Influence of the COVID-19 pandemic on labor and childbirth care practices in Brazil: a cross-sectional study.

BACKGROUND: It has been hypothesized that the coronavirus disease 2019 (COVID-19) pandemic may have changed the conduct of obstetric practices at the time of labor, delivery, and birth. In Brazil, many practices lacking scientific evidence are implemented in this care, which is charcaterized by excessive use of unnecessary interventions. This scenario may have been worsened by the pandemic. Thus, we analyzed the effects of the pandemic on care during prenatal care and delivery by comparing the results of two surveys (one was administered before the pandemic and the other during the pandemic) in public hospitals in Belo Horizonte - Minas Gerais (MG), Brazil. METHODS: This cross-sectional and comparative study analyzed preliminary data from the study "Childbirth and breastfeeding in children of mothers infected with SARS-CoV-2", which was conducted in three referral maternity hospitals in Belo Horizonte - MG during the pandemic in the first half of 2020 in Brazil. The final sample consisted of 1532 eligible women. These results were compared with data from 390 puerperae who gave birth in the three public hospitals in the study "Birth in Belo Horizonte: labor and birth survey", conducted before the pandemic to investigate the changes in practices of labor and delivery care for the mother and her newborn, with or without COVID-19 infection, before and during the pandemic. In this research, "Birth in Belo Horizonte: labor and birth survey", data collection was performed between November 2011 and March 2013 by previously trained nurses. Between study comparisons were performed using Pearson's chi-square test, with a confidence level of 95%, and using Stata statistical program. RESULTS: We found a significant increase in practices recommended by the World Health Organization during the pandemic including the following: diet offering (48.90 to 98.65%), non-pharmacological pain relief (43.84 to 67.57%), and breastfeeding in the newborn´s first hour of life (60.31 to 77.98%) (p < 0.001). We found a significant reduction of non-recommended interventions, such as routine use of episiotomy (15.73 to 2.09%), the Kristeller maneuver (16.55 to 0.94%), oxytocin infusion misused (45.55 to 28.07%), amniotomy (30.81 to 15.08%), and lithotomy position during labor (71.23 to 6.54%) (p < 0.001). CONCLUSION: Our study revealed a statistically significant increase in the proportion of use of recommended practices and a reduction in non-recommended practices during labor and delivery. However, despite advances in the establishment of World Health Organization recommended practices in labor, delivery, and birth, the predominance of interventionist and medicalized practices persists, which is worsened by events, such as the pandemic.

Lower limb wounds in diabetic and non-diabetic patients: survival analysis. / Feridas em membros inferiores em diabéticos e não diabéticos: estudo de sobrevida.

OBJECTIVE: To evaluate the survival of wounds in lower limbs of diabetic and non-diabetic patients. METHOD: Retrospective cohort study of patients with lower limb ulcers treated at a specialized center between 2011 and 2013. Outcome: healing of lower limb injuries in days. The survival function of lower limb wounds and the differences between diabetic and non-diabetic were analyzed. The Log-rank test was used to compare the survival curves between the study groups. RESULTS: In up to 600 days, 23% of the diabetic patients presented wound healing, while 63% of the non-diabetic patients had their wounds healed, with a statistically significant difference in survival curves in comparison between the groups. The Hazard Ratios (RH) of healing were lower for diabetic patients (HR = 0.13, 95% CI = 0.02-0.97). CONCLUSION: The results show that there is a delay in wound healing in diabetic patients.

Factors associated with the incidence of pressure ulcer during hospital stay.

