ter tido duas ou mais gestações anteriores (ORaj=1,85) foram independentemente associados ao alto risco gestacional. Para prevenir complicações na gestação, a equipe de saúde deve considerar os fatores modificáveis, como o tabagismo, hipertensão, infecção de trato urinário e também não modificáveis, como raça/cor negra, história de IMC pré-gestacional elevado e reação negativa do pai da criança à gestação.

RESUMEN El objetivo fue clasificar y estimar los factores asociados al riesgo gestacional en mujeres atendidas para el parto por el Sistema Único de Salud (SUS). Estudio transversal con entrevista y consulta al registro de la gestante y al registro hospitalario de 607 puérperas residentes en un municipio del estado de Paraná, Brasil. El riesgo gestacional fue clasificado según criterios del programa Rede Mãe Paranaense (RMP), y la asociación con características maternas fue realizada por medio de análisis de regresión logística. De las puérperas, 50,9% tuvieron embarazo clasificado como de riesgo habitual, 5,8% riesgo intermediario y 43,3% alto riesgo. Para clasificación del riesgo, el consumo de tabaco (12,7%), la raza negra (11,4%), los trastornos hipertensivos (9,6%) y la infección urinaria de repetición (8,4%) fueron las condiciones más frecuentes. La reacción paterna negativa al embarazo (ORaj=1,71), el IMC pregestacional elevado (ORaj=1,67) y haber tenido dos o más embarazos anteriores (ORaj=1,85) fueron independientemente asociados al embarazo de alto riesgo. El equipo de salud debe considerar los factores modificables, como el consumo de tabaco, hipertensión, infección urinaria, y también no modificables, como raza negra, historia de IMC pregestacional elevado y reacción negativa del padre del niño al embarazo, para prevenir complicaciones en la gestación.

ABSTRACT This study aimed to classify and estimate the factors associated with gestational risk in women cared for delivery by the Unified Health System (SUS). A cross-sectional study with interviews and consultation to the card of the pregnant woman and the hospital records of 607 puerperal women resident in the municipality of the state of Paraná, Brazil. The gestational risk was classified according to the criteria of the program Parent Network Paranaense - RMP and the association with maternal characteristics was performed by means of logistic regression analysis. The puerperal women, 50.9% had risk pregnancy classified as usual, 5.8% intermediate risk and 43.3% high risk. For the classification of risk, smoking (12.7%), black race (11.4%), hypertensive disorders (9.6%) and urinary tract infection (8.4%) were the most frequent conditions. The paternal reaction in the negative pregnancy (ORaj=1.71), the pre-gestational BMI high (ORaj=1.67) and having had two or more previous pregnancies (ORaj=1.85) were independently associated with a high risk pregnancy. To prevent complications in pregnancy, the health care team should consider the modifiable factors such as smoking, hypertension, urinary tract infection and also non-modifiable, such as race/color black, history of pre-gestational BMI high and negative reaction of the father of the child to the pregnancy.

Use of mother and child healthcare services according to social and demographic characteristics in a city in Paraíba, Brazil / Utilizaςão de serviς os de saúde materno-infantil segundo características sociodemográficas em cidade do interior do estado da Paraíba, Brasil / Utilización de servicios de salud materno-infantil según características sociodemográficas en una ciudad del interior del estado de Paraíba, Brasil

Objective: To analyse the type of service used (public or private) for antenatal care and during delivery and post-partum according to maternal social and demographic characteristics in the city of Campina Grande, Paraiba, Brazil. Materials and methods: Cross-sectional analytical study of 633 mothers with children under one year of age who were surveyed in order to gather social, demographic, antenatal, partum and post- partum data, including the type of service used. The association between maternal social and demographic characteristics and the type of service used was analysed. Results: The usage of public services was 77% for antenatal care and 80.1% for delivery/puerperium. A systematic difference was found in the use of public services among women with a lower level of schooling (PR = 1.31 95% CI: 1.14-1.43) and families covered by the social programme (PR = 1.28 95 % CI: 1.14-1.33). Conclusion: Findings highlight inequalities in the use of antenatal and partum/post-partum healthcare services.

