Edna Maria Rezende

Prevalence of nosocomial infections in general hospitals in Belo Horizonte

OBJECTIVE To assess the magnitude of nosocomial infections (NI) in general hospitals of Belo Horizonte. DESIGN Multicenter point-prevalence study of nosocomial infections. SETTING All of the 11 general hospitals of Belo Horizonte that have more than 20 beds, from August 27 to October 5, 1992. RESULTS Of the 2,339 patients surveyed, 267 patients had 328 nosocomial infections. The global prevalence rate of NI was 14.0%, ranging from 4.6% to 27.3% in the hospitals surveyed. The most prevalent infections were found to be pneumonia and surgical-wound infections, representing 19.5% and 19.2%, respectively, of the total infections. The highest prevalence rates of NI were observed in the cardiac surgery (31.9%), pediatric (27.2%), and orthopedic (20.7%) services. The most frequently isolated microorganisms were Staphylococcus aureus, Escherichia coli, Pseudomonas species, and Klebsiella species. CONCLUSION The study allowed a thorough evaluation of the NI distribution profile in Belo Horizonte, Minas Gerais, Brazil, and showed it to be a serious public health problem that requires interinstitutional efforts so that effective action can be taken.

[Multiple causes of death due to non-communicable diseases: a multidimensional analysis]

This study approaches multiple causes of death to analyze the associations between causes of death from non-communicable diseases, age, and gender in 3,106 death certificates issued in 1998, comprising individuals who were 20 years old or over and resided in Belo Horizonte, Minas Gerais State, Brazil. The multiple cause of death approach, by considering all the diagnoses mentioned in the death certificate, highlights conditions that are underestimated by the underlying-cause approach that has traditionally been used in mortality statistics. Association of causes of death was analyzed using the multidimensional data analysis method with the multiple correspondence factor analysis technique. The results reinforce the usefulness of the multiple causes approach to improve information on mortality and demonstrate important associations, such as hypertension and cerebrovascular diseases, obesity and diabetes or ischemic heart diseases, allowing to plan, prioritize, and reevaluate health actions.

Mortality of malnourished elderly in Belo Horizonte, Minas Gerais State, Brazil: a multidimensional analysis focusing on multiple causes of death

This study aimed to identify the mortality profiles of elderly individuals with malnutrition, based on associations between multiple causes of death and other variables recorded on the death certificate. We studied the deaths of elderly (> 60 years) living in Belo Horizonte, Minas Gerais State, Brazil, with malnutrition recorded as one of the causes. Data were used from the mortality information system. Multiple correspondence analysis was used to investigate these associations. The study showed excess mortality among women, whites, widowers, and individuals with low schooling. Ten mortality profiles were studied, and malnutrition was five times more frequent according to the multiple-causes technique. The results showed both the importance of multiple causes of death not detected by focusing on the underlying cause and the adequacy of multiple correspondence analysis for identifying the associations between causes and other variables listed on the death certificate.

Principais causas de óbitos infantis pós-neonatais em Belo Horizonte, Minas Gerais, Brasil, 1996 a 2004

OBJECTIVES: to analyze the evolution of the leading causes of post-neonatal mortality by underlying cause of death in the city of Belo Horizonte, Minas Gerais Brazil, between 1996 and 2004. METHODS: causes of death were grouped according to the chapters of the International Statistical Classification of Diseases and Related Health Problems, 10th review (ICD-10) and an abbreviated ICD-10 list. Diarrhea, pneumonia, malnutrition and septicemia were analyzed in a specific group for avoidable causes. Rates and proportional mortality by cause were calculated for three-year periods. RESULTS: 2,010 post-neonatal deaths were registered in the period, and the tendency was for the number to decrease. Infant mortality rate dropped from 26.6 to 13.3/1000 live births (LB), and post-neonatal from 8.6 to 4.3/1000 LB between 1996 and 2004. Mortality rates from both respiratory and infectious diseases were down 60%. However, the diarrhea-pneumonia-malnutrition-septicemia group was still responsible for a quarter of all deaths in 2002-2004. Congenital malformations have become the leading post-neonatal cause of death, along with perinatal conditions, responsible for 34% of deaths. In addition, an increase in the proportion of mortality accounted for by injuries and ill-defined causes was observed. CONCLUSIONS: a change was observed in the profile of the causes of post-neonatal mortality in Belo Horizonte, with an increase in the risk of death from congenital anomalies and perinatal conditions. This increase may be a consequence of displacement of neonatal deaths to the postneonatal component.

