ABSTRACT
MAIN RESULTS: From 2000 to 2020, maternal mortality among adolescents and young adults showed a decreasing trend in the state of Bahia. It could be seen an inverse and significant correlation between the highest number of prenatal care visits and maternal mortality in the studied groups. IMPLICATIONS FOR SERVICES: The study suggests the importance of quality obstetric care during prenatal, childbirth, and postpartum period for reducing maternal mortality among adolescents and young adults, especially from preventable causes. PERSPECTIVES: Improving the records of causes of death on information systems, enhancing obstetric care, and investing in sexual and reproductive health policies aimed at adolescents may contribute to the reduction of maternal deaths. OBJECTIVE: to analyze the temporal trend of maternal mortality and correlate it with prenatal care coverage among adolescents and young adults, state of Bahia, Brazil, 2000-2020. METHODS: this was an ecological time-series study and correlation between maternal deaths and prenatal care visits in 10-19 and 20-24 age groups, using the Mortality Information System; the trend analysis was performed by means of Prais-Winsten regression, according to race/skin color, timing and causes of death; and Spearman coefficient was used for correlation. RESULTS: in the study period, 418 deaths among adolescents and 574 among young adults were recorded; maternal mortality ratio was 59.7 and 63.2 deaths/100,000 live births, with a significant decreasing trend (-2.2% and -2.9% respectively); it could be seen an inverse correlation between a higher number of prenatal care visits and maternal mortality in the age groups. CONCLUSION: maternal mortality showed a decreasing trend in the study period, but with high proportions of death; there was a significant correlation between prenatal care coverage and maternal mortality among adolescents and young adults.
Subject(s)
Maternal Death , Maternal Mortality , Female , Pregnancy , Humans , Adolescent , Young Adult , Brazil/epidemiology , Prenatal Care , Delivery, ObstetricABSTRACT
BACKGROUND: Cognitive event-related potentials (ERPs) allow for lateralization of the epileptogenic zone (EZ) to estimate the reserve of memory in the contralateral non-epileptogenic hemisphere, and to investigate the prognosis of temporal lobe seizure control in unilateral temporal lobe epilepsy (TLE). OBJECTIVE: To define the accuracy of cognitive evoked anterior mesial temporal lobe (AMTL-N400) and P600 potentials in detecting the epileptogenic zone in temporal lobe epilepsy (TLE), and second, to evaluate the possibility of using them as markers of cognitive outcome. METHODS: The systematic review using Medline/PubMed, Embase, and Lilacs database was conducted in September 2021. Only articles published in English from 1985 to June 2021 were included. We searched for studies with: (1) depth intracranial electroencephalography (iEEG) recordings analysis of rhinal and hippocampal activity (2) correlations between ERP results obtained in the mesial temporal regions (AMTL-N400 and P600) and the epileptogenic zone. RESULTS: Six out of the seven studies included in this review defined the laterality of the epileptogenic zone (EZ) during presurgical investigation using ERPs. One study showed that the contralateral AMTL-N400 predicts seizure control. Another study found correlation between the amplitudes of the right AMTL-N400 and postoperative memory performance. CONCLUSIONS: There is evidence that the reduced amplitude of the AMTL-N400 has high accuracy in identifying the epileptogenic zone, as it does in estimating the extent of seizure control and memory impairment in postoperative patients.
ANTECEDENTES: Potenciais relacionados a eventos (PREs) cognitivos permitem a lateralização da zona epileptogênica (ZE), estimar a reserva de memória no hemisfério contralateral não-epileptogênico, e estimar o prognóstico pós-operatório em pacientes com epilepsia do lobo temporal (ELT) unilateral quanto ao controle de crises. OBJETIVO: Definir a acurácia dos potenciais evocados cognitivos do lobo temporal mesial anterior (LTMA-N400) e P600 na detecção da zona epileptogênica na epilepsia do lobo temporal (ELT), além de avaliar a possibilidade de usá-los como marcadores de desfecho cognitivo. MéTODOS: A revisão sistemática foi realizada em setembro de 2021 usando as bases de dados Medline/PubMed, Embase e Lilacs. Apenas artigos publicados em inglês no período entre 1985 e junho de 2021 foram incluídos. Buscamos estudos com: (1) análises dos registros de electroencefalografia intracraniana (EEGi) da atividade rinal e hipocampal (2) correlações entre os resultados de PREs obtidos nas regiões temporais mesiais (AMTL-N400 e P600) e a zona epileptogênica. RESULTADOS: Seis dos sete estudos incluídos nesta revisão definiram a lateralidade da zona epileptogênica (ZE) durante a investigação pré-cirúrgica usando PREs. Um estudo mostrou que o AMTL-N400 contralateral prediz o controle das crises. Outro estudo encontrou correlação entre as amplitudes do AMTL-N400 direito e o desempenho da memória pós-operatória. CONCLUSõES: Há evidências de que a amplitude reduzida do AMTL-N400 tem alta precisão na identificação da zona epileptogênica, assim como na estimativa do prognóstico quanto ao controle de crises a longo prazo e prejuízo da memória em pacientes submetidos à cirurgia ressectiva.
Subject(s)
Epilepsy, Temporal Lobe , Epilepsy , Humans , Male , Female , Evoked Potentials/physiology , Epilepsy, Temporal Lobe/surgery , Epilepsy, Temporal Lobe/psychology , Electroencephalography , Hippocampus/surgery , SeizuresABSTRACT
Abstract Background Cognitive event-related potentials (ERPs) allow for lateralization of the epileptogenic zone (EZ) to estimate the reserve of memory in the contralateral non-epileptogenic hemisphere, and to investigate the prognosis of temporal lobe seizure control in unilateral temporal lobe epilepsy (TLE). Objective To define the accuracy of cognitive evoked anterior mesial temporal lobe (AMTL-N400) and P600 potentials in detecting the epileptogenic zone in temporal lobe epilepsy (TLE), and second, to evaluate the possibility of using them as markers of cognitive outcome. Methods The systematic review using Medline/PubMed, Embase, and Lilacs database was conducted in September 2021. Only articles published in English from 1985 to June 2021 were included. We searched for studies with: (1) depth intracranial electroencephalography (iEEG) recordings analysis of rhinal and hippocampal activity (2) correlations between ERP results obtained in the mesial temporal regions (AMTL-N400 and P600) and the epileptogenic zone. Results Six out of the seven studies included in this review defined the laterality of the epileptogenic zone (EZ) during presurgical investigation using ERPs. One study showed that the contralateral AMTL-N400 predicts seizure control. Another study found correlation between the amplitudes of the right AMTL-N400 and postoperative memory performance. Conclusions There is evidence that the reduced amplitude of the AMTL-N400 has high accuracy in identifying the epileptogenic zone, as it does in estimating the extent of seizure control and memory impairment in postoperative patients.
