High risk pregnancies and factors associated with neonatal death.

OBJECTIVE: To identify the factors associated with intra-hospital neonatal mortality based on the individual characteristics of at-risk pregnant mothers, delivery and newborns. METHOD: This was a cross-sectional epidemiological study of live newborns delivered by women attended at the high-risk outpatient unit of a philanthropic hospital in Maringá, Paraná, Brazil between September 2012 and September 2013. RESULTS: Six hundred and eighty-eight women participated in the study. The neonatal mortality coefficient found was 17.7/1,000 live births, most in the early neonatal phase. Premature labor, fetal malformation and multiple gestations were associated with neonatal death. Premature, very low birth weight newborns and those with an Apgar score of less than seven, five minutes after birth were at high risk of death. CONCLUSION: Identifying risk factors can help plan actions to consolidate the perinatal network. Specific programs should be incentivized in other countries, in the search for significant perinatal results such as reducing neonatal mortality. OBJETIVO: Identificar os fatores associados à mortalidade neonatal intra-hospitalar com base nas características individuais de gestantes de risco, do parto e do recém-nascido. MÉTODO: Estudo epidemiológico do tipo transversal, realizado com crianças nascidas vivas de partos hospitalares de mulheres acompanhadas pelo ambulatório de alto risco de um hospital filantrópico de Maringá, Paraná, Brasil, no período de setembro de 2012 a setembro de 2013.RESULTADOS Fizeram parte da pesquisa 688 mulheres. O coeficiente de mortalidade neonatal foi de 17,7 óbitos/1.000 nascidos vivos, sendo sua maioria no período neonatal precoce. Trabalho de parto prematuro, malformação fetal e gestação múltipla foram as intercorrências associadas ao óbito neonatal. Recém-nascidos prematuros, com muito baixo peso ao nascer e Índice de Apgar menor que sete no quinto minuto de vida apresentaram risco elevado de morte. CONCLUSÃO: A identificação de fatores de risco pode auxiliar no planejamento de ações para consolidação da rede perinatal. Programas específicos devem ser incentivados em outros países, na busca de resultados perinatais expressivos, como a redução da mortalidade neonatal.

Sexual violence against children and adolescents in Paraná State: geospatial analysis and main socioeconomic indicators.

OBJECTIVE: Child sexual violence is a multidimensional problem of many contemporary societies, affecting people of all sexes, social stratum and age groups. Offenses involving children and adolescents are more serious, given their total or partial dependence on parents and caregivers. Information on child sexual violence in Brazil is found in raw form and without detail. The objective was to compare the information with social and economic data in the state of Paraná. METHODS: The authors conducted a retrospective study of secondary data from the Notifiable Diseases Information System (SINAN) on cases of sexual violence involving victims aged 0 to 19 years. Results are presented according to notification characteristics. The authors applied exploratory spatial data analysis to assess spatial autocorrelations and investigated relationships by the ordinary least squares regression model. RESULTS: Between 2017 and 2021, there were 13,403 reports of child sexual violence in Paraná State, Brazil. Most victims (82.8%) were female and aged between 10 and 14 years. The majority of sexual violence cases (67.8%) occurred in the home environment. The highest rates on a population basis were observed in the North Central and Greater Curitiba regions, mainly in cities with higher population density and with higher rates of other types of violence. CONCLUSION: The results provide data that can promote a broader understanding of the distribution of sexual violence and the state and associated variations. It is expected to improve the provision of care for victims of child sexual violence and assist in strategic planning to prevent future offenses.

[Heavy alcohol consumption among women]. / Consumo abusivo de álcool em mulheres.

This descriptive, exploratory study aimed to characterize women attending a Teaching Hospital in Northwest Paraná, for alcohol abuse in the years 1999 to 200, according to sociodemographic data of intoxication and associated with trauma and violence. Among 823 visits, the most frequent age range was from 20 to 49 years (58.32%). 13 (1.58%) were pregnant, 12.5% had 9-12 years of schooling. Liquor was the main beverage used and its intake was more prevalent at night. Approximately 156 (18.96%) women required hospitalization. Hospital avoidance was observed in 8.5% of cases. We conclude that woman are likely to abuse alcohol, and this study enabled a description of the areas in women's health that are impacted allowing the implementation of preventive measures to decrease occurrence and recurrence in this population.

