Maternal mortality in adolescents and young adults: temporal trend and correlation with prenatal care coverage in the state of Bahia, Brazil, 2000-2020.

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.

[Teenage pregnancy and prematurity in Brazil, 2011-2012]. / Prematuridade e gravidez na adolescência no Brasil, 2011-2012.

The study aims to evaluate the association between teenage pregnancy and prematurity. The data are from the Birth in Brazil study, a national survey consisting of 23,894 postpartum women and their newborn infants. The information was obtained from interviews with the mothers during their postpartum hospital stay. A matching method was established, based on propensity scores, to deal with differences between the groups due to the non-experimental design of the Birth in Brazil study. The study outcome was gestational age, considering all the premature births (gestational age < 37 weeks) and term births (gestational age 37 weeks to 41 weeks and 6 days). The study revealed social, economic, and maternal care disparities between the women according to age bracket. The highest proportions of teenage mothers were in the least developed regions of Brazil (North and Northeast) and in the poorest economic classes. After matching for socioeconomic and obstetric care characteristics, the highest odds of spontaneous prematurity were seen in younger adolescents compared to older adolescents (OR = 1.49; 95%CI: 1.07-2.06), and young adults (OR = 2.38; 95%CI: 1.82-3.12). Prematurity is still an issue in the field of maternal and child health, and the association with teenage pregnancy identified in this study is worrisome, especially because younger adolescent mothers were associated with higher odds of spontaneous prematurity.

Este trabalho tem como objetivo avaliar a associação entre gravidez na adolescência e prematuridade. Os dados são provenientes da pesquisa Nascer no Brasil, inquérito nacional composto por 23.894 puérperas e seus recém-nascidos. As informações foram obtidas por meio de entrevista com a puérpera durante a internação hospitalar. Um método de pareamento foi estabelecido, baseado nos escores de propensão, para lidar com diferenças entre os grupos em razão de um desenho não experimental, caso do estudo Nascer no Brasil. O desfecho do estudo foi a idade gestacional, sendo considerados todos os partos prematuros (idade gestacional < 37 semanas) e a termo (idade gestacional entre 37 e 41 semanas e 6 dias). O estudo evidenciou disparidades sociais, econômicas e assistenciais maternas entre as mulheres segundo a faixa etária. A maior proporção de puérperas adolescentes se concentrou nas regiões menos desenvolvidas do país, Norte e Nordeste, e nas classes econômicas menos favorecidas (D/E). Depois de equiparadas quanto às características socioeconômicas e assistenciais, foram observadas maiores chances de prematuridade espontânea nas adolescentes precoces, tanto em comparação às adolescentes tardias (OR = 1,49; IC95%: 1,07-2,06), quanto às adultas jovens (OR = 2,38; IC95%: 1,82-3,12). A prematuridade permanece em pauta no campo da saúde materno-infantil, sendo preocupante a associação com a gestação na adolescência encontrada neste trabalho, destacando-se que quanto mais jovem a gestante, maior a chance de parto prematuro espontâneo.

Este estudio tiene como objetivo evaluar la asociación entre embarazo en la adolescencia y prematuridad. Los datos provienen de la encuesta Nacer en Brasil, encuesta nacional compuesta por 23.894 puérperas y sus recién nacidos. La información se obtuvo mediante una entrevista con la puérpera durante el internamiento hospitalario. Se estableció un método de emparejamiento, basado en las puntuaciones de propensión, para tratar las diferencias entre los grupos, según un diseño no experimental, como es el caso del estudio Nacer en Brasil. El resultado del estudio fue la edad gestacional, considerándose todos los partos prematuros (edad gestacional < 37 semanas) y a término (edad gestacional entre 37 y 41 semanas y 6 días). El estudio evidenció disparidades sociales, económicas y asistenciales maternas entre las mujeres, según su franja de edad. La mayor proporción de puérperas adolescentes se concentró en las regiones menos desarrolladas del país, Norte y Nordeste, y en las clases económicas menos favorecidas (D/E). Tras equiparlas respecto a las características socioeconómicas y asistenciales, se observaron mayores oportunidades de prematuridad espontánea en las adolescentes precoces, tanto en comparación con las adolescentes tardías (OR = 1,49; IC95%: 1,07-2,06), como con las adultas jóvenes (OR = 2,38; IC95%: 1,82-3,12). La prematuridad permanece en pauta en el campo de la salud materno-infantil, siendo preocupante la asociación con la gestación en la adolescencia hallada en este estudio, destacándose que cuanto más joven es la gestante, mayor es la oportunidad de parto prematuro espontáneo.

