Factors Associated with Intrapartum Cesarean Section in Women Submitted to Labor Induction.

OBJECTIVE: To evaluate the results of induced labor and to determine the main factors associated with intrapartum cesarean section after patients being submitted to this procedure at the Hospital Universitário of the Universidade Federal de Santa Catarina (HU/UFSC, in the Portuguese acronym), Florianópolis, state of Santa Catarina, Brazil. METHODS: A retrospective cross-sectional study that included all the pregnancies that resulted in single-fetus births, whose gestational-age was > 22 weeks and that had been submitted to labor induction at the HU/UFSC in the period from 2013 to 2016. RESULTS: During the proposed period, 1,491 pregnant women were submitted to the labor induction protocol. In 1,264 cases (84.8%), induction resulted in labor, with 830 (65.7%) progressing to vaginal delivery. Gestational age ≥ 41 + 0 weeks was the most common indication for induced labor (55.2%), and vaginal administration of misoprostol was the most commonly used method (72.0%). Among these pregnant women, the cesarean section rate was of 34.3%. Considering the cases of induction failure, the cesarean section rate rose to 44.3%. The factors associated with cesarean section were: previous history of cesarean delivery (PR [prevalence ratio] = 1.48; 95%CI [confidence interval]: 1.51-1.88), fetuses with intrauterine growth restriction (IUGR) (PR = 1.82; 95%CI: 1.32-2.19), Bishop score ≤ 6 (PR = 1.33; 95%CI: 1.01-1.82), and induction time either < 12 hours (PR = 1.44; 95%CI: 1.17-1.66) or > 36 hours (PR = 1.51; 95%CI 1.22-1.92) between the beginning of the induction and the birth. CONCLUSION: Labor induction was successful in most patients. In the cases in which the final outcome was a cesarean section, the most strongly associated factors were: previous history of cesarean delivery, presence of fetuses with IUGR, and either excessively short or excessively long periods of induction.

OBJETIVO: Avaliar os resultados da indução de trabalho de parto e determinar os principais fatores associados à realização de cesarianas intraparto em pacientes do Hospital Universitário da Universidade Federal de Santa Catarina (HU-UFSC), Florianópolis, SC, Brasil. MéTODOS: Trata-se de um estudo epidemiológico transversal que incluiu todas as gestantes de feto único e com idade gestacional > 22 semanas, submetidas a indução de trabalho de parto no HU-UFSC no período de 2013 a 2016. RESULTADOS: No período proposto, 1.491 gestantes foram submetidas ao protocolo de indução. Em 1.264 casos (84,8%), a indução resultou em trabalho de parto, com 830 (65,7%) progredindo para o parto vaginal. Gestação ≥ 41 + 0 semanas foi a causa mais comum de indicação de indução de trabalho de parto (55,2%), e misoprostol foi o método mais utilizado (72,0%). Nessas gestantes, o índice de cesariana foi de 34,3%. Considerando os casos de falha de indução, o índice de cesariana sobe para 44,3%. Os fatores associados às cesarianas foram: história prévia de cesárea (RP [razão de prevalência] = 1,48; IC [índice de confiança]: 95% 1,51­1,88), fetos com restrição de crescimento intrauterino (RP = 1,82; IC95%: 1,32­2,19), índice de Bishop ≤ 6 (RP = 1,33; IC95%: 1,01­1,82) e tempo de indução < 12 horas (RP = 1,44; IC95%: 1,17­1,66), ou > 36 horas (RP = 1,51; IC95%: 1,22­1,92) entre o início da indução e o parto. CONCLUSãO: A indução de trabalho de parto foi bem-sucedida na maioria das pacientes. Naquelas em quem o desfecho final foi a cesariana, os fatores mais fortemente associados foram: história prévia de cesárea, presença de fetos com restrição de crescimento intrauterino, e tempos muito curtos ou muito longos de indução.

Prevalence of spontaneous, induced labour or planned caesarean section and factors associated with caesarean section in low-risk women in southern Brazil.

OBJECTIVES: This study aimed to examine the prevalence of spontaneous labour, induced labour and planned caesarean section in low-risk women; to identify the contribution of each group to the overall caesarean section rate; and to estimate factors associated with caesarean section in low-risk women according to spontaneous labour, induced labour and planned caesarean section. DESIGN: Cross-sectional hospital-based study of postpartum women and newborns, using data from the survey Birth in Brazil, Southern region. In the sample of 2,668 low-risk women, a descriptive analysis was undertaken and a Multinomial Logistic Regression model was applied to verify associations among caesarean section and spontaneous labour, induced labour and planned caesarean section in comparison with vaginal birth. MEASUREMENTS AND FINDINGS: The results showed the prevalence of spontaneous labour (48.0%), induced labour (14.0%) and planned caesarean sections (38.0%); these frequencies contributed to an overall caesarean section rate of 50.5%. Obstetric characteristics like previous vaginal birth or previous caesarean section were differentially associated with caesarean section, independently of the labour. Caesarean section without labour was significantly associated with age ≥ 35 years (ORadj 5.45 95%CI 3.16-9.39), economic class A and B (ORadj 3.10 95%CI 1.92-4.99), pregnancy between 37 and 38 weeks (ORadj 1.65 95%CI 1.22-2.24), same obstetrician in prenatal and childbirth (ORadj 13.83 95%CI 8.85-21.61) and private payment source at birth (ORadj 11.50 95%CI 6.64-19.93). KEY CONCLUSION: For low-risk women in Southern Brazil, the results identify high planned caesarean section rates, not associated with socioeconomic, obstetric, institutional or prenatal factors that justify these rates.

