Association between placental efficiency with anthropometry and nutritional phenotypes in full-term newborns from the 2010/2011 BRISA birth cohort.

OBJECTIVE: To study the association between placental efficiency with anthropometry and nutritional phenotypes in full-term newborns from a birth cohort. METHOD: This was a secondary cross-sectional analysis of data obtained in a cohort study (Brazilian RibeirãoPreto and São Luís Birth Cohort Studies - BRISA), whose deliveries were performed between 2010 and 2011. Standardized questionnaires were applied to mothers, and placentas and newborns were evaluated shortly after delivery. Placental efficiency was assessed using the ratio between birth weight and placental weight (BW/PW ratio); values below the lower quartile (25th percentile for gestational age) were considered to have low placental efficiency. Newborn phenotypes were small and large for gestational age, stunted and wasted, evaluated using the INTERGROWTH-21 growth standard. To identify the confounding variables theoretical model was constructed using Directed Acyclic Graphs, and unadjusted and adjusted logistic regression were performed. Placental measurements were obtained blindly from pregnancy and delivery data. RESULTS: 723 mother-placenta-child triads were studied. 3.2 % of newborns were small-for-gestational-age (SGA), 6.5 %large-for-gestational-age (LGA), 5.7 %had stunting, and 0.27 % wasting. A significantly higher risk was found between low placental efficiency and SGA (OR 2.82;95 % CI 1.05-7.57), stunting (OR 2.23; 95 % CI 1.07-4.65), and wasting (OR 8.22; 95 % CI 1.96-34.37). No relationship was found between LGA and placental efficiency. CONCLUSIONS: Low placental efficiency was associated with increased risk for small-for-gestational-age, stunting, and wasting. Placental morphometry can provide valuable information on intrauterine conditions and neonatal health, helping to identify newborns at higher risk of future comorbidities.

Clinical validation of the nursing diagnosis "Ineffective health self-management" in people living with HIV.

OBJECTIVE: Check diagnostic accuracy of the defining characteristics of the nursing diagnosis "Ineffective health self-management" in people living with HIV. METHODS: Methodological study conducted in a specialized public service for people living with HIV in Northeastern Brazil, between February and April 2021, with a sample of 203 people. Latent class analysis was used to calculate the accuracy measurements of the defining characteristics, as well as the sensitivity and specificity values with their respective 95% confidence intervals. The likelihood ratio test (G2 ) was applied to evaluate the adequacy of the fit of the models obtained (p > 0.05). RESULTS: The prevalence of Ineffective health self-management estimated through the latent class model was 67.5%. "Exacerbation of diseases symptoms," "failure to take action that reduces risk factor," "exacerbation of diseases signs," and "ineffective choices in daily living for meeting health goal" had the highest sensitivity values (0.80-0.9429). "Exhibits disease sequelae," "inattentive to diseases signs," and "inattentive to disease symptoms" had the highest specificity values (0.9999-1.0000). CONCLUSIONS: The useful characteristics for discriminating PLHIV with and without diagnosis are "exacerbation of diseases symptoms," "failure to take action that reduces risk factor," "exacerbation of diseases signs," and "ineffective choices in daily living for meeting health goal." The diagnosis can be confirmed by the indicators "exhibits disease sequelae", "inattentive to diseases signs," and "inattentive to disease symptoms." IMPLICATIONS FOR NURSING PRACTICES: The study demonstrates the levels of importance of the defining characteristics of "Ineffective health self-management" in people living with HIV contributes to suspicion and accurate diagnostic identification of nurses and researchers.

OBJETIVO: Verificar a acurácia diagnóstica das características definidoras do Diagnóstico de Enfermagem "Autogestão Ineficaz da Saúde" em pessoas vivendo com HIV. MÉTODOS: Estudo metodológico realizado em um serviço público de atendimento para pessoas que vivem com HIV no Nordeste brasileiro, entre fevereiro e abril de 2021 com amostra de 203 indivíduos. A análise de classe latente foi utilizada para calcular as medidas de acurácia das características definidoras, bem como os valores de sensibilidade e especificidade com seus respectivos intervalos de confiança a 95%. O teste da razão de verossimilhança (G2 ) foi aplicado para avaliar a adequação do ajuste dos modelos obtidos (p>0,05). RESULTADOS: A prevalência da "Autogestão Ineficaz da Saúde" estimada pelo modelo de classe latente foi de 67,5%. "Exacerbação dos sintomas da doença", "Falha em tomar medidas para reduzir os fatores de risco", "Exacerbação dos sinais da doença" e "Escolhas ineficazes na vida diária para cumprir a meta de saúde" tiveram os mais altos valores de sensibilidade (0.803-0.9429).  "Exibir sequelas da doença", "Desatento aos sinais da doença" e "Desatento aos sintomas da doença" obtiveram os mais altos valores de especificidade (0.9999-1.0000). CONCLUSÕES: As características úteis para discriminar pessoas vivendo com HIV com e sem o diagnóstico são: "Exacerbação dos sintomas da doença", "Falha em tomar medidas para reduzir os fatores de risco", "Exacerbação dos sinais da doença" e "Escolhas ineficazes na vida diária para cumprir a meta de saúde". O diagnóstico também pode ser confirmado pelos indicadores "Exibir sequelas da doença", "Desatento aos sinais da doença" e "Desatento aos sintomas da doença". IMPLICAÇÕES PARA AS PRÁTICAS DE ENFERMAGEM: Estudo demonstra os níveis de importância das características definidoras de "Autogestão Ineficaz da Saúde" em pessoas vivendo com HIV, contribui para suspeição e identificação diagnóstica acurada de enfermeiros e pesquisadores.

Nutritional and cardiovascular disease risk in older persons living in Quilombola communities. / Risco nutricional e cardiovascular em idosos quilombolas.

