Validation of SmartVA using conventional autopsy: A study of adult deaths in Brazil.

Background: Accurate cause of death data are essential to guide health policy. However, mortality surveillance is limited in many low-income countries. In such settings, verbal autopsy (VA) is increasingly used to provide population-level cause of death data. VAs are now widely interpreted using the automated algorithms SmartVA and InterVA. Here we use conventional autopsy as the gold standard to validate SmartVA methodology. Methods: This study included adult deaths from natural causes in São Paulo and Recife for which conventional autopsy was indicated. VA was conducted with a relative of the deceased using an amended version of the SmartVA instrument to suit the local context. Causes of death from VA were produced using the SmartVA-Analyze program. Physician coded verbal autopsy (PCVA), conducted on the same questionnaires, and Global Burden of Disease Study data were used as additional comparators. Cause of death data were grouped into 10 broad causes for the validation due to the real-world utility of VA lying in identifying broad population cause of death patterns. Findings: The study included 2,060 deaths in São Paulo and 1,079 in Recife. The cause specific mortality fractions (CSMFs) estimated using SmartVA were broadly similar to conventional autopsy for: cardiovascular diseases (46.8% vs 54.0%, respectively), cancers (10.6% vs 11.4%), infections (7.0% vs 10.4%) and chronic respiratory disease (4.1% vs 3.7%), causes accounting for 76.1% of the autopsy dataset. The SmartVA CSMF estimates were lower than autopsy for "Other NCDs" (7.8% vs 14.6%) and higher for diabetes (13.0% vs 6.6%). CSMF accuracy of SmartVA compared to autopsy was 84.5%. CSMF accuracy for PCVA was 93.0%. Interpretation: The results suggest that SmartVA can, with reasonable accuracy, predict the broad cause of death groups important to assess a population's epidemiological transition. VA remains a useful tool for understanding causes of death where medical certification is not possible.

Drainage on augmentation mammoplasty: Does it work?

BACKGROUND: Breast prostheses could be associated with complications, despite many studies on surgical materials and techniques. The role of surgical drainage in preventing complications on breast prostheses surgery is controversial. OBJECTIVES: This study aimed to evaluate the role and effectiveness of vacuum drainage in the augmentation mammoplasty. METHODS: A prospective multicentric randomized comparative clinical trial was conducted with 150 patients, who were the candidates for breast augmentation. The candidates were split into two groups to analyze the breast drain role. Group1: closed-suction drainage; measurements were taken every 24 h for 48 h. Group2: control (no drainage); all the patients were submitted to a clinical and postoperative ultrasonography evaluation (7th day and 3rd month). The late consultations (1st-, 2nd-, and 3rd-year postoperative time) were carried out to identify any complication, such as infection, seroma, hematoma, asymmetry, hypertrophic scarring, rippling, implant position, visible edges, and sensibility alteration. RESULTS: A total of 150 female patients were operated with 300 breast implants placed into subglandular pocket. In the first 24 h postoperative (D1), the drainage volume ranged from 12 ml to 210 ml (mean= 74.90 ml; SD= 43.29 ml). After 24 h, on the second day (D2), the collected volume ranged from 10 ml to 120 ml (mean= 44.76 ml; SD= 24.80 ml). The total drainage volume in the 48 h ranged from 22 ml to 320 ml (mean= 119.7 ml; SD= 62.20 ml). The breast ultrasonography series (BUSGS) analysis was done on the 7th day and 3rd month in both groups. There was no significant difference between G1 and G2 groups (p = 0.05 and 0.25, respectively). In the follow-up, some patients (33-44%) declared sensitivity disturbing on the nipple-areola complex (NAC) and lower breast segment. CONCLUSIONS: The closed-suction breast drainage in breast augmentation was associated with high cost and time-consuming and not demonstrated any benefit in a recent postoperative time.

Psychiatric disorders in children with enuresis at 6 and 11 years old in a birth cohort / Transtornos psiquiátricos em crianças com enurese aos 6 e 11 anos numa coorte de nascimentos