[Medical and non-medical factors associated with cesarean section rates in a university hospital in southern Brazil]. / Fatores médicos e não-médicos associados às taxas de cesariana em um hospital universitário no Sul do Brasil.

The objective of this study was to describe factors associated with the increase in cesarean rates in a university hospital in 2002 and 2004, exploring medical and non-medical factors. A cross-sectional study investigated 2,905 deliveries: 1,441 in 2002 and 1,464 in 2004. Differences in adjusted prevalence rates using Poisson regression and attributable risk percent were estimated for the associations between cesarean section and demographic, clinical, reproductive, institutional, obstetric, and delivery-related factors. The cesarean rate increased from 28.4% in 2002 to 36.7% in 2004. Higher maternal schooling, time of day at delivery, illness during pregnancy, and number of prenatal visits were associated with the excess rate in 2004 compared to 2002. The increased cesarean rate can be attributed at least partially to an increase in relative clinical indications and non-medical factors.

Temporal analysis of the relationship between leptospirosis, rainfall levels and seasonality, Santa Catarina, Brazil, 2005-2015.

The objective of the study is to analyze the temporal trend of leptospirosis incidence, according to rainfall levels in Santa Catarina, according to seasonality, from 2005 to 2015. This is an ecological study of time series, with date of leptospirosis, rainfall levels and population. The incidence rates of leptospirosis, relative excess of incidence, Pearson's correlation coefficient (r) and an angular coefficient (ß) were analyzed from the linear regression adjustment, with a 5% significance level. Distribution of leptospirosis cases, rainfall levels and cases reason/rainfall levels, stratified by month of occurrence were presented. There were 5,274 cases of leptospirosis, with the monthly average being 439 cases, ranging from 211 in September to 770 in January. The mean rate of leptospirosis was 7.03 per 100,000 habitants. The average rainfall level was 158.68 mm, with the lowest levels occurring in August, average of 124.9 mm, and the highest in January average of 213.20 mm. The positive correlation between leptospirosis rates and rainfall levels, during the period from January to December (r = 0.68, p = 0.023), indicates a positive temporal association between the amount of rainfall and the cases of the disease. The disease occurred all year round and presented a distinct seasonality from October to March.

Nascer no Brasil: the presence of a companion favors the use of best practices in delivery care in the South region of Brazil.

OBJECTIVE To analyze if the presence of a companion favors the use of best practices in the delivery care in the South region of Brazil. METHODS This is a cross-sectional analysis of the longitudinal study Nascer no Brasil. We analyzed data from 2,070 women from the South region of Brazil who went into labor. The data were collected between February and August 2011, by interviews and medical records. We performed a bivariate and multivariate analysis, calculating the crude and adjusted prevalence ratios using Poisson regression with robust variance estimation. The level of significance adopted was 5%. RESULTS Most women had a companion during labor (51.7%), but few remained during delivery (39.4%) or cesarean section (34.8%). Less than half of the women had access to several recommended practices, while non-recommended practices continue to be performed. In the model adjusted for age, education level, source of payment for the delivery, parity, and score of the Brazilian Association of Market Research Institutes, the presence of a companion was statistically associated with a greater supply of liquids and food (aPR = 1.34), dietary prescription (aPR = 1.34), use of non-pharmacological methods for pain relief (aPR = 1.37), amniotomy (aPR = 1.10), epidural or spinal analgesia (aPR = 1.84), adoption of non-lithotomy position in the delivery (aPR = 1.77), stay in the same room during labor, delivery, and postpartum (aPR = 1.62), skin-to-skin contact in the delivery (aPR = 1.81) and cesarean section (PR = 2.43), as well as reduced use of the Kristeller maneuver (aPR = 0.67), trichotomy (aPR = 0.59), and enema (aPR = 0.49). CONCLUSIONS In the South region of Brazil, most women do not have access to the best practices in addition to undergoing several unnecessary interventions. The presence of a companion is associated with several beneficial practices and the reduction in some interventions, although other interventions are not impacted.

Serial Palliative Performance Scale Assessment in a University General Hospital: A Pilot Study.

BACKGROUND: Serial Palliative Performance Scale (PPS) assessments may predict functional decline and prognosis in cancer and noncancer patients and help with end-of-life decision making. OBJECTIVE: To evaluate the functional status of using serial PPS assessments of patients being assisted in collaboration with the palliative care team (PCT). DESIGN: Prospective cohort pilot study. MEASUREMENTS: The sample consisted of 64 cancer and noncancer inpatients being assisted in collaboration with the PCT during the period from 2012 to 2016 (included 12 months). Patients' PPS scores were assessed in three sequential stages: prehospital, first PCT assessment, and outcome (discharge, transference to another unit or death). Functional performance was classified in categories as stable (PPS scores between 70% and 100%), transitional (PPS scores between 40% and 60%), and end of life (PPS scores between 10% and 30%). RESULTS: The mean PPS score during the three assessment stages (respectively, 60.5%, 38.9%, and 25.9%) was significantly different (p < 0.001). Cancer patients had higher PPS scores than noncancer patients; however, both groups exhibited a functional decline along the hospital stay. In both groups there was a negative correlation between the time frame between the different assessment stages and PPS scores (respectively, Pearson -0.4 and -0.6; p < 0.01). The survival curve of the first palliative assessment stage demonstrated earlier death in patients in the end-of-life category. CONCLUSION: Serial PPS assessments are feasible and predicted functional decline in cancer and noncancer patients in this sample. Cancer patients exhibited higher initial functional scores but both cancer and noncancer patients declined in functionality along hospitalization. Earlier deaths occurred in the terminal PPS category than in the transitional PPS category.

