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.

Neurological Development of Children With Isolated Robin Sequence Treated With Nasopharyngeal Intubation in Early Infancy.

The study assessed the neurodevelopment of children with isolated Robin sequence (IRS) and evaluated if children treated exclusively with nasopharyngeal intubation (NPI) present delay in neurological development. The prospective and cross-sectional study was conducted at the Hospital for Rehabilitation of Craniofacial Anomalies, Brazil. Children with IRS were divided into two groups according to the type of treatment in early infancy: 38 were treated with NPI (more severe cases) and 24 with postural treatment (less severe cases). Regarding interventions, children were assessed at 2 to 6 years of age using the Denver II Developmental Screening Test (Denver II) and Neurological Evolutionary Examination (NEE). According to Denver II, 73.7% in the NPI group and 79.2% in the postural group presented normal development. This result was similar to the results of different studies in the literature with typical population. Considering all areas of development, there were no significant differences in Denver II between the NPI and postural groups (P = .854). In the NPI group, 89.5% of children and 87.5% in the postural group presented normal development in NEE. Language was the most affected area, as 18.4% and 20.8% of children in NPI and postural group, respectively, presented risk for delay in the Denver II. The increased risk for delay in language area was probably due to anatomical conditions of the muscles involved in speech, and to hearing oscillations, as 47.4% in NPI group and 58.3% in postural group underwent myringotomy. IRS treated with NPI had neurological development similar to those in less severe cases. Children treated exclusively with NPI did not present delay in neurological development.

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.

Temporal trend in the incidence of tuberculosis-HIV coinfection in Brazil, by macro-region, Federative Unit, sex and age group, 2010-2021.

OBJECTIVE: To analyze the temporal trend in the incidence of tuberculosis-HIV coinfection in Brazil, by macro-region, Federative Unit, sex and age group, from 2010 to 2021. METHODS: This was a time series study using surveillance data to estimate average annual percentage changes (AAPC), and 95% confidence intervals (95%CI) via joinpoint regression. RESULTS: 122,211 cases of tuberculosis-HIV coinfection were analyzed; a falling trend was identified for Brazil as a whole (AAPC = -4.3; 95%CI -5.1;-3.7), and in the country's Southern (AAPC = -6.2; 95%CI -6.9;-5.5) and Southeast (AAPC = -4.6; 95%CI -5.6;-3.8) regions, even more so during the COVID-19 pandemic (2020-2021); the greatest falling trend was seen in Santa Catarina (AAPC = -9.3; 95%CI -10.1;-8.5), while the greatest rising trend was found in Tocantins (AAPC = 4.1; 95%CI 0.1;8.6); there was a rising trend among males, especially in Sergipe (AAPC = 3.9; 95%CI 0.4;7.9), and those aged 18 to 34 years, especially in Amapá (AAPC = 7.9; 95%CI 5.1;11.5). CONCLUSION: The burden and trends of tuberculosis-HIV coinfection were geographically and demographically disparate.

Long COVID among Brazilian Adults and Elders 12 Months after Hospital Discharge: A Population-Based Cohort Study.

The persistence of symptoms for more than three months following infection with severe acute respiratory syndrome coronavirus 2 is referred to as "Long COVID". To gain a deeper understanding of the etiology and long-term progression of symptoms, this study aims to analyze the prevalence of Long COVID and its associated factors in a cohort of Brazilian adults and elders, twelve months after hospital discharge. An observational, prospective, and follow-up study was performed with a cohort of adults and older adults diagnosed with COVID-19 in 2020 in the State of Paraná, Brazil. Twelve months after hospital discharge, patients answered a phone questionnaire about the persistence of symptoms after three levels of exposure to COVID-19's acute phase (ambulatory, medical ward, and intensive care unit). According to the characteristics of participants, the prevalence of Long COVID-19 was calculated, and logistic regression analyses were conducted. We analyzed data from 1822 participants (980 adults [≥18-<60 years] and 842 older people [≥60 years]) across three exposure levels. The overall Long COVID prevalence was 64.2%. Long COVID was observed in 646 adults (55%; of which 326 were women) and 523 older people (45%; of which 284 were women). Females had a higher prevalence of long-term symptoms (52%) compared with men. The most common post-COVID-19 conditions in the 12-month follow-up were neurological (49.8%), followed by musculoskeletal (35.1%) and persistent respiratory symptoms (26.5%). Male individuals were less likely to develop Long COVID (aOR = 0.50). Other determinants were also considered risky, such as the presence of comorbidities (aOR = 1.41). Being an adult and having been hospitalized was associated with the development of Long COVID. The risk of developing Long COVID was twice as high for ward patients (aOR = 2.53) and three times as high for ICU patients (aOR = 3.56) when compared to non-hospitalized patients. Presenting clinical manifestations of digestive (aOR = 1.56), endocrine (aOR = 2.14), cutaneous (aOR = 2.51), musculoskeletal (aOR = 2.76) and psychological systems (aOR = 1.66) made adults more likely to develop Long COVID. Long COVID was present in a large proportion of people affected by the SARS-CoV-2 infection. Presence of Long COVID symptoms displayed a dose-response relationship with the level of disease exposure, with a greater prevalence of symptoms associated with the severe form in the acute period.