Resumo Antecedentes Potenciais relacionados a eventos (PREs) cognitivos permitem a lateralização da zona epileptogênica (ZE), estimar a reserva de memória no hemisfério contralateral não-epileptogênico, e estimar o prognóstico pós-operatório em pacientes com epilepsia do lobo temporal (ELT) unilateral quanto ao controle de crises. Objetivo Definir a acurácia dos potenciais evocados cognitivos do lobo temporal mesial anterior (LTMA-N400) e P600 na detecção da zona epileptogênica na epilepsia do lobo temporal (ELT), além de avaliar a possibilidade de usá-los como marcadores de desfecho cognitivo. Métodos A revisão sistemática foi realizada em setembro de 2021 usando as bases de dados Medline/PubMed, Embase e Lilacs. Apenas artigos publicados em inglês no período entre 1985 e junho de 2021 foram incluídos. Buscamos estudos com: (1) análises dos registros de electroencefalografia intracraniana (EEGi) da atividade rinal e hipocampal (2) correlações entre os resultados de PREs obtidos nas regiões temporais mesiais (AMTL-N400 e P600) e a zona epileptogênica. Resultados Seis dos sete estudos incluídos nesta revisão definiram a lateralidade da zona epileptogênica (ZE) durante a investigação pré-cirúrgica usando PREs. Um estudo mostrou que o AMTL-N400 contralateral prediz o controle das crises. Outro estudo encontrou correlação entre as amplitudes do AMTL-N400 direito e o desempenho da memória pós-operatória. Conclusões Há evidências de que a amplitude reduzida do AMTL-N400 tem alta precisão na identificação da zona epileptogênica, assim como na estimativa do prognóstico quanto ao controle de crises a longo prazo e prejuízo da memória em pacientes submetidos à cirurgia ressectiva.
ABSTRACT
Objetivo: analisar a tendência temporal da mortalidade materna e correlacioná-la com a cobertura pré-natal entre adolescentes e adultas jovens, Bahia, Brasil, 2000-2020. Métodos: estudo ecológico de série temporal e correlação entre óbitos maternos e consulta de pré-natal aos 10-19 e 20-24 anos, utilizando-se o Sistema de Informações sobre Mortalidade; a tendência foi analisada pela regressão de Prais-Winsten, segundo raça/cor da pele, causas e momento do óbito; para a correlação, utilizou-se o coeficiente de Spearman. Resultados: no período, foram registrados 418 óbitos de adolescentes e 574 de adultas jovens; razão de mortalidade materna de 59,7 e 63,2 óbitos/100 mil nascidos vivos, com tendência decrescente significante (-2,2% e -2,9% respectivamente); observou-se correlação inversa entre maior número de consultas e mortalidade materna, nos grupos etários. Conclusão: a mortalidade materna apresentou tendência de redução no período, porém com altas proporções de óbito; houve correlação significante entre cobertura pré-natal e mortalidade materna, entre adolescentes e adultas jovens.
Objective: to analyze the temporal trend of maternal mortality and correlate it with prenatal care coverage among adolescents and young adults, state of Bahia, Brazil, 2000-2020. Methods: this was an ecological time-series study and correlation between maternal deaths and prenatal care visits in 10-19 and 20-24 age groups, using the Mortality Information System; the trend analysis was performed by means of Prais-Winsten regression, according to race/skin color, timing and causes of death; and Spearman coefficient was used for correlation. Results: in the study period, 418 deaths among adolescents and 574 among young adults were recorded; maternal mortality ratio was 59.7 and 63.2 deaths/100,000 live births, with a significant decreasing trend (-2.2% and -2.9% respectively); it could be seen an inverse correlation between a higher number of prenatal care visits and maternal mortality in the age groups. Conclusion: maternal mortality showed a decreasing trend in the study period, but with high proportions of death; there was a significant correlation between prenatal care coverage and maternal mortality among adolescents and young adults.
Objetivo: analizar la tendencia temporal de la mortalidad materna y correlacionarla con la cobertura prenatal, entre adolescentes y adultas jóvenes, en el estado de Bahía, período 2000-2020. Métodos: estudio ecológico de series temporales y correlación entre muertes maternas y atención prenatal, en grupos de edad de 10-19 y 20-24, utilizando el Sistema de Información de Mortalidad. Analizó la tendencia mediante regresión de Prais-Winsten, según raza/color de piel, causas y hora de muerte; para correlación, el coeficiente de Spearman. Resultados: en el período se registraron 418 muertes de adolescentes y 574 de adultas jóvenes; razón de mortalidad materna de 59,7 y 63,2 muertes/100.000 nacidos vivos, con importante tendencia a la baja (-2,2%; -2,9%, respectivamente). Se observó correlación inversa entre el mayor número de consultas y la mortalidad materna en grupos. Conclusión: la mortalidad materna mostró tendencia descendente en el período, pero con altas proporciones de muertes. Hubo una correlación significativa entre la cobertura prenatal y la mortalidad materna, adolescente y adulta joven.
Subject(s)
Humans , Female , Pregnancy , Adolescent , Young Adult , Pregnancy Complications/epidemiology , Prenatal Care/statistics & numerical data , Maternal Mortality/trends , Brazil , Time Series Studies , Ecological Studies , Social Determinants of Health , Maternal HealthABSTRACT
BACKGROUND: In the past twenty years, there has been an increasing interest among neuroscientists and physicians in mapping the cortical areas involved in the epileptogenic zone (EZ) through event-related potentials (ERPs) that enable the evaluation of the functional preservation of these areas. The present review is an update on publications on this topic. OBJECTIVE: To investigate the accuracy of the cognitive evoked of the medial temporal lobe P300 (MTL-P300) potential in detecting the EZ in temporal lobe epilepsy (TLE). METHODS: The systematic review of articles on the PubMed, Embase and Lilacs databases was conducted between February and December 2020. Articles published in English from 1985 to December 2020 were included. Additional studies were identified by searching the references of the selected studies and review articles. The studies were included for the following reasons: in-depth intracranial electroencephalography (iEEG) analysis of hippocampal activity; investigations of patients with TLE; and correlations between regarding the ERP results obtained in the temporal regions (MTL-P300) and the EZ. RESULTS: In the three studies analyzed, the authors were able to define the laterality of the EZ during the preoperative investigation through the MTL-P300 results. The sensitivity of this method was of â¼ 70% to 80%, and the specificity between 70% and 94.7%. One of the limitations of the present review was the low number of studies. CONCLUSION: There is evidence that the reduced amplitude of the MTL-P300 has high specificity in identifying the EZ, and this is a good marker for diagnosis in unilateral TLE. The low sensitivity and negative likelihood ratios negative that a normal MTL-P300 response does not exclude the epileptogenicity of the hippocampus.