This article aims to assess nutritional and cardiovascular disease (CVD) risk based on anthropometric measures among older persons living in Quilombola communities in the state of Maranhão, Brazil. We conducted a cross-sectional study with 205 older persons living in 11 Quilombola communities in Bequimão, Maranhão. Nutritional and CVD risk were estimated according to sex and age group based on anthropometric indicators using Pearson's chi-square or Fisher's exact tests and analysis of variance, adopting a significance level of p<0.05. The study participants suffer precarious housing, basic sanitation and social conditions. Prevalence of nutritional and CDV risk was high across the sample, showing differences between sexes and age groups. Prevalence of excess weight was higher in women and the youngest age group, while prevalence of malnourishment and loss of muscle mass was higher in men and individuals aged 80 years and over. Prevalence of CVD risk was high across all age groups and higher in women than men. The older persons living in the Quilombola communities investigated by this study are socially vulnerable and showed high prevalence of low weight, loss of muscle mass and CDV risk. The prevalence of CVD risk was higher among women and the oldest age group.

O objetivo deste artigo é avaliar o risco nutricional e cardiovascular segundo medidas antropométricas em idosos quilombolas do estado do Maranhão. Trata-se de estudo transversal realizado em 11 comunidades remanescentes de quilombolas do município de Bequimão, Maranhão, Brasil. Realizou-se censo da população idosa que representou 205 pessoas. Foram estimados os riscos nutricional e cardiovascular por meio dos indicadores antropométricos segundo sexo e idade. Realizou-se Testes de Qui-quadrado de Pearson ou Exacto de Fisher e análises de variância. Diferenças foram consideradas estatisticamente significantes quando p<0,05. Idosos quilombolas vivem em precárias condições de moradia e de infraestrutura sanitária, com elevado risco nutricional e cardiovascular, mas com diferenças entre sexo e idade. O excesso de peso foi mais prevalente em mulheres e idosos mais jovens, enquanto os homens e idosos com 80 ou mais anos apresentaram-se mais desnutridos e com maior perda de massa corporal. O risco cardiovascular foi maior entre as mulheres e em todas as faixas etárias. Idosos quilombolas vivem em vulnerabilidade socioeconômica e apresentaram alta prevalência de baixo peso, perda de massa muscular e alto risco cardiovascular, sendo maior risco entre mulheres e idosos do grupo de maior idade.

Abuse, disrespect and mistreatment during childbirth care: contribution of the Ribeirão Preto cohorts, Brazil.

This study aimed to estimate the perception and frequency of abuse, disrespect and mistreatment (ADM) situations during childbirth care of 745 women from the Ribeirão Preto birt cohorts. Confidential questionnaires containing one question regarding perceived abuse during childbirth care and other questions addressing exposure to ADM situations were applied. The chi-squared test was used to compare the situations presented between women who did and did not report mistreatment using the Stata 14.0 software. Among the 745 women evaluated, 66.2% were exposed to some situation of ADM and 8.3% reported having perceived ADM. The most frequent situations were that the woman could not eat or drink (30.5%), the woman had her belly squeezed to help the child be born (27.5%), and the woman could not stay with a companion of her choice (25.5%). Women who reported to have suffered maltreatment more frequently responded positively to all situations of ADM when compared to the other participants, except for the following statements: "I was not allowed to eat or drink anything" (p = 0.975) and "I was forced to have a cesarean delivery against my will" (p = 0.073). Although most women of the Ribeirão Preto cohorts reported exposure to ADM situations during childbirth care, a minority perceived disrespect or mistreatment.

Trend in infant mortality rate caused by sepsis in Brazil from 2009 to 2018.

Sepsis is the organ dysfunction resulting from an infection associated with an unregulated host inflammatory response, which generates high mortality rates in Brazil. The aim of this stydy was to analyze the trend of early, late and post-neonatal mortality rates due to sepsis in Brazilian regions, from 2009 to 2018. This is an ecological study of time series. The trend of infant mortality from sepsis was analyzed using the International Classification of Diseases (ICD10) according to the place of residence (North, Northeast, Southeast, South and Midwest). Death Certificate data were collected from the Mortality Information System database. The temporal trend was analyzed using the Prais-Winsten estimate, interpreted as increasing, decreasing or stable, through the dependent variable (logarithm of mortality rates) and interdependent variables (years of the historical series). The Stata 14.0 statistical software was used. There were 39,867 infant deaths due to sepsis (78.67% for unspecified bacterial sepsis of the neonate ). Most of the children were male, had mixed ethnicity (black and white) , were born preterm with low birth weight and most mothers were 20-34 years old. There were decreasing trends in mortality rates from 2009 to 2018: early neonatal, in the Southeast (-3.57%), North (-3.33%) and South (-2.91%); late neonatal, in the South (-4.12%), Southeast (-4.53%), North (-4.55%) and Midwest (-6.21%); and post-neonatal, in the Northeast (-1.84%), North (-3.62%), Southeast (-3.83%) and Midwest (-5.81%). The Northeast showed a stable trend in early and late neonatal mortality rates. It was concluded that most regions showed a decreasing trend in mortality rates from sepsis in all age components, despite regional differences.

Congenital syphilis in Brazil: distribution of cases notified from 2009 to 2016.

INTRODUCTION: Congenital syphilis is considered a severe public health problem because it accounts for approximately 40% of the perinatal mortality rates, 25% of stillbirths, and 14% of neonatal deaths, in addition to causing severe consequences for the fetus. This study aimed to describe the rates of congenital syphilis in children under one year of age in Brazilian capitals from 2009 to 2016. METHODS: Ecological time series study, using rates of congenital syphilis in children under one year of age and living in Brazilian capitals. The Prais-Winsten regression model was used to assess the trend. RESULTS: A total of 44,056 cases of congenital syphilis in children under one year of age were reported in Brazilian capitals between 2009 and 2016. The highest rate of congenital syphilis in children under one year of age occurred in 2016 in Porto Alegre (31.07/1,000 live births). The Northeastern capitals showed high rates, particularly the capital Recife (23.67/1,000 live births). CONCLUSIONS: Congenital syphilis represents a major challenge for public policies. The need for improvements in the quality of prenatal care is highlighted, as it is essential to reduce the alarming rates.