OBJECTIVE: Estimating the incidence rate of pressure ulcers and verifying factors associated with this occurrence in a cohort of hospitalized patients. METHOD: This is a cohort study in which the considered outcome was the time until pressure ulcer occurrence. Estimated effect of the variables on the cumulative incidence ratio of the outcome was performed using the Cox proportional hazards model. Variable selection occurred via the Logrank hypothesis test. RESULTS: The sample consisted of 442 adults, with 25 incidents of pressure ulcers. Patients with high scores on the Braden scale presented a higher risk of pressure ulcer incidence when compared to those classified into the low score category. CONCLUSION: These results reinforce the importance of using the Braden Scale to assist in identifying patients more likely to develop pressure ulcers. OBJETIVO: Estimar a taxa de incidência de úlcera por pressão e verificar fatores associados a essa ocorrência em uma coorte de pacientes hospitalizados. MÉTODO: Trata-se de estudo de coorte no qual o desfecho foi a ocorrência da úlcera por pressão. A estimativa do efeito das variáveis para a proporção de incidência acumulada do desfecho foi realizada utilizando o modelo de riscos proporcionais de Cox. A seleção das variáveis ocorreu por meio do teste de hipóteses Logrank. RESULTADOS: A amostra foi composta de 442 adultos, com 25 casos incidentes de úlcera por pressão. Pacientes com altos escores na escala de Braden apresentaram maior risco de incidência de úlcera por pressão quando comparados com aqueles classificados na categoria de baixo escore. CONCLUSÃO: Os resultados reforçam a importância do uso da Escala de Braden para auxiliar na identificação dos pacientes com maior probabilidade de desenvolver úlcera por pressão.

Awareness of the diagnosis, treatment, and control of diabetes mellitus in Brazil.

OBJECTIVE: To estimate the proportions of awareness, treatment, and control of diabetes mellitus (DM) in the Brazilian adult population. METHOD: This is a cross-sectional study, with data from a representative sample of the Brazilian population, taken from the National Health Survey(PNS 2014/2015). Outcomes were defined based on glycated hemoglobin (HbA1c) measurements, self-reported DM diagnosis, and use of hypoglycemic agents or insulin. The proportion of DM awareness, treatment, and control was estimated according to sociodemographic characteristics, health conditions, and access to health services, and their respective 95% confidence intervals. RESULTS: DM prevalence in the Brazilian population was of 8.6% (95%CI: 7.8-9.3): 68.2% (95%CI: 63.9-72.3) were aware of their diagnosis, 92.2% (95%CI: 88.6-94.7) of those who were aware were undergoing drug treatments, and, of these, 35.8% (95%CI: 30.5-41.6) had controlled HbA1c levels. The proportions of DM awareness, control, and treatment were lower in men aged 18 to 39 years, individuals with low education, without health insurance, and beneficiaries of the Bolsa Família program. CONCLUSION: Approximately one in ten Brazilians has DM. A little more than half of this population is aware of their diagnosis, a condition measured by HbA1c dosage and clinical diagnosis. Among those who know, the vast majority are undergoing drug treatments. However, less than half of these have their HbA1c levels controlled. Worse scenarios were found in subgroups with high social vulnerability.

Investigation of cancer incidence in ELSA-Brasil.

Low- and middle-income countries have high cancer-related mortality rates, and Brazil has one of the highest incidences of all cancers in South America. Since 2008, the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) follows up 15,105 civil adult servants of college education and research institutions in six Brazilian capitals, collecting relevant information on risk factors for the incidence of cancer and other noncommunicable diseases. This study aimed to describe the methodology for surveillance and investigation of the incidence of primary cancers in ELSA-Brasil. The surveillance and investigation involve annual telephone interviews, data collection of medical registries (biopsy records, chemotherapy/radiotherapy reports, hospital records or death certificates/autopsy statements), eligibility and final classification, date and basis of diagnosis, tumor topography and histological type. The cumulative incidence of all types of cancer in ELSA-Brasil during the first five years of follow-up (2009-2013) was 2.27 %. The challenges encountered in the investigation process are related to the lack of data on the occurrence of distant metastasis and essential details regarding diagnoses. However, the quality control and the adequacy of the methods adopted enables the construction of a solid and pioneering database in the country, which will contribute to advance in research on the natural history of the most frequent types of cancer.

Arterial hypertension and associated factors: National Health Survey, 2019.