Embryonic development of quail eggs (Coturnix coturnix japonica) in a homemade incubator.

Knowledge of the embryonic development of species such as quail is important for our understanding of its production and reproduction. Quail provides a practical solution to the animal protein shortage problem in developing countries and is an excellent alternative to chicken (Shanaway, 1994). This study evaluated quail embryonic viability by comparing the main morphological changes that occur over the development in a homemade incubator with previous data; the incubator was built using easily accessible and low-cost materials, which allows small producers and communities to develop quail farms as an activity to increase income or even produce a source of animal protein for the community in the Brazilian Amazon region. The homemade incubator measured 40 cm × 42 cm × 32 cm and was constructed with wooden boards, a digital thermostat, and an incandescent lamp. A total of 24 fertile eggs were incubated at a temperature of 37.5 °C and 60% relative humidity; age "0" was set at the start of incubation. Two eggs were opened on each day of development, starting from day 5 to day 16 of incubation. After gently opening the eggs, the embryos were removed, separated from the placenta and amniotic fluid, washed with running water, and weighed on a digital scale (SHIMADZU AUY 220 brand and UNI BLOC model). Crown-rump length and other measurements were performed with a digital caliper and the morphological structures were observed using a stereomicroscope (NOVA brand and NOVA ZTX-E model). All eggs opened contained live embryos, indicating that the homemade incubator temperature, relative humidity, and manual turning were adequate to maintain the quail's viability. The morphometric data of the embryos at different developmental time points were similar to those described in the literature. Embryos weighed 0.0069 g at day 5 and 4.7863 g at day 16, and the crown-rump length (CRL) means were 0.368 cm and 3.657 cm, respectively. Weight and CRL increased by 0.434 g and 2.593 cm per day of incubation, respectively. In conclusion, after 16 days of incubation in a homemade incubator, the embryos presented all phases of the development cycle, with appropriate development of weight and height based on the days of incubation without anomaly or external interference. These findings demonstrate that the homemade incubator does not alter the embryonic development of quail embryos in the Brazilian Amazon region.

O conhecimento do desenvolvimento embrionário de espécies como a codorna é importante para nosso entendimento de sua produção e reprodução. A codorna fornece uma solução prática para o problema de escassez de proteína animal nos países em desenvolvimento e é uma excelente alternativa ao frango (Shanaway, 1994). Este estudo avaliou a viabilidade embrionária de codornas comparando as principais alterações morfológicas que ocorrem ao longo do desenvolvimento em uma incubadora caseira com dados anteriores; a incubadora foi construída com materiais de fácil acesso e baixo custo, o que permite que pequenos produtores e comunidades desenvolvam criações de codornas como atividade para aumentar a renda ou mesmo produzir uma fonte de proteína animal para comunidades da Amazônia brasileira. A incubadora caseira media 40 cm × 42 cm × 32 cm e foi construída com tábuas de madeira, termostato digital e lâmpada incandescente. Um total de 24 ovos férteis foram incubados a uma temperatura de 37,5 °C e 60% de umidade relativa; idade "0" foi definida no início da incubação. Dois ovos foram abertos a cada dia de desenvolvimento, começando do dia 5 ao dia 16 de incubação. Após a abertura cuidadosa dos ovos, os embriões foram retirados, separados da placenta e do líquido amniótico, lavados em água corrente e pesados em balança digital (marca SHIMADZU AUY 220 e modelo UNI BLOC). O comprimento cabeça-cauda e demais medidas foram realizadas com paquímetro digital e as estruturas morfológicas foram observadas com auxílio de estereomicroscópio (marca NOVA e modelo NOVA ZTX-E). Todos os ovos abertos continham embriões vivos, indicando que a temperatura da incubadora caseira, a umidade relativa e a viragem manual foram adequadas para manter a viabilidade das codornas. Os dados morfométricos dos embriões em diferentes momentos do desenvolvimento foram semelhantes aos descritos na literatura. Os embriões pesaram 0,0069 g no dia 5 e 4,7863 g no dia 16, e as médias do comprimento cabeça-cauda (CRL) foram de 0,368 cm e 3,657 cm, respectivamente. Peso e CRL aumentaram 0,434 g e 2,593 cm por dia de incubação, respectivamente. Em conclusão, após 16 dias de incubação em incubadora caseira, os embriões apresentaram todas as fases do ciclo de desenvolvimento, com desenvolvimento adequado de peso e altura com base nos dias de incubação sem anomalia ou interferência externa. Esses achados demonstram que a incubadora caseira não altera o desenvolvimento embrionário de embriões de codorna na Amazônia brasileira.