ANTECEDENTES: Nos últimos 20 anos, tem havido um crescente interesse de neurocientistas e médicos em mapear áreas corticais envolvidas na zona epileptogênica (ZE) por meio de potenciais relacionados a eventos (PREs), que permitem avaliar a preservação funcional dessas áreas. Esta revisão é uma atualização das publicações sobre esse tema. OBJETIVO: Investigar a acurácia do potencial evocado cognitivo do lobo temporal medial P300 (medial temporal lobe P300, MTL-P300, em inglês) na detecção da ZE em casos de epilepsias do lobo temporal (ELT). MéTODOS: A revisão sistemática de artigos nas bases de dados PubMed, Embase e Lilacs foi realizada entre fevereiro e dezembro de 2020. Foram incluídos artigos publicados em inglês de 1985 a dezembro de 2020. Estudos adicionais foram identificados por meio de busca nas referências dos estudos selecionados e artigos de revisão. Os estudos foram incluídos pelas seguintes razões: análise detalhada por meio de eletroencefalografia intracraniana (iEEG) da atividade hipocampal; investigações de pacientes com ELT; e correlações entre os resultados de ERP obtidos nas regiões temporais (MTL-P300) e na ZE. RESULTADOS: Nos três estudos analisados, os autores foram capazes de definir a lateralidade da ZE durante a investigação pré-operatória por meio dos resultados do MTL-P300. A sensibilidade deste método foi de 70% a 80%, e a especificidade, entre 70% e 94.7%. Uma das limitações desta revisão foi o baixo número de estudos. CONCLUSãO: Há evidências de que a amplitude reduzida do MTL-P300 tem alta especificidade na identificação da ZE, e este é um bom marcador para o diagnóstico na ELT unilateral. A baixa sensibilidade e a razão de verossimilhança negativa indicam que a resposta MTL-P300 normal não exclui a epileptogenicidade do hipocampo.
Subject(s)
Epilepsy, Temporal Lobe , Humans , Epilepsy, Temporal Lobe/surgery , Temporal Lobe , Hippocampus , Evoked Potentials , Electrocorticography , Electroencephalography , Magnetic Resonance ImagingABSTRACT
Abstract Background In the past twenty years, there has been an increasing interest among neuroscientists and physicians in mapping the cortical areas involved in the epileptogenic zone (EZ) through event-related potentials (ERPs) that enable the evaluation of the functional preservation of these areas. The present review is an update on publications on this topic. Objective To investigate the accuracy of the cognitive evoked of the medial temporal lobe P300 (MTL-P300) potential in detecting the EZ in temporal lobe epilepsy (TLE). Methods The systematic review of articles on the PubMed, Embase and Lilacs databases was conducted between February and December 2020. Articles published in English from 1985 to December 2020 were included. Additional studies were identified by searching the references of the selected studies and review articles. The studies were included for the following reasons: in-depth intracranial electroencephalography (iEEG) analysis of hippocampal activity; investigations of patients with TLE; and correlations between regarding the ERP results obtained in the temporal regions (MTL-P300) and the EZ. Results In the three studies analyzed, the authors were able to define the laterality of the EZ during the preoperative investigation through the MTL-P300 results. The sensitivity of this method was of ~ 70% to 80%, and the specificity between 70% and 94.7%. One of the limitations of the present review was the low number of studies. Conclusion There is evidence that the reduced amplitude of the MTL-P300 has high specificity in identifying the EZ, and this is a good marker for diagnosis in unilateral TLE. The low sensitivity and negative likelihood ratios negative that a normal MTL-P300 response does not exclude the epileptogenicity of the hippocampus.
Resumo Antecedentes Nos últimos 20 anos, tem havido um crescente interesse de neurocientistas e médicos em mapear áreas corticais envolvidas na zona epileptogênica (ZE) por meio de potenciais relacionados a eventos (PREs), que permitem avaliar a preservação funcional dessas áreas. Esta revisão é uma atualização das publicações sobre esse tema. Objetivo Investigar a acurácia do potencial evocado cognitivo do lobo temporal medial P300 (medial temporal lobe P300, MTL-P300, em inglês) na detecção da ZE em casos de epilepsias do lobo temporal (ELT). Métodos A revisão sistemática de artigos nas bases de dados PubMed, Embase e Lilacs foi realizada entre fevereiro e dezembro de 2020. Foram incluídos artigos publicados em inglês de 1985 a dezembro de 2020. Estudos adicionais foram identificados por meio de busca nas referências dos estudos selecionados e artigos de revisão. Os estudos foram incluídos pelas seguintes razões: análise detalhada por meio de eletroencefalografia intracraniana (iEEG) da atividade hipocampal; investigações de pacientes com ELT; e correlações entre os resultados de ERP obtidos nas regiões temporais (MTL-P300) e na ZE. Resultados Nos três estudos analisados, os autores foram capazes de definir a lateralidade da ZE durante a investigação pré-operatória por meio dos resultados do MTL-P300. A sensibilidade deste método foi de 70% a 80%, e a especificidade, entre 70% e 94.7%. Uma das limitações desta revisão foi o baixo número de estudos. Conclusão Há evidências de que a amplitude reduzida do MTL-P300 tem alta especificidade na identificação da ZE, e este é um bom marcador para o diagnóstico na ELT unilateral. A baixa sensibilidade e a razão de verossimilhança negativa indicam que a resposta MTL-P300 normal não exclui a epileptogenicidade do hipocampo.