Use and Applicability of the Gail Model to Calculate Breast Cancer Risk: A Scoping Review.

OBJECTIVE: To perform a scoping review of the applicability of the Gail model in different countries for different ethnicities. METHODS: The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist and search strategies based on the PICOS approach. The reviewed articles were included if they were published between 2013 and 2018 in English, Portuguese, or Spanish; were original articles available in full online; and described the use of the Gail model. The PubMed, Embase, and Web of Science data bases were searched. RESULTS: A total of 38 articles eligible for analysis were identified, of which 16 used the Gail model to assess breast cancer risk in women, eight analyzed the applicability of this tool in their population, seven compared the tool and/or modified it according to the specific risk factors of their population, and seven cited the model in determining eligibility for chemoprevention. CONCLUSION: The Gail model has different applicabilities Greater effectiveness and breast cancer risk are found in developed countries.

[Hospitalization in an intensive care unit: how patients perceive it]. / Internação em unidade de terapia intensiva: percepção de pacientes.

This qualitative study aims to understand how adult patients experience hospitalization in an Intensive Care Unit (ICU), thus contributing to the improvement of care and a better adaptation to such a stigmatized environment. The data were collected in an ICU of a hospital in the southwest of the state of São Paulo, Brazil. Ten patients were interviewed. Three themes related to the previous perception of the ICU were identified: difference to the assistance in inpatient units; technology and expert assistance; environmental and behavioral changes in the ICU. In the beginning, informants related the ICU to the terminally ill, but they began to view the unit as a place for treatment and recovery, thereby acquiring a positive view of its environment.

[The experience of a family when approached for organs donation in case of cerebral death of a relative]. / A experiência da família frente a abordagem para doaçcão de orgãos na morte encefálica.

The objective of the study was to get in contact with the experience of a family that was asked to donate organs of a relative and the reasons that led them to authorize it or not. It was an exploratory research, with qualitative approach accomplished with relatives of individuals who presented cerebral death (CD) in a University Hospital of the municipal district of Maringá, Paraná, Brazil, in the period from 2006 to 2008. The study allowed the analysis of the approaching process in case of CD, identifying through the family view, the needs of improvement in the approaching system and in the entire process, to provide a more humanized and holistic assistance.

The Obesity and the Risk of Breast Cancer among Pre and Postmenopausal Women

Background: Breast cancer is the most common cancer among women worldwide and the obesity is one of the factors related to the risk of breast cancer mainly in postmenopausal women. This study investigated the association between obesity in pre- and postmenopausal women with the development of breast cancer and the expression of estrogen, progesterone, HeR-2 and triple-negative (TN) receptors. Methods: A case-control study was conducted on 100 patients with recently diagnosed breast cancer and 400 age-matched controls. The women were divided into pre- and post-menopausal groups. Results: The multivariate analysis showed that postmenopausal women with a BMI ≥ 30 kg/m2 at pre-diagnosis and at the most recent measurement were 1.50 (95% CI 1.06-2.13) and 1.56 (95% CI 1.11-2.21) times more likely to develop breast cancer, respectively. These women had a prevalence of obesity of 27.7% when considering pre-diagnosis BMI and 29.4% when analyzing the indicator of recent BMI. When only the cases regarding the presence of obesity with clinicopathological variables were analyzed, a total of 95.2% of the postmenopausal women with pre-diagnostic obesity according to BMI presented the positive estrogen receptor (ER) subtype. Conclusions: In Brazilian women, there is an association between obesity and the risk of breast cancer postmenopause; moreover, there is an association between the occurrence of the positive ER subtype in postmenopausal women and pre-diagnostic obesity according to BMI.

Prevalence of metabolic syndrome in pre- and postmenopausal women.