Inversion of traditional gender roles and intimate partner violence against pregnant women.

This study analyzed the association between the inversion of traditional gender roles and exclusive psychological and physical/sexual intimate partner violence, in a cross-sectional study of Brazilian pregnant women, identified through prenatal services in the municipalities of São Luís, Maranhão State (n = 992) and Ribeirão Preto, São Paulo State (n = 943). The pregnant women ranged from 12 to 45 years. Inversion of traditional gender roles was assessed by calculating differences in age, education and occupation between pregnant women and their co-residing intimate partners and identifying the largest contribution to family income. The conceptual model was tested with structural equation modeling and showed acceptable fit. The prevalence of any type of intimate partner violence was 29.8% in São Luís and 20.1% in Ribeirão Preto. In both municipalities, pregnant women were more likely to suffer exclusive psychological and physical/sexual violence when they had the highest income in the family (p < 0.005). In São Luís, physical/sexual violence was more common among women who were better educated than their partners (standardized coefficient, SC = -0.466; p = 0.007). In Ribeirão Preto, exclusive psychological violence was more frequent among women who had lower status occupations than their partners (SC = 0.236; p = 0.004). Inversion of traditional gender roles is associated with exclusive psychological and physical/sexual violence against pregnant women by their co-residing intimate partners. These findings suggest that women's empowerment at an individual level does not necessarily relieve them of intimate partner abuse in social contexts where traditional gender norms persist.

Prevalence of excessive daytime sleepiness and associated factors in adolescents of the RPS cohort, in São Luís (MA), Brazil. / Prevalência de sonolência diurna excessiva e fatores associados em adolescentes da coorte RPS, em São Luís (MA).

OBJECTIVES: To estimate the prevalence and factors associated with excessive daytime sleepiness (EDS) in adolescents from the São Luís, Maranhão birth cohort. METHOD: Cross-sectional study conducted with 2,514 adolescents aged 18 and 19 years old. A hierarchical approach was used, and prevalence ratios were calculated using Poisson regression with robust variance adjustment. Sociodemographic characteristics (gender, race, economic class, and occupation), lifestyle (leisure activities, smoking, alcohol, illicit drug use, coffee and energy consumption, physical activity, body adiposity, screen time, and depression), and factors related to sleep were studied. RESULTS: The prevalence of EDS was 36.8%. The female gender (PR = 1.33; 95%CI 1.19 - 1.49), high risk for alcohol consumption (PR = 1.26; 95%CI 1.09 - 1.46), current major depressive episode (PR = 1.26; 95%CI 1.08 - 1.46), sleep alteration score from 10 to 18 (PR = 1.43; 95%CI 1.10 - 1.85), and sleep score from 5 to 7 of daytime dysfunction (PR = 2.51; 95%CI 2.06 - 3.07) were risk factors for EDS. Economic class D/E was a protective factor for EDS (PR = 0.47; 95%CI 0.27 - 0.85). CONCLUSION: More than one-third of adolescents had EDS. Adolescents at higher risk need to improve their sleeping habits and lifestyle so that they no longer have EDS and can improve their quality of life.

Association between placental efficiency with anthropometry and nutritional phenotypes in full-term newborns from the 2010/2011 BRISA birth cohort

Abstract Objective: To study the association between placental efficiency with anthropometry and nutritional phenotypes in full-term newborns from a birth cohort. Method: This was a secondary cross-sectional analysis of data obtained in a cohort study (Brazilian RibeirãoPreto and São Luís Birth Cohort Studies - BRISA), whose deliveries were performed between 2010 and 2011. Standardized questionnaires were applied to mothers, and placentas and newborns were evaluated shortly after delivery. Placental efficiency was assessed using the ratio between birth weight and placental weight (BW/PW ratio); values below the lower quartile (25th percentile for gestational age) were considered to have low placental efficiency. Newborn phenotypes were small and large for gestational age, stunted and wasted, evaluated using the INTERGROWTH-21 growth standard. To identify the confounding variables theoretical model was constructed using Directed Acyclic Graphs, and unadjusted and adjusted logistic regression were performed. Placental measurements were obtained blindly from pregnancy and delivery data. Results: 723 mother-placenta-child triads were studied. 3.2 % of newborns were small-for-gestational-age (SGA), 6.5 %large-for-gestational-age (LGA), 5.7 %had stunting, and 0.27 % wasting. A significantly higher risk was found between low placental efficiency and SGA (OR 2.82;95 % CI 1.05-7.57), stunting (OR 2.23; 95 % CI 1.07-4.65), and wasting (OR 8.22; 95 % CI 1.96-34.37). No relationship was found between LGA and placental efficiency. Conclusions: Low placental efficiency was associated with increased risk for small-for-gestational-age, stunting, and wasting. Placental morphometry can provide valuable information on intrauterine conditions and neonatal health, helping to identify newborns at higher risk of future comorbidities.

Does height catch-up in schoolchildren have an effect on bone mass in adolescents? Analysis in a Brazilian birth cohort.

OBJECTIVE: To analyze the effect of height catch-up at school age on the bone mass of adolescents of a Brazilian birth cohort. METHODS: A cohort study using data obtained from the three moments (birth, 7/9 years and 18/19 years of age) of the Cohorts-RPS study. Height catch-up was defined based on the difference between the schoolchild's z-score and birth z-score. The adolescents' bone mineral mass was analyzed using the z-score index for the lumbar spine measured by dual emission X-ray absorptiometry. A theoretical model was developed for the proposed analysis using directed acyclic graphs paired through the nearest-neighbor matching propensity score using the STATA software, version 14.0. The level of significance was set at 5%. RESULTS: Of the 297 studied children, 24.5% achieved height catch-up. The bone mass below the expected for age was observed in 5.39% of the subjects. The mean lumbar spine z-score was -0.34 (±1.01). After the adjustment, no effect was observed between height catch-up at school age and bone mass in adolescents (Coeff=0.598; 95% CI -0.117 to 1.313; p=0.101). CONCLUSION: Even using the directed acyclic graphs and the causal inference method by adjusting the propensity score, the height catch-up did not seem to affect bone mass in adolescents, a result perhaps related to the sample size.