ABSTRACT
Abstract Objectives: to analyze possible associations between Specific Hypertensive Gestation Syndrome (SHGS) and sociodemographic, prenatal, and delivery characteristics of young adult and teenage mothers. Methods: a hospital-based cross-sectional study and regional level, gathered from 54 municipalities in the Northeast region of Brazil from 2011-2012, using records from the National Survey, "Born in Brazil". A theoretical conceptual model with three-level hierarchy was established, with SHGS being the outcome variable. A multivariate analysis was performed from the bivariate analysis and p-value, with a significance of < 0.2 by the Wald test. Results: of the 2,960 adolescents and young adults included in the study, 135 (4.6%) developed HSP. The mothers without a partner had 50% (OR=1.53) greater chance of presenting this pathology; while those without adequate schooling for age presented 90% higher chance (OR = 1.86) and those with a prior clinical risk factor, the chance of presenting the outcome was 21 times the chance of those without this antecedent (OR = 21.72). Conclusions: significant associations were identified between SHGS and postpartum adolescents and young adults without a partner, with low schooling and prior clinical risk, signaling the importance of investments in the quality of prenatal care and labor of the most vulnerable groups.
Resumo Objetivos: analisar possíveis associações entre Síndrome Hipertensiva Específica da Gestação (SHEG) e características sociodemográficas, do prénatal e do parto de mães adolescentes e adultas jovens. Métodos: estudo transversal, de base hospitalar e nível regional, ocorrido em 54 municípios da Região Nordeste do Brasil, no período de 2011 e 2012, utilizando registros da Pesquisa Nacional "Nascer no Brasil". Foi estabelecido um modelo teórico conceitual com três níveis de hierarquia, tendo a SHEG como variável desfecho, sendo realizada análise multivariada, a partir das análises bivariadas e p valor, com significância <0,20, pelo teste de Wald. Resultados: do total de 2.960adolescentes e adultas jovens, 135 (4,6%) desenvolveram SHEG. Puérperas sem companheiro apresentaram chance 50% maior (OR=1,53) de apresentar esta patologia; aquelas comescolaridade inadequada para a idade, foi 90% maior (OR = 1,86) e coma presença de antecedente clínico de risco, a chance de apresentar o desfecho foi 21 vezes a chance daquelas sem este antecedente (OR=21,72). Conclusões: foram identificadas associações significantes entre SHEG e puérperas adolescentes e adultas jovens sem companheiro, com baixa escolaridade e antecedentes clínicos de risco, sinalizando a importância dos investimentos na qualidade da assistência prénatal e trabalho de parto dos grupos mais vulneráveis.
Subject(s)
Humans , Female , Pregnancy , Pregnancy in Adolescence , Hypertension, Pregnancy-Induced , Postpartum Period , Young Adult , Prenatal Care , Socioeconomic Factors , Multivariate Analysis , MidwiferyABSTRACT
Introdução: Na prática clínica são muitos os métodos utilizados na avaliação de pacientes em hemodiálise, a maioria com limitações. O ângulo de fase, uma variável da bioimpedância elétrica, vem se destacando como importante indicador prognóstico, mas sua relação com marcadores nutricionais é controversa. Objetivo: Avaliar a existência de correlação e concordância entre o ângulo de fase padronizado e marcadores tradicionais do estado nutricional em pacientes renais crônicos, antes e após o tratamento dialítico. Métodos: Estudo transversal com 57 pacientes em hemodiálise, de ambos os sexos, em uma unidade de tratamento dialítico, Salvador, Bahia, Brasil. Os participantes foram avaliados por antropometria, bioimpedância e dinamometria, antes e após a hemodiálise. Foram realizadas análises descritivas, teste T de Student, correlação de Pearson e concordância a partir do coeficiente Kappa. Resultados: Não houve diferença significante no período pré e pós-diálise para as variáveis: circunferência muscular do braço, força do aperto de mão e percentual de massa celular corporal. No período pré-diálise, a correlação foi positiva e fraca entre o ângulo de fase padronizado e o índice de massa corporal, a circunferência muscular do braço, a força do aperto de mão e o percentual de massa celular corporal. No período pós-diálise o percentual de massa celular corporal foi a única variável que não teve correlação estatisticamente significante. A análise de concordância entre o ângulo de fase padronizado e demais parâmetros, no período pré-diálise, mostrou concordâncias pobres ou fracas. No período pós-diálise houve discordância com a percentual de massa celular corporal e concordância moderada com a força do aperto de mão. Conclusão: O ângulo de fase padronizado apresentou correlações fracas com os indicadores antropométricos e moderada concordância com a força do aperto de mão (AU)
Introducion: In clinical practice there are many methods used to assess patients on hemodialysis, most with limitations. The phase angle, a variable of the electric bioimpedance, has been excelling as an important prognostic indicator, but its relation to nutritional markers is controversial. Objective: To evaluate the existence of correlations and concordances between the standard phase angle and traditional markers of nutritional status in patients with chronic renal failure, prior to and following dialysis treatment. Methods: A transversal study with fifty-seven hemodialysis patients, of both sexes, in a dialysis treatment unit, in Salvador, Bahia (Brazil). The participants were evaluated for anthropometry, bioimpedance, and dynamometry, before and after hemodialysis. We performed a descriptive analysis, Students t test, Pearson correlation and agreement from the kappa coefficient. Results: There was no significant difference between the pre- and post-dialysis period for the following variables: muscular circumference of the arm, handgrip force, and percentage of cellular body mass. In the pre-dialysis period, the correlation was positive and weak between the standard phase angle and the body mass index, the muscular circumference of the arm, handgrip force, and cellular body mass. In the post-dialysis period the percentage of cellular body mass was the only variable that had no statistically significant correlation. The analysis of concordance between the standard phase angle and other parameters, in the pre-dialysis period, showed poor or weak concordances. In the post-dialysis period there were discordances for the percentage of cellular body mass and moderate concordance for handgrip force. Conclusion: The standard phase angle presented weak correlations with the anthropométric indicators and moderate concordance for handgrip force (AU)
Subject(s)
Humans , Renal Insufficiency, Chronic/complications , Nutrition Assessment , Nutritional Status/physiology , Renal Dialysis , Biomarkers/analysis , Body Weights and Measures/statistics & numerical data , Anthropometry/methods , Hand Strength , Electric Impedance , Body Composition , Muscle Strength Dynamometer , Cross-Sectional StudiesABSTRACT