Comparative Analysis of Mortality due to Breast Cancer and Mammography Uptake in the Federative Units of Brazil-2015 to 2021.

Objective: Compare the breast cancer mortality rate and the rate of mammograms with socioeconomic factors, in Brazilian´s Federative Units, during the period of 2015 to 2021. Methods: This is an ecological study, of a descriptive nature, which covers the 27 Brazilian federative units, using secondary data extracted from the DATASUS System. The information analyzed was mammography data, breast cancer mortality, demographic and economic data of the resident population and women over 20 years of age. Results: There is a direct relationship between mortality rate and mammograms rates in the Federative Units. The data obtained for Brazil presents a total of 133,048 deaths from breast cancer and 17,324,526 mammography exams in the period from 2015 to 2021. In other words, Brazil presents a standardized mortality rate value, 19.25 deaths per 100,000 women. Regarding the mammography rate, the value of the exam-specific mammography rate was 2,506.55 per 100,000 women. In relation to socioeconomic data by mortality rate group, higher mortality rates from breast cancer present higher rates in the variables: income rate by State (2,594.86), people with income (63.5), average percentage of women with more over 50 years old (29.5%), women with average years of education (6.64), white population (55.1%) and mammography exam rate (2873.20). When analysing the highest rates of mammography exam rates, higher rates are observed income rate by State (2,161.47), people with income (62.5%), average percentage of women over 50 years old (28.6%), women with an average number of years of education (5.8). Conclusion: Brazil has a high mortality rate due to breast cancer, when compared to other countries. The reasons are diverse, such as the modern, industrialized and populous lifestyle. The Federative Units with the highest mortality rate also have high rates of mammograms, that is, in the Federative Units with "better" sociodemographic conditions, the South and Southeast.

Time trend and spatial distribution of the cases of lethal violence against women in Brazil. / Tendência temporal e distribuição espacial dos casos de violência letal contra mulheres no Brasil.

OBJECTIVE: to analyze the time trend and the spatial distribution of the cases of lethal violence against women in Brazil, according to age group and to race/skin color. METHOD: an ecological study of time series, with spatial distribution of the deaths of women victims of aggression, registered in the Mortality Information System, resident in Brazil, Brazilian geographic regions and states. Due to underreporting of deaths in some states, correction factors of the mortality rates were employed. For the trend analysis, we adopted the polynomial regression model. In addition to that, the mean rates and annual upward/downward trends were distributed considering the Brazilian federative units as analysis units. RESULTS: the mean rate was 6.24 cases of lethal violence per 100,000 women, with a significant variation across the Brazilian regions and states. The main victims of violent death in Brazil are young, black-/brown-skinned and indigenous women, with a growing trend in these population segments. The North and Northeast regions stood out with the most significant mean annual increases (0.33; r2= 0.96 and 0.26; r2= 0.92, respectively). CONCLUSION: there was a stable trend regarding lethal violence against women, with significant regional differences. Young, black-/brown-skinned and indigenous women are more vulnerable to violent death in Brazil.

Factors associated with vaccination against Covid-19 in pregnant and hospitalized postpartum women: A retrospective cohort study.