OBJECTIVE: To analyze the factors associated with self-reported arterial hypertension, as well as its prevalence in the Brazilian adult population. METHODS: Data from 88,531 individuals aged 18 years or older who responded to the 2019 National Health Survey were analyzed. The outcome studied was self-reported arterial hypertension. Sociodemographic variables and clinical and lifestyle conditions were considered as exposures. The prevalence ratio (PR), crude and adjusted for sex, age, and schooling was used as a measure of association to verify the factors related to its prevalence, obtained by Poisson regression with robust variance. RESULTS: The prevalence of self-reported arterial hypertension was of 23.9% (95%CI: 23.4-24.4). When adjusting for age, sex, and schooling, the adjusted Prevalence Ratios (APR) were higher among: regular health self-assessment (APR = 1.6; 95%CI: 1.5-1.6) and bad health self-assessment (APR = 1.7; 95%CI: 1.6-1.8); self-reference to heart disease (APR = 1.7; 95%CI: 1.6-1.7), diabetes (APR = 1.7; 95%CI: 1.6-1.8), high cholesterol (APR = 1.6; 95%CI: 1.6-1.7), overweight (APR = 1.4; 95%CI: 1.4-1.5), and obesity (APR = 2.0; 95%CI: 1.9-2.1); high salt intake (APR = 1.1; 95%CI: 1.0-1.1); higher among former smokers (APR = 1.1; 95%CI: 1.1-1.2) and lower among smokers (APR = 0.9; 95%CI: 0.8-0.9); and consumption of ultra-processed foods (APR = 0.9; 95%CI: 0.8-0.9). CONCLUSION: A quarter of the Brazilian adult population claims to have arterial hypertension, more prevalent among women and associated with older age groups, Black, mixed-race, and others, low schooling, high salt intake, former smoking, presence of comorbidities, and worse health self-assessment.

Prevalence and factors associated with self-reported diagnosis of high cholesterol in the Brazilian adult population: National Health Survey 2019. / Prevalência e fatores associados ao diagnóstico autorreferido de colesterol alto na população adulta brasileira: Pesquisa Nacional de Saúde 2019.

OBJECTIVE: To estimate the prevalence of self-reported high cholesterol diagnosis and to analyze the factors associated with the prevalence in the Brazilian adult population. METHODS: Cross-sectional study, using data from the 2019 National Health Survey. The diagnosis of high cholesterol was self-reported. Poisson regression models yielded prevalence ratios (PR) and 95% confidence intervals (95%CI). RESULTS: In the 88,531 adults, the prevalence of high cholesterol was 14.6%. Positively associated: female sex (PR = 1.44; 95%CI 1.40;1.52), age ≥ 60 years (PR = 3.80; 95%CI 3.06;4.71), health insurance (PR = 1.33; 95%CI 1.24;1.42), poor or very poor self-rated health (PR = 1.75; 95%CI 1.60;1.90), hypertension (PR = 1.78; 95%CI 1.68;-1.89), diabetes (RP = 1.54; 95%CI 1.45;1.65), renal failure (PR = 1.33; 95%CI 1.15;1.53), obesity (PR = 1.27; 95%CI 1.18;1.36), former smoker (PR = 1.13; 95%CI 1.07;1.20), alcohol abuse (PR = 1.11; 95%CI 1.01;1.21), physically active during leisure time (PR = 1.22; 95%CI 1.15;1.30). CONCLUSION: High cholesterol was associated with sociodemographic characteristics, health condition and lifestyle.

Association between Adiposity Indexes and Kidney Disease: Findings from the Longitudinal Study of Adult Health (Elsa-Brazil).

INTRODUCTION: Chronic kidney disease (CKD) is a public health problem and it is associated with a high risk of mortality. Overweight and obesity are known as independent risk factors for CKD. OBJECTIVE: To investigate the association between adiposity indexes and kidney disease. METHODS: This study included 14,636 adults from ELSA-Brazil. Outcome variables: altered glomerular filtration rate (GFR), categorized as yes (GFR <60 mL/min/1.73 m2) and no (GFR ≥60 mL/min/1.73 m2), albuminuria, estimated by albumin-creatinine ratio and categorized as yes (≥30 mg/g) and no (<30 mg/g), and presence of chronic kidney disease (CKD) (altered GFR and/or albuminuria). Exposure variables: obesity and overweight (body mass index (BMI)≥30 and ≥25 kg/m2, respectively), high waist circumference (WC) (≥102 cm in men and ≥88 cm in women), high waist-to-hip ratio (WHR) (≥0.90 in men and ≥0.85 in women), and high waist-to-height ratio (WHtR) (≥0.5). To estimate the association between main exposures and outcomes, logistic regression analyses were performed using models adjusted for sociodemographic variables (age, gender, race/skin color, education), behavioral (smoking, physical activity, alcohol consumption), components of the metabolic syndrome (HDL cholesterol, triglycerides, hypertension, diabetes mellitus) and history of cardiovascular disease (myocardial infarction, angina or heart failure). RESULTS: Individuals with obesity, high WC, WHR and WHtR were more prone to albuminuria when compared to individuals with normal values for these measures. It was also observed that these altered measures were positively associated with the presence of CKD. CONCLUSION: Adiposity indexes have a direct and significant association with albuminuria and CKD.