Objective: To assess the nutritional status of elderly living in nursing homes in the city of Salvador, Brazil and associated factors. Methods: Cross-sectional study performed with 359individuals of both sexes, ages equal or over 60 years old, located in Nursing Homes in the urban area of the city of Salvador, Bahia, Brazil. Results: Regarding nutritional status according to Mini Nutritional Assessment (MNA), 66.3% of the evaluated elderly were malnourished and at risk of malnutrition. When comparing sexes, it has been observed that among men the prevalence of this condition (76.6%) was higher than in women (62.4%). It has been observed, as a result of the multivariate analysis, that only the variable functional capacity for Activities of Daily Living (ADL)was statistically significant. There was moderate correlation between MNA and Mini-Mental State Examination(r=0.454; p<0.0001), as well as between MNA and the ADL scale (r=0.569; p<0.0001). There was weak negative correlation between MNA total score and age (r=0.159;p=0.002).Conclusion: Malnutrition and malnutrition risk were conditions of remarkable importance, with almost two thirds of the elderly in this situation. ADL functional capacity must be monitored given their close relationship with the nutritional status of the elderly. An interdisciplinary approach in the context of institutionalization is needed due to the association between nutritional status and variables of different dimensions (AU)
Objective: Evaluar el estado nutricional de los ancianos residentes en Hogares para Ancianos, en la ciudad de Salvador, Brasil y factores asociados. Métodos: Estudio transversal con 359 individuos mayores de 60 años, de ambos sexos y residentes en hogares de ancianos en la zona urbana de la ciudad de Salvador, Bahia, Brasil. Resultados: En cuanto al estado nutricional de acuerdo con Mini Nutritional Assessment (MNA), el 66,3% de los ancianos evaluados estaban desnutridos y en riesgo de desnutrición. La prevalencia de esta afección fue mayor entre los hombres (76,6%) en comparación con las mujeres (62,4%). Se ha observado, como resultado del análisis multivariado, que sólo la capacidad funcional variable para Actividades de la Vida Diaria (AVD) fue estadísticamente significativa. Hubo correlación moderada entre MNA y Mini Examen del Estado Mental (r = 0,454; p <0,0001), así como entre MNA y la escala AVD (r = 0,569; p <0,0001). Hubo correlación débil negativa entre la puntuación total del MNA y la edad (r = 0,159; p = 0,002). Conclusión: La desnutrición y el riesgo de desnutrición fueron de importancia excepcional de las condiciones, porque casi dos tercios de los ancianos estaban en esta situación. La capacidad funcional para AVD debe ser supervisada por su estrecha relación con el estado nutricional de las personas mayores. Un enfoque interdisciplinario en el contexto de la institucionalización es necesario debido a la asociación entre el estado nutricional y variables de diferentes dimensiones (AU)
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Nutrition Assessment , Nutritional Status , Elderly Nutrition , Malnutrition/epidemiology , Health of Institutionalized Elderly , Geriatric Assessment/methodsABSTRACT
OBJETIVO: Analisar a atuação dos profissionais das unidades de emergência em saúde para notificação dos casos de violência infanto-juvenil, considerando características sociodemográficas, categoria profissional e dificuldades. MÉTODOS: Estudo transversal, com amostra casual simples (n=200), do universo de 523 profissionais de Feira de Santana, Bahia, distribuídos entre um hospital geral regional e seis policlínicas. Foram realizadas análises bivariadas e medidas de associação para determinar significância estatística. RESULTADOS: A maioria dos profissionais era do sexo feminino (82,5%), com idade entre 20 e 40 anos (75,5%), técnicos de enfermagem (52,5%) e enfermeiros (22,5%), sendo que 69,0% tinha contrato temporário de trabalho. A notificação foi registrada por 69,5% e 60,0% solicitaram parecer de outro profissional, 54,0% conversaram com familiares e 42,9% notificaram no Sistema de Vigilância a Acidentes e Violência (VIVA). Na categoria técnico de enfermagem foi verificada significância estatística para notificação aos setores de referência, com intervalo de confiança de 95% (IC95%) 1,28 - 2,09 e para o Sistema VIVA (IC95% 1,06 - 7,40). Na atuação dos médicos, o resultado significante foi não solicitar parecer a outro profissional (IC95% 1,02 - 3,51); não ter receio de envolvimento judicial (IC95% 1,19 - 4,06) e ter formação nessa área (IC95% 1,21 - 5,00). As principais dificuldades citadas foram omissão familiar (91,5%), receio de envolvimento com sistema judicial (63,5%) e falta de capacitação (47,0%). CONCLUSÃO: A maioria dos casos de violência atendidos nas unidades de emergência foi notificada, entretanto, menos de 50% dos profissionais não notificaram no Sistema VIVA, apontando necessidade de investimento institucional em apoio técnico e qualificação permanente. Ações direcionadas à notificação fortalecem instituições e responsabilizam o setor para atendimento e proteção às vítimas. .
OBJECTIVE: To analyze the performance of professionals in the Emergency Units for the notification of cases of violence against children, considering sociodemographic characteristics, professional category and difficulties. METHODS: Cross-sectional study with a simple random sample (n=200), selected from the universe of professionals (n=523) of these Emergency Units in Feira de Santana, Bahia, Brazil, from a regional general hospital and six polyclinics. Bivariate analyses and measures of association were performed to determine statistical significance. RESULTS: Most professionals were female (82.5%), aged between 20 and 40 years old (75.5%), being nursing technicians (52.5%) and nurses (22.5%), 69.0% with a temporary employment contract. The notification was recorded by 69.5%, of them, and 60.0% asked for the opinion of another professional; 54.0% talked with the family and 42.9% reported to the Accident and Violence Surveillance System (VIVA). Statistical significance was observed in the nursing technicians category for the notification to sectors of reference, with a 95% confidence interval (95%CI) 1.28 - 2.09; and VIVA (95%CI 1.06 - 7.40). In the medical category, the significant result was not requesting the opinion of another professional (95%CI 1.02 - 3.51); not being afraid of judicial involvement (95%CI 1.19 - 4.06) and being trained in the violence matter (95%CI 1.21 - 5.00). The main difficulties cited were family omission (91.5%), fear of judicial involvement (63.5%) and lack of training (47.0%). CONCLUSION: Most cases of violence seen at the Emergency Units were notified, however, less than 50% of professionals did not notify VIVA, pointing the need for institutional investment in technical support and ongoing training. Actions addressed to notification strengthen institutions and make the sector responsible for victim care and protection. .
