Rosana Rosseto de Oliveira

Aspectos da mortalidade infantil, conforme informações da investigação do óbito

Objective: To analyze some characteristics of infant mortality of residents in the area of the 15th Health Region of Parana, from 2005 to 2008. Methods: A descriptive exploratory study covering 397 deaths investigated by the Committee for the Prevention of Infant Mortality, using data from the research data sheets. Results: In 82.3% of families, monthly income was up to three times the minimum wage; 65.1% of the mothers received prenatal care through the public network; 83.4% of births were financed by the National Health System; and, 59 2% of women began prenatal care in the first trimester. Of the mothers, 68.5% had complications during pregnancy: 18.2% had preterm labor; 18.2% had a urinary tract infection, and 16.5% had arterial hypertension. Conclusion: Low income, the use of public services for prenatal care and childbirth shows that public institutions, public health workers and nurses are improving the care of pregnant women with attributes of gestational risk, and contribute to the continued reduction of infant mortality.

The Growing Trend of Moderate Preterm Births: An Ecological Study in One Region of Brazil.

Background Preterm birth is a serious public health problem, as it is linked to high rates of neonatal and child morbidity and mortality, with Brazil listed among the countries with the ten highest numbers of premature births. Nonetheless, knowledge is scarce regarding prematurity and associated factors in mid-sized cities. The objective of this study was to analyze the trend of preterm births and associated factors in a municipality located in the state of Paraná, Brazil. Methods This was an ecological time series study of births recorded into the Live Birth Information System for residents of Maringá, Paraná, Brazil, between 2000 and 2013. The polynomial regression model was used for trend analysis of preterm birth, characteristics of the mother, gestation and delivery, and newborn. The association with preterm birth was analyzed using odds ratio (OR). Results A total of 61,634 live births were analyzed, of which 5,632 were preterm births. Prematurity increased from 7.9% in 2000 to 11.2% in 2013 –an average increase of 0.54% per year (r2 = 0.93)–with a growing share of moderate preterm births (32 to <37 weeks), which rose from 7.0% in 2000 to 9.7% in 2013. Between 2011 and 2013, multiple pregnancy (OR = 16.64; CI = 13.24–20.92), inadequate number of prenatal visits (OR = 2.81; CI = 2.51–3.15), Apgar score below 7 at 1 (OR = 4.07; CI = 3.55–4.67) and 5 minutes (OR = 10.88; CI = 7.71–15.36), low birth weight (OR = 38.75; CI = 33.72–44.55) and congenital malformations (OR = 3.18; CI = 2.14–4.74) were associated with preterm birth. A growing trend was observed for multiple pregnancies, with an average annual increase of 0.32% (r2 = 0.90), as well as for C-section birth (2.38% yearly increase). Of all newborn characteristics, Apgar score below 7 at 5 minutes (-0.19% per year) and low birth weight (-1.43%) decreased, whereas congenital malformations rose (0.20% per year). Conclusions Efforts are required to prevent premature delivery, particularly during the moderate period, as well as greater care during the prenatal period towards expectant mothers bearing multiple pregnancies, birth defects, in addition to reducing C-section birth as it may be linked to preterm birth.

Hospitalization of children under five years of age due to avoidable causes

El objetivo de este estudio fue caracterizar el perfil de la morbilidad hospitalaria segun el diagnostico principal de internacion, en menores de cinco anos, residentes en las ciudades de Maringa, Sarandi y Paicandu. Fueron utilizadas informaciones registradas en los formularios de Autorizacion de Internacion Hospitalaria, en los anos de 1998 a 2009. Se analizaron 41.220 internaciones en menores de 5 anos. Los resultados evidencian una disminucion de 16,1% de internaciones de menores de cinco anos en relacion al total de internaciones en todos los intervalos de edad. En cuanto a las principales causas de hospitalizacion se encontraron las enfermedades del aparato respiratorio (55,6%), enfermedades infecciosas y parasitarias (14,8%) y afecciones originadas en el periodo perinatal (12,9%); estas enfermedades pueden evitadas con medidas de atencion basica, senalando la necesidad de intensificar las acciones preconizadas por los programas dirigidos a la salud del nino.Descriptores: Hospitalizacion; Nino Hospitalizado; Salud del Nino.This study characterizes the profile of hospital morbidity according to the main diagnosis upon admission, in individuals younger than five years old, residents of three cities (Maringá, Sarandi and Paiçandu) in the Paraná state, Brazil. Information contained in hospital admission forms from 1998 to 2009 was used. The hospitalizations of 41,220 individuals younger than five years old were analyzed. The results indicate a decline of 16.1% in hospital admissions of patients younger than five years old in relation to the total number of admissions in all age groups. As for the main diagnoses, there were diseases of the respiratory system (55.6%), infectious and parasitic diseases (14.8%) and diseases originating in the perinatal period (12.9%). Such conditions can be avoided by implementing primary health care measures, which shows the need to intensify the actions recommended by the programs directed to child health.

