RESUMEN
Objetivo: identificar os fatores sociodemográficos associados à via de parto. Método: trata-se de revisão sistemática com busca nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde, PubMed e Cochrane em maio de 2021. O protocolo do estudo foi registrado na PROSPERO sob o nº CRD42021257340. Os artigos selecionados foram posteriormente analisados pelos sistemas Joanna Briggs Institute e Sistema Grading of Recommendations Assessment, Development and Evaluation. Resultados: mulheres com maior nível socioeconômico, maior nível de escolaridade, com idade acima de 35 anos e parto em instituições privadas possuem maior chance de realizar cesariana comparado ao parto vaginal. A qualidade da evidência para variável de prestador hospitalar foi baixa, para idade e escolaridade materna a qualidade é moderada e classe econômica a qualidade é alta. Conclusões: os fatores sociodemográficos contribuem para o aumento da taxa de cesárea e reforçam o cenário encontrado na literatura.
Objective: to identify the sociodemographic factors associated with the mode of delivery. Method: this is a systematic review with a search in the Latin American and Caribbean Literature on Health Sciences, PubMed and Cochrane databases in May 2021. The study protocol was registered with PROSPERO under number CRD42021257340. The selected articles were analyzed by the Joanna Briggs Institute and the Grading System of Recommendations Assessment, Development and Evaluation systems. Results:women with a higher socioeconomic level, higher education, aged over 35 years and private institutions have a greater chance of having a cesarean section compared to the vaginal level. The quality of quality of quality for the service provider variable was low and the quality of maternal schooling is low and the quality of economic class is high. Conclusion: Sociodemographic conclusions in the literature.
Objetivo: identificar los factores sociodemográficos asociados a la modalidad de parto. Método: se trata de una revisión sistemática con búsqueda en las bases de datos Literatura Latinoamericana y del Caribe en Ciencias de la Salud, PubMed y Cochrane en mayo de 2021. El protocolo de estudio fue registrado en PROSPERO con el número CRD42021257340. Los artículos seleccionados fueron analizados por el Instituto Joanna Briggs y los sistemas Grading System of Recommendations Assessment, Development and Evaluation. Resultados: las mujeres con mayor nivel socioeconómico, educación superior, mayores de 35 años e instituciones privadas tienen mayor probabilidad de tener una cesárea en comparación con el nivel vaginal. La calidad de calidad de calidad para la variable proveedor de servicios fue baja y la calidad de escolaridad materna es baja y la calidad de clase económica es alta.
Asunto(s)
Humanos , Femenino , Embarazo , Recién Nacido , Cesárea/tendencias , Factores Sociodemográficos , Parto Normal/tendencias , Factores Socioeconómicos , Trabajo de Parto , Determinantes Sociales de la Salud/tendenciasRESUMEN
OBJECTIVE: To analyze the association between social determinants and morbidities for the outcomes of hospitalization, intensive care unit admission and death by COVID-19 in Espírito Santo State, Brazil. METHODS: Cross-sectional study with secondary data from confirmed cases of COVID-19, reported in the Notifiable Diseases Information System. Poisson regression was used to estimate the prevalence ratios. RESULTS: 104,384 cases reported between February 28th and September 1st, 2020 were studied. The outcomes under study were more frequent among male, elderly, yellow, followed by black, uneducated and with multimorbidity. There was a higher risk of death among people over the age of 60 (PR=56.31 - 95%CI 34.24;92.61), multimorbidities (PR=3.63 - 95%CI 3.16;4.17), kidney disease (PR=3.42 - 95%CI 2.81;4.15) and neoplasms (PR=3.15 - 95%CI 2.41;4.13). CONCLUSION: The effect of social determinants and morbidities on hospitalization and deaths by COVID-19 is evident.
Asunto(s)
COVID-19/epidemiología , Hospitalización/estadística & datos numéricos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Determinantes Sociales de la Salud/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Brasil/epidemiología , COVID-19/mortalidad , Comorbilidad , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Adulto JovenRESUMEN
OBJECTIVE: To analyze early and late maternal complications associated with the mode of delivery in a birth cohort in Brazil, using the propensity score technique for analysis. METHODS: This is a prospective cohort study, using data from the Pelotas Birth Cohort, RS, 2004. A total of 4,189 women were included and a descriptive analysis of the data and subsequent calculation of the propensity and pairing score of vaginal delivery women and cesarean delivery women with similar scores (1,366 pairs). We then assessed the difference in outcome risk between the groups. RESULTS: Women in the cesarean group had 2.9 percentage points (pp) more risk of postpartum infection, 1.13 p.p. more risk of urinary infection, 1.10 p.p. more risk of anesthetic complications and 1.24 p.p. higher risk of headache compared to vaginal delivery, but less risk of anemia (-2.43 pp) and hemorrhoids (-1.24 p.p.). The use of propensity scores is extremely useful for reducing bias and increasing accuracy in observational studies when experimental studies cannot be performed. CONCLUSION: Cesarean sections have been associated with a higher prevalence of postpartum and urinary tract infections, anesthetic complications and headache and lower prevalence of anemia and hemorrhoids, so they should be performed with clear indications and when their benefits outweigh potential risks.