Mortalidade materna na adolescência e juventude: tendência temporal e correlação com cobertura pré-natal na Bahia, 2000-2020 / Maternal mortality in adolescents and young adults: temporal trend and correlation with prenatal care coverage in the state of Bahia, Brazil, 2000-2020 / Mortalidade materna na adolescência e juventude: tendência temporal e correlação com cobertura pré-natal na Bahia, 2000-2020

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.

Cross-cultural adaptation of the Parcours Amoureux des Jeunes - PAJ inventory of Canadian origin to the Brazilian context.

Analyzing violent events in the amorous trajectory of young people mobilizes researchers worldwide. The scope of this study is to perform the cross-cultural adaptation and content validation of the Canadian Parcours Amoureux des Jeunes (PAJ) inventory in the Brazilian context. It is a methodological study with the following steps: (a) translation and back-translation; (b) committee of experts (10) for analysis of equivalence, clarity and matching percentages; (c) calculation of the Content Validity Index / CVI. This analysis generated Pilot version III (d) submitted to a pre-test group of 36 adolescents aged 14 to 24 of both sexes to obtain cultural, conceptual, semantic and idiomatic equivalence. The PAJ showed adequate content validity (CVI 0.97). In section 1 (sociodemographic aspects of youths and families inherent to the Canadian context), the questions were appropriate to the Brazilian context shown by the low value of the CVI. Cross-cultural adaptation and content validation processes showed that the PAJ had adequate clarity and equivalence properties. This step makes it viable to conduct psychometric analysis to assess the replicability and reliability of the instrument to be applied in the Brazilian context.

Notification of juvenile violence in Emergency Services of the Brazilian Unified Health System in Feira de Santana, Bahia, Brazil.

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.

Prematuridade e gravidez na adolescência no Brasil, 2011-2012 / Teenage pregnancy and prematurity in Brazil, 2011-2012 / Prematuridad y embarazo durante la adolescencia en Brasil, 2011-2012

Este trabalho tem como objetivo avaliar a associação entre gravidez na adolescência e prematuridade. Os dados são provenientes da pesquisa Nascer no Brasil, inquérito nacional composto por 23.894 puérperas e seus recém-nascidos. As informações foram obtidas por meio de entrevista com a puérpera durante a internação hospitalar. Um método de pareamento foi estabelecido, baseado nos escores de propensão, para lidar com diferenças entre os grupos em razão de um desenho não experimental, caso do estudo Nascer no Brasil. O desfecho do estudo foi a idade gestacional, sendo considerados todos os partos prematuros (idade gestacional < 37 semanas) e a termo (idade gestacional entre 37 e 41 semanas e 6 dias). O estudo evidenciou disparidades sociais, econômicas e assistenciais maternas entre as mulheres segundo a faixa etária. A maior proporção de puérperas adolescentes se concentrou nas regiões menos desenvolvidas do país, Norte e Nordeste, e nas classes econômicas menos favorecidas (D/E). Depois de equiparadas quanto às características socioeconômicas e assistenciais, foram observadas maiores chances de prematuridade espontânea nas adolescentes precoces, tanto em comparação às adolescentes tardias (OR = 1,49; IC95%: 1,07-2,06), quanto às adultas jovens (OR = 2,38; IC95%: 1,82-3,12). A prematuridade permanece em pauta no campo da saúde materno-infantil, sendo preocupante a associação com a gestação na adolescência encontrada neste trabalho, destacando-se que quanto mais jovem a gestante, maior a chance de parto prematuro espontâneo.