Objetivo: Analisar o tipo de serviςo utilizado (se público ou privado) na assistência pré-natal e ao parto/puerpério segundo características sociodemográficas maternas na cidade de Campina Grande, Paraíba, Brasil. Materiais e métodos: Estudo transversal analítico no qual entrevistaram-se 633 mães de filhos menores de um ano, obtendo-se informaςões sociodemográficas e da atenςão ao pré-natal, ao parto e ao puerpério, inclusive sobre o tipo de serviςo utilizado. Analisou-se a associaςão das caraterísticas sociodemográficas maternas com o tipo de serviςo utilizado. Resultados: A utilizaςão do serviςo público foi de 77,0% na assistência pré-natal e de 80,1% no caso do parto/puerpério. Verificou-se vantagem sistemática na utilizaςão de serviςos públicos de saúde durante o pré-natal e o parto/puerpério nas mulheres de menor escolaridade (PR=1.31 95%CI: 1.14-1.43) e nas de famílias beneficiadas pelo Programa Bolsa Família (PR= 1.28 95%CI: 1.14-1.33). Conclusões: Os achados destacam desigualdades no uso de serviςos de saúde do pré-natal e parto/ puerpério.

Objetivo: analizar el tipo de servicio utilizado (público o privado) en la asistencia prenatal y el parto/ posparto según características sociodemográficas maternas en la ciudad de Campina Grande, Paraíba (Brasil). Materiales y métodos: estudio transversal analítico, en el cual se entrevistaron 633 madres de hijos menores de un año, obteniéndose información sociodemográfica del prenatal, parto y puerperio, incluido el tipo de servicio utilizado. Se analizó la asociación de las características sociodemográficas maternas con dicho servicio. Resultados: la utilización del servicio público fue de 77,0 % en la asistencia prenatal y de 80,1 % en el parto/puerperio. Se encontró una diferencia sistemática en la utilización de servicios públicos en las mujeres de menor escolaridad (PR = 1,31; IC 95 %: 1,14-1,43) y en familias beneficiadas por programa social (PR = 1,28 IC 95 %: 1,14-1,33). Conclusión: los hallazgos destacan desigualdades en la utilización de los servicios de salud prenatal y parto/posparto.

Estratégias de integração das práticas assistenciais de saúde e de vigilância sanitária no contexto de implementação da Rede Cegonha / Strategies for integration of health care practices and sanitary surveillance in the context of the implementation of Rede Cegonha - a Brazilian mother and infant health care network

As mortalidades maternas e infantis têm sido objeto de análise ao longo da história da saúde coletiva no Brasil e diversas têm sido as estratégias de enfrentamento propostas. O Ministério da Saúde tem trabalhado nesse sentido, sendo a estratégia da Rede Cegonha a mais recente política nesse contexto. Tendo em vista o princípio da integralidade e a conformação do Sistema Único de Saúde (SUS) em redes de atenção, faz-se necessária efetiva integração das práticas em saúde desenvolvidas, dentre as quais estão as ações de Vigilância Sanitária (Visa). Considerando que a integração de práticas assistenciais e de Visa pode contribuir para melhorias nas taxas de mortalidade citadas, este artigo é decorrente de uma pesquisa qualitativa que analisou a integração destas ações em quatro municípios do Estado de São Paulo: Campinas, Indaiatuba, Jaguariúna e Santa Bárbara D'Oeste. A pesquisa foi realizada através de entrevistas com gestores de Visa e de saúde da mulher, e os dados foram analisados através da técnica de análise temática. Os resultados convergem com outros estudos, identificando o isolamento das práticas assistenciais e de Visa. A inserção da Visa nos espaços coletivos de gestão mostra-se estratégia em potencial para o planejamento e execução das ações de saúde no contexto estudado.

Mother and infant mortality has been the scope of analysis throughout the history of public health in Brazil and various strategies to tackle the issue have been proposed to date. The Ministry of Health has been working on this and the Rede Cegonha strategy is the most recent policy in this context. Given the principle of comprehensive health care and the structure of the Unified Health System in care networks, it is necessary to ensure the integration of health care practices, among which are the sanitary surveillance actions (SSA). Considering that the integration of health care practices and SSA can contribute to reduce mother and infant mortality rates, this article is a result of qualitative research that analyzed the integration of these actions in four cities in the State of São Paulo/Brazil: Campinas, Indaiatuba, Jaguariúna and Santa Bárbara D'Oeste. The research was conducted through interviews with SSA and maternal health managers, and the data were evaluated using thematic analysis. The results converge with other studies, identifying the isolation of health care practices and SSA. The insertion of SSA in collectively-managed areas appears to be a potential strategy for health planning and implementation of actions in the context under scrutiny.

