Ana Maria Rigo Silva

Fatores de risco para nascimentos pré-termo em Londrina, Paraná, Brasil

The objective of this study was to identify risk factors associated with pre-term birth among live births in a hospital in Londrina, Parana State, Brazil. Cases consisted of 328 pre-term births, and controls were 369 births with gestational age greater than 37 weeks. A multiple hierarchical logistic regression analysis was carried out. There was a significant correlation (p 30 kg/m2; history of prematurity; history of assisted reproduction; mothers in a relationship for less than two years; maternal stress; weekly maternal alcohol consumption; insufficient prenatal care; gestational complications such as bleeding, genital tract infection, altered amniotic fluid volume, high blood pressure, and hospital admission; and twin pregnancy. Regular walks during pregnancy were a protective factor. Improved quality of prenatal care and the identification of the above factors during pregnancy may help reduce premature birth.

Risk factors for foot ulcers—A cross sectional survey from a primary care setting in Brazil

AIMS To identify the prevalence of higher risk of foot ulceration and associated factors among patients with diabetes mellitus (DM) at primary health care services. METHODS Individuals with DM, registered at primary health care services in a municipality in southern Brazil, were interviewed and underwent foot examinations. Their risk of ulceration was classified in accordance with the recommendations of the International Working Group on the Diabetic Foot. Poisson bivariate and multivariate analyses were performed and adjusted prevalence ratios (PR) and 95% confidence intervals (CI) were calculated. RESULTS The prevalence of higher risk of foot ulceration among the 337 interviewees was 27.9% (95% CI 23.1-32.9). The following factors were associated with this risk: having been diagnosed with DM for more than 10 years (Adjusted-PR 1.669; 95% CI 1.175-2.373; p=0.004); having had previous diagnoses of acute myocardial infarction (Adjusted-PR 1.873; 95% CI 1.330-2.638; p<0.001) and stroke (Adjusted-PR 1.684; 95% CI 1.089-2.604; p=0.019); presenting interdigital mycosis (Adjusted-PR 1.539; 95% CI 1.030-2.300; p=0.035) and calluses (Adjusted-PR 1.654; 95% CI 1.117-2.451; p=0.012). CONCLUSIONS The prevalence of higher risk of ulceration was high, which reinforces the importance of continued education for health care professionals in order to prevent complications in the feet of these patients.

Risk factors for infant mortality in a municipality in southern Brazil: a comparison of two cohorts using hierarchical analysis

This study compared risk factors for infant mortality in 2000-2001 and 2007-2008 in Londrina, Paraná State, Brazil. Data on live births and infant deaths were linked in a single database, and a hierarchical regression model was used. Distal risk factors for infant mortality in 2000-2001 were maternal age < 20 or ≥ 35 years and lower maternal schooling. In 2007-2008, maternal age ≥ 35 or < 20 years were risk factors, while low schooling appeared as a protective factor. The following intermediate factors were associated with increased infant mortality in 2000-2001: multiple pregnancy, history of stillbirth, and insufficient number of prenatal visits, while cesarean delivery was a protective factor. Multiple pregnancy was the only intermediate risk factor in 2007-2008. All of the proximal factors were associated with higher infant mortality in 2000-2001, but only gestational age and 5-minute Apgar in 2007-2008. The risk factors for infant mortality changed from the first to the second cohort, which may be related to the expansion of social policies and primary care and changes in the reproductive and social patterns of Brazilian women.

Opinions of mothers whose children died during their first year of life in Londrina, Paraná, Brazil

This research focused on opinions of mothers in Londrina whose infant children had died in 1997, attempting to demonstrate the feasibility and utility of studies on user satisfaction with health services. Opinions were analyzed according to type (positive, negative, or both positive and negative) and comments. The majority of mothers had positive opinions of the health services, especially prenatal care (75.6%), while fewer (52.6%) gave a positive assessment towards the hospital care provided to their infants who had died before they could be discharged from hospital. Most of the low opinions (21.1%) concerned intrapartum care. Analysis of comments revealed satisfaction but also some problems in the relationship between the physician staff and patients; others related to the organization of services and medical techniques or guidance. This type of study can be useful for a more comprehensive evaluation of health care provision.

Mortalidade infantil na percepção de gestores e profissionais de saúde: determinantes do seu declínio e desafios atuais em município do sul do Brasil

Este estudo objetivou analisar a percepcao de gestores e profissionais da saude sobre os determinantes para o declinio da mortalidade infantil nas ultimas decadas, bem como os desafios para a continuidade da reducao dos valores desse indicador em Londrina (PR). Foi realizado uma pesquisa qualitativa com analise de entrevistas de 38 gestores, profissionais de saude e pesquisadores, selecionados pela tecnica da bola de neve. Na visao dos entrevistados, os determinantes para a reducao da mortalidade infantil foram melhorias das condicoes de vida e medidas implantadas por politicas publicas e acoes setoriais e extrassetoriais. Os desafios atuais dizem respeito, principalmente, a qualificacao da assistencia pre-natal, a reducao da gravidez na adolescencia, a melhoria da atencao hospitalar ao recem-nascido prematuro, a prevencao da prematuridade e ao financiamento do Sistema Unico de Saude (SUS). O aumento da proporcao de mortes neonatais torna mais complexo e dificil reduzir a mortalidade infantil. Compreender as dificuldades e identificar os desafios, sob a percepcao de gestores e profissionais da saude, pode contribuir para o planejamento das acoes necessarias para a melhoria da saude das criancas menores de 1 ano e para a reducao da mortalidade infantil.