Asunto(s)
Cesárea , Parto Obstétrico , Brasil/epidemiología , Femenino , Humanos , Embarazo , Puntaje de Propensión , Estudios ProspectivosRESUMEN
BACKGROUND: Tuberculosis (TB) in migrants is of concern to health authorities worldwide and is even more critical in Brazil, considering the country´s size and long land borders. The aim of the study was to identify critical areas in Brazil for migrants diagnosed with TB and to describe the temporal trend in this phenomenon in recent years. METHODS: This is an ecological study that used spatial analysis and time series analysis. As the study population, all cases of migrants diagnosed with TB from 2014 to 2019 were included, and Brazilian municipalities were considered as the unit of ecological analysis. The Getis-Ord Gi* technique was applied to identify critical areas, and based on the identified clusters, seasonal-trend decomposition based on loess (STL) and Prais-Winsten autoregression were used, respectively, to trace and classify temporal trend in the analyzed series. In addition, several municipal socioeconomic indicators were selected to verify the association between the identified clusters and social vulnerability. RESULTS: 2,471 TB cases were reported in migrants. Gi* analysis showed that areas with spatial association with TB in immigrants coincide with critical areas for TB in the general population (coast of the Southeast and North regions). Four TB clusters were identified in immigrants in the states of Amazonas, Roraima, São Paulo, and Rio de Janeiro, with an upward trend in most of these clusters. The temporal trend in TB in immigrants was classified as increasing in Brazil (+ 60.66% per year [95% CI: 27.21-91.85]) and in the clusters in the states of Amazonas, Roraima, and Rio de Janeiro (+1.01, +2.15, and + 2.90% per year, respectively). The cluster in the state of São Paulo was the only one classified as stationary. The descriptive data on the municipalities belonging to the clusters showed evidence of the association between TB incidence and conditions of social vulnerability. CONCLUSIONS: The study revealed the critical situation of TB among migrants in the country. Based on the findings, health authorities might focus on actions in regions identified, stablishing an intensive monitoring and following up, ensuring that these cases concluded their treatment and avoiding that they could spread the disease to the other regions or scenarios. The population of migrants are very dynamic, therefore strategies for following up them across Brazil are really urgent to manage the tuberculosis among international migrants in an efficient and proper way.
Asunto(s)
Emigrantes e Inmigrantes/estadística & datos numéricos , Migrantes/estadística & datos numéricos , Tuberculosis/epidemiología , Brasil , Humanos , Agrupamiento Espacio-TemporalRESUMEN
BACKGROUND: Migrants are a high priority group for TB control measures due to their high exposure to risk factors such as poverty and social vulnerability. The study aimed to identify factors associated with latent TB among international migrants living in four Brazilian state capitals. This was a cross-sectional study conducted in September and October 2020 in a sample of 903 international migrants living in four Brazilian state capitals: Boa Vista/RR (458), Manaus/AM (136), São Paulo/SP (257), and Curitiba/PR (52). Data were collected with a questionnaire consisting of open and closed questions on personal characteristics, information on TB, and use of preventive measures. Tuberculin skin test (TST) was performed, with reading after 72 h by trained nurses and using 5 mm induration as the positive cutoff. Chi-square test (X2) and Fisher's exact test, both two-tailed, were used to compare statistically significant levels of association between the migrants´ sociodemographic characteristics, vulnerability, and latent TB infection (LTBI). Binary logistic regression was applied to calculate odds ratios and respective 95% confidence intervals. For all the tests, type I error of 5% was defined as statistically significant (p < 0.05). RESULTS: Prevalence of LTBI among migrants was 46.1% in Manaus/AM, 33.3% in São Paulo/SP, 28.1% in Curitiba/PR, and 23.5% in Boa Vista/RR. Factors associated with latent infection were age, male gender, and brown or indigenous race. CONCLUSIONS: The study showed high prevalence of latent TB among international migrants.