Association between institutional factors, birth care profile, and cesarean section rates in Santa Catarina. / Associação entre fatores institucionais, perfil da assistência ao parto e as taxas de cesariana em Santa Catarina.

OBJECTIVES:: To investigate how institutional factors, represented by the social profile of childbirth care, can relate to cesarean section rates. METHODS:: A cross-sectional study based on data from Sistema de Informações sobre Nascidos Vivos (SINASC) for the state of Santa Catarina collected information for each of the six municipalities with the largest number of births from the six macroregional areas. For those municipalities, all of the establishments that had obstetric facilities were considered. A total of 61.278 births took place over 61 selected maternity services. Cesarean prevalence ratios (PR), both crude and adjusted for confounders, were estimated for each one of the individual variables using robust Cox regression. RESULTS:: Cesarean births were almost as twice as high in private maternity facilities (89%) when compared to the public ones (45.1%). Giving birth in private hospitals increased by at least 50% the prevalence of caesarean section among primiparae (PR = 1.64), Caucasian (PR = 1.57), women with greater attendance to prenatal care (PR = 1.54), and women having daylight birth (PR = 1.5), when compared with those delivering inside the public sector. CONCLUSION:: Differences in cesarean rates in favor of the private system, among women with better social conditions, amongst which it would be expected a lower obstetric risk, have pointed toward differences in obstetric/medical culture permeability and flexibility on medical judgment concerning clinical criteria for cesarean sections.

[Social inequalities in cesarean section rates in primiparae, Southern Brazil]. / Desigualdade social nas taxas de cesariana em primíparas no Rio Grande do Sul.

OBJECTIVE: To investigate the effect of social inequalities in cesarean section rates among primiparae having single pregnancy and delivering in maternity hospitals. METHODS: The study was carried out in Southern Brazil in 1996, 1998 and 2000. Data from the Live Birth National Information System were used to estimate annual rates and crude and adjusted odds ratios (OR) of cesarean sections according to social conditions (maternal age and education, newborn skin color/ethnicity and macro-regions), duration of pregnancy, and number of prenatal visits. RESULTS: The overall cesarean section rate was 45%, and above 37% in all macro-regions. Increased rates were seen among native and black mothers, aged 30 years or more, living in metropolitan, river valley and mountain macro-regions and having attended to more than six prenatal visits. Crude and adjusted OR show that cesarean rates were negatively associated with all categories of skin color/ethnicity when compared to white newborns, particularly those of native Brazilian (ORadj=0.43; 95% CI: 0.31-0.59), and they were positively associated with higher maternal education (ORadj=3.52; 95% CI: 3.11-3.99), older age (ORadj=6.87; 95% CI: 5.90-8.00) and greater number of prenatal visits (ORadj=2.16; 95% CI: 1.99-2.35). The effects of age and education were partly mediated by the greater number of prenatal visits among higher educated older women. The OR varied among macro-regions but were greater for the wealthier mountain region. CONCLUSIONS: High rates of cesarean section rates in Southern Brazil are a public health concern. They are associated with social, economic and cultural factors which can lead to misuse of medical technology during labor and delivery.

Uso do Sistema de Classificação de Robson na avaliação das taxas de cesariana em Santa Catarina e sua associação com perfil institucional / Use of Robson Classification to assess cesarean section rates in Santa Catarina and its association with source of payment for childbirth

Objetivo: analisar as diferenças nas taxas de cesariana em Santa Catarina, ao comparar os perfis público e privado, de acordo com grupos do Sistema de Classificação de Robson. Métodos: estudo transversal baseado no Sistema de Informação dos Nascidos Vivos de Santa Catarina (SINASC/SC), 2012. Foram calculadas as taxas globais e específicas de cesariana de acordo com o grupo do SCR, além do excesso de cesarianas pelo Risco Atribuível Proporcional (RAP). Diferenças nas proporções de partos e taxas de cesariana em cada grupo, de acordo com a forma de pagamento, foram analisadas pelo teste do qui-quadrado, a 5% de significância. Resultados: a taxa global de cesariana foi de 60,7%, sendo 88,9% no sistema privado e 45,7% no setor público. Os grupos 1, 4 e 5 do SCR tiveram maior impacto nas taxas globais. No setor privado, chamou à atenção a baixa utilização da indução, com mais de 65% dos partos ocorrendo eletivamente, além da alta concentração de multíparas com cesariana prévia. Conclusão: taxas elevadas entre primíparas antecipam o efeito cumulativo da cesariana prévia em multíparas. A grande proporção de cesarianas eletivas em detrimento do manejo ativo do trabalho de parto, principalmente no setor privado, aponta para um grande número de cesarianas realizadas sem indicações médicas e preocupam devido a potenciais efeitos adversos para mães e recém-nascidos.