Hospitalizações de menores de cinco anos por causas evitáveis

El objetivo de este estudio fue caracterizar el perfil de la morbilidad hospitalaria segun el diagnostico principal de internacion, en menores de cinco anos, residentes en las ciudades de Maringa, Sarandi y Paicandu. Fueron utilizadas informaciones registradas en los formularios de Autorizacion de Internacion Hospitalaria, en los anos de 1998 a 2009. Se analizaron 41.220 internaciones en menores de 5 anos. Los resultados evidencian una disminucion de 16,1% de internaciones de menores de cinco anos en relacion al total de internaciones en todos los intervalos de edad. En cuanto a las principales causas de hospitalizacion se encontraron las enfermedades del aparato respiratorio (55,6%), enfermedades infecciosas y parasitarias (14,8%) y afecciones originadas en el periodo perinatal (12,9%); estas enfermedades pueden evitadas con medidas de atencion basica, senalando la necesidad de intensificar las acciones preconizadas por los programas dirigidos a la salud del nino.Descriptores: Hospitalizacion; Nino Hospitalizado; Salud del Nino.This study characterizes the profile of hospital morbidity according to the main diagnosis upon admission, in individuals younger than five years old, residents of three cities (Maringá, Sarandi and Paiçandu) in the Paraná state, Brazil. Information contained in hospital admission forms from 1998 to 2009 was used. The hospitalizations of 41,220 individuals younger than five years old were analyzed. The results indicate a decline of 16.1% in hospital admissions of patients younger than five years old in relation to the total number of admissions in all age groups. As for the main diagnoses, there were diseases of the respiratory system (55.6%), infectious and parasitic diseases (14.8%) and diseases originating in the perinatal period (12.9%). Such conditions can be avoided by implementing primary health care measures, which shows the need to intensify the actions recommended by the programs directed to child health.

The Rise in Mortality from Breast Cancer in Young Women: Trend Analysis in Brazil.

Introduction Breast cancer is the most common cause of cancer death among women. Objective The objective of this study was to analyze time trends in overall mortality from breast cancer in Brazil, Brazilian regions and States. Methods This is an exploratory study, of the time series of deaths from breast cancer contained in the Mortality Information System (SIM), of women living in Brazil, Brazilian regions and States, from 1996 to 2013. For the trend analysis, the polynomial regression model was used, and a significant trend was considered when the estimated model obtained a p value <0.05. Results There was a tendency of increased mortality from breast cancer in Brazilian women (average increase of 0.18 per year; p <0.001), with regional differences, particularly in the age group 20–49 years (0.07 per year; p <0.001). The age group 50–69 years remained constant but had high average rates (37.14). Conclusion More effective planning is needed to focus on the different scenarios of the Brazilian regions. Screening strategies for the incidence and mortality from breast cancer must also be rethought according to age group in the country.

Aspects of infant mortality, according to an investigation of death

Objective: To analyze some characteristics of infant mortality of residents in the area of the 15th Health Region of Parana, from 2005 to 2008. Methods: A descriptive exploratory study covering 397 deaths investigated by the Committee for the Prevention of Infant Mortality, using data from the research data sheets. Results: In 82.3% of families, monthly income was up to three times the minimum wage; 65.1% of the mothers received prenatal care through the public network; 83.4% of births were financed by the National Health System; and, 59 2% of women began prenatal care in the first trimester. Of the mothers, 68.5% had complications during pregnancy: 18.2% had preterm labor; 18.2% had a urinary tract infection, and 16.5% had arterial hypertension. Conclusion: Low income, the use of public services for prenatal care and childbirth shows that public institutions, public health workers and nurses are improving the care of pregnant women with attributes of gestational risk, and contribute to the continued reduction of infant mortality.

Morbidade materna grave identificada no Sistema de Informações Hospitalares do Sistema Único de Saúde, no estado do Paraná, 2010

Resumo OBJETIVO: descrever a morbidade materna grave (near miss) entre mulheres no estado do Parana, Brasil, em 2010. METODOS: estudo descritivo com dados do Sistema de Informacoes Hospitalares do Sistema Unico de Saude (SIH/SUS); foram incluidas todas as internacoes com diagnostico principal contemplado no Capitulo XV da Classificacao Estatistica Internacional de Doencas e Problemas Relacionados a Saude - 10a Revisao - e/ou com registro de procedimentos obstetricos indicativos de near miss; utilizaram-se tres criterios definidores de morbidade materna grave. RESULTADOS: foram identificadas 4.890 internacoes por morbidade materna grave, a taxa de 52,9 internacoes/1.000 partos, sendo 69,8/1.000 para mulheres de 35 a 39 e 356,6/1.000 para mulheres de 44 a 49 anos; as principais causas de internacao foram pre-eclâmpsia (28,2%), hemorragia grave (23,7%) e disfuncao do sistema imunologico (14,0%). CONCLUSAO: evidenciou-se a necessidade de dispensar maior atencao as gestantes a partir de 35 anos de idade que apresentaram maiores taxas de near miss.OBJECTIVE to describe near miss maternal morbidity among women living in Paraná State, Brazil, in 2010. METHODS this was a descriptive study using Brazilian National Hospital Information System (SIH/SUS) data on all hospital admissions with primary diagnosis falling under Chapter XV of the International Statistical Classification of Diseases and Related Health Problems 10th Revision and/or with records of obstetric procedures indicative of near misses; three criteria were used to define severe maternal morbidity. RESULTS 4,890 admissions owing to near miss were identified, with a rate of 52.9 hospitalizations per 1,000 births, a rate of 69.8/1,000 among women aged 35-39 and a rate of 356.6/1,000 among women aged 44-49; the leading causes of hospitalization were preeclampsia (28.2%), haemorrhage (23.7%) and immune system dysfunction (14.0%). CONCLUSION the results indicate the need to pay greater attention to women aged 35 and over since they had higher rates of near miss.