Asunto(s)
Tuberculosis Latente/epidemiología , Migrantes/estadística & datos numéricos , Adulto , Brasil/epidemiología , Estudios Transversales , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Encuestas y Cuestionarios , Prueba de Tuberculina/efectos adversosRESUMEN
A formação de vínculo entre famílias de crianças com Síndrome Congênita do Zika (SCZ) e profissionais de saúde é condição sine qua non para o desenvolvimento das crianças afetadas. O estudo objetiva compreender a perspectiva de mães de crianças com SCZ acerca da abordagem profissional e da formação de vínculos no processo de cuidado em saúde durante a epidemia de Zika vírus. Trata-se de uma pesquisa qualitativa, descritivo-exploratória que entrevistou 25 mães. Os resultados revelam que os profissionais de saúde tiveram práticas de desumanização da assistência e cometeram violência obstétrica. Contrapondo a desumanização, também houve casos esporádicos de práticas humanizadas com formação de vínculo. Os resultados deste estudo apontam a necessidade de estratégias e intervenções em prol de melhor atendimento à gestante com diagnóstico de malformação congênita e adequado manejo na abordagem de doenças emergentes e pandemias. (AU)
La formación de vínculo entre familias de niños con Síndrome Congénito del Zika y profesionales de salud es condición sine qua non para el desarrollo de los niños afectados. El objetivo del estudio es comprender la perspectiva de madres de niños con SCZ sobre el abordaje profesional, formación de vínculos en el proceso de cuidado de la salud durante la epidemia de Zika Vírus. Se trata de un estudio cualitativo, descriptivo-exploratorio, que entrevistó a 25 madres. Los resultados revelan que los profesionales de salud tuvieron prácticas de deshumanización de la asistencia y cometieron violencia obstétrica. Contraponiendo la deshumanización, también hubo casos esporádicos de prácticas humanizadas con formación de vínculo. Los resultados de este estudio señalan la necesidad de estrategias e intervenciones en pro de una mejor atención a la gestante con diagnóstico de malformación congénita y adecuado manejo en el abordaje de enfermedades emergentes y pandemias. (AU)
The bonding between families of children with Zika Congenital Syndrome and health professionals is a sine qua non for the development of the affected children. This study aims to know the perspective of mothers of children with ZCS regarding the professional approach, forming bonds in the health care process during the Zika Virus epidemic. It is a qualitative, descriptive-exploratory research, with interview of 25 mothers. The results reveal that health professionals had practices of dehumanizing care and committed obstetric violence. In contrast to dehumanization, there have also been sporadic cases of humanized practices with bonding. The results of this study point to the need for strategies and interventions for better care for pregnant women with a diagnosis of congenital malformation and adequate management in addressing emerging diseases and pandemics. (AU)
Asunto(s)
Humanos , Femenino , Práctica Profesional/ética , Humanización de la Atención , Infección por el Virus Zika/psicología , Madres/psicología , Salud de la Mujer , Investigación Cualitativa , Violencia ObstétricaRESUMEN
Objetivo: Analisar a associação entre determinantes sociais e morbidades para os desfechos de internação, internação em unidade de terapia intensiva e óbito por COVID-19 no Espírito Santo, Brasil. Métodos: Estudo transversal, com dados secundários de casos confirmados de COVID-19 notificados no Sistema de Informação de Agravos de Notificação. Utilizou-se regressão de Poisson para estimar as razões de prevalências. Resultados: Foram estudados 104.384 casos, notificados entre 28 de fevereiro e 1º de setembro de 2020. Os desfechos em estudo foram mais frequentes entre indivíduos do sexo masculino, idosos, de raça/cor da pele amarela ou preta, sem escolaridade, com multimorbidade. Todas as morbidades associaram-se a maior risco de desfechos desfavoráveis. Observou-se maior risco de óbito entre pessoas com idade superior a 60 anos (RP=56,31 - IC95% 34,24;92,61), multimorbidades (RP=3,63 - IC95% 3,16;4,17), doença renal (RP=3,42 - IC95% 2,81;4,15) e neoplasias (RP=3,15 - IC95% 2,41;4,13). Conclusão: Evidencia-se o efeito dos determinantes sociais e morbidades em internação e óbitos por COVID-19.
Objetivo: Analizar la asociación entre determinantes sociales y morbilidad para los resultados de hospitalización, ingreso en unidad de cuidados intensivos y muerte por COVID-19 en el Estado de Espírito Santo, Brasil. Métodos: Estudio transversal con datos secundarios de casos confirmados de COVID-19, reportados en el Sistema de Información de Enfermedades Notificables. Se utilizó la regresión de Poisson para estimar las razones de prevalencia. Resultados: Se estudiaron 104.384 casos notificados entre el 28 de Febrero y el 1 de Septiembre de 2020. Los desenlaces en estudio fueron más frecuentes entre hombres, ancianos, amarillos, seguidos de negros, no educados y con multimorbilidad. Hubo un mayor riesgo de muerte entre las personas mayores de 60 años (RP=56,31 - IC95% 34,24;92,61), multimorbilidades (RP=3,63 - IC95% 3,16;4,17), enfermedad renal (RP=3,42 - IC95% 2,81;4,15) y neoplasias (RP=3,15 - IC95% 2,41;4,13). Conclusión: El efecto de los determinantes sociales y las morbilidades sobre la hospitalización y las muertes por COVID-19 es evidente.