Elaboration and validation of an e-book with the laws about diabetes in schools.

OBJECTIVES: to elaborate an e-book about children and adolescents' rights and duties concerning diabetes in schools. METHODS: we developed this methodological study in nine steps: Creation process definition, bibliographic survey, e-book elaboration, readability and apprehensibility examination, illustration, committee of judges and targeted audience validation (students' moms with diabetes and school staff), experts' meetings and final discussion. We have considered acceptable the Content Validity Coefficient minimum of 0.80. RESULTS: we obtained an average Content Validity Coefficient of 0,97 for clarity and relevance, and the images had 94% approval. In the face-to-face test, the targeted audience have considered the material clear and adequate to the intended purpose. Conclusions: the e-book was elaborated and validated regarding the content and relevance, and may be used to instruct the population about diabetes' laws in schools.

Fruit and vegetable consumption, leisure-time physical activity and binge drinking in Belo Horizonte, Brazil, according to the Health Vulnerability Index.

OBJECTIVE: To estimate the prevalence of fruit and vegetable consumption, practice of leisure time physical activity (LTPA) and binge drinking for small areas of Belo Horizonte, Minas Gerais. METHODS: Ecological study conducted with data from the Surveillance System for Risk and Protection Factors for Noncommunicable Diseases by Telephone Survey (Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico - Vigitel). The prevalence of risk and protection factors from 2006 to 2013 were estimated and the 95% confidence intervals calculated. "Small areas" corresponded to the municipality division into four strata of health risk classification given by the Health Vulnerability Index 2012 (Índice de Vulnerabilidade à Saúde - IVS). RESULTS: The mean prevalences for the period were: about 42% of regular intake of fruit and vegetable, 34.7% of leisure time activity and 20.4% of binge drinking. The prevalence of fruit and vegetable consumption was higher in low-risk areas (58.5%; 95%CI 56.8 - 60.2) and lower in very high-risk areas (32.3%; 95%CI 27.7 - 36.9). The practice of LTPA was higher in low-risk areas (40.8%; 95%CI 38.9 - 42.8) and lower in very high risk (25.2%; 95%CI 20.6 - 29.9). Binge drinking was higher in low-risk areas (22.9%; 95%CI 21.7 - 24.2) compared to very high-risk areas (14.3%; 95%CI 11.4 - 17.3). CONCLUSION: It was identified a gradient in the distribution of risk and protection factors for noncommunicable diseases in Belo Horizonte according to the risk classification. This information can support programs aimed at reducing health inequalities, especially in the most vulnerable areas.

Association of self-reported sleep disturbances with ideal cardiovascular health in Brazilian adults: A cross-sectional population-based study.

