Hospitalization during pregnancy according to childbirth financial coverage: a population-based study. / Hospitalização durante a gravidez segundo financiamento do parto: um estudo de base populacional.

Objective To analyze the occurrence, profile and main causes of hospitalization during pregnancy according to the type of childbirth financial coverage. Method A cross-sectional population-based study carried out with puerperal women through a stratified sample, calculated according to the hospital and the type of childbirth financial coverage source: public sector (SUS) or private (not SUS). The sociodemographic profile, the rate of obstetric complications and the causes of hospitalization were analyzed, coded according to International Classification of Diseases. Results A total of 928 postpartum women were interviewed, of whom 32.2% reported at least one hospitalization during pregnancy. Those with childbirth covered by SUS were less favored because they were the majority among hospitalized women (57.2%), with a higher percentage of adolescents (18.1%), lower education level (91.8%), low family income (39.3%) and fewer prenatal consultations (25.3%). The most frequent causes of hospitalization were "other maternal diseases that complicate pregnancy" (24.6%) (with emphasis on anemia and influenza), urinary tract infection (13.1%), preterm labor (8.7%) and hypertension (7.2%). Conclusion Anemia, influenza, urinary tract infection, preterm labor and hypertension should especially be prevented and treated to avoid hospital admissions during pregnancy, especially among pregnant women covered by SUS.

The inner state differences of preterm birth rates in Brazil: a time series study.

BACKGROUND: Preterm birth is a serious public health problem, as it is linked to high rates of neonatal and child morbidity and mortality. The prevalence of premature births has increased worldwide, with regional differences. The objective of this study was to analyze the trend of preterm births in the state of Paraná, Brazil, according to Macro-regional and Regional Health Offices (RHOs). METHODS: This is an ecological time series study using preterm births records from the national live birth registry system of Brazil's National Health Service - Live Birth Information System (Sinasc), for residents of the state of Paraná, Brazil, between 2000 and 2013. The preterm birth rates was calculated on a yearly basis and grouped into three-year periods (2000-2002, 2003-2005, 2006-2008, 2009-2011) and one two-year period (2012-2013), according to gestational age and mother's Regional Health Office of residence. The polynomial regression model was used for trend analysis. RESULTS: The predominance of preterm birth rate increased from 6.8 % in 2000 to 10.5 % in 2013, with an average increase of 0.20 % per year (r(2) = 0.89), and a greater share of moderate preterm births (32 to <37 weeks), which increased from 5.8 % to 9 %. The same pattern was observed for all Macro-regional Health Offices, with highlight to the Northern Macro-Regional Office, which showed the highest average rate of prematurity and average annual growth during that period (7.55 % and 0.35 %, respectively). The trend analysis of preterm birth rates according to RHO showed a growing trend for almost all RHOs - except for the 7(th) RHO where a declining trend was observed (-0.95 a year); and in the 20(th), 21(st) and 22(nd) RHOs which remained unchanged. In the last three-year of the study period (2011-2013), no RHO showed preterm birth rates below 7.3 % or prevalence of moderate preterm birth below 9.4 %. CONCLUSIONS: The results show an increase in preterm births with differences among Macro-regional and RHOs, which indicate the need to improve actions during the prenatal period according to the specificities of each region.

Factors associated to Caesarean delivery in public and private health care systems.