Objective: To analyze the association between social determinants and morbidities for the outcomes of hospitalization, intensive care unit admission and death by COVID-19 in Espírito Santo State, Brazil. Methods: Cross-sectional study with secondary data from confirmed cases of COVID-19, reported in the Notifiable Diseases Information System. Poisson regression was used to estimate the prevalence ratios. Results: 104,384 cases reported between February 28th and September 1st, 2020 were studied. The outcomes under study were more frequent among male, elderly, yellow, followed by black, uneducated and with multimorbidity. There was a higher risk of death among people over the age of 60 (PR=56.31 - 95%CI 34.24;92.61), multimorbidities (PR=3.63 - 95%CI 3.16;4.17), kidney disease (PR=3.42 - 95%CI 2.81;4.15) and neoplasms (PR=3.15 - 95%CI 2.41;4.13). Conclusion: The effect of social determinants and morbidities on hospitalization and deaths by COVID-19 is evident.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Determinantes Sociales de la Salud , COVID-19/mortalidad , COVID-19/epidemiología , Hospitalización/estadística & datos numéricos , Brasil/epidemiología , Comorbilidad , Factores de Riesgo , Unidades de Cuidados Intensivos/estadística & datos numéricosRESUMEN
ABSTRACT: Objective: To analyze early and late maternal complications associated with the mode of delivery in a birth cohort in Brazil, using the propensity score technique for analysis. Methods: This is a prospective cohort study, using data from the Pelotas Birth Cohort, RS, 2004. A total of 4,189 women were included and a descriptive analysis of the data and subsequent calculation of the propensity and pairing score of vaginal delivery women and cesarean delivery women with similar scores (1,366 pairs). We then assessed the difference in outcome risk between the groups. Results: Women in the cesarean group had 2.9 percentage points (pp) more risk of postpartum infection, 1.13 p.p. more risk of urinary infection, 1.10 p.p. more risk of anesthetic complications and 1.24 p.p. higher risk of headache compared to vaginal delivery, but less risk of anemia (-2.43 pp) and hemorrhoids (-1.24 p.p.). The use of propensity scores is extremely useful for reducing bias and increasing accuracy in observational studies when experimental studies cannot be performed. Conclusion: Cesarean sections have been associated with a higher prevalence of postpartum and urinary tract infections, anesthetic complications and headache and lower prevalence of anemia and hemorrhoids, so they should be performed with clear indications and when their benefits outweigh potential risks.
RESUMO: Objetivo: Analisar as complicações maternas precoces e tardias, associadas à via de parto, em uma coorte de nascimentos no Brasil, utilizando para a análise a técnica de escores de propensão. Métodos: Trata-se de estudo do tipo coorte prospectiva, utilizando dados da Coorte de Nascimentos de Pelotas (RS), de 2004. Incluíram-se 4.189 mulheres, e realizaram-se análise descritiva dos dados e posterior cálculo do escore de propensão e pareamento das mulheres de parto vaginal com as mulheres de parto cesárea com escores semelhantes (1.366 pares), avaliando a diferença no risco do desfecho entre os grupos. Resultados: As mulheres do grupo cesárea apresentaram 2,9 pontos percentuais (p.p.) a mais de risco de infecção pós-parto, 1,13 p.p. a mais de risco de infecção urinária, 1,10 p.p. a mais de risco de complicações anestésicas e 1,24 p.p. a mais de risco de cefaleia que as de parto vaginal, porém apresentaram menor risco de anemia (-2,43 p.p.) e hemorroidas (-1,24 p.p.). A utilização de escores de propensão é extremamente útil para a redução de vieses e o aumento da precisão em estudos observacionais, quando estudos experimentais não podem ser realizados. Conclusão: As cesáreas associaram-se a maiores prevalências de infecções pós-parto e urinária, complicações anestésicas e cefaleia e menores prevalências de anemia e hemorroidas, portanto devem ser realizadas com indicações claras e quando seus benefícios superam potenciais riscos.
Asunto(s)
Humanos , Femenino , Embarazo , Cesárea , Parto Obstétrico , Brasil/epidemiología , Estudios Prospectivos , Puntaje de PropensiónRESUMEN
INTRODUCTION: The rates of cesarean section births significantly increased in Brazil and worldwide in recent years; and along with them, the interest in studying the complications related to this procedure. OBJECTIVE: To assess the early and late maternal complications associated with the mode of delivery in up to six years after labor. METHODS: This is a prospective cohort study that followed all births in the city of Pelotas, in Southern Brazil (4,244 mothers) in 2004, for a period of 6 years. Descriptive analyses and the association between the outcome and mode of delivery were performed. The control for potential confounding factors was performed using Poisson regression with robust error variance. RESULTS: About half (44.9%) of the women underwent cesarean section. Cesarean sections were associated with a 56% higher risk of early complications, 2.98 times higher risk of postpartum infection, 79% higher risk of urinary tract infection, 2.40 times higher risk of pain, 6.16 times higher risk of headaches, and 12 times higher risk of anesthetic complications compared to the vaginal delivery. Cesarean section was a protection factor against the presence of hemorrhoids. The mode of delivery was not associated with any of the late complications studied. CONCLUSIONS: Due to the risk of associated complications, cesarean sections should be performed with caution, when their benefits outweigh the risks.
INTRODUÇÃO: As taxas de cesárea aumentaram significativamente no Brasil e no mundo nos últimos anos; e junto delas o interesse em estudar as complicações relacionadas a esse procedimento. OBJETIVO: Avaliar as complicações maternas precoces e tardias relacionadas à via de parto, por até seis anos após o parto. MÉTODOS: Trata-se de um estudo tipo coorte prospectiva que acompanhou todos os nascimentos da cidade de Pelotas, no Sul do Brasil (4.244 mães), no ano de 2004, por um período de 6 anos. Foram realizadas análises descritivas e de associação entre o desfecho e a via de parto. O controle para potenciais fatores de confusão foi realizado através da regressão de Poisson com variância robusta. RESULTADOS: Cerca da metade das mulheres (44,9%) foram submetidas à cesárea. O parto cesárea foi associado a um risco 56% maior de complicações precoces, 2,98 vezes maior de infecção pós-parto, 79% mais risco de infecção urinária, 2,40 vezes maior de dor, 6,16 vezes maior de cefaleia e mais de 12 vezes maior de complicações anestésicas, quando comparado ao parto vaginal. A cesárea foi proteção contra a presença de hemorroidas. A via de parto não foi associada a nenhuma das complicações tardias estudadas. CONCLUSÃO: Devido ao risco de complicações associado, as cesáreas devem ser realizadas com cautela, quando seus benefícios superam os riscos.