OBJECTIVE: To analyze the characteristics associated with vaccination against Covid-19 in pregnant and postpartum women with Severe Acute Respiratory Syndrome in Brazil and to investigate a possible association between vaccination and the clinical course and outcome of the disease. METHODS: Retrospective cohort study of hospitalized pregnant and postpartum women diagnosed with Severe Acute Respiratory Syndrome (SARS) by SARS-CoV-2, presenting onset of signs and symptoms between May and October 2021. Secondary data were used, available in the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe). Data were analyzed using the SPSS statistical program, medians were applied to present continuous variables and frequencies, and proportions were calculated for categorical variables, using logistic and multivariate regression analysis. RESULTS: The final study population included 3,585 pregnant and postpartum women, of whom 596 (16.6) were vaccinated: 443 (74.3%) received one dose and 153 (25.7%) received two doses. They were factors associated with non-vaccination against Covid-19 age ≤ 19 anos (OR: 2.57; IC95% 1.40;4.71), non-white women (OR: 1.34; IC95% 1.07;1.67) and those who required ventilatory support (OR: 1.51; IC95% 1.19;1.90) and invasive ventilation (OR: 2.05; IC95% 1.37;3.08). On the other hand, vaccination was associated with advanced maternal age (OR: 0.60; IC95% 0.48;0.76), presence of comorbidities (OR: 0.57; IC95% 0.45;0.72) and loss of taste (OR: 0.63; IC95% 0.48;0.82). CONCLUSIONS: Demographic, ethnic-racial and clinical characteristics were associated with the vaccination status of pregnant and postpartum women with SARS by SARS-CoV-2 in Brazil. Vaccination against Covid-19 in the obstetric population has already shown positive results in the evolution of severe cases, which reiterates its importance. It is essential that health services advance vaccination against Covid-19 in the obstetric population, especially adolescentes and non-white women.

Rede Cegonha: maternal characteristics and perinatal outcomes related to prenatal consultations at intermediate risk.

OBJECTIVE: to analyze the correlation between maternal characteristics and perinatal outcomes, with the number of prenatal consultations performed. METHOD: a cross-sectional study, carried out with 1,219 mothers and newborns stratified as intermediate risk according to the Programa Rede Mãe Paranaense, adaptation of the Rede Cegonha at the state level. Data were collected from the Birth Certificates. Spearman, Wilcoxon and Kruskal-Wallis tests were used to analyze the correlation between the variables of interest. RESULTS: married women, with higher education, white and aged 30 years or older were the ones who most attended prenatal consultations. With regard to perinatal outcomes, children whose mothers had more frequent prenatal consultations had better Apgar and birth weight scores. High rates of cesarean delivery were identified before the onset of labor. CONCLUSION: maternal characteristics influence the process of adherence to prenatal care, impacting perinatal outcomes, indicating the relevance of these risk factors and the need to improve actions aimed at greater compliance with risk stratification and qualified and resolute care for pregnant women at intermediate risk.

Spatial correlation of covid-19 with intensive care unit beds in Paraná.

OBJECTIVE: To analyze the spatial correlation between confirmed cases of covid-19 and the intensive care unit beds exclusive to the disease in municipalities of Paraná. METHODS: This is an epidemiological study of ecological type which used data from the Epidemiological Report provided by the Department of Health of Paraná on the confirmed cases of covid-19 from March 12, 2020, to January 18, 2021. The number of intensive care beds exclusive to covid-19 in each municipality of Paraná was obtained by the Cadastro Nacional de Estabelecimentos de Saúde (CNES - National Registry of Health Establishments), provided online by the Departamento de Informática do Sistema Único de Saúde (Datasus - Informatics Department of the Brazilian Unified Health System). The Bivariate Moran's Index (local and global) was used to analyze the intensive care bed variable and spatial correlation, with a 5% significance level. LISA Map was used to identify critical and transition areas. RESULTS: In the analyzed period, we found 499,777 confirmed cases of covid-19 and 1,029 intensive care beds exclusive to the disease in Paraná. We identified a positive spatial autocorrelation between the confirmed cases of covid-19 (0.404-p ≤ 0.001) and intensive care beds exclusive to the disease (0.085-p ≤ 0.001) and disparities between the regions of Paraná. CONCLUSION: Spatial analysis indicated that confirmed cases of covid-19 are related to the distribution of intensive care beds exclusive to the disease in Paraná, allowing us to find priority areas of care in the state regarding the dissemination and control of the disease.

Lethal violence against women in southern Brazil: Spatial analysis and associated factors.