Internação hospitalar por transtornos mentais e comportamentais em adolescentes no Brasil, 2008-2017 / Hospitalization for mental and behavioral disorders in adolescents in Brazil, 2008-2017

Resumo Introdução Internações por transtornos mentais e comportamentais não são ocorrências raras em adolescentes. Estima-se que aproximadamente 30% dos adolescentes brasileiros sejam acometidos por transtornos mentais. Objetivo Analisar a evolução das internações por transtornos mentais e comportamentais em adolescentes brasileiros de 2008 a 2017. Método Estudo ecológico de séries temporais utilizando dados do Sistema de Informações Hospitalares do Sistema Único de Saúde e do IBGE. As variáveis utilizadas foram regiões de residência, sexo, faixa etária e grupos de diagnósticos. A tendência do coeficiente de internação foi analisada através da regressão de Prais-Winsten utilizando o Stata 14.0. Resultados Houve 152.465 internações no período; o coeficiente de internação hospitalar reduziu na região Nordeste de 27,75 a 23,16 por 100 mil habitantes (Coef = -0,0070; -1,6%), aumentou de 13,70 a 21,61 por 100 mil habitantes no Norte (Coef = 0,0192; 4,5%) e nas regiões Sul, Sudeste e Centro-oeste houve tendência estável. Verificou-se tendência crescente de internações entre as mulheres (Coef = 0,0136; 3,2%), e por transtornos do humor [afetivos] (0,0266; 6,33%) e outros transtornos mentais e comportamentais (0,0295; 7,03%). Conclusão Estudos epidemiológicos como este ajudam a fornecer informações úteis para o planejamento de serviços de prevenção e tratamento primário, secundário e terciário voltados à saúde mental, especialmente entre crianças e adolescentes.

Abstract Background Hospitalizations for mental and behavioral disorders are not rare occurrences in adolescents. It is estimated that approximately 30% of Brazilian adolescents are affected by mental disorders. Objective To analyze the evolution of hospitalizations for mental and behavioral disorders in Brazilian adolescents from 2008 to 2017. Method Ecological study of time series using data from the hospital information system collected of the Unified Health System (SUS) and IBGE was carried out. The variables used were regions of residence, gender, age group, and groups of diagnoses. The trend of the hospitalization coefficient was analyzed using the Prais-Winsten regression, by Stata 14.0. Results There were 152,465 hospitalizations in the period; the hospitalization coefficient decreased in the Northeast region from 27.75 to 23.16 per 100 thousand inhabitants (Coef. = -0.0070; -1.6%), increased from 13.70 to 21.61 per 100 thousand inhabitants in the North (Coef. = 0.0192; 4.5%) and in the South, Southeast and Midwest regions, had a stable trend. There was an increasing trend of hospitalizations among women (Coef. = 0.0136; 3.2%) and concerning affective mood disorders (0.0266; 6.33%), besides other mental and behavioral disorders (0.00295; 7.0 3%). Conclusion Epidemiological studies such as this service provide useful information for planning primary, secondary and tertiary prevention, and treatment services aimed at mental health, especially among children and adolescents.

Risco nutricional e cardiovascular em idosos quilombolas / Nutritional and cardiovascular disease risk in older persons living in Quilombola communities

Resumo O objetivo deste artigo é avaliar o risco nutricional e cardiovascular segundo medidas antropométricas em idosos quilombolas do estado do Maranhão. Trata-se de estudo transversal realizado em 11 comunidades remanescentes de quilombolas do município de Bequimão, Maranhão, Brasil. Realizou-se censo da população idosa que representou 205 pessoas. Foram estimados os riscos nutricional e cardiovascular por meio dos indicadores antropométricos segundo sexo e idade. Realizou-se Testes de Qui-quadrado de Pearson ou Exacto de Fisher e análises de variância. Diferenças foram consideradas estatisticamente significantes quando p<0,05. Idosos quilombolas vivem em precárias condições de moradia e de infraestrutura sanitária, com elevado risco nutricional e cardiovascular, mas com diferenças entre sexo e idade. O excesso de peso foi mais prevalente em mulheres e idosos mais jovens, enquanto os homens e idosos com 80 ou mais anos apresentaram-se mais desnutridos e com maior perda de massa corporal. O risco cardiovascular foi maior entre as mulheres e em todas as faixas etárias. Idosos quilombolas vivem em vulnerabilidade socioeconômica e apresentaram alta prevalência de baixo peso, perda de massa muscular e alto risco cardiovascular, sendo maior risco entre mulheres e idosos do grupo de maior idade.

Abstract This article aims to assess nutritional and cardiovascular disease (CVD) risk based on anthropometric measures among older persons living in Quilombola communities in the state of Maranhão, Brazil. We conducted a cross-sectional study with 205 older persons living in 11 Quilombola communities in Bequimão, Maranhão. Nutritional and CVD risk were estimated according to sex and age group based on anthropometric indicators using Pearson's chi-square or Fisher's exact tests and analysis of variance, adopting a significance level of p<0.05. The study participants suffer precarious housing, basic sanitation and social conditions. Prevalence of nutritional and CDV risk was high across the sample, showing differences between sexes and age groups. Prevalence of excess weight was higher in women and the youngest age group, while prevalence of malnourishment and loss of muscle mass was higher in men and individuals aged 80 years and over. Prevalence of CVD risk was high across all age groups and higher in women than men. The older persons living in the Quilombola communities investigated by this study are socially vulnerable and showed high prevalence of low weight, loss of muscle mass and CDV risk. The prevalence of CVD risk was higher among women and the oldest age group.