Subject(s)
Humans , Male , Female , Adult , Young Adult , Violence/statistics & numerical data , Brazil , Cross-Sectional Studies , Emergency Medical ServicesABSTRACT
OBJECTIVE: To analyze the performance of professionals in the Emergency Units for the notification of cases of violence against children, considering sociodemographic characteristics, professional category and difficulties. METHODS: Cross-sectional study with a simple random sample (n=200), selected from the universe of professionals (n=523) of these Emergency Units in Feira de Santana, Bahia, Brazil, from a regional general hospital and six polyclinics. Bivariate analyses and measures of association were performed to determine statistical significance. RESULTS: Most professionals were female (82.5%), aged between 20 and 40 years old (75.5%), being nursing technicians (52.5%) and nurses (22.5%), 69.0% with a temporary employment contract. The notification was recorded by 69.5%, of them, and 60.0% asked for the opinion of another professional; 54.0% talked with the family and 42.9% reported to the Accident and Violence Surveillance System (VIVA). Statistical significance was observed in the nursing technicians category for the notification to sectors of reference, with a 95% confidence interval (95%CI) 1.28 - 2.09; and VIVA (95%CI 1.06 - 7.40). In the medical category, the significant result was not requesting the opinion of another professional (95%CI 1.02 - 3.51); not being afraid of judicial involvement (95%CI 1.19 - 4.06) and being trained in the violence matter (95%CI 1.21 - 5.00). The main difficulties cited were family omission (91.5%), fear of judicial involvement (63.5%) and lack of training (47.0%). CONCLUSION: Most cases of violence seen at the Emergency Units were notified, however, less than 50% of professionals did not notify VIVA, pointing the need for institutional investment in technical support and ongoing training. Actions addressed to notification strengthen institutions and make the sector responsible for victim care and protection.
Subject(s)
Violence/statistics & numerical data , Adult , Brazil , Cross-Sectional Studies , Emergency Medical Services , Female , Humans , Male , Young AdultABSTRACT
Objective To determine how endocrinologists in Latin America deal with clinical case scenarios related to hypothyroidism and pregnancy. Materials and methods In January 2013, we sent an electronic questionnaire on current practice relating to management of hypothyroidism in pregnancy to 856 members of the Latin American Thyroid Society (LATS) who manage pregnant patients with thyroid disease. Subsequently, we have analyzed responses from physician members. Results Two hundred and ninety-three responders represent clinicians from 13 countries. All were directly involved in the management of maternal hypothyroidism and 90.7% were endocrinologists. The recommendation of a starting dose of L-thyoxine for a woman diagnosed with overt hypothyroidism in pregnancy, preconception management of euthyroid women with known thyroid autoimmunity and approach related to ovarian hyperstimulation in women with thyroid peroxidase antibodies were widely variable. For women with known hypothyroidism, 34.6% of responders would increase L-thyroxine dose by 30-50% as soon as pregnancy is confirmed. With regard to screening, 42.7% of responders perform universal evaluation and 70% recommend TSH < 2.5 mUI/L in the first trimester and TSH < 3 mUI/L in the second and third trimester as target results in known hypothyroid pregnant women. Conclusion Deficiencies in diagnosis and management of hypothyroidism during pregnancy were observed in our survey, highlighting the need for improvement of specialist education and quality of care offered to patients with thyroid disease during pregnancy in Latin America. Arq Bras Endocrinol ...
Objetivo Determinar, na América Latina, como os endocrinologistas lidam com cenários clínicos relacionados ao hipotireoidismo durante a gravidez. Materiais e métodos Em Janeiro de 2013, foi enviado, para 856 membros da Sociedade Latino-Americana de Tireoide (LATS), um questionário eletrônico sobre práticas relacionadas ao manejo do hipotireoidismo durante a gestação. Subsequentemente, as respostas foram analisadas. Resultados Duzentos e noventa e três médicos, de 13 países, responderam ao questionário. Todos estavam diretamente envolvidos no manejo de hipotireoidismo materno e 90,7% eram endocrinologistas. As recomendações de iniciar terapia com levotiroxina para uma mulher com hipotireoidismo franco durante a gravidez e o manejo na fase de pré-concepção de pacientes eutireoidianas com conhecida autoimunidade em hiperestimulação ovariana variaram amplamente. Para mulheres com hipotireoidismo conhecido, apenas 34,6% dos respondedores aumentariam a dose de levotiroxina em 30-50% assim que a gravidez fosse confirmada. Em relação ao rastreamento, 42,7% dos respondedores realizam avaliação universal. Setenta por cento recomendam TSH < 2,5 mUI/L no primeiro trimestre e TSH < 3 mUI/L no terceiro trimestre como alvos. Conclusão Observamos problemas no diagnóstico e manejo do hipotireoidismo durante a gestação, enfatizando a necessidade, na América Latina, de melhoria na educação médica continuada em áreas como tireoiodopatias na gestação. Arq Bras Endocrinol Metab. ...
Subject(s)
Adult , Female , Humans , Pregnancy , Hypothyroidism/diagnosis , Hypothyroidism/drug therapy , Practice Patterns, Physicians'/statistics & numerical data , Pregnancy Complications/diagnosis , Pregnancy Complications/drug therapy , Surveys and Questionnaires , Europe , Latin America , Mass Screening , Practice Guidelines as Topic , Societies, Medical/statistics & numerical data , Thyroid Gland/immunology , Thyrotropin/analysis , Thyroxine/therapeutic useABSTRACT
Avaliar a associação entre as características sociodemográficas, do pré-natal e do parto de mães adolescentes e adultas jovens com o baixo peso ao nascer, em capitais e outros municípios da Região Nordeste do Brasil, no período de 2011 e 2012. Métodos: estudo transversal, de base hospitalar e nível regional, realizado em 2011 e 2012. As informações foram obtidas por meio de entrevista com a puérpera no pós-parto imediato e coletados dados dos prontuários maternos e dos recém-nascidos. Um modelo teórico conceitual foi estabelecido com três níveis de hierarquia e a variável dependente foi o baixo peso ao nascer (BPN). Resultados: do total de 3009 puérperas entrevistadas, 9,7 por cento apresentaram conceptos com baixo peso. As puérperas que realizaram menos que seis consultas no pré-natal apresentaram uma chance 1,7 vezes maior de ter RN com baixo peso; ser primigesta aumentou a chance da ocorrência do BPN em 1,5 vezes; assim como a prematuridade que representou o principal fator de exposição, elevando em 21 vezes a chance desse desfecho. Conclusões: o estudo demonstrou alta frequência de baixo peso ao nascer entre mães adolescentes e adultas jovens, tendo como principais fatores associados o número insuficiente de consultas pré-natal, primigestação e prematuridade...
