[Preference and factors associated with the type of delivery among new mothers in a public maternity hospital]. / Preferência e fatores associados ao tipo de parto entre puérperas de uma maternidade pública.

OBJECTIVE: To identify reproductive and socioeconomic factors that influence the preference for a method of childbirth. METHOD: Data were collected using semi-structured interviews with 233 women in postpartum care. Data were analyzed using association tests, namely the Chi-square test and multiple logistic regression. RESULTS: The preference for vaginal childbirth was cited by 58% of women. The main reasons for this preference were quick postpartum recovery, a negative experience in Caesarean childbirth and fulfilment through motherhood. Analysis of the logistic models of preference for vaginal delivery according to the independent variables revealed a greater occurrence in women who had previous experience of this type of delivery (PR: 1.91; CI: 1.15-3.17) and had received prior guidance (PR: 1.76; CI: 1.06-2.90). CONCLUSION: Findings highlight the need to transform the model of care provided during pregnancy and childbirth.

Prevalence and factors associated with wound colonization by Staphylococcus spp. and Staphylococcus aureus in hospitalized patients in inland northeastern Brazil: a cross-sectional study.

BACKGROUND: Infections by Staphylococcus spp. are often associated with wounds, especially in hospitalized patients. Wounds may be the source of bacteria causing cross-contamination, and are a risk factor for methicillin-resistant Staphylococcus aureus (MRSA) infection. The aim of this study was to investigate the prevalence of wound colonization by Staphylococcus spp., especially S. aureus and MRSA, in hospitalized patients, and to identify the factors associated with such colonization. METHODS: This cross-sectional study enrolled patients with wounds who were hospitalized in a remote and underdeveloped inland region of northeastern Brazil with extreme poverty. Samples were collected using sterile swabs with 0.85% saline solution, and coagulase-negative Staphylococcus spp., S. aureus, and MRSA were identified using standard laboratory procedures. Data regarding the sociodemographic characteristics, antibiotic use, and comorbidities of the patients were collected using the medical records and a questionnaire. RESULTS: A total of 125 wounds were analyzed. The patients had a mean age of 63.88 years and a mean 3.84 years of school education. Eighty-one wounds (64.80%) were colonized by Staphylococcus spp. Twenty-five wounds (20%) were colonized by S. aureus, 32% of which were colonized by MRSA. Wound colonization by Staphylococcus spp. was associated with pneumonia or other respiratory disease (p = 0.03). Wound colonization by S. aureus was associated with nasal colonization by S. aureus (p < 0.001), fewer days of prior antibiotic use (p = 0.04), admission to a medical ward (p = 0.02), and age >65 years (p = 0.05). Among patients with wound colonization by MRSA, 37.50% had a history of prior antibiotic use, 75% had two or more comorbidities, 25% had cancer or diabetes, 50% had cardiovascular disease, and 50% died. CONCLUSIONS: Wounds can be the source of Staphylococcus spp. infection, and high proportions of wounds are colonized by S. aureus and MRSA. Nasal colonization by S. aureus may be a source for wound colonization by S. aureus, illustrating the importance of preventing cross-contamination in hospital environments, especially among elderly patients. Wounds should be carefully managed to prevent microbial spread, thereby assisting patient recovery and reducing healthcare costs.

Analyzing a national health surveillance strategy to reduce mother-to-child transmission of syphilis: The case of Brazilian investigation committees.

Objectives: This study aimed to analyze the relevance of investigation committees in eliminating mother-to-child transmission of syphilis in Brazil. Methods: Questionnaires and interviews were conducted with health managers of 25 Brazilian Federative Units and Brazil's Federal District. Data were analyzed using Bardin's content analysis technique and subsequently compared with the global prescriptions for syphilis response of the Pan American Health Organization, World Health Organization, and recent research publications examining the course of syphilis in Brazil, in Brazilian regions, and globally. Results: While the investigation committees drew on the successful experience of those in reducing maternal mortality, which helped the country achieve the Millennium Development Goals, they are not demonstrated to be sufficient for preventing mother-to-child transmission of syphilis. The committees' systematic and bureaucratic agenda has not been efficient in managing avoidable factors for syphilis, nor do they operate in the scope of the integration of surveillance and care actions, as recommended by the health policy. Conclusion: The committees' model needs to be reviewed in the context of Brazil's National Health System. The research process should be rescaled in order to remain a cornerstone for the induction of health policy that integrates surveillance and healthcare across Brazilian Federative Units. The advancement toward an automated case management model becomes relevant for the country to meet global commitments to eliminate congenital syphilis transmission and achieve the goals outlined in the 2030 Agenda.