Abstract Objective: Enuresis may have a negative impact on the self-image in childhood and adolescence. The objective of this study was to evaluate the association between enuresis and psychiatric disorders at 6 and 11 years of age. Method: 3,356 children of a birth cohort were evaluated. A standard questionnaire on urinary habits and mental health (Development and Well-Being Assessment [DAWBA]), was used. The prevalence of psychiatric disorders pursuant to the existence of enuresis and its subtypes (monosymptomatic and non-monosymptomatic), stratified by sex, was described. A logistic regression was used for adjusted analysis. Results: The prevalence of enuresis at age 6 years was of 10.2% (9% non-monosymptomatic) and, at 11 years old, of 5.4% (4.5% non-monosymptomatic). At age 6 years, boys with non-monosymptomatic enuresis showed more hyperactivity disorders than those without enuresis (6.2% vs. 2.7%, p = 0.017). At 11 years old, after adjustment, among the boys with non-monosymptomatic enuresis, the prevalence of any psychiatric disorder, hyperactivity disorders, and oppositional disorders was, respectively, 3.2, 3.4, and 2.6 times higher than in boys without enuresis; and, among the girls with non-monosymptomatic enuresis, the prevalence of any psychiatric disorder and oppositional disorders was, respectively, 4 and 5.5 times higher than among girls without enuresis. Conclusion: There is a strong association between non-monosymptomatic enuresis and psychiatric disorders at 6 and 11 years old.

Resumo Objetivo: A enurese pode ter grande impacto negativo na autoimagem na infância e adolescência. O objetivo deste estudo foi avaliar a associação entre enurese e transtornos psiquiátricos aos 6 e 11 anos de idade. Métodos: Foram avaliadas 3.356 crianças de uma coorte de nascimentos. Foi usado questionário padronizado sobre hábitos urinários e saúde mental (Development and Well-Being Assesment - DAWBA). Foi descrita a prevalência de transtornos psiquiátricos conforme a presença de enurese e seus subtipos (monossintomática e não monossintomática), estratificados por sexo. Para análise ajustada usou-se regressão logística. Resultados: A prevalência de enurese aos 6 anos foi 10,2% (9% não monossintomática) e aos 11 anos, 5,4% (4,5% não monossintomática). Aos 6 anos, meninos com enurese não monossintomática apresentaram mais transtornos de hiperatividade, em comparação com os não enuréticos (6,2% x 2,7%, p = 0,017). Aos 11 anos, após ajuste, entre os meninos com enurese não monossintomática, a prevalência de transtornos psiquiátricos, de hiperatividade e de oposição foi, respectivamente, 3,2, 3,4 e 2,6 vezes maior do que nos meninos não enuréticos; e entre as meninas com enurese não monossintomática, a prevalência de transtornos psiquiátricos e de oposição foi, respectivamente, 4 e 5,5 vezes maior do que entre meninas não enuréticas. Conclusões: Há uma forte associação entre enurese não-monossintomática e transtornos psiquiátricos aos 6 e 11 anos de idade.

Psychiatric disorders in children with enuresis at 6 and 11 years old in a birth cohort.

OBJECTIVE: Enuresis may have a negative impact on the self-image in childhood and adolescence. The objective of this study was to evaluate the association between enuresis and psychiatric disorders at 6 and 11 years of age. METHOD: 3,356 children of a birth cohort were evaluated. A standard questionnaire on urinary habits and mental health (Development and Well-Being Assessment [DAWBA]), was used. The prevalence of psychiatric disorders pursuant to the existence of enuresis and its subtypes (monosymptomatic and non-monosymptomatic), stratified by sex, was described. A logistic regression was used for adjusted analysis. RESULTS: The prevalence of enuresis at age 6 years was of 10.2% (9% non-monosymptomatic) and, at 11 years old, of 5.4% (4.5% non-monosymptomatic). At age 6 years, boys with non-monosymptomatic enuresis showed more hyperactivity disorders than those without enuresis (6.2% vs. 2.7%, p=0.017). At 11 years old, after adjustment, among the boys with non-monosymptomatic enuresis, the prevalence of any psychiatric disorder, hyperactivity disorders, and oppositional disorders was, respectively, 3.2, 3.4, and 2.6 times higher than in boys without enuresis; and, among the girls with non-monosymptomatic enuresis, the prevalence of any psychiatric disorder and oppositional disorders was, respectively, 4 and 5.5 times higher than among girls without enuresis. CONCLUSION: There is a strong association between non-monosymptomatic enuresis and psychiatric disorders at 6 and 11 years old.

Fatherhood in adolescence: prevalence and associated factors in a community sample of youngsters.

This article aims to assess the prevalence of fatherhood in adolescence (FA) and associated factors in a community sample of 14 to 35 year-old men. Cross-sectional population-based study realized in the urban area of the city of Pelotas-RS, Brazil. The sample was selected by clusters, according to the city census. This sub-study only comprised sexually active men. Data were collected using a self-administered questionnaire in the participants' homes. The sample was composed for 934 men. The prevalence of fatherhood in adolescence was 8% (n = 75). We verified higher prevalence of FA among those that reported paternal absence (p < 0.001), those that had lived with stepfather (p = 0.044), and among those that had sexual debut before the age of 14 (p = 0.011). Paternal absence, have lived with a stepfather, and early sexual experience are associated factors to fatherhood in adolescence.