OBJECTIVE: The objective of this study was to determine the prevalence of metabolic syndrome (MS) and its components among pre- and postmenopausal women, as well as the association between menopausal status and MS. MATERIALS AND METHODS: A retrospective study was conducted at a reference cardiology outpatient clinic in a city located in Northwestern Paraná State, Brazil. A total of 958 medical records of symptomatic climacteric women evaluated between 2010 and 2014 were analyzed. The study consisted of two groups: pre- and post-menopausal women. MS was characterized according to the criteria of the National Cholesterol Education Program's Adult Treatment Panel III - NCEP-ATP III-2005. RESULTS: MS was observed in 18.5% of the total study population; 9.4% of the premenopausal women and 22.2% of the postmenopausal women displayed MS, corresponding to a relative risk of 2.75. In addition, the frequency of MS increased with age. Regarding the components of MS, postmenopausal women were more likely to have high density lipoprotein (HDL-C) levels < 50 mg/dL; systolic blood pressure (SBP) values ≥ 130 mmHg or diastolic blood pressure (DBP) values ≥ 85 mmHg; and fasting glucose levels ≥ 100 mg/dL. CONCLUSION: MS was more prevalent among postmenopausal women than among premenopausal women.

Delay in Diagnosis and Treatment of Breast Cancer among Women Attending a Reference Service in Brazil

Background: Cancer is a major public health problem. Early diagnosis and treatment are essential for reducing mortality. This study aimed to analyze factors associated with delay in breast cancer diagnosis and treatment among women attending a reference cancer service. Methods: This retrospective, cross-sectional study was performed with data collected from medical records and interviews conducted with women diagnosed with breast cancer and treated from October 2013 to October 2014 at a cancer reference hospital in Paraná, Southern Brazil. Results: A total of 82 participants were enrolled during the study period; their average age was 58.2 ± 11.5 years. The average time taken for final diagnosis of breast cancer was 102.5 ± 165.5 days. Treatment onset was delayed in the majority of cases, and the average time elapsing from diagnostic biopsy to onset of primary treatment was 72.3 ± 54.0 days. The odds of treatment delay were higher among the women with a low educational level. Conclusions: The results underline the need for proposals aimed at early detection, identification of risk factors and timely provision of treatment by health managers that focus on this group.

Mammographic Screening of Women Attending a Reference Service Center in Southern Brazil.

BACKGROUND: To investigate the prevalence of and factors associated with performance of annual mammography by women above 40 years of age. MATERIALS AND METHODS: This cross-sectional retrospective study was conducted at an oncology reference service in Southern Brazil from October 2013 to October 2014 with 525 women aged 40 years or older. RESULTS: The prevalence of annual mammography was 54.1%; annual mammographic screening was performed for women without private medical insurance, who were under hormone replacement therapy and who had used contraception in the past. An association was found between non-performance of breast clinical and self-examination and non-performance of mammographic screening. CONCLUSIONS: Use of mammography for breast cancer screening in the public health care setting proved to be accessible; nevertheless, the proportion of screened women was low, and they exhibited poor adherence to the basic measures of care recommended for breast assessment. Thus, control of breast cancer requires implementing actions targeting the population most vulnerable to non-adherence to screening in addition to continuously monitoring and assessing that population to reduce the prevalence of this disease.

Sexualidade feminina após cirurgia bariátrica segundo a fenomenologia de Merleau-Ponty: revisão integrativa / Female sexuality after bariatric surgery according to the Merleau-Ponty phenomenology: integrative review / Sexualidad femenina después de la cirugía bariátrica según la fenomenología de Merleau-Ponty: revisión integrativa

Objetivo: Analisar as alterações na sexualidade das mulheres submetidas à cirurgia bariátrica, por meio de revisão integrativa da literatura. Método: A busca ocorreu nas bases Medical Literature Analysis and Retrieval System Online, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Enfermagem, Scientific Electronic Library Online e Portal de Periódicos Coordenação de Aperfeiçoamento de Pessoal de Nível Superior. Resultados: Foram identificados 158 publicações, sendo incluídos estudos originais, quantitativos e qualitativos, publicados em inglês e português, com as palavras-chave sexualidade feminina e cirurgia bariátrica, restando 7 artigos, os quais foram analisados segundo a fenomenologia de Merleau-Ponty. Foram identificadas 4 categorias temáticas: Alterações positivas, negativas, questões médicas e fatores psicossociais. Conclusão: A essência do fenômeno se mostrou multifatorial de modo que a representação do corpo físico em alguns casos gerou melhora psicossocial, conjugal, cultural, e na sexualidade, porém não na sua plenitude de prazer e satisfação e em outros repercutiu em alterações negativas

