The relationship between periodontal disease and preterm low birthweight: clinical and microbiological results.

BACKGROUND AND OBJECTIVE: Findings on the effect of periodontal disease on preterm low birthweight are inconclusive. The objective of this study was to compare periodontal clinical measures and the levels and proportions of 39 bacterial species in subgingival biofilm samples in puerperal women with preterm low birthweight and nonpreterm low birthweight. MATERIAL AND METHODS: A case-control study with 116 postpartum women over 30 years of age was conducted. Four case groups of subjects with preterm and/or low birthweight [preterm (n = 40), low birthweight (n = 35), preterm and/or low birthweight (n = 50) and preterm and low birthweight (n = 25)] were compared with normal nonpreterm low-birthweight controls (n = 66). Periodontal clinical parameters of dental plaque, calculus, bleeding on probing, periodontal pocket depth and clinical attachment level were recorded. Covariates included socio-demographic and anthropometric characteristics, smoking, alcohol consumption, obstetric history, prenatal care and diseases during pregnancy. Two subgingival biofilm samples per women were analyzed for 39 bacterial species using a checkerboard DNA-DNA hybridization technique. RESULTS: The mean periodontal pocket depth was significantly higher in nonpreterm low-birthweight controls than in subjects in the preterm low birthweight, preterm and/or low birthweight, and preterm and low-birthweight groups. Clinical attachment level measures were not different between all pairs of cases and control groups. Groups did not differ with respect to the mean proportions of different microbial complexes. The mean counts of Treponema socranskii were lower in all case groups compared with the control group. CONCLUSION: Maternal periodontal microbiota and clinical characteristics of periodontal disease were not associated with having preterm low-birthweight babies.

[Rooming-in and cesarean section in maternity hospitals in the State of Rio de Janeiro, Brazil]. / Alojamento conjunto e parto cesáreo em maternidades do Estado do Rio de Janeiro, Brasil.

OBJECTIVE: To disclose the existence of rooming-in (RI) in public and government contracted private hospitals that offer obstetric beds, in the State of Rio de Janeiro, Brazil, and to examine whether there is any association between RI and another quality care indicator which influences breastfeeding, namely the rate of cesarean section operations performed in these hospitals. METHODS: A survey was made of the existence of RI through a questionnaire sent to the Municipal Health Offices, the information collected being confirmed by telephone with each maternity hospital. The C-section rate data was obtained from the Rio de Janeiro State Health Office and divided into 2 groups: "below 40%" and "40% and above". The prevalence ratio was applied to the measurement of the association between the variables. RESULTS: A rooming-in rate of 65.2% was found for the State as a whole, with regional variations: a better situation in the capital (84.8%), an intermediate one in the interior (69.9%), and a worse one in the metropolitan belt (44.2%). The public maternity hospitals revealed a higher rate (89.7%) than that of the government contracted private hospitals (53.3%). A direct relation between the practice of RI and low C-section rates was found in the hospitals. However, this association did not present the same weight in all regions of the State. The lowest proportion of hospitals adopting RI was verified in the metropolitan belt, whereas the highest relative number of hospitals with high C-section rates was observed in the interior. CONCLUSION: It is concluded that to reverse the observed status, government authorities must fulfil their gerencial role within their own health system, as well as in the government contracted private hospitals.

[Characteristics of neonatal mortality in the State of Rio de Janeiro, Brazil, in the 1980's: a spatio-temporal analysis]. / Características da mortalidade neonatal no estado do Rio de Janeiro na década de 80: uma visão espaço-temporal.

OBJECTIVE: The spatial distribution of neonatal mortality by age-group (0-23 hours, 1-6 days and 7-27 days) in the State of Rio de Janeiro, Brazil, for two periods of time 1979-81 and 1990-92, is analysed. METHODOLOGY: A methodology was used to perform the spatial analysis which took the counties of Rio de Janeiro as the spatial units and "first-nearest-neighbors" as the neighborhood criterion. For the purpose of detecting anisotropy, the connection matrix was defined through "first-nearest-neighbors" in a particular direction. To understand the spatial behavior of neonatal mortality, social and environmental indicators and indicators of medical assistance by county for both periods of time were constructed. RESULTS AND CONCLUSIONS: At the beginning of the 80's, the neonatal mortality for the age group 7-27 days showed the presence of clusters in the East and Southeast in direct association with the poorest conditions of life in the State, characteristics that had vanished by the next decade. Spatial dependence for the mortality rates for the first day of life, for 1991, was identified clusters in two different regions beings detected, followed by a positive correlation with "number of private hospital beds per inhabitant". Some of the cluster counties were, in particular, death receivers from neighboring counties and showed hospital case fatality rates much greater than the overall mean rate.