OBJECTIVE: To examine the association between sleep disturbances and cardiovascular health in Brazilian adults. METHODS: We analyzed cross-sectional data from a nationally representative sample of 36,480 Brazilian adults ages 18 and over. Multivariate Poisson regression models were used to assess the association between sleep disturbances (difficulty falling asleep, frequent interruptions in sleep, or sleeping more than usual) and Life's Simple 7 (LS7) cardiovascular health (CVH) scores through consideration of four behaviors (smoking, physical activity, body mass index, and diet) and three biological factors (hypercholesterolemia, hypertension, and diabetes). RESULTS: Adults with no sleep disturbances had better CVH, with higher mean LS7 CVH scores (4.2, 95% confidence interval [CI]: 4.1; 4.2) when compared to those experiencing some level of sleep disturbance within a 2-week timespan (3.8, 95% CI: 3.7; 3.8). Specifically, compared to those with no sleep disturbance, adults reporting sleep disturbances for half of the weekdays had significantly lower LS7 CVH mean scores (ß = -0.02, 95% CI: -0.04; 0.01). Adults who had disturbances more than half of the weekdays had even lower scores (ß = -0.06, 95% CI: -0.09; -0.02), followed by those who reported disturbances almost every day (ß = -0.08, 95% CI: -0.11; -0.04), even after adjusting for age, sex, education status, depressive symptoms, and night shift work. CONCLUSION: Brazilian adults with sleep disturbances are less likely to achieve ideal CVH. Given that sleep disturbances seem to be increasingly common in Brazil, recent gains in CVH mortality may be affected.

Consumption of alcoholic and non-alcoholic beverages: ELSA-Brasil results. / Consumo de bebidas alcoólicas e não alcoólicas: Resultados do ELSA-Brasil.

The study aims to describe the consumption of alcoholic and non-alcoholic beverages according to sociodemographic, health and location variables. Cross-sectional study with ELSA-Brasil data (2008-2010). A questionnaire was used to collect sociodemographic, food, health data and anthropometry. Descriptive analysis and association with variables of interest were carried out. In the sample, 8% of the total caloric value comes from non-alcoholic beverages (5.6%: sugary drinks), and 4% from alcoholic beverages (2.7%: beer). Consumers of unsweetened and artificially sweetened beverages reported moderate/strong physical activity, former smokers and higher education. The opposite was true for sugary drinks. Eutrophic people reported higher consumption of sugary drinks and those obese, artificially sweetened and beer. Alcohol consumption varied with age (young: beer; elderly: wine/spirits) and education (low education: beer/spirits; higher education: wine). Coffee, natural juice and soda were the most consumed non-alcoholic beverages and beer was the most prevalent alcoholic beverage. Consumption variation was observed according to geographic location. The consumption of sugary and alcoholic beverages is high in Brazil and public health strategies are required.

Objetiva-se descrever o consumo de bebidas alcoólicas e não alcoólicas segundo variáveis sociodemográficas, de saúde e localização. Estudo transversal com dados do ELSA-Brasil (2008-2010). Aplicou-se questionário para coleta de dados sociodemográficos, de alimentação, saúde, além de antropometria. Realizou-se análise descritiva e associação com variáveis de interesse. Na amostra, 8% do valor calórico total é proveniente de bebidas não alcoólicas (5,6%: bebidas açucaradas), e 4% de bebidas alcoólicas (2,7%: cerveja). Os consumidores de bebidas não adoçadas e adoçadas artificialmente realizam atividade física moderada/forte, são ex-fumantes e apresentam escolaridade alta. O oposto foi verificado para as bebidas açucaradas. Indivíduos eutróficos relataram maior consumo de bebidas açucaradas e os obesos, as adoçadas artificialmente e cerveja. O consumo de bebidas alcoólicas variou com a idade (jovens: cerveja; idosos: vinho/destiladas) e escolaridade (baixa: cerveja/destiladas; alta: vinho). Café, suco natural e refrigerante foram as bebidas não alcoólicas mais consumidas e a cerveja a alcoólica mais prevalente. Observou-se variação de consumo segundo a localização geográfica. O consumo de bebidas açucaradas e alcoólicas é alto no Brasil e estratégias de saúde pública são necessárias.

Estimates of hypertension and diabetes mellitus prevalence according to Health Vulnerability Index in Belo Horizonte, MG, Brazil.