Objective: to analyze cesarean section rates in Santa Catarina and its association with source of payment for childbirth. Methods: Cross-sectional study based on the Information System of Live Births of Santa Catarina (SINASC/SC), 2012. The global and specific cesarean rates were calculated according to the SCR groups, in addition to the excess of cesarean sections due to the Proportional Attributable Risk (RAP). Differences in birth proportions and cesarean section in each group, according to the form of payment, were analyzed by the chi-square test at 5% significance level. Results: The overall cesarean section rate was 60.7%, being 88.9% in the private system and 45.7% in the public one. Groups 1, 4 and 5 of RCS were the ones with the greatest impact on cesarean overall rates. In the private sector, attention was drawn to the low use of induction, with more than 65% of deliveries occurring electively, in addition to the high concentration of multiparous women with previous cesarean section. Conclusions: High rates among primiparous women anticipate the cumulative effect of previous cesarean section in multiparous women. The large proportion of elective cesareans sections at the expense of active labor management, especially in the private sector, points to a large number of cesarean sections performed without medical indications and concerns due to potential adverse effects on mothers and newborns.

[The position of the Brazilian Federal Board of Medicine on incentives for reimbursement of childbirth care and the impact on cesarean rates]. / O parecer do Conselho Federal de Medicina, o incentivo à remuneração ao parto e as taxas de cesariana no Brasil.

This study analyzed incentives for reimbursement of childbirth care advocated by the Brazilian Federal Board of Medicine (CFM) and their impact on cesarean rates. A consecutive sample of 600 postpartum women was surveyed. The overall cesarean rate was 59.2%, as compared to 92.3% among women that had the same physician for their prenatal care and childbirth. Cesarean rates were significantly greater in the groups of women with higher prevalence of the same physician during prenatal care and delivery, that is, higher rates were associated with older maternal age (PR = 1.65), more schooling (PR = 1.25), prenatal care in the private sector (PR = 1.39) or through private health plans (PR = 1.43), previous cesarean section (PR = 2.78), and admission earlier in labor (PR = 1.93). The results challenge the position by the CFM that financial incentives for women to have the same obstetrician during prenatal care and labor would encourage normal childbirth, when these women are precisely the ones with the highest cesarean rates.

[Social inequalities and other determinants of height in children: a multi-level analysis]. / Desigualdade social e outros determinantes da altura em crianças: uma análise multinível.

A cross-sectional household survey of height among children under five years of age (n = 2,632) was conducted in the city of Porto Alegre, Rio Grande do Sul State, Brazil. Multi-level linear regression was applied to investigate the effect of socioeconomic and demographic factors, physical and social environment, and health conditions on children s height, measured by the height-for-age z-scores of the National Center for Health Statistics standards. Area of residence (census tract) was classified as good versus poor in terms of housing and sanitation standards. On average, children s height was -0.18 z-score. Average height increased with maternal and paternal schooling, parents work skills, per capita family income, improved housing, maternal age, birth intervals, and birth weight. Height decreased with hospitalization in the first two years of life, number of under-five children in the household, and preterm birth. In the poor residential areas, the effect of maternal schooling was twice as great as in the better-off areas. The effect of parental work skills was only evident in the more deprived areas. Area of residence modified the effects of socioeconomic conditions on children s growth. Housing and sanitation programs are potentially beneficial to offset the negative effect of social disadvantage on children's growth.

Factors associated with intrapartum cesarean section in women submitted to labor induction / Fatores associados à cesárea intraparto em mulheres submetidas a indução do parto

Abstract Objective To evaluate the results of induced labor and to determine the main factors associated with intrapartum cesarean section after patients being submitted to this procedure at the Hospital Universitário of the Universidade Federal de Santa Catarina (HU/UFSC, in the Portuguese acronym), Florianópolis, state of Santa Catarina, Brazil. Methods A retrospective cross-sectional study that included all the pregnancies that resulted in single-fetus births, whose gestational-age was > 22 weeks and that had been submitted to labor induction at the HU/UFSC in the period from 2013 to 2016. Results During the proposed period, 1,491 pregnant women were submitted to the labor induction protocol. In 1,264 cases (84.8%), induction resulted in labor, with 830 (65.7%) progressing to vaginal delivery. Gestational age ≥ 41 + 0 weekswas themost common indication for induced labor (55.2%), and vaginal administration of misoprostol was themost commonly usedmethod (72.0%). Among these pregnant women, the cesarean section rate was of 34.3%. Considering the cases of induction failure, the cesarean section rate rose to 44.3%. The factors associated with cesarean section were: previous history of cesarean delivery (PR [prevalence ratio] = 1.48; 95%CI [confidence interval]: 1.51-1.88), fetuses with intrauterine growth restriction (IUGR) (PR = 1.82; 95%CI: 1.32-2.19), Bishop score ≤ 6 (PR = 1.33; 95%CI: 1.01-1.82), and induction time either < 12 hours (PR = 1.44; 95%CI: 1.17-1.66) or > 36 hours (PR = 1.51; 95% CI 1.22-1.92) between the beginning of the induction and the birth. Conclusion Labor induction was successful inmost patients. In the cases in which the final outcome was a cesarean section, the most strongly associated factors were: previous history of cesarean delivery, presence of fetuses with IUGR, and either excessively short or excessively long periods of induction.

