This cross-sectional study of 831 low-risk pregnancies compared the management of labor and delivery in a birthing center, a hospital that had previously won the "Galba de Araújo" Award (for excellence in obstetric and neonatal care), and a standard-protocol maternity facility. The rates for use of ocytocin during labor were 27. 9%, 59.5%, and 40.1%, while amniotomy was performed in 67.6%, 73.6%, and 82.2% IntroduçãoA assistência obstétrica no Brasil é caracterizada pelo emprego inapropriado de intervenções no processo fisiológico do trabalho de parto, cujo uso abusivo pode levar a efeitos danosos para mãe e filho 1,2,3 . Além de desconfortos físicos para a mulher e dos riscos associados às altas taxas de partos cirúrgicos, de episiotomias e do uso rotineiro da ocitocina e da amniotomia, acumulamse evidências sobre uma epidemia de prematuridade tardia causada pela interrupção eletiva e sem indicação clínica precisa da gravidez 4,5 .A taxa de cesárea, indicador importante do modelo de atenção chamado de "tecnicista" que está em vigor no Brasil 1,2,6 , alcançou em 2006 uma média nacional de 43,8% 7 . Essa tendência foi concomitante ao aumento da prematuridade que variou entre 3,4% e 15% em diferentes regiões do país 4 . A episiotomia, outro indicador importante, apresenta média nacional de 71,6% 7 , e estudos no Rio de Janeiro mostraram uso de ocitocina entre 39,3% e 64,4% 8,9 .Apesar do acesso praticamente universal ao pré-natal e ao parto hospitalar em todo país e dos avanços importantes no conhecimento científico, observa-se um paradoxo na assistência obstétri-ca brasileira: as mulheres e seus recém-nascidos adoecem e morrem tanto pela falta quanto pelo uso inapropriado e inseguro da tecnologia 2 .Entendendo-se como modelo de atenção a forma de organização das práticas assistenciais, ARTIGO ARTICLE Vogt SE et al.

Trabalho resultante do processo FAP/ESP nº 2006/06902-2-2, realizado pelo

The current study focuses on factors associated with sexual initiation and condom use among teenagers on Santiago Island, Cape Verde, according to gender. This was a representative, probabilistic sample of 13-to-17-year-olds (n = 768) attending public secondary schools on Santiago Island in 2007. Associations were tested by test of proportion, Pearson's chi-square, or Fisher's exact test and logistic regression. Factors related to sexual initiation among boys were: age over 14 years, Catholic religion, and alcohol consumption. For girls, the factors included: > 9 years of schooling and involvement in an affective-sexual relationship. Unlike other Sub-Saharan countries, this study showed a high prevalence of condom use during initial sexual activity. Adolescents are able to safely begin sexually active life if they have access to information, sex education, and other STD prevention and contraceptive methods. This study provides insights on the development of policies to reduce the vulnerability of the young population to STD/AIDS and the limits and challenges related to the promotion of condom use and sex education, focusing on unequal gender relations.

Os Centros de Atenção Psicossociais Infantojuvenis (CAPSi) são elementos estratégicos da atenção pública em saúde mental ofertado para população infantojuvenil com sofrimento psíquico intenso e persistente. São articulados numa rede de atenção que extrapola o campo da saúde e interage com os recursos do território de determinada comunidade para promover inclusão social de crianças e adolescentes e conta para tanto também com a co-responsabilização das famílias, escolas e outros setores sociais. No rol de suas condutas terapêuticas há espaço reservado para o atendimento de familiares quando essa medida for necessária para aquela dirigida à clientela em foco. OBJETIVO: identificar condutas terapêuticas oferecidas às famílias de crianças e adolescentes atendidos nos CAPSi. MÉTODO: estudo transversal em crianças e adolescentes provenientes dos prontuários ativos, selecionados aleatoriamente, de 19 CAPSi do Estado de São Paulo no período de setembro de 2008 a fevereiro de 2009. A análise descritiva foi apresentada por meio de tabelas de número e porcentagem. RESULTADOS: a mãe se revelou a principal cuidadora dessa população fora dos serviços. Contudo, há de se destacar a importante ausência de registros de atendimento ou propostas realizadas às famílias. CONSIDERAÇÕES FINAIS: a principal conduta indicada para as famílias são os atendimentos grupais, as famílias têm sido pouco privilegiadas nas condutas terapêuticas dentro dos projetos terapêuticos da população atendida. As falhas de registro nos prontuários pesquisados podem ser uma limitação do estudo. As ações são preponderantemente institucionais e as ofertas extramuros são raríssimas.

