High risk pregnancies and factors associated with neonatal death.

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

[Outcomes in late-age pregnancies]. / Resultados perinatais em gestações tardias.

The objective of the present study was to compare perinatal outcomes in women aged 35 or older with women aged 20 to 34 years. This retrospective study was performed by reviewing the obstetric records of 1255 mothers who gave birth at the only hospital in Sarandi-PR, from January 2007 to December 2008. The analyzed variables were: marital status, education, gestational age at birth, type of delivery, newborn birth weight, Apgar score at one and five minutes and stillbirths. Logistic regression showed that advanced maternal age was significantly associated with adverse outcomes such as cesareans (OR 1.23, 95% CI 0.19-0.44) and 5-minute Apgar scores below 7 (OR 5.78 95% CI 0.74-0.76). These results are important to show the risk of complications in pregnant women aged 35 years or older, and the need to provide guidance to women who wish to postpone pregnancy.

[Perinatal outcomes in the extremes of reproductive age and factors associated with low weight at birth]. / Resultados perinatais nos extremos da vida reprodutiva e fatores associados ao baixo peso ao nascer.

The aim of this study is to investigate perinatal outcomes in the extremes of reproductive age and verify the risk factors for low birth weight. This is a retrospective study of deliveries in the city of Sarandi, state of Paraná, Brazil in 2008, and it was performed by accessing data from the Information System on Live Births. The 331 expectant mothers were subdivided into two groups: adolescents (10-19 years of age) and late-age (35 years or older). Rates of cesarean deliveries were significantly higher (66.1%) in mothers 35 or older than in adolescents (26.8%). Regarding risk factors for low weight at birth, it was observed that this condition was strongly associated with prematurity and marital status. The perinatal outcomes of mothers 35 or older were not significantly different from the results of the adolescents, thus confirming the occurrence of adverse results in both extremes of reproductive age, with the exception of the incidence of cesarean delivery.

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

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

Screening Cervical Cancer by the Pap Test ­ Relevance of Age Ranges Recommended by the Brazilian Programme for Prevention and Control

Objective: To evaluate screening by the Papanicolaou smear (Pap) and the frequency of cervical abnormalities in the age range recommended by the Brazilian programme for prevention and control of cervical cancer (CC) in the years 2012 and 2013 in a high prevalence city. Methods: This retrospective study covered results of Pap examinations performed on women aged ≥12 years residing in urban areas of the city of Maringá, Paraná in Brazil. The examinations were performed in the years 2012 and 2013 for the System of Public Health (SPH) which maintains a city database. The age ranges were grouped as recommended into <15-24, 25-64, and >64 years. Results: A total 40,866 women were screened, 19,606 in 2012 and 21,260 in 2013. The Pap exams performed for the age range 25-64 years accounted for 80.7% of the total in 2012 and 80.3% in 2013 (p=0.13), while those for <15 to 24 years accounted for 11.7% and 11.3%, respectively. There were more tests performed in the >64 years age group in 2013 (8.46%) than in 2012 (7.52%) (p<0.001). A total of 1,354 (3.31%) women presented with abnormal test results, with atypical squamous cells of undetermined significance (ASC-US) as the most prevalent finding (2.12%) in 2012, while in 2013 it was LSIL (1.56%) (p<0.001 for both). Women with ASC-US showed a lower mean age than did those with other lesions in both years. Conclusions: This study detected a significant expansion of women screened for CC in age ranges not recommended by the Brazilian government.

The Rise in Mortality from Breast Cancer in Young Women: Trend Analysis in Brazil.

INTRODUCTION: Breast cancer is the most common cause of cancer death among women. OBJECTIVE: The objective of this study was to analyze time trends in overall mortality from breast cancer in Brazil, Brazilian regions and States. METHODS: This is an exploratory study, of the time series of deaths from breast cancer contained in the Mortality Information System (SIM), of women living in Brazil, Brazilian regions and States, from 1996 to 2013. For the trend analysis, the polynomial regression model was used, and a significant trend was considered when the estimated model obtained a p value <0.05. RESULTS: There was a tendency of increased mortality from breast cancer in Brazilian women (average increase of 0.18 per year; p <0.001), with regional differences, particularly in the age group 20-49 years (0.07 per year; p <0.001). The age group 50-69 years remained constant but had high average rates (37.14). CONCLUSION: More effective planning is needed to focus on the different scenarios of the Brazilian regions. Screening strategies for the incidence and mortality from breast cancer must also be rethought according to age group in the country.

Prevalence of metabolic syndrome in pre- and postmenopausal women.

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

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

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

Risk Factors for Breast Cancer in Postmenopausal Women in Brazil.

