Effects of preoperative epidemiological factors on the surgical outcomes of benign prostatic hyperplasia / 现代泌尿外科杂志

【Objective】 To investigate the preoperative epidemiological factors affecting the surgical outcomes of transurethral resection of the prostate (TURP) in patients with benign prostatic hyperplasia (BPH) and to evaluate the clinical predictive value. 【Methods】 Patients undergoing TURP at our hospital during Dec.2018 and Sep.2021 whose pathological examination suggestive of BPH were involved. Before operation, the clinical data, International Prostate Symptom Score (IPSS), quality of life (QoL) score, overactive bladder (OAB) score, prostate-specific antigen (PSA), and urological ultrasound results were collected. After operation, all patients were followed up with telephone call or face-to-face interview, and the IPSS, QoL score and OAB score were examined. Patients were divided into effective and ineffective groups according to the efficacy rubrics. The epidemiological factors affecting the efficacy of TURP were identified with univariate analysis, the independent influencing factors were screened with binary logistic regression, and the diagnostic value of each independent influencing factor was evaluated using receiver operating characteristic (ROC) curve. 【Results】 OAB score (OR=0.749, 95%CI: 0.627-0.895, P=0.001), IPSS-V/S (OR=4.919, 95%CI: 1.617-14.963, P=0.005), history of urinary retention (OR=7.513, 95%CI: 2.289-24.656, P=0.001), and history of urinary incontinence (OR=2.656, 95%CI: 1.015-6.950, P=0.047) were independent influencing factors for poor postoperative outcomes. ROC curve revealed that the area under the ROC curve (AUC) showed that AUC of OAB score, IPSS-V/S, history of urinary retention, and history of urinary incontinence were 0.784 (95%CI: 0.718-0.841), 0.686 (95%CI: 0.614-0.751), 0.713 (95%CI: 0.643-0.777), and 0.723 (95%CI: 0.654-0.786), respectively. ROC curve of the regression model showed that the AUC was 0.888 (95%CI: 0.834-0.930), and the sensitivity and specificity were 93.53% and 67.35%, respectively. 【Conclusion】 Preoperative OAB score, IPSS-V/S, history of urinary retention, and history of urinary incontinence were independent epidemiological factors of poor outcomes after TURP in BPH patients. The diagnostic efficacy ranked from the highest to the lowest as regression model >OAB score>history of urinary incontinence >history of urinary retention>IPSS-V/S.

El suicidio en la Región de La Araucanía: dinámica socioespacial durante los años 2004-2015 / Suicide rates in the Araucania Region of Chile

Background: Suicide is a public health problem in the world. In Chile, suicide rates increased since 1990 with regional differences in rates. Aim: To analyze the geographical distribution of deaths due to suicide that occurred in the Region of Araucanía between the years 2004-2015. Material and Methods: The geographic distribution of suicide in the Araucania Region at district level (2004-2015) was analyzed using death data available at the web page of the Ministry of Health. Socio-demographic variables of suicide were characterized. The spatial distribution of suicide rates was represented using cartography, and suicide spatial clusters were identified through spatial-temporal exploration. Results: There were 1,562 suicides, 86% in men, with a mean rate of 13.07 x105 inhabitants. The highest rates were registered in people aged over 70 years. Most individuals committing suicide were active workers. Hanging was the most common method to accomplish suicide. The territories from the coastal area in Cautín, and Nahuelbuta registered the highest suicide rates. Two statistically significant conglomerates with high incidence of suicide cases were identified. Conclusions: The use of geographic methods and the disaggregation of suicide cases at district level, allowed the identification of territorial variability in the distribution of suicide rates within the Araucanía Region. Spatial patterns of areas with high suicide risk were found.

Knowledge of oral and oropharyngeal cancer by dental surgeons: an integrative review / Conocimiento de los quirúrgicos dentistas sobre cáncer de boca y orofaríngeo: una revisión integrativa / Conhecimento dos cirurgiões-dentistas sobre câncer de boca e orofaringe: uma revisão integrativa

ABSTRACT Objectives: to identify the evidence available in the literature on the knowledge of dentists regarding risk factors and early diagnosis of oral and oropharyngeal cancer. Methods: it is an integrative review of the literature. Boolean descriptors and operators were searched in the PubMed and LILACS databases, using gray literature, in English, Spanish and Portuguese. Results: of the 79 PubMed and 152 LILACS articles, 24 were selected. Of these, eight showed good knowledge of dentists, while most showed low or little knowledge of risk factors and early diagnosis in dentists. All studies, however, highlight the need for continuing education to improve and maintain knowledge about risk factors and early diagnosis. Conclusions: most dental surgeons have insufficient knowledge of oral/oropharyngeal cancer. Continued education is suggested, aiming at improving knowledge and early diagnosis.

RESUMEN Objetivos: identificar evidencias disponibles en la literatura sobre el conocimiento de los quirúrgicos dentistas cuanto a los factores de riesgo y diagnóstico precoz del cáncer de boca/ orofaríngeo. Métodos: revisión integrativa de la literatura. Se realizaron búsquedas mediante los descriptores y operadores booleanos en base de datos PubMed y LILACS, con uso de literatura gris, en los idiomas inglés, español y portugués. Resultados: de los 79 artículos del PubMed y 152 del LILACS, 24 seleccionados. De estos, ocho mostraron bueno conocimiento de los dentistas, mientras la mayoría mostró bajo o poco conocimiento sobre factores de riesgo y diagnóstico precoz en dentistas. Todos los estudios, aunque, destacan la necesidad de educación continuada para mejorar y mantener el conocimiento sobre factores de riesgo y diagnóstico precoz. Conclusiones: gran parte de los quirúrgicos dentistas presenta un conocimiento insuficiente sobre cáncer de boca/orofaríngeo. Sugerida educación continuada, objetivando mejorar el conocimiento y el diagnóstico precoz.

