Maternal near-miss in labor and delivery in the light of technologies in health.

OBJECTIVE: To know maternal near-miss situations during labor and delivery according to technologies in health. METHOD: A quantitative study conducted with puerperal women in a public institution in which the maternity department is a reference for high risk care. Data collection was performed from October 2016 to August 2017, and data were processed in SPSS 20.0. Technologies in health were used for discussing the results. RESULTS: Participation of 319 puerperal women. Primiparous women (p=0.027), previous diagnosis of hypertension (p=0.0001), preeclampsia (p=0.0001) and urinary tract infection (p=0.002) were items with statistical significance for the maternal near-miss outcome in labor and delivery. The hard technology associated with the outcome was transportation for hospitalization (p=0.035). Among the light-hard technologies, the following were associated: characteristics of amniotic fluid (p=0.05), vital signs check (p=0.0001), and initiation of the partograph for cesarean section (p=0.026). Among the light technologies, user satisfaction was relevant (p=0.007). CONCLUSION: Health technologies can be used for structuring the assistance in order to prevent maternal near-miss.

EFFECT OF AN ORAL HEALTH PROMOTION PROGRAM ON GASTROPLASTY PATIENTS: A RANDOMIZED CLINICAL TRIAL.

BACKGROUND: Bariatric surgery can cause oral health problems in individuals, such as an increase in dental caries, periodontal diseases and dental erosion, which can be avoided if oral health promotion actions are implemented. AIMS: To assess the impact of an oral health promotion program implemented among gastroplasty patients. METHODS: This randomized clinical trial involved 208 patients undergoing gastroplasty; they were divided into two groups: Intervention Group, with participation in the Oral Health Promotion Program for Bariatric Patients, or Control Group. Assessments were carried out preoperatively, and six and 12 months postoperatively. The oral conditions assessed were: dental caries, periodontal diseases, tooth wear, dental plaque, and salivary flow. Sociodemographic information was obtained through application of structured questionnaires. For data analysis, the Chi-Square, Fisher's Exact, and Mann-Whitney tests were performed - α=5%. RESULTS: Patients in the Intervention Group, when compared to those in the Control Group, presented: fewer changes in enamel (6M: p<0.0001; 12M: p=0.001), in dentin (6M: p<0.0001; 12M: p<0.0001), moderate tooth wear (6M=0.002; 12M=0.005), gingival bleeding (6M: p<0.0001), dental calculus (6M=0.002; 12M: p=0.03), periodontal pocket 4-5 mm (6M=0.001; 12M: p=<0.0001); greater reduction in the bacterial plaque index (6M: p<0.0001; 12M: p<0.0001), and increased salivary flow (6M: p=0.019). CONCLUSIONS: The oral health promotion program had a positive impact on the prevention and control of the main problems to the oral health of the gastroplasty patients.

Sensitivity to bitter and sweet taste perception in schoolchildren and their relation to dental caries.

PURPOSE: The objective of the present study was to evaluate whether sensitivity to bitter taste and perception of sweet taste have an influence on dental caries in urban and rural areas. MATERIALS AND METHODS: The caries experience in 181 children, aged 12 years, from rural and urban areas of southern Brazil, was assessed according to World Health Organization guidelines. Sensitivity to the bitterness of phenylthiocarbamide was determined using the Harris­Kalmus procedure, and the sweet taste thresholds of sucrose were measured by Nilsson and Holm's method. RESULTS: The caries index (DMFT > 0) was 3.73 (SD = 2.26) in the rural area and 3.51 (SD = 2.14) in the urban area. The sensitivity to bitter taste and sweet taste perception showed significant association with the gender of schoolchildren (P = 0.04). Girls were predominant in the high sweet perception taster group (62.3%) and the bitter taster group (59.4%). No significant difference in sweet perception status could be observed between the groups of low and high caries severity. The genetic ability to taste bitterness significantly influenced the levels of caries only in children from the urban area (P = 0.005). Bitter non-tasters presented higher severity of caries. A positive correlation was observed between sensitivity to bitter taste and sweet taste perception among children in the rural (r = 0.42, P = 0.002) and urban areas (r = 0.36, P = 0.001). CONCLUSIONS: These findings suggest that the bitter non-tasters are more susceptible to dental caries than the tasters in the urban area.

Maternal and child health care: adequacy index in public health services.

