Regional and social inequalities in the performance of Pap test and screening mammography and their correlation with lifestyle: Brazilian national health survey, 2013.

BACKGROUND: Mass population screening for the early detection of cervical and breast cancer has been shown to be a safe and effective strategy worldwide and has reduced the incidence and mortality rates of these diseases. The aim of this study is to analyse the reach of screening tests for cervical and breast cancer according to sociodemographic variables and to analyse their correlation with a healthy lifestyle. METHODS: We have analysed data collected from 31.845 women aged 18 and over, who were interviewed for the Brazilian National Health Survey, a nationwide household inquiry, which took place between August 2013 and February 2014. The Pap tests performed in the last 3 years in women aged between 25 and 64 and screening mammogram performed in the last 2 years in women aged between 50 and 69 were considered adequate. We identified habits that constitute a healthy lifestyle, such as the consumption of five or more daily servings of fruits and vegetables, 30 min or more of leisurely physical activity and not smoking. RESULTS: We observed that the Pap test (78.8 %) was more widespread than the screening mammogram (54.5 %), with significant geographical and social differences concerning access to health care. Access for such screening was higher for women living in more developed regions (Southeast and South), who were white-skinned, better educated, living with a partner and, especially, who were covered by private health insurance. Those who underwent the tests according to established protocols also had a healthy lifestyle, which corroborates the healthy behaviour pattern of damage prevention. CONCLUSION: Despite the progress made, social disparity still defines access to screening tests for cervical and breast cancer, with women covered by private health insurance tending to benefit the most. It is necessary to reduce social and regional inequalities and ensure a more uniform provision and access to the tests, especially for socially disadvantaged women, in order to reduce the incidence and mortality rate resulting from the aforementioned diseases.

Resultados fetais e infantis da gravidez na adolescência e sua recorrência: um estudo no município do Rio de Janeiro / Fetal and infant outcomes of teenage pregnancy and its recurrence: a study in the city of Rio de Janeiro

Esta tese é produto do “Estudo da Morbi-mortalidade e da Atenção Peri e Neonatal no Município do Rio de Janeiro”. O estudo teve o propósito de investigar os resultados fetais e infantis da gravidez na adolescência e da sua recorrência no município. A tese foi apresentada sob a forma de artigos. No primeiro deles, o objetivo foi identificar o efeito da gravidez na adolescência e de outros determinantes da mortalidade fetal e infantil no Município do Rio de Janeiro, usando o modelo de análise hierarquizada. Uma amostra com 9.041 nascimentos e 228 óbitos foi selecionada. A gravidez na adolescência se destacou como variável com efeito direto para o óbito no período pós-neonatal. O baixo peso ao nascer e a prematuridade foram corroborados como determinantes do óbito fetal e neonatal. A agressão física surgiu como importante determinante do óbito neonatal. Os resultados mostraram o efeito protetor do pré-natal adequado para o óbito fetal e neonatal. Os achados do segundo artigo apontaram a magnitude da recorrência da gravidez adolescência no município e verificou a associação entre as gestações sucessivas, o perfil das adolescentes e os efeitos adversos na saúde do recém-nascido. A análise estatística testou a hipótese de homogeneidade de proporções mediante análise bi e multivariada. Observou-se que, entre as 1.986 adolescentes, 31,4 por cento já haviam experimentado a maternidade anteriormente. Características socioeconômicas e viver com o companheiro se associaram com a recorrência da gravidez na adolescência...