RESUMO Objetivos: identificar as evidências disponíveis na literatura sobre o conhecimento dos cirurgiõesdentistas quanto aos fatores de risco e diagnóstico precoce do câncer de boca e orofaringe. Métodos: trata-se de uma revisão integrativa da literatura. Foram realizadas buscas mediante os descritores e operadores booleanos na base de dados PubMed e LILACS, com uso de literatura cinza, nos idiomas inglês, espanhol e portugês. Resultados: dos 79 artigos do PubMed e 152 do LILACS, 24 foram selecionados. Destes, oito mostraram bom conhecimento dos dentistas, enquanto a maioria mostrou baixo ou pouco conhecimento sobre fatores de risco e diagnóstico precoce em dentistas. Todos os estudos, no entanto, destacam a necessidade de educação continuada para melhorar e manter o conhecimento sobre fatores de risco e diagnóstico precoce. Conclusões: grande parte dos cirurgiões-dentistas apresenta um conhecimento insuficiente sobre câncer de boca/orofaringe. É sugerida a educação continuada, visando melhorar o conhecimento e o diagnóstico precoce.

Prevalence of Hearing Loss and Associated Factors in School-Age Individuals in an Urban Area of Northeast Brazil

Abstract Introduction Hearing loss interferes in the development of language and verbal capacities, which causes learning difficulties and deleterious effects. Objective To analyze the prevalence and associated factors for hearing loss in school-age individuals of the municipality of Natal, state of Rio Grande do Norte, Northeast Brazil. Methods Cross-sectional study that evaluated 238 school-age individuals (6-17 years old) in municipal public schools. Meatoscopy was performed and school-age individuals answered the questions "Do you think that you hear well?" and "Do you have earaches?". Auditory evaluation was performed with a Telessaúde audiometer. The responsible adults answered socioeconomic, speech and audiology aspects and risk factors for hearing loss questionnaire. Results The prevalence of hearing loss was 16% (11.7-21.4%); 16% reported not to hear well, 18.9% reported earaches, and 26.1% presented altered meatoscopy. The prevalence of hearing loss was higher in school-age individuals who reported hearing difficulties, in children between the ages of 6 and 12, and with altered meatoscopy results (p< 0.05). Airway infection (PR = 3.37; 95% confidence interval [CI]: 1.48-7.68) was found as a risk factor associated with hearing loss, remaining significant in the multivariate model (PR = 6.79; 95%CI: 1.98-23.26; p= 0.002). Conclusions Hearing loss in this sample is above the values reported in other studies performed in Brazil for this age group. This highlights the necessity of better structure of speech and audiology attention, so that auditory health promotion actions can be systematized for this population.

Padrões de consumo de álcool e fatores associados entre idosos brasileiros: Pesquisa Nacional de Saúde (2013) / Alcohol consumption patterns and associated factors among elderly Brazilians: National Health Survey (2013)

Resumo O objetivo foi analisar o padrão de consumo de álcool entre idosos (60 anos ou mais) brasileiros e sua associação com fatores sociodemográficos, hábitos de vida e condições de saúde. Trata-se de um estudo transversal, realizado com 10.537 idosos (90,1%) participantes da Pesquisa Nacional de Saúde de 2013. O consumo de bebidas alcoólicas foi classificado em não uso, uso leve/ moderado e uso de risco. Utilizou-se o modelo de regressão multinomial para o estudo dos fatores associados. A prevalência para uso leve/moderado e de risco foi de 9,4% (IC95%: 8,4-10,6%) e 4,6% (IC95%:4,0-5,3%), respectivamente. Os dois padrões de consumo foram inversamente associados à idade, mais frequentes entre homens, mais escolarizados, fumantes e que praticavam atividade física. O consumo leve/moderado foi menos frequente entre não brancos e entre aqueles com relato de AVC e diabetes, enquanto o consumo de risco foi menos frequente entre idosos com diagnóstico para doenças do coração e mais frequentes entre os que reportaram depressão. Esse resultado identifica perfis de maior vulnerabilidade, com pequenas diferenças entre os padrões de consumo. Essas informações devem ser consideradas na elaboração de propostas para promoção de hábitos saudáveis e controle do abuso de álcool em idosos.

Abstract The scope of this study was to analyze the pattern of alcohol consumption among elderly Brazilians (60 years and over) and their association with sociodemographic factors, lifestyle habits and health conditions. This is a cross-sectional study of 10,537 elderly (90.1%) participants from the National Health Survey of 2013. The consumption of alcoholic beverages was classified as non-use, mild / moderate use and risk use. The multinomial regression model was used to study the associated factors. The prevalence for mild / moderate and risk use was 9.4% (95% CI: 8.4- 10.6%) and 4.6% (95%CI: 4.0-5.3%), respectively. The two consumption patterns were inversely associated with age and more frequent among men, better schooling, smokers and physical activity practitioners. Mild / moderate consumption was less frequent among non-whites and those with a history of stroke and diabetes, whereas risk use was less frequent among the elderly diagnosed for heart disease and more frequent among those suffering from depression. This result identifies profiles of greater vulnerability, with small differences between two patterns of consumption. This information should be considered in the preparation of proposals to promote healthy habits and control of alcohol use among the elderly.