OBJECTIVES: to analyze the adequacy of maternal and child-care in prenatal care, childbirth and the puerperal period, in the public health service. METHODS: longitudinal study carried out in a city in Paraná with 357 puerperal women in a public maternity ward, outpatient clinic for immediate puerperal return and home visit 42 days postpartum. Four care domains were grouped (1 - Prenatal, 2 - Maternity, 3 - Immediate puerperal return, 4 - Late puerperal return). Mean, median, standard deviation and coefficient of variance were calculated considering adequate assistance when ≥ 70%; and inadequate, inferior. RESULTS: lowest suitability average in Domain 3 (39.37%) and highest for Domain 4 (74.82%); median of 50.00% at 3 and 76.90% at 4. The largest standard deviation, in Domain 3 (25.18%); and high coefficient of variance for 1 and 3. CONCLUSIONS: in maternal and child follow-up, rates close to adequate in maternity care and higher in late puerperal return, meanwhile prenatal and immediate puerperal return were below the recommended in the health care network.

Effect of an oral health promotion program on gastroplasty patients: a randomized clinical trial / Efeito de um programa de promoção de saúde bucal em gastroplastizados: ensaio clínico randomizado

ABSTRACT BACKGROUND: Bariatric surgery can cause oral health problems in individuals, such as an increase in dental caries, periodontal diseases and dental erosion, which can be avoided if oral health promotion actions are implemented. AIMS: To assess the impact of an oral health promotion program implemented among gastroplasty patients. METHODS: This randomized clinical trial involved 208 patients undergoing gastroplasty; they were divided into two groups: Intervention Group, with participation in the Oral Health Promotion Program for Bariatric Patients, or Control Group. Assessments were carried out preoperatively, and six and 12 months postoperatively. The oral conditions assessed were: dental caries, periodontal diseases, tooth wear, dental plaque, and salivary flow. Sociodemographic information was obtained through application of structured questionnaires. For data analysis, the Chi-Square, Fisher's Exact, and Mann-Whitney tests were performed — α=5%. RESULTS: Patients in the Intervention Group, when compared to those in the Control Group, presented: fewer changes in enamel (6M: p<0.0001; 12M: p=0.001), in dentin (6M: p<0.0001; 12M: p<0.0001), moderate tooth wear (6M=0.002; 12M=0.005), gingival bleeding (6M: p<0.0001), dental calculus (6M=0.002; 12M: p=0.03), periodontal pocket 4-5 mm (6M=0.001; 12M: p=<0.0001); greater reduction in the bacterial plaque index (6M: p<0.0001; 12M: p<0.0001), and increased salivary flow (6M: p=0.019). CONCLUSIONS: The oral health promotion program had a positive impact on the prevention and control of the main problems to the oral health of the gastroplasty patients.

RESUMO RACIONAL: A cirurgia bariátrica pode ocasionar agravos bucais no indivíduo, como o aumento de cárie dentária, doença periodontal e erosão dentária, que podem ser evitados se ações de promoção em saúde bucal forem implementadas. OBJETIVO: Avaliar o impacto de um programa de promoção de saúde bucal implementado junto a gastroplastizados. MÉTODOS: Este ensaio clínico randomizado envolveu 208 pacientes submetidos à gastroplastia, divididos em dois grupos: Grupo de Intervenção, com participação no Programa de Promoção de Saúde Bucal para Pacientes Bariátricos ou Grupo Controle. As avaliações foram feitas no pré-operatório e pós-operatório de 6 e 12 meses. As condições bucais avaliadas foram: cárie dentária, doença periodontal, desgaste dentário, placa dentária e fluxo salivar. Informações sociodemográficas foram obtidas pela aplicação de questionários estruturados. Para análise dos dados foram aplicados os testes Qui- Quadrado, Exato de Fisher e Mann-Whitney, α=5%. RESULTADOS: Pacientes do Grupo de Intervenção, quando comparados aos do Grupo Controle, apresentaram: menos alterações de esmalte (6M: p<0,0001; 12M: p=0,001), de dentina (6M: p<0,0001; 12M: p<0,0001), desgaste dentário moderado (6M=0,002; 12M=0,005), sangramento gengival (6M: p<0,0001), cálculo dentário (6M=0,002; 12M: p=0,03), bolsa periodontal de 4-5 mm (6M=0,001; 12M: p=<0,0001); maior redução no índice de placa bacteriana (6M: p<0,0001; 12M: p<0,0001) e aumento do fluxo salivar (6M: p=0,019). CONCLUSÕES: Houve impacto positivo do programa de promoção de saúde bucal na prevenção e controle dos principais agravos à saúde bucal dos gastroplastizados.

Prenatal follow-up of high-risk pregnancy in the public service.

OBJECTIVE: to analyze the prenatal follow-up of high-risk pregnancy in the public service. METHOD: an analytical cross-sectional study carried out in a public maternity hospital in the South of Brazil, during the hospitalization of 319 postpartum women using a semi-structured tool for transcription of the prenatal card records and interview. The data were analyzed using the Chi-Square test (p≤0.05). RESULTS: the adequacy of prenatal care was high (74%); 22.6% intermediate; 3.4% inefficient. Prenatal care had high coverage (100%), early onset (81.5%) and six or more visits (92.4%), but (77.4%) did not receive information about gestational disease and examinations (69.3%). There was statistical significance between the quality of prenatal care and the place of prenatal care (p=0.005). CONCLUSION: the need to implement a specific protocol for high-risk gestation and continuous education to the teams was evidenced.

