Resumo em Espanhol:

OBJETIVOS: 1) Determinar el nivel de satisfacción de las usuarias (SU) de control prenatal en hospitales donde se implementó un programa de mejora continua de la calidad (PMC), y comparar la SU en estos pacientes y en un grupo de referencia. 2) Estudiar comparativamente las razones de insatisfacción en ambos grupos. 3) Identificar los factores asociados a la SU y estudiar su relación con el programa de calidad. MÉTODOS: Estudio cuasiexperimental con una muestra representativa de gestantes que acudieron a atención prenatal hospitalaria. Se aplicaron encuestas de salida en el grupo de intervención (n= 191) y el grupo de referencia (n= 185). La variable dependiente fue la satisfacción con la atención prenatal, y las independientes fueron satisfacción de expectativas, trato del personal, nivel de información, equipamiento, percepción del tiempo de espera, limpieza y comodidad. Se realizaron análisis estadísticos descriptivos y multivariados para responder a los objetivos. RESULTADOS: En el grupo de pacientes que acudieron a los hospitales que participaron en el PMC se encontraron mayores niveles de SU (67,5% frente al 55,1% en el grupo de referencia, P = 0,014). Las razones de insatisfacción fueron el tiempo de espera prolongado y el trato inadecuado, siendo estas últimas más frecuentes en el grupo de referencia. El análisis multivariado indicó que el trato del personal, la información durante la consulta, la satisfacción de las expectativas y la aplicación del PMC fueron factores que mostraron una asociación estadísticamente significativa con la SU. CONCLUSIONES: Se encontró que el PMC en los servicios maternos y perinatales tuvo una asociación positiva con la SU. Asimismo, los resultados refuerzan la necesidad de ofertar servicios humanizados de atención prenatal basados en el buen trato y en la información al usuario, con la idea de mejorar la aceptabilidad de los servicios de salud y la adherencia de la gestante a ellos.

Resumo em Inglês:

OBJECTIVES: 1. To compare the level of health service user satisfaction (US) with antenatal care in hospitals where a program of continuous quality improvement (CQI) was implemented, in comparison to a reference group of patients seen at hospitals that did not participate in the program. 2. To compare the reasons for dissatisfaction in both groups of users. 3. To identify the factors associated with US. METHODS: A quasi-experimental study of a representative sample of pregnant women attending prenatal care services. The women in the intervention group (n = 191) and the reference group (n = 185) were interviewed on leaving the prenatal care clinic. The dependent variable was satisfaction with prenatal care, and the independent variables were satisfaction of expectations, amiability, level of health information, perception of the equipment, waiting time, cleanliness and comfort. Descriptive and multivariate statistics were calculated. RESULTS: The intervention group showed higher rates of US (67.5% versus 55.1% in the reference group, P = 0,014). The main reasons for dissatisfaction were long waiting times and discourteous treatment, which were more frequent in the reference group. The multivariate analysis identified cordiality of the health professionals, information provided during the visit, satisfaction of expectations and implementation of the CQI program as the factors that were significantly associated with US. CONCLUSIONS: Our findings show that the CQI program in maternal and perinatal health services was positively associated with US. These results reinforce the need for cordiality during prenatal care contacts with providers, and the need to provide appropriate information to the user, in order to help increase acceptability of and adhesion to health care recommendations among pregnant women.

Resumo em Espanhol:

OBJETIVOS: Calcular la cobertura con el régimen de vacunación completo y con vacunas contra antígenos particulares en niños de 13 a 59 meses de edad en Buenos Aires; comparar los resultados de una encuesta comunitaria a domicilio con los porcentajes de cobertura indicados en los registros públicos; e identificar los factores que ponen a los niños en riesgo de no recibir todas las dosis de vacunas recomendadas bajo el régimen oficial. MÉTODOS: Se encuestaron sistemáticamente los corredores censales en Buenos Aires en marzo y abril de 2002. En cada cuadra de cada corredor censal se encuestó a tres niños entre las edades de 13 a 24 meses y de 25 a 29 meses. Se solicitaba ver una constancia de vacunación escrita. Se identificaron factores de riesgo asociados con la falta de vacunación completa mediante un análisis unifactorial y regresión logística multifactorial. RESULTADOS: Se encuestó a un total de 1 391 niños. La cobertura con vacunas contra antígenos particulares varió de 69,4% (IC95%: 66,7%-72%) en el caso de la vacuna contra Haemophilus influenzae tipo B a 99% (IC95%: 98,4%-99,6%) en el caso de la vacuna BCG. Exceptuando la vacuna contra el sarampión, las coberturas estimadas mediante la encuesta prácticamente no difirieron de las obtenidas de los registros sanitarios públicos. El análisis de regresión logística multifactorial reveló que la edad del niño (P < 0,001) y el proveedor de la vacuna (público o privado) (P = 0,001) eran factores de riesgo asociados con la vacunación incompleta. No ser el primer hijo (P < 0,001) se asoció con un régimen de vacunas incompleto en el contexto del programa de vacunación habitual. Ser residente de la zona norte de la ciudad (P = 0,001), no tener seguro (P = 0,02) y la baja escolaridad del principal guardián del niño (P = 0,04) fueron factores de riesgo asociados con la administración incompleta del régimen de vacunación bajo el programa de vacunación vigente. CONCLUSIÓN: A pesar de que los porcentajes de cobertura con algunas vacunas son altos, sigue siendo baja la frecuencia de la vacunación con el régimen completo en niños de 13 a 59 meses de edad en Buenos Aires. Para poder mejorar esta cobertura tendrá que haber mayor acceso a las vacunas, especialmente en los sectores de la comunidad que están expuestos a los factores de riesgo.

Resumo em Inglês:

OBJECTIVES: To estimate antigen-specific and series-complete vaccination coverage among children aged 13 to 59 months in Buenos Aires; to compare the results of a community-based household survey with coverage rates obtained from administrative records; and to identify risk factors for incomplete vaccination. METHODS: Census tracts in Buenos Aires were surveyed systematically in March and April, 2002. Three children aged 13 to 24 months and 25 to 59 months were surveyed per block in each census tract. Written documentation of vaccination was required. Risk factors associated with incomplete vaccination were identified with univariate analysis and multivariate logistic regression. RESULTS: A total of 1391 children were surveyed. Antigen-specific coverage ranged from 69.4% (95% CI 66.7%-72%) for Haemophilus influenzae type b vaccination to 99% (95% CI 98.4%-99.6%) for BCG vaccination. Except for measles, coverage estimates found in the survey did not differ substantially from those obtained from city health authority records. Multivariate logistic regression analysis showed child's age (P <0.001) and vaccination provider (public or private) (P= 0.001) to be risk factors associated with incomplete vaccination. Not being the first child (P <0.001) was associated with incomplete coverage under the long-standing program. Living in the Northern zone of the city (P= 0.001), being uninsured (P= 0.02), and lower educational level of the primary caregiver (P= 0.04) were risk factors associated with incomplete coverage under the current vaccination program. CONCLUSIONS: Although coverage rates for some vaccines were high, complete vaccination coverage remains low among children aged 13 to 59 months in Buenos Aires. Increasing coverage will require better access to vaccination, particularly in sections of the community with risk factors.

Resumo em Português:

OBJETIVO: Estudar os fatores associados à sorologia positiva para sífilis em puérperas atendidas em 24 centros cadastrados pelo Programa Nacional de Doenças Sexualmente Transmissíveis/ AIDS. MÉTODOS: Estudo transversal com amostra aleatória probabilística de 3 047 puérperas, tendo como critério de elegibilidade as gestantes admitidas para parto ou curetagem nos centros selecionados. Após a entrevista foi coletada alíquota de sangue para realização de teste do Venereal Disease Research Laboratory (VDRL). No caso de VDRL positivo, foi realizado o teste fluorescent treponemal antibody-absorption (FTA-abs). O evento considerado para análise foi a positividade para VDRL confirmada pelo FTA-abs. Na análise estatística foi estimada a razão de chances (OR) com intervalo de confiança de 95%. A adequação do modelo foi feita pelo teste de Hosmer-Lemeshow. RESULTADOS: A prevalência de sífilis na amostra estudada foi de 1,7%. A análise multivariada mostrou que o maior risco de positividade para VDRL estava associado a renda familiar menor do que 1 salário mínimo, idade < 17 anos na primeira relação sexual, idade < 14 anos na primeira gravidez, história de sífilis e história de doença sexualmente transmissível anteriores a esta gravidez, tratamento para sífilis nesta gravidez, realização de exame de sífilis no parceiro, exame anti-HIV positivo ou não realizado, parto pré-termo anterior e feto natimorto como resultado da gravidez. Apenas 43% das puérperas realizaram seis ou mais consultas de pré-natal e apenas 3% realizaram um VDRL no 1° e outro no 3° trimestres de gestação, conforme recomenda o Ministério da Saúde. CONCLUSÕES: O estudo mostra que o problema da sífilis congênita ainda está longe de ser equacionado no Brasil. São necessárias ações de orientação sexual e de planejamento familiar para adolescentes. Também é preciso melhorar o acompanhamento pré-natal e investigar a história pregressa de doenças sexualmente transmissíveis na gestante e em seu parceiro sexual.