Objective: The study's main goal has been to analyze changes in the sexuality of women who underwent bariatric surgery. In order to do so, an integrative literature review was undertaken. Methods: The search took place on the following databases: the Medical Literature Analysis and Retrieval System Online (MEDLINE), the Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) [Latin American and Caribbean Literature on Health Sciences], the Base de Dados de Enfermagem (BDENF) (Nursing Database) and the Scientific Electronic Library Online (SciELO); moreover, the Periodicals Portal from the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) [Coordination for the Improvement of Higher Education Personnel]. Results: A total of 158 publications were identified, including original, quantitative and qualitative studies, published in English and Portuguese. By using the keywords female sexuality and bariatric surgery, 7 articles remained, which were analyzed according to the MerleauPonty's phenomenology of perception. Four thematic categories were identified, as follows: positive, negative, medical, and psychosocial factors. Conclusion: The essence of the phenomenon was considered multifactorial. In some cases, the physical body's representation led to psychosocial, marital, cultural, and sexual improvement, yet, not in its fullness of pleasure and satisfaction. On the other hand, others have experienced negative repercussions

Objetivo: Analizar los cambios en la sexualidad de las mujeres sometidas a cirugía bariátrica, a través de una revisión integradora de la literatura. Método: La búsqueda se realizó sobre la base del Sistema de Análisis y Recuperación de Literatura Médica en línea, Literatura Latinoamericana y del Caribe en Ciencias de la Salud, Enfermería, Biblioteca Científica Electrónica en línea y Portal de Periódicas Coordinación de Mejora de Personal de Nivel Superior. Resultados: Se identificaron un total de 158 publicaciones, incluyendo estudios originales, cuantitativos y cualitativos, publicados en inglés y portugués, con las palabras clave sexualidad femenina y cirugía bariátrica, restantes 7 artículos, que fueron analizados según la fenomenología de Merleau-Ponty. Se identificaron cuatro categorías temáticas: factores positivos, negativos, médicos y psicosociales. Conclusión: La esencia del fenómeno fue multifactorial por lo que la representación del cuerpo físico en algunos casos generó una mejora psicosocial, marital, cultural y sexual, pero no en su plenitud de placer y satisfacción, y en otros tuvo repercusiones negativas

Pregnancy after Bariatric Surgery: Obstetric and Perinatal Outcomes and the Growth and Development of Children.

BACKGROUND: Several outcomes of pregnancy after bariatric surgery are currently being studied. METHODS: This cross-sectional, retrospective study evaluated the obstetric and perinatal outcomes of pregnancies in 19 women who underwent bariatric surgery, as well as the growth and development of their children, in the Southern Brazil. RESULTS: Among these women, 11 children were born prior to surgery and 32 were born post-surgery. The mean time between the surgery and the first pregnancy was 42.96 months. Preterm newborns were more common among the pre-surgery childbirths. Regarding growth, normal weights were observed in 27.3 % of the children in the pre-surgery births and obesity was observed in 54.5 %. In contrast, normal weights were observed in 59.4 % of the children born during the postoperative period and obesity was observed in 31.2 %. The average excess weight that the women lost prior to pregnancy was 64.88. Speech delays were found in three male children evaluated using the Denver Developmental Screening Test II. A statistical association was found between the interval from the surgery to the pregnancy and the outcome of the questionable Denver II test results (p = 0.011). CONCLUSIONS: Except for the large index of low birth weight, it can be concluded that pregnancy after bariatric surgery is safe. The growth rate was found to be adequate in the children born after the surgery, with reduced obesity. Although changes in speech development were detected, no factors were supported an association with pregnancy after bariatric surgery.

Treatment and Follow-up of Human Papillomavirus Infected Women in a Municipality in Southern Brazil.