ORAL HEALTH PROMOTION IN PATIENTS WITH MORBID OBESITY AFTER GASTROPLASTY: A RANDOMIZED CLINICAL TRIAL.

BACKGROUND: The bariatric surgery may have negative repercussions on oral conditions. AIM: To evaluate the impact of oral health educational/preventive program developed with patients submitted to gastroplasties. METHOD: The sample consisted of 109 patients randomly allocated to two groups: intervention group (IG), where they participated in the oral health promotion program that include multiple educational-preventive approaches; control group (CG), where they received usual care from the bariatric clinic staff, without participation in the program. The oral conditions investigated in the pre-operative and postoperative periods of one month (1M) and six months (6M) were: dental caries, periodontal disease, tooth wear, dental plaque and salivary flow. RESULTS: After bariatric surgery, patients in IG presented: fewer changes in enamel (6M: p=0.004), dentin (6M: p=0.005) and gingival bleeding (6M: p<0.0001), reduction in plaque index (1M, 6M: p<0.0001) and increased salivary flow (6M: p=0.039), when compared with CG. Incipient tooth wear was recorded in both groups (6M: p=0.713). CONCLUSION: There was a positive impact of the implemented program in the prevention of the main oral health problems in patients who underwent gastroplasties, contributing to their quality of life.

Association between near miss maternal with sociodemographic factors and health assistants / Associação entre o near miss materno com fatores sociodemográficos e assistenciais de saúde

Abstract Objectives: evaluate the association between the maternal near miss rate (TNMM) and sociodemographic and health care factors. Methods: this is an aggregated, cross- sectional epidemiological survey, with regression analysis and spatial analysis, with the units of analysis being the 399 municipalities that make up the four health macro- regions in the state of Paraná, Brazil. Data from the years 2018 to 2021 were obtained through the state maternal near miss report and monitoring system. Results: the state's total TNMM was 6.4 per 1,000 live births, with an increasing trend during the studied period (p<0.001). Sociodemographic and healthcare factors were not associated with TNMM, except for municipalities with a higher degree of urbanization (β adjusted=0.022; CI95%=0.002-0.041) and located in the northern health macro-region (β adjusted=12.352; CI95%= 10.779-15.099), demonstrated by clusters with high and positive associations (high-high). Conclusion: the lack of association with sociodemographic and care factors may be due to their low effect on near miss, or the underreporting of near miss cases in the state. The differences found can be justified by the organization of health services and the intense regionalization of municipalities belonging to the macronorth, which have a better near miss report culture.

Resumo Objetivos: avaliar a associação existente entre a taxa de near miss materno (TNMM) com fatores sociodemográficos e assistenciais de saúde. Métodos: trata-se de uma pesquisa epidemiológica agregada, transversal, com análises de regressão e análise espacial, sendo as unidades de análise os 399 municípios que compõem as quatro macrorregiões de saúde do estado do Paraná, Brasil. Os dados provenientes dos anos de 2018 a 2021 foram obtidos por meio do sistema estadual de notificação e monitoramento do near miss materno. Resultados: a TNMM total do estado foi de 6,4 por 1.000 nascidos-vivos, com tendência de aumento no período estudado (p<0,001). Fatores sociodemográficos e assistenciais não se associaram com a TNMM, exceto municípios com maior grau de urbanização (β ajustado=0,022; IC95%= 0,002-0,041) e localizados na macrorregião norte de saúde (β ajustado=12,352; IC95%= 10,779; 15,099), demonstrado por clusters com associações altas e positivas (high- high). Conclusão: a ausência de associação com os fatores sociodemográficos e assistenciais podem decorrer do baixo efeito dos mesmos sobre o near miss, ou à subnotificação de casos de near miss materno no estado. As diferenças encontradas podem ser justificadas pela organização dos serviços de saúde e intensa regionalização dos municípios pertencentes à macronorte, os quais apresentam melhor cultura de notificação de near miss.