PURPOSE: To analyze risk factors for postmenopausal breast cancer. METHODS: The present casecontrol study included 600 women treated at a cancer center reference hospital in a municipality in the South of Brazil. RESULTS: Totals of 100 patients and 500 control subjects were evaluated. The mean age of the women was 52.5 ± 11.9 years; the average was 57.4 ± 11.8 years, and the average age of the control subjects was 51.5 ± 11.7 years. The risk factors for breast cancer that were considered included an age ≥ 40 years, postmenopausal status, a body mass index (BMI) ≥ 30 kg/m2, and reduced physical activity. Variables like postmenopausal status and an obese BMI were associated with cases of breast cancer. Women who were postmenopausal or obese were 3.80 or 1.80 times more likely to develop breast cancer, respectively, and physically inactive women were 1.72 times more likely to develop breast cancer. CONCLUSIONS: Obesity and postmenopausal status are associated with the occurrence of breast cancer in this population. Being over 40 years of age was also a statistically significant factor for postmenopausal women.

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

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

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

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

Years of potential life lost due to breast and cervical cancer: a challenge for Brazilian public policy.

BACKGROUND: The purpose of the article was to analyze the years of potential life lost (YPLL) of women who died from breast and cervical cancer in the State of Parana, Southern Brazil. This was a temporal trend study (2000 to 2010) about the coefficients of mortality and the years of potential life lost in women aged 20 to 70 years. MATERIALS AND METHODS: Data were obtained through the database of the Department of the Unified Health System (DATASUS) and the National Mortality Information System. RESULTS: There was a loss of 125.075 YPLL due to breast cancer, with an average of 11.370 YPLL. Regarding cervical cancer, the figure obtained was 91.625 YPLL from 2000 to 2010, with an average of 8.329 YPLL. Increased risk of death from breast cancer was observed for women aged 50 to 59 years, with a significant increase among those in the age group from 40 to 49 years. There was an increased rate of cervical cancer among women 40 to 69 years. CONCLUSIONS: The risk of death grows with increasing age, being higher from 40 years. Prevention is paramount for both cancers. Thus, preventive measures are required and a reassessment of political strategies should be adopted.

Population inquiry regarding mammography in postmenopausal women in southern Brazil.

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

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

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

Síndrome hipertensiva e resultados perinatais em gestação de alto risco / Hypertensive syndrome and perinatal outcomes in high-risk pregnancies / Síndrome hipertensivo y resultados perinatales en embarazos de alto riesgo

Esta pesquisa teve como objetivo analisar os resultados perinatais de gestantes de alto risco com síndrome hipertensiva. Estudo transversal, de base documental, com 920 prontuários de gestantes de um ambulatório de alto risco. A variável independente foi a síndrome hipertensiva, considerando a hipertensão arterial como condições preexistentes, pré-eclâmpsia como antecedente obstétrico e doença hipertensiva específica da gestação (DHEG) como intercorrência clínica. As variáveis dependentes foram prematuridade, baixo peso ao nascer, Apgar inferior a sete no 1° e 5° minutos, morte fetal, morte infantil, parto normal e parto cesáreo. Para analisar a associação entre as variáveis, utilizou-se o teste qui-quadrado e comparou-se o risco relativo no intervalo de confiança (IC) a 95%. Da amostra estudada, 25,32% apresentaram síndrome hipertensiva; 14,36% foram classificadas com hipertensão arterial (grupo 1), 6,73% com pré-eclâmpsia (grupo 2); 4,02% apresentaram DHEG (grupo 3); e 30,65% eram normotensas (grupo 4). No grupo 1 constatou-se risco elevado para morte fetal e o parto normal foi fator de proteção. No grupo 2 verificou-se risco elevado para parto cesáreo. No grupo 3, constituiu risco elevado para prematuridade e baixo peso ao nascer. Os três grupos apresentaram risco elevado para Apgar baixo no 1º e 5º minuto. As síndromes hipertensivas na gestação relacionaram-se a resultados perinatais desfavoráveis, evidenciando a necessidade de cuidados especializados à gestante, por meio de um pré-natal especializado e de qualidade.

This study aimed to analyze the perinatal outcomes of high risk pregnancies of women with hypertensive syndrome. It was a cross-sectional study,with a documental basis, with 920 records of pregnant women from a high-risk outpatient clinic. The independent variable was hypertensivesyndrome, considering arterial hypertension as pre-existing conditions, pre-eclampsia as obstetric antecedents and heart disease of pregnancy(HDP) as clinical complications. The dependent variables were prematurity, low birth weight, Apgar score below than seven in the 1st and 5thminutes of life, fetal death, infant death, normal delivery and cesarean delivery. To analyze the association between the variables, the Chi-squaretest was used and Relative Risk was compared in the 95% confidence interval (CI). Of the sample studied, 25.32% presented hypertensive syndrome;14.36% were classified with arterial hypertension (group 1), 6.73% with preeclampsia (group 2); 4.02% presented DHEG (group 3) and a total of30.65% normotensive (group 4). In group 1, there was a high risk for fetal death and normal delivery was a protective factor. In group 2, there was ahigh risk for cesarean section. In group 3, it was a high risk for prematurity and low birth weight. The three groups were at high risk for low Apgarat the 1st and 5th minute. Hypertensive syndromes during pregnancy were associated with unfavorable perinatal outcomes, evidencing the needfor specialized care to the pregnant woman through a specialized prenatal and quality.