Asunto(s)
Cesárea/efectos adversos , Parto Normal/efectos adversos , Trastornos Puerperales/etiología , Adulto , Brasil , Estudios de Cohortes , Parto Obstétrico/efectos adversos , Parto Obstétrico/métodos , Femenino , Humanos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Embarazo , Trastornos Puerperales/epidemiología , Medición de Riesgo , Factores de Tiempo , Adulto JovenRESUMEN
ABSTRACT Objectives. To identify evidence that income, education, or ethnicity might be associated with low birthweight, small-for-gestational-age birth, or preterm birth. Methods. A systematic review was conducted using searches in two online databases, PubMed and Literature in the Health Sciences in Latin America and the Caribbean (LILACS). The searches covered materials published between 1 January 1982 and 5 May 2016. The search terms used were (“infant, premature” OR “infant, small for gestational age” OR “fetal growth retardation”) AND (“socioeconomic factors” OR “ethnic groups” OR “maternal age”). Results. A total of 3 070 references that met the initial selection criteria were analyzed, and 157 relevant studies were fully read. We located 18 studies that investigated associations of family or maternal income, education, or ethnicity with low birthweight, small-for-gestational-age birth, or preterm birth. Of the 18, 10 of them involved high-income countries, and 8 dealt with middle- or low-income countries. Greater evidence was found for an association between ethnicity and the three outcomes studied, particularly for prematurity among children of black mothers. There was little evidence for an association between maternal/family income or education and any of the three outcomes. Conclusions. Income and education weren’t determinants for low birthweight, small-for-gestational-age birth, or preterm birth. However, black ethnicity was strongly associated with the three outcomes, especially with prematurity.
[RESUMEN]. Objetivos. Encontrar evidencia de que los ingresos, la educación o la etnicidad podrían estar asociados con el peso bajo al nacer, el peso bajo para la edad gestacional o el nacimiento prematuro. Métodos. Se realizó una revisión sistemática mediante búsquedas en dos bases de datos en línea, PubMed y LILACS (Literature in the Health Sciences in Latin America and the Caribbean). Las búsquedas abarcaron los materiales publicados entre el 1 de enero de 1982 y el 5 de mayo del 2016. Los términos de búsqueda usados fueron (“infant, premature” O “infant, small for gestational age” O “fetal growth retardation”) [“lactante, prematuro” O “lactante, pequeño para edad gestacional” O “retraso del crecimiento fetal”] Y (“socioeconomic factors” O “ethnic group”) [“factores socioeconómicos” O “grupos étnicos” O “edad materna”]. Resultados. Se analizó un total de 3 070 referencias que satisficieron los criterios de selección iniciales y se leyeron íntegramente 157 estudios pertinentes. Ubicamos 18 estudios que investigaron las asociaciones entre los ingresos, la educación o la etnicidad de la familia o la madre y el peso bajo al nacer, el peso bajo para la edad gestacional o el nacimiento prematuro. De estos 18 estudios, 10 fueron en países de ingresos altos y 8 en países de ingresos medianos o bajos. Se encontró más evidencia con respecto a la asociación entre la etnicidad y los tres resultados estudiados, en particular para la prematuridad en los hijos de mujeres de raza negra. Fue poca la evidencia respecto de la asociación entre los ingresos o la educación de la madre o la familia y cualquiera de los tres resultados. Conclusiones. Los ingresos y la educación no fueron determinantes para el peso bajo al nacer o el peso bajo para la edad gestacional. Sin embargo, la etnicidad negra mostró una asociación estrecha con los tres resultados, especialmente con la prematuridad.