OBJECTIVE: Identifying factors associated to Caesarean sections among the residents of Maringá-PR, according to the financing source for delivery. METHODS: A cross-sectional study with data from 920 postpartum women interviewed between October 2013 and February 2014. Association analysis was performed by logistic regression. RESULTS: Caesarean section rates were 55.5% in the Unified Healthcare System (SUS) and 93.8% in the private system. Factors associated with Caesarean section in the SUS were: previous Caesarean section (OR=8.9; CI=4.6-16.9), desire for Caesarean section early in pregnancy (OR=2.0; CI=1.1-3.6), pregestational overweight/obesity (OR=1.8; CI=1.1-2.8), and per capita family income higher than one minimum wage (OR=2.1; CI=1.3-3.4). In the private system, desire for Caesarean section early in pregnancy (OR=25.3) and a previous Caesarean section (OR=11.3) were strongly associated to its performance. CONCLUSION: It is necessary to properly orientate all pregnant women who desire a Caesarean delivery, from both the SUS and the private system, about the inherent risks of the surgical procedure without indication. In the public health sector, guidelines should be focused on pregnant women with previous Caesarean delivery, with a per capita income higher than one minimum wage and those who are overweight or obese, as these women are more likely to have a Caesarean section. OBJETIVO: Identificar fatores associados à cesárea entre residentes de Maringá-PR, segundo a fonte de financiamento do parto. MÉTODO: Estudo transversal com dados de 920 puérperas entrevistadas entre outubro de 2013 e fevereiro de 2014. A análise de associação foi feita por regressão logística. RESULTADOS: A taxa de cesariana foi de 55,5% e 93,8% no Sistema Único de Saúde (SUS) e no sistema privado, respectivamente. Associou-se à cesárea no SUS: realização de cesárea anterior (OR=8,9; IC=4,6-16,9), desejo pela cesárea no início da gestação (OR=2,0; IC=1,1-3,6), sobrepeso/obesidade pré-gestacional (OR=1,8; IC=1,1-2,8), e renda familiar per capita maior que um salário mínimo (OR=2,1; IC=1,3-3,4). No sistema privado, o desejo pela cesárea no início da gestação (OR=25,3) e uma cesárea anterior (OR=11,3) estiveram fortemente associados à sua realização. CONCLUSÃO: É necessário orientar adequadamente todas as gestantes que desejam o parto cesárea, no SUS e no sistema privado, sobre os riscos inerentes ao procedimento cirúrgico sem indicação. No setor público de saúde, devem ser foco das orientações as gestantes com parto cesárea anterior, as com renda familiar per capita maior que um salário mínimo e com sobrepeso ou obesidade, as quais têm mais chances de realizar cesárea.

Evolution of hospital spending with drug-related psychiatric hospital admissions. / Evolução dos gastos hospitalares com internações psiquiátricas por drogas.

OBJECTIVE: To analyse the trend of expenditure on drug-related psychiatric hospital admissions in Maringá, Paraná, Brazil, from 1999 to 2012. METHOD: Ecological time series research with secondary data from the hospital information system of the unified health system ("SIH-SUS"). The records of admissions with a main diagnosis of drug abuse were used to calculate average expenditure. Chapter V of the ICD-10 was used to classify the most frequent diagnoses, namely abuse of alcohol, cannabis, cocaine, and psychoactive substances. The trend was expressed using a polynomial regression model. RESULTS: Average expenditure showed an increasing trend for cocaine and other psychoactive substances, and a decreasing trend for cannabis. Average expenditure for illicit drugs increased significantly. CONCLUSION: The scarcity of economic studies on this subject calls for national studies that address expenditure with drug-related hospital admission to promote the implementation of a psychosocial, outpatient and hospital care network in accord with public healthcare expenditure.

[Factors associated with the quality of prenatal care: an approach to premature birth]. / Fatores associados à qualidade do pré-natal: uma abordagem ao nascimento premature.

OBJECTIVE: To assess the quality of prenatal care in mothers with premature and term births and identify maternal and gestational factors associated with inadequate prenatal care. METHOD: Cross-sectional study collecting data with the pregnant card, hospital records and interviews with mothers living in Maringa-PR. Data were collected from 576 mothers and their born alive infants who were attended in the public service from October 2013 to February 2014, using three different evaluation criteria. The association of prenatal care quality with prematurity was performed by univariate analysis and occurred only at Kessner criteria (CI=1.79;8.02). RESULTS: The indicators that contributed most to the inadequacy of prenatal care were tests of hemoglobin, urine, and fetal presentation. After logistic regression analysis, maternal and gestational variables associated to inadequate prenatal care were combined prenatal (CI=2.93;11.09), non-white skin color (CI=1.11;2.51); unplanned pregnancy (CI=1.34;3.17) and multiparity (CI=1.17;4.03). CONCLUSION: Prenatal care must follow the minimum recommended protocols, more attention is required to black and brown women, multiparous and with unplanned pregnancies to prevent preterm birth and maternal and child morbimortality.