Fatherhood in adolescence: prevalence and associated factors in a community sample of youngsters / Paternidade na adolescência: prevalência e fatores associados em uma amostra comunitária de jovens

This article aims to assess the prevalence of fatherhood in adolescence (FA) and associated factors in a community sample of 14 to 35 year-old men. Cross-sectional population-based study realized in the urban area of the city of Pelotas-RS, Brazil. The sample was selected by clusters, according to the city census. This sub-study only comprised sexually active men. Data were collected using a self-administered questionnaire in the participants’ homes. The sample was composed for 934 men. The prevalence of fatherhood in adolescence was 8% (n = 75). We verified higher prevalence of FA among those that reported paternal absence (p < 0.001), those that had lived with stepfather (p = 0.044), and among those that had sexual debut before the age of 14 (p = 0.011). Paternal absence, have lived with a stepfather, and early sexual experience are associated factors to fatherhood in adolescence.

O artigo tem por objetivo avaliar a prevalência de paternidade na adolescência (PA) e fatores associados em uma amostra comunitária de homens de 14 a 35 anos. Estudo transversal de base populacional realizado na zona urbana de Pelotas/RS, Brasil. A seleção amostral foi realizada por múltiplos estágios, considerando a divisão censitária do município. Neste estudo foram incluídos indivíduos do sexo masculino e sexualmente ativos. Os dados foram coletados através de questionário autoaplicável nos domicílios dos participantes. A amostra do estudo foi composta por 934 homens. A prevalência de paternidade na adolescência foi de 8% (n = 75). Verificou-se maior prevalência de PA entre aqueles que relataram ausência paterna na infância (p < 0,001), aqueles que viveram com padrasto (p = 0,044) e entre aqueles que tiverem o início da vida sexual antes dos 14 anos. Conclusões: A ausência paterna e o convívio com padrasto na infância, bem como a iniciação sexual precoce são fatores associados à paternidade na adolescência.

Síndrome da Morte Súbita Infantil em Pelotas de 2006 a 2013: uma análise descritiva / Sudden Infant Death Syndrome in Pelotas from 2006 to 2013: a descriptive analysis

Introdução e objetivo: A Síndrome da Morte Súbita Infantil (SMSI) ocupa a oitava posição entre as causas de anos potenciais de vida perdidos e as primeiras posições como causa de mortalidade infantil pós-neonatal em países desenvolvidos. O presente estudo objetiva conhecer as características socioepidemiológicas das crianças que foram a óbito por SMSI no município de Pelotas. Métodos: Estudo observacional, retrospectivo, descritivo baseado nos dados da Secretaria Municipal de Saúde, coletados através da aplicação de Fichas de Investigação de óbitos padronizadas pelo Ministério da Saúde de todos os casos de SMSI que ocorreram do ano de 2006 a 2013 em Pelotas/RS. Resultados: Houve 37 óbitos registrados no período, o que representa um coefi ciente de mortalidade por SMSI de 1,5 por mil. A média de idade materna foi de 23,5 anos (dp=5,2), 29 (78%) eram fumantes e 23 (62%) concederam aleitamento materno exclusivo até a data do óbito, 28 (76%) tiverem seus bebês nascidos a termo. Dentre os 37 casos, 16 (43%) vieram a falecer com menos de 1 mês de vida, 26 (70%) dormiam junto aos pais e 23 (61%) em decúbito lateral, enquanto que apenas 2 (5%) em decúbito ventral e 16 (43%) dos casos de SMSI ocorreram durante o inverno. Conclusão: O presente estudo é o único que abrange tamanha amostra (37 casos) de SMSI na cidade de Pelotas, a qual apresenta um coefi ciente de mortalidade por essa patologia semelhante aos mais altos encontrados na literatura. Portanto, políticas públicas que visem à prevenção de SMSI em Pelotas são necessárias.

Introduction and aim: Sudden Infant Death Syndrome (SIDS) ranks eighth among the causes of potential years of life lost and is among the leading causes of post-neonatal infant mortality in developed countries. This study aimed to evaluate the social and epidemiological characteristics of children who died of SIDS in the city of Pelotas. Methods: An observational, retrospective, and descriptive study based on Municipal Health Department data collected by applying Research Sheets standardized by the Ministry of Health to all cases of SIDS occurring from 2006 to 2013 in Pelotas, South Brazil. Results: A total of 37 deaths were recorded in the studied period, placing the SIDS mortality rate at 1.5 per thousand. The mean maternal age was 23.5 years (SD = 5.2), 29 (78%) were smokers, 23 (62%) granted exclusive breastfeeding until the date of death, 28 (76%) had term infants. From the 37 cases, 16 (43%) died under 1 month of age, 26 (70%) were sleeping with their parents, and 23 (61%) in the lateral position, while only 2 (5%) in the prone position, and 16 cases (43%) of SIDS occurred during the winter. Conclusion: This study is the only one that covers such sample (37 cases) of SIDS in the city of Pelotas, whose mortality rate from this disorder is close to the highest in the literature. Therefore, public policies for the prevention of SIDS in Pelotas are required.

