Incidence of congenital syphilis in a metropolitan region of Rio de Janeiro state: social inequalities

Congenital syphilis remains a public health matter, with no perspective of reaching governmental reduction goals. There are few studies about social inequalities and its relation with this disease in Brazil. Objective: describe occurrence of congenital syphilis in a reference hospital in a Metropolitan Region of Rio de Janeiro State, according to socioeconomic and clinical-laboratorial variables as well. Methods: cross-sectional study, basedon interviews, review of medical records and prenatal cards. Population: all women admitted to a maternity ward during a trimester in 2011. Maternal variables: age, schooling, skin color, income, prenatal visits. Fetus/neonate variables: birth weight, gestational age, clinical and laboratory outcomes.Incidence of congenital syphilis (Brazilian Ministry of Health criteria) was calculated for all live births and for each social and economical variable.Results: there were 666 eligible women, comprehending 576 deliveries ? 558 live births and 18 stillbirths. We identified 22 CS cases: 18 live births, threefetal deaths and 1 abortion. One of the neonates died in the third day of life. The incidence of CS was of 39.4/1,000 live births. Socioeconomic variables - low education, low income and black skin - were related to a greater incidence. Only 13 out of 22 cases were identified in prenatal care. Conclusion: ourresults pointed to social inequalities in the congenital syphilis incidence. As prenatal care is also related to socioeconomic variables, investments in quality of maternal assistance should be directed to more vulnerable women.

Learning difficulties in schoolchildren born with very low birth weight

OBJECTIVES: To investigate the relationship between very low birth weight and learning difficulties at school by means of a systematic review of the literature, identifying patterns of learning difficulties among these schoolchildren, possible cognitive correlations, peculiarities of the lowest birth weight ranges and any interference with outcomes by socioeconomic and/or clinical factors. SOURCES OF DATA: Bibliographic search (MEDLINE, LILACS, Excerpta Medica, reference lists of original articles, periodicals related to the subject, information from experts in the area and thesis and dissertation databases) on the keywords: prematurity/very low birth weight, learning difficulties/academic achievement/school performance, follow-up/results/cohort. SUMMARY OF THE FINDINGS: The search returned 114 articles and the 18 of these were selected as having investigated learning difficulties in schoolchildren born with very low birth weights using appropriate methodology. The academic performance of these children was observed to be inferior the whole study population was compared with those born full term. The subject most compromised was mathematics. The risk of suffering from learning difficulties increased in inverse proportion to birth weight. An association was identified between very low birth weight and cognitive compromise. CONCLUSIONS: The systematic approach corroborated the results obtained by published studies: schoolchildren born with very low birth weights exhibited increased risk of learning difficulties when compared with those born at full term. There was a predominance of children with multiple academic subjects compromised and mathematics was the most affected. Risk was observed to follow an ascending gradient as birth weight reduced. There was an association between very low birth weight and cognitive compromise.