Relationship between tooth loss, nutritional status and consumption of macro and micronutrients in elderly people from southern Brazil

Maintaining a functional natural dentition plays an important role in keeping a satisfactory nutritional status. The aim of this study was to evaluate the relationship between oral health conditions determined by the presence of edentulism and the number of missing teeth, nutritional status and consumption of nutrients by the elderly. This cross-sectional study comprised 494 independent elderly of both genders, over 60 years of age, registered at the Brazilian public health service in Londrina, southern Brazil. The data collection included: oral examinations; anthropometric measurements by calculating the Body Mass Index (BMI); analysis of food consumption based on a multiple pass 24-hour dietary recall and a food intake frequency questionnaire; and structured interviews to obtain sociodemographic information. Multiple linear regression, the Fisher's Exact test, chi-square and Mann-Whitney tests, were applied at a 5% significance level. The prevalence of edentulism was 47.3%; this predominated in females, age group from 65 to 74 years, low education level and low/medium economic classification. A larger numberof underweight and fewer number of overweight elderly were recorded among the edentulous versus dentate participants (< 0.0001). Significantly lower consumption of several nutrients, as well as fruit, was recorded among the edentulous group. In particular, carbohydrates, vitamins (B1, B9 and C), and the majority of the minerals studied were associated with a larger number of missing teeth. In conclusion, tooth loss was associated with the food consumption pattern of some macro-and micronutrients and the nutritional status of the Brazilian elderly.

Correlation between antioxidant activity and bonding strength on bleached enamel.

Objective: This study used the 2,2-diphenyl-1-picryl-hydrazyl-hydrate (DPPH) method to evaluate the percentage of antioxidant activity (%AA) of green tea (GT) and sodium ascorbate (SA) gel in three concentrations (10%, 20% and 30%), and the influence of these concentrations on the microshear bond strength (µ-SBT) values of bleached enamel, using 10% carbamide peroxide (CP). Materials and methods: Eighty intact third molars were selected to perform the µ-SBT test, and were randomly divided into eight experimental groups: G1: positive control - no treatment; G2: negative control - bleached with CP; G3: PC +10% GT; G4: PC +20% GT; G5: PC +30% GT; G6: PC +10% SA; G7: PC +20% SA and G8: PC +30% SA. After applying the treatments, adhesive procedures were performed using Single Bond 2 and Filtek Z350XT. After 24 h, the samples were tested in a universal testing machine until fracture. The %AA was assessed in triplicate by DDPH method using a UV-VIS spectrophotometer. Results: In the µ-SBT, ANOVA revealed no significant difference between the antioxidants evaluated (p = .625), but did reveal significant effects of the concentrations studied (p = .007). A negative correlation was observed between µ-SBT and solution concentrations. The values of %AA were from 90.58 to 96.75. Conclusions: The reverse results occurred in µ-SBT values, only when the antioxidants were used in a 10% concentration and, %AA did not influence µ-SBT.

Knowledge and Practices of Mothers towards Infant Oral Health Care in Their Children's First Year of Life / Conhecimentos e Práticas de Mães Sobre a Saúde Bucal Infantil no Primeiro Ano de Vida de seus Filhos

This study aimed to assess mothers' oral health-related knowledge and practices in immediate and late puerperium, and in the child's first year of life. This study is a prospective cohort study, in which data were collected from 358 mothers of children born between 2013 and 2014, in immediate and late puerperium, and in children's first year of life, by interviews with sociodemographic characterization and oral health questionnaires, and were analyzed by descriptive statistics and Chi-square test (α = 5%). Participants were mainly aged 20 to 29 years (53.9%), with 7 to 11 years of education (67.6%), from low social class (72.3%), unemployed (58.9%), married or in common-law marriage (84.1%), with more than one child (60.1%). Although 51.7% of them had received information about children's oral health, only 0.8%, 32.4% and 13.7%, respectively, knew the concept, etiology and preventive attitudes regarding dental caries. Mothers aged under 20 and over 30 years, with lower education and from low social class presented significantly lower oral health related knowledge. At children's first year of life, although 78.7% of the children had already been taken to the dentist, half of them had already tasted sugary foods and drinks. It is highlighted the social determination and the need of an improvement of mothers' oral health-related knowledge and practices. Educational actions, especially in prenatal programs, are important to achieve this improvement and to decrease early childhood caries rates. (AU)

Avaliar o conhecimento e as práticas de mães sobre a saúde bucal de seus filhos no puerpério imediato, tardio, e no primeiro ano de vida da criança. Trata-se de um estudo de coorte prospectiva, no qual os dados foram coletados de 358 mães de bebês nascidos entre 2013 e 2014, no puerpério imediato, tardio e um ano após o parto, por entrevistas com perguntas sobre dados sociodemográficos e sobre saúde bucal. Os dados foram analisados por estatísticas descritivas e pelo teste Qui-quadrado (α = 5%). As participantes apresentavam, majoritariamente, idades entre 20 a 29 anos (53,9%), com 7 a 11 anos de estudo (67,6%), eram de baixa classe social (72,3%), desempregadas (58,9%), casadas ou em união estável (84,1%), e tinham mais de um filho (60,1%). Apesar de 51.7% delas afirmarem ter recebido informações sobre saúde bucal infantil, apenas 0,8%, 32,4% e 13,7%, respectivamente, sabiam o conceito, etiologia e as atitudes preventivas à cárie. Mães com idades abaixo de 20 e acima de 29 anos apresentaram menor conhecimento sobre saúde bucal do que as demais. No primeiro ano de vida, apesar de 78,7% das crianças já terem ido ao dentista, metade delas já havia experimentado alimentos e bebidas açucarados. Destaca-se a determinação social e a necessidade de melhora no conhecimento e práticas das mães sobre saúde bucal. Ações educativas, especialmente em programas de atenção pré-natal, são importantes para atingir essa melhora e, consequentemente, diminuir as taxas da cárie na primeira infância. (AU)

Association between oral health status and central obesity among Brazilian independent-living elderly.