Prevalence of enuresis and urinary symptoms at age 7 years in the 2004 birth cohort from Pelotas, Brazil / Prevalência de enurese e sintomas miccionais aos sete anos na coorte de nascimentos de 2004, Pelotas, Brasil

OBJECTIVE: To determine the prevalence of enuresis, urinary, and bowel symptoms and associated factors in children aged 7 years in a birth cohort. METHODS: A pre-coded questionnaire was applied to 3,602 children who belonged to a birth cohort initiated in 2004 in Pelotas, Brazil. During home visits at 12, 24, and 48 months and at age 7 years, mothers answered a questionnaire with demographic questions and characteristics of bladder and bowel habits of children using a urinary symptom score. Poisson regression was used for the hierarchical multivariable analysis, with robust variance. RESULTS: The prevalence of enuresis was 10.6%;11.7% in males and 9.3% in females; enuresis was monosymptomatic in 9.8% of the children (10.8% of males and 8.3% of females); 37.4% had symptoms up to once a week; 32.9%, two to four times a week; and 26.2%, every day, with no difference between genders. The most common urinary symptoms were urinary urgency (22.7%) and urinary retention maneuvers (38.2%). In the multivariate analysis, it was observed that the number of urinary symptoms and the number of children at home showed a direct association with the presence of enuresis, whereas maternal education was inversely associated. CONCLUSIONS: Enuresis is a prevalent condition and should be investigated in clinical practice, especially in children of lower socioeconomic status. A detailed history of urinary habits detects associated urinary symptoms, which is important for adequate classification of enuresis and subsequent management. .

OBJETIVO: Determinar a prevalência de enurese, sintomas urinários e intestinais e fatores associados em crianças de sete anos, em uma coorte de nascimentos. MÉTODOS: Foi aplicado um questionário pré-codificado em 3.602 crianças pertencentes à coorte de nascimentos iniciada em 2004, em Pelotas, RS. Em visitas domiciliares realizadas aos 12, 24 e 48 meses e aos sete anos, as mães responderam um questionário com questões sociodemográficas e sobre as características e hábitos miccionais e intestinais das crianças, utilizando um escore de sintomas miccionais. Para a análise multivariável hierarquizada, utilizou-se regressão de Poisson com variância robusta. RESULTADOS: A prevalência de enurese de foi 10,6%, sendo 11,7% nos meninos e 9,3% nas meninas; a enurese foi monossintomática em 9,8% das crianças (10,8% dos meninos e 8,3% das meninas); 37,4% apresentavam o sintoma até uma vez por semana; 32,9%, duas a quetro vezes por semana; e 26,2% todos os dias, sem diferença entre os sexos. Os sintomas urinários mais frequentes foram urgência miccional (22,7%) e manobras de contenção urinária (38,2%). Na análise multivariável, observou-se que o número de sintomas miccionais e o número de crianças em casa mostraram relação direta com presença de enurese, enquanto que a escolaridade materna apresentou relação inversa. CONCLUSÕES: A enurese é uma patologia prevalente e deve ser investigada em consultas de rotina, especialmente em crianças com menor nível socioeconômico. Uma história detalhada sobre hábitos urinários pode detectar sintomas miccionais associados, importantes para uma adequada classificação da enurese e posterior manejo. .

Prevalence of enuresis and urinary symptoms at age 7 years in the 2004 birth cohort from Pelotas, Brazil.

OBJECTIVE: To determine the prevalence of enuresis, urinary, and bowel symptoms and associated factors in children aged 7 years in a birth cohort. METHODS: A pre-coded questionnaire was applied to 3,602 children who belonged to a birth cohort initiated in 2004 in Pelotas, Brazil. During home visits at 12, 24, and 48 months and at age 7 years, mothers answered a questionnaire with demographic questions and characteristics of bladder and bowel habits of children using a urinary symptom score. Poisson regression was used for the hierarchical multivariable analysis, with robust variance. RESULTS: The prevalence of enuresis was 10.6%;11.7% in males and 9.3% in females; enuresis was monosymptomatic in 9.8% of the children (10.8% of males and 8.3% of females); 37.4% had symptoms up to once a week; 32.9%, two to four times a week; and 26.2%, every day, with no difference between genders. The most common urinary symptoms were urinary urgency (22.7%) and urinary retention maneuvers (38.2%). In the multivariate analysis, it was observed that the number of urinary symptoms and the number of children at home showed a direct association with the presence of enuresis, whereas maternal education was inversely associated. CONCLUSIONS: Enuresis is a prevalent condition and should be investigated in clinical practice, especially in children of lower socioeconomic status. A detailed history of urinary habits detects associated urinary symptoms, which is important for adequate classification of enuresis and subsequent management.