OBJECTIVE: To estimate the prevalences of hypertension and diabetes for small areas in Belo Horizonte, according to the Health Vulnerability Index (HVI). METHODS: Ecological study with data from the Surveillance of Risk and Protection Factors for Chronic Diseases by Telephone Survey (Vigitel) conducted in Belo Horizonte, from 2006 to 2013. The self-reported diagnosis of diabetes and hypertension were evaluated. The estimates of prevalence and the 95% confidence interval (95%CI) were calculated using the direct and indirect method by HVI grouped into four categories: low, medium, high and very high health risk. RESULTS: During the period evaluated, 26% (95%CI 25.2 - 26.8) and 6.1% (95%CI 6.7 - 6.5) of the adult population from Belo Horizonte reported being hypertensive and diabetic, respectively. According to the indirect method to obtain estimates of hypertension and diabetes prevalences per HVI, it was found that areas of very high risk had a higher prevalence of adults with hypertension (38.6%; 95%CI 34.8 - 42.4) and diabetes (16.2%; 95%CI 13.1 - 19.3) when compared to the low risk (28.2%; 95%CI 27.0 - 29.4 and 6%; 95%CI 5.4 - 6.7, respectively). CONCLUSION: The adult population living in areas at high risk for health had a higher prevalence of hypertension and diabetes compared to those with a lower risk.

Elaboration and validation of a booklet on diabetes for Community Health Workers.

OBJECTIVES: to develop and validate a diabetes booklet for Community Health Workers. METHODS: methodological study developed in seven steps: Bibliographic review; Development of the booklet; Calculation of readability and comprehensibility scores; Validation of the booklet by the committee of judges; Discussion between experts; Validation of the booklet by the target audience; and Final discussion between experts. Validation was performed by 10 judges via e-Surv and on a face-to-face test with 5 Community Health Workers, considering the minimum Content Validity Coefficient of 0.80. RESULTS: the booklet had a mean Content Validity Coefficient of 0.97 in the validation by the committee of judges, and the images had 96.67% approval. In the face-to-face test, the Community Health Workers considered the material clear and appropriate to the function. CONCLUSIONS: the booklet was developed and validated on its content and relevance, and it can be used by Community Health Workers for diabetes education.

Cardiovascular health and validation of the self-reported score in Brazil: analysis of the National Health Survey. / Saúde cardiovascular e validação do escore autorreferido no Brasil: uma análise da Pesquisa Nacional de Saúde.

This paper aims to estimate the prevalence of cardiovascular health and the validity of the Brazilian population's self-reported score. This is a cross-sectional, methodological study with 8,943 individual adults and laboratory data from the 2013 National Health Survey. We employed behavioral (body mass index, tobacco use, diet, physical activity, ideal if ≥ 3 ideal factors), biological (tobacco use, dyslipidemia, hypertension, and diabetes, ideal if ≥ 3 ideal factors), and cardiovascular health scores (all factors, ideal if ≥ 4 ideal factors). Prevalence of sensitivity and specificity scores and analyses of the self-reported scores were estimated, considering the scores with measured variables as the gold standard. Approximately 56.7% of individuals had ideal values for the measured cardiovascular health score. Sensitivity was 92% and specificity 30% for the self-reported biological score. Sensitivity and specificity scores were, respectively, 90.6% and 97.2% for self-reported behavior. The self-reported cardiovascular health score had a sensitivity of 92.4% and specificity of 48.5%. A little over half of the population had an ideal cardiovascular health score. The self-reported score showed good sensitivity and lower proportions of specificity.

O objetivo deste artigo é estimar a prevalência de saúde cardiovascular e a validade do escore autorreferido na população brasileira. Estudo transversal, metodológico, com 8.943 indivíduos adultos e dados laboratoriais da Pesquisa Nacional de Saúde 2013. Escores utilizados: comportamental (índice de massa corporal, tabagismo, dieta, atividade física, ideal se ≥ 3 fatores ideais), biológico (tabagismo, dislipidemia, hipertensão e diabetes, ideal se ≥ 3 fatores ideais) e saúde cardiovascular (todos os fatores, ideal se ≥ 4 fatores ideais). Estimaram-se prevalências dos escores e análises de sensibilidade e especificidade dos escores autorreferidos, considerando padrão -ouro os escores com variáveis aferidas. Apresentaram valores ideais para o escore de saúde cardiovascular 56,7% dos indivíduos aferidos. Para o escore biológico autorreferido, a sensibilidade foi de 92% e a especificidade 30%. Para o comportamental autorreferido, a sensibilidade e a especificidade foram, respectivamente, 90,6% e 97,2%. O escore de saúde cardiovascular autorreferido teve sensibilidade 92,4% e especificidade 48,5%. Pouco mais da metade da população apresentou escore de saúde cardiovascular ideal. O escore autorreferido apresentou boa sensibilidade e menores proporções de especificidade.

