Eunice Francisca Martins

Determinantes da mortalidade neonatal a partir de uma coorte de nascidos vivos, Montes Claros, Minas Gerais, 1997-1999

OBJECTIVES: to identify the factors of risk for the neonatal mortality with information from born alive information system and mortality information system in city of Montes Claros, in the period of 1997 through 1999. METHODS: the linkage technique has been used to link the declarations of death with the respective declarations of the infants who were born alive. The identification of factors associated to neonatal mortality has been done through bivaried and multi-variable analysis, obtaining the calculus of risk and its 95% confidence interval. RESULTS: the infants who were born alive were 20.506 and the deaths 275 which resulted in a coefficient of neonatal mortality of 13.4 to one thousand who were born alive. Through the multi-varied analysis, independent factors of risk were obtained for the occurrence of neonatal deaths to prematurely born infants, the low weight when they are born and the score of Apgar lower than seven in the first and fifth minute of life. CONCLUSIONS: efforts have been made to improve the obstetrics and neonatal assistance in the city of Montes Claros, providing conditions for safe pregnancy and birth, thus increasing the chances of survival in the beginning of life.

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.

Tendência da mortalidade perinatal em Belo Horizonte, 1984 a 2005

The study aimed at to analyze the tendency of the mortality perinatal in the municipal district of Belo Horizonte in the period from 1984 to 2005. The source of the data was the System of Information of Mortality. Took place simple lineal regression to esteem the tendency of reduction of the percentile of unknown information in the system and of the mortality taxes. The improvement of the quality of the information went significant just for the maternal education and weight when being born. The medium reduction of the mortality perinatal in the period was of 57,52%. The decrease of the mortality perinatal in the last two decades in Belo Horizonte it was significant, but efforts should be addressed in the sense of improving the complete of the System of Information of Mortality for important variables in the elaboration of the indicators perinatais.

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.

Practices in childbirth care in maternity with inclusion of obstetric nurses in 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.

Classificação das mortes infantis em Belo Horizonte: utilização da lista atualizada de causas de mortes evitáveis por intervenções do Sistema Único de Saúde do Brasil

Objectives: to examine deaths among infants under one year of age living in Belo Horizonte according to the avoidability criteria proposed in the Updated List of Causes of Death that could be avoided by Brazilian National Health Service Intervention. Methods: a descriptive study was carried out using data from the Mortality Information and Live Births databases of the Brazilian Ministry of Health (DATASUS), between 2006 and 2011. The basic causes of death were classified according to avoidability criteria. Mortality and proportional mortality coefficients were calculated for components and principal groups of causes. Results: the infant mortality rate decreased by 18.7% during the period studied. Rates for avoidable causes declined in the following subgroups: reducible by adequate diagnosis and treatment (38.8%) and reducible by adequate care for the fetus and newborn (30.6%). The reducible by adequate care for the pregnant woman and action to promote health related to care subgroups increased by 17.1% and 22.7%), respectively. Conclusions: the use of the list made it possible to identify which deaths could be prevented and to assess which category requires greater investment to reduce mortality. It was shown to be especially applicable to avoiding deaths among newborns weighing less than 1000 grams.

The work of nurses in high-risk prenatal care from the perspective of basic human needs

OBJECTIVE To analyze the work of nurses in high-risk prenatal care in secondary care, considering nursing problems and the basic human needs of pregnant women. METHOD Cross-sectional and quantitative study, developed in a high-risk prenatal care clinic. Data were selected in the records of the nursing consultation. The studied variables were related to sociodemographic and obstetric characteristics, in addition to nursing problems. We performed the descriptive analysis of the data and the grouping of nursing problems within the levels of Basic Human Needs (BHN). RESULTS We evaluated 54 nursing consultations of pregnant women, mostly young, multiparous, and with nine or more years of study. Every pregnant woman reported, on average, 7.4 nursing problems. The psychobiological BHN prevailed in relation to psychosocial ones. CONCLUSION In high-risk prenatal care, nurses can use the nursing consultation considering their mastery of light technologies to engage with hard and light-hard technologies.