OBJECTIVE: estimate the risk for the occurrence of lethal violence against women and to identify the associated factors in the state of Paraná. METHOD: ecological study of deaths of women aged between 15 and 59 years, victims of aggression. The units of analysis were the cities of Paraná. Latent Bayesian Gaussian models with negative binomial probability distribution were used. The modeling considered intercept, spatial random effects and covariates, performed with the deterministic Integrated Nested Laplace Approximations approach. RESULTS: There was a positive association between lethal violence against women and the percentage of mothers who were heads of households. Finally, male homicide rates, rates of non-lethal violence against women and the cities with women mayors and councilors were also associated. CONCLUSION: This type of violence was associated with low education, structural violence and the participation of women in politics.

First Confirmed Diagnosis of Nocardioform Placentitis (Amycolatopsis lexingtonensis) in South America.

Nocardioform placentitis is a pathologically unique form of placental disease first diagnosed in central Kentucky in the mid-80s. Since then, the occurrence of nocardioform placentitis in the region has varied over the years, from sporadic cases to outbreaks. The disease has been sporadically detected in other countries and has not been confirmed in South America. A 13-year-old multiparous Mangalarga delivered a healthy filly at 340d gestation. The mare passed the fetal membranes 33 minute after foaling. Gross examination of the fetal membranes identified two focal lesions on the chorionic surface consistent with focal mucoid placentitis. Histopathologic evaluation revealed hyperplasia and degeneration of the allantoic mesoderm, intense mononuclear inflammatory infiltrates with marked lymphocytes and plasma, and occasional macrophages and neutrophils in the microvilli. Necrotic debris and exudate were identified in the chorionic epithelium, with macrophages, plasma cells, and neutrophils confirming the diagnosis of focal mucoid placentitis. The exudate culture revealed white, firm, punctiform colonies of ∼1 mm diameter. Gram staining revealed bacilli with rounded ends and branching aspect typical of actinomycetes. PCR using primers for the 16S rRNA identified the genera of bacteria as Amycolatopsis. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry analysis identified the isolate as Amycolatopsis lexingtonensis. In conclusion, we described the first confirmed case of nocardioform placentitis in South America. The present case was associated with the birth of a full-term healthy live foal; this result is consistent with Amycolatopsis spp and, in this case, was caused by A. lexingtonensis.

Colorectal cancer mortality in women: trend analysis in Brazil and its regions and states.

OBJECTIVES: to analyze colorectal cancer mortality trends in women in Brazil and its regions and states. METHODS: ecological, time-series study with trend analysis of deaths caused by colorectal cancer in women in Brazil and its regions and states between 2008 and 2019. Polynomial regression was used to treat the data. RESULTS: 48,225 deaths of women caused by colorectal cancer were examined. There was an increasing mortality trend in Brazilian women, with regional differences that resulted from socioeconomic, political, and cultural inequalities. The South Region stood out with the highest rate (7.32) in 2008, which increased to 8.65 in 2019, followed by the Southeast Region, whose rates were 6.72 and 9.05 in 2008 and 2019, respectively. CONCLUSIONS: colorectal cancer mortality increased, which indicates the need to expand public policies oriented toward screening and early diagnosis of colorectal cancer in women.

Monitoring of high-risk children in health services: A geospatial mixed-methods study.

OBJECTIVE: to analyze adherence, non-adherence and abandonment of the monitoring of children referred to the high-risk reference centers of Rede Mãe Paranaense. METHOD: a parallel and convergent mixed-methods study, in which both approaches have the same weight. The study loci were two high-risk outpatient services from the South of the country. In the quantitative part, 3,107 medical charts of high-risk children were analyzed and the spatial distribution was performed. In the qualitative part, interviews were conducted with 29 health professionals, in addition to 34 family members, and content analysis was performed. Two databases were produced, which were analyzed separately and eventually integrated. RESULTS: the rates regarding adherence to monitoring are decreasing, mainly in the municipalities that are far away from the high-risk outpatient services, and the non-adherence and abandonment rates are increasing. In the reports by the representatives and the manager, a failure was observed between the transportation offer and the active search flow of the absent patients, which contributes to the increase in the non-adherence and abandonment rates and to the consequent decrease in adherence. CONCLUSION: in high-risk children, adherence is decreasing and the non-adherence and abandonment rates increased.

Post-acute COVID and long-COVID among adults and older adults in the State of Paraná, Brazil: protocol for an ambispective cohort study.