Aleitamento materno e cuidado: uma proposta winnicotiana / Breastfeeding and care: winnicott?s purpose / Lactancia materna y cuidado: una propuesta winnicitiana

As campanhas de incentivo ao aleitamento materno há décadas vem alertando para os benefícios de tal prática, tanto do ponto de vista fisiológico quanto emocional. Porém, para que esses benefícios estejam presentes, é preciso que a mãe apresente uma disponibilidade afetiva para a amamentação e a atuação dos profissionais da saúde pode interferir consideravelmente nesta prática. Considerando a relevância deste tema nos tempos atuais e o fato de Winnicott ter se dedicado à orientação aos profissionais da saúde, o presente estudo almeja apresentar uma reflexão teórica acerca do aleitamento materno, a partir da teoria winnicottiana, e as implicações da mesma para o cuidado em saúde materno-infantil. Dentre as conclusões obtidas, destacamos que cabe aos profissionais facilitar a manifestação dos cuidados maternos, processo que pertence à mãe. O respeito ao tempo, ritmo e desejo da mãe por amamentar é um dos principais ensinamentos winnicottianos às equipes de saúde.

Campaigns to encourage breastfeeding have been informing people for decades about the benefits of this practice, both physiologically and emotionally. However, for this to happen it is necessary the mother to show an affective availability in breastfeeding, and health professionals may considerably affect this practice. Considering the current relevance of this topic and the fact that Winnicott is dedicated to guiding health professionals, this study aims to present a theoretical reflection on breastfeeding from the Winnicottian theory and its implications in mother-child health care. Among the conclusions, we highlight that the professionals should facilitate the manifestation of mothering care, a process which belongs to the mother. Respecting the mother?s time and her breastfeeding rhythm and wishes is one of the main Winnicottian teachings to the health team.

Las campañas de incentivo a la lactancia materna desde hace décadas ha estado advirtiendo para los beneficios de tal práctica, tanto del punto de vista fisiológico cuanto emocional. Pero, para que dichos beneficios estén presentes, es necesario que la madre presente una disponibilidad afectiva para la amamantar y la actuación de los profesionales de la salud puede interferir considerablemente en esta práctica. Considerando la relevancia de este tema en los tiempos actuales y el hecho de Winnicott haberse dedicado a la orientación de los profesionales de la salud, el presente estudio almeja presentar una reflexión teórica sobre la lactancia materna, a partir de la teoría Winnicottiana, y las implicaciones de la misma para el cuidado con la salud materno-infantil. Entre las conclusiones obtenidas, destacamos que cabe a los profesionales facilitar la manifestación de los cuidados maternos, proceso que pertenece a la madre. Respetar el tiempo, ritmo y deseo de la madre de amamantar es una de las principales enseñanzas winnicottianas a los equipos de salud.

Development of Beijing Mother and Child Health Care Information System and its problems / 中华医学图书情报杂志

After a description of Beijing Mother and Child Health Care Information System and its characteristics , the needs of its users were analyzed, its problems were summarized, its functions were verified, and suggestions were proposed for its future development .

Pesquisa do estreptococo do Grupo B em gestantes da Zona Leste de São Paulo / A study of group B streptococcus in pregnant women of eastern São Paulo / Investigación del estreptococo del grupo B en gestantes de zona este de São Paulo

O presente trabalho trata-se de estudo transversal e retrospectivo, realizado com trinta mulheres usuárias de uma Unidade Básica de Saúde (UBS) da Zona Leste de São Paulo, por meio de entrevista e consulta de prontuários, com o objetivo de verificar como ocorre a pesquisa do estreptococo do grupo B em gestantes. As participantes da amostra realizaram pré-natais na UBS etiveram seus bebês no período de janeiro de 2009 a dezembro de 2010. Realizaram a cultura do EGB 23 mulheres (76,7% do total), 82,6% com resultados negativos e 17,4%, positivos; 43,5% delas realizaram o exame entre 35 e 37 semanas de gestação; 23,5% não realizaram o exame, a maior parte por ausência de solicitação. Foi possível verificar que ocorreram falhas no rastreamento do EGB durante o período selecionado.