[RESUMO]. Objetivos. Identificar evidências de que renda, escolaridade ou grupo étnico poderiam estar associados ao baixo peso ao nascer, recém-nascido pequeno para a idade gestacional ou prematuridade. Métodos. Um estudo de revisão sistemática foi realizado fazendo-se buscas em duas bases de dados online, PubMed e Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). As buscas abrangeram os materiais publicados entre 1o de janeiro de 1982 e 5 de maio de 2016. Os termos de busca usados foram: (“infant, premature” OR “infant, small for gestational age” OR “fetal growth retardation”) [(“recém-nascido, prematuro” OU “recém-nascido, pequeno para idade gestacional” OU “retardo do crescimento fetal”)] E (“socioeconomic factors” OR “ethnic groups” OR “maternal age”) [(“fatores socioeconômicos” OU “grupos étnicos” OU “idade materna”)]. Resultados. Todas as 3.070 referências que satisfizeram os critérios iniciais de seleção foram analisadas e 157 estudos relevantes foram lidos na íntegra. Foram identificados 18 estudos que investigaram a associação entre renda familiar ou materna, escolaridade ou grupo étnico com baixo peso ao nascer, recém-nascido pequeno para a idade gestacional ou prematuridade. Dentre os 18 estudos, 10 foram conduzidos em países de alta renda e 8 em países de baixa e média renda. Um volume maior de evidências foi observado para a associação entre grupo étnico e os três desfechos estudados, sobretudo prematuridade em filhos de mulheres negras. Poucas evidências foram encontradas para a associação entre renda familiar/materna ou escolaridade e qualquer um dos três desfechos. Conclusões. Renda e escolaridade não foram determinantes do baixo peso ao nascer, recém-nascido pequeno para a idade gestacional e prematuridade. Porém, o grupo étnico negro teve uma forte associação com os três desfechos, sobretudo com prematuridade.
Asunto(s)
Renta , Educación , Etnicidad , Retardo del Crecimiento Fetal , Recien Nacido Prematuro , Renta , Educación , Etnicidad , Retardo del Crecimiento Fetal , Recien Nacido Prematuro , Recien Nacido Prematuro , Renta , Educación , Retardo del Crecimiento FetalRESUMEN
OBJECTIVES: To identify evidence that income, education, or ethnicity might be associated with low birthweight, small-for-gestational-age birth, or preterm birth. METHODS: A systematic review was conducted using searches in two online databases, PubMed and Literature in the Health Sciences in Latin America and the Caribbean (LILACS). The searches covered materials published between 1 January 1982 and 5 May 2016. The search terms used were ("infant, premature" OR "infant, small for gestational age" OR "fetal growth retardation") AND ("socioeconomic factors" OR "ethnic groups" OR "maternal age"). RESULTS: A total of 3 070 references that met the initial selection criteria were analyzed, and 157 relevant studies were fully read. We located 18 studies that investigated associations of family or maternal income, education, or ethnicity with low birthweight, small-for-gestational-age birth, or preterm birth. Of the 18, 10 of them involved high-income countries, and 8 dealt with middle- or low-income countries. Greater evidence was found for an association between ethnicity and the three outcomes studied, particularly for prematurity among children of black mothers. There was little evidence for an association between maternal/family income or education and any of the three outcomes. CONCLUSIONS: Income and education weren't determinants for low birthweight, small-for-gestational-age birth, or preterm birth. However, black ethnicity was strongly associated with the three outcomes, especially with prematurity.
RESUMEN
ABSTRACT Objectives. To identify evidence that income, education, or ethnicity might be associated with low birthweight, small-for-gestational-age birth, or preterm birth. Methods. A systematic review was conducted using searches in two online databases, PubMed and Literature in the Health Sciences in Latin America and the Caribbean (LILACS). The searches covered materials published between 1 January 1982 and 5 May 2016. The search terms used were ("infant, premature" OR "infant, small for gestational age" OR "fetal growth retardation") AND ("socioeconomic factors" OR "ethnic groups" OR "maternal age"). Results. A total of 3 070 references that met the initial selection criteria were analyzed, and 157 relevant studies were fully read. We located 18 studies that investigated associations of family or maternal income, education, or ethnicity with low birthweight, small-for-gestational-age birth, or preterm birth. Of the 18, 10 of them involved high-income countries, and 8 dealt with middle- or low-income countries. Greater evidence was found for an association between ethnicity and the three outcomes studied, particularly for prematurity among children of black mothers. There was little evidence for an association between maternal/family income or education and any of the three outcomes. Conclusions. Income and education weren't determinants for low birthweight, small-for-gestational-age birth, or preterm birth. However, black ethnicity was strongly associated with the three outcomes, especially with prematurity.
RESUMEN Objetivos. Encontrar evidencia de que los ingresos, la educación o la etnicidad podrían estar asociados con el peso bajo al nacer, el peso bajo para la edad gestacional o el nacimiento prematuro. Métodos. Se realizó una revisión sistemática mediante búsquedas en dos bases de datos en línea, PubMed y LILACS (Literature in the Health Sciences in Latin America and the Caribbean). Las búsquedas abarcaron los materiales publicados entre el 1 de enero de 1982 y el 5 de mayo del 2016. Los términos de búsqueda usados fueron ("infant, premature" O "infant, small for gestational age" O "fetal growth retardation") ["lactante, prematuro" O "lactante, pequeño para edad gestacional" O "retraso del crecimiento fetal"] Y ("socioeconomic factors" O "ethnic group") ["factores socioeconómicos" O "grupos étnicos" O "edad materna"]. Resultados. Se analizó un total de 3 070 referencias que satisficieron los criterios de selección iniciales y se leyeron íntegramente 157 estudios pertinentes. Ubicamos 18 estudios que investigaron las asociaciones entre los ingresos, la educación o la etnicidad de la familia o la madre y el peso bajo al nacer, el peso bajo para la edad gestacional o el nacimiento prematuro. De estos 18 estudios, 10 fueron en países de ingresos altos y 8 en países de ingresos medianos o bajos. Se encontró más evidencia con respecto a la asociación entre la etnicidad y los tres resultados estudiados, en particular para la prematuridad en los hijos de mujeres de raza negra. Fue poca la evidencia respecto de la asociación entre los ingresos o la educación de la madre o la familia y cualquiera de los tres resultados. Conclusiones. Los ingresos y la educación no fueron determinantes para el peso bajo al nacer o el peso bajo para la edad gestacional. Sin embargo, la etnicidad negra mostró una asociación estrecha con los tres resultados, especialmente con la prematuridad.