Utilização da imprensa escrita na qualificação das causas externas de morte

OBJETIVO: Complementar a informacao sobre a causa basica de morte em obitos por causas externas com uso de noticias veiculadas em jornais. METODOS: Estudo de investigacao de 153 obitos por causas externas ocorridas em residentes de Belo Horizonte, MG, em 2008. Construiu-se o banco de dados denominado imprensa, com informacoes de jornais de grande circulacao nacional e estadual, o qual foi relacionado ao banco de dados do Sistema de Informacoes de Mortalidade. Os dados foram analisados nos programas EpiInfo e o Link-plus. A concordância dos resultados foi avaliada pelo coeficiente kappa. RESULTADOS: Foram localizadas 1.530 noticias sobre acidentes e violencias, 201 das quais foram pareadas as declaracoes de obito do banco do Sistema de Informacoes de Mortalidade e 153 noticias eram de residentes de Belo Horizonte. As principais causas de morte identificadas nos bancos foram agressoes e acidentes de transporte. No banco imprensa, agressoes e acidentes de transporte corresponderam a 86,3%, outros acidentes 7,8%, eventos de intencao indeterminada 4,6%, e casos de intervencao legal 1,3%. Apos a complementacao com o banco imprensa houve aumento nos obitos por acidentes de automoveis (220,0%) e motos (100,0%), o que resultou em diminuicao do numero de obitos por causa indeterminada e por acidentes de transporte nao especificados notificados no Sistema de Informacoes de Mortalidade. CONCLUSOES: Noticias de jornais tem grande potencial para qualificar e complementar a causa basica de morte em obitos por causas externas no Sistema de Informacoes de Mortalidade, principalmente daqueles por acidentes de transporte.

Length of preoperative hospital stay: a risk factor for reducing surgical infection in femoral fracture cases

Objective To analyze infections of the surgical site among patients undergoing clean-wound surgery for correction of femoral fractures. Methods This was a historical cohort study developed in a large-sized hospital in Belo Horizonte. Data covering the period from July 2007 to July 2009 were gathered from the records in electronic medical files, relating to the characteristics of the patients, surgical procedures and surgical infections. The risk factors for infection were identified by means of statistical tests on bilateral hypotheses, taking the significance level to be 5%. Continuous variables were evaluated using Students t test. Categorical variables were evaluated using the chi-square test, or Fishers exact test, when necessary. For each factor under analysis, a point estimate and the 95% confidence interval for the relative risk were obtained. In the final stage of the study, multivariate logistic regression analysis was performed. Results 432 patients who underwent clean-wound surgery for correcting femoral fractures were included in this study. The rate of incidence of surgical site infections was 4.9% and the risk factors identified were the presence of stroke (odds ratio, OR = 5.0) and length of preoperative hospital stay greater than four days (OR = 3.3). Conclusion To prevent surgical site infections in operations for treating femoral fractures, measures involving assessment of patients’ clinical conditions by a multiprofessional team, reduction of the length of preoperative hospital stay and prevention of complications resulting from infections will be necessary.

Práticas na assistência ao parto em maternidades com inserção de enfermeiras obstétricas, em Belo Horizonte, Minas Gerais