[Hospital admissions due to ambulatory care sensitive conditions among children by age group and health region]. / Hospitalizações sensíveis à atenção primária em crianças, segundo grupos etários e regionais de saúde.

OBJECTIVE: to describe hospital admissions for ambulatory care sensitive conditions in children under five years of age in the State of Paraná, Brazil by condition type, age group and health region. METHOD: a temporal ecological study was conducted using data from the Unified Health System Hospital Information System for the period 2000 to 2011. Conditions were grouped in accordance with the list of ambulatory care sensitive conditions in Brazil. RESULTS: there was an increase in the rate of admissions for ambulatory care sensitive conditions in all age groups in 50% of the health regions, with a marked increase in children under the age of one. Pneumonia, gastroenteritis and asthma were the main causes of admissions. There was an increase in the proportion of overall admissions accounted for by pneumonia and gastroenteritis. CONCLUSION: the increase in admissions reveals the need for actions to improve access to primary healthcare and provide effective treatment of the main ambulatory care sensitive conditions in order to prevent hospital admissions among children.

[Hospitalizations leading causes for maternal disorders]. / Principais causas de internações hospitalares por transtornos maternos.

UNLABELLED: Presenting the rates of obstetric admissions of women living in Paraná in 2010. METHOD: A descriptive study in which the admission information of the hospital system of the Unified Health System was analyzed. Data from women aged between 10 to 49 years available on the DATASUS website were analyzed, using percentage and according to primary diagnosis, age and Regional Health area. RESULTS: The Rate of Obstetric Complications (RtOC) was 38%, increasing with the age of women. Complications of labor and delivery (10.5%), and pregnancy with abortive outcome (9.1%) were the diagnoses with highest RtOC. The RtOC ranged between 8.4% in Telêmaco Borba, until 62.6% in Ponta Grossa. CONCLUSION: The healthcare team should monitor the rates of admissions for obstetric complications as these indicate the quality of health care of women, mainly focused on labor, delivery and women of older age.

[Access to care for women during childbirth in university hospitals: characterization and associated factors]. / Acesso de parturientes para a assistência ao parto em hospitais universitários: caracterização e fatores associados.

This study aimed to analyze the socioeconomic, demographic, obstetric, neonatal and healthcare factors associated with access to care by women during childbirth. It was a transversal study conducted on puerperal women in two university hospitals in the state of Paraná, Brazil in 2011. Access to childbirth was analyzed according to socioeconomic, demographic, obstetric, neonatal and healthcare variables. The puerperal women were interviewed during hospitalization, in the first 72 hours after birth. The data was analyzed by relative frequencies and calculation of the chi2, considering a significant association when p < or = 0.05. The overall rate of women referred to university hospitals was 17.7%. A significant associated was found between access to childbirth and residing in other cities; premature birth; underweight newborns; complications in the current pregnancy and the use of ambulances. It was concluded that the associated factors found in this study suggest that pregnant women with some risk required referral to university hospitals.

[Health services use among elderly people living in the community]. / Utilização de serviços de saúde por idosos vivendo na comunidade.

The objective of this study was to analyze the pattern of health service use of aged patients enrolled with the public health services of Guarapuava, Paraná, Brazil. Home interviews were performed with 359 aged individuals, who were selected using stratified proportional sampling. The interviews were conducted in the period between January and April of 2010 at the homes of the aged participants, using sections I and III of the BOAS (Brazil Old Age Schedule). Association analysis was performed using the χ² test. The health services most used by the aged subjects over the last three months were medical appointments (49.6%) and clinical exams (38.4%). Women used health services more often (p=0.0240); 55.6% of the aged participants reported not seeking dental care. In conclusion, the aged population is a large user of health services and the city's public health network must be organized in view of an increasing demand for therapeutic diagnostic procedures.