Factors associated with normal and cesarean delivery in public and private maternity hospitals: a cross-sectional study.

OBJECTIVES: to investigate the factors associated with the mode of delivery in pregnant women in the city of Belo Horizonte. METHODS: cross-sectional study developed with data from the study "Being born in Belo Horizonte: survey on childbirth and birth" carried out in seven maternity hospitals in Belo Horizonte - Minas Gerais. The final sample consisted of 1088 pregnant/postpartum women. In this study, to verify the magnitude of the association between the outcome variable and its possible determinants (exposure variables) logistic regression models were constructed to estimate the Odds Ratio. RESULTS: increasing age, the lack of companionship, the hospital's private financing for performing delivery and being a first-time pregnant woman increased the chance of delivery by cesarean section. Final Considerations: the knowledge of factors associated with the prevalence of cesarean sections can support reflections among health professionals about this surgical procedure in certain situations, especially when there are no precise clinical indications.

Characteristics of elderly patients attended in an emergency room due to falls. / Características dos idosos atendidos em um pronto-socorro em decorrência de queda.

OBJECTIVE: To describe the characteristics of elderly patients attended in a teaching hospital emergency room due to falls. METHOD: Descriptive, quantitative, cross-sectional study performed at a hospital emergency room. The data was collected in November 2017, considering the medical records of 1.460 elderly patients, with a registry related to fall as the main complain. A descriptive analysis of the data was performed. RESULTS: The main results show that most elders were female (66.92%), older than 80 years old (27.27%), single (41.37%), and hypertensive (78.79%). Falls from ground level comprised 88.56% and their main consequence was trauma (55.65%). 66.30% were discharged after consultation. CONCLUSION: The characteristics of the elderly were: female, age above 80 years old, single, and hypertensive. The most frequent type of fall was from ground level, traumas were the main consequences and the discharge after consulting the most common outcome.

Factors associated to type 2 diabetes among employees of a public hospital in Belo Horizonte, Brazil.

BACKGROUND: Occupational aspects have been described as additional risk factors for type 2 diabetes mellitus (DM2). Workers whose job interferes with healthy eating and physical activity might be more susceptible to disease. OBJECTIVE: To investigate sociodemographic, clinical, occupational and lifestyle factors associated with DM2 among employees of a public hospital in Belo Horizonte, Minas Gerais, Brazil. METHODOLOGY: Cross-sectional study with 443 employees of a public hospital in Belo Horizonte. We administered a sociodemographic and occupational questionnaire and the Finnish Diabetes Risk Score (FINDRISC) and collected biochemical data. We performed multivariate logistic regression analysis to investigate factors associated with diabetes. The significance level was set to 5%. RESULTS: 6.3% of the participants had a diagnosis of DM2 and 13% were found to be at high or very high risk to develop disease within 10 years. Participants aged above 54, with abnormal waist circumference, who took antihypertensive drugs or had family history of diabetes exhibited higher odds of developing disease. CONCLUSION: Older age, abdominal obesity, hypertension and family history of diabetes were associated with diagnosis of DM2.

INTRODUÇÃO: Características ocupacionais têm sido apontadas como fatores de risco adicionais para o desenvolvimento do diabetes mellitus tipo 2 (DM2). Trabalhadores cujas rotinas de trabalho dificultam a adoção de hábitos saudáveis relacionados à alimentação e atividade física podem estar mais vulneráveis a desenvolver esse agravo. OBJETIVO: Estimar os fatores sociodemográficos, clínicos, ocupacionais e de hábitos de vida associados ao DM2 entre trabalhadores de uma empresa pública de Belo Horizonte. METODOLOGIA: Trata-se de um estudo transversal com 443 trabalhadores de uma empresa hospitalar pública de Belo Horizonte (MG). Foram aplicados questionários envolvendo características sociodemográficas, ocupacionais, juntamente com o Finnish Diabetes Risk Score (FINDRISC) e coletados dados bioquímicos. Para análise dos fatores associados ao diabetes, utilizou-se a regressão logística multivariada, considerando nível de significância de 5%. RESULTADOS: Entre os trabalhadores, 6,3% tinham diagnóstico de diabetes tipo 2 e 13% encontravam-se na faixa de risco alto/muito alto de desenvolver a doença nos próximos 10 anos. Observou-se que as pessoas com idade acima de 54 anos, circunferência da cintura alterada, que usavam medicamentos para hipertensão arterial e que tinham história de diabetes na família apresentaram maior chance de desenvolver a doença em comparação a pessoas com menos de 45 anos, cintura normal, que não usavam medicamento para hipertensão e sem história familiar. CONCLUSÃO: A idade avançada, a obesidade abdominal, a hipertensão arterial e a história familiar foram fatores associados ao diagnóstico de diabetes mellitus tipo 2.

