the main risk factors associated with wheezing in Fortaleza were respiratory infections and family history of asthma. Knowing the risk factors for this disease should be a priority for public health, in order to develop control and treatment strategies.
Background: To evaluate the association between delays in obstetric care and neonatal near-miss mortality events and death in a public maternity referral center. Methods: This case-control study enrolled 142 neonates, meeting the near-miss criteria of 5-min Apgar < 7, weight < 1500 g, gestational age < 32 weeks, and use of mechanical ventilation or congenital malformation, as well as 284 controls (without the near-miss criteria), at a ratio of 1:2. After follow-up, the following outcomes were reclassified: survival of the neonatal period without the near-miss criteria (true "controls"), "near-miss," and "neonatal death." Maternal sociodemographic characteristics, prenatal care, and pregnancy resolution were evaluated. Pearson's chi-square and Fisher's exact tests were used. Simple logistic regression was performed to determine the association between the three delay factors with near-miss outcomes and/or neonatal death. The variables that had maintained values of p < 0.05 were subjected to multinomial logistic regression. Results: Comparisons revealed the following associations: for controls and near-miss events, delayed access to health services due to a lack of specialized services (odds ratio [OR], 3.0; 95% confidence interval [CI], 1.8-5.1) and inappropriate conduct with the patient (OR, 12.1; 95% CI, 1.3-108.7); for controls and death, absent or inadequate prenatal care (OR, 3.3; 95% CI, 1.6-7.1) and delayed access to health services due to a lack of specialized services (OR, 2.5; 95% CI, 1.1-5.6); and for near-miss events and death, absent or inadequate prenatal care (OR, 2.2; 95% CI, 1.0-5.0). Logistic regression for the combined outcome (near-miss plus neonatal deaths) revealed absent or inadequate prenatal care (OR, 1.9; 95% CI, 1.2-2.8), lack of specialized services (OR, 2.8; 95% CI, 1.7-4.5), and improper conduct with the patient (OR, 10.6; 95% CI, 1.2-91.8). Conclusions: The delays in obstetric care associated with the presence of near-miss and/or neonatal death included absent or inadequate prenatal care, delayed access to health services due to a lack of specialized services, and inappropriate conduct with the patient.
Context Complementary and Alternative Medicine (CAM) are unconventional care practices that, according to the World Health Organization, should be implemented in the Health System, particularly in poor regions of the country. In Brazil, they have been adopted by Care Programs and introduced into undergraduate medical education. In this study we were interested in evaluating the teaching-learning process of Integrative Practices in Brazilian medical schools. Methodology A cross-sectional study was carried out at Brazilian medical schools with a self-administered questionnaire for teachers and a secondary data survey was obtained from medical school websites and government database institutions. For the presentation of the variables, frequency distribution and the Pearson coefficient (X2) -Chi-square tests were used. The proportions were compared using the Chi-square test or the Fisher’s Exact Test. When the expected value of a contingency table was equal to or greater than 5, the Chi-square test was used; in all other situations, Fisher’s Exact Test was used. The difference between proportions was estimated by the Odds Ratio, calculated through simple logistic regression (95% CI). Results 57 of the 272 medical schools in Brazil address CAM, with it being proportionally higher in the South and Mid-West regions. The medical schools are highly concentrated in state capitals, and the Northeast region presents a significant concentration of medical schools with CAM in the capitals. The number of schools with active and traditional methodologies in CAM is equivalent. Homeopathy, Acupuncture and Integrative Medicine predominate, with a minority using Indigenous Practices, Chronotherapy and Anthroposophic Medicine. The new educational guidelines have not affected the number of schools with CAM. Growth in CAM has been insignificant (p <0.05) in the last ten years. Conclusion There has been no growth in teaching Complementary and Alternative Medicine in undergraduate medical training in Brazil since the introduction of the new curricular guidelines, even in view of the needs of the health system.
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