Factors associated with road accidents among Brazilian motorcycle couriers.

The objective of the study was to identify factors associated with reports of road accidents, among motorcycle couriers in two medium-sized municipalities in southern Brazil. A self-administered questionnaire was answered by motorcycle couriers that had worked for at least 12 months in this profession. The outcomes analyzed were reports on accidents and serious accidents over the 12 months prior to the survey. Bivariate and multivariate analyses by means of logistic regression were carried out to investigate factors that were independently associated with the outcomes. Seven hundred and fifty motorcycle couriers, of mean age 29.5 years (standard deviation = 8.1 ), were included in the study. Young age (18 to 24 years compared to ≥ 25 years, odds ratio [OR] = 1.77) speeding (OR = 1.48), and use of cell phones while driving (OR = 1.43) were factors independently associated with reports of accidents. For serious accidents, there was an association with alternation of work shifts (OR = 1.91) and speeding (OR = 1.67). The characteristics associated with accidents-personal (young age), behavioral (use of cell phones while driving and speeding), and professional (speeding and alternation of work shifts)-reveal the need to adopt wide-ranging strategies to reduce these accidents, including better work conditions for these motorcyclists.

Content and usability validation of the Retire with Health web software.

OBJECTIVES: to validate the content and usability of the Retire with Health web software. METHODS: a methodological study. The content validation was carried out by seven experts in the aging subject, using an instrument that evaluated the objectives, contents, relevance, and the environment of the web software. Usability was validated by seven experts in software development, referring to ergonomics, functionality, usability, and efficiency. The data were submitted to statistical analysis, described by calculating the Content Validity Index. RESULTS: the global Content Validity Index found 0.97 for the usability aspects and 1.00 for the content. After incorporating all the experts' suggestions, the Retire with Health web software was made available on the internet (www.aposentarsecomsaude.com.br). CONCLUSIONS: content validation and usability showed that the web software meets the objective of supporting reflection on retirement, with a high level of agreement among experts.

Spatial distribution and self-correlation of mother and child health indicators in the state of Parana, Brazil.

Aiming to analyze the spatial distribution and self-correlation of data of mother-child health in Parana, Brazil, variables were selected from the Information System on Live Births, grouped into socioeconomic indicators: teenage mother, low education, high parity, race/color black of newborn; healthcare indicators: the prenatal coverage, prematurity and cesarean delivery and result indicators: low birth weight. The indicators were distributed in thematic maps and spatial self-correlation was measured using Moran's index that quantifies the degree of self-correlation. There was significant spatial self-correlation of teenage mother, low education and high parity of the "high-high" type in the macro-regions East, Campos Gerais and South; of low coverage of antenatal care in Campos Gerais, Central-south and North and of cesarean delivery in the Northwest. Elevated proportions of indicators of risk to the health of mother and child were found in the regions East, Campos Gerais and South. These results support the evaluation and planning of health services.

Risk factors for death of trauma patients admitted to an Intensive Care Unit.

OBJECTIVE: To analyze the risk factors for death of trauma patients admitted to the intensive care unit (ICU). METHOD: Retrospective cohort study with data from medical records of adults hospitalized for trauma in a general intensive care unit. We included patients 18 years of age and older and admitted for injuries. The variables were grouped into levels in a hierarchical manner. The distal level included sociodemographic variables, hospitalization, cause of trauma and comorbidities; the intermediate, the characteristics of trauma and prehospital care; the proximal, the variables of prognostic indices, intensive admission, procedures and complications. Multiple logistic regression analysis was performed. RESULTS: The risk factors associated with death at the distal level were age 60 years or older and comorbidities; at intermediate level, severity of trauma and proximal level, severe circulatory complications, vasoactive drug use, mechanical ventilation, renal dysfunction, failure to perform blood culture on admission and Acute Physiology and Chronic Health Evaluation II. CONCLUSION: The identified factors are useful to compose a clinical profile and to plan intensive care to avoid complications and deaths of traumatized patients.