The aim of this study was to investigate the association between oral health status and central obesity (CO) in Brazilian independent-living elderly. A cross-sectional study was carried out in a sample of 489 elderly, who were participants of the Study on Aging and Longevity, in Londrina, state of Parana. The number of natural teeth and use of prostheses were evaluated according to the World Health Organization criteria. The presence of CO was assessed using measures of waist circumference (WC) and waist-hip ratio (WHR). Information concerning sociodemographic profile and some systemic conditions was also collected. Data were analyzed using stepwise logistic regression, α=5%. According to WC and WHR measures, the prevalence of central obesity was 79.3% and 76.1%, respectively. CO according to WC was not associated with oral status. Considering the WHR measure, the following oral conditions were associated to CO: having fewer natural teeth (OR = 2.61; 95%CI = 1.17-5.80), being edentulous and wearing both upper and lower complete dentures (OR = 2.34; 95%CI = 1.11-4.93), and being edentulous wearing only the upper complete denture (OR = 2.64; 95%CI = 1.01-6.95). Traditional risk factors for CO such as gender, dyslipidemia, hypertension and diabetes were associated with both measures. A poor oral health due to extensive tooth loss, whether partial or complete, even if rehabilitated by removable prostheses, may be considered a good predictor of CO in Brazilian independent-living elderly.

Pacifier-sucking habit duration and frequency on occlusal and myofunctional alterations in preschool children.

The objective of this study was to evaluate the association of pacifier-sucking habit with occlusal and oral myofunctional alterations in preschool children. Eighty-four 2- to 5-year-old children participated in the study. Data on duration and frequency of pacifier use were collected from parents or guardians. Occlusal and oral myofunctional characteristics were examined by a dentist and a speech therapist, respectively. Chi-square tests and Poisson regression were used to analyze the data. The occlusal characteristics that were significantly associated with a pacifier-sucking habit were anterior open bite, altered canine relation, posterior crossbite, increased overjet, and malocclusion. The oral myofunctional characteristics that were significantly associated with a pacifier-sucking habit were resting lip position, resting tongue position, shape of the hard palate, and swallowing pattern. The strongest associations were for anterior open bite (prevalence ratio [PR] = 11.33), malocclusion ( PR = 2 .33), altered shape of the hard palate ( PR = 1.29), and altered swallowing pattern (PR = 1.27). Both duration and frequency of pacifier-sucking habit were associated with occlusal and oral myofunctional alterations. These results emphasize the need for pediatric dentists to advise parents and caregivers about the risks of prolonged pacifier use and refer children to professionals for multidisciplinary assistance to minimize these risks whenever necessary.

In vitro effect of Paullinia cupana (guaraná) on hydrophobicity, biofilm formation, and adhesion of Candida albicans' to polystyrene, composites, and buccal epithelial cells.

OBJECTIVE: In vitro evaluation of the effect of guaraná (GUAR) on cell surface hydrophobicity (CSH), on biofilm formation, and on adhesion of C. albicans to polystyrene, to composite resins, and to buccal epithelial cells (BEC). MATERIALS AND METHODS: Lyophilised aqueous extract of GUAR was tested on C. albicans ATCC (90028). The effect of GUAR was evaluated by examining the CSH of C. albicans, as determined by microbial adhesion to hydrocarbons test, by assessing biofilm production and through adhesion assays (microplates of polystyrene, BEC and composites). One nanoparticle (Z350(®)) and two microhybrid (LLis(®), Opallis(®)) composites were tested. Scanning electron microscopy (SEM) was used to analyse adhesion of C. albicans composites. Assays were performed in triplicate and the results analysed by Chi-square test, Kruskal-Wallis test and Dunn's Multiple Comparison post hoc test at 5% significance level. RESULTS: GUAR did not inhibit growth of C. albicans at any concentration, but it reduced adhesion to polystyrene surface (p < 0.001). Exposure to GUAR did not change CSH and biofilm formation, but it increased adhesion of C. albicans to the nanoparticle composite (p = 0.042) and reduced its adhesion to BEC (p < 0.001). SEM confirmed an aggregatory pattern of adhesion of C. albicans to composites. CONCLUSION: GUAR increased the adhesion of C. albicans to the surface of the nanoparticle composite. However, it reduced the adhesion of C. albicans to BEC and to polystyrene, which reveals its potential use in prevention of oral diseases.