Resumo em Inglês:

OBJECTIVE: To investigate the factors associated with positive syphilis serology results in puerperal women who were receiving care at 24 health centers accredited by Brazil's National Program on Sexually Transmitted Diseases and AIDS. METHODS: This cross-sectional study included a probabilistic random sample of 3 047 puerperal women. The eligibility criterion was being admitted for delivery or curettage in the selected centers. After an interview to collect demographic and clinical information, a blood sample was taken and then examined with the Venereal Disease Research Laboratory (VDRL) slide test. With positive VDRL results, the fluorescent treponemal antibody-absorption test (FTA-Abs) was used for confirmation. The event considered for analysis was positivity on the VDRL test, with confirmation by the FTA-Abs. For the statistical analysis, odds ratios and 95% confidence intervals were calculated. The model fit was assessed using the Hosmer-Lemeshow test. RESULTS: The prevalence of syphilis among the women studied was 1.7%. Multivariate analysis showed that increased risk for positive VDRL and FTA-Abs results was associated with the following characteristics: family income below one minimum wage, age < 17 years at first sexual intercourse, age < 14 years at first pregnancy, history of syphilis or of other sexually transmitted diseases prior to the current pregnancy, treatment for syphilis during the current pregnancy, partner having been tested for syphilis, having a positive HIV test result or having no HIV test result on record, previous preterm delivery, and stillbirth as an outcome of pregnancy. Only 43% of the women had had six or more prenatal visits, and only 3% had had one VDRL test during the first trimester of pregnancy and another VDRL test during the third trimester, as is recommended by Brazil's national Ministry of Health. CONCLUSIONS: This study shows that the problem of congenital syphilis is far from being solved in Brazil. It is necessary to provide adolescents with family planning services as well as guidance on sexual issues, to improve prenatal follow-up, and to research the history of sexually transmitted diseases in both the pregnant woman and her sexual partner.

Resumo em Espanhol:

OBJETIVO: Examinar la relación entre la presencia o ausencia de anticuerpos y los diversos factores de riesgo hipotéticos asociados con la infección por Toxoplasma gondii en dos poblaciones amerindias diferentes del este de Panamá. Como secuela a una investigación preliminar, en este trabajo se explora el papel de los perros en la transmisión natural de Toxoplasma y en la facilitación de la transmisión, así como el efecto interactivo de los perros y gatos y el acceso de los niños a materiales infecciosos. MÉTODOS: En 1991, 10 estudiantes de medicina panameños llevaron a cabo entrevistas y les tomaron muestras de sangre a 760 niños kunas y emberas de 2 a 12 años de edad en la cuenca superior del río Bayano y en las islas de San Blas. Se hicieron pruebas serológicas mediante aglutinación directa. Todos los datos, menos los de los perros, se estudiaron mediante análisis unifactorial, bifactorial y multifactorial. En 2003 se efectuaron nuevos análisis bifactoriales y multifactoriales para examinar la contribución de los perros. RESULTADOS: En comunidades con una alta prevalencia de anticuerpos contra Toxoplasma en niños, la regresión logística indicó que los siguientes factores tenían valor pronóstico en relación con la presencia de anticuerpos: pisos de tierra compacta en las chozas (P = 0,001), tener perro (P = 0,038), y que el investigador hubiera visto un gato dentro de la vivienda (P = 0,049). Según nuestros resultados, los perros de los habitantes de las aldeas desempeñan un papel importante en la facilitación de la transmisión de Toxoplasma gondii a los seres humanos, la mayor parte de las veces en presencia de gatos dentro de la vivienda y solamente en comunidades con una alta seroprevalencia de Toxoplasma en niños. CONCLUSIONES: Los perros pueden ser vectores mecánicos debido a su hábito de revolcarse en sustancias fétidas y de comer heces. En zonas donde la prevalencia de Toxoplasma en niños es alta y donde hay muchos perros y gatos, a las personas inmunodeprimidas y las mujeres embarazadas se les debe advertir del peligro de infectarse con Toxoplasma gondii por contacto con perros o con tierra contaminada por gatos. Se debe alentar a las personas a lavarse las manos después de tocar tierra, perros o gatos y antes de comer.