Objective: To discuss practices in childbirth care in health institutions where doctors and obstetric nurses act together. Methods: Cross-sectional study, which had as data source the survey Born in Belo Horizonte: a survey about delivery and birth, conducted between 2011 and 2013. The sample consisted of 230 and 238 mothers for practices in childbirth labor and delivery, respectively. The analysis was given by absolute and relative frequencies. Results: Useful practices: oral diet (54.6%); freedom of movement (96%); non-pharmacological methods of pain relief (74.2%); companion (95.4%); partogram (77.4%). Harmful practices: enema (0); trichotomy (0); lying position (66.8%); Kristeller (9.3%). Practices used inappropriately: amniotomy (67.1%); oxytocin (41.7%); analgesia (14%), episiotomy (8.4%). Conclusion: Even in institutions engaged in changing the model of obstetric care, it was identified practices that reproduce the technocratic model. The transition of the model of obstetric care remains a challenge, which requires efforts from managers and health professionals.Objetivo: Discutir praticas na assistencia ao parto em instituicoes de saude, onde atuam conjuntamente medicos e enfermeiras obstetricas. Metodos: Estudo transversal que teve como fonte de dados a pesquisa Nascer em Belo Horizonte: um inquerito sobre parto e nascimento, realizada entre 2011 e 2013. A amostra foi de 230 e 238 puerperas para praticas no trabalho de parto e parto, respectivamente. A analise deu-se mediante frequencias absoluta e relativa. Resultados: Praticas uteis: dieta oral (54,6%), livre movimentacao (96%), metodos nao farmacologicos para dor (74,2%), acompanhante (95,4%), partograma (77,4%); praticas prejudiciais: enema (0), tricotomia (0), posicao deitada (66,8%), Kristeller (9,3%); praticas usadas inapropriadamente: amniotomia (67,1%), ocitocina (41,7%), analgesia (14%), episiotomia (8,4%). Conclusao: Mesmo em instituicoes que se empenham na mudanca do modelo de atencao obstetrica, identificaram-se praticas que reproduzem o modelo tecnocratico. A transformacao do modelo de assistencia permanece um desafio que requer esforcos conjuntos de gestores e profissionais de saude.

Perinatal mortality and socio-spatial inequalities

OBJECTIVE To analyze the social inequalities in the distribution of perinatal mortality in Belo Horizonte. MATERIAL AND METHODS The perinatal deaths of residents in Belo Horizonte in the period 2003 to 2007 were studied on the basis of the Information Systems on Mortality and Newborns. The space analysis and the Health Vulnerability Index were used to identify existing inequalities in the sanitary districts regarding coverage and risk, determined by the Odds Ratio and a value p<0.05. The multivariate analysis was used to describe a model for perinatal mortality. RESULTS There was a proved variation in the numbers of perinatal mortality per one thousand total births in the sanitary districts (12.5 to 19.4), coverage areas (5.3 to 49.4) and areas of risk (13.2 to 20.7). The mortality rate diminished as the maternal schooling increased. The death rates deriving from asphyxia/hypoxia and non-specified fetal death grew with the increase of risk in the area. CONCLUSION It was verified that the perinatal deaths are distributed in a differentiated form in relation to the space and the social vulnerabilities. The confrontation of this complex problem requires the establishment of intersecting partnerships.OBJETIVO: analizar las desigualdades sociales en la distribucion de la mortalidad perinatal en Belo Horizonte. MATERIAL Y METODOS: fueron estudiadas las muertes perinatales de residentes en Belo Horizonte, en el periodo de 2003 a 2007, con base en los Sistemas de Informacion sobre Mortalidad y Nacidos Vivos. El analisis espacial y el Indice de Vulnerabilidad de la Salud fueron utilizados para identificar desigualdades existentes en los Distritos Sanitarios, en las areas de influencias y de riesgo, determinadas por el Odds Ratio y el valor p<0,05. Fue utilizado el analisis multivariado para describir un modelo para la mortalidad perinatal. RESULTADOS: se evidencio una variacion en las tasas de mortalidad perinatal por mil nacimientos totales en los Distritos Sanitarios (12,5 a 19,4), areas de influencia (5,3 a 49,4) y areas de riesgo (13,2 a 20,7). La tasa de mortalidad se redujo a medida que aumento la escolaridad materna. Las tasas de muerte provenientes de la asfixia/hipoxia y la muerte fetal no especificada fueron crecientes con el aumento del riesgo del area. CONCLUSION: se constato que las muertes perinatales se distribuyen de forma diferenciada en relacion al espacio y a las vulnerabilidades sociales. El enfrentamiento de ese complejo problema requiere el establecimiento de alianzas intersectoriales

