Adaptation of the Youth Connectedness to Provider scale to assess the relationship between health professionals and adolescent and young adult patients

Abstract Objective: The aim was to adapt an instrument that evaluates the relationship between young individuals and health professionals to the Brazilian population, which will be called the Escala de Avaliação de Vínculo entre Jovens e Profissionais de Saúde (Youth Connectedness to Provider scale). Method: The questionnaire known as the Youth Connectedness to Provider scale consists of seven Likert-like questions. The translation, back-translation, evaluation by ten specialists, and pre-test with 43 adolescents and young adults aged between 10 and 24 years were performed to assess the clarity and reliability of meanings. The content validity index was calculated for each question. Subsequently, the clinical validation was performed with 83 patients aged 10-24 years old and Cronbach's alpha coefficient was calculated. Results: A content validity index >0.8 (considered satisfactory) was obtained for all items analyzed by experts and adolescents. At the clinical validation, it showed a high internal consistency (Cronbach's alpha = 0.76). The questions showed a good correlation, except for the question about judgment (Spearman's rho = 0.03-0.19). Conclusions: The scale adaptation showed an adequate agreement rate at the translation evaluation and a good reliability index in the questions. This instrument provides information on strengths and topics that require more attention from professionals to improve the relationship with their patients; it can be a valuable parameter in assessing the medical consultation quality.

Adaptation of the Youth Connectedness to Provider scale to assess the relationship between health professionals and adolescent and young adult patients.

OBJECTIVE: The aim was to adapt an instrument that evaluates the relationship between young individuals and health professionals to the Brazilian population, which will be called the Escala de Avaliação de Vínculo entre Jovens e Profissionais de Saúde (Youth Connectedness to Provider scale). METHOD: The questionnaire known as the Youth Connectedness to Provider scale consists of seven Likert-like questions. The translation, back-translation, evaluation by ten specialists, and pre-test with 43 adolescents and young adults aged between 10 and 24 years were performed to assess the clarity and reliability of meanings. The content validity index was calculated for each question. Subsequently, the clinical validation was performed with 83 patients aged 10-24 years old and Cronbach's alpha coefficient was calculated. RESULTS: A content validity index >0.8 (considered satisfactory) was obtained for all items analyzed by experts and adolescents. At the clinical validation, it showed a high internal consistency (Cronbach's alpha=0.76). The questions showed a good correlation, except for the question about judgment (Spearman's rho=0.03-0.19). CONCLUSIONS: The scale adaptation showed an adequate agreement rate at the translation evaluation and a good reliability index in the questions. This instrument provides information on strengths and topics that require more attention from professionals to improve the relationship with their patients; it can be a valuable parameter in assessing the medical consultation quality.

Satisfaction with care in a Brazilian psychiatric inpatient unit: differences in perceptions among patients according to type of health insurance.

INTRODUCTION: User satisfaction assessment in mental health services is an important indicator of treatment quality. The objective of this study was to evaluate treatment satisfaction in a sample of inpatients with mental disorders and the associations between levels of satisfaction and clinical/sociodemographic variables. METHODS: This exploratory study investigated 227 psychiatric inpatients who answered the Patient Satisfaction with Mental Health Services Scale (SATIS-BR) and the Perception of Change Scale (EMP). SATIS scores were analyzed according to associations with clinical and sociodemographic data. Pearson correlations were used to correlate SATIS scores with other variables. RESULTS: We found a high degree of satisfaction with care at the psychiatric inpatient unit assessed. In general, patients rated maximum satisfaction for most items. The highest satisfaction scores were associated with patients receiving treatment through the Brazilian Unified Health System (SUS) and with less education. SATIS showed a moderate positive correlation with EMP. The worst evaluated dimension was physical facilities and comfort of the ward. CONCLUSION: Patients treated via SUS may be more satisfied than patients with private health insurance when treated in the same facility. The evaluation of treatment satisfaction can be used to reorganize services at psychiatric inpatient units.