Achados comportamentais e cognitivos em crianças de 5 a 11 anos nascidas com baixo peso / Behavioral and cognitive fi ndings in 5-11-year-old children born underweight

Introdução: O número de nascimentos prematuros cresceu nos últimos anos, aumentando a morbimortalidade infantil. Sabe-se que estes estão mais sujeitos a problemas futuros, devido à pouca maturidade de órgãos e ao baixo peso ao nascer. Contudo, a interação do indivíduo com o ambiente familiar e social também influencia no desenvolvimento e comportamento. O estudo avaliou crianças entre cinco e 11 anos de idade em acompanhamento no ambulatório de Pediatria da Faculdade de Medicina da Universidade Federal de Pelotas nascidas prematuras ou com baixo peso ao nascer e avaliou o perfil cognitivo e comportamental. Método: Participaram do estudo 47 crianças, sendo 11 prematuras e 36 nascidas a termo. Os instrumentos de avaliação utilizados foram: uma escala de Avaliação de Sintomas de Transtorno de Déficit de Atenção e Hiperatividade, o MTA SNAP-IV e o Questionário de Habilidades e Dificuldades (SDQ). Para avaliação econômica, utilizou-se o Critério de Classificação Econômica Brasil ­ ABEP. Utilizou-se ainda o teste das matrizes progressivas de Raven para estimar o quociente intelectual e um questionário com dados do histórico da criança, gestação e antecedentes dos pais. Resultados: Foi observada diferença estatisticamente significativa entre crianças a termo e prematuras, no sintoma impulsividade e e nos sintomas de transtorno de conduta, além de uma maior pontuação nos sintomas psiquiátricos em geral. Conclusão: Os achados sugerem que crianças prematuras apresentam maior prevalência de problemas de comportamento do que as nascidas a termo (AU)

Introduction: The number of preterm births has grown in recent years, increasing infant morbidity and mortality rates. It is known that preterm infants are more prone to future problems due to low maturity of organs and low birth weight. However, the interaction of the individual with the family and social environment also influences the development and behavior. This study assessed the cognitive and behavioral characteristics of children with low weight between 5 and 11 years as pediatric outpatients cared for in the School of Medicine, Federal University of Pelotas. Method: The study included 47 children, 11 preterm and 36 term born. The assessment instruments used were the MTA SNAP-IV ­ Assessment Scale of Symptoms of Attention Deficit Hyperactivity Disorder (ADHD) and the Skills and Difficulties Questionnaire (SDQ). For socioeconomic evaluation, we followed the Economic Classification Criterion Brazil ­ ABEP. We also used Raven's Progressive Matrices and a questionnaire with the child's historical data, gestation, and parental background. Results: A statistical difference between preterm and full-term children was observed in the symptom impulsivity and conduct disorders as well as a higher score in psychiatric symptoms in general. Conclusion: The findings suggest that preterm infants have a higher prevalence of behavior problems than those born at term (AU)

Sem centro, no meio / With no center, in the middle / Sin centro, en el medio

O trabalho propõe uma diferença entre pensar nos vínculos e a partir dos vínculos. Nessa segunda opção, é necessário incluir a lógica da multiplicidade, um pensamento rizomático, ou seja, que não coloque o centro nem no sujeito, nem na história, nem no inconsciente, mas sim que transite pelo Entre, a partir do meio. Entre como produção vincular. Essas ideias são trabalhadas a partir do relato de uma consulta familiar.

The paper proposes that there is a difference between thinking of the links and thinking with the links as a starting point. In the latter, it is necessary to include the logic of multiplicity, a rhizomatic thought; in other words, one which doesn't place the center in the subject, in the story, nor in the unconscious, but instead which travels through the Between, from the middle. Between being link production. These ideas are developed from the report of a session of family therapy.

El trabajo propone una diferencia entre pensar en los vínculos y a partir de los vínculos. En esta segunda opción es necesario incluir la lógica de la multiplicidad, un pensamiento rizomático, es decir, que no coloque el centro ni en el sujeto, ni en la historia, ni en el inconsciente, sino que transite por el Entre, desde el medio. Entre como producción vincular. Se trabajan estas ideas a partir del relato de una consulta familiar.