Quality of life of individuals treated in an outpatient burn treatment centre: application of the BSHS-R.

BACKGROUND: Burns are injuries that affect individuals' physical and emotional health and may impair their quality of life (QOL). This study aimed to evaluate the QOL of individuals from an outpatient burn treatment centre in southern Brazil, according to the Burn Specific Health Scale-Revised (BSHS-R), and to determine the relationships between sociodemographic variables, burns history and the mean domains of BSHS-R. METHODS: A cross-sectional study was carried out with 107 participants from July 2012 to January 2013 by administering the BSHS-R scale and a questionnaire to collect sociodemographic data and the participants' history of burns. Statistical analyses were performed comparing the scores obtained in the domains of the BSHS-R. Multiple linear regressions with the stepwise method were used to obtain a model that allowed the prediction of BSHS-R as a function of independent variables. RESULTS: A negative impact on the individuals' quality of life was revealed for the domains Simple Functional Ability, Work, Affect and Body Image and Interpersonal Relationships. Predictors of a poorer BSHS-R total score were: environment of trauma occurrence (reg. coefficient -0.39 95% CI -0.77;-0.01), gender (reg. coefficient -0.52 95% CI -0.82;-0.21), occupation (reg. coefficient -0.52 95% CI -0.86;-0.18) and place of residence (reg. coefficient -0.52 95% CI -0.83;-0.13). CONCLUSIONS: Sociodemographic determinants have the greatest effect on determining the QOL of individuals who have suffered burns. Therefore, actions to promote education on preventing burns in workplaces and homes are needed.

Maternal and child health care: adequacy index in public health services / Asistencia a la salud materno-infantil: índice de adecuación en servicios públicos de salud / Assistência à saúde materno-infantil: índice de adequação em serviços públicos de saúde

ABSTRACT Objectives: to analyze the adequacy of maternal and child-care in prenatal care, childbirth and the puerperal period, in the public health service. Methods: longitudinal study carried out in a city in Paraná with 357 puerperal women in a public maternity ward, outpatient clinic for immediate puerperal return and home visit 42 days postpartum. Four care domains were grouped (1 - Prenatal, 2 - Maternity, 3 - Immediate puerperal return, 4 - Late puerperal return). Mean, median, standard deviation and coefficient of variance were calculated considering adequate assistance when ≥ 70%; and inadequate, inferior. Results: lowest suitability average in Domain 3 (39.37%) and highest for Domain 4 (74.82%); median of 50.00% at 3 and 76.90% at 4. The largest standard deviation, in Domain 3 (25.18%); and high coefficient of variance for 1 and 3. Conclusions: in maternal and child follow-up, rates close to adequate in maternity care and higher in late puerperal return, meanwhile prenatal and immediate puerperal return were below the recommended in the health care network.

RESUMEN Objetivos: analizar la adecuación de la asistencia materno-infantil en el prenatal, parto y período puerperal, en el servicio público de salud. Métodos: estudio longitudinal realizado en ciudad de Paraná con 357 puérperas en maternidad pública, ambulatorio de retorno puerperal inmediato y visita domiciliar 42 días postparto. Se ha agrupado cuatro dominios de asistencia (1 - Prenatal, 2 - Maternidad, 3 - Retorno puerperal inmediato, 4 - Retorno puerperal tardío). Se ha calculado media, mediana, desvío estándar y coeficiente de desviación considerando asistencia adecuada cuando ≥ 70%; y inadecuada, inferior. Resultados: menor media de adecuación en el Dominio 3 (39,37%) y mayor para 4 (74,82%); mediana de 50,00% en 3 y 76,90% en 4. El desvío estándar mayor, en el Dominio 3 (25,18%); y coeficiente de desviación alta para 1 y 3. Conclusiones: en el seguimiento materno infantil, índices próximos al adecuado en la atención en la maternidad y superior en el retorno puerperal tardío, entretanto prenatal y retorno puerperal inmediato se presentaron lejos del preconizado en la red de atención a la salud.

RESUMO Objetivos: analisar a adequação da assistência materno-infantil no pré-natal, parto e período puerperal, no serviço público de saúde. Métodos: estudo longitudinal realizado em cidade do Paraná com 357 puérperas em maternidade pública, ambulatório de retorno puerperal imediato e visita domiciliar 42 dias pós-parto. Agruparam-se quatro domínios de assistência (1 - Pré-natal, 2 - Maternidade, 3 - Retorno puerperal imediato, 4 - Retorno puerperal tardio). Calculou-se média, mediana, desvio-padrão e coeficiente de variância considerando assistência adequada quando ≥ 70%; e inadequada, inferior. Resultados: menor média de adequação no Domínio 3 (39,37%) e maior para o 4 (74,82%); mediana de 50,00% no 3 e 76,90% no 4. O desvio-padrão maior, no Domínio 3 (25,18%); e coeficiente de variância alta para 1 e 3. Conclusões: no seguimento materno-infantil, índices próximos ao adequado no atendimento na maternidade e superior no retorno puerperal tardio, entretanto pré-natal e retorno puerperal imediato se apresentaram aquém do preconizado na rede de atenção à saúde.