The study aims to evaluate the association between teenage pregnancy and prematurity. The data are from the Birth in Brazil study, a national survey consisting of 23,894 postpartum women and their newborn infants. The information was obtained from interviews with the mothers during their postpartum hospital stay. A matching method was established, based on propensity scores, to deal with differences between the groups due to the non-experimental design of the Birth in Brazil study. The study outcome was gestational age, considering all the premature births (gestational age < 37 weeks) and term births (gestational age 37 weeks to 41 weeks and 6 days). The study revealed social, economic, and maternal care disparities between the women according to age bracket. The highest proportions of teenage mothers were in the least developed regions of Brazil (North and Northeast) and in the poorest economic classes. After matching for socioeconomic and obstetric care characteristics, the highest odds of spontaneous prematurity were seen in younger adolescents compared to older adolescents (OR = 1.49; 95%CI: 1.07-2.06), and young adults (OR = 2.38; 95%CI: 1.82-3.12). Prematurity is still an issue in the field of maternal and child health, and the association with teenage pregnancy identified in this study is worrisome, especially because younger adolescent mothers were associated with higher odds of spontaneous prematurity.

Este estudio tiene como objetivo evaluar la asociación entre embarazo en la adolescencia y prematuridad. Los datos provienen de la encuesta Nacer en Brasil, encuesta nacional compuesta por 23.894 puérperas y sus recién nacidos. La información se obtuvo mediante una entrevista con la puérpera durante el internamiento hospitalario. Se estableció un método de emparejamiento, basado en las puntuaciones de propensión, para tratar las diferencias entre los grupos, según un diseño no experimental, como es el caso del estudio Nacer en Brasil. El resultado del estudio fue la edad gestacional, considerándose todos los partos prematuros (edad gestacional < 37 semanas) y a término (edad gestacional entre 37 y 41 semanas y 6 días). El estudio evidenció disparidades sociales, económicas y asistenciales maternas entre las mujeres, según su franja de edad. La mayor proporción de puérperas adolescentes se concentró en las regiones menos desarrolladas del país, Norte y Nordeste, y en las clases económicas menos favorecidas (D/E). Tras equiparlas respecto a las características socioeconómicas y asistenciales, se observaron mayores oportunidades de prematuridad espontánea en las adolescentes precoces, tanto en comparación con las adolescentes tardías (OR = 1,49; IC95%: 1,07-2,06), como con las adultas jóvenes (OR = 2,38; IC95%: 1,82-3,12). La prematuridad permanece en pauta en el campo de la salud materno-infantil, siendo preocupante la asociación con la gestación en la adolescencia hallada en este estudio, destacándose que cuanto más joven es la gestante, mayor es la oportunidad de parto prematuro espontáneo.

[Initiation and consumption of psychoactive substances among adolescents and young adults in an Anti-Drug Psychosocial Care Center]. / Iniciação e consumo de substâncias psicoativas entre adolescentes e adultos jovens de Centro de Atenção Psicossocial Antidrogas/CAPS-AD.

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.

[Factors associated with HIV/AIDS infection among adolescents and young adults enrolled in a Counseling and Testing Center in the State of Bahia, Brazil]. / Fatores associados à infecção pelo HIV/AIDS entre adolescentes e adultos jovens matriculados em Centro de Testagem e Aconselhamento no Estado da Bahia, Brasil.

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.

[Sexual violence and co-occurrences suffered by children and adolescents: study of incidents over a decade]. / Violência sexual e coocorrências em crianças e adolescentes: estudo das incidências ao logo de uma década.

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.

[Surveillance System for Violence and Accidents (VIVA) and notification of infant-juvenile violence in the Brazilian Unified Health System (SUS) in Feira de Santana in the state of Bahia]. / Sistema de Vigilância de Violências e Acidentes/VIVA e a notificação da violência infanto-juvenil, no Sistema Único de Saúde/SUS de Feira de Santana-Bahia, Brasil.

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.