BACKGROUND: This study aimed toanalyze the risk behavior for cervical cancer (CC) and the human papillomavirus (HPV) prevalence and resolution among women who received care through the private healthcare network of a municipality in southern Brazil. MATERIALS AND METHODS: This descriptive and retrospective study was conducted with 25 women aged 20 to 59 years who received care through the private healthcare network and were treated at a specialty clinic in the period from January to December 2012 in a municipality in Northwest Parana, Southern Brazil. Data from medical records with cytological and HPV results were used. Following treatment, these women were followed-up and reassessed after 6 months. Data were statistically analyzed using the t-test and chi-squared test at a 5% significance level. RESULTS: The mean age of the studied women was 27.8±7.75 years old, and the majority were married, with paid employment and were non-smokers. The mean age at menarche was 13.0±0.50 years old, and the mean age at first intercourse was 17.5±1.78 years, with only 8.0% (2) initiating sexual activity at an age ≤15 years old. The majority had 1 to 2 children (60.0%), while 88.0% reported having had one sexual partner in their lifetime, and all the women were sexually active. A total of 68.0% used a hormonal contraceptive method. All the women had leukorrhea and pain and were infected by a single HPV type. Regarding the lesion grade, 80.0% showed high risk and 20.0% low risk. The most prevalent high-risk HPV strain was 16. CONCLUSIONS: These findings provide relevant information on HPV risk factors and infection, as well as the treatment and 6-month follow-up results, in economically and socially advantaged women with no traditional risk factors, corroborating previous reports that different risk factors may be described in different populations. Thus, this study reinforces the fact that even women without the traditional risk factors should undergo HPVmonitoring and assessment to determine the persistence of infection, promoting early diagnosis of the lesions presented and appropriate treatment to thus prevent the occurrence of CC.

Variables that affect the satisfaction of Brazilian women with external breast prostheses after mastectomy.

BACKGROUND: : In 2012, the breast cancer estimate worldwide stood at 1.67 million new cases, these accounting for 25% of all types of cancer diagnosed in women. For 2014, 57,120 new cases are expected, with a risk estimated at 56.1 cases for every 100,000 women. The objective of this study was to analyze the satisfaction regarding the use of external breast prostheses by women undergoing mastectomy. MATERIALS AND METHODS: This cross-sectional study was conducted with 76 women who used an external breast prosthesis (EBP), registered in the services of the Cuiaba Center for Comprehensive Rehabilitation, Mato Grosso, Brazil, from 2009 to 2012. Data were collected from the records of women who had requested the opening of a process of external breast prosthesis concession. RESULTS: Satisfaction with the EBP was identified in 56.6% of the women. Those satisfied with the EBP reported that its weight was not annoying (p<0.01). Although the women felt body sensations of stitches, pains, pulling, dormancy and phantom limb, they are satisfied with the EBP. The variable related to the displacement of the breast prosthesis during activity of everyday life has demonstrated that even though the women have reported the possibility of displacements, they are satisfied with the EBP. The satisfaction with the use of external breast prosthesis did not affect the sexuality of the women with mastectomy. CONCLUSIONS: Learning the specificities of the EBP, taking into consideration the satisfaction of its use, allows the rehabilitation team, by listening to their clientele more attentively, following up this woman throughout her life journey, supporting and guiding the best way of use, with an eye to her personal, emotional and social life, as well as to her self-esteem.

Population inquiry regarding mammography in postmenopausal women in southern Brazil.

This study was conducted to analyze the prevalence of non-performance of mammography, and associated factors, among postmenopausal women. This analytical, exploratory, cross-sectional study, of a domicile population inquiry type, was performed in the municipality of Maringa, Parana, Brazil. A total of 456 women were interviewed, aged 45 to 69 years, who presented with natural menopause and cessation of menstruation for at least twelve months. Statistical associations were found between the non-performance of mammography and schooling of less than seven years, paid employment, sedentary lifestyle, smoking, the non-use of hormone replacement therapy, not having consulted a doctor in the previous year, not having consulted a gynecologist, lacking a family history of breast cancer, not having performed the Papanicolaou test, not having performed clinical breast examination, and not having difficult access to health services. After logistic regression analysis, not performing mammography was associated with reports of a fair or bad health status. The study data revealed factors "responsible" for the non-performance of mammography, and the results should contributing to improvement/enhancement of healthy behaviour of Brazilian women in the post-menopausal phase.