Road traffic accidents attending casualty in a tertiary care hospital : a 03 year study from South Western India

Background: Road Traffic Accident (RTA) is any vehicular accident occurring on the roadway i.e. originating on, terminating on, or involving a vehicle partially on the roadway. Road traffic accidents are a human tragedy which has an immeasurable impact on the families affected. The WHO estimates that over 1.2 million people pass away every year on the world’s roads, and between 20 and 50 million fall victims to non-fatal injuries.  The incidence of RTA remains poorly measured in India.Methods: The present study is conducted at casualty department of a tertiary care hospital in South Western India among victims of road traffic accident. This cross sectional study was conducted to elucidate the role of various factors involved in road traffic accidents and to study demographic profile and injury pattern among RTA victims. All the reported RTA cases from 1st January 2016 to 31st December 2018 were included in the study.Results: A total of 875 cases of RTA were studied. There were 83.77%(n=733) male and 16.23%(n=142) female accident victims. Most of the patients were aged between 21 and 30 years. Monsoons witnessed 46.63%(n=408) cases. Most cases occurred between 6 and 12pm (54.4%, n=476). Commonest injury was a simple injury (72.91%, n=638), dangerous injuries (27.09% percent, n=237) and dead was (7.43%, n=65). The highest number of accidents took place in the month of June (19.09%, n=167) and on Sundays (22.17%). Among the motorized vehicles, two-wheeler drivers were more (76.91%, n=673) involved in accidents. In this study 17.60% (n=154) were under influence of alcohol while driving.Conclusions: This study shows there are multiple factors associated with road traffic accidents. Most of the factors responsible for RTA and its fatal consequences are preventable. India, as a signatory to the Brasilia declaration, intends to reduce road accidents and traffic fatalities by 50% by 2022. A comprehensive multipronged approach can mitigate most of them.

Trypanosoma cruzi infection in transfusion medicine

ABSTRACT Introduction: Infection by Trypanosoma cruzi is challenging to blood bank supplies in terms of accurate diagnosis, mostly due to its clinical complexity. Infected individuals may remain asymptomatic for years, albeit they may have circulating parasites potentially transferable to eventual receptors of a transfusion. Objective: Although risk donors are systematically excluded through a survey, an important residual risk for transmission remains, evidencing the need to implement additional actions for the detection of T. cruzi in blood banks. Method: A review of the scientific literature is presented with the objective of identifying relevant publications on this subject. Results: We discuss the diagnostic considerations of this chronic infection on transfusion medicine and some recent advances in the processing of blood and derivatives units. Conclusion: Finally, recommendations are made on how the transmission of T. cruzi can be avoided through the implementation of better diagnostic and pathogen control measures at blood banks.

Clinico-epidemiological profile of malaria cases admitted in a tertiary care hospital, in South India

Background: Malaria is a global health problem leading to huge morbidity and mortality. India accounts for 4% of global malaria cases and 52% of malaria deaths outside the African region. A disease that was relatively unknown in Mangaluru till 1990, has shown consistent rise till 2015 killing nearly 300 people. Though, declining trends are being observed since 2015, yet its incidence continues to be high. Present study was undertaken to study clinical as well as epidemiological factors associated with malaria transmission in Mangaluru.Methods: A record based retrospective study was conducted in A J Institute of Medical Sciences and Research Centre Mangaluru tertiary care hospital. The data was retrieved from the Medical Record Department of the hospital for three years i.e. 2015 to 2017 and analysed.Results: A total of 1779 confirmed cases of malaria were admitted during the study period. Out of these 1309 (73.58%) cases were due P. vivax, 73 (04.10%) cases due to P. falciparum 306 (17.20%) cases had mixed infections while species of remaining 91 (05.11%) cases remained unspecified. A peak in the number of inpatients was seen in June while mean duration of hospital stay was 5.17±3.31 days. A total of 252 (14.16%) patients had one or more severe manifestations of malaria as per WHO guidelines.Conclusions: The present study reveals that majority of admitted malaria cases were young adult males belonged to urban area. Majority of the cases were infected by Plasmodium vivax or had mixed infections.

Determinantes dos óbitos infantis hospitalares e não hospitalares nos municípios do Vale do Jequitinhonha, Minas Gerais / Determinants of hospital and nonhospital infant deaths in the municipalities of Jequitinhonha Valley, Minas Gerais