INTRODUCTION: Since 2020, the world has been going through a viral pandemic with a high morbidity and mortality rate along with the potential to evolve from an acute infection to post-acute and long-COVID, which is still in the process of elucidation. Diagnostic and prognostic research is essential to understand the complexity of factors and contexts involving the illness's process. This protocol introduces a study strategy to analyse predictors, sequelae, and repercussions of COVID-19 in adults and older adults with different disease severities in the State of Paraná, Brazil. METHODS AND ANALYSIS: A mixed-methods sequential explanatory design. The quantitative data will be conducted by an ambispective cohort study, which will explore the manifestations of COVID-19 for 18 months, with nearly 3000 participants with confirmed diagnoses of COVID-19 (reverse transcription-PCR test) between March and December of 2020, retrieved from national disease reporting databases, over 18 years old, living in a Brazilian State (Paraná) and who survived the viral infection after being discharged from a health service. Data collection will be conducted through telephone interviews, at two different occasions: the first will be a recall 12 months after the acute phase as a retrospective follow-up, and the second will be another prospective interview, with data of the following 6 months. For the qualitative step, Grounded Theory will be used; participants will be selected from the cohort population. The first sample group will be composed of people who were discharged from the intensive care unit, and other sample groups will be composed according to theoretical saturation. The qualitative data will follow the temporal design and classification of the disease provided for in the cohort. ETHICS AND DISSEMINATION: Ethics approval was granted by the State University of Maringá, under opinion number: 4 165 272 and CAAE: 34787020.0.0000.0104 on 21 July 2020, and Hospital do Trabalhador (Worker's Hospital), which is accountable for the Health Department of the State of Paraná, under opinion number: 4 214 589 and CAAE: 34787020.0.3001.5225 on 15 August 2020. The participants will verbally consent to the research, their consent will be recorded, and the informed consent form will be sent by mail or email. Outcomes will be widely disseminated through peer-reviewed manuscripts, conference presentations, media and reports to related authorities.

[Increase in physical violence against women perpetrated by the intimate partner: a trend analysis]. / Aumento da violência física contra a mulher perpetrada pelo parceiro íntimo: uma análise de tendência.

The scope of this article is to analyze the temporal trend by conducting a time series study of physical violence against women by an intimate partner in the State of Paraná between 2009 and 2016. Records of violence were obtained from the Notifiable Diseases and Violent Events Information System-SINAN. Levels of physical violence against women were calculated according to sociodemographic characteristics and means of aggression. For the trend analysis, polynomial regression was used. The notifications increased from 11.1 cases/100,000 women in 2009 to 91.2 in 2016, with an average annual increase of 14.84. There was an increase in rates of physical violence against women in all the Health Macroregional units, especially in the West with the highest average rate and in the North with the highest average annual increase. The spouse was the main aggressor. However, there was an increase in aggression by ex-spouses and boyfriends. There was also an increase in notifications among women aged 20-29 and 50-59 years, with eight years or more of study, and black/brown, yellow and indigenous race/color. The results reveal an increase in notifications of physical violence against women by an intimate partner, with changes in the sociodemographic profile of the victims.

O objetivo deste artigo é analisar a tendência temporal da violência física contra a mulher perpetrada pelo parceiro íntimo no Paraná. Trata-se de um estudo de séries temporais (2009 a 2016) dos registros de violência física contra a mulher por parceiro íntimo no Paraná. Os dados foram obtidos no Sistema de Informação de Agravos de Notificação-SINAN. Foram calculadas taxas de violência física contra a mulher por parceiro íntimo, segundo características sociodemográficas e meio de agressão. Para a análise de tendência, utilizou-se a regressão polinomial. As notificações aumentaram de 11,1 casos/100.000 mulheres em 2009 para 91,2 em 2016, com aumento anual médio de 14,84. Houve elevação nas taxas de violência física contra a mulher em todas as macrorregionais de saúde, destacando-se a Oeste, com a maior taxa média, e a Norte, com maior crescimento anual médio. O cônjuge foi o principal agressor. Entretanto, registrou-se crescimento das agressões por ex-cônjuges e namorados(as). Também houve aumento de notificações entre mulheres de 20-29 e 50-59 anos, com oito anos ou mais de estudo, e raça/cor preta/parda, amarela e indígena. Os resultados mostram aumento das notificações de violência física contra a mulher por parceiro íntimo, com mudanças no perfil sociodemográfico das vítimas.