[Climacteric symptoms and nutritional status of women in post-menopause users and non-users of hormone therapy]. / Sintomas climatéricos e estado nutricional de mulheres na pós-menopausa usuárias e não usuárias de terapia hormonal.

PURPOSE: To analyze the climacteric symptoms, nutritional status and distribution of abdominal fat in postmenopausal women using or not hormone therapy. METHODS: exploratory analytical study of the population survey type in the urban area of Maringa, Parana, conducted on 456 postmenopausal women aged 45 to 69 years. Data collection was based on the urbanized census sector (368) of the municipality, according to the Brazilian Demographic Census. A simple random sample proportional to women residing in each census sector was used, and a questionnaire was applied during a home visit, when anthropometric measurements were performed and blood pressure was determined. The Blatt and Kupperman Menopausal Index was used for the evaluation of climacteric symptoms. The outcome variable was the use of hormone therapy. RESULTS: Mean subject age was 58.7 years. Overweight was present in 72.6% of the women and abdominal obesity in 81.4% of them. Mild climacteric symptoms were observed in 69.5% of the women. Only 18.4% of the women studied were using hormone therapy and they were white, non-smokers, had no comorbidities, and had a partner. Users of hormone therapy had a lower frequency of overweight and obesity and had a lower prevalence of severe climacteric symptoms. CONCLUSION: Overweight and obesity were prevalent in this sample. Although fewer in number, the hormone therapy users had a lower frequency of overweight and mild and severe menopausal symptoms during the postmenopausal period.

High risk pregnancies and factors associated with neonatal death / Gestación de alto riesgo y factores asociados con la defunción neonatal / Gestação de alto risco e fatores associados ao óbito neonatal

Abstract OBJECTIVE To identify the factors associated with intra-hospital neonatal mortality based on the individual characteristics of at-risk pregnant mothers, delivery and newborns. METHOD This was a cross-sectional epidemiological study of live newborns delivered by women attended at the high-risk outpatient unit of a philanthropic hospital in Maringá, Paraná, Brazil between September 2012 and September 2013. RESULTS Six hundred and eighty-eight women participated in the study. The neonatal mortality coefficient found was 17.7/1,000 live births, most in the early neonatal phase. Premature labor, fetal malformation and multiple gestations were associated with neonatal death. Premature, very low birth weight newborns and those with an Apgar score of less than seven, five minutes after birth were at high risk of death. CONCLUSION Identifying risk factors can help plan actions to consolidate the perinatal network. Specific programs should be incentivized in other countries, in the search for significant perinatal results such as reducing neonatal mortality.

Resumen OBJETIVO Identificar los factores asociados con la mortalidad neonatal intrahospitalaria con base en las características individuales de gestantes de riesgo, del parto y del recién nacido. MÉTODO Estudio epidemiológico del tipo transversal, realizado con niños nacidos vivos de partos hospitalarios de mujeres seguidas en el ambulatorio de alto riesgo de un hospital filantrópico de Maringá, Paraná, Brasil, en el período de septiembre de 2012 a septiembre de 2013. RESULTADOS Hicieron parte de la investigación 688 mujeres. El coeficiente de mortalidad neonatal fue de 7,7 defunciones/1.000 nacidos vivos, siendo su mayoría en el período neonatal precoz. Trabajo de parto prematuro, malformación fetal y gestación múltiple fueron los sucesos asociados con la defunción neonatal. Recién nacidos prematuros, con muy bajo peso al nacer e Índice de Apgar menor que siete el quinto minuto de vida presentaron riesgo elevado de muerte. CONCLUSIÓN La identificación de factores de riesgo puede auxiliar la planificación de acciones para consolidación de la red perinatal. Se deben incentivar programas específicos en otros países, en la búsqueda por resultados perinatales considerables, como la reducción de la mortalidad neonatal.