Maternal and child health care: adequacy index in public health services / Asistencia a la salud materno-infantil: índice de adecuación en servicios públicos de salud / Assistência à saúde materno-infantil: índice de adequação em serviços públicos de saúde

ABSTRACT Objectives: to analyze the adequacy of maternal and child-care in prenatal care, childbirth and the puerperal period, in the public health service. Methods: longitudinal study carried out in a city in Paraná with 357 puerperal women in a public maternity ward, outpatient clinic for immediate puerperal return and home visit 42 days postpartum. Four care domains were grouped (1 - Prenatal, 2 - Maternity, 3 - Immediate puerperal return, 4 - Late puerperal return). Mean, median, standard deviation and coefficient of variance were calculated considering adequate assistance when ≥ 70%; and inadequate, inferior. Results: lowest suitability average in Domain 3 (39.37%) and highest for Domain 4 (74.82%); median of 50.00% at 3 and 76.90% at 4. The largest standard deviation, in Domain 3 (25.18%); and high coefficient of variance for 1 and 3. Conclusions: in maternal and child follow-up, rates close to adequate in maternity care and higher in late puerperal return, meanwhile prenatal and immediate puerperal return were below the recommended in the health care network.

RESUMEN Objetivos: analizar la adecuación de la asistencia materno-infantil en el prenatal, parto y período puerperal, en el servicio público de salud. Métodos: estudio longitudinal realizado en ciudad de Paraná con 357 puérperas en maternidad pública, ambulatorio de retorno puerperal inmediato y visita domiciliar 42 días postparto. Se ha agrupado cuatro dominios de asistencia (1 - Prenatal, 2 - Maternidad, 3 - Retorno puerperal inmediato, 4 - Retorno puerperal tardío). Se ha calculado media, mediana, desvío estándar y coeficiente de desviación considerando asistencia adecuada cuando ≥ 70%; y inadecuada, inferior. Resultados: menor media de adecuación en el Dominio 3 (39,37%) y mayor para 4 (74,82%); mediana de 50,00% en 3 y 76,90% en 4. El desvío estándar mayor, en el Dominio 3 (25,18%); y coeficiente de desviación alta para 1 y 3. Conclusiones: en el seguimiento materno infantil, índices próximos al adecuado en la atención en la maternidad y superior en el retorno puerperal tardío, entretanto prenatal y retorno puerperal inmediato se presentaron lejos del preconizado en la red de atención a la salud.

RESUMO Objetivos: analisar a adequação da assistência materno-infantil no pré-natal, parto e período puerperal, no serviço público de saúde. Métodos: estudo longitudinal realizado em cidade do Paraná com 357 puérperas em maternidade pública, ambulatório de retorno puerperal imediato e visita domiciliar 42 dias pós-parto. Agruparam-se quatro domínios de assistência (1 - Pré-natal, 2 - Maternidade, 3 - Retorno puerperal imediato, 4 - Retorno puerperal tardio). Calculou-se média, mediana, desvio-padrão e coeficiente de variância considerando assistência adequada quando ≥ 70%; e inadequada, inferior. Resultados: menor média de adequação no Domínio 3 (39,37%) e maior para o 4 (74,82%); mediana de 50,00% no 3 e 76,90% no 4. O desvio-padrão maior, no Domínio 3 (25,18%); e coeficiente de variância alta para 1 e 3. Conclusões: no seguimento materno-infantil, índices próximos ao adequado no atendimento na maternidade e superior no retorno puerperal tardio, entretanto pré-natal e retorno puerperal imediato se apresentaram aquém do preconizado na rede de atenção à saúde.

[Association between interleukin-6 polymorphism in the -174 G/C region and hearing loss in the elderly with a history of occupational noise exposure]. / Associação entre interleucina-6 polimorfismo na região de -174 G/C e perda auditivaem idosos com história de exposição ao ruído ocupacional.