Introdução: A mortalidade infantil (MI) é um indicador de iniquidades em saúde e possui etiologia multifatorial. Os determinantes relacionados às mortes infantis apontam para circunstâncias de fragilidades socioeconômicas, disparidades no acesso e na assistência à saúde. O local de ocorrência do óbito, que pode ocorrer em hospitais ou fora deles, é uma das situações que sinaliza para características de fragilidades. Assim, é fundamental a compreensão da cadeia de eventos que possa desencadear as mortes em subgrupos populacionais. Objetivo: Analisar os determinantes dos óbitos infantis hospitalares e não hospitalares nos municípios do Vale do Jequitinhonha, Minas Gerais. Metodologia: Trata-se de um estudo transversal, retrospectivo, de análise de dados secundários. Foram utilizados dados dos bancos de mortalidade e nascimento do Ministério da Saúde, entre os anos de 2009 e 2014. Foram analisadas variáveis demográficas, socioeconômicas, biológicas e assistenciais de pré-natal, parto e nascimento. Para a análise de associação da ocorrência de óbito infantil hospitalar e não hospitalar com as variáveis do estudo foi realizada regressão logística tendo como medida de associação o odds ratio. Também foi realizada análise de tendência de mortalidade infantil através do modelo de regressão logística mista com efeitos aleatórios. Resultados: No período do estudo foram analisados 54.319 nascidos vivos dos quais 849 foram a óbito no primeiro ano de vida. Os resultados apontaram uma predominância de óbitos no período neonatal precoce em hospitais e os óbitos pós-neonatais foram mais prevalentes fora dos hospitais. No modelo final, as crianças que nasceram prematuras, com baixo peso ao nascer e apgar menor que sete no quinto minuto de vida apresentaram associação significativa com o óbito infantil hospitalar e não hospitalar. Crianças cujas mães possuíam menos que sete anos de estudo e residiam em regiões de maior vulnerabilidade social apresentaram maior chance de morrer fora dos hospitais. Ademais, filhos de mães que não possuíam companheiro, que realizaram até seis consultas de pré-natal, crianças do sexo masculino, com algum tipo de anomalia, apgar menor que sete no primeiro minuto de vida, foram determinantes significativos somente para a ocorrência de óbito infantil hospitalar. Na análise de tendência observou-se que os óbitos tenderam a diminuir com o tempo, mas não foi significativo o decrescimento no período do estudo. Conclusão: Os determinantes dos óbitos ocorridos em ambiente hospitalar e no não hospitalar possuem algumas diferenças, apesar de ambos estarem associados à situações de vulnerabilidade social e falhas de assistência à saúde. É preciso melhorar as ações direcionadas a vigilância em saúde.(AU)

Introduction: Infant mortality (MI) is an indicator of health inequities and has a multifactorial etiology. The determinants related to child deaths point to circumstances of socioeconomic fragility, disparities in access and health care. The place of death, which may occur in or outside hospitals, is one of the situations that signals the characteristics of fragility. Thus, understanding the chain of events that can trigger deaths in population subgroups is critical. Objective: To Analyze the determinants of infant and non hospital deaths in the municipalities of Vale do Jequitinhonha, Minas Gerais. Methodology: This is a crossectional, retrospective study with secondary data analysis. Data from the mortality and birth banks of the Ministry of Health, between 2009 and 2014 years, were used. Demographic, socioeconomic and biological variables of pre-natal, childbirth and birth were analyzed. For The analysis of the association between the occurrence of infant and non hospital deaths with the study variables, logistic regression was performed with the odds ratio as a measure of association. A trend analysis of infant mortality was Also performed through the mixed logistic regression model with random effects. Results: In The study period 54,319 live births ofwhich 849 died in the first year of life were analyzed. The results showed a predominance of deaths in theearly neonatal period in hospitals and the proportion of infant deaths outside the hospitals was higher inthe post-neonatal period. In the final model, children who were born prematurely, with low birth weight and apgar less than seven in the fifth minute of life presented significant association with hospital and non hospital infant death. Children whose mothers had less than seven years of schooling and lived in regions of greater social vulnerability had a greater chance of dying outside the hospitals. Moreover, children of mothers who did not have a partner, who made up to six prenatal consultations, male children, with some type of anomaly, apgar less than seven in the first minute of life, were significant determinants only for the occurrence of infant death in hospitals. In the trendanalysis, it was observed that the deaths tended to decrease, but the decrease in the study period was not significant. Conclusion: The determinants of deaths occurring in hospital and nonhospitalenvironments have some differences despite both being associated with situations of social vulnerability and health care failures. However, it is necessary to better target the actions directed at the reflection on health surveillance.(AU)

Maternal risk factors for the transmission of congenital chagas disease

The present article looks at the association between the epidemiological history of women infected with Trypanosoma cruzi and the risk of vertical transmission. Eighty-three chronically infected mothers and their 237 children were studied, using a cohort design. All patients reside in Santa Fe city, Argentina. Twenty-five women transmitted the infection to 38 children. The potential risk factors evaluated in the mothers were exposure to vector transmission, blood transfusion history, maternal seropositivity, parasitemia and age at birth of the child. 72% (18/25) of the mothers who transmitted the infection to their children, had little or no contact with the vector, while only 28% (7/25) of the mothers presented a history of medium or high risk of vector infection. The differences were significant (p < 0.05). Forty-one percent of the women who presented maternal history as the probable route of infection, transmitted the parasite to more than one child (1.86 ± 0.33; CI95% = 1.03-2.68). In addition, the most frequent history, among the women who transmitted the disease to their children, was the absence of exposure to vector transmission and transfusion with unknown maternal serology. The route of infection was probably transplacental. These observations suggest that there are family genetic characteristics involved in vertical transmission. The parasite was found in 71% of the mothers who transmitted the infection to their children and were able to perform xenodiagnoses. After controlling for the other variables, the logistic regression analysis showed that xenodiagnosis (+) is a risk factor for congenital transmission; the relative risk was 12.2 (95% confidence interval: 2.9 - 50.1). No differences were found when analyzing the mother's age and transfusion history. The highest risk of congenital transmission was associated with detectable parasitemia and less maternal exposure to the vector.