This thesis is product of the “Study of Perinatal and Neonatal Morbidity and Mortality and Childbirth Care in the Municipality of Rio de Janeiro”. The study aimed at the investigation the fetal and infantile results of the pregnancy in the adolescence and the repeated pregnancy among adolescence in the city. The thesis was presented in three scientific papers. In the first of them, the objective was to identify the effect of teenage pregnancy and of others determinants of fetal and infant mortality in the Municipality of Rio de Janeiro. The study was conducted on a sample of births in Rio de Janeiro and exposure variables were organized in hierarchical levels. A sample of 9.041 births and 228 deaths were selected. Teenage pregnancy itself was a direct effect for post-neonatal death. Low birth weight and prematurity were corroborated as determinants of fetal and neonatal death. Self-report of physical abuse were significantly more with having a neonatal death. The results showed the protective effect of adequate prenatal care for fetal and neonatal death. The second article tries to investigate the magnitude of the repeated pregnancy among adolescence, and to verify the association among the successive gestations, the profile of adolescents and the effects in the health of the newborns. The statistical analysis aimed to test the hypothesis of homogeneity of proportions, including bi and multivariate analysis. Among 1986 adolescents, 31.4% reported a repeated pregnancy. Results indicated the association of sociodemographic characteristics and stable partner to repeat pregnancy among adolescent...

[Teenage pregnancy and other risk factors for fetal and infant mortality in the city of Rio de Janeiro, Brazil]. / Gravidez na adolescência e outros fatores de risco para mortalidade fetal e infantil no Município do Rio de Janeiro, Brasil.

This article analyzes teenage pregnancy and other risk factors for fetal and infant mortality in the city of Rio de Janeiro, Brazil. The study included a sample of births in Rio de Janeiro, and exposure variables were organized hierarchically. For fetal death, the results showed the protective effect of adequate prenatal care, while maternal morbidity increased the risk. For neonatal death, adequate prenatal care and female gender in the newborn were protective factors, while black or brown maternal skin color, history of stillbirth, maternal morbidity, and physical aggression during the index pregnancy increased the risk. Low birth weight and prematurity were corroborated as determinants of fetal and neonatal death. Risk of post-neonatal death was highest with increased parity, intra-gestational morbidity, and low birth weight. Teenage pregnancy itself was an independent factor for post-neonatal death. The findings reaffirm the relevance of social and health policies targeting adolescents, as well as improvements in prenatal care.

Gravidez na adolescência e outros fatores de risco para mortalidade fetal e infantil no Município do Rio de Janeiro, Brasil / Teenage pregnancy and other risk factors for fetal and infant mortality in the city of Rio de Janeiro, Brazil

O objetivo foi identificar o efeito da gravidez na adolescência e outros fatores de risco para a mortalidade fetal e infantil no Município do Rio de Janeiro, Brasil. O estudo foi desenvolvido em uma amostra de nascimentos do município, e as variáveis de exposição foram organizadas em níveis de hierarquia. Para óbito fetal, pré-natal adequado revelou efeito protetor, e morbidade materna aumentou seu risco. No óbito neonatal, pré-natal adequado e recém-nascido do sexo feminino foram fatores de proteção. No entanto, cor da pele da mãe preta ou parda, história prévia de nascido morto, morbidade materna e agressão física na gestação elevaram o risco. O baixo peso e a prematuridade foram corroborados como determinantes do óbito fetal e neonatal. No óbito pós-neonatal, o risco foi mais elevado na presença de maior número de gestações anteriores, morbidade na gestação e o baixo peso ao nascer. A gravidez na adolescência surgiu com um efeito direto para o óbito pós-neonatal. Os achados reafirmam a relevância das políticas sociais e de saúde voltadas para os adolescentes e a melhoria da atenção pré-natal.

This article analyzes teenage pregnancy and other risk factors for fetal and infant mortality in the city of Rio de Janeiro, Brazil. The study included a sample of births in Rio de Janeiro, and exposure variables were organized hierarchically. For fetal death, the results showed the protective effect of adequate prenatal care, while maternal morbidity increased the risk. For neonatal death, adequate prenatal care and female gender in the newborn were protective factors, while black or brown maternal skin color, history of stillbirth, maternal morbidity, and physical aggression during the index pregnancy increased the risk. Low birth weight and prematurity were corroborated as determinants of fetal and neonatal death. Risk of post-neonatal death was highest with increased parity, intra-gestational morbidity, and low birth weight. Teenage pregnancy itself was an independent factor for post-neonatal death. The findings reaffirm the relevance of social and health policies targeting adolescents, as well as improvements in prenatal care.