INTRODUCTION: The biological processes involved in noise-induced hearing loss (NIHL) are still unclear. The involvement of inflammation in this condition has been suggested. OBJECTIVE: To investigate the association between interleukin - 6 (IL-6) polymorphism and susceptibility to NIHL. METHODS: This was a cross-sectional study with a sample of 191 independent elderly individuals aged >60 years of age. Information on exposure to occupational noise was obtained by interviews. Audiological evaluation was performed using pure tone audiometry and genotyped through PCR by restriction fragment length polymorphism - PCR-RFLP. Data were analyzed using the chi-square test and the odds ratio (OR), with the significance level set at 5%. RESULTS: Among elderly with hearing loss (78.0%), 18.8% had a history of exposure to occupational noise. There was a statistically significant association between the genotype frequencies of the IL-6 -174 and NIHL. The elderly with the CC genotype were less likely to have hearing loss due to occupational noise exposure when compared to those carrying the GG genotype (OR=0.0124; 95% CI 0.0023-0.0671; p<0.001). CONCLUSION: This study suggests there is an association of polymorphisms in the IL-6 gene at position - G174C with susceptibility to noise-induced hearing loss.

[Factors associated with regular cigarette smoking by adolescents from public schools in Londrina, Paraná, Brazil]. / Fatores associados ao uso regular de cigarros por adolescentes estudantes de escolas públicas de Londrina, Paraná, Brasil.

This cross-sectional epidemiological study aimed to identify factors associated with regular cigarette smoking among adolescents. The sample included 517 public school 9th graders in Londrina, Paraná State, Brazil. A structured questionnaire was used to collect information, including social and demographic characteristics, social relations, and health risk behaviors. Logistic regression was used in the statistical analysis, with significance set at 5%. 8.9% of the adolescents reported smoking at least one cigarette a day in the previous 30 days. Age ≥ 15 years (OR = 2.28; 95%CI: 1.21-4.32; p = 0.011) and having friends that smoked (OR = 12.62; 95%CI: 4.44-35.89; p < 0.0001) were associated with regular smoking in both the univariate and multivariate analyses. Meanwhile, gender, race, social class, living with father and mother, religion, maternal education, having tried alcohol, physical activity, and paid work were not associated with smoking. These findings support the development of community-based tobacco control strategies targeting adolescents.

Prenatal follow-up of high-risk pregnancy in the public service / Acompañamiento prenatal de la gestación de alto riesgo en el servicio público / Acompanhamento pré-natal da gestação de alto risco no serviço público

ABSTRACT Objective: to analyze the prenatal follow-up of high-risk pregnancy in the public service. Method: an analytical cross-sectional study carried out in a public maternity hospital in the South of Brazil, during the hospitalization of 319 postpartum women using a semi-structured tool for transcription of the prenatal card records and interview. The data were analyzed using the Chi-Square test (p≤0.05). Results: the adequacy of prenatal care was high (74%); 22.6% intermediate; 3.4% inefficient. Prenatal care had high coverage (100%), early onset (81.5%) and six or more visits (92.4%), but (77.4%) did not receive information about gestational disease and examinations (69.3%). There was statistical significance between the quality of prenatal care and the place of prenatal care (p=0.005). Conclusion: the need to implement a specific protocol for high-risk gestation and continuous education to the teams was evidenced.

RESUMEN Objetivo: analizar el seguimiento prenatal de la gestación de alto riesgo en el servicio público. Método: el estudio transversal analítico, realizado en una maternidad pública en el Sur de Brasil, durante la internación de 319 puérperas, por medio de un instrumento semiestructurado para la transcripción de los registros de la tarjeta prenatal y la entrevista. Se realizó análisis de los datos por medio del Test Qui-Cuadrado (p≤0,05). Resultados: la adecuación del prenatal fue alta (74%); 22,6% intermedio; 3,4% ineficiente. El prenatal tuvo alta cobertura (100%), inicio precoz (81,5%) y realización de seis o más consultas (92,4%), pero (77,4%) no recibieron información sobre enfermedad gestacional y resultados de exámenes (69,3%). Se observó una significativa estadística entre la calidad del prenatal y el lugar de la realización del prenatal (p=0,005). Conclusión: se evidenció la necesidad de implementación de protocolo específico a la gestación de alto riesgo y educación continuada a los equipos.

RESUMO Objetivo: analisar o acompanhamento pré-natal da gestação de alto risco no serviço público. Método: estudo transversal analítico, realizado em uma maternidade pública no Sul do Brasil, durante internação de 319 puérperas, por meio de instrumento semiestruturado para transcrição dos registros do cartão pré-natal e entrevista. Realizou-se análise dos dados por meio do Teste Qui-Quadrado (p≤0,05). Resultados: a adequação do pré-natal foi alta (74%); 22,6% intermediária; 3,4% ineficiente. O pré-natal teve alta cobertura (100%), início precoce (81,5%) e realização de seis ou mais consultas (92,4%), porém (77,4%) não receberam informação sobre doença gestacional e resultados de exames (69,3%). Houve significância estatística entre a qualidade do pré-natal e o local da realização do pré-natal (p=0,005). Conclusão: evidenciou-se a necessidade de implementação de protocolo específico à gestação de alto risco e educação continuada às equipes.