Satisfaction with care in a Brazilian psychiatric inpatient unit: differences in perceptions among patients according to type of health insurance / Satisfação com o cuidado em uma unidade de internação psiquiátrica brasileira: diferenças nas percepções dos pacientes segundo tipo de plano de saúde

Abstract Introduction User satisfaction assessment in mental health services is an important indicator of treatment quality. The objective of this study was to evaluate treatment satisfaction in a sample of inpatients with mental disorders and the associations between levels of satisfaction and clinical/sociodemographic variables. Methods This exploratory study investigated 227 psychiatric inpatients who answered the Patient Satisfaction with Mental Health Services Scale (SATIS-BR) and the Perception of Change Scale (EMP). SATIS scores were analyzed according to associations with clinical and sociodemographic data. Pearson correlations were used to correlate SATIS scores with other variables. Results We found a high degree of satisfaction with care at the psychiatric inpatient unit assessed. In general, patients rated maximum satisfaction for most items. The highest satisfaction scores were associated with patients receiving treatment through the Brazilian Unified Health System (SUS) and with less education. SATIS showed a moderate positive correlation with EMP. The worst evaluated dimension was physical facilities and comfort of the ward. Conclusion Patients treated via SUS may be more satisfied than patients with private health insurance when treated in the same facility. The evaluation of treatment satisfaction can be used to reorganize services at psychiatric inpatient units.

Resumo Introdução A avaliação da satisfação do usuário nos serviços de saúde mental é um importante indicador da qualidade do tratamento. O objetivo deste estudo foi avaliar a satisfação com o tratamento em uma amostra de pacientes internados com transtornos mentais e as associações entre os níveis de satisfação e variáveis clínicas/sociodemográficas. Métodos Este estudo exploratório investigou 227 pacientes psiquiátricos internados que responderam a Escala de Satisfação do Paciente com os Serviços de Saúde Mental (SATIS-BR) e a Escala de Percepção da Mudança (EMP). Os escores SATIS-BR foram analisados segundo associações com dados clínicos e sociodemográficos. Correlações de Pearson foram usadas para correlacionar escores SATIS com outras variáveis. Resultados Encontramos alto grau de satisfação com o atendimento na unidade de internação psiquiátrica avaliada. Em geral, os pacientes atribuíram satisfação máxima para a maioria dos itens. Os maiores escores de satisfação foram associados a pacientes em tratamento pelo Sistema Único de Saúde (SUS) e com menor escolaridade. A SATIS mostrou uma correlação positiva moderada com EMP. A pior dimensão avaliada foi associada às instalações físicas e conforto da enfermaria. Conclusão Pacientes com cobertura pelo SUS podem estar mais satisfeitos do que pacientes com planos privados de saúde quando tratados na mesma unidade. A avaliação da satisfação com o tratamento pode ser usada para reorganizar serviços em unidades de internação psiquiátrica.

Radiotherapy Reduces Microhardness and Mineral and Organic Composition, and Changes the Morphology of Primary Teeth: An in vitro Study.

OBJECTIVE: We aimed to evaluate whether radiotherapy causes changes in the mineral composition, hardness, and morphology of enamel and dentin of primary teeth. MATERIALS AND METHODS: Thirty specimens of primary teeth were subjected to radiotherapy. At baseline and after 1,080, 2,160, and 3,060 cGy, the specimens were subjected to microhardness, FT-Raman spectroscopy, and scanning electron microscopy (SEM) analysis. The pH of artificial saliva was determined, as were the calcium and phosphate concentrations. The data were subjected to the Shapiro-Wilk normality test, showed a nonnormal distribution, and were compared by the Kruskal-Wallis test. RESULTS: The results showed that the microhardness of the enamel surface decreased after 2,160 cGy (281.5 ± 58 kgf/mm2) when compared to baseline (323.6 ± 59.5 kgf/mm2) (p = 0.045). For dentin, the surface hardness decreased after 1,080 cGy (34.9 ± 11.4 kgf/mm2) and 2,160 cGy (26 ± 3.5 kgf/mm2) when compared to baseline (56.5 ± 7.7 kgf/mm2) (p < 0.0001). The mineral and organic contents of phosphate (p < 0.0001), carbonate (p < 0.0001), amide (p = 0.0002), and hydrocarbons (p = 0.0031) of enamel decreased after 3,060 cGy (5,178 ± 1,082, 3,868 ± 524, 999 ± 180, and 959 ± 168 kgf/mm2, respectively). For dentin, we noticed a growing increase in phosphate v2, amide, and hydrocarbon content after 1,080 cGy (8,210 ± 2,599, 5,730 ± 1,818, and 6,118 ± 1,807 kgf/mm2, respectively) and 2,160 cGy (1,0071 ± 2,547, 7,746 ± 1,916, and 8,280 ± 2,079 kgf/mm2, respectively) and a reduction after 3,060 cGy (6,782 ± 2,175, 3,558 ± 1,884, and 3,565 ± 1,867 kgf/mm2, respectively) (p < 0.0001). SEM images showed cracks on enamel and degradation of peritubular dentin. CONCLUSION: We concluded that radiotherapy caused a reduction in surface hardness, changed mineral and organic composition, and promoted morphological changes on the enamel and dentin of primary teeth.