A retrospective, cross-sectional study of 30 women seen at a Basic Health Care Unit (BHCU) in the Eastern Section of São Paulo, using interviews and medical record reviews, to determine how group B streptococcus (GBS) was detected in pregnant women. The patients in the studied sample received prenatal care at the UBS and delivered their babies between January 2009 and December 2010. Twenty-three of the women (76.7% of the total) underwent a GBS culture, 82.6% of which yielded a negative result and 17.4% of which yielded a positive result; 43.5% of these women underwent the test between 35 and 37 weeks of gestation; and 23.5% of the participants were not tested, mostly because no test was requested. GBS screening failures were shown have occurred during the selected period.

Estudio transversal y retrospectivo, realizado con 30 mujeres pacientes de una Unidad Básica de Salud (UBS) de la Zona Este de São Paulo mediante entrevista y consulta de historias clínicas, con el objetivo de verificar como se efectúa la investigación de estreptococos del grupo B en gestantes. La muestra realizó prenatal en la UBS y tuvo sus bebés en el período de enero de 2009 a diciembre de 2010. Veintitrés mujeres (76,7% del total) realizaron la cultura de EGB, 82,6% con resultados negativos y 17,4% positivos; 43,5% de las pacientes realizaron el examen entre las semanas 35 y 37 de gestación; 23,5% no realizaron el examen, la mayor parte por no haber efectuado la solicitud. Fue posible verificar que ocurrieron fallas en el rastreo del EGB durante el período seleccionado.

Retention of the Mother and Child Health Handbook and Additional Immunization of Japanese Encephalitis and Tetanus Vaccine / 가정의학회지

BACKGROUND: Improvement of additional immunization rate is indicated as an important factor for effective immunization of diseases. In this study, the relationship between retention of mother and child health handbook and additional immunization rate of Japanese encephalitis and tetanus was examined. METHODS: A survey via questionnaire was performed against parents of students of middle schools in Gwangmyeong-si, Gyeonggi-do, and elementary schools in Seoul. Among 350 copies of the questionnaire delivered via post mail, 261 copies were collected and used in the analysis. The questionnaire included general features of subjects and their children, retention of the mother and child health handbook, and recognition of additional immunization of the Japanese encephalitis and tetanus vaccine. RESULTS: It was found that 80.8% of subjects answered affirmative to retaining the mother and child health handbook, and the group retaining the handbook had higher recognition rate of the need for additional immunization than the group that did not, for the Japanese encephalitis vaccine (83.2% vs. 51.2%, P < 0.001) and for the tetanus vaccine (66.5% vs. 31.7%, P < 0.001). Although the group retaining the handbook had a significantly higher additional immunization rate of the tetanus vaccine of 48.6% vs. 17.1% (P = 0.001), the immunization rate of the Japanese encephalitis vaccine did not show a significant difference (P = 0.231). The group recognizing the need for additional immunization of the Japanese encephalitis and tetanus vaccine had a significantly higher additional immunization rate than the counterpart (P < 0.001). CONCLUSION: It was considered that retention of the mother and child health handbook was related to recognition and execution of additional immunizations.

Difficulties of pregnancy, delivery, and child raising for immigrant women in Japan and their strategies for overcoming them / 国際保健医療

<B>Objectives</B><br>The study aims to clarify the difficulties of pregnancy, delivery, and child raising for immigrant women in Japan and their strategies for overcoming them.<br><B>Methods</B><br>The semi-structured interviews were conducted with 18 immigrant women who have experience of delivery or child raising in Japan. The participants were asked about their experiences and difficulties faced during pregnancy, delivery, and child raising, and how they overcame them. The data were analyzed in a qualitative and descriptive manner.<br><B>Results</B><br>Seven core categories of difficulties were extracted:«anxiety about child raising»,«problems with relationships with others»,«socio-economic problems»,«anxiety about pregnancy, delivery, and diseases»,«problems caused by illiteracy»,«lack of understanding about Japanese health system»,«choice of the delivery country». Women's«making efforts to manage»is supported by family members and it leads to«use of the Japanese health system». Getting support from friends and neighbors, and the use of an interpreter also leads to this. Some women try to overcome the difficulties by«using a non- Japanese health system»or«doing nothing».<br><B>Conclusions</B><br>When foreigners access health services, not only literacy but also health literacy, such as understanding medical terms or health systems are necessary. Many immigrant women got support from family and friends to overcome the difficulties. However, some women could not get such support and it is necessary for them to make a support network. Foreign women who take negative strategies and use non-Japanese health systems may be in the process of adjusting to Japanese society. Health providers should not deny such strategies, but understand them as a way of decreasing anxiety.