Economic and racial inequalities in the prenatal care of pregnant teenagers in Brazil, 2011-2012 / Desigualdades econômicas e raciais na assistência pré-natal de grávidas adolescentes, Brasil, 2011-2012

Abstract Objectives: to analyze the prenatal care of pregnant teenagers interviewed in the post-partum period in Brazilian maternity hospitals, according to economic status and skin color. Methods: data were obtained from the Birth in Brazil study, a national hospital-based survey in 2011 and 2012. Information was obtained from interviews with the postpartum women and from data collected from their prenatal cards. Multivariate logistic regression was used to verify whether maternal and prenatal care characteristics were associated with ina-dequate prenatal care. Results: a total of 3,317 teenage mothers were interviewed in the postpartum period, 84.4% of whom had received inadequate prenatal care, with worse results for lower-income, lower-schooling, and multiparous teens. In the same way, it became evident the higher proportion of black teenagers and those from economic classes D/E among those who failed to receive routine laboratory tests, who received little orientation on the pregnancy, labor, and childbirth, and who were forced to go from one maternity hospital to another before being admitted to give birth. Conclusions: strategies targeted to the most vulnerable pregnant teenagers should be implemented in order to achieve greater equality in teenagers' prenatal care, seeking to assure easier access, earlier initiation of care, and greater case-resolution capacity

Resumo Objetivos: analisar a assistência pré-natal de puérperas adolescentes brasileiras, segundo as características econômicas e de cor da pele. Métodos: foram utilizados dados da pesquisa Nascer no Brasil, um inquérito nacional de base hospitalar, realizado entre 2011 e 2012. As informações foram obtidas por meio de entrevistas com as puérperas e coleta de dados dos cartões de pré-natal. Realizou-se regressão logística multivariada para verificar quais características maternas e dos cuidados recebidos estavam associadas à inadequação da assistência pré-natal. Resultados: um total de 3.317 puérperas adolescentes foram entrevistadas, tendo 84,4% recebido cuidado inadequado durante o pré-natal, com pior resultado para as adolescentes de classe econômica mais baixa, menor escolaridade e multíparas. Do mesmo modo, ficou evidente a maior proporção de adolescentes da classe econômica D/E e de cor da pele preta que não conseguiram realizar exames preconizados como rotina durante a gravidez, que receberam poucas orientações sobre a gestação e parto, e que mais peregrinaram em busca de maternidade para realização do parto. Conclusões: estratégias direcionadas ao grupo de adolescentes mais vulneráveis devem ser implementadas visando maior equidade na assistência pré-natal de adolescentes, buscando garantir acesso facilitado, início precoce da assistência e maior resolutividade.

Factors associated with caesarean section among primiparous adolescents in Brazil, 2011-2012.

This paper presents the factors associated with caesarean section in primiparous adolescents in Brazil using data from a national hospital-based survey conducted between 2011 and 2012. Information was obtained from postpartum women through face-to-face and telephone interviews and a theoretical model with three levels of hierarchy was used to analyze associations with the dependent variable mode of delivery (caesarean or vaginal). The results show that the caesarean section rate among primiparous teenagers is high (40%). The most significant contributing factors for caesarean section were: considering this mode of delivery safer (OR=7.0; 95%CI: 4.3-11.4); giving birth under the private health system (OR=4.3; 95%CI: 2.3-9.0); being attended by the same health care professional throughout prenatal care and delivery (OR=5.7; 95%CI: 3.3-9.0) and clinical history of risk and complications during pregnancy (OR=10.8; 95%CI: 8.5-13.7). Adolescent pregnancy continues to be an important concern on the reproductive health agenda and the rates observed by this study are worrying given the effects of early exposure to caesarean section.

[Teenage pregnancy: analysis of risk factors for low birth weight, prematurity and cesarean delivery]. / Gravidez na adolescência: análise de fatores de risco para baixo peso, prematuridade e cesariana.

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.

Factors associated with Specific Hypertensive Gestation Syndrome (SHGS) in postpartum adolescent and young adult mothers in the Northeast of Brazil: a multiple analysis of hierarchical models / Fatores associados à Síndrome Hipertensiva Específica da Gestação em puérperas adolescentes e adultas jovens da Região Nordeste do Brasil: análise múltipla em modelos hierárquicos

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.