Evolución de la mortalidad fetal, inmersa en las desigualdades socioeconómicas de la República Argentina: Período 2007-2014 / Evolution of fetal mortality in the setting of Argentine socioeconomic inequalities: Period 2007-2014

Introducción. Pocos estudios relacionaron las condiciones sociales adversas en cuanto a áreas geográficas (AG) con la mortalidad fetal (MF). Objetivo. Evaluar la desigualdad en salud en la MF según las AG. Población y métodos. Estudio descriptivo ecológico. Se analizaron los componentes principales de 525 AG. Se construyó y calculó el indicador de situación socioeconómica e índices de desigualdad, y se estimó la razón de mortalidad fetal (RMF). Resultados. El índice relativo de desigualdad de Kunst y Mackenbach varió de 1,8 a 1,4 para los bienios 2007/2008-2013/2014, y se estimó la mayor RMF para el estrato de situación socioeconómica muy desfavorable. Conclusión. La RMF es mayor para dicho estrato. La brecha entre los extremos de situación socioeconómica disminuyó hacia el último bienio. Independientemente, para las AG de situación socioeconómica muy desfavorable, la RMF descendió en el último bienio y, para las de situación socioeconómica muy favorable, se incrementó.

Introduction. Few studies have established a relationship between adverse social conditions by geographic area (GA) and fetal mortality (FM). Objective. T o assess health inequalities in relation to FM by GA. Population and methods. Descriptive, ecological study. The principal components of 525 GAs were analyzed. A socioeconomic status indicator and indices of inequality were developed and estimated, and the FM ratio was calculated. Results. The Kunst and Mackenbach relative index of inequality ranged from 1.8 to 1.4 in the 2007/2008 and 2013/2014 biennia, and a higher FM ratio was estimated for the highly unfavorable socioeconomic level stratum. Conclusion. The FM ratio is higher in this stratum. The gap between the ends of the socioeconomic spectrum narrowed towards the latest biennium. Regardless of this, in the GAs with a very unfavorable socioeconomic status, the FM ratio reduced in the latest biennium and increased in those with a very favorable socioeconomic status.

Detección de Leptospira spp. en animales y muestras ambientales de áreas peridomésticas en Nicaragua / Detection of Leptospire spp. in animals and in environmental samples from peridomestic areas in Nicaragua / Detecção de Leptospira spp. em animais e em amostras ambientais de áreas peridomiciliares na Nicarágua

RESUMEN Objetivo El objetivo de este estudio fue conocer las características epidemiológicas de la leptospirosis en animales domésticos y en los casos de leptospirosis humana en áreas peridomésticas en Nicaragua entre 2014 y 2016. Métodos Las muestras se extrajeron en áreas donde se confirmaron casos en humanos utilizando un muestreo no probabilístico en 10 de los 17 departamentos del país. Se incluyeron 112 muestras de orina de animales domésticos, 129 muestras de agua y 69 de tierra para aislar leptospiras en medio Ellinghausen-McCullough-Johnson-Harris (EMJH). Además, se aplicó la prueba de microaglutinación (MAT) en 263 muestras de suero de animales y 88 aislados se analizaron mediante PCR. Resultados En 32,6% (101/310) de las muestras se aislaron espiroquetas, 23,2% (26/112) se aislaron en la orina de animales domésticos, 47,3% (61/129), en las muestras de agua y 20,3 % (14/69), en las de tierra. El análisis de aislamiento mostró diferencias significativas (P < 0,05) entre los departamentos para los diferentes tipos de muestras, y el aislamiento fue más frecuente en agua que en tierra (OR = 3,49; IC95%: 1,56-7,80). El 14,1% (37/263) de los animales fueron reactores en la prueba de microaglutinación. El serogrupo más frecuente fue Icterohaemorrhagiae (40%). En el análisis con la PCR para identificar leptospiras de las especies patógenas 10,2% (9/88) de los aislamientos fueron positivos. Conclusiones Esta investigación demuestra que los animales domésticos y el ambiente desempeñan un papel importante en la aparición de brotes de la leptospirosis y confirma el comportamiento endémico de la enfermedad en Nicaragua.

ABSTRACT Objective The objective of this study was to determine the epidemiological characteristics of leptospirosis in pets and in humans in peridomestic settings in Nicaragua between 2014 and 2016. Methods The samples were taken in areas where cases were confirmed in humans using non-probabilistic sampling in 10 of the country's 17 departments. This included 112 urine samples from pets, 129 water samples, and 69 soil samples in order to isolate leptospires in Ellinghausen-McCullough-Johnson-Harris (EMJH) medium. Furthermore, the microscopic agglutination test (MAT) was applied to 263 samples of animal serum, and 88 isolates were analyzed using PCR. Results In 32.6% (101/310) of the samples, spirochetes were isolated: 23.2% (26/112) in the pet urine, 47.3% (61/129) in water samples, and 20.3% (14/69) in soil samples. Isolation analysis showed significant differences (p<0.05) between departments for the different types of samples, and isolation was more frequent in water than in soil (OR = 3.49; CI95%: 1.56-7.80). In total, 14.1% (37/263) of the animals were reactors in the microscopic agglutination test. The most frequent serogroup was Icterohaemorrhagiae (40%). PCR analysis to identify pathogenic species of leptospires resulted in 10.2% (9/88) positive isolations. Conclusions This research demonstrates that pets and environment conditions play an important role in the emergence of outbreaks of leptospirosis, and confirms the endemic behavior of the disease in Nicaragua.