Evaluation of DSM-5 and ICD-11 personality traits using the Personality Inventory for DSM-5 (PID-5) in a Brazilian sample of psychiatric inpatients.

OBJECTIVE: The objective of this study was to test if the Personality Inventory for DSM-5 (PID-5) is an adequate instrument to evaluate psychiatric inpatients' pathological personality traits. METHODS: Inpatients (n = 130; mean age: 38.5 years; 62.3% female; 63.9% single) answered the PID-5 after clinical improvement of their psychiatric symptoms. The mean scores of the DSM-5 personality domains, facets and profiles, and ICD-11 domain traits were compared with the mean scores of a Brazilian normative sample (n = 656). We investigated the diagnostic performance of the scales to identify individuals with and without psychopathology. RESULTS: The final sample included mainly diagnoses of mood disorders. Except for Antagonism and Disinhibition, all DSM-5 personality domains and most facets as well as almost all DSM-5 personality disorder profiles (except Narcissist) and ICD-11 trait domains (except Detachment and Dissociality) of the inpatients presented high differences compared with the normative sample. In general, the PID-5 scales presented a high negative predictive value and a low positive predictive value to identify individuals with severe psychopathology. DISCUSSION: This study found high scores of pathological personality traits in a sample of Brazilian psychiatric inpatients. The PID-5 may be a promising instrument to measure pathological personality traits among psychiatric inpatients. Methodological and sample size limitations may have influenced the results. © 2018 John Wiley & Sons, Ltd.

Is there a correlation between physicians' clinical impressions and patients' perceptions of change? Use of the Perceived Change Scale with inpatients with mental disorders / Existe correlação entre a mudança percebida pelo médico e a mudança percebida pelo paciente? Uso da Escala de Mudança Percebida em pacientes com transtornos mentais internados

Abstract Introduction: Assessment of the results of treatment for mental disorders becomes more complete when the patient's perspective is incorporated. Here, we aimed to evaluate the psychometric properties and application of the Perceived Change Scale - Patient version (PCS-P) in a sample of inpatients with mental disorders. Methods: One hundred and ninety-one psychiatric inpatients answered the PCS-P and the Patients' Satisfaction with Mental Health Services Scale (SATIS) and were evaluated in terms of clinical and sociodemographic data. An exploratory factor analysis (EFA) was performed and internal consistency was calculated. The clinical impressions of the patient, family, and physician were correlated with the patient's perception of change. Results: The EFA indicated a psychometrically suitable four-factor solution. The PCS-P exhibited a coherent relationship with SATIS and had a Cronbach's alpha value of 0.856. No correlations were found between the physician's clinical global impression of improvement and the patient's perception of change, although a moderate positive correlation was found between the patients' clinical global impression of improvement and the change perceived by the patient. Conclusions: The PCS-P exhibited adequate psychometric proprieties in a sample of inpatients with mental disorders. The patient's perception of change is an important dimension for evaluation of outcomes in the treatment of mental disorders and differs from the physician's clinical impression of improvement. Evaluation of positive and negative perceptions of the various dimensions of the patient's life enables more precise consideration of the patient's priorities and interests.