Food consumption pattern and obesity in preschool children in Feira de Santana, Bahia, Brazil / Padrão de consumo alimentar e obesidade em pré-escolares, Feira de Santana, Bahia

ABSTRACT Objective To evaluate the association between food consumption patterns and obesity in preschool children in Feira de Santana, Bahia, Brazil. Methods Cross-sectional, population-based nested within a live-birth cohort study of 813 children, which has started in 2004 in Feira de Santana, Bahia. The anthropometric status among children under four years of age was evaluated based on their body mass index; obesity/severe obesity was defined as a Z-score >+2. The Food Frequency Questionnaire was used to identify dietary patterns using principal components analysis. The association between obesity and food consumption patterns was assessed using Pearson's Chi-squared test and logistic regression, adopting p<0.05 to denote statistical significance. Results Obesity was detected in 12.7% of the children investigated. Four food consumption patterns were identified: dietary pattern 1 (milk and other dairy products, vegetables and tubers, cereals, legumes, fruits, and fish); dietary pattern 2 (deep-fried or baked snacks, soft drinks/artificial fruit juices, oils and fats, sweets, and coffee/tea); dietary pattern 3 (encased meats, fast food, ketchup/mayonnaise, and eggs); and, dietary pattern 4 (chicken and red meats). Obesity was statistically associated with high adherence to the dietary pattern 3 (OR=1.92; 95%CI=1.01-3.66). Conclusion The results obtained showed that the high intake of energy-dense foods (dietary pattern 3) was a contributing factor to childhood obesity. These data reinforce the need for public policies and food education programs in health units and schools, aiming to change children's eating habits, significant predictors of nutritional problems.

RESUMO Objetivo Avaliar a associação entre padrões de consumo alimentar e a obesidade de pré-escolares em Feira de Santana, Bahia. Métodos Análise transversal de 813 crianças de uma coorte de nascidos vivos de base populacional, iniciada em 2004 em Feira de Santana, Bahia. O estado antropométrico entre menores de quatro anos foi avaliado por meio do cálculo do índice de massa corporal, sendo a obesidade/obesidade grave definida em escore Z (>+2). O Questionário de Frequência Alimentar foi o instrumento utilizado para identificar os padrões alimentares por meio da análise fatorial de componentes principais. A associação entre a obesidade e os padrões de consumo alimentar foi avaliada mediante teste Qui-quadrado de Pearson e da regressão logística, tomando-se como critério de associação, valor de p<0,05. Resultados A obesidade para idade foi observada em 12,7% das crianças estudadas. Foram identificados quatro padrões alimentares: padrão alimentar 1 (leite e derivados, verduras e tubérculos, cereais, leguminosas, frutas e pescados); padrão alimentar 2 (salgadinhos, refrigerante/sucos artificiais, óleos e gorduras, doces e café/chá); padrão alimentar 3 (embutidos, fast-food, catchup/maionese e ovos); e, padrão alimentar 4 (frango e carnes vermelhas). A obesidade mostrou-se estatisticamente associada à alta adesão ao padrão alimentar 3 (OR=1,92; IC95%=1,01-3,66). Conclusão Os resultados da pesquisa mostraram que a elevada ingestão de alimentos altamente energéticos (padrão alimentar 3) foi fator contributivo para a ocorrência da obesidade na infância. Estes dados reforçam a necessidade de políticas públicas e programas de educação alimentar, nas unidades de saúde e escolas, para mudança dos hábitos alimentares das crianças, importante preditor de problemas nutricionais.

Sobrevida em crianças e adolescentes infectados via vertical pelo HIV e fatores associados ao óbito / Survival on vertically infected children and adolescents by HIV and factors associated with death

Objetivo: analisar o tempo de sobrevida e fatores associados ao óbito em crianças e jovens infectados viavertical pelo HIV. Método: estudo quantitativo, observacional, longitudinal, utilizando registros do Centro deReferência DST/HIV/SIDA. Foram revisados 63 prontuários clínicos de indivíduos entre 0 e 24 anos e utilizadaanálise de sobrevivência com teste log-rank e regressão de riscos proporcionais de Cox para estimativaajustada dos fatores de risco para óbito. Resultados: análises multivariadas mostraram significância paraidade cronológica como fator de proteção (HR: 0,88; IC 95%: 0,78-0,98) e infecção oportunista não oral comofator de risco (HR:4,3; IC 95%: 1,51-12,1). O tempo médio da sobrevida foi 8,8 anos, sendo 10,6 anos, após usode antirretroviral, e 6 anos, sem uso. Conclusão: houve aumento da sobrevida, com uso de TARV pelamaioria, controle clínico-laboratorial e infecções oportunistas, possivelmente influenciando este resultado epredomínio de óbitos relacionados à AIDS.