Mortalidade perinatal e desigualdades socioespaciais

OBJECTIVE To analyze the social inequalities in the distribution of perinatal mortality in Belo Horizonte. MATERIAL AND METHODS The perinatal deaths of residents in Belo Horizonte in the period 2003 to 2007 were studied on the basis of the Information Systems on Mortality and Newborns. The space analysis and the Health Vulnerability Index were used to identify existing inequalities in the sanitary districts regarding coverage and risk, determined by the Odds Ratio and a value p<0.05. The multivariate analysis was used to describe a model for perinatal mortality. RESULTS There was a proved variation in the numbers of perinatal mortality per one thousand total births in the sanitary districts (12.5 to 19.4), coverage areas (5.3 to 49.4) and areas of risk (13.2 to 20.7). The mortality rate diminished as the maternal schooling increased. The death rates deriving from asphyxia/hypoxia and non-specified fetal death grew with the increase of risk in the area. CONCLUSION It was verified that the perinatal deaths are distributed in a differentiated form in relation to the space and the social vulnerabilities. The confrontation of this complex problem requires the establishment of intersecting partnerships.OBJETIVO: analizar las desigualdades sociales en la distribucion de la mortalidad perinatal en Belo Horizonte. MATERIAL Y METODOS: fueron estudiadas las muertes perinatales de residentes en Belo Horizonte, en el periodo de 2003 a 2007, con base en los Sistemas de Informacion sobre Mortalidad y Nacidos Vivos. El analisis espacial y el Indice de Vulnerabilidad de la Salud fueron utilizados para identificar desigualdades existentes en los Distritos Sanitarios, en las areas de influencias y de riesgo, determinadas por el Odds Ratio y el valor p<0,05. Fue utilizado el analisis multivariado para describir un modelo para la mortalidad perinatal. RESULTADOS: se evidencio una variacion en las tasas de mortalidad perinatal por mil nacimientos totales en los Distritos Sanitarios (12,5 a 19,4), areas de influencia (5,3 a 49,4) y areas de riesgo (13,2 a 20,7). La tasa de mortalidad se redujo a medida que aumento la escolaridad materna. Las tasas de muerte provenientes de la asfixia/hipoxia y la muerte fetal no especificada fueron crecientes con el aumento del riesgo del area. CONCLUSION: se constato que las muertes perinatales se distribuyen de forma diferenciada en relacion al espacio y a las vulnerabilidades sociales. El enfrentamiento de ese complejo problema requiere el establecimiento de alianzas intersectoriales

Óbitos perinatais investigados e falhas na assistência hospitalar ao parto

Objetivou-se analisar as falhas na assistencia hospitalar ao parto, o perfil materno e as caracteristicas do feto e do recem-nascido que evoluiram para obito perinatal, em Belo Horizonte. METODOS: Estudo transversal, dos obitos perinatais investigados pelo Comite de Prevencao de Obitos de Belo Horizonte, ocorridos entre 2003 e 2007. A fonte dos dados foram as fichas de investigacao do Comite. Os dados foram analisados pela distribuicao de frequencia das variaveis e analise bivariada utilizando-se o teste de Qui-quadrado de Pearson, considerando o nivel de significância de 5% (p<0,05). RESULTADOS: Foram estudados 253 obitos, a maioria de nascidos a termo, com peso adequado ao nascer. Em 65,6% dos casos houve falhas na assistencia, principalmente relacionadas ao acompanhamento da gestante durante o trabalho de parto e parto. CONCLUSOES: Foram identificados um alto percentual de falhas assistenciais no processo do parto e um grande potencial de evitabilidade dos obitos perinatais.Resumen To analyze the shortcomings in hospital care delivery, the maternal profile and characteristics of the fetus and newborn that died perinatally, in Belo Horizonte. Methods: Cross sectional study of perinatal deaths investigated by the Committee for the Prevention of Deaths of Belo Horizonte, which occurred between 2003 and 2007. The data source was the Committee’s investigation forms. Data were analyzed by frequency distribution of variables and the bivariate analysis used the chi-square test, considering the significance level of 5% (p <0.05). Results: We studied 253 deaths, most born at term with adequate weight infants. In 65.6% of cases there were gaps in care, mainly related to the monitoring of pregnant women during labor and delivery. Conclusions: We identified a high percentage of failures in the process of care delivery and a great potential avoidability of perinatal deaths.