RESUMO Objetivos. Identificar evidências de que renda, escolaridade ou grupo étnico poderiam estar associados ao baixo peso ao nascer, recém-nascido pequeno para a idade gestacional ou prematuridade. Métodos. Um estudo de revisão sistemática foi realizado fazendo-se buscas em duas bases de dados online, PubMed e Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). As buscas abrangeram os materiais publicados entre 1o de janeiro de 1982 e 5 de maio de 2016. Os termos de busca usados foram: ("infant, premature" OR "infant, small for gestational age" OR "fetal growth retardation") [("recém-nascido, prematuro" OU "recém-nascido, pequeno para idade gestacional" OU "retardo do crescimento fetal")] E ("socioeconomic factors" OR "ethnic groups" OR "maternal age") [("fatores socioeconômicos" OU "grupos étnicos" OU "idade materna")]. Resultados. Todas as 3.070 referências que satisfizeram os critérios iniciais de seleção foram analisadas e 157 estudos relevantes foram lidos na íntegra. Foram identificados 18 estudos que investigaram a associação entre renda familiar ou materna, escolaridade ou grupo étnico com baixo peso ao nascer, recém-nascido pequeno para a idade gestacional ou prematuridade. Dentre os 18 estudos, 10 foram conduzidos em países de alta renda e 8 em países de baixa e média renda. Um volume maior de evidências foi observado para a associação entre grupo étnico e os três desfechos estudados, sobretudo prematuridade em filhos de mulheres negras. Poucas evidências foram encontradas para a associação entre renda familiar/materna ou escolaridade e qualquer um dos três desfechos. Conclusões. Renda e escolaridade não foram determinantes do baixo peso ao nascer, recém-nascido pequeno para a idade gestacional e prematuridade. Porém, o grupo étnico negro teve uma forte associação com os três desfechos, sobretudo com prematuridade.
Asunto(s)
Etnicidad , Retardo del Crecimiento Fetal/diagnóstico , Recien Nacido Prematuro , Educación , RentaRESUMEN
RESUMO: Introdução: As taxas de cesárea aumentaram significativamente no Brasil e no mundo nos últimos anos; e junto delas o interesse em estudar as complicações relacionadas a esse procedimento. Objetivo: Avaliar as complicações maternas precoces e tardias relacionadas à via de parto, por até seis anos após o parto. Métodos: Trata-se de um estudo tipo coorte prospectiva que acompanhou todos os nascimentos da cidade de Pelotas, no Sul do Brasil (4.244 mães), no ano de 2004, por um período de 6 anos. Foram realizadas análises descritivas e de associação entre o desfecho e a via de parto. O controle para potenciais fatores de confusão foi realizado através da regressão de Poisson com variância robusta. Resultados: Cerca da metade das mulheres (44,9%) foram submetidas à cesárea. O parto cesárea foi associado a um risco 56% maior de complicações precoces, 2,98 vezes maior de infecção pós-parto, 79% mais risco de infecção urinária, 2,40 vezes maior de dor, 6,16 vezes maior de cefaleia e mais de 12 vezes maior de complicações anestésicas, quando comparado ao parto vaginal. A cesárea foi proteção contra a presença de hemorroidas. A via de parto não foi associada a nenhuma das complicações tardias estudadas. Conclusão: Devido ao risco de complicações associado, as cesáreas devem ser realizadas com cautela, quando seus benefícios superam os riscos.
ABSTRACT: Introduction: The rates of cesarean section births significantly increased in Brazil and worldwide in recent years; and along with them, the interest in studying the complications related to this procedure. Objective: To assess the early and late maternal complications associated with the mode of delivery in up to six years after labor. Methods: This is a prospective cohort study that followed all births in the city of Pelotas, in Southern Brazil (4,244 mothers) in 2004, for a period of 6 years. Descriptive analyses and the association between the outcome and mode of delivery were performed. The control for potential confounding factors was performed using Poisson regression with robust error variance. Results: About half (44.9%) of the women underwent cesarean section. Cesarean sections were associated with a 56% higher risk of early complications, 2.98 times higher risk of postpartum infection, 79% higher risk of urinary tract infection, 2.40 times higher risk of pain, 6.16 times higher risk of headaches, and 12 times higher risk of anesthetic complications compared to the vaginal delivery. Cesarean section was a protection factor against the presence of hemorrhoids. The mode of delivery was not associated with any of the late complications studied. Conclusions: Due to the risk of associated complications, cesarean sections should be performed with caution, when their benefits outweigh the risks.