Resumo Objetivo Avaliar os resultados da indução de trabalho de parto e determinar os principais fatores associados à realização de cesarianas intraparto em pacientes do Hospital Universitário da Universidade Federal de Santa Catarina (HU-UFSC), Florianópolis, SC, Brasil. Métodos Trata-se de um estudo epidemiológico transversal que incluiu todas as gestantes de feto único e comidade gestacional > 22 semanas, submetidas a indução de trabalho de parto no HU-UFSC no período de 2013 a 2016. Resultados No período proposto, 1.491 gestantes foram submetidas ao protocolo de indução. Em 1.264 casos (84,8%), a indução resultou em trabalho de parto, com 830 (65,7%) progredindo para o parto vaginal. Gestação ≥ 41 + 0 semanas foi a causa mais comumde indicação de indução de trabalho de parto (55,2%),emisoprostol foi o método mais utilizado (72,0%). Nessas gestantes, o índice de cesariana foi de 34,3%. Considerando os casos de falha de indução, o índice de cesariana sobe para 44,3%. Os fatores associados às cesarianas foram: história prévia de cesárea (RP [razão de prevalência] = 1,48; IC [índice de confiança]: 95% 1,51-1,88), fetos com restrição de crescimento intrauterino (RP = 1,82; IC95%: 1,32-2,19), índice de Bishop ≤ 6 (RP = 1,33; IC95%: 1,01-1,82) e tempo de indução < 12 horas (RP = 1,44; IC95%: 1,17-1,66), ou > 36 horas (RP = 1,51; IC95%: 1,22-1,92) entre o início da indução e o parto. Conclusão A indução de trabalho de parto foi bem-sucedida na maioria das pacientes. Naquelas em quem o desfecho final foi a cesariana, os fatores mais fortemente associados foram: história prévia de cesárea, presença de fetos com restrição de crescimento intrauterino, e tempos muito curtos ou muito longos de indução.

Estudo dos critérios determinantes de procura pelo serviço de emergência, por pacientes classificados como pouco urgentes e não urgentes, em um hospital geral do sul do Brasil / Study of the determinant criteria for the search for the emergency department by patients classified as little urgent and not urgent, in a general hospital of the south of Brazil

Avaliar as características da demanda e os determinantes de procura pelo SE por pacientes classificados como pouco urgentes e não-urgentes em hospital geral, Sul do Brasil. Estudo epidemiológico, transversal. A coleta de dados foi realizada por entrevista, com duração aproximada de 15 minutos, em 2017, por pesquisadores treinados. Desfecho do estudo: determinantes de procura. Variáveis independentes: demográficas, socioeconômicas e características gerais de procura. Também coletou-se dados sobre a auto percepção do paciente (urgência e preocupação) e escolha do local para atendimento (Escala Likert 0-10). Os dados qualitativos apresentados na forma de frequências simples e relativa, os quantitativos como média e desvio padrão. Foram analisadas associações entre variáveis independentes e o desfecho, através do teste qui-quadrado de Pearson, seguido de Razão de Prevalência e Intervalo Confiança 95%. Participaram do estudo 290 pacientes: 50 (17%) pouco urgentes e 240 (83,0%) não urgentes, sexo feminino (57,2%), faixa etária entre 15-29 anos (39,0%), sem companheiro (51,0%), ensino superior/médio (69,3%), em atividade ocupacional (61,2%). Sobre características gerais da demanda: 77,9% oriundos de suas residências e 39,3% utilizou veículo próprio para o deslocamento. Distância média deslocamento (12,47±15,8 Km) e tempo médio deslocamento (25,98±23,55 minutos). Tempo médio triagem (17,69min.±15,36) e de espera atendimento médico (1h13min±1h10min). Não houve associação com significância estatística entre características demográficas, socioeconômicas e motivos de procura pelo SE. Conclui-se que os critérios determinantes de procura pelo SE foram resolutividade (40,9%) e funcionamento inadequado das UBS (24,7%), seguidos de procura por especialista e agudização da doença crônica.

To evaluate the demand and the determinants of the search for the Emergency service by patients classified as not very urgent and not-urgent in a general hospital, South of Brazil. Cross epidemiological study. Data collect was performed by interview, with an approximated duration of 15 minutes, in 2017, by trained researchers. Study outcome: Search determinants. Independent variables: demographic, socioeconomic and general demand characteristics. It was also collected data on the patient self-perception (urgency and concern) and the choice of the medical care (Likert Scale 0-10). The qualitative data presented by simple and relative way frequencies, the quantitative ones as average and standard deviation. Associations between independent variables and the outcome were analyzed using Pearson's chi-square test, followed by a Prevalence Ratio and 95% Confidence Interval. The study included 290 patients: 50 (17%) were not very urgent and 240 (83.0%) female not-urgent were (57.2%), 15-29 years old (39.0%), without partner (51.0%), higher /college degree (69.3%) in occupational activity (61.2%). On general demand characteristics: 77.9% come from their homes and 39.3% used their own vehicle for the trip. Average displacement distance (12.47 ± 15.8 Km) and average displacement time (25.98 ± 23.55 minutes). Average screening time (17.69min ± 15.36) and waiting for medical care (1h13min ± 1h10min). There was no association with statistical significance between demographic, socioeconomic and reasons for Emergency Service search. The determinant criteria of the search for ES were resolutiveness (40.9%) and inadequate working of the BHU (24.7%), followed by specialist search and chronic disease exacerbation.