[Breast cancer mortality in women from Maringá city, Paraná State, Brazil]. / Mortalidade por câncer de mama em mulheres do município de Maringa, Parana, Brasil.

This study aims at analyzing the mortality behavior by breast cancer in women from Maringá city, Paraná state, Brazil, from 1990 to 2004. It is a quantitative, descriptive and transversal cut study. The data were collected from the Information System on Mortality of the Health Ministry where the following variables were considered: age, educational level and race/ color groups. The result showed 170 deaths by breast cancer in the period studied gradually ascending during the first triennium, decreasing in the second triennium and soon rising until 2004. For the period of eight years it was noticed an increase of obits predominantly in women aged between 40 and 69 years and presenting an educational level of eight completed years at school. There was an expressive increase of mortality in white women but not statistically significant. This study suggests immediate preventive measures in order to reduce the number of deaths due to this disease

[Activities of university extension in an infant mortality prevention committee and health statistics]. / Atividades de extensão universitária em comitê de prevenção de mortalidade infantil e estatísticas de saúde.

Extra classes' activities with the Committee of Infant Mortality Prevention of the 15th Paraná Health Office (15th HO) and some approaches to health statistics, are described. Those activities articulate a partnership between the Nursing Department of the State University of Maringá and the 15th HO. A description of the Committee's attributions, the advances since the partnership start, the importance of the infant mortality investigations as well as understanding the information systems are presented. There are still challenges such as to improve the quality of the inquiry form. The partnership University -15th HO improves the quality of the Information Systems, provides the students a wider perspective of the intra-urban inequalities to access to health services, stimulating their commitment with public health.

Epidemiological overview - 18 years of ICU hospitalization due to trauma in Brazil.

OBJECTIVE: Assess the magnitude and trend of hospitalization rates due to traumatic injuries in intensive care units (ICU) in Brazil from 1998 to 2015. METHODS: This is an ecological time-series study that analyzed data from the Hospital Information System. A trend analysis of hospitalization rates was performed according to diagnosis, sex and age using generalized linear regression models and Prais-Winsten estimation. RESULTS: Rates were higher among male patients, but increased hospitalization due to trauma among female patients influenced the ratio between both sexes. Falls and transport accidents were the most frequent causes of trauma. The average annual growth was 3.6% in ICU trauma hospitalization rates in Brazil, the highest growth was reported in the North region (8%; 95%CI 6.4-9.6), among women (5.4%; 95%CI 4.5-6.3), and among people aged 60 years and older (5.5%; 95%CI, 4.7-6.3). The most frequent causes of trauma are falls (4.5%; 95%CI 3.5-5.5) and care complications (5.4%; 95%CI 4.5-6.3). On the other hand, the annual hospital mortality rate due to trauma in ICU is 1.7% lower, on average (95%CI 2.1-1.3). CONCLUSION: An increase in ICU hospitalization rate due to trauma in Brazil may be the result of some factors, such as an increasing number of accidents and cases of violence, the implementation of pre-hospital care, and improved access to care, with more beds in ICU. In addition, population aging is another factor, as a greater increase in hospitalization was observed among people aged 60 years and older.

Trend and spatial distribution of infectious diseases in pregnant women in the state of Paraná-Brazil. / Tendência e distribuição espacial de doenças infecciosas em gestantes no estado do Paraná-Brasil.