Early neonatal mortality and risk factors: a case-control study in Paraná State

Objective: to analyze the Early Neonatal Mortality risk factors according to the risk stratifi cation criteria of the Guideline of the Rede Mãe Paranaense Program. Method: a case-control epidemiological study with secondary data from the Mortality and Live Birth Information System in 2014. The crude analysis was performed by the Odds Ratio association measure, followed by the adjusted analysis, considering risk factors as independent variables, and early neonatal death as dependent variable. Results: were considered as maternal risk factors: absence of partner and miscarriages; neonatal: male, low birth weight, prematurity, Apgar less than seven in the fi fth minute, presence of congenital anomaly; and care: up to six prenatal appointments. Conclusion: an innovative study of risk factors for early neonatal death from the Guideline’s perspective, a technological management tool for maternal and child health, in search of its qualifi cation and greater sensitivity. Descriptors: Early Neonatal Mortality; Risk Factors; Public Health Nursing; Nursing; Information Systems. RESUMEN Objetivo: analizar los factores de riesgo para Mortalidad Neonatal Precoce, según los criterios de estratifi cación de riesgo de la Línea Guía del Programa Rede Mãe Paranaense (Programa Red Madre Paranaense). Método: el estudio epidemiológico, tipo caso-control, con datos secundarios del Sistema de Información de Mortalidad y de Nacidos Vivos, en 2014. Se realizó el análisis bruta por la medida de asociación Odds Ratio, seguida del análisis ajustado, considerando las variables independientes los factores de riesgo, y como dependiente, el óbito neonatal precoz. Resultados: fueron considerados como factores de riesgo materno: ausencia de compañero y pérdidas fetales; neonatales: sexo masculino, bajo peso al nacer, prematuridad, Apgar menor que siete en el quinto minuto, presencia de anomalía congénita; y asistenciales: hasta seis consultas de prenatal. Conclusión: estudio innovador de factores de riesgo al óbito neonatal precoz en la perspectiva de la Línea Guía, instrumento tecnológico de gestión para salud materna e infantil, en la búsqueda de su califi cación y mayor sensibilidad. Descriptores: Mortalidad Neonatal Precoz; Factores de Riesgo; Enfermería en Salud Pública; Enfermería; Sistemas de Información. Mortalidade neonatal precoce e fatores de risco: estudo caso-controle no Paraná Early neonatal mortality and risk factors: a case-control study in Paraná State Mortalidad neonatal precoz y factores de riesgo: estudio caso-control en Paraná PESQUISA Márcia Helena de Souza Freire E-mail: marciahelenafreire@gmail.com AUTOR CORRESPONDENTEOBJECTIVE to analyze the Early Neonatal Mortality risk factors according to the risk stratification criteria of the Guideline of the Rede Mãe Paranaense Program. METHOD a case-control epidemiological study with secondary data from the Mortality and Live Birth Information System in 2014. The crude analysis was performed by the Odds Ratio association measure, followed by the adjusted analysis, considering risk factors as independent variables, and early neonatal death as dependent variable. RESULTS were considered as maternal risk factors: absence of partner and miscarriages; neonatal: male, low birth weight, prematurity, Apgar less than seven in the fifth minute, presence of congenital anomaly; and care: up to six prenatal appointments. CONCLUSION an innovative study of risk factors for early neonatal death from the Guidelines perspective, a technological management tool for maternal and child health, in search of its qualification and greater sensitivity.

Cognitive and Functional Decline among Individuals 50 Years of Age or Older in Cambé, Paraná, Brazil: A Population-Based Study

Aims: To identify the frequency of cognitive and functional decline (CFD) among adults 50 years of age and older by a population-based study. Methods: Cognitive function was analyzed by the Mini-Mental State Examination, and the functional conditions were based on instrumental activities of daily living (IADL). Cases of CFD included individuals with cognitive decline and 2 or more compromised IADL. Results: A total of 693 individuals were studied. The frequency of CFD was 16.3%. A low socioeconomic profile was associated with greater CFD independent of gender, age, education, and presence of depression (OR = 2.46; 95% CI: 1.53-3.97). Conclusions: These data show a high frequency of CFD among adults 50 years and older. Individuals with less education and a lower socioeconomic level exhibited poorer cognitive and functional conditions.