A peregrinação das gestantes no Município do Rio de Janeiro: perfil de óbitos e nascimentos / La peregrinación de las gestantes en lo municipio del rio de janeiro: perfil de obitos y nacimiento / The peregrination of the pregnants in rio de janeiro city: deaths and births profile

Trata-se de um estudo ecológico. Objetivou-se analisar as trajetórias dos nascimentos no município do Rio de Janeiro e identificar a relação entre oferta de serviços de saúde e fluxo de gestantes entre local de residência e a maternidade. Foram utilizados dados dos Sistemas de Informação sobre Mortalidade (SIM) e Nascidos Vivos (SINASC) de 2004. O processamento e mapeamento dos dados foram feitos através do programa TabWin. O SINASC processou 99.042 declarações de nascidos vivos e o SIM processou 1.318 declarações de óbitos em menores de um ano no Município do Rio de Janeiro. Concluiu-se que a possibilidade de intervenção no perfil da mortalidade infantil e materna desloca-se cada vez mais para a esfera dos serviços de saúde, e o acesso à assistência de qualidade tem papel fundamental na determinação da mortalidade. Deve-se investigar a existência de desigualdades no acesso a tais serviços.

This ecological study presented analyze of the birth pathways in the Rio de Janeiro City and identification of the relationship between the health services offer and pregnant flow between their households and the maternity. It was used the data available in the Mortality Information System (MIS) and Live Birth Information System (LBIS) in 2004. The TabWin program processed the data and drew the maps. The LBIS processed 99,042 declarations of live birth and MIS processed 1,318 declarations of deaths in less than one year old in the Rio Janeiro City. The conclusion was that the possibility of intervention in the infantile and maternal mortality profile has happened at the health services, and the access to the quality assistance has fundamental hole in the mortality determination. The existence of access inequalities to the services must be investigated.

Tratase de un estudio ecológico que tiene como objetivo analizar las trayectorias de los nacimientos en lo Municipio del Rio de Janeiro y identificar la relación entre oferta de servicios de la salud y del flujo de gestantes entre el lugar de la residencia y la maternidad. Fueron utilizados los datos de los Sistemas de la Información sobre Mortalidad (SIM) y Nacidos Vivos (SINASC) de 2004. El proceso y el mapeamento de los datos fueron hechos a través del programa TabWin. El SINASC procesó 99.042 declaraciones de nacidos vivos y el SIM procesó 1.318 declaraciones de óbitos en menores de un año en lo Municipio del Rio de Janeiro. Concluyese que la posibilidad de intervención en el perfil de la mortalidad infantil y materna dislocase cada vez más para la esfera de los servicios de la salud, y el acceso a la asistencia de calidad tiene papel fundamental en la determinación de la mortalidad, débese, investigar la existencia de desigualdades en el acceso a tales servicios.

Is Definitive Surgery Necessary for Fistula-in-ano in Infant

To clarify the necessity of surgery for fistula-in-ano (FIA) in infant, a retrospective analysis of 82 cases FIA in infant were performed for 11 years period from 1987 to 1998. Group A included 44 cases in the period of surgery oriented treatment to 1992, and group B contained 38, period of feeding control oriented management (FC) after 1993. FC, that was indicated in case with loose stool and eczematoid perianal skin (LSES), composed of quit breast feeding, change of cow milk or complete weaning. Surgical decision was made after improvement of stool condition. Fistulectomy was performed in 29 cases (65.9 %) of group A. However, in group B, only 15 cases (39.5 %) required surgery (p=0.0036). Thirty-four cases in B had the history of LSES, and FC was applied in 25, and was effective in 24. Among 24 cases, 21 showed complete healing with FC, 3 had surgery because of the persistent FIA, and 1 got operation due to no improvement of stool condition. In conclusion, FC has to be applied to FIA in infant before surgery, particularly in cases with history of LSES. As one of the etiologic factors for FIA, LSES could be considered to this particular age group.