Resumo Introdução: A avaliação dos resultados do tratamento para transtornos mentais torna-se mais completa quando a perspectiva do paciente é incluída. O objetivo deste trabalho foi avaliar as propriedades psicométricas e a aplicação da Escala de Mudança Percebida - Versão do Paciente (EMP-P) em uma amostra de pacientes internados com transtornos mentais. Métodos: Um total de 191 pacientes psiquiátricos internados responderam a EMP-P e a Escala de Avaliação da Satisfação dos Usuários com os Serviços de Saúde Mental (SATIS), além de serem avaliados quanto a dados clínicos e sociodemográficos. Foi realizada análise fatorial exploratória (AFE) e calculada a consistência interna. As impressões clínicas do paciente, da família e do médico foram correlacionadas com a mudança percebida pelo paciente. Resultados: A AFE indicou uma solução de quatro fatores psicometricamente adequada. A EMP-P apresentou uma relação coerente com a SATIS e um alfa de Cronbach de 0,856. Não foi encontrada correlação entre impressão clínica global de melhora pelo médico e mudança percebida pelo paciente, embora uma correlação positiva moderada tenha sido observada entre impressão clínica global de melhora pelo paciente e mudança percebida pelo paciente. Conclusão: A EMP-P exibiu propriedades psicométricas adequadas em uma amostra de pacientes com transtornos mentais internados. A percepção de mudança pelo paciente é uma importante dimensão para a avaliação de resultados no tratamento de transtornos mentais e difere da impressão clínica de melhora do médico. A avaliação das percepções positivas e negativas das diversas dimensões da vida dos pacientes permite uma análise mais precisa de suas prioridades e interesses.

Is there a correlation between physicians' clinical impressions and patients' perceptions of change? Use of the Perceived Change Scale with inpatients with mental disorders.

INTRODUCTION:: Assessment of the results of treatment for mental disorders becomes more complete when the patient's perspective is incorporated. Here, we aimed to evaluate the psychometric properties and application of the Perceived Change Scale - Patient version (PCS-P) in a sample of inpatients with mental disorders. METHODS:: One hundred and ninety-one psychiatric inpatients answered the PCS-P and the Patients' Satisfaction with Mental Health Services Scale (SATIS) and were evaluated in terms of clinical and sociodemographic data. An exploratory factor analysis (EFA) was performed and internal consistency was calculated. The clinical impressions of the patient, family, and physician were correlated with the patient's perception of change. RESULTS:: The EFA indicated a psychometrically suitable four-factor solution. The PCS-P exhibited a coherent relationship with SATIS and had a Cronbach's alpha value of 0.856. No correlations were found between the physician's clinical global impression of improvement and the patient's perception of change, although a moderate positive correlation was found between the patients' clinical global impression of improvement and the change perceived by the patient. CONCLUSIONS:: The PCS-P exhibited adequate psychometric proprieties in a sample of inpatients with mental disorders. The patient's perception of change is an important dimension for evaluation of outcomes in the treatment of mental disorders and differs from the physician's clinical impression of improvement. Evaluation of positive and negative perceptions of the various dimensions of the patient's life enables more precise consideration of the patient's priorities and interests.

Factors related to positive and negative outcomes in psychiatric inpatients in a general hospital psychiatric unit: a proposal for an outcomes index

Background General Hospital Psychiatric Units have a fundamental importance in the mental health care systems. However, there is a lack of studies regarding the level of improvement of patients in this type of facility. Objective To assess factors related to good and poor outcomes in psychiatric inpatients using an index composed by clinical parameters easily measured. Methods Length of stay (LOS), Global Assessment of Functioning (variation and at discharge) and Clinical Global Impression (severity and improvement) were used to build a ten-point improvement index (I-Index). Records of psychiatric inpatients of a general hospital during an 18-month period were analyzed. Three groups (poor, intermediate and good outcomes) were compared by univariate and multivariate models according to clinical and sociodemographic variables. Results Two hundred and fifty patients were included, with a percentage in the groups with poor, regular and good outcomes of 16.4%, 59,6% and 24.0% respectively. Poor outcome at the discharge was associated mainly with lower education, transient disability, antipsychotics use, chief complaint “behavioral change/aggressiveness” and psychotic features. Multivariate analysis found a higher OR for diagnoses of “psychotic disorders” and “personality disorders” and others variables in relation to protective categories in the poor outcome group compared to the good outcome group. Discussion Our I-Index proved to be an indicator of that allows an easy and more comprehensive evaluation to assess outcomes of inpatients than just LOS. Different interventions addressed to conditions such as psychotic disorders and disruptive chief complaints are necessary.