RESUMO OBJETIVO Identificar os fatores associados à mortalidade neonatal intra-hospitalar com base nas características individuais de gestantes de risco, do parto e do recém-nascido. MÉTODO Estudo epidemiológico do tipo transversal, realizado com crianças nascidas vivas de partos hospitalares de mulheres acompanhadas pelo ambulatório de alto risco de um hospital filantrópico de Maringá, Paraná, Brasil, no período de setembro de 2012 a setembro de 2013. RESULTADOS Fizeram parte da pesquisa 688 mulheres. O coeficiente de mortalidade neonatal foi de 17,7 óbitos/1.000 nascidos vivos, sendo sua maioria no período neonatal precoce. Trabalho de parto prematuro, malformação fetal e gestação múltipla foram as intercorrências associadas ao óbito neonatal. Recém-nascidos prematuros, com muito baixo peso ao nascer e Índice de Apgar menor que sete no quinto minuto de vida apresentaram risco elevado de morte. CONCLUSÃO A identificação de fatores de risco pode auxiliar no planejamento de ações para consolidação da rede perinatal. Programas específicos devem ser incentivados em outros países, na busca de resultados perinatais expressivos, como a redução da mortalidade neonatal.

Seventeen years of American cutaneous leishmaniasis in a Southern Brazilian municipality.

We reviewed the records of 151 patients diagnosed with American cutaneous leishmaniasis (ACL) from 1993 to 2009 in the municipality of Japura, Paraná, Brazil. Gender, age, occupation, place of residence, location of lesions, type and number of lesions were analyzed. The prevalence rate of ACL was 11.5/10,000 hab, of which 84.7% were male, 58.3% lived in rural area and 49.0% were farmers. The most frequent age group was between 30 to 39 years (26.6%). Skin lesions occurred in 92.7% of the patients with predominance in the lower limbs (23.9%) and 49.1% of the records did not include the number of lesions location due to incomplete filling. A single ulceration was present in 44.4%. Japurá is an endemic area for ACL, requiring public actions and preventive education.

[Factors associated with lack of Pap smear screening in a group of postmenopausal Brazilian women]. / Papanicolaou na pós-menopausa: fatores associados a sua não realização.

This study aimed to analyze risk factors for lack of Pap smear screening among menopausal women. This population-based study evaluated 456 women 45-69 years of age (mean 58.7; SD 5.7), with age at menopause 48.0 years (SD 5.0) living in the urban area of Maringá, Paraná State, Brazil. Most reported having 7 years of schooling or less, were married or living with a partner, had paid work, were sedentary, and were not on hormone replacement therapy. Coverage of Pap smear screening was 84.5%. After adjustment by multivariate analysis, the 45-69-year age bracket, paid work, no visit to the gynecologist in the previous year, and no mammogram in the two previous years were statistically associated with lack of Pap smear screening. Efforts to improve cervical cancer screening should focus on women's knowledge and reduce the factors that hinder women from performing Pap smear tests.

Pregnancy after bariatric surgery: implications for mother and newborn.

BACKGROUND: The present study aimed to identify the implications for the mother and the newborn in pregnancies occurring after the bariatric surgery. METHODS: The present retrospective, exploratory cohort study was conducted to analyze the implications for the mother and the newborn in women of childbearing age (10 to 49 years) who became pregnant after undergoing bariatric surgery in Maringá, Paraná, Brazil, during the period from 1999 through 2008. RESULTS: The study identified 32 women with the following characteristics: the majority of the women were Caucasian, slightly more than half were living with a partner, had some higher education, and most of them were without surgical complications. In addition, the mean weight loss post-surgery was 44.09 lbs, with an average interval of 40 months between the surgery and the pregnancy, with improvement of various comorbidities post-surgery. Conversely, they presented more neuropsychiatric disorders, post-surgery anemia, and higher prevalence of cesarean delivery. The majority of children were born at term with normal birth weight and no history of anemia. Hospitalization was required for 36.58% of the post-surgery pregnant women, while 17.07% of such cases required blood transfusion due to anemia. Lastly, there were fewer pregnancy-related hypertension cases than before the surgery. CONCLUSIONS: Pregnancy after bariatric surgery has proven to be safe for both the mother and the newborn. The newborn birth weight was not compromised even though some of the pregnant women were anemic.