Resumo em Inglês:

OBJECTIVE: To examine the relationship between antibody status and various hypothesized risk factors for Toxoplasma gondiiinfection among two different Amerindian populations in eastern Panama. Following up on earlier research that we conducted, we now explore the role of dogs in the natural transmission of Toxoplasma,the role that dogs play in promoting transmission, the interactive effect of cats and dogs, and the accessibility of infective material to children. METHODS: In 1991, 10 Panamanian medical students conducted interviews and took blood samples from 760 Kuna and Embera children aged 2 through 12 years in the Upper Bayano River Basin and the San Blas Islands. Serologic assays were performed using direct agglutination. The data analyses in the 1990s included univariate, bivariate, and multivariate analyses, without regard to data on dogs. Further bivariate and multivariate analyses were performed in 2003 to examine the contribution of dogs. RESULTS: In communities with high Toxoplasmaantibody prevalence in children, logistic regression suggested that the factors predictive of antibody presence were: compacted soil floors of huts (P= 0.001), having a dog (P= 0.038), and the interviewer seeing a cat in the house (P= 0.049). Our results suggest that the villagers' dogs play a significant role in facilitating the transmission of Toxoplasma gondiito humans, most often in the presence of cats in the houses, and only in those communities with higher Toxoplasmas eroprevalence in children. CONCLUSIONS: Dogs may act as mechanical vectors, by rolling in foul-smelling substances and by ingesting fecal material. In areas of high Toxoplasma prevalence in children and where dogs and cats are plentiful, immunocompromised individuals and pregnant women should be warned of the possibility of acquiring Toxoplasma gondii from dogs as well as from soil contaminated by cats. People should be encouraged to wash their hands after contact with soil, dogs, or cats as well as before eating.

Resumo em Espanhol:

OBJETIVOS: Evaluar cómo responden los estafilococos hospitalarios sensibles y resistentes a la meticilina ante la acción de diferentes antisépticos y desinfectantes empleados habitualmente en los hospitales de la Provincia de Buenos Aires, Argentina. Demostrar la eficacia de esas sustancias mediante la determinación de sus concentraciones bactericidas eficaces, así como analizar si existe correlación entre la resistencia a biocidas y la resistencia a la meticilina en esta población bacteriana. MÉTODOS: Se evaluó la acción de siete biocidas con 25 cepas de estafilococos nosocomiales sensibles y resistentes a la meticilina y una cepa de colección, Staphylococcus aureus ATCC 6538. Las cepas hospitalarias provienen de dos hospitales de máxima complejidad y fueron obtenidas, durante los meses de abril de 2000 a mayo de 2002, de muestras clínicas (hemocultivo, urocultivo, punta de catéter y abceso) pertenecientes a pacientes de ambos sexos, internados y ambulatorios. Después del aislamiento de dichas cepas, determinamos la sensibilidad a antibióticos mediante el método de difusión en agar de Kirby y Bauer. Para estudiar la acción de los biocidas de uso hospitalario sobre estas cepas, empleamos el ensayo de Kelsey-Sykes, que permite establecer las concentraciones bactericidas eficaces de tales compuestos. RESULTADOS: Los resultados muestran que la respuesta de las cepas hospitalarias resistentes y sensibles a la meticilina varía con respecto a la cepa de colección. El digluconato de clorhexidina, la yodopovidona, la tintura de yodo débil y el glutaraldehído alcalino fueron eficaces contra la mayoría de las cepas, independientemente de su resistencia o sensibilidad a los antibióticos. CONCLUSIONES: Estas evaluaciones no indican ninguna asociación entre la resistencia a la meticilina y la resistencia a los biocidas evaluados. Asimismo, apuntan a la necesidad de seguir investigando para valorar la eficacia de los agentes químicos contra los microorganismos que han sido expuestos a antibióticos.