OBJECTIVE: to analyze the trend and spatial distribution of some diseases that require compulsory notification in pregnant women. METHOD: ecological study, with data from the National Notifiable Diseases Surveillance System, of the incidence of the six most frequent diseases that, require compulsory notification, in pregnant women. The Prais-Winsten model was used to analyze the trend classified as stable, decreasing and increasing, according to macro-regions. For the spatial analysis, the incidences distributed in percentiles, in choropleth maps, by Health Regions were calculated. RESULTS: the most frequent infections were syphilis, dengue, Human Immunodeficiency Virus, influenza, hepatitis and toxoplasmosis. Incidence increased by 30.8%, 30.4%, 15.4% and 2.6%, on average, for syphilis, toxoplasmosis, dengue and Human Immunodeficiency Virus, respectively. On average, the incidence of syphilis increased by 40.5% in Macro-regional North and 38% in Macro-regional Northwest. The spatial analysis showed, in the last four years, high incidence of dengue, syphilis and infection by Human Immunodeficiency Virus, which reached 180.2, 141.7 and 100.8 cases per 10,000 live births, respectively. CONCLUSION: there were increased incidences of infection in pregnant women due to syphilis, toxoplasmosis and Human Immunodeficiency Virus, with differences in their spatial distribution, indicating that these diseases should be a priority in the care of pregnant women in more affected regions.

[Prospects for the elimination of leprosy as a public health problem in the State of Paraná, Brazil]. / Perspectivas de eliminação da hanseníase como problema de saúde pública no Estado do Paraná, Brasil.

Leprosy, an endemic contagious/infectious disease, is still a public health problem in most States of Brazil, despite an important decrease in the prevalence rate in recent years. The current study aims to analyze the prospects for the elimination of leprosy in the State of Paraná, based on detection and prevalence rates for the years 2000 to 2005, in addition to data on gender, age, clinical form, operational classification, and number of skin lesions. Data were obtained from the Reportable Diseases Information System (SINAN) and the Tabnet software. Leprosy detection and prevalence rates in Paraná remained unaltered during the study period. The leprosy detection rates were high or very high in the majority of the health districts in the State. In terms of prevalence, eight health districts had reached the goal of eliminating the disease. In conclusion, the State of Paraná is close to reaching the goal of eliminating leprosy. Based on the study results, actions are recommended to eliminate the disease as a public health problem.

Behavior, knowledge and perception of risks about sexually transmitted diseases in a group of people over 50 years old.

The goal was to analyze the behavior, knowledge and risk perception about sexually transmitted diseases / AIDS (STD/AIDS) in people over 50 years old. 165 public servants at a State Secretary in Mato Grosso, Brazil were interviewed. The chi-square test and logistic regression tests were used for the analysis of risk perception and the behavior and knowledge variables about STD/AIDS. Most of the respondents were female (60.6%), 63.2 had a fixed partner, 72.4% had sexual relations in the past six months, and only 13.3% always wore condoms, with 21.5% being male and 8% female. Perception of risk was associated with non-use of condoms in their last sexual relation (p<0.001) and answering that anyone may acquire a STD/AIDS (p=0.039). The challenge of public policies is to increase actions, directing them to promote the health of the adult and elderly populations, especially regarding sexuality and vulnerability to STD/AIDS.

[Infant deaths investigated by the Prevention Committee of Infant Mortality in region of Parana State]. / Obitos infantis investigados pelo Comitê de prevenção da Mortalidade Infantil em região do Estado do Paraná.

This study had the purpose to analyze infant deaths in the 15th Regional Health Center of Paraná State, using the result of the investigations of the Committee for the Prevention of Infant Mortality. It is a descriptive exploratory study based on the System of Investigation of Infant Mortality and on the Information System of Live Births in the period of 2000-2006. The infant mortality coefficient decreased from 13.2% to 11.6%. Of the 799 deaths, the Committee investigated 74.5%; 56.5% of which were in the early neonatal period. The diseases originated in the perinatal period and the congenital malformations were the main causes of death. Among them, 70.1% were considered reducible. The reducibility of death was greater among adolescent mothers' babies, newborns of > or = 2500g, normal childbirth, black, mulatto and indigenous races, and on mothers without prenatal care. The analyses of the deaths should be performed together with the family health teams, who know the pregnant women best, in orderto improve the work and the quality of the analyses from the Committee.