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Humanos , Femenino , Embarazo , Adulto , Adulto Joven , Trastornos Puerperales/etiología , Cesárea/efectos adversos , Parto Normal/efectos adversos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Trastornos Puerperales/epidemiología , Factores de Tiempo , Brasil , Estudios de Cohortes , Medición de Riesgo , Parto Obstétrico/efectos adversos , Parto Obstétrico/métodosRESUMEN
OBJECTIVE: The objective of this study was to determine the risks of severe acute maternal complications associated with cesarean section without medical indication. METHODS: A systematic review was carried out with meta-analysis. The literature search was performed systematically, in multiple stages, in the PubMed, Lilacs, and Web of Science databases using the following descriptors: (postpartum period) and (cesarean section or natural childbirth) and ((morbidity or mortality) or (postpartum hemorrhage) or (puerperal infection) or (surgical infection) or (puerperal disorders)). The protocol of the study was registered at PROSPERO as CRD42016032933. A total of 1,328 articles were found; after selection, eight publications that met the study objective and inclusion criteria were selected, with information on 1,051,543 individuals. RESULTS: The results obtained in the meta-analyses indicate that women with cesarean section have a higher chance of maternal death (OR = 3.10, 95%CI 1.92-5.00) and postpartum infection (OR = 2.83, 95%CI, 1.585.06), but they have a lower chance of hemorrhage (OR = 0.52, 95%CI 0.48-0.57). For the blood transfusion outcome, the group effect was not associated with the type of delivery (95%CI 0.88-2.81). CONCLUSIONS: The quality of evidence was considered low for hemorrhage and blood transfusion and moderate for postpartum infection and maternal death. Thus, cesarean sections should be performed with caution and safety, especially when its benefits outweigh the risks of a surgical procedure.
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Cesárea/efectos adversos , Mortalidad Materna , Parto Normal/estadística & datos numéricos , Trastornos Puerperales/epidemiología , Transfusión Sanguínea , Cesárea/estadística & datos numéricos , Femenino , Humanos , Hemorragia Posparto/etiología , Hemorragia Posparto/mortalidad , Periodo Posparto , Embarazo , Resultado del Embarazo/epidemiología , Trastornos Puerperales/mortalidad , Factores de RiesgoRESUMEN
This study aimed to analyze time trend of female mortality due to assault in Brazil, regions and states from 2002 to 2012. This is an ecological times series study with secondary data from women aged 20-59 years who died due to assault. Mortality rates were analyzed by simple linear regression and stratified by region, Gini Index and Human Development Index (HDI). The trend of female rate of mortality due to assault was stable in the country, with differences between states and regions. The Midwest had the highest rates and stagnation trend. There was an increased trend in the North, Northeast and South and a decreased trend in the Southeast. The states of the tertile with the highest HDI evidenced a declining trend and stabilization in the first and second tertiles. An increased mortality rate was recorded in states with greater social inequality. Notwithstanding the national stabilization behavior, results point to the need for social policies appropriate to the specificities of states and regions.
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Violencia de Género/estadística & datos numéricos , Mortalidad/tendencias , Adulto , Brasil/epidemiología , Femenino , Humanos , Modelos Lineales , Persona de Mediana Edad , Factores Socioeconómicos , Factores de Tiempo , Adulto JovenRESUMEN
Resumo O objetivo do estudo foi analisar a tendência temporal da taxa de mortalidade feminina por agressão no Brasil, regiões e estados no período de 2002 a 2012. Estudo ecológico de série temporal com dados secundários de mulheres na faixa etária de 20 a 59 anos mortas por agressão. As taxas de mortalidade foram analisadas por regressão linear simples, estratificadas por região, Índice de Gini e Índice de Desenvolvimento Humano (IDH). Evidenciou-se no país tendência estável na taxa de mortalidade feminina por agressão, com diferenças entre estados e regiões. O Centro-Oeste apresentou maiores taxas e tendência de estagnação. Observou-se tendência de aumento nas regiões Norte, Nordeste e Sul e diminuição na região Sudeste. Os estados pertencentes ao tercil com maior IDH apresentam tendência de declínio e estabilização nos 1º e 2º tercis. Foi observado aumento da taxa de mortalidade nos estados com maior desigualdade social. Apesar do comportamento de estabilização no país os resultados apontam para a necessidade de políticas sociais adequadas às especificidades dos estados e regiões.
Abstract This study aimed to analyze time trend of female mortality due to assault in Brazil, regions and states from 2002 to 2012. This is an ecological times series study with secondary data from women aged 20-59 years who died due to assault. Mortality rates were analyzed by simple linear regression and stratified by region, Gini Index and Human Development Index (HDI). The trend of female rate of mortality due to assault was stable in the country, with differences between states and regions. The Midwest had the highest rates and stagnation trend. There was an increased trend in the North, Northeast and South and a decreased trend in the Southeast. The states of the tertile with the highest HDI evidenced a declining trend and stabilization in the first and second tertiles. An increased mortality rate was recorded in states with greater social inequality. Notwithstanding the national stabilization behavior, results point to the need for social policies appropriate to the specificities of states and regions.