RESUMO Objetivo Descrever as características epidemiológicas da leptospirose em animais domésticos e em casos de leptospirose humana em áreas peridomiciliares na Nicarágua entre 2014 e 2016. Métodos As amostras foram coletadas por amostragem não probabilística em áreas com casos confirmados de leptospirose humana em 10 das 17 províncias do país. Foram analisadas 112 amostras de urina de animais domésticos, 129 amostras de água e 69 amostras de solo com o uso do meio de cultura padrão para o isolamento de leptospiras (Ellinghausen-McCullough-Johnson-Harris, EMJH). Além disso, foi realizado o teste de aglutinação microscópica em 263 amostras séricas de animais e 88 isolados foram analisados com a técnica de PCR. Resultados Em 32,6% (101/310) das amostras foram isoladas espiroquetas, sendo 23,2% (26/112) isoladas na urina de animais domésticos, 47,3% (61/129) nas amostras de água e 20,3% (14/69) nas amostras de solo. Houve diferença significativa (P < 0,05) entre as províncias no isolamento nos diferentes tipos de amostras analisadas, sendo o isolamento mais frequente nas amostras de água que de solo (OR = 3,49; IC95%: 1,56-7,80). Reatividade no teste de aglutinação microscópica foi observada em 14,1% (37/263) das amostras de animais. O sorogrupo mais frequentemente isolado foi Icterohaemorrhagiae (40%). A técnica de PCR demonstrou que 10,2% (9/88) dos isolados eram positivos para espécies patogênicas de leptospiras. Conclusões Esta pesquisa demonstra que os animais domésticos e o entorno têm papel importante no surgimento de surtos de leptospirose e confirma o comportamento endêmico da doença na Nicarágua.

Internações em idosos e fatores contextuais associados no nordeste brasileiro / Hospitalizations in the elderly and associated contextual factors in northeastern Brazil

Esse estudo objetivou investigar as internações dos idosos por grupo de causa e por condições sensíveis à atenção primária (ICSAP), identificando sua relação com fatores contextuais na região Nordeste do Brasil. Realizou-se um estudo com delineamento ecológico, que utilizou dados secundários oriundos do Sistema de Informação Hospitalar (SIHSUS) para a descrição das taxas de internação por grupo de causas e por ICSAP em idosos a partir de 60 anos ou mais, nos anos de 2010 a 2015. Como variável dependente, utilizou-se a taxa de internação hospitalar nos idosos por grupo de causas e por ICSAP. Realizou-se a análise de cluster não-hierárquica (K-means) agrupando os municípios com base nos grupos de causas de internações gerais e aquelas sensíveis à atenção primária, sendo formado 3 Clusters, os quais foram classificados como altas taxas, intermediárias e baixas taxas de internação. Para a associação com as variáveis dependentes, foram selecionadas 11 variáveis independentes socioeconômicas contextuais, resumindo-as através da Análise Fatorial, tendo a extração dos fatores sido realizada pela Análise de Componentes Principais (ACP). Obteve-se, portanto, um componente denominado "Urbanização e seus reflexos", o segundo nominado de "Contexto socioeconômico favorável" e o terceiro intitulado "Pouca escolaridade e dependência do Estado". Além dessas variáveis, utilizou-se o Índices de GINI, IDH, FIRJAN, a média da cobertura da Atenção Básica dos municípios nos anos de 2010 a 2015 e a taxa do número de consultas em idosos na atenção básica nesse mesmo período. A taxa total de internação no período foi 1.212,60, sendo em maior quantidade aquelas por doenças do aparelho circulatório, seguidas de doenças do aparelho respiratório e das doenças infecciosas e parasitárias. Os clusters de taxas de internação diferiram significativamente em relação aos fatores contextuais, de modo que os municípios que possuem as maiores taxas de internações apresentaram os valores mais altos para o contexto socioeconômico favorável, sendo os maiores valores relativos à pouca escolaridade e dependência do estado os dos municípios de menores taxas de internação. Em relação às ICSAP, a taxa total de internação foi de 527,524 (43,5% do total das internações), sendo em maior quantidade aquelas por insuficiência cardíaca, seguidas das doenças cerebrovasculares e das gastroenterites infecciosas. Existiu diferença significativa entre os clusters e os fatores, onde o cluster que possui as maiores taxas de internações foi o que apresentou as maiores médias para o contexto socioeconômico favorável e para pouca escolaridade e dependência do estado. O cluster que possui menores taxas de internação possuiu as maiores médias para o fator "urbanização e seus reflexos". Na análise da cobertura da atenção básica e taxa de consultas de idosos na atenção básica, observou-se que os clusters não diferiram significativamente. Diante desse contexto, conclui-se que na população idosa do Nordeste há predomínio de internações por doenças do aparelho circulatório e das ICSAP por insuficiência cardíaca. Os fatores contextuais interferem de modo significativo nas internações da população idosa, sendo importante analisá-los na construção das políticas públicas de saúde, atentando para as vulnerabilidades dessa população e contribuindo com a equidade em saúde (AU).

