RESUMO ABSTRACTThis is a popula on-based, descrip ve, and analy c study conducted with a randomized and probabilis c sample comprising 340 hypertensive individuals representa ve of the Family Health Strategy (FHS) Service in João Pessoa, PB, Brazil. The present study corresponds to the fi rst part of a cohort started in 2008. The instrument used was an adapta on of the Primary Care Assessment Tool revalidated in Brazil. Logis c regression was used to inves gate the associa ons between blood pressure (BP) control, sociodemographic variables, and an indicator of adherence/ a achment. Among the 340 hypertensive parcipants, 32.6% were followed up at the FHS, and 89.1% exhibited sa sfactory adherence/ a achment. The older adults were more likely to control BP, which suggests a more accurate self-care percep on and greater adherence to treatment. The present study highlights the problem posed by the control of hypertension by means of the assessment of services. We expected the present model to be applied at other loca ons to generate parameters to compare diff erent municipali es. DESCRIPTORS Hypertension Primary Health Care Health evalua on RESUMENEstudio descriptivo y analítico, de base poblacional, realizado con muestra aleatoria y probabilís ca de 340 hipertensos, representa va de la Estrategia Salud de la Familia (ESF) de João Pessoa-PB. El estudio consiste en la primera parte de una cohorte iniciada en 2008. El instrumento u lizado fue adaptado del Primary Care Assessment Tool, revalidado en Brasil. La regresión logís-ca evaluó la asociación entre el control de presión, las variables sociodemográfi cas y el indicador de adhesión/vínculo. Entre los 340 hipertensos, 32,6% recibía seguimiento de la ESF y 89,1% presentó adhesión/ vínculo sa sfactorio. Los ancianos presentaron mayores posibilidades de controlar la presión, lo que sugiere una mejor percepción del autocuidado y mayor adhesión al tratamiento. El estudio permi ó poner en evidencia la problemá ca del control de la hipertensión mediante la evaluación del servicio. Se espera que este modelo pueda adoptarse en otras localidades, generando parámetros para comparaciones entre dis ntos municipios.

ObjectiveTo assess the number of children born with microcephaly in the State of Paraíba, north-east Brazil.MethodsWe contacted 21 maternity centres belonging to a paediatric cardiology network, with access to information regarding more than 100 000 neonates born between 1 January 2012 and 31 December 2015. For 10% of these neonates, nurses were requested to retrieve head circumference measurements data from delivery-room books. We used three separate criteria to classify whether a neonate had microcephaly: (i) the Brazilian Ministry of Health proposed criterion: term neonates (gestational age ≥ 37 weeks) with a head circumference of less than 32 cm; (ii) Fenton curves: neonates with a head circumference of less than −3 standard deviation for age and gender; or (iii) the proportionality criterion: neonates with a head circumference of less than ((height/2))+10) ± 2.FindingsBetween 1 and 31 December 2015, nurses obtained data for 16 208 neonates. Depending on which criterion we used, the number of neonates with microcephaly varied from 678 to 1272 (4.2–8.2%). Two per cent (316) of the neonates fulfilled all three criteria. We observed temporal fluctuations of microcephaly prevalence from late 2012.ConclusionThe numbers of microcephaly reported here are much higher than the 6.4 per 10 000 live births reported by the Brazilian live birth information system. The results raise questions about the notification system, the appropriateness of the diagnostic criteria and future implications for the affected children and their families. More studies are needed to understand the epidemiology and the implications for the Brazilian health system.

ProblemProviding health care for children with congenital heart diseases remains a major challenge in low- and middle-income countries.ApproachIn October 2011, the Government of Paraíba, Brazil, established a paediatric cardiology network in partnership with the nongovernmental organization Círculo do Coração. A cardiology team supervised all network activities, using the Internet to keep in contact with remote health facilities. The network developed protocols for screening heart defects. Echocardiograms were performed by physicians under direct online supervision of a cardiologist; alternatively, a video recording of the examination was subsequently reviewed by a cardiologist. Cardiovascular surgeons came to a paediatric hospital in the state capital once a week to perform heart surgeries.Local settingUntil 2011, the State of Paraíba had no structured programme to care for children with heart disease. This often resulted in missed or late diagnosis, with adverse health consequences for the children.Relevant changesFrom 2012 to 2014, 73 751 babies were screened for heart defects and 857 abnormalities were identified. Detection of congenital heart diseases increased from 4.09 to 11.62 per 1000 live births (P < 0.001). Over 6000 consultations and echocardiograms were supervised via the Internet. Time to diagnosis, transfers and hospital stays were greatly reduced. A total of 330 operations were carried out with 6.7% (22/330) mortality.Lessons learntAccess to an echocardiography machine with remote supervision by a cardiologist improves the detection of congenital heart disease by neonatologists; virtual outpatient clinics facilitate clinical management; the use of Internet technology with simple screening techniques allows resources to be allocated more efficiently.

RESUMO: A oximetria de pulso nas unidades neonatais apresenta-se como um processo de triagem de cardiopatias congênitas graves. O estudo tem como objetivo avaliar o nível de informação e a atuação dos enfermeiros na oximetria de pulso realizada nos recém-nascidos de uma maternidade pública do município de João Pessoa, Paraíba. Trata-se de estudo descritivo com abordagem quanti-qualitativa, realizado com 13 enfermeiras assistenciais através de entrevista semiestruturada no período de janeiro a março de 2015. Os resultados mostraram que a maioria das enfermeiras tem conhecimento sobre o teste do coraçãozinho, a justificativa para realizá-lo, os parâmetros de normalidades da saturação de oxigênio, assim como as condutas que devem ser tomadas diante de um resultado alterado. No entanto, 84,6% referiram dificuldades na sua implantação em virtude de modificar a rotina da assistência de enfermagem. Acredita-se que o teste do coraçãozinho para triagem de cardiopatias congênitas traz bons resultados na captação precoce dessas malformações. DESCRITORES: Enfermagem; Cardiopatia; Oximetria de pulso.

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