Abuse, disrespect and mistreatment during childbirth care: contribution of the Ribeirão Preto cohorts, Brazil / Abuso, desrespeito e maltrato na assistência ao parto: contribuição das Coortes de Ribeirão Preto, Brasil

Abstract This study aimed to estimate the perception and frequency of abuse, disrespect and mistreatment (ADM) situations during childbirth care of 745 women from the Ribeirão Preto birt cohorts. Confidential questionnaires containing one question regarding perceived abuse during childbirth care and other questions addressing exposure to ADM situations were applied. The chi-squared test was used to compare the situations presented between women who did and did not report mistreatment using the Stata 14.0 software. Among the 745 women evaluated, 66.2% were exposed to some situation of ADM and 8.3% reported having perceived ADM. The most frequent situations were that the woman could not eat or drink (30.5%), the woman had her belly squeezed to help the child be born (27.5%), and the woman could not stay with a companion of her choice (25.5%). Women who reported to have suffered maltreatment more frequently responded positively to all situations of ADM when compared to the other participants, except for the following statements: "I was not allowed to eat or drink anything" (p = 0.975) and "I was forced to have a cesarean delivery against my will" (p = 0.073). Although most women of the Ribeirão Preto cohorts reported exposure to ADM situations during childbirth care, a minority perceived disrespect or mistreatment.

Resumo O objetivo do estudo foi estimar percepção e ocorrência de situações de abuso, desrespeito e maltrato (ADM) na assistência ao parto de 745 mulheres pertencentes às coortes de nascimentos de Ribeirão Preto. Foram aplicados questionários sigilosos contendo uma pergunta sobre percepção de maltrato na assistência ao parto e outras sobre exposição a situações de ADM. Utilizou-se o teste qui-quadrado para comparar as situações apresentadas entres as mulheres que relataram ou não maltrato. A análise foi realizada por meio do programa Stata 14. Das 745 mulheres avaliadas, 66,2% foram expostas a alguma situação de ADM e 8,3% referiram ter percebido ADM. As situações mais frequentes foram: 30,5% não puderam comer nem beber nada; 27,5% tiveram sua barriga apertada para ajudar a criança a nascer; e 25,5% não puderam ficar com acompanhante de sua escolha. Mulheres que afirmaram ter sofrido maltrato apresentaram maiores frequências de respostas positivas a todas situações de ADM quando comparadas com às demais, exceto para os seguintes relatos: "Não me deixaram comer nem beber nada" (p = 0,975) e "Fui forçada a ter parto cesáreo contra minha vontade" (p = 0,073). Apesar de a maior parte das mulheres pertencentes às coortes de Ribeirão Preto relatarem exposição a situações de ADM durante a assistência ao parto, uma minoria percebeu desrespeito ou maltrato.

[Maternal depressive symptoms and anxiety and interference in the mother/child relationship based on a prenatal cohort: an approach with structural equations modeling]. / Sintomas depressivos e de ansiedade maternos e prejuízos na relação mãe/filho em uma coorte pré-natal: uma abordagem com modelagem de equações estruturais.

This study aimed to investigate the association between maternal depressive symptoms and anxiety and interference in the mother/child relationship, using structural equations modeling. Data were used from a prospective cohort study initiated during the prenatal period with 1,140 mothers in São Luís, Maranhão State, Brazil. Data were collected during prenatal care and when the children reached two years of age. Interference in the mother/child relationship was measured with the Postpartum Bonding Questionnaire - PBQ (N = 1,140). In the initial theoretical model, socioeconomic status determined the maternal demographic, psychosocial, and social support factors, which determined the outcome, i.e., the mother/child relationship. Adjustments were performed by structural equations modeling, using Mplus 7.0. The final model showed good fit (RMSEA = 0.047; CFI = 0.984; TLI = 0.981). Depressive symptoms in pregnancy and the postpartum were associated with higher PBQ scores, indicating interference in the mother/child relationship. The greatest effect was from depressive symptoms in pregnancy. Other factors associated with higher PBQ scores were lower social support, unfavorable socioeconomic status, and living without a partner, by indirect association. Anxiety symptoms and maternal age were not associated with the mother/child relationship. The results suggest that identifying and treating depression in pregnancy and postpartum can improve mother/child bonding in childhood.

Check list da visita pré-operatória de enfermagem avaliação da qualidade dos dados / Check list de visitas de enfermería preoperatorias: evaluación de calidad de datos / Preoperative Nursing Visit Check list: Data Quality Assessment

Objetivo: avaliar a qualidade dos dados do check list da visita pré-operatória de enfermagem em um hospital universitário do nordeste brasileiro. Método: estudo transversal no período de julho a dezembro de 2017. Utilizou-se os parâmetros incompletude do preenchimento e confiabilidade dos dados. Adotou-se para o cálculo da incompletude, o sistema de escores proposto por Romero e Cunha. A confiabilidade foi medida pelo indicador Kappa. Resultados: analisadas 203 fichas de visitas pré-operatórias; 68,2% das variáveis (15 das 22 variáveis analisadas) tiveram percentual de não preenchimento que variou entre >5% a 9,9%, classificadas como muito baixa/baixa incompletude. Considerando os valores Kappa, 81,8% das variáveis estudadas tiveram confiabilidade dos dados considerada quase perfeita. Conclusão: a qualidade dos dados do check list da visita pré-operatória é satisfatória, uma vez que a incompletude da maioria das variáveis analisadas é muito baixa/baixa e a análise de concordância apontou que as informações são robustas e fidedignas.

Aim: to evaluate the quality of the preoperative nursing visit check list data in a university hospital in northeastern Brazil. Method: cross-sectional study from July to December 2017. The parameters non-fulfillment and reliability of data were used. For the calculation of incompleteness, the scoring system proposed by Romero and Cunha was adopted. Reliability was measured by the Kappa indicator. Results: 203 preoperative visit sheets were analyzed; 68.2% of the variables (15 of 22 variables analyzed) had a percentage of non-fulfillment ranging from >5% to 9.9%, classified as very low/low non-fulfillment. Considering the Kappa values, 81.8% of the studied variables had data reliability considered almost perfect. Conclusion: The quality of the preoperative visit check list data is satisfactory, since the non-fulfillment of most of the analyzed variables is very low/low and the agreement analysis indicated that the information is robust and reliable.