Pregnancy complications in Brazilian puerperal women treated in the public and private health systems

ABSTRACT Objective: to analyze the prevalence of pregnancy complications and sociodemographic profile of puerperal patients with complications, according to the form of financing of the childbirth service. Method: cross-sectional study with interview of 928 puerperal women whose childbirth was financed by the Unified Health System, health plans and private sources (other sources than the Unified Health System). The sample was calculated based on the births registered in the Information System on Live Births, stratified by hospital and form of financing of the childbirth service. Data were analyzed using the chi-square and Fisher’s exact tests. Results: the prevalence was 87.8% for all puerperal women, with an average of 2.4 complications per woman. In the case of deliveries covered by the Unified Health System, urinary tract infection (38.2%), anemia (26.0%) and leucorrhea (23.5%) were more frequent. In turn, vaginal bleeding (26.4%), urinary tract infection (23.9%) and leucorrhoea (23.7%) were prevalent in deliveries that were not covered by the Unified Health System. Puerperal women that had their delivery covered by the Unified Health System reported a greater number of intercurrences related to infectious diseases, while women who used health plans and private sources reported intercurrences related to chronic diseases. A higher frequency of puerperal adolescents, non-white women, and women without partner among those assisted in the Unified Health System (p < 0.001). Conclusion: the high prevalence of complications indicates the need for monitoring and preventing diseases during pregnancy, especially in the case of pregnant women with unfavorable sociodemographic characteristics.

Syphilis in during pregnancy: association of maternal and perinatal characteristics in a region of southern Brazil

ABSTRACT Objective: To analyze the prevalence of syphilis in during pregnancy and its association with socioeconomic characteristics, reproductive history, prenatal and labor care, and newborn characteristics. Method: A retrospective, cross-sectional study based on gestational and congenital syphilis reports. A (records) linkage was performed in the Brazilian databases: “Information System for Notifiable Diseases” (Sistema de Informação de Agravos de Notificação - SINAN); “Live Births Information System” (Sistema de Informação sobre Nascidos Vivos - SINASC); and “Mortality Information System” (Sistema de Informação sobre Mortalidade - SIM). Results: The prevalence of gestational syphilis was 0.57%. The following associations of syphilis in pregnancy were found: non-white skin color/ethnicity (PR=4.6, CI=3.62-5.76); low educational level (PR=15.4; CI=12.60-18.86); and absence of prenatal care (PR=7.4, CI=3.68-14.9). The perinatal outcomes associated with gestational syphilis were prematurity (PR=1.6 CI=1.17-2.21) and low birth weight (PR=1.6; CI=1.14-2.28). Two deaths from congenital syphilis, one death from another cause and five stillbirths were reported. Conclusion: The results signify a long way until reaching the World Health Organization’s goal of eradicating congenital syphilis.

Risk Factors Associated with Overweight and Obesity in Japanese-Brazilians

Objective To estimate which risk factors (sociodemographic, lifestyle, and health conditions) are associated with overweight and obesity in Japanese-Brazilians. Methods This was a cross-sectional study carried out with Japanese-Brazilians living in the southern region of Brazil. Data were collected between March and December of 2016 through a household survey addressing sociodemographic characteristics, lifestyle, and health conditions. Data were analyzed by means of logistic regression considering 95% level of significance. Results A total of 542 Japanese-Brazilians with a mean age of 47.75 years were evaluated; 52.8% were eutrophic, 36.9% were overweight, and 10.3% were people with obesity. The following variables remained associated with overweight after adjustments; male gender (ORaj = 1.85, CI = 1.24–2.76), age range of 40–49 years (ORaj = 2.27, CI = 1.10–4.68), and 50 to 59 years (ORaj = 2.17, CI = 1.004–4.72), alcohol consumption (ORaj = 2.11, CI = 1.07–4.16), and presence of chronic disease (ORaj = 1.59, CI = 1.02–2.46). The following were independent factors associated with obesity: male gender (ORaj = 3.63, CI = 1.78–7.40), the presence of chronic disease (ORaj = 4.13, CI = 1.96–8.71), the age range of 30 to 39 years (ORaj = 4.74, CI = 1.65–13.64) and 40 to 49 years (ORaj = 2.89, CI = 1.05–7.95), and irregularly active lifestyle (ORaj = 2.73, CI = 1.12–6.69). Conclusion The results of this study show that being a male in the age range of 30–49 years old, alcohol consumption, and presence of chronic disease are associated with overweight and obesity in Japanese-Brazilians.