Características sociodemográficas maternas e perfil das crianças internadas em um hospital do sul do Brasil / Características sociodemográficas maternas y perfil de los niños hospitalizado en hospital del sur de Brasil / Sociodemographic maternal characteristics and profile of children hospitalized in a hospital in south of Brazil

Objetivo: conhecer as características sociodemográficas maternas e o perfil epidemiológico dos pacientes pediátricos internados em um Hospital Universitário.Método: estudo transversal descritivo realizado entre janeiro de 2008 a dezembro de 2010.A coleta de dados foi realizada através de questionário aos familiares, incluindo informações socioeconômicas maternas e características das crianças. As variáveis foram analisadas através do programa Data Analysis and Statistical Software (Stata C11).Resultados: constatou-se um predomínio de mães jovens, fumantes, com mais de quatro anos de estudo, renda familiar entre um e dois salários mínimos e que desenvolvem atividades no lar. A maioria das crianças era do sexo masculino menores de um mês de idade com diagnóstico de doenças respiratórias e período de internação inferior a uma semana. Conclusão: notou-se uma melhora nas condições socioeconômicas e escolaridade entre as mães e um aumento de mães fumantes. Entre as crianças houve um predomínio do sexo masculino e de recém nascidos com problemas respiratórios.

Aim: to now the sociodemographic maternal characteristics andepidemiological profile of pediatric patients hospitalized in a university hospital. Method: cross-sectional study conducted from January 2008 to December 2010. Data collection wasconducted through a questionnaire to family members, including maternal socioeconomicinformation and children characteristics. The variables were analyzed in Stata C11program. Results: was observed a predominance of young mothers, smokers, with morethan four years of education, family income between one and two minimum wages anddevelop activities in the home. Most children were male, younger than one month of age,diagnosed with respiratory illnesses and hospital stay less than one week. Conclusion: wasnoted an improvement in socioeconomic conditions and educational level among mothersand an increase in smoking mothers. Among children there was a predominance of males,and infants with breathing problems.

Objetivo: conocer las características sociodemográficas maternas y el perfilepidemiológico de pacientes pediátricos hospitalizados en Hospital Universitario. Método:estudio transversal y descriptivo realizado entre enero 2008 hasta diciembre 2010. Larecolección de datos se realizó a través de cuestionario, incluyendo informacionessocioeconómicas y características de los niños. Las variables fueron analizadas con elprograma Data Analysis and Statistical Software (Stata C11).Resultados: predominio demadres jóvenes, fumadoras, más de cuatro años de estudio, rendimiento familiar entreuno y dos sueldos y que se dedican a la casa. La mayoría de los niños eran varones,menores de un mes de edad, con diagnóstico de enfermedades respiratorias y período demenos de una semana de hospitalización. Conclusión:se observó una mejora en lascondiciones socioeconómicas y la educación de las madres y el aumento de fumadoras.Entre los niños hubo un predominio del sexo masculino y de los recién nacidos conproblemas respiratorios.

Gestational age at birth and morbidity, mortality, and growth in the first 4 years of life: findings from three birth cohorts in Southern Brazil.

BACKGROUND: We assessed anthropometric status, breastfeeding duration, morbidity, and mortality outcomes during the first four years of life according to gestational age, in three population-based birth cohorts in the city of Pelotas, Southern Brazil. METHODS: Total breastfeeding duration, neonatal mortality, infant morbidity and mortality, and anthropometric measures taken at 12 and 48 months were evaluated in children of different gestational ages born in 1982, 1993 and 2004 in Southern Brazil. RESULTS: Babies born <34 weeks of gestation and those born between 34-36 weeks presented increased morbidity and mortality, were breastfed for shorter periods, and were more likely to be undernourished at 12 months of life, in comparison with the 39-41 weeks group. Children born with 37 weeks were more than twice as likely to die in the first year of life, and were also at increased risk of hospitalization and underweight at 12 months of life. Post-term infants presented an increased risk of neonatal mortality. CONCLUSION: The increased risks of morbidity and mortality among preterm (<37 weeks of gestation) and post-term (>41 weeks) are well known. In our population babies born at 37 also present increased risk. As the proportion of preterm and early term babies has increased markedly in recent years, this is a cause for great concern.

Characteristics of intestinal habits in children younger than 4 years: detecting constipation.