Objetivo: Evaluar la calidad de los datos del check list de la visita de enfermería preoperatoria en un hospital universitario del noreste brasileño. Método: estudio transversal de julio a diciembre de 2017. Utilizaron los parámetros de incompletitud y fiabilidad. Para cálculo de incompletitud, se adoptó el sistema de puntuación propuesto por Romero y Cunha. La fiabilidad se midió por indicador Kappa. Resultados: analizaron 203 hojas de visitas preoperatorias; 68,2% de las variables (15 de 22 variables analizadas) tenían un porcentaje de incumplimiento que oscilaba entre >5% y 9,9%, clasificado como muy baja/baja incompletitud. Teniendo en cuenta los valores de Kappa, 81,8% de las variables estudiadas tenían la fiabilidad de los datos casi perfecta. Conclusión: La calidad de los datos es satisfactoria, ya que la incompletitud de la mayoría de las variables analizadas es muy baja/baja y el análisis de acuerdo indicó que la información es sólida y confiable.

Prevalência de sonolência diurna excessiva e fatores associados em adolescentes da coorte RPS, em São Luís (MA) / Prevalence of excessive daytime sleepiness and associated factors in adolescents of the RPS cohort, in São Luís (MA), Brazil

RESUMO: Objetivos: Estimar a prevalência de sonolência diurna excessiva (SDE) e os fatores associados a ela em adolescentes da coorte de nascimentos de São Luís (MA). Método: Estudo transversal realizado com 2.514 adolescentes com idade de 18 e 19 anos. Utilizou-se abordagem hierarquizada e calculou-se a razão de prevalências utilizando regressão de Poisson com ajuste robusto da variância. Foram estudadas características sociodemográficas (sexo, cor, classe econômica, ocupação), hábitos de vida (lazer, fumo, álcool, uso de drogas ilícitas, consumo de café e de bebidas energéticas, prática de atividade física, adiposidade corporal, tempo de tela, depressão) e fatores relacionados ao sono. Resultados: A prevalência de SDE foi de 36,8%. Sexo feminino (razão de prevalência - RP = 1,33; intervalo de confiança de 95% - IC95% 1,19 - 1,49), alto risco de consumo de bebidas alcoólicas (RP = 1,26; IC95% 1,09 - 1,46), episódio depressivo maior atual (RP = 1,26; IC95% 1,08 - 1,46), escore de 10 a 18 de alterações do sono (RP = 1,43; IC95% 1,10 - 1,85) e escore de 5 a 7 da disfunção durante o dia (RP = 2,51; IC95% 2,06 - 3,07) foram os fatores de risco para SDE. A classe econômica D/E foi fator de proteção para SDE (RP = 0,47; IC95% 0,27 - 0,85). Conclusão: Mais de um terço dos adolescentes apresentou SDE, e aqueles com maiores riscos precisam melhorar seus hábitos de vida e de sono para que não tenham mais SDE, visando melhorar sua qualidade de vida.

ABSTRACT: Objectives: To estimate the prevalence and factors associated with excessive daytime sleepiness (EDS) in adolescents from the São Luís, Maranhão birth cohort. Method: Cross-sectional study conducted with 2,514 adolescents aged 18 and 19 years old. A hierarchical approach was used, and prevalence ratios were calculated using Poisson regression with robust variance adjustment. Sociodemographic characteristics (gender, race, economic class, and occupation), lifestyle (leisure activities, smoking, alcohol, illicit drug use, coffee and energy consumption, physical activity, body adiposity, screen time, and depression), and factors related to sleep were studied. Results: The prevalence of EDS was 36.8%. The female gender (PR = 1.33; 95%CI 1.19 - 1.49), high risk for alcohol consumption (PR = 1.26; 95%CI 1.09 - 1.46), current major depressive episode (PR = 1.26; 95%CI 1.08 - 1.46), sleep alteration score from 10 to 18 (PR = 1.43; 95%CI 1.10 - 1.85), and sleep score from 5 to 7 of daytime dysfunction (PR = 2.51; 95%CI 2.06 - 3.07) were risk factors for EDS. Economic class D/E was a protective factor for EDS (PR = 0.47; 95%CI 0.27 - 0.85). Conclusion: More than one-third of adolescents had EDS. Adolescents at higher risk need to improve their sleeping habits and lifestyle so that they no longer have EDS and can improve their quality of life.

Congenital syphilis in Brazil: distribution of cases notified from 2009 to 2016

Abstract INTRODUCTION: Congenital syphilis is considered a severe public health problem because it accounts for approximately 40% of the perinatal mortality rates, 25% of stillbirths, and 14% of neonatal deaths, in addition to causing severe consequences for the fetus. This study aimed to describe the rates of congenital syphilis in children under one year of age in Brazilian capitals from 2009 to 2016. METHODS: Ecological time series study, using rates of congenital syphilis in children under one year of age and living in Brazilian capitals. The Prais-Winsten regression model was used to assess the trend. RESULTS: A total of 44,056 cases of congenital syphilis in children under one year of age were reported in Brazilian capitals between 2009 and 2016. The highest rate of congenital syphilis in children under one year of age occurred in 2016 in Porto Alegre (31.07/1,000 live births). The Northeastern capitals showed high rates, particularly the capital Recife (23.67/1,000 live births). CONCLUSIONS: Congenital syphilis represents a major challenge for public policies. The need for improvements in the quality of prenatal care is highlighted, as it is essential to reduce the alarming rates.

