The aim of this study was to identify risk factors for self-injurious behaviours (SIBs) in children with autistic disorders. The occurrence of SIB was examined in comparison with the following variables: chronological age, sex, adaptive skills, speech level, associated medical condition, degree of autism and parental social class. The subjects were 222 children aged under 7 years and all of them fulfilled the ICD-10 criteria for infantile autism. Retrospective data were collected on demographic characteristics and medical condition. Children were assessed in terms of speech, degree of autism and adaptive skills in communication, socialization and daily living skills domains. Results indicated that 50% of the children experienced SIB and 14.6% had severe SIBs. Lower chronological age, associated perinatal condition, a higher degree of autism and a higher daily living skills delay were risk factors of SIBs but parental class, sex and epilepsy were not.

During this study, CPR was uncommon but not rare. Respiratory failure was the most common precipitating cause, followed by shock. Preexisting chronic diseases were prevalent among these children. Asystole was the most common initial cardiac rhythm, and bradycardia with pulses and poor perfusion was the second most common. Ventricular fibrillation was rare, but children with acute cardiac diseases, such as cardiac surgery and acute cardiomyopathies, were not admitted to this children's hospital. CPR was effective: nearly two thirds of these children were initially successfully resuscitated, and one third were alive at 24 hours compared with imminent death without CPR and advanced life support. Nevertheless, survival progressively decreased over time, generally as a result of the underlying disease process. One-year survival was 15%. Importantly, most of these survivors had no demonstrable change in gross neurologic function from their pre-CPR status.

Family Health Support Centers (NASF) were created in Brazil to increase the case-resolution capacity of primary healthcare. Prior to their implementation in the West Side of the city of São Paulo, Brazil, a series of workshops were held for primary healthcare professionals to prepare a proposal for such centers. Hermeneutic analysis was used to study the transcribed material. The thematic categories were: role, constitution, and functioning of the NASF, relationship with family health teams, and interdisciplinarity. The participants' expected the NASF to be an empowering device for comprehensiveness of care, intervening in an existing culture of unnecessary referrals while fostering linkage with other levels of care. The participants also expected the NASF to contribute to the discussion on health professionals' training and stimulating reflection with policymakers on health indicators based exclusively on the number of consultations. These indicators fail to reflect the impact on the services' activities and the quality of care offered to the population in the coverage area.

OBJETIVOS: avaliar o aleitamento materno, ressaltando os fatores que levaram ao desmame precoce conforme as condições socioeconômico-culturais. MÉTODOS: analisou-se uma amostra de 599 crianças e seus responsáveis que procuraram o Pronto Socorro do Instituto da Criança, São Paulo, de agosto a dezembro de 1998. Utilizou-se um questionário incluindo: idade, profissão e escolaridade dos pais, condições de moradia, renda familiar, trabalho materno, duração da amamentação exclusiva, introdução de novos alimentos, causas de desmame e importância do leite materno. RESULTADOS: 86,1% das mães amamentaram e 92% referiram saber a importância do leite materno. A idade média do desmame foi de 3,3 meses, sendo que 75,9% das mães suspenderam a amamentação sem orientação médica. 38,9% referiram que o leite era "fraco", ou "secou" ou que a criança "largou" o peito. Maior escolaridade da mãe e presença de rede de esgoto mostraram relação com maior tempo de aleitamento (p = 0,016 e p = 0,011 respectivamente). Não houve associação entre acompanhamento da criança no posto de saúde e tempo de aleitamento materno. CONCLUSÕES: embora a grande maioria das mães saiba a importância do leite materno e tenha amamentado seu filho, a duração do aleitamento materno exclusivo é menor do que o preconizado pela Organização Mundial da Saúde, sendo a baixa escolaridade um fator para o desmame precoce.

Sex differences in the prevalence of psychiatric disorders are well documented, with exposure to stress during gestation differentially impacting females and males. We explored sex-specific DNA methylation in the cord blood of 39 females and 32 males born at term and with appropriate weight at birth regarding their potential connection to psychiatric outcomes. Mothers were interviewed to gather information about environmental factors (gestational exposure) that could interfere with the methylation profiles in the newborns. Bisulphite converted DNA was hybridized to Illumina HumanMethylation450 BeadChips. Excluding XYS probes, there were 2,332 differentially methylated CpG sites (DMSs) between sexes, which were enriched within brain modules of co-methylated CpGs during brain development and also differentially methylated in the brains of boys and girls. Genes associated with the DMSs were enriched for neurodevelopmental disorders, particularly for CpG sites found differentially methylated in brain tissue between patients with schizophrenia and controls. Moreover, the DMS had an overlap of 890 (38%) CpG sites with a cohort submitted to toxic exposition during gestation. This study supports the evidences that sex differences in DNA methylation of autosomes act as a primary driver of sex differences that are found in psychiatric outcomes.