This study aimed to investigate the hospitalizations of the elderly by cause group and conditions sensitive to primary care (ICSAP), identifying their relationship with contextual factors in the Northeast region of Brazil. A study with an ecological proposal was carried out by using secondary data from the Hospital Information System (SIH-SUS) to describe hospitalization rates by cause group and by ICSAP in the elderly aged 60 and over from the years 2010 to 2015. As a dependent variable, the hospital admission rate in the elderly was used by cause group and by ICSAP. Non-hierarchical cluster analysis (K-means) was performed by grouping the municipalities based on the groups of causes of general admissions and those sensitive to primary care, with 3 Clusters being formed, which were classified as high, intermediate and low hospitalization rates. For the association with the dependent variables, 11 independent socioeconomic contextual variables were selected, summarizing them through the Factor Analysis, with the extraction of the factors being performed by Principal Component Analysis (PCA). Therefore, a component called "Urbanization and its reflexes" was obtained, the second named "Favorable socioeconomic context" and the third entitled "Little education and necessity of the State". Other than these variables, the indexes of GINI, IDH, FIRJAN, the average coverage of primary care in the municipalities from the years 2010 to 2015, and the rate of the number of consultations in the elderly in basic care in the same period were used. The total hospitalization rate in the period was 1,212.60, with the greatest number being due to diseases of the circulatory system, followed by diseases of the respiratory system and infectious and parasitic diseases. The clusters of hospitalization rates differed significantly in relation to the contextual factors, so that the municipalities with the highest hospitalization rates presented the highest values for the favorable socioeconomic context, the highest values being related to the little education and state necessity of municipalities with lower hospitalization rates. In relation to the ICSAP, the total hospitalization rate was 527,524 (43.5% of all hospitalizations), with the highest number due to heart failure, followed by cerebrovascular diseases and infectious gastroenteritis. There was a significant difference between all the clusters and factors, where the cluster with the highest admission rates was the one that presented the highest averages for the favorable socioeconomic context and for little education and state necessity. The cluster with the lowest hospitalization rates had the highest averages for the "urbanization and its reflexes" factor. In the analysis of the coverage of primary care and the rate of consultations of the elderly in basic care, it was observed that the clusters did not differ significantly. Having this context in mind, one may conclude that in the elderly population of the Northeast there is a majority of hospitalizations due to diseases of the circulatory system and ICSAP due to heart failure. Contextual factors interfere significantly in hospitalizations of the elderly population, and it is important to analyze them in the construction of public health policies, taking into account the vulnerabilities of this population and contributing to health equity (AU).

Fatores associados à inatividade física em mulheres com excesso de peso / Factors associated with physical inactivity in women with overgheit

Introdução: O excesso de peso é um fenômeno universal cuja prevalência é crescente nos últimos anos. Associa-se ao modo de viver da sociedade moderna, mais especificamente à prática de atividade física e ao padrão alimentar. Por esta razão, a atividade física é um fator crítico para determinar se um indivíduo será capaz de manter um peso saudável. Objetivo: Verificar os fatores associados à inatividade física total e no lazer em mulheres com excesso de peso. Método: Estudo transversal, com 142 mulheres submetidas a entrevista e avaliação antropométrica em ambulatório para tratamento da obesidade, em Salvador, Bahia. Na análise bivariada empregou-se a razão de prevalência com intervalo de confiança (IC) de 95% para analisar a associação entre variáveis de interesse e a inatividade física total e no lazer. Na análise bivariada, empregou-se também o teste de Qui-quadrado de Pearson ou Exato de Fisher e as variáveis com p ≤0,20 entraram no modelo de regressão logística múltipla sendo a Odds Ratio corrigida pelo modelo de Poisson. Adotou-se significância estatística de 5%. Resultados: A idade média foi 50,66 anos (DP=11,59); predominaram mulheres negras (93,7%), com filhos (81,8%), ensino médio completo/incompleto (58%), união estável (55,9%), baixa renda (39,2%), ≤ oito horas de trabalho/dia (65,7%). Houve maior proporção de obesidade grau III (31,5%) seguida do grau I (29,4%) e II (21,7 %). A prevalência da inatividade física por domínio, avaliada pelo International Physical Activity Questionnaire, foi de 64,4% no trabalho; 78,1% no deslocamento; 54,2% no domicílio e 85,2% no lazer. Considerando o nível de atividade física total 34,5% eram inativas. Na análise bivariada houve associação significante entre inatividade física no lazer e índice de massa corporal, autoeficácia para atividade física, percepção do ambiente, dependentes no domicílio, estado de saúde percebido e número de comorbidades. Na regressão, a inatividade física no lazer associouse ao número de comorbidades (RP:1,31; IC 95% 1,06;1,64); a autopercepção de saúde ruim (RP: 1,28; 1,01;1,61); a baixa autoeficácia (RP:1,27; 1,06; 1,51) e a percepção do ambiente ruim (RP:1,27; IC 95% 1,01;1,60). Para o nível de atividade física total, na análise bivariada verificou-se associação entre inatividade física e idade ≥ 60 anos, mulheres com companheiro, sobrepeso; duas comorbidades e autopercepção de saúde e autoeficácia regular/ruim e, no modelo multivariado, mulheres com autopercepção de saúde regular e ruim tiveram aumento respectivo de 124% (RP 2,24; IC 95% 1,05;4,77) e 150% (RP: 2,50; IC 95% 1,10;5,67) na inatividade física total. Mulheres com pior autoeficácia, ≥ 60 anos, com companheiro e agregação de comorbidades apresentaram direção de aumento da inatividade física total. Conclusão: A maioria das mulheres eram ativas no escore total de atividade física. Na análise multivariada a autopercepção de saúde associou-se significativamente à inatividade física total. Houve alta prevalência de inatividade física no lazer. No modelo multivariado, a inatividade física no lazer associouse significativamente ao número de comorbidades, a autopercepção de saúde ruim, a baixa autoeficácia e a percepção do ambiente ruim. O estudo orienta para a elaboração de programas de promoção da saúde e redução de agravos associados a inatividade física. (AU)