Effects of Weight Loss on Acoustic Parameters After Bariatric Surgery.

BACKGROUND: Patients with morbid obesity may present vocal alterations, since large accumulation of fat in the vocal tract may interfere with voice production of these individuals. OBJECTIVE: Verify the neck circumference and the acoustic parameters of voice in obese women, before and after the bariatric surgery, and compare the results with a control group, with normal weight. METHODS: Observational, longitudinal, descriptive study with patients referred to the SCODE (Obesity Surgery and Related Disorders Center) in a university hospital. The sample consisted of 25 morbidly obese women, age range 28-43 years and 23 non-obese women, aged 21-41 years control group. To measure the neck circumference, a tape measure was used and all participants were seated upright with the head positioned in the Frankfort horizontal plane. The fundamental frequency was calculated through the sustained emission of vowel [a] at usual intensity and pitch, to measure the fundamental frequency of the voice, that is, how much the vocal fold vibrates per second. After the recording, participants were prompted to produce vowels [a], [i], and [u] sustained at usual intensity and pitch, and a stopwatch was used to measure the maximum phonation time, to verify the balance between myoelastic and dynamic forces of the larynx. After 8 months post-surgery, the patients were recruited to be re-evaluated using the same pre-surgical data collection procedures. RESULTS: There was an increase in the mean value of f0. The maximum phonation time of all vowels increased after surgery. CONCLUSION: Obese individuals with post-surgery weight loss may present neck circumference, fundamental frequency, and maximum phonation time values closer to the mean values of normal weight individuals. In this study, weight loss was sufficient to adjust the acoustic parameter measurements.

Neck Circumference and Vocal Parameters in Women Before and After Bariatric Surgery.

BACKGROUND: Morbidly obese patients may suffer from vocal disorders, as vocal production is directly related to the volume of the vocal tract, and the large-scale accumulation of fat in this region may interfere with voice production. The aim of this study was to analyze the neck circumference, fundamental frequency, and maximum phonation time of a group of morbidly obese women before and after bariatric surgery. METHODS: An observational, longitudinal, and descriptive study was performed with patients of the Obesity and Related Diseases Surgery Unit of a university hospital. A total of 21 morbidly obese women aged 28-68 years, with a mean age of 41.33 years, participated in the study. Neck circumference was measured using a tape measure. To obtain fundamental frequency values, the patient was asked to produce the vowel [a] at normal intensity and pitch for an average period of 3 s. After recording, the participants were asked to produce the sustained vowels [a], [i], and [u] at normal intensity and pitch, with a stopwatch used to measure maximum phonation time. Eight months after surgery, patients were reassessed using the same data collecting procedures as were carried out prior to surgery. RESULTS: After surgery, there was an increase in the average value of fundamental frequency and maximum phonation time for all the vowels and a reduction in neck circumference. The differences were statistically significant. CONCLUSIONS: Weight reduction and a consequent decrease in neck circumference affected the changes in maximum phonation time and fundamental frequency values in the voices of these patients, after weight loss.

VOCAL COMPLAINT, AUDITORY-PERCEPTUAL ASSESSMENT OF VOICE AND VOCAL SELF-ASSESSMENT IN WOMEN WITH MORBID OBESITY.

BACKGROUND: Obese people often have altered breathing patterns and therefore may experience difficulties in voice production. AIM: To verify the presence of vocal complaints and the correlation between the auditory-perceptual analysis of voice and vocal self-assessment of a group of women with morbid obesity before and after bariatric surgery. METHODS: A longitudinal, exploratory, descriptive study of 21 morbidly obese women aged between 28 and 68 years, assessed before and after bariatric surgery, was performed. The women filled out a form containing identification data and type of vocal complaint. Perceptual evaluation of voice and vocal self-assessment were performed using a visual analog scale. For perceptual assessment of voice the women were asked to say three sentences from the Consensus Auditory-Perceptual Evaluation of Voice. RESULTS: Of the 21 patients, 14 (66.6%) reported vocal complaints, of which 10 (71%) vocal fatigue, eight (57.14%) voice failures and seven (50%) vocal effort. All participants reported improvements in the voice after surgery, irrespective of having reported vocal complaints before surgery. There was no correlation between vocal self-assessment and auditory-perceptual assessment of the voice before or after the procedure. There was no correlation between vocal self-assessment and perceptual evaluation of the voice before surgery. CONCLUSION: Obesity interfered with voice production and influenced negative perception and therefore vocal complaints. Complaints about vocal production cannot be perceived by a speech therapist with the same impact as by patients, as both employ different criteria for vocal evaluation. Vocal self-assessment is an important tool in voice evaluation.