To evaluate the association between characteristics relating to socio-demographic factors and the prenatal and delivery period of adolescent and young adult mothers whose newborns present with low weight at birth in State capitals and other municipalities in the Northeast region of Brazil, between 2011 and 2012. Methods: a hospital-based cross-sectional study was carried out at regional level in 2011 and 2012. Information was obtained by way of an interview with the mother immediately post-partum and from data contained in the medical records of mothers and newborns. A conceptual theoretical model was established with three hierarchical levels and the dependent variable was low weight at birth (LWB). Results: of the 3009 mothers interviewed, 9.7 percent had had newborns of low birth weight. The mothers who had received less than six prenatal consultations had a 1.7 times greater chance of giving birth to a child of low weight; a first pregnancy increased the risk of occurrence of LWB by an order of 1.5; while prematurity was the principal exposure factor, with 21 greater likelihood of this outcome. Conclusions: the study showed a high frequency of low birth weight among adolescent and young adult mothers, the main associated factors being an insufficient number of prenatal consultations, a first pregnancy and prematurity...
Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Adolescent , Young Adult , Brazil , Prenatal Care/statistics & numerical data , Statistical Data , Parturition , Infant, Premature , Infant, Very Low Birth Weight , Cross-Sectional StudiesABSTRACT
The accumulation of visceral fat is strongly associated with cardiometabolic changes. Alternative methods, such as the association between anthropometric indicators and hypertriglyceridemia, are used as the best estimate for the accumulation of visceral fat, preventing cardiovascular diseases. The aim of this study was to evaluate the association of anthropometric indicators with hypertriglyceridemia in the prediction of visceral fat in men and women. This was a cross-sectional study conducted with 192 individuals, of both genders, submitted to anthropometric evaluation (sagittal abdominal diameter [SAD], waist circumference [WC], and waist-hip ratio [WHR]), serum dosage of triglycerides (TG), and computed tomography scan, in order to measure the visceral adipose tissue (VAT) area. Descriptive analysis, Pearson's Correlation, and multiple linear regression were performed. Anthropometric indicators had high correlation with the VAT area (p=0.000). Regardless of serum TG levels, individuals with high values of anthropometric indicators had excess VAT area (p<0.05). For every centimeter increased in SAD, there was an average increase of 12.46 cm² in the VAT area. The study showed that both SAD and WC were good indicators to explain the variability in the VAT area, independently of changes in TG levels, making it possible to identify individuals with a risk of developing cardiovascular diseases.
O acúmulo de gordura visceral está fortemente associada com alterações cardiometabólicas. Métodos alternativos, como a associação de indicadores antropométricos e hipertrigliceridemia, são usados como uma melhor estimativa para o acúmulo de gordura visceral, prevenindo doenças cardiovasculares. O objetivo foi avaliar a associação entre indicadores antropométricos com a hipertrigliceridemia para predição de gordura visceral em homens e mulheres. Estudo transversal, realizado com 192 indivíduos, de ambos os sexos, que foram submetidos à avaliação antropométrica (Diâmetro Abdominal Sagital -DAS, Circunferência da Cintura -CC e Relação Cintura-quadril -RCQ), dosagem sérica de triglicérides (TG) e tomografia computadorizada, a fim de medir a área do tecido adiposo visceral (ATAV). Análise descritiva, Correlação de Pearson e Regressão Linear Múltipla foram realizados. Indicadores antropométricos apresentaram alta correlação com a ATAV (p=0,000). Independente do nível sérico de TG, os indivíduos com indicadores antropométricos elevados tinham excesso de ATAV (p<0,05). Para cada aumento de um centímetro no DAS, houve um aumento médio de 12,46 cm² de ATAV. O estudo mostrou que ao mesmo tempo, DAS e CC foram os melhores indicadores para explicar a variabilidade na ATAV, independentemente de mudanças no nível de triglicérides, o que possibilitou a identificação de indivíduos com risco de desenvolver doenças cardiovasculares.
ABSTRACT
The scope of the study was to analyze possible associations between maternal age under 16 years and the weight and gestational age of the newborn child, as well as the occurrence of cesarean delivery. A cross-sectional study was conducted using data of Live Birth Certificates/DN from the National System of Live Births/SINASC in Feira de Santana, State of Bahia, Brazil, in the 2006-2012 period. In the analyses, logistic regression for the odds ratio (OR) and a confidence interval of 95% was used, measuring the strength of association between variables adjusted for confounding factors. Newborns (NB), with low birth weight and underweight, revealed a significant association with maternal age (≤ 16 years) and statistical interaction of inadequate prenatal care and cesarean delivery. In teenage pregnancy under the age of 16 years, cesarean delivery showed a significant association with single marital status (OR 1.24), inadequate prenatal care (OR 1.58) and newborns with low weight (OR 1.34). The data suggest that multiple factors may interfere with the type of delivery and pregnancy outcome of adolescents at an early age, pointing to the importance of investment in policies and actions directed at this group considered highly vulnerable to perinatal and pregnancy complications.
Subject(s)
Cesarean Section/statistics & numerical data , Infant, Low Birth Weight , Obstetric Labor, Premature/epidemiology , Adolescent , Child , Cross-Sectional Studies , Female , Humans , Pregnancy , Risk Factors , Young AdultABSTRACT
The study seeks to characterize the initiation and consumption pattern of psychoactive substances among adolescents and young adults enrolled in an Alcohol and Drug Psychosocial Care Center (CAPS-AD). This study was conducted with records of attendance and the consumption pattern was classified in accordance with WHO: infrequent use (lifetime use, per year or up to five days per month); frequent use (6 to 19 times in the past 30 days); heavy use (≥ 20 times in the last 30 days). In the age group comparison, the test for proportion and association analysis was used and the prevalence and prevalence ratio was calculated with a significance level of 5% and 95% confidence interval. Of the total of adolescents and young adults treated between 2003 and 2008 (475), most were male, single, poorly educated, live with relations and have psychic symptoms. Statistical significance was found for age at initiation of use: adolescents compared to young adults started earlier (≤ 14 years): tobacco, marijuana, cocaine, crack and other SPA consumption. Among adolescents, significant results were found for the less frequent consumption of tobacco, more frequent use of alcohol, and heavy consumption of marijuana. These findings may contribute to the preventive and therapeutic CAPS-AD programs.