En esta investigación se busca analizar los resultados perinatales de embarazadas de alto riesgo con síndrome hipertensivo. Estudio transversal,de base documental con 920 registros de embarazadas de una clínica ambulatoria de alto riesgo. La variable independiente fue el síndrome hipertensivo, considerando la hipertensión arterial como condición preexistente, la preeclampsia como antecedente obstétrico y la enfermedad hipertensiva específica del embarazo (DHEG) como intercurrencia clínica. Las variables dependientes fueron prematuridad, bajo peso al nacer,Apgar inferior a siete en el 1 ° y 5 ° minutos, muerte fetal, muerte infantil, parto normal y cesárea. Para analizar la asociación entre las variables seutilizó la prueba Chi-cuadrado y se comparó el riesgo relativo en el intervalo de confianza (IC) al 95%. De la muestra estudiada, 25,32% presentaron síndrome hipertensivo; 14,36% se clasificaron con hipertensión arterial (grupo 1), 6,73% con preeclampsia (grupo 2); 4,02% presentaron DHEG(grupo 3) y un total de 30,65% normotensas (grupo 4). En el grupo 1 se constató riesgo elevado para la muerte fetal y el parto normal fue unfactor de protección. En el grupo 2 se observó riesgo elevado para la cesárea. En el grupo 3, riesgo elevado para la prematuridad y el bajo peso alnacer. Los tres grupos presentaron riesgo elevado para Apgar bajo el primero y quinto minutos. Los síndromes hipertensivos en el embarazo serelacionaron con resultados perinatales desfavorables, evidenciando la necesidad de cuidados especializados a la embarazada, por medio de un prenatal especializado y de calidad.

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

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

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

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

Rastreamento de casos de sífi lis na gestação no sul do Brasil / Syphilis case tracking in pregnancy in southern Brazil

Objetiva-se descrever os casos de sífi lis em gestantes notifi cados no período de 2012 a 2014. Trata-se de um estudo descritivo, transversal e retrospectivo, utilizando fonte secundária de dados da fi cha de notifi cação dos casos de sífi lis em gestantes do Sistema de Informação de Agravos de Notifi cação da Secretaria Municipal de Saúde. Dos 95 casos notifi cados durante o período, notou-se um aumento da notifi cação ano a ano. 66,3% das gestantes tinham idade entre 20 e 34 anos, em 56,8% a cor da pele prevalente foi branca, 48,4% dos casos foram diagnosticados no primeiro trimestre. 63,2% das gestantes encontravam-se na fase primária da doença e 63,2% dos parceiros não foram tratados. Concluí-se que os resultados encontrados apontam um longo caminho a ser percorrido rumo a eliminação deste agravo

The aim is to describe the cases of syphilis in pregnant women reported in the period from 2012 to 2014. A descriptive, cross-sectional retrospective study using secondary source notifi cation form data of syphilis cases in Grievances Information System Pregnant Notifi cation Municipal Health. In the 95 reported cases during the period, it was noted an increase in the reporting year to year. 66.3 % of pregnant women were aged between 20 and 34 years, 56.8% in the prevalent skin color was white, 48.4 % of cases were diagnosed in the fi rst quarter. 63.2 % of women were in the early stage of the disease and 63.2 % of partners were not treated. It concludes that he results indicate a long way to go towards the elimination of this disease

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

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

Prevalence of metabolic syndrome in pre- and postmenopausal women

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

Prevalência e fatores associados à realização de mamografia e exame citopatológico / Prevalence and factors associated with the performance of mammography and pap smear test

Estimar a prevalência e os fatores associados à realização de mamografia e examecitopatológico em mulheres da cidade de Maringá, Paraná. Métodos: Estudo transversal,de base populacional, feito com 345 mulheres com idade superior a 20 anos, no período demarço de 2011 a abril de 2012. Realizou-se entrevista por meio de um questionário propostopelo Ministério da Saúde, o qual abordava aspectos sociodemográficos, fatores de risco paradoenças crônicas não transmissíveis e questões relacionadas ao rastreamento mamográficoe citopatológico. Os dados foram analisados mediante análise bivariada, análise brutamediante Odds Ratio (OR) e qui-quadrado por meio do programa Epi Info 3.5.1, e análisemultivariada por meio da regressão logística, realizada com o programa Statistica 7.1, comnível de significância de 5% e intervalo de confiança de 95%. Resultados: A média deidade das mulheres foi de 52,19 (±5,27) anos. A maioria (56,5%) apresentou de 0 a 8 anosde estudo. Além disso, 84,6% (n=266) das mulheres realizaram o exame de Papanicolaue 74.3% (n=169), a mamografia. Foram associadas à menor realização de Papanicolau asmulheres com escolaridade entre 9 e 11 anos de estudo (p=0,01), e quanto à mamografia,tiveram menor adesão as mulheres sem plano de saúde privado (p<0,01). Conclusão: Acobertura da mamografia e do Papanicolau foi satisfatória entre as mulheres da cidade deMaringá, Paraná. A baixa escolaridade e as mulheres que dependiam da rede pública de saúdetiveram menor adesão à realização da mamografia...