OBJECTIVES: The aim of the present study was to describe the prevalence of childhood constipation, stool characteristics, and their relationship with toilet training and age of introduction of cow's milk. METHODS: A total of 4231 children born in 2004, from a birth cohort study, were assessed at 12, 24, and 48 months of age, when their mothers provided information on sociodemographic characteristics, bowel habits, toilet training, and age of introduction of cow's milk and other foods. RESULTS: The prevalence of constipation was 27.3% and 31.0% at 24 and 48 months of age, respectively. Among girls, at 48 months of age, it was 34.4% versus 27.4% in boys (P<0.001). The most common features of constipation were scybalous stools (47.7% and 41.0% at 24 and 48 months, respectively), evacuation difficulty (24.3% and 23.1%), and hard stools (17.8% and 34.1%). Toilet training starting before 24 months was associated with constipation at 24 months and its persistence up to 48 months. Among children who did not receive cow's milk in their first year of life, 22% had constipation at 24 months, 22.6% at 48 months, and 8.3% at 24 and 48 months. Among children who started cow's milk before 30 days of life, the respective proportions of children with constipation was 28.2%, 33%, and 12.4%. CONCLUSIONS: The prevalence of constipation increases with age and cannot be detected using only information on evacuation interval. Toilet training before 24 months and introduction of cow's milk before 1 year of age is positively associated with constipation at 24 months and its persistence up to 48 months.

Single block costal cartilage graft in rhinoplasty / Enxerto de cartilagem costal em monobloco na rinoplastia

INTRODUCTION: It is often necessary to use inclusion materials in rhinoplasty for nose restructuring. The costal cartilage graft is one of the inclusion material options, and its use is indicated when septal cartilage is not available or is not sufficient to provide necessary remodeling of the nose. METHODS: Four patients who, for diverse reasons, had saddle nose or poor projection of the nasal dorsum underwent rhinoplasty. All received a costal cartilage graft carved in an "L" shape. The long branch of the "L" was used to reconstruct the dorsum and the short branch was used to support the new dorsum and the columella, repositioning the nasal tip. RESULTS: All patients had a good postoperative evolution and had no significant complications. There was a clear reconstruction of the dorsum and harmonization of the nasal tip. The results were as expected and were long-lasting. CONCLUSIONS: The use of a costal cartilage graft carved in a single block in rhinoplasty provides enhancement of the nasal dorsum and tip projection, promoting appropriate nasal remodeling.

INTRODUÇÃO: Na rinoplastia frequentemente é necessário o uso de materiais de inclusão para que se obtenha a reestruturação nasal. O enxerto de cartilagem costal é uma das opções e tem seu uso indicado quando a cartilagem septal não está disponível ou não é suficiente para promover o necessário remodelamento nasal. MÉTODO: Quatro pacientes que, por motivos diversos, apresentavam nariz em sela ou dorso nasal pouco projetado foram submetidos a rinoplastia. Todos receberam enxerto de cartilagem costal esculpido em formato de "L". O ramo longo do "L" teve como objetivo reconstituir o dorso e o ramo curto, dar suporte ao novo dorso e à columela, reposicionando a ponta nasal. RESULTADOS: Todos os pacientes evoluíram bem no pós-operatório e não apresentaram complicação significativa. Houve nítida reconstituição do dorso e harmonização da ponta do nariz. Os resultados mostraram-se previsíveis e duradouros. CONCLUSÕES: O emprego de enxerto de cartilagem costal esculpido em monobloco na rinoplastia proporciona ganho de projeção do dorso e da ponta nasais, promovendo adequado remodelamento nasal.

Longitudinal study of sphincter control in a cohort of Brazilian children.

OBJECTIVES: To analyze sphincter control acquisition in a birth cohort. METHOD: 4,231 children born in 2004 in Pelotas, Brazil, were included in a longitudinal study. During home visits at the ages of 12, 24 and 48 months, the mothers answered a questionnaire about sociodemographic questions and characteristics of their children's voiding and bowel habits, with special attention to toilet training. RESULTS: At 48 months, most children were off diapers during the day (98.5%) and by night (83%), with no difference between sexes. The average age for starting toilet training was 22 months, with earlier initiation in girls. The training was, on average, 3.2 months long, showing no difference between sexes. Children with developmental delay had late voiding and bowel control; the higher the deviation from normality, the later the child was off diapers. Medical advice was given to 15.9% of mothers. The training initiated before the age of 24 months was inversely correlated with an older age of sphincter control and longer training. Premature and low birth weight children showed no significant difference in training time and age of acquisition of sphincter control. CONCLUSIONS: At the age of 48 months, most children, including premature and low birth weight ones, acquired sphincter control regardless of external factors and sex. The beginning of training (before 24 months) did not anticipate sphincter control, but only prolonged the duration of training.