Levantamento de marcas de mordidas humanas em vítimas de violência periciadas no Instituto Médico Legal de Feira de Santana-BA, entre 2007 e 2014 / Bites brand survey on human violence victims examined in the Legal Medical Institute of Feira de Santana-BA, between 2007 and 2014

Objetivo: Descrever a prevalência de marcas de mordidas em vítimas de violência periciadas no Instituto Médico Legal de Feira de Santana no período de 2007 até 2014, levando em consideração a análise do perfil sociodemográfico das vítimas, a relação destas com os supostos agressores, bem como fatores inerentes às particularidades da violência, características da mordida e região do corpo atingida. Métodos: Estudo de casuística, de caráter exploratório com base em dados secundários, produzidos a partir das perícias realizadas por peritos odontolegistas registradas em laudos arquivados no Instituto Médico Legal (IML), no período de 2007 à 2014. Resultados: Os resultados apontam um maior índice de vítimas do sexo feminino (78,1%), entre 20-60 anos (53,1%), faiodermas, estudantes (28,6%) e naturais de Feira de Santana (56,2%). A região de cabeça e pescoço (29,2%) e membros superiores (29,2%) tiveram destaque nas agressões e a maioria das vítimas apresentaram mais de uma lesão, apresentando-se clinicamente como escoriações (34,2%) e equimoses (31,6%). Em nenhum dos casos houve tentativa de identificação do agressor pela mordida. Conclusão: Desse modo, conclui-se que a maior parte das vítimas de violência física que apresentaram lesão provocada por mordida humana era do sexo feminino, faioderma e adultos. Os supostos agressores na maioria dos casos tem ou tiverem um vínculo conjugal com a vítima. As marcas de mordidas foram predominantes na região de cabeça e pescoço e membros superiores. Como manifestação clínica destacou-se as escoriações e equimoses.(AU)

Aim: To describe the prevalence of bitemarks in victims of physical violence logged in forensics reports at the Legal Medical Institute (IML) of Feria de Santana, BA, Brazil, between 2007 and 2014, taking into account the analysis of the sociodemographic profile of the victims, their relationships with their aggressors, as well as factors inherent to the particularities of the violence, characteristics of thebite, and the region of the body that was affected. Methods: Exploratory study of the cause, based on secondary data, identified in forensics reports carried out by dental forensics experts, duly recorded in reports at the IML from 2007 to 2014. Results: The results point out a higher index of female victims (78.1%), between 20 and 60 years of age (53.1%), light-skinned black students (28.6%), and natives of the city of Feira de Santana (56.2%). The head and neck region (29.2%) and upper limbs (29.2%) were the most commonly attacked regions, and the majority of victims presented more than one lesion, appearing clinically as excoriations (34.2%) and ecchymosis (31.6%). None of the cases attempted to identify the aggressor through the bitemark. Conclusion: Therefore, it can be concluded that the majority of the victims of physical violence who presented lesions provoked by human bites were female, light-skinned back, adults. The supposed aggressors, in the majority of cases, have or had some form of marital relationship with the victim. Bitemarks were predominantly found in the head and neck region and upper limbs. Excoriations and ecchymosis stood out as the main clinical manifestations.(AU)

Injúrias dentárias traumáticas em crianças e adolescentes vítimas de violência periciadas no Instituto Médico Legal de Feira de Santana, Bahia