Inversion of traditional gender roles and intimate partner violence against pregnant women / Inversão de papéis tradicionais de gênero e violência por parceiros íntimos contra gestantes / Inversión de los roles tradicionales de género y violencia doméstica contra mujeres embarazadas

This study analyzed the association between the inversion of traditional gender roles and exclusive psychological and physical/sexual intimate partner violence, in a cross-sectional study of Brazilian pregnant women, identified through prenatal services in the municipalities of São Luís, Maranhão State (n = 992) and Ribeirão Preto, São Paulo State (n = 943). The pregnant women ranged from 12 to 45 years. Inversion of traditional gender roles was assessed by calculating differences in age, education and occupation between pregnant women and their co-residing intimate partners and identifying the largest contribution to family income. The conceptual model was tested with structural equation modeling and showed acceptable fit. The prevalence of any type of intimate partner violence was 29.8% in São Luís and 20.1% in Ribeirão Preto. In both municipalities, pregnant women were more likely to suffer exclusive psychological and physical/sexual violence when they had the highest income in the family (p < 0.005). In São Luís, physical/sexual violence was more common among women who were better educated than their partners (standardized coefficient, SC = -0.466; p = 0.007). In Ribeirão Preto, exclusive psychological violence was more frequent among women who had lower status occupations than their partners (SC = 0.236; p = 0.004). Inversion of traditional gender roles is associated with exclusive psychological and physical/sexual violence against pregnant women by their co-residing intimate partners. These findings suggest that women's empowerment at an individual level does not necessarily relieve them of intimate partner abuse in social contexts where traditional gender norms persist.

O estudo analisou a associação entre a inversão de papéis tradicionais de gênero e violência psicológica exclusiva e física/sexual por parceiros íntimos, em um estudo transversal com gestantes brasileiras usuárias de serviços de pré-natal nos municípios de São Luís, Maranhão (n = 992) e Ribeirão Preto, São Paulo (n = 943). As gestantes tinham idades de 12 e 45 anos. A inversão dos papéis tradicionais de gênero foi avaliada cálculando diferenças em idade, escolaridade e ocupação entre as gestantes e seus parceiros íntimos residentes, e a pessoa que mais contribuía para a renda familiar. O modelo conceitual foi testado com modelagem de equações estruturais e mostrou ajuste aceitável. A prevalência de qualquer tipo de violência cometida pelo parceiro íntimo foi de 29,8% em São Luís e 20,1% em Ribeirão Preto. Nos dois municípios, as gestantes mais frequentemente sofreram violência psicológica exclusiva e física/sexual quando eram a pessoa de maior renda na família (p < 0,005). Em São Luís, violência física/sexual era mais comum entre mulheres com mais escolaridade em relação aos seus parceiros (coeficiente padrão, CP = -0,466; p = 0,007). Em Ribeirão Preto, violência psicológica exclusiva era mais frequente entre mulheres com ocupações de menor status em relação aos parceiros (CP = 0,236; p = 0,004). A inversão dos papéis de gênero tradicionais está associada à violência psicológica exclusiva e à violência física/sexual contra as gestantes por seus parceiros íntimos. Os achados sugerem que o empoderamento individual das mulheres não necessariamente protege contra o abuso pelos parceiros íntimos em contextos sociais em que persistem as normas de gênero tradicionais.

Este estudio analizó la asociación entre la inversión de los tradicionales roles de género y la violencia doméstica exclusiva psicológica y física/sexual, en un estudio transversal con mujeres embarazadas brasileñas, identificadas a través de los servicios prenatales en los municipios de São Luís, Maranhão (n = 992) y Ribeirão Preto, São Paulo (n = 943). Las mujeres embarazas se encontraban en un rango de edad entre los 12 y los 45 años. La inversión de los roles tradicionales de género fue evaluada calculando las diferencias de edad, educación y ocupación entre las mujeres embarazadas y las parejas que residen con ellas, e identificando quién realiza la contribución más grande a los ingresos familiares. El modelo conceptual fue probado con el modelado de ecuaciones estructurales, y mostró un ajuste aceptable. La prevalencia de cualquier tipo de violencia por parte de la pareja fue del 29,8% en São Luís y 20,1% en Ribeirão Preto. En ambos municipios, las mujeres embarazadas fueron más proclives a sufrir violencia exclusiva psicológica y física/sexual, cuando contaban con los ingresos más altos en la familia (p < 0.005). En São Luís, la violencia física/sexual fue más común entre mujeres que estuvieron mejor educadas que sus parejas (coeficiente estandarizado, CE = -0.466; p = 0.007). En Ribeirão Preto, la violencia exclusiva sicológica fue más frecuente entre mujeres que tenían ocupaciones de estatus inferior al de sus parejas (CE = 0.236; p = 0.004). La inversión de roles tradicionales está asociada con la violencia exclusiva psicológica y física/sexual contra las mujeres embarazadas por parte de las parejas que residen con ellas. Estos hallazgos sugieren que el empoderamiento de las mujeres en un nivel individual no las alivia necesariamente del abuso por parte sus parejas en contextos sociales donde persisten las normas tradicionales de género.

Aleitamento materno complementado e fatores associados: coorte de nascimento brisa / Supplemented breastfeeding and associated factors: brazilian birth cohort studies / Lactancia materna complementada y sus factores asociados: cohorte de nacimiento de brisa

Apesar dos avanços, as taxas de aleitamento materno complementado antes dos seis meses de vida ainda são altas. Nesse sentido, o objetivo deste estudo foi estimar a prevalência de aleitamento materno complementado e analisar seus fatores associados em uma coorte de nascimento realizada em São Luís, Maranhão, Brasil. Trata-se de um estudo transversal utilizando os dados da Coorte de Nascimentos BRISA (Brazilian Birth Cohort Studies). Para analisar os fatores associados ao desfecho de aleitamento materno complementar foi construído um modelo teórico hierarquizado no qual as variáveis socioeconômicas e demográficas, de assistência pré-natal e reprodutivas, além de características da criança, foram divididas em três níveis. Realizou-se então a regressão de Poisson com ajuste robusto da variância bivariada e multivariada a fim de estimar as razões de prevalência (RP) e seus respectivos intervalos de confiança não ajustados e ajustados, utilizando o programa estatístico STATA 14.0. Na amostra, de 3.107 crianças avaliadas, 60,4% das mães relataram realizar aleitamento materno complementado antes dos seis meses de vida. Obteve-se como fatores de risco para o aleitamento complementado não ter realizado pré- -natal (RP 1,32; IC95% 1,09-1,60), usar chupeta atualmente (RP 1,38; IC95% 1,30-1,47) ou já ter usado (RP 1,28; IC95% 1,15-1,41) e ser pré-termo (RP 1,11; IC95% 1,03-1,20). Assim, conclui-se que a prevalência de aleitamento materno complementado acompanha a média nacional, podendo-se identificar os fatores associados em São Luís, o que permite traçar intervenções e ações mais eficientes em Saúde Pública.