Avaliação longitudinal do controle esfincteriano em uma coorte de crianças Brasileiras / Longitudinal study of sphincter control in a cohort of Brazilian children

OBJETIVOS: Avaliar a trajetória do controle esfincteriano em uma coorte de nascimento. MÉTODO: Quatro mil duzentos e trinta e uma crianças nascidas no ano de 2004, em Pelotas, RS, foram incluídas em um estudo longitudinal. Em visitas domiciliares realizadas aos 12, 24 e 48 meses, as mães responderam a um questionário com questões sociodemográficas, características dos hábitos miccionais e intestinais das crianças, com atenção ao treinamento esfincteriano. RESULTADOS: Aos 48 meses, a maioria das crianças estava sem fraldas durante o dia (98,5 por cento) e à noite (83 por cento), sem diferença entre os sexos. A idade média de início de treinamento esfincteriano foi 22 meses, com início mais precoce nas meninas. A duração média do treinamento foi de 3,2 meses, sem diferença entre os sexos. Crianças com atraso de desenvolvimento apresentaram controle esfincteriano mais tardio, havendo relação direta entre a intensidade do desvio da normalidade e a idade da retirada de fraldas. A orientação médica foi fornecida a 15,9 por cento das mães. O treinamento iniciado antes dos 24 meses esteve relacionado com uma maior idade de controle esfincteriano e maior duração do treinamento. Crianças prematuras ou com baixo peso não apresentaram diferença significativa no tempo de treinamento e idade de aquisição do controle esfincteriano. CONCLUSÕES: Até os quatro anos de idade, a maioria das crianças, inclusive prematuros e de baixo peso ao nascer, obtém controle esfincteriano independentemente de fatores externos e do sexo. O início do treinamento (antes dos 24 meses) não antecipou o controle esfincteriano, apenas prolongou o tempo de treinamento.

OBJECTIVES: To analyze sphincter control acquisition in a birth cohort. METHOD: 4,231 children born in 2004 in Pelotas, Brazil, were included in a longitudinal study. During home visits at the ages of 12, 24 and 48 months, the mothers answered a questionnaire about sociodemographic questions and characteristics of their children's voiding and bowel habits, with special attention to toilet training. RESULTS: At 48 months, most children were off diapers during the day (98.5 percent) and by night (83 percent), with no difference between sexes. The average age for starting toilet training was 22 months, with earlier initiation in girls. The training was, on average, 3.2 months long, showing no difference between sexes. Children with developmental delay had late voiding and bowel control; the higher the deviation from normality, the later the child was off diapers. Medical advice was given to 15.9 percent of mothers. The training initiated before the age of 24 months was inversely correlated with an older age of sphincter control and longer training. Premature and low birth weight children showed no significant difference in training time and age of acquisition of sphincter control. CONCLUSIONS: At the age of 48 months, most children, including premature and low birth weight ones, acquired sphincter control regardless of external factors and sex. The beginning of training (before 24 months) did not anticipate sphincter control, but only prolonged the duration of training.

Epidemiologia do co-leito e do despertar nocturno aos 12 meses de idade em uma coorte de nascimentos / Epidemiology of co-sleeping and nighttime waking at 12 months of age in a birth cohort

Investigar a prevalência e os fatoresassociados ao co-leito e ao despertar noturno entre as crianças da coorte de Pelotas de 2004, aos 12 meses deidade.

Effects of buflomedil and pentoxifylline on hamster skin-flap microcirculation: prediction of flap viability using orthogonal polarization spectral imaging.

OBJECTIVE: This study investigated the effects of buflomedil and pentoxifylline, both of which are used in reconstructive surgery of hamster skin flap microcirculation, and evaluated the skin flap survival rate by orthogonal polarization spectral imaging. METHOD: Twenty-four adult male Syrian golden hamsters were divided into three groups: a control (C, 0.1 ml 0.9% saline), buflomedil (B, 3 mg/kg/day), and pentoxifylline group (P, 14.5 mg/kg/day). Treatments administered intraperitoneally were initiated 1 hour before skin flap preparation and continued for 7 days post-operatively at 12-hour intervals. Preparations (skin flaps) were divided into 12 fields, which were organized into six bands. Functional capillary density (FCD, in mm/mm(2)), distance from the skin flap base to blood flow cessation (Dist(with flow), in cm), percentage of viable skin (VA, in%), and qualitative analysis of blood flow by orthogonal polarization spectral imaging were performed at 1 and 24 hours and on the seventh post-operative day. RESULT: Bands IV, V, and VI presented no flow independent of time. The functional capillary density group B was higher than that of groups C and P, primarily after 24 hours. All groups showed an increase in D with time but reached similar final distances (C = 2.73, B = 2.78 and P = 2.70 cm). Moreover, the percentage of viable areas remained at approximately 50%. The orthogonal polarization spectral imaging was useful to assess viability by counting fields with and without blood flow. CONCLUSIONS: Functional capillary density values were higher in the buflomedil group compared to the control and pentoxifylline groups in this model. Functional capillary density did not influence D or the percentage of VA, and the technique showed favorable potential to assess/predict the viability of skin flaps within 1 h after surgery.