Nascer no Brasil: the presence of a companion favors the use of best practices in delivery care in the South region of Brazil / Nascer no Brasil: a presença do acompanhante favorece a aplicação das boas práticas na atenção ao parto na região Sul

ABSTRACT OBJECTIVE To analyze if the presence of a companion favors the use of best practices in the delivery care in the South region of Brazil. METHODS This is a cross-sectional analysis of the longitudinal study Nascer no Brasil. We analyzed data from 2,070 women from the South region of Brazil who went into labor. The data were collected between February and August 2011, by interviews and medical records. We performed a bivariate and multivariate analysis, calculating the crude and adjusted prevalence ratios using Poisson regression with robust variance estimation. The level of significance adopted was 5%. RESULTS Most women had a companion during labor (51.7%), but few remained during delivery (39.4%) or cesarean section (34.8%). Less than half of the women had access to several recommended practices, while non-recommended practices continue to be performed. In the model adjusted for age, education level, source of payment for the delivery, parity, and score of the Brazilian Association of Market Research Institutes, the presence of a companion was statistically associated with a greater supply of liquids and food (aPR = 1.34), dietary prescription (aPR = 1.34), use of non-pharmacological methods for pain relief (aPR = 1.37), amniotomy (aPR = 1.10), epidural or spinal analgesia (aPR = 1.84), adoption of non-lithotomy position in the delivery (aPR = 1.77), stay in the same room during labor, delivery, and postpartum (aPR = 1.62), skin-to-skin contact in the delivery (aPR = 1.81) and cesarean section (PR = 2.43), as well as reduced use of the Kristeller maneuver (aPR = 0.67), trichotomy (aPR = 0.59), and enema (aPR = 0.49). CONCLUSIONS In the South region of Brazil, most women do not have access to the best practices in addition to undergoing several unnecessary interventions. The presence of a companion is associated with several beneficial practices and the reduction in some interventions, although other interventions are not impacted.

RESUMO OBJETIVO Analisar se a presença do acompanhante favorece a aplicação das boas práticas na atenção ao parto na região Sul do Brasil. MÉTODOS Análise transversal do estudo longitudinal Nascer no Brasil. Foram analisados dados de 2.070 mulheres da região Sul que entraram em trabalho de parto. Os dados foram coletados entre fevereiro e agosto de 2011, por meio de entrevista e prontuário. Realizou-se análise bivariada e multivariada, calculando-se razões de prevalência brutas e ajustadas por regressão de Poisson com estimação de variância robusta. Adotou-se nível de significância de 5%. RESULTADOS A maioria das mulheres teve o acompanhante durante o trabalho de parto (51,7%), mas poucas permaneceram com ele no parto (39,4%) ou na cesariana (34,8%). Menos da metade das mulheres teve acesso às várias práticas recomendadas, enquanto práticas não recomendadas continuam sendo realizadas. No modelo ajustado por idade, escolaridade, fonte de pagamento do parto, paridade e escore da Associação Brasileira de Institutos de Pesquisa de Mercado, a presença do acompanhante esteve estatisticamente associada à maior oferta de líquidos/alimentos (RPa = 1,34), prescrição de dieta (RPa = 1,34), uso de métodos não farmacológicos para alívio da dor (RPa = 1,37), amniotomia (RPa = 1,10), analgesia peridural ou ráqui (RPa = 1,84), adoção de posição não litotômica no parto (RPa = 1,77), permanência na mesma sala durante o trabalho de parto, parto e pós-parto (RPa = 1,62), contato pele a pele no parto (RPa = 1,81) e na cesariana (RP = 2,43), bem como redução da manobra de Kristeller (RPa = 0,67), tricotomia (RPa = 0,59) e enema (RPa = 0,49). CONCLUSÕES Na região Sul do Brasil, além de sofrer várias intervenções desnecessárias, a maioria das mulheres não têm acesso às boas práticas. A presença do acompanhante está associada a diversas práticas benéficas e à redução de algumas intervenções, embora outras não sofram impacto.

Análise temporal da relação entre leptospirose, níveis pluviométricos e sazonalidade, na região da Grande Florianópolis, Santa Catarina, Brasil, 2005-2015 / Temporal analysis of the relationship between leptospirose, pluviometric levels and seasonality, in the region of Grande Florianópolis, Santa Catarina, Brazil, 2005-2015

O objetivo do estudo é analisar a tendência temporal da incidência de leptospirose, de acordo com índices pluviométricos na Região da Grande Florianópolis, conforme sazonalidade - 2005 a 2015. Trata-se de estudo ecológico de séries temporais, com dados de leptospirose, índices pluviométricos e população. Foram analisadas taxas de incidência de leptospirose, excesso relativo da incidência, coeficiente de correlação de Pearson (r), coeficiente angular (ß), a partir do ajuste da regressão linear, com nível de significância de 95%. Apresenta distribuição dos casos de leptospirose, índices pluviométricos e razão casos/índices pluviométricos, estratificados por mês de ocorrência. Foram registrados 1.001 casos de leptospirose, média mensal de 83 casos, com variação de 43, nos meses de agosto, a 146, nos meses de fevereiro. A taxa média de leptospirose foi 8,24/100 mil habitantes. O índice pluviométrico médio foi 154,83 mm, os índices mais baixos ocorreram nos meses de junho, média de 99,48 mm, e, os mais elevados nos meses de janeiro, média de 226,16 mm. Uma correlação positiva entre taxas de leptospirose e níveis pluviométricos, ao longo do período, janeiro a dezembro (r=0,64; p=0,003), aponta para associação temporal positiva entre quantidade de chuva e casos da doença. A doença ocorreu o ano todo e apresentou nítida sazonalidade no período de outubro a março.