Resumo em Inglês:

OBJECTIVE: To assess the response to the action of different antiseptics and disinfectants usually used in Argentinian hospitals of hospital staphylococci sensitive and resistant to methicillin. To test the effectiveness of the biocides by measuring their effective bactericidal concentrations, and to determine whether there is any correlation between biocide resistance and methicillin resistance in this bacterial population. METHODS: The action of seven biocides was tested against 25 strains of nosocomial Staphylococcus spp. sensitive and resistant to methicillin, and in Staphylococcus aureus ATCC 6538. Hospital strains were obtained from April, 2000 to May, 2002, from clinical samples (blood culture, urine culture, catheter tip or abscess) from male and female inpatients and outpatients at two tertiary hospitals. After isolation, antibiotic sensitivity was tested with the agar diffusion method of Kirby and Bauer. The action of hospital biocides on the strains was studied with the Kelsey-Sykes test, which establishes the effective bactericide concentrations of these compounds. RESULTS: The results showed that the response of strains sensitive and resistant to methicillin varied in comparison to the collection strain. Chlorhexidine digluconate, povidone iodine, weak tincture of iodine and alkaline glutaraldehyde were effective against most strains, regardless of whether they were sensitive or resistant to methicillin. CONCLUSIONS: We found no indication of a relationship between resistance to methicillin and resistance to biocides. Our study shows that further research is needed to evaluate the efficacy of chemical agents against microorganisms that have been exposed to antibiotic therapies.

Resumo em Espanhol:

OBJETIVO: Comparar, en las dos islas que integran la república de Trinidad y Tabago, la prevalencia de síntomas de asma y de rinitis en escolares de primaria expuestos al humo de tabaco en el ambiente domiciliario con la prevalencia de los mismos síntomas en coetáneos sin la exposición. MÉTODOS: Entre septiembre y diciembre de 2002, se distribuyeron cuestionarios basados en el instrumento elaborado para el Estudio Internacional de Asma y Alergias en la Niñez (ISAAC, por International Study of Asthma and Allergies in Childhood). La distribución la efectuaron los escolares de 106 escuelas escogidas aleatoriamente en Trinidad y Tabago (5 511 escolares en Trinidad y 1 100 en Tabago) entre los padres de 6 611 escolares de segundo o tercer grado (por lo general de 6 y 7 años de edad, respectivamente). Añadimos dos preguntas al cuestionario ISAAC, una de ellas sobre el tabaquismo en el domicilio y la otra sobre el origen étnico de los niños. RESULTADOS: Un total de 3 170 cuestionarios llenados se prestaron a análisis (2 618 de Trinidad y 552 de Tabago). En Trinidad 782 (29,9%) de los niños vivían en hogares donde uno de los padres o ambos padres fumaban, y 513 (19,6%) tenían otros parientes en el domicilio que fumaban. En Tabago 94 de los niños (17,0%) tenían padres que fumaban y 84 (15,4%) venían de hogares donde otros residentes fumaban. El tabaquismo en los padres mostró una asociación significativa con la presencia de sibilancias (razón de posibilidades [RP]: 1,43; intervalo de confianza de 95% [IC95%]: 1,11- 1,83), sibilancias provocadas por el ejercicio (RP: 2,12; IC95%: 1,59-2,82), tos nocturna (RP: 1,64; IC95%: 1,37-1,97) y síntomas de rinitis (RP: 1,35; IC95%: 1,10-1,65) en los 12 meses más recientes, así como antecedentes de fiebre del heno o problemas sinusales (RP: 1,39; IC95%: 1,11-1,74). La presencia en el domicilio de parientes fumadores distintos de los padres también mostró una asociación significativa con todos estos síntomas y con antecedentes de asma (RP: 1,49; IC95%: 1,13-1,97). En cuanto a diferencias por razones étnicas, el tabaquismo de los padres fue más frecuente en los hogares de escolares del sur del Asia, mientras que el tabaquismo de otros adultos en el domicilio se observó con más frecuencia en los hogares de escolares de raza mixta. CONCLUSIONES: Aun en Trinidad y Tabago, que se ubica en un ambiente tropical donde se pasa más tiempo al aire libre y donde las viviendas tienen mejor ventilación que en climas templados, la exposición a humo de tabaco en el ambiente se asocia estrechamente con una prevalencia aumentada de síntomas de asma y rinitis en escolares de primaria.