Subject(s)
Psychotropic Drugs/adverse effects , Substance-Related Disorders/epidemiology , Adolescent , Child , Female , Humans , Male , Retrospective Studies , Substance Abuse Treatment Centers , Young AdultABSTRACT
The study seeks to investigate factors associated with HIV infection among adolescents and young adults registered in the Counseling and Testing Center (CTC) of Feira de Santana, Bahia. An analytical study with a cross-sectional design was conducted using data from the CTC Information System in the period from 2007 to 2011. Information on 3,768 individuals were studied and the proportional difference was checked using the Pearson chi-squared test and stratified analysis by Prevalence Rate (PR) with confidence intervals of 95%, considering the serological status as the outcome. During the period under study, 73 young people were infected with HIV (1.94%). In the female population, statistically significant associations were identified for HIV status and drug use and consumption of alcohol and other drugs, as well as being married or in a stable relationship. In males, the consumption of other drugs and homosexual/bisexual orientation were associated with HIV status. In both sexes, in the category in a stable relationship the HIV status was associated with a partner using drugs and/or infected with a STD and/or HIV. These findings indicate the need for effective measures for the control and prevention of HIV infection among young people.
Subject(s)
HIV Infections/epidemiology , AIDS Serodiagnosis , Acquired Immunodeficiency Syndrome/diagnosis , Acquired Immunodeficiency Syndrome/epidemiology , Adolescent , Ambulatory Care Facilities , Brazil/epidemiology , Child , Counseling , Cross-Sectional Studies , Female , HIV Infections/diagnosis , Humans , Male , Risk Factors , Socioeconomic Factors , Young AdultABSTRACT
The study analyzes the evolution of the incidence of sexual violence (SV) and co-occurrences between 2001 and 2010. The records of the Guardianship Councils in Feira de Santana, State of Bahia, Brazil were used and the incidence rates and graphs of the events during the period were calculated. Of the total of the different types of violence, 21.8 % involved co-occurrences, the majority being female, most frequently during adolescence. There was a high proportion of abuse in male children, with most offenders bring family members or acquaintances. The incidence of SV revealed an increasing trend in both sexes during the decade, more significantly in females in 2002 and 2009. The age groups indicated the same trend, with a higher proportion of cases in adolescence. The record of co-occurrences with SV was more pronounced in the second half of the decade, namely psychological violence in 2008, neglect in 2008 and physical violence in 2009. The conclusion is that the increase in the coefficients of sexual violence and co-occurrences may indicate an improvement of the reporting system of instances in reference, as well as greater citizen participation through the Dial 100 complaint hotline. The indicators help to prevent and control violence against children.
Subject(s)
Sex Offenses/statistics & numerical data , Adolescent , Brazil , Child , Child, Preschool , Female , Humans , Male , Time Factors , Violence/statistics & numerical dataABSTRACT
The scope of the study is to analyze data of children and adolescents who are the victims of different forms of violence, registered in the Surveillance System for Violence and Accidents (VIVA/MS) in Feira de Santana in the state of Bahia, Brazil. The total number of records, since the implementation of VIVA in the city (01/2009 to 01/2011) was used and the analyses sought associations between characteristics of violence and profiles of victims and perpetrators. The results showed that children and adolescents were molested using different types of violence, including the use of physical force, verbal threats and weapons and sundry cases of personal injury. Approximately 35% were hospitalized and 15% died. Physical violence was more common among males during adolescence in the home environment and perpetrated by a family member. Sexual violence occurred with greater frequency among females during childhood and 55.5% of the cases occurred in the home environment and more frequently perpetrated by a family member or acquaintances. The results highlight the importance of investments in policies and programs for harm prevention and reduction, seeking to broaden coverage in the care and the enhancement of the information system and surveys of these indicators.
Subject(s)
Accidents/statistics & numerical data , Violence/statistics & numerical data , Adolescent , Brazil , Child , Child, Preschool , Delivery of Health Care , Epidemiological Monitoring , Female , Humans , Infant , MaleABSTRACT
O estudo tem como objetivo analisar os dados de crianças e adolescentes vítimas das distintas formas de violência, registrados no Sistema de Vigilância de Violências e Acidentes/VIVA/MS, de Feira de Santana, Bahia, Brasil. Utilizou-se o total de registros, desde a implantação do Sistema VIVA no município (01/2009 a 01/2011), cujas análises buscaram associações entre características das violências e perfis de vítimas e agressores. Os resultados mostraram que crianças e adolescentes foram molestados por diversas violências; com uso de força corporal, ameaça verbal e armas; ocorrência de lesões corporais diversas; aproximadamente 35% foram hospitalizados e 15% evoluíram a óbito; a violência física apresentou maior frequência no sexo masculino, nas faixas da adolescência, ocorrência em ambiente domiciliar e causado por familiar; a violência sexual ocorreu com maior proporção no sexo feminino, nas faixas da infância, 55,5% das ocorrências foram em nível domiciliar, sendo mais frequentemente perpetrada por conhecidos e familiares. Os resultados sugerem a importância de investimentos em políticas e programas de prevenção e redução de danos, buscando ampliar a cobertura no atendimento e aprimoramento do Sistema de Informação e levantamento desses indicadores.
The scope of the study is to analyze data of children and adolescents who are the victims of different forms of violence, registered in the Surveillance System for Violence and Accidents (VIVA/MS) in Feira de Santana in the state of Bahia, Brazil. The total number of records, since the implementation of VIVA in the city (01/2009 to 01/2011) was used and the analyses sought associations between characteristics of violence and profiles of victims and perpetrators. The results showed that children and adolescents were molested using different types of violence, including the use of physical force, verbal threats and weapons and sundry cases of personal injury. Approximately 35% were hospitalized and 15% died. Physical violence was more common among males during adolescence in the home environment and perpetrated by a family member. Sexual violence occurred with greater frequency among females during childhood and 55.5% of the cases occurred in the home environment and more frequently perpetrated by a family member or acquaintances. The results highlight the importance of investments in policies and programs for harm prevention and reduction, seeking to broaden coverage in the care and the enhancement of the information system and surveys of these indicators.