Impacto da lei seca na taxa de mortalidade por acidentes de trânsito, Santa Catarina, entre 2005 e 2011 / Impact of alcohol prohibition in the death rate from traffic accidents, in Santa Catarina, from 2005 to 2011

O objetivo do estudo foi investigar o impacto da Lei Seca na taxa de mortalidade por acidentes de trânsito, Santa Catarina, 2005 a 2011. Estudo Ecológico baseado nos dados do Sistema de Informações sobre Mortalidade (SIM/Datasus). Foram obtidas as taxas de mortalidade geral, por sexo e faixa etária, pré e pós Lei Seca; foram calculadas as diferenças entre as taxas, Risco Relativo, Fração Etiológica e o número absoluto de casos evitáveis. Os resultados mostram uma queda nas taxas de mortalidade geral por acidentes de trânsito, ao comparar os períodos pré e pós Lei Seca, de 97,18 para 91,80/100 mil (p<0,01).As diferenças relativas mais importantes, se deram nas faixas etárias mais elevadas, com destaque a partir dos 40 anos de idade e ainda que entre os indivíduos do sexo masculino e das faixas etárias mais jovens, as diferenças relativas (RR) não tenham sido tão expressivas quanto para os demais grupos, os números absolutos de casos gerados, foram mais do que o dobro nestes grupos, com 246 e 225 casos atribuíveis, entre os homens e entre indivíduos na faixa etária dos 20-29 anos, respectivamente.Resultados apontam para sexo masculino como fator de risco independente para óbito por acidentes de trânsito, sendo ingestão de álcool um fator potencializador. O presente estudo é original ao enfatizar a importância da fração etiológica, medida de impacto populacional, essencial quando os resultados visam direcionar ações na área da Saúde Pública.

Investigate the impact of alcohol prohibition in the death rate from traffic accidents, in Santa Catarina, from 2005 to 2011. Ecological Study based on data from the Mortality Information System (SIM / DATASUS). The overall mortality rates were obtained by sex and age group, pre- and postprohibition; the differences between rates, Relative Risk, Etiological Fraction and the absolute number of preventable cases, were calculated. The results show a fall in the overall mortality rates from traffic accidents, when comparing the period before and after Prohibition, from 97.18 to 91.80 / 100,000 (p <0.01).The relative differences more important, occurred among the older age groups, especially those with 40 or more years of age. Although, among males and younger age groups, the relative differences (RR) were not as expressive as for other groups, the absolute numbers of cases generated, were more than double for those groups, with 246 and 225 cases attributable, among men and among individuals in the age group of 20-29 years, respectively. Results indicate male as an independent risk factor for death from traffic accidents and, alcohol intake a potentiating factor. This study is unique in emphasizing the importance of the Etiologic Fraction, a measure of population impact, essential when the results are aimed to actions directed to Public Health.

[Difficulties for identification of cause of fetal death: how to solve?]. / Dificuldades para a identificação da causa do óbito fetal: como resolver?

PURPOSE: To identify the causes of fetal death in the studied population and to measure their contribution in identifying the cause of this outcome. To propose the use of the system Relevant Condition of Death (ReCoDe) in elucidating the causes of fetal death to minimize the number of unknown causes. METHODS: Cross-sectional study related to fetal deaths seen at a specialized academic hospital in the South of Brazil, from January 2000 to December 2009. The data were collected in the death certificates, maternal medical records and the reports of study of fetuses and attachments, and the findings were compared. Data analysis was performed using SPSS version 17.0. RESULTS: Were included 111 fetuses and their respective mothers in this study. The comparison between the diagnostic causes in the pathology and clinical evaluation showed 74 (66.7%) and 73 (65.8%), respectively. Together, they found a potential cause in 48.7% of cases, while 16.2% remained unknown. When analyzing both together with the ReCoDe system, only 9.9% of stillbirths remained as "unclassified." CONCLUSIONS: The proportion of diagnoses in the cause of death among the pathological and clinical evaluation showed no significant difference. When comparing the results of the cause of death suggested by the clinic/pathology with the use of the ReCoDe system, it appears that this tool has helped to clarify the cause by reducing the amount of those that remained without a possible etiology.

[Social inequalities in post-cesarean complication rates: a hierarchical analysis]. / Desigualdades sociais nas complicações da cesariana: uma análise hierarquizada.

This study focused on the association between social factors and complications following cesarean sections. A sample of 604 women delivering in the two main maternity hospitals in a city in southern Brazil were interviewed 24 hours after delivery and two weeks postpartum, using in-hospital and home interviews. Cox regression was applied, using a hierarchical framework of factors associated with post-cesarean complications. Post-partum complications were twice as frequent after cesareans as compared to vaginal delivery, independently of socioeconomic conditions. However, the increased the risk of complications associated with cesarean section proved to be mediated by socioeconomic circumstances, as represented by prenatal and childbirth care in the public health system, not having the same physician throughout prenatal care and delivery, and having the decision made for the cesarean while the patient was already in labor. The study's results show that post-cesarean complications can adversely impact women, especially those living in the worst social and health conditions, that is, precisely those that lack support when returning home with a surgical wound.