Despite advancements in this field, supplemented breastfeeding rates before the six months of life are still high. This cross-sectional study estimated the prevalence of supplemented breastfeeding and analyzed its associated factors in a birth cohort in São Luís, Maranhão, with use of data from the Brazilian Birth Cohort Studies (BRISA). To analyze the factors associated with the outcome of supplementary breastfeeding, a hierarchical theoretical model was constructed in which socioeconomic and demographic variables, prenatal and reproductive care, and child characteristics were divided into three levels. Poisson regression was performed with robust adjustment of the bivariate and multivariate variance to estimate prevalence ratios (PR) and their respective unadjusted and adjusted confidence intervals using the statistics program STATA 14.0. Out of the 3.107 children evaluated, 60.4% of mothers reported completing breastfeeding before the child had six months. The following risk factors for supplementary breastfeeding were found: not undergoing prenatal care (PR 1.32, 95% CI 1.09-1.60), child currently using pacifier (PR 1.38, 95% CI 1.30-1.47), having previously used one (RP 1.28, 95% CI 1.15-1.41), and being preterm (RP 1.11, 95% CI 1.03-1.20). The prevalence of supplementary breastfeeding follows the national average and the associated factors can be identified in São Luís. This allows for a more effective intervention and actions in Public Health.

A pesar de los avances, las tasas de lactancia materna complementadas antes de los seis meses de vida siguen siendo altas. El objetivo de este estudio fue estimar la prevalencia de la lactancia materna complementada y analizar sus factores asociados en una cohorte de nacimiento en São Luís (MA, Brasil). Es un estudio transversal que utiliza datos de la cohorte de nacimiento de BRISA (Brazilian Birth Cohort Studies). Para analizar los factores asociados con el resultado de la lactancia materna complementaria, se construyó un modelo teórico jerárquico en el que las variables socioeconómicas y demográficas, la atención prenatal y reproductiva y las características del niño se dividieron en tres niveles. La regresión de Poisson se realizó con un ajuste robusto de la varianza bivariada y multivariada para estimar los índices de prevalencia (RP) y sus respectivos intervalos de confianza no ajustados y ajustados utilizando el programa estadístico STATA 14.0. En la muestra de 3107 niños evaluados, el 60,4% de las madres informaron haber completado la lactancia antes de los seis meses. Los factores de riesgo para la lactancia materna complementada fueron: no haber realizado atención prenatal (PR 1,32, IC95% 1,09-1,60), usar chupete actualmente (PR 1,38, IC95% 1,30-1,47) o ya haberlo usado (RP 1,28, IC 95% 1,15-1,41) y ser prematuros (RP 1,11, IC 95% 1,03-1,20). Se concluye que la prevalencia de la lactancia materna complementada acompaña al promedio nacional y los factores asociados se pueden identificar en São Luís, lo que permite la elaboración de intervenciones y acciones más efectivas en salud pública.

Mortalidade por suicídio na população brasileira, 1996-2015: qual é a tendência predominante? / Mortality by suicide in the Brazilian population, 1996-2015: what's the predominant trend?

Resumo Introdução O suicídio é uma das três causas de morte mais frequentes no mundo e varia conforme o sexo e a idade. Objetivo Analisar a tendência da mortalidade por suicídio nas regiões brasileiras no período de 1996 a 2015 e sua associação com o sexo e a faixa etária. Método Estudo ecológico de série temporal, utilizando os óbitos por suicídio analisados por regiões no período de 1996 a 2015 contidos no Sistema de Informações sobre Mortalidade. Para avaliação da tendência da mortalidade por suicídio, foi considerado o modelo de regressão de Prais-Winsten. Para comparar os percentuais de mortalidade por sexo e faixa etária, foi utilizado o teste qui-quadrado. Resultados Observou-se tendência crescente de óbitos por suicídio nas regiões Norte (1,73%, Coef = 0,007; p-valor < 0,001), Nordeste (2,30%, Coef = 0,010; p-valor = 0,006) e Sudeste (1,41%, Coef = 0,006; p-valor < 0,001) e decrescente no Sul (-0,57%, Coef = -0,002; p-valor = 0,001), além de predomínio de homens no percentual de óbitos (p < 0,001). Conclusão O suicídio é considerado importante problema de saúde pública, necessitando de ações para divulgação dos riscos e programas de prevenção.

Abstract Background Suicide is one of the three most common causes of death worldwide and varies according to sex and age. Objective to analyze the trend of suicide mortality in the Brazilian regions from 1996 to 2015, and its association with sex and age. Method Ecological study of a time series using the suicide deaths analyzed by regions from 1996 to 2015, contained in the Mortality Information System. We used Prais-Winsten regression model to evaluate the trend of suicide mortality; and chi-square to compare the percentages of mortality by sex and age. Results There was a growing trend of deaths by suicide in the North (1.73%, Coef = 0.007, p-value <0.001), Northeast (2.30%, Coef = 0.010, p-value = 0.006) and Southeast (1.41%, Coef = 0.006, p-value <0.001) and decreasing in the South (-0.57%, Coef = -0.002, p-value = 0.001). Prevalence of men in the percentage of deaths (p <0.001). Conclusion Suicide is considered an important public health problem, requiring actions to disseminate risk and prevention programs.