BackgroundAddressing impaired foetal growth is recognized as a public health priority. Certain risk factors for this condition, such as poor nutritional status at birth, have been found to be highly correlated with poverty. However, the role of psychosocial factors, specifically the mother’s mental health and exposure to violence during pregnancy, have yet to be further explored. Our objective was to determine if there is a measurable association between combined psychosocial factors, specifically domestic violence and mental disorders, and birth outcomes, specifically birth nutritional status and preterm delivery.MethodsWe followed 775 women from an underserved, urban area, beginning their 28th week of gestation. Diagnostic interviews were performed to determine if any of the mothers had any of the following disorders: mood disorder, anxiety, obsessive–compulsive disorder (OCD), substance dependence, psychotic disorder, or anti-social personality disorder. Physical, psychological, and sexual domestic violence were also assessed.ResultsDomestic violence and mental disorders were highly correlated in our sample. About 27.15% of the women in our study experienced domestic violence, and about 38.24% of them were diagnosed with mental disorders. The main association we found between combined psychosocial factors and neonate outcomes was between anxiety (IRR = 1.83; 95%CI = 1.06–3.17)/physical violence (IRR = 1.95; 95%CI = 1.11–3.42) and the rate of small-for-gestational age (SGA) in new-borns. More specifically, the combination of anxiety (beta = −0.48; 95%CI = −0.85/−0.10) and sexual violence (beta = −1.58; 95%CI = −2.61/−0.54) was also associated with birth length. Maternal risk behaviours such as smoking, drinking, inadequate prenatal care, and inadequate weight gain could not sufficiently explain these associations, suggesting that these psychosocial factors may be influencing underlying biological mechanisms.ConclusionDomestic violence against women and mental disorders amongst pregnant women are extremely prevalent in under-resourced, urban areas and ultimately, have detrimental effects on birth outcomes. It is imperative that actions be taken to prevent violence and improve mental health during pregnancy.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-017-1438-x) contains supplementary material, which is available to authorized users.

Objective: To describe breastfeeding prevalence and associated factors, in the municipality of Londrina, PR, Brazil. Methods: This quantitative, descriptive study included interviews of 770 companions of children younger than 12 months of age during an anti-polio vaccination campaign in August 2008. Results: A total of 72.5% of the children were breastfed in the first hour after birth; 33.8% were exclusively breastfed from zero to six months of age, 53.7% until the fourth month and 7.8% until the sixth month; 51.5% were in continued breastfeeding between 9 and 12 months of age. The women who breastfed the most were 35 years old or older, had a bachelor's degree, had more than one child and were on maternity leave. Conclusion: Breastfeeding rates increased in the city, however, analyzing health services actions is needed to improve these rates. ReSumo Objetivo: Descrever a prevalência do aleitamento materno e fatores associados no município de Londrina-PR. Métodos: Estudo quantitativo, descritivo, entrevistando 770 acompanhantes de crianças menores de 12 meses, durante a campanha de vacinação antipoliomielite, em agosto de 2008. Resultados: Na primeira hora, foram amamentadas 72,5% das crianças; 33,8% estavam em aleitamento materno exclusivo de zero a seis meses, no quarto mês, 53,7% e no sexto mês 7,8%; 51,5% em aleitamento materno continuado entre 9 e 12 meses. As mulheres que mais amamentaram tinham idade igual ou superior a 35 anos, escolaridade de terceiro grau, mais de um filho e estavam em licença-maternidade. Conclusão: os índices de aleitamento materno do município apresentaram evolução, porém faz-se necessário analisar as ações nos serviços de saúde para melhora desses índices. Descritores: Aleitamento materno; Prevalência; Estudos transversais; Nutrição do lactente ReSumeN Objetivo: Describir la prevalencia de la lactancia materna y factores asociados en el municipio de Londrina-PR. Métodos: Estudio cuantitativo, descriptivo, realizado con la entrevista a 770 acompañantes de niños menores de 12 meses, durante la campaña de vacunación antipoliomielítica, en agosto del 2008. Resultados: En la primera hora, fueron amamantadas el 72,5% de los niños; el 33,8% estaban con lactancia materna exclusiva de cero a seis meses, en el cuarto mes, el 53,7% y en el sexto mes el 7,8%; el 1,5% en lactancia materna continuada entre 9 y 12 meses. Las mujeres que más amamantaron tenían edad igual o superior a 35 años, escolaridad de tercer grado, más de un hijo y estaban con licencia-maternidad. Conclusión: los índices de lactancia materna del municipio presentaron evolución, sin embargo se hace necesario analizar las acciones en los servicios de salud para mejorar esos índices.

INTRODUCTION:The profile of child morbidity is an important parameter for defining and altering health policies. Studies about infant mortality are more numerous than those on morbidity, especially related to hospital admissions. The objective of this study is to describe the causes of admission in the public health system for children from zero to nine years of age in the city of São Paulo during the years 2002 to 2006 and compare these results to those from the national data.METHOD:Through a cross-sectional study, data were obtained from the Hospital Information System, which is available in the Information System of the Unified Health System - DATASUS.RESULTS:Within the period, 16% of the total admissions corresponded to children from zero to nine years of age, with most of the children being younger than one year of age. In the city of São Paulo, the admission coefficient increased 11%, and in Brazil, it decreased 14%. Respiratory diseases were the main causes of hospitalization. In São Paulo, the second most frequent causes of admission were diseases that originated during the perinatal period (15.9%), and in Brazil, the second most frequent cause of admission was infectious-parasitic diseases (21.7%). Admissions for perinatal diseases increased 32% in São Paulo and 6% in Brazil. While hospitalizations for diarrhea decreased in Brazil, an increase was recorded in the city of São Paulo for children under five years old.CONCLUSIONS:The findings of this study show a paradoxical increase in the number of hospitalizations during an expansion of primary attention, indicating that the rise was not associated with a significant improvement in the quality of service.