Reconstrução parcial de nariz baseada em retalho nasogeniano após ressecção de carcinoma espinocelular envolvendo septo nasal, columela e lábio superior / Partial reconstruction of a nose based on a nasolabial flap after the resection of a squamous cell carcinoma involving the nasal septum, columella, and upper lip

INTRODUÇÃO: Reconstruções de defeitos complexos na face constituem um desafio para os cirurgiões. Após ressecção da lesão, o reparo nasal é difícil, já que possui uma variedade de tecidos e área local doadora reduzida para reconstrução. Já as lesões de lábio possuem como principal dificuldade a restauração da função, priorizando a integridade da estrutura esfincteriana, a continência oral, a abertura bucal e a sensibilidade. Entre as alternativas para reconstrução dessas áreas, podemos optar por retalhos locais, entre os quais o nasogeniano. OBJETIVO: Analisar desfechos de reconstrução nasal e de lábio superior em dois tempos cirúrgicos, utilizando retalho nasogeniano, após defeito complexo causado por ressecção de carcinoma espinocelular (CEC). RELATO DO CASO: Paciente do gênero feminino, 56 anos, apresentou CEC de progressão avançada em região nasal da columela, terço anterior do septo e parte do lábio superior. A paciente foi submetida à reconstrução com retalho nasogeniano e, em segundo momento cirúrgico, ao enxerto de cartilagem costal para reconstrução de columela. Apresenta evolução com boa integração e viabilidade dos enxertos e retalhos. O resultado estético foi satisfatório. CONCLUSÃO: A utilização de retalho nasogeniano como opção terapêutica para a reconstrução parcial de nariz e de lábio superior apresentou desfechos funcionais/estéticos favoráveis. Além disso, a segmentação do procedimento cirúrgico traz segurança na utilização dos retalhos locais, principalmente em indivíduos de difícil cicatrização.

INTRODUCTION: Reconstruction of complex facial defects is a challenge for surgeons. After the excision of a lesion, nasal reconstruction is challenging because of the variety of tissues involved and the reduced local donor area for reconstruction. On the other hand, a major difficulty in the reconstruction of lip lesions is restoration of function, with the priority being the maintenance of the integrity of the sphincter structure, oral continence, mouth opening, and sensitivity. Among the alternatives for the reconstruction of these areas are local flaps, including the nasolabial flap. AIM: To analyze the outcome of nasal and upper lip reconstruction performed in two surgical stages, by using a nasolabial flap for complex defects resulting from the resection of squamous cell carcinoma (SCC). CASE REPORT: A 56-year-old female patient presented with advanced SCC in the nasal region of the columella, anterior third of the septum, and part of the upper lip. She underwent reconstruction with a nasolabial flap and, in a second surgical procedure, with a costal cartilage graft for the reconstruction of the columella. The procedures resulted in good integration and viability of grafts and flaps. The aesthetic result was satisfactory. CONCLUSION: The use of a nasolabial flap as a therapeutic option for the partial reconstruction of the nose and upper lip produces favorable functional and aesthetic outcomes. In addition, the division of the surgical procedure into stages provides safety in the use of local flaps, particularly in patients with poor healing.

Características clínicas de pacientes obstétricas admitidas em uma Unidade de Tratamento Intensivo Terciária: revisão de dez anos / Clinical features and results of obstetric patients admitted to a Tertiary Intensive Care Unit: ten-year review