[Evolution of neonatal mortality in the State of Rio de Janeiro, Brazil, from 1979 to 1993. 1--Analysis by age-group according to area of residence]. / Evolução da mortalidade neonatal no Estado do Rio de Janeiro, Brasil, de 1979 a 1993. 1--Análise por grupo etário segundo região de residência.

The behavior of the infant mortality rate in the State of Rio de Janeiro, Brazil, from 1979 to 1993, is analysed. The annual rate of variation, calculated as the slope of an exponential regression model, indicates an overall decreasing trend of approximately 5% per year. Although the neonatal component is also decreasing, the annual rate of variation is much lower, of only 2.4% per year, and is even lower (1.6%) when deaths caused by malnutrition or infectious diseases are not taken into account. Examining date by region of residence, the area composed of the counties located outside the metropolitan region-called the "Interior"-presents the worst performance. When mortality rates are analysed by age-group an interesting pattern is found: the shorter the time of life the lower the value of the rate variation. In contrast to what is found in developed countries, where care is more intensive for newborn children, the infant mortality rate in Rio de Janeiro State decreases less as the number of hours of life approaches the delivery; for the groups of deaths that occurred within the first of life, an increasing trend is found in all of the residential regions considered in this study. To face this situation, it is necessary to reaffirm the priorities of the health services, not only in respect to the improvement of the quality of medical assistance but also to the development of strategies for the epidemiological monitoring of the Brazilian situation.

["Avoidable" infant mortality in two cities of northeastern Brazil: quality indicator of the local health system]. / Mortalidade infantil "evitável" em duas cidades do nordeste do Brasil: indicador de qualidade do sistema local de saúde.

This paper seeks to discover the magnitude and causality structure of infant mortality--considered a "sentinel even" for quality-of-care indexes in health--in two municipalities of Northeastern Brazil. This is a population based study of the "invoked experimentation" type comparing observed infant mortality with that expected, given a properly functioning maternal and infant care program, allowing for the calculation of a "preventable index" (PDI) for these two municipalities. The preliminary step consisted of an active search and epidemiological investigation of deaths in order to eliminate their underreporting as events. Infant mortality rates in the two areas were relatively low--39 and 44 per thousand live births, respectively--but PDI in both was classified of the order of 40%, thus indicating a causality structure compatible with mortality rates of 100 per thousand. These findings suggest an uneven distribution of deaths, proved by an analytical comparison of the low income population with that of other income brackets (with risk ratios of 8 and 17.6 for total infant mortality and infant mortality from infectious diseases, respectively). PDI proved to be a useful index of preventability of infant deaths, and has the advantage of being simple and easy for health system managers concerned with the quality of health programs devoted to mothers and children to use.

[Growth, diarrhea, and breastfeeding: the case of Vila do João]. / Crescimento, diarréia e aleitamento materno: o caso da Vila do João.

A prospective study on children under six months old living in an urban area on the periphery of Rio de Janeiro was carried out to examine the possible effect of diarrhea in differentiating the monthly growth rate in weight and height, according to type of nursing. The results seem to indicate that infants show a delay in growth of weight and height as a result of greater incidence and prevalence of diarrhea. It was also shown that human breast milk has a protective effect, reducing weight loss from episodes of diarrhea. The study concludes that the promotion of breastfeeding, together with the control of diarrheal diseases, can provide immediate benefits in improving the nutritional status of the infant population.

Diarrhea and growth among children under 18 months of age in Rio de Janeiro.

A study conducted in a periurban Rio de Janeiro community, Vila do João, sought to assess the extent to which diarrhea was influencing the growth of infants and young children. Using a prospective research design, the investigators studied a population of 159 children under 18 months of age living in the study area during the period January--September 1985. Weight and length measurements were used to calculate monthly weight and length increases. Information on diarrhea morbidity was collected at seven-day intervals by means of house-to-house visits. A multiple linear regression model was used to carry out the statistical analysis, which showed inverse and statistically significant correlations between the prevalence of diarrhea and increases in weight and length. It was estimated that the presence of diarrhea reduced increases in weight and length. It was estimated that the presence of diarrhea reduced increases in weight and length by averages of 13.4 g and 0.132 mm per day. These findings support the idea that control of diarrhea can improve nutritional status among children in developing countries.

[Prognostic factors of hospital mortality from diarrhea or pneumonia in infants younger than 1 year old. A case-control study]. / Fatores prognósticos de letalidade hospitalar por diarréia ou pneumonia em menores de um ano de idade. Estudo de caso e controle.