Associação entre fatores institucionais, perfil da assistência ao parto e as taxas de cesariana em Santa Catarina / Association between institutional factors, birth care profile, and cesarean section rates in Santa Catarina

RESUMO: Objetivo: Investigar como fatores institucionais, representados pelo perfil social da maternidade na assistência ao parto, se associam às taxas de cesariana. Métodos: Estudo com delineamento transversal com base em dados do Sistema de Informações sobre Nascidos Vivos (SINASC) para Santa Catarina. Foram selecionados, para cada uma das macrorregionais, os seis municípios com o maior número de partos. Para esses municípios, foram considerados todos os estabelecimentos que possuíam leitos obstétricos. Um total de 61.278 partos teve lugar nas 61 maternidades selecionadas. Razões de prevalência de cesariana (RP), brutas e ajustadas para confundimento, foram estimadas para cada uma das variáveis individuais por meio de Regressão de Cox Robusta. Resultados: Nascimentos por cesariana foram quase o dobro nas maternidades privadas (89%), quando comparados aos do Sistema Único de Saúde (SUS) (45,1%). Ter parto nas maternidades privadas aumentou em pelo menos 50% a ocorrência de cesariana entre as primíparas (RP = 1,64), caucasianas (RP = 1,57), mulheres com maior frequência ao pré-natal (RP = 1,54) e tendo parto diurno (RP = 1,51), quando comparadas àquelas tendo parto pelo SUS. Conclusão: Diferenças nas taxas de cesariana em favor do sistema privado, entre mulheres de melhores condições sociais, em meio às quais seria esperado menor risco obstétrico, apontaram para diferenças de permeabilidade da cultura médica/obstétrica e flexibilização na interpretação médica das indicações clínicas do parto operatório.

ABSTRACT: Objectives: To investigate how institutional factors, represented by the social profile of childbirth care, can relate to cesarean section rates. Methods: A cross-sectional study based on data from Sistema de Informações sobre Nascidos Vivos (SINASC) for the state of Santa Catarina collected information for each of the six municipalities with the largest number of births from the six macroregional areas. For those municipalities, all of the establishments that had obstetric facilities were considered. A total of 61.278 births took place over 61 selected maternity services. Cesarean prevalence ratios (PR), both crude and adjusted for confounders, were estimated for each one of the individual variables using robust Cox regression. Results: Cesarean births were almost as twice as high in private maternity facilities (89%) when compared to the public ones (45.1%). Giving birth in private hospitals increased by at least 50% the prevalence of caesarean section among primiparae (PR = 1.64), Caucasian (PR = 1.57), women with greater attendance to prenatal care (PR = 1.54), and women having daylight birth (PR = 1.5), when compared with those delivering inside the public sector. Conclusion: Differences in cesarean rates in favor of the private system, among women with better social conditions, amongst which it would be expected a lower obstetric risk, have pointed toward differences in obstetric/medical culture permeability and flexibility on medical judgment concerning clinical criteria for cesarean sections.

Prematuridade e fatores associados em Santa Catarina, Brasil: análise após alteração do campo idade gestacional na Declaração de Nascidos Vivos / Premature birth and associated factors in the Brazilian State of Santa Catarina: an analysis after alteration of the gestational age section of the Live Birth Declarations

Estimar a prevalência de prematuridade e os fatores associados, após a alteração do campo idade gestacional na Declaração de Nascidos Vivos, no Estado de Santa Catarina, Brasil, em 2012.Métodos:estudo seccional com base nos dados do Sistema de Informações de Nascidos Vivos (SINASC). Razões de Prevalência (RP) de prematuridade, brutas e ajustadas, por Regressão de Cox Robusta para o ano de 2012, foram calculadas e os resultados comparados aqueles reportados para 2005.Resultados:as taxas de prematuridade aumentaram de 6,1 por cento, em 2005, para 10,6 por cento em 2012. Ao se comparar os dois anos, maiores diferenças foram encontradas entre as mulheres com menor número de consultas pré-natal, menor nível de escolaridade e de cor não branca. Após o ajuste pelos fatores de confusão, as taxas de prematuridade se mostraram associadas à menor frequência de consultas de pré-natal (RP=2,64; IC95 por cento: 2,58-3,28), menor escolaridade (RP= 1,65; IC95 por cento: 1,11-2,45), idade materna <20 anos (RP= 1,24; IC95 por cento: 1,17-1,31) e maior que 39 anos (RP= 1,32; IC95 por cento: 1,17-1,49) e de cor não branca (RP=1,14; IC95 por cento: 1,07-1,21.)Conclusões:mudanças no campo idade gesta-cional, agora preenchido como semanas completas de gestação, resultaram em medidas mais confiáveis das taxas de prematuridade no Brasil...

To estimate the prevalence of premature birth and associated factors, after alteration of the gestational age section of Live Birth Declarations in the Brazilian State of Santa Catarina, in 2012.Methods:a cross-sectional study was carried out based on data from the Live Births Information System (SINASC). Prevalence rates for premature birth, raw and adjusted by Cox’s robust regression were calculated for the year 2012 and the results compared with those reported for 2005.Results:the prevalence of premature birth rose from 6.1 percent, in 2005, to 10.6 percent in 2012. Comparison of the two years found greater differences among non-Caucasian women and those with fewer prenatal consultations and a lower level of schooling. After adjustment for confounding factors, the prevalence of premature birth was found to be associated with a lower frequency of prenatal consultations (PR=2.64; CI95 percent: 2.58-3.28), lower levels of schooling (PR= 1.65; CI95 percent: 1.11-2.45), maternal age <20 years (PR= 1.24; CI95 percent: 1.17-1.31) and > 39 years (PR= 1.32; CI95 percent: 1.17-1.49) and non-Caucasian (PR=1.14; CI95 percent: 1.07-1.21.)Conclusions:changes in the gestational age section, now recorded as full weeks of gestation, have resulted in more reliable measurement of the preva-lence of premature birth in Brazil...