Factors associated with the length of hospital stay of women undergoing cesarean section.

OBJECTIVE: To evaluate whether age group, complications or comorbidities are associated with the length of hospitalization of women undergoing cesarean section. METHODS: A cross-sectional study was carried out between June 2012 and July 2017, with 64,437 women undergoing cesarean section and who did not acquire conditions during their hospital stay. Hospital discharge data were collected from national health institutions, using the Diagnosis-Related Groups system (DRG Brasil®). The DRG referring to cesarean section with additional complications or comorbidities (DRG 765) and cesarean section without complications or associated comorbidities (DRG 766) were included in the initial diagnosis. The influence of age group and comorbidities or complications present at admission on the length of hospital stay was assessed based on the means of the analysis of variance. The size of the effect was verified by Cohen's D, which allows evaluating clinical relevance. The criticality levels were identified using the Duncan test. RESULTS: The longest length of hospital stay was observed in the age group from 15 to 17 years old and among those aged 45 years old or more. The hospital stay of women with complications or comorbidities at the time of admission was also longer. Moreover, it was noted that the increase in criticality level was associated with an increase in the mean length of hospital stay. CONCLUSIONS: The length of hospital stay of women is higher among those belonging to the age group ranging from 15 to 17 years old and for those aged 45 years old or more. The presence of associated comorbidities, such as eclampsia, pre-existing hypertensive disorder with superimposed proteinuria and gestational hypertension (induced by pregnancy) with significant proteinuria increase the length of hospital stay. This study enabled the construction of distinct criticality level profiles based on the combination of age groups and the main comorbidities, which were directly related to the length of hospital stay.

Hospital-acquired conditions and length of stay in the pregnancy and puerperal cycle.

OBJECTIVE: To analyze the impact of the Hospital-Acquired Conditions (HAC) in women in the puerperal and pregnancy cycle during length of stay. METHODS: This cross-sectional study was conducted with 113,456 women, between July 2012 and July 2017, in Brazil's national hospitals of the supplementary healthcare networks and philanthropists accredited to the Unified Health System (SUS). Data on hospital discharges were collected using the Diagnosis-Related Groups (DRG Brasil®) system. All DRGs of the major diagnostic category 14 (MDC14), including pregnancy, childbirth and puerperium, were included. The impact of HAC on length of stay was estimated by Student's t-test, and the effect size by Cohen's d, which allows to assess clinical relevance. RESULTS: The most prevalent diagnostic categories related to MDC14 were vaginal and cesarean deliveries without complicating diagnoses, both at institutions accredited to SUS and those for supplementary health care. The prevalence of HAC was 3.8% in supplementary health and 2.5% in SUS. Hospitals providing services to supplementary health care providers had a longer length of stay considering HAC for patients classified as DRG: cesarean section with complications or comorbidities at admission (p < 0.001; Cohen's d = 0.74), cesarean section without complications or comorbidities at admission (p < 0.001, Cohen's d = 0.31), postpartum and post abortion without listed procedure (p < 0.001, Cohen's d = 1.05), and other antepartum diagnoses with medical complications (p < 0.001; Cohen's d = 0.77). CONCLUSIONS: This study showed that the prevalence of HAC was low both in the institutions accredited to attend by SUS and in those of supplementary health; however, its presence contributes to increasing the length of stay in cases of cesarean sections without complications or comorbidities in supplementary health institutions.