The medicolegal understanding regarding fetocide in the criminal law and artificial termination in the mother and child health law / 대한산부인과학회지

Recently, in our society, there have been a lot of talks about fetocide and artificial abortion. I suppose it would be natural in a way. Because the very problem of fetocide and artificial abortion has been always there in our society and various concerns about it still hover above our lives. Fetocide in the criminal law, by legal definition, means the artificial evacuation of growing fetus from mother's uterus or killing the fetus in the mother's uterus. Meanwhile, artificial termination in the mother and child health law, by legal definition, means artificial evacuation of growing fetus and gestational by-products through medical procedure within such a early period in fetal life unable to survive outside the mother's uterus. A couple of jurisprudential reasoning about fetocide and artificial abortion could be possibly constituted in accordance with the legal point of view. But, in the scene of medical practice of Obstetrics and Gynecology, there would be very little difference in terms of criminal charges. It is concluded that both occasions of any artificial abortion with no allowable reasons and any artificial abortion with allowable reasons committed in the period beyond 24 weeks of gestation are to be punished by the current criminal law.

The Necessity and Direction of revising Article 14 of the Mother and Child Health Law / 대한산부인과학회지

According to the social development, women's participation of social work is increased, and it is argued that artificial abortion of fetus can be accepted freely and easily as the respect of the women's right of self-decision on reproduction. This is the conflicts of view in prolife and prochoice. In Korea, there is the strong forbidden clause of criminal law about abortion. But in reality, a lot of illegal abortion are performed despite of the permissible clause in the Mother and Child Health Law. So I reviewed and recommended the revision of Article 14 in the Mother and Child Health Law to the active direction. I am basically opposed to abortion for human dignity especially the right to life of fetus and the prevention of the mother's health from the complication of abortion procedure. The permissible period of abortion must be shortened from gestation 28 weeks to gestation 24 weeks. The reason of severe fetal abnormality need not to be inserted to the permissible clause to abortion, but it is desirable that the meaning of that reason should be included. The socioeconomic reason of the permissible clause to abortion could mean the permission of abortion. So I object to adding the socioeconomic reason for artificial abortion to the revised the Mother and Child Health Law. But if needed, it is necessary to prepare for the effective procedure on consultation before abortion. I agree to the revision of the penalty provision against illegal abortion for the purpose of protecting life and preventing the illegal abortion. It is rightful to prevent human life and keep the value, and in addition, we must concern to the prevention of embryos who have the potential to the individual in the future. So I think that it is necessary to prepare the ethical guidelines or the regulations for the protection of embryos.

The Necessity and Direction of revising Article 14 of the Mother and Child Health Law / 대한산부인과학회지

According to the social development, women's participation of social work is increased, and it is argued that artificial abortion of fetus can be accepted freely and easily as the respect of the women's right of self-decision on reproduction. This is the conflicts of view in prolife and prochoice. In Korea, there is the strong forbidden clause of criminal law about abortion. But in reality, a lot of illegal abortion are performed despite of the permissible clause in the Mother and Child Health Law. So I reviewed and recommended the revision of Article 14 in the Mother and Child Health Law to the active direction. I am basically opposed to abortion for human dignity especially the right to life of fetus and the prevention of the mother's health from the complication of abortion procedure. The permissible period of abortion must be shortened from gestation 28 weeks to gestation 24 weeks. The reason of severe fetal abnormality need not to be inserted to the permissible clause to abortion, but it is desirable that the meaning of that reason should be included. The socioeconomic reason of the permissible clause to abortion could mean the permission of abortion. So I object to adding the socioeconomic reason for artificial abortion to the revised the Mother and Child Health Law. But if needed, it is necessary to prepare for the effective procedure on consultation before abortion. I agree to the revision of the penalty provision against illegal abortion for the purpose of protecting life and preventing the illegal abortion. It is rightful to prevent human life and keep the value, and in addition, we must concern to the prevention of embryos who have the potential to the individual in the future. So I think that it is necessary to prepare the ethical guidelines or the regulations for the protection of embryos.