Resumo em Inglês:

OBJECTIVE: To compare, in the twin-island republic of Trinidad and Tobago, the prevalence of symptoms of asthma and rhinitis among children of primary school age who are exposed to household environmental tobacco smoke with the prevalence of these symptoms in their colleagues without this exposure. METHODS: Between September and December 2002, questionnaires based on the instrument developed for the International Study of Asthma and Allergies in Childhood (ISAAC) were distributed, via the children in their schools, to parents of 6 611 Year 2 pupils (typically 6 years old) or Year 3 pupils (typically 7 years old) in 106 randomly selected schools in Trinidad and Tobago (5 511 pupils on Trinidad and 1 100 pupils on Tobago). We added to the standard ISAAC questionnaires two questions, one on household smoking and one on the ethnicity of the children. RESULTS: A total of 3 170 completed questionnaires were suitable for further analysis (2 618 from Trinidad and 552 from Tobago). On Trinidad 782 of the children (29.9%) lived in homes where one or both parents smoked, and 513 (19.6%) had other relatives in the household who smoked. On Tobago 94 of the pupils (17.0%) had parents who smoked, and 84 (15.4%) came from homes where other residents smoked. Parental smoking was significantly associated with wheezing (odds ratio (OR): 1.43; 95% confidence interval (CI): 1.11-1.83), exercise-induced wheezing (OR: 2.12; 95% CI: 1.59-2.82), nocturnal coughing (OR: 1.64; 95% CI: 1.37-1.97), and symptoms of rhinitis (OR: 1.35; 95% CI: 1.10-1.65) in the last 12 months as well as a history of hay fever/sinus problems (OR: 1.39; 95% CI: 1.11-1.74). Smoking in the home by adult residents other than parents was also significantly associated with all of these symptoms as well as a history of asthma (OR: 1.49; 95% CI: 1.13-1.97). In terms of ethnic differences, parental smoking was most prevalent in the homes of South Asian students, while smoking by other adults in the home occurred most commonly in the households of pupils of mixed race. CONCLUSIONS: Even in Trinidad and Tobago, which is a tropical environment where more time is spent outdoors and homes have more open ventilation than in temperate climates, environmental tobacco smoke exposure is closely associated with an increased prevalence of symptoms of asthma and rhinitis in primary-school-aged children.

Resumo em Português:

OBJETIVO: Analisar a composição de macro e micronutrientes minerais no leite humano coletado e processado em bancos de leite e desenvolver um complemento que, incorporado a esse leite, satisfaça as exigências nutricionais específicas do recém-nascido de baixo peso. MÉTODO: Para a determinação de macronutrientes, 46 amostras de leite pasteurizado obtidas de dois bancos de leite foram analisadas em triplicata: 26 amostras de leite maduro, 10 de colostro e 10 de leite de mães de bebês prematuros. Em 30 dessas amostras (10 de cada tipo) foram determinados também os micronutrientes. Após a determinação dos macro e micronutrientes, desenvolveu-se um complemento de simples preparo, composto de hidrolisado protéico e minerais quelatos. RESULTADOS: A composição variou tanto entre os diferentes tipos de leite quanto entre doadoras do mesmo tipo de leite. Os valores de micro e macronutrientes foram inferiores às necessidades dos recém-nascidos de baixo peso. A composição média observada (e desvio-padrão) para leite maduro, colostro e leite de mães de prematuros foi: lipídios (g/100 mL), 2,56 (± 0,8), 2,48 (± 0,91), 2,48 (± 0,76); lactose (g/100 mL), 8,6 (± 0,93), 7,05 (± 0,92), 6,56 (± 1,41); proteínas (g/100 mL), 1,07 (± 0,22), 1,71 (± 0,29), 1,72 (± 0,4); calorias (kcal/100 mL), 61,67 (± 8,92), 57,36 (± 8,37), 55,44 (± 8,00); cálcio (mg/100 mL), 17,88 (± 5,56), 22,75 (± 10,24), 22,03 (± 9,39); magnésio (mg/ 100 mL), 2,15 (± 0,39), 2,64 (± 0,67), 2,16 (± 0,26); potássio (mg/100 mL), 35,53 (± 7,54), 43,75 (± 14,32), 44,37 (± 12,83); sódio (mg/100 mL), 16,27 (± 5,92), 43,36 (± 11,34), 37,98 (± 11,34); zinco (mg/100 mL), 0,46 (± 0,26), 0,75 (± 0,25), 0,72 (± 0,26); fósforo (mg/100 mL), 9,98 (± 1,72), 9,31 (± 4,30), 8,47 (± 2,43). Com a adição do complemento, os níveis de proteína e dos minerais estudados passaram a se enquadrar nas recomendações para recém-nascidos de baixo peso. CONCLUSÃO: Com base nos resultados obtidos é justificável a complementação do leite armazenado em bancos para uso por recém-nascidos de baixo peso. O complemento desenvolvido mostrou viabilidade operacional, não interferindo na qualidade microbiológica do leite humano.