Introdução: Taxas significativas de morbimortalidade materna ainda podem ser observadas no período gestacional. Um indicador importante de morbidade materna é a necessidade de transferência de paciente obstétrica para a Unidade de Terapia Intensiva. O objetivo do estudo foi avaliar os desfechos maternos e perinatais relacionados a pacientes obstétricas admitidas em unidade de cuidados intensivos. Mé-todos: Estudo observacional e consecutivo das pacientes obstétricas admitidas na Unidade de Tratamento Intensivo do Hospital Geral da Universidade de Caxias do Sul, de Março/1998 a Dezembro/2008. Foram analisadas variáveis maternas, obstétricas e neonatais. As variáveis contínuas foram apresentadas sob a forma de porcentagens e as categóricas, sob a forma de proporções. Foi realizado o cálculo de intervalo de confiança com nível de significância (alfa) de 5%. Resultados: no Hospital Geral, no período citado, ocorreram 17.071 nascimentos e 2.758 internações em Unidade de Tratamento Intensivo, sendo que dessas, 87 (3,2%) estiveram relacionadas a complicações da gravidez ou abortos. O principal motivo de internação hospitalar foram as síndromes hipertensivas (70,1%); de óbito, a coagulação intravascular disseminada e o choque séptico. A média da idade materna foi 26,8±7,8; 45 (51,7%) eram nulíparas; 21 (27,6%) apresentaram algum tipo de complicação intraparto. A taxa de mortalidade materna foi de 8,1% (n=7) e a de mortalidade perinatal foi de 22,4% (n=17). Conclusões: Oitenta e sete pacientes obstétricas necessitaram de tratamento intensivo. Fundamentalmente, eram pacientes nulíparas, hipertensas, com pouca escolaridade e assistência pré-natal inadequada. Sete (8,1%) pacientes morreram durante a estada hospitalar.

Introduction: Significant rates of maternal morbidity and mortality still occur during pregnancy. An important indicator of maternal morbidity is the need for transfer of obstetric patients to the Intensive Care Unit. The aim of the study was to evaluate maternal and perinatal outcomes related to obstetric patients admitted to intensive care units. Methods: An observational study of consecutive patients admitted to the obstetric intensive care unit of the General Hospital of the University of Caxias do Sul, from March/1998 to December/2008. Maternal, obstetric and neonatal variables were analyzed. Continuous variables were presented as percentages, and categorical variables as proportions. Confidence interval with significance level (alpha) at 5% was calculated. Results: In the general Hospital, in the mentioned period, there were 17,071 births and 2,758 admissions to the Intensive Care Unit, and of these, 87 (3.2%) were related to complications of pregnancy or abortion. The main reason for hospital admission were hypertensive disorders (70.1%); for death, disseminated intravascular coagulation and septic shock. The mean maternal age was 26.8 ± 7.8; 45 (51.7%) were nulliparous; and 21 (27.6%) had some type of intrapartum complication. The maternal mortality rate was 8.1% (n = 7) and the perinatal mortality rate was 22.4% (n = 17). Conclusions: Eighty-seven obstetric patients required intensive care. Fundamentally, they were nulliparous, hypertensive, with poor education and inadequate prenatal care. Seven (8.1%) patients died during their hospital stay.

Factores de riesgo asociados a traumatismo al nacimiento / Risk factors associated with birth trauma

ANTECEDENTES: Se define trauma al nacimiento las lesiones sufridas por el feto durante el trabajo de parto o expulsión. OBJETIVO: Identificar los factores de riesgo asociados a lesiones originadas durante el nacimiento en recién nacidos. MÉTODO: Estudio casos y controles, realizado en el período de julio/2004 a diciembre/2005, en la División de Ginecología y Obstetricia del Hospital General de Caxias do Sul/ Facultad de Medicina, Universidad de Caxias do Sul, RS, Brasil. Fueron analizadas variables maternas, del parto y fetales, utilizando el programa estadístico SPSS versión 19.0. Los factores que obtuvieron nivel significativo <0,10 en los análisis bivariado fueron insertas en la regresión logística. Se utilizó el modelo de entrada por bloques (block entry) para selección del modelo final de la regresión. RESULTADOS: En el período citado nacieron 2.137 infantes, 26 de ellos (1,2%) sufrieron trauma al nacimiento. La fractura de clavícula fue la lesión más frecuente (n=14; 53,8%), seguida del cefalohematoma (n=5; 19,2%). Las variables gasométricas no presentaron diferencia estadística. En la regresión logística, las únicas variables independientes asociadas a traumatismo al nacimiento fueron parto vaginal (OR-A: 11,08; IC95%: 2,45-49,98; p=0,002) y perímetro torácico >33 cm (OR-A: 3,36; IC95%: 1,35-9,73; p=0,010). CONCLUSIÓN: Los factores de riesgo asociados a lesiones durante el nacimiento involucran el parto vaginal y el perímetro torácico igual o superior a 33cm.