BackgroundTo assess the motor development of infants exposed to maternal human immunodeficiency virus (HIV).MethodsThirty infants were assessed in the period from November 2009 to March 2010 at the AIDS Reference and Training Centre, in São Paulo, Brazil. The assessment instrument used in the research was the Alberta Infant Motor Scale (AIMS). All 30 infants used the antiretroviral drug properly for 42 consecutive days, in accordance with the protocol of the World Health Organization.ResultsOut of the total number of infants, 27 (90%) had proper motor performance and 3 (10%) presented motor delay, according to the AIMS.DiscussionThis study demonstrated that only 10% of the assessed group had developmental delay and no relation with environmental variables was detected, such as maternal level of education, social and economic issues, maternal practices, attendance at the day care center, and drug use during pregnancy. It is important to emphasize the necessity of studies with a larger number of participants.

In this minireview we describe the involvement of the atrial natriuretic peptide (ANP) in cardiovascular pathophysiology and exercise. The ANP has a broad homeostatic role and exerts complex effects on the cardio-circulatory hemodynamics, it is produced by the left atrium and has a key role in regulating sodium and water balance in mammals and humans. The dominant stimulus for its release is atrial wall tension, commonly caused by exercise. The ANP is involved in the process of lipolysis through a cGMP signaling pathway and, as a consequence, reducing blood pressure by decreasing the sensitivity of vascular smooth muscle to the action of vasoconstrictors and regulate fluid balance. The increase of this hormone is associated with better survival in patients with chronic heart failure (CHF). This minireview provides new evidence based on recent studies related to the beneficial effects of exercise in patients with cardiovascular disease, focusing on the ANP.

Family violence is a social and public health issue across the world for many populations and affects many different types of people, for example, children, women, and vulnerable adults. Adolescents are one of the main victims of this important phenomenon. This article estimates the prevalence of family violence in adolescents and associated factors. The study was carried out in 2012 with a probability and representative sample of 656 adolescents aged between 11 and 17 years who were enrolled at public schools located in the extreme South of the city of São Paulo. The association was tested by the proportion test, Pearson's chi-square or Fischer's exact test, and Poisson regression adjusted by robust variance estimation, considering a level of significance of 5%. Among adolescents, 38.9% reported having been victims of family violence. Women were victimized with higher frequency (44.1%). The factors associated with prevalence of family violence were being of the female sex (prevalence ratio [PR] = 1.47; 95% confidence interval [CI] = [1.20, 1.80]) and living only with the father (PR = 1.52; 95% CI = [1.11, 2.08]). The prevalence of adolescents who were victims of family violence is high; however, special attention must be paid to women and adolescents who live only with their father-they were established, in this study, as a risk group. Epidemiological studies of this nature are important to reveal the reality of family violence and to aid the construction of intersectoral public policies to promote health, prevent violence, and foster a peaceful culture.

Objective: To analyze the evolution of child mortality. Methods: A descriptive ecological study was conducted. The database of deaths provided by the Mortality Information System between 2006 and 2010 was used. Only records in which the city of residence and occurrence of deaths corresponded to the city of Porto Velho and whose children were younger than 12 months at the time of death were included in this study. In addition, only deaths from preventable neonatal and post-neonatal causes were analyzed. Results: In the city of Porto Velho, during the period studied, there is a predominance of mothers aged between 20 and 34 years, whose percentages of child deaths varied between 26.0% in 2006 and 29.0% in 2010, with small variations in the remaining years. There was an increasing trend towards premature deaths, except in 2009, when the percentage was 45.0%. Between 2006 and 2007, this percentage remained at 50.0%, increasing to 53% in 2008 and subsequently to 54.0% of deaths among children younger than one year in 2010. Conclusion: The estimate of incidence of child mortality in the period studied remained higher than the value expected by 2015 in Brazil.