Medicolegal understandings on the protection of maternity / 대한산부인과학회지

Maternity has the concept of woman who can be a mother having the reproductive function. It is not only an important factor for making the family, but also socially an important duty for producing the members of nation. The protection for maternity means the woman as a mother with reproduction and also means widely and comprehensively protecting for the psychological function as well as the physiological function including the pregnancy and procreation. The methods for maternity protection are various on the social, economic, and cultural factors by the individual nations. Recently the concept of the reproductive health in maternity protection is introduced and it is expanded to the whole woman's life from the period related with the pregnancy. The maternity in women is socially very important and needs for the deliberate concern and the long term proper care. I reviewed the various medicolegal aspects for the maternity protection. And from it, I pointed out the direction for protection. In the level of the maternity protection, it must be firstly considered that the completeness of maternity is preserved. Maternity is the natural process completed by pregnancy and procreation. Maternity is gained from the continuing process of 'from the mother' and 'in the mother', and two factors are essential and inseparable for preserving the completeness of maternity which is a basic premise forming the human beings. The protection of maternity is the right of the person who will be born, and it is also a duty of the social members. The related legal system needs to be prepared by the systemic process for the special protection of the right. It is important to focus at the preservation of the maternal completeness for the maternity protection and the maternal health with women's reproductive health. In the future, it is necessary to make the field of the discussion and the communication with the related person in the various studies.

Study on the Effects of Urbanization on Pregnancy, Childbirth, and Child Care: Based on a Survey on Mothers in Rural Areas in the Suburbs of the Capital of Nepal / 国際保健医療

<b>Objectives</b><br> The present study aimed to elucidate issues in maternal and child health in suburban areas by comparing the effects of increases in population, economic power, and amount of information on health behaviors among mothers such as pregnancy, childbirth, and child care in village A in the suburbs of Kathmandu between 2001 and 2006.<br><b>Methods</b><br> We conducted an interview survey on mothers of children aged 0-12month in village one in Lalitpur district in Nepal. Data from 2001 and 2006 were compared for the educated group, non-educated group, and all subjects.<br><b>Results</b><br> The number of mothers in ethnic minorities increased in 2006. The most commonly used facility for pregnancy examinations, delivery, and child illnesses was hospitals, and their use tended to increase from 2001 to 2006 for each type of visit. In addition, the cost of pregnancy examination and delivery increased approximately 7-and 2-fold, respectively. Kaup index increased by one point for the condition of child development. Prevalence of general infections among children decreased.<br><b>Conclusion</b><br> Subjects were polarized into the middle class, which included individuals who had increased income by working as migrants abroad, and an economically disadvantaged group which included individuals who had migrated from rural areas. The active use of health services at hospitals among pregnant women and children was attributed to recognition of the safety and comfort of hospitals as well as the consumer culture resulting from growth of the middle class. The economically disadvantaged group was considered to be at high risk with regard to maternal and child health, and was thus thought to require affordable and accessible support. Issues in child care appeared to be shifting from “nutritional improvement” and “infection control” to “nutritional balance”.

Environmental Lead Exposure / 国際保健医療

<b>Introduction</b><br>In this review, we present: (1) trends of environmental lead exposure of global dimension including Japan, (2) environmental lead exposure issue in the field of international health, (3) effects of environmental lead exposure in mothers and children, (4) introduction of our research in Kunming, China, and (5) further consideration. Lead poisoning is one of the oldest diseases to humankind because human has been used lead for long time to fabricate various products. Industrial uses of lead have decreased sharply in many industrially developed nations including Japan in the past several decades. However, environmental lead exposure still remains an important problem because of rapid industrialization in less developed nations and the persistence of lead in the environment. Since elevated blood lead levels of immigrating children and people who are exposed to lead from imported consumer products have been reported, health-care providers should be aware of the information for appropriate follow-up care. In addition, lead is a well-known human reproductive toxin, and moreover, several studies have demonstrated that lead can be mobilized from the maternal skeleton during pregnancy and lactation. It is very important to prevent lead exposure for not only mothers and children but also women in pre-pregnancy period. Health burden of environmental lead exposure are only a part of issues of environmental lead pollution. To solve this problem, health-care providers should state expert opinion and collaborate with other field of specialists.