Objetivo: traçar o perfil epidemiológico de crianças e adolescentes que apresentaram como fator etiológico do traumatismo dentário a violência física. Sujeitos e método: estudo de casuística em crianças (0-11) e adolescentes (12-18) vítimas de violência submetidas a exame de lesão corporal, periciadas por peritos odontolegais no IML de Feira de Santana, Bahia, utilizando dados secundários, no período de 1º de janeiro de 2007 a 31 de dezembro de 2014. Resultados: no período entre 2007 e 2014, foram periciados, por odontolegistas, no Instituto Médico Legal (IML) de Feira de Santana, Bahia, 107 casos de violência física contra crianças e adolescentes. Desses, 39,2% apresentaram lesões dentárias, todas provocadas por instrumento contundente; os anos de 2011 e 2012 tiveram o maior número de vitimados (21,5%); a maior prevalência de traumatismo dentário ocorreu em 2011 (20,0%); 57 (53,3%) ví- timas eram do sexo feminino; 86 (80,4%) pertenciam à faixa etária adolescente (12 a 18 anos); com relação à cor de pele da vítima, 76 (76,8%) eram faiodermas; 36 (83,7%) agressores não eram membros da família; 37 (50,7%) vítimas foram agredidas na rua; 33 (32,7%) vítimas apresentaram duas lesões e, dessas, 10 (30,3%) foram de traumatismo dentário; o braço foi o meio mais utilizado para provocar as injúrias dentais traumáticas. Conclusão: a maior parte dos vitimados pela violência física que sofreram traumatismo dentário era do sexo masculino, adolescente e faioderma. Os responsáveis pelas agressões, na maioria dos casos, não tinha vínculo familiar com a vítima e as agressões ocorreram em maior prevalência na rua. As vítimas que apresentaram duas lesões foram as que sofreram o maior número de traumatismo dentário sendo na maioria dos casos provocados pelas mãos, com socos e murros.

Notificação da violência infanto-juvenil em Serviços de Emergência do Sistema Único de Saúde em Feira de Santana, Bahia, Brasil / Notification of juvenile violence in Emergency Services of the Brazilian Unified Health System in Feira de Santana, Bahia, Brazil

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. .

Adaptação transcultural do inventário Parcours Amoureux des Jeunes – PAJ de origem canadense para o contexto brasileiro / Cross-cultural adaptation of the Parcours Amoureux des Jeunes - PAJ inventory of Canadian origin to the Brazilian context / Cross-cultural adaptation of the Parcours Amoureux des Jeunes - PAJ inventory of Canadian origin to the Brazilian context

Analisar eventos violentos no percurso amoroso de jovens mobiliza estudiosos em nível mundial. O objetivo deste estudo é realizar a adaptação transcultural e validação de conteúdo do inventário PAJ Parcours Amourex des Jeunes, do Canadá, para o contexto brasileiro. Estudo metodológico envolvendo etapas: (a) Tradução e Retrotradução; (b) Comitê de Especialistas (10) – análise da equivalência, clareza e porcentagens de concordância; (c) Cálculo do Índice de Validade de Conteúdo/IVC. Esta análise originou a versão Piloto III: (d) Submissão ao Pré-teste com grupo de 36 jovens, de 14 a 24 anos, ambos os sexos, visando obter equivalências cultural, conceitual, semântica, idiomática. O PAJ apresentou adequada validade de conteúdo (IVC 0,97). Na seção 1 (aspectos sociodemográficos de jovens e famílias, inerentes ao contexto canadense), as questões foram adequadas ao contexto brasileiro pelo baixo valor do IVC. Os processos de adaptação transcultural e validação de conteúdo apontaram que o PAJ apresentou adequação nas propriedades de clareza e equivalência. Esta etapa viabiliza as análises psicométricas visando à reprodutibilidade e confiabilidade do instrumento a ser aplicado no contexto brasileiro.

Analyzing violent events in the amorous trajectory of young people mobilizes researchers worldwide. The scope of this study is to perform the cross-cultural adaptation and content validation of the Canadian Parcours Amoureux des Jeunes (PAJ) inventory in the Brazilian context. It is a methodological study with the following steps: (a) translation and back-translation; (b) committee of experts (10) for analysis of equivalence, clarity and matching percentages; (c) calculation of the Content Validity Index / CVI. This analysis generated Pilot version III (d) submitted to a pre-test group of 36 adolescents aged 14 to 24 of both sexes to obtain cultural, conceptual, semantic and idiomatic equivalence. The PAJ showed adequate content validity (CVI 0.97). In section 1 (sociodemographic aspects of youths and families inherent to the Canadian context), the questions were appropriate to the Brazilian context shown by the low value of the CVI. Cross-cultural adaptation and content validation processes showed that the PAJ had adequate clarity and equivalence properties. This step makes it viable to conduct psychometric analysis to assess the replicability and reliability of the instrument to be applied in the Brazilian context.