BACKGROUND: Obstetrics injuries can be defined as fetal lesions suffered by the fetus during labor or expulsion. OBJECTIVE: Identify risk factors for fetal birth trauma. METHOD: Case-control study conducted from July 2004 to December 2005. We analyzed maternal and fetal variables using software SPSS 19.0. The variables showing a significance level <0.10 in the bivariate analysis were included in the logistic regression analysis. We used the block entry model for selection of the final regression model. RESULTS: During these period, we identified 2137 births and 26 (1.2%) were related to fetal birth injury. Clavicle fracture was the most frequent injury (n = 14; 53.8%), followed by cephalohematoma (n = 5; 19.2%). Umbilical cord blood gas analysis did not show statistical significance. In the regression analysis of the variables that had significance level <0.10, the only independent variables associated with fetal birth injury were vaginal delivery (OR-A: 11.08; 95%CI: 2.45-49.98; p=0.002) and thorax circumference > 33 cm (OR-A: 3.36; 95%CI: 1.35-9.73; p=0.010). CONCLUSION: The risk factors for fetal birth injury were vaginal delivery and chest circumference equal to or larger than 33 cm. Other variables were not associated with the outcome in discussion.

Fatores de risco para tocotraumatismo materno / Risk factors to maternal birth injury

Os tocotraumatismos maternos acometem com mais frequência partes moles da genitália materna e, por isso, estão relacionados a substancial morbidade, como nos casos de rupturas perineais, vaginais e cervicais. A mortalidade é representada principalmente pela ruptura uterina. O objetivo deste estudo foi identificar os fatores de risco relacionados ao tocotraumatismo materno. Métodos: Estudo caso-controle, realizado em uma enfermaria de puerpério, no período de julho/2004 a dezembro/2005. Foram avaliadas variáveis maternas e fetais. As variáveis categóricas foram apresentadas como proporções, as com distribuição normal como média e desvio padrão, e as sem distribuição normal como mediana e intervalo interquartil. Para verificação das variáveis associadas ao tocotraumatismo materno, foram conduzidas análises bivariadas, com o teste qui-quadrado. Resultados: Dentre 2.137 puérperas, foram identificados 37 casos (1,7%) de tocotraumatismo. As lesões de primeiro e segundo graus foram as mais prevalentes (n=29; 78,4%). Foi observado um caso de ruptura uterina. As variáveis: a) segundo período de trabalho de parto inferior a 30 minutos, b) peso fetal entre 3.000g e 3.499 g, c) comprimento fetal entre 46 cm e 50 cm e d) perímetro torácico ≥33 cm estiveram associadas ao tocotraumatismo materno na análise bivariada, mas não tiveram significância quando da regressão logística. Conclusão: As lesões de primeiro e segundo graus foram as mais prevalentes (n=29). Parto vaginal, multiparidade e perímetro cefálico ≥33 cm foram identificados como fatores de risco independentes para lesão materna.

Maternal birth injuries affect most often the soft parts of the maternal genitalia and therefore are related to substantial morbidity, such as in cases of perineal, vaginal and cervical ruptures. Mortality is mainly represented by uterine rupture. The aim of this study was to identify risk factors related to maternal birth trauma. Methods: A case-control study conducted in a postpartum ward from Jul 2004 to Dec 2005. Maternal and fetal variables were evaluated. Categorical variables were shown as proportions, those with normal distribution as mean and standard deviation, and those without normal distribution as median and interquartile range. In order to check the variables associated with maternal birth trauma, bivariate analysis was conducted with the chi-square test. Results: Of 2,137 women, 37 cases (1.7%) of maternal birth trauma were identified. Lesions of first and second degrees were the most prevalent (n = 29, 78.4%). One case of uterine rupture was found. Variables (a) second period of labor less than 30 minutes, (b) fetal weight between 3,000 g and 3,499 g, (c) fetal length between 50 cm and 46 cm) and (d) chest girth ≥ 33 cm were associated with maternal birth trauma in the bivariate analysis, but had no significance in the logistic regression. Conclusion: First and second degrees lesions were the most prevalent (n = 29). Vaginal delivery, multiparity and head circumference ≥ 33 cm were identified as independent risk factors for maternal injury.