Diarrhea and pneumonia are common diseases in children aged under one year, for which there are simple therapeutic measures. However, infant mortality due to these diseases is still very high, varying markedly according to socio-economic status. The characteristics of children who died (cases) and of those who were hospitalized with diarrhea or pneumonia, but survived (controls), were studied. The following groups of variables were studied: socio-economic, environmental and biological conditions, nutritional status and breast-feeding. Information on cases and controls was collected from hospital records and through home interviews. Important losses occurred in the latter: 40% of cases and 50% of controls were not interviewed. There were no significant differences between cases who were included and those who were not, in terms of age, sex or place of residence. To estimate relative risks of prognostic factors unconditional Logistic Regression was used to calculate the odds ratios and their 95% confidence intervals. Prematurity, low birth weight, weight/age deficit, presence of edema and poor general status at hospital admission were prognostic factors for hospital case-fatality. In relation to the anthropometric variables, it was not possible to conclude for certain whether the increased case-fatality was linearly or non-linearly (threshold) associated with nutritional deficit. The duration of breast-feeding was only associated with case-fatality for pneumonia. Socio-economic factors were not important for the prognosis of children admitted to hospital with diarrhea or pneumonia. Some of the expected risk factor associations were not detected, maybe due to the small sample size (resulting from the high losses) which was insufficient to show small differences. In this study the biological conditions of children with diarrhea or pneumonia appeared to be the important prognostic factors for hospital case-fatality.

[Risk factors for death caused by pneumonia in children younger than 1 year old in a metropolitan region of southeastern Brazil. A case- control study]. / Fatores de risco para morte por pneumonia em menores de um ano em uma região metropolitana do sudeste do Brasil. Um estudo tipo caso-controle.

In a case-control study, a sample of post-neonatal deaths from pneumonia occurring in the Metropolitan Area of Rio de Janeiro, Brazil (1986-1987) were compared with healthy controls who lived in the same neighborhood. Risk factors investigated were variables related to the mother's pregnancy history and the child's birth, to the family's social condition and to the use of health services. Using the univariate logistic regression model, the coefficients of each independent variable, the relative risk and its confidence limits were first estimated. Birth weight and age of weaning were strongly associated with the dependent variable. After adjustment by means of the multiple logistic regression model, only 4 variables remained statistically associated with mortality: age of weaning, birth weight, over crowding, and BCG vaccination. Based on the available data, it was concluded that mortality from pneumonia in children under 1 year of age is significantly related to the social condition of the family, particularly to that of the mother.

[Maternal perception of dehydration in children with diarrhea. A study on agreement with clinical diagnosis]. / Percepção materna da desidratação em crianças com diarréia. Estudo de concordância com diagnóstico médico.

The mother's perception of signs and symptoms of dehydration in children under three years of age was studied and compared with the medical classification. The study was carried out in a children's hospital in the city of Rio de Janeiro, among children hospitalized with diarrhoea between January, 1987 and February, 1988. The number of excretions and of vomitings, thirst and condition of eyes constituted the signs and symptoms most frequently reported by mothers. However, they had difficulty in judging the amount of urine, humidity of mouth and tongue and turgidity of the skin. These signs were almost always regarded as normal or, at most, as indicating only slight alteration. Those mothers who tended to underestimate the severity of the dehydration indicated by the physician were of a lower educational level and had more severely undernourished children and greater difficulty of access to the hospital. On the other hand, those who tended to overestimate it belonged to a higher educational level, had better-nourished children, greater ease of access to the hospital and were attended to by a smaller number of health care services before reaching the hospital surveyed. Those who agreed with the medical diagnosis were in an intermediate situation, although they tended to be closer to those who underestimated the gravity of the dehydration. Those mothers whose children had already gone through a dehydration episode did not present a more intense agreement with the physician's diagnosis, thus evidencing that the information afforded at the health care service was either non-existent or inadequate.

Salt and blood pressure in Rio Grande do Sul, Brazil.

A 1978 survey of 4,565 people in Rio Grande do Sul obtained interview and blood pressure data as well as casual urine specimens for subsequent sodium and creatinine titrations. Data derived from this survey have demonstrated a variety of complex relationships between blood pressure and sodium, a number of which are examined here. The main conclusion is that observed blood pressure differentials could reflect the kidney's ability to handle sodium, an ability subject to the influences of age, heredity, and the environment. As a consequence, it is suggested that the adoption of salt restriction by populations could bring them large health benefits.