Resumo em Inglês:

OBJECTIVE: To determine the macronutrient and micronutrient contents of human milk from milk banks as well as to develop a supplement for addition to this milk that could satisfy the specific nutritional requirements of low birthweight newborns. METHOD: For the determination of macronutrients, 46 samples of pasteurized milk obtained from two milk banks were analyzed in triplicate: 26 samples of mature milk, 10 samples of foremilk and 10 samples of milk from mothers of preterm babies. Thirty of these samples (10 of each type of milk) were also analyzed for their micronutrient content. Following the determination of macronutrients and micronutrients, an easy-to-prepare supplement was developed. The supplement was made from protein hydrolysate powder and chelate minerals. RESULTS: The nutritional content varied both among the different types of milk and among the donors of the same type of milk. The levels of macronutrients and micronutrients were below the requirements for low birthweight newborns. The mean composition (and standard deviation) observed for mature milk, foremilk, and preterm milk, respectively, was as follows: fats (g/100 mL), 2.56 (± 0.8), 2.48 (± 0.91), 2.48 (± 0.76); lactose (g/100 mL), 8.6 (± 0.93), 7.05 (± 0.92), 6.56 (± 1.41); protein (g/ 100 mL), 1.07 (± 0.22), 1.71 (± 0.29), 1.72 (± 0.4); calories (kcal/100 mL), 61.67 (± 8.92), 57.36 (± 8.37), 55.44 (± 8.00); calcium (mg/100 mL), 17.88 (± 5.56), 22.75 (± 10.24), 22.03 (± 9.39); magnesium (mg/100 mL), 2.15 (± 0.39), 2.64 (± 0.67), 2.16 (± 0.26); potassium (mg/100 mL), 35.53 (± 7.54), 43.75 (± 14.32), 44.37 (± 12.83); sodium (mg/100 mL), 16.27 (± 5.92), 43.36 (± 11.34), 37.98 (± 11.34); zinc (mg/100 mL), 0.46 (± 0.26), 0.75 (± 0.25), 0.72 (± 0.26); and phosphorus (mg/100 mL), 9.98 (± 1.72), 9.31 (± 4.30), 8.47 (± 2.43). After the addition of the supplement, the protein and mineral contents reached the levels recommended for low birthweight newborns. CONCLUSION: Based on our results obtained, the supplementation of human milk from milk banks is warranted for use with low birthweight newborns. The proposed supplement was shown to be practical and safe, and it did not interfere with the microbiological quality of human milk.

Resumo em Inglês:

From the data submitted to the Pan American Health Organization (PAHO) by nationwide programs against sexually transmitted diseases (STD), HIV infection, and AIDS (2002), one can estimate the overall prevalence of syphilis among pregnant women to be 3.1% and to range from 1.00% in Peru to 6.21% in Paraguay. According to these data, the incidence of congenital syphilis ranges from 1.4 per 1 000 live births in El Salvador to 12.0 per 1 000 live births in Honduras. Among men who engage in sex with other men, who often classify themselves as heterosexual, as well as in female sex workers, the prevalence of syphilis ranged from 5% to 15%. Factors that determine the persistence of congenital syphilis as a public health problem include a lack of awareness of the seriousness of the problem among politicians, health officials, and health care providers, difficult access to prenatal care and screening services, a low demand for the test among users, and the stigma and discrimination that surround sexually transmitted diseases (STD). This paper seeks to focus the attention of health professionals on maternal and congenital syphilis so they will undertake actions, using an interprogrammatic approach, to eliminate congenital syphilis from Latin America and the Caribbean. Eliminating congenital syphilis will only become possible if interventions targeting vulnerable groups are also implemented. PAHO's role in eliminating congenital syphilis includes determining the baseline situation in the Region as a whole and in each country, developing communication and procurement strategies, supporting nationwide programs, promoting operational research, and facilitating interprogrammatic coordination.