Introduction: Overweight is a universal phenomenon whose prevalence has increased in recent years. It is associated to the way of life of modern society, more specifically to the practice of physical activity and to the dietary pattern. For this reason, physical activity is a critical factor in determining if an individual will be able to maintain a healthy weight. Objective: To verify the factors associated with total physical inactivity and leisure time in overweight women. Method: A cross-sectional study with 142 women submitted to an interview and anthropometric evaluation in an outpatient clinic for treatment of obesity, in Salvador, Bahia. In the bivariate analysis, the prevalence ratio with a 95% confidence interval (CI) was used to analyze the association between variables of interest and total and physical inactivity in leisure. In the bivariate analysis, the Pearson's Chi-square test or the Fisher's exact test were also used, and the variables with p ≤0.20 entered into the multiple logistic regression model and the Odds Ratio was corrected by the Poisson model. Statistical significance was set at 5%. Results: The mean age was 50.66 years (SD = 11.59); (81.8%), complete / incomplete high school (58%), stable union (55.9%), low income (39.2%), ≤ eight hours Of work / day (65.7%). There was a higher proportion of grade III obesity (31.5%) followed by grade I (29.4%) and grade II (21.7%). The prevalence of physical inactivity per domain, evaluated by the International Physical Activity Questionnaire, was 64.4% at work; 78.1% in displacement; 54.2% at home and 85.2% at leisure. Considering the level of total physical activity, 34.5% were inactive. In the bivariate analysis there was a significant association between physical inactivity in leisure and body mass index, autoefficacy for physical activity, perception of the environment, dependents at home, perceived health status and number of comorbidities. In the regression, physical inactivity in leisure was associated with the number of comorbidities (RP: 1.31, 95% CI 1.06, 1.64); Self-perception of poor health (RP: 1.28, 1.01, 1.61); (RP: 1.27, 1.06, 1.51) and the perception of poor environment (RP: 1.27, CI 95% 1.01, 1.60). For the level of total physical activity, in the bivariate analysis there was an association between physical inactivity and age ≥ 60 years, women with partners, overweight; Two comorbidities and self-perception of health and regular / poor selfefficacy, and in the multivariate model, women with regular and poor self-perception of health had a respective increase of 124% (PR 2.24, CI 95% 1.05, 4.77) and 150 % (RP: 2.50, CI 95% 1.10, 5.67) in overall physical inactivity. Women with worse self-efficacy, ≥ 60 years, with companion and aggregation of comorbidities presented a direction of increase of total physical inactivity. Conclusion: Most of the women were active in the total physical activity score. In the multivariate analysis the self-perception of health was significantly associated to the total physical inactivity. There was a high prevalence of physical inactivity in leisure. In the multivariate model, physical inactivity in leisure was significantly associated with the number of comorbidities, poor self-perception of health, low self-efficacy and poor environment perception. The study guides the development of health promotion programs and the reduction of diseases associated with physical inactivity. (AU)

Determinantes ambientales que afectan el perfil de salud de población del Meta 2012-2014 / Environmental determinants that affect population health profile of Meta 2012-2014 / Determinantes ambientais que afetam o perfil de saúde da população do Meta 2012-2014

Resumen Se construyeron indicadores sintéticos basados en la morbilidad y la mortalidad como método para describir los factores ambientales presentes en los municipios del Meta en el periodo 2012 a 2014. Mediante transversal retrospectivo, utilizando las bases de datos estatales de vigilancia en salud pública y el registro único de afiliados (RUAF) de 2012 a 2014, las cuales posterior a validación fueron analizadas en fases: construcción de los indicadores simples, índices temáticos e indicadores sintéticos. Se obtienen cuatro indicadores que permiten medir el grado de afectación en salud de cada uno de los municipios del Meta y la diferencia entre los mismos, permitiendo evidenciar la existencia de efectos diferenciales en cada municipio relacionados con factores ambientales como: sustancias químicas, agua, aire y fauna, la evidencia sobre la existencia de un efecto causado por estos factores se deriva de la presencia de morbilidad y mortalidad en diferentes eventos en salud.

Abstract Synthetic indicators based on morbidity and mortality were constructed as a method to describe the environmental factors present in the Meta municipalities in the period 2012 to 2014. Through a retrospective cross-section, using the public da- tabases of surveillance in public health and the single registry of affiliates (RUAF) from 2012 to 2014, which after validation were analyzed in phases: construction of simple indicators, thematic indexes and synthetic indicators. Four indicators are obtained that allow measuring the degree of health impairment of each of the municipalities of the Meta and the difference between them, allowing evidence of the existence of differential effects in each municipality related to environmental factors such as: chemical substances, water, air and fauna, the evidence on the existence of an effect caused by these factors is derived from the presence of morbidity and mortality in different health events.

Resumo Foram construidos indicadores sintéticos baseados na morbilidade e mortalidade como método para descrever os fatores ambientais presentes nos municípios do Meta no período de 2012 a 2014. Através de uma retrospectiva transversal, utili zando as bases de dados estatísticos de vigilância na saúde pública e de registro único de filiados (RUAF) de 2012 a 2014, as quais após validação foram analisadas em fases: construção de indicadores simples, índices temáticos e indicadores sintéticos. Se obtêm quatro indicadores que permitem medir o grau de afetividade em cada um dos municípios do Meta e a diferença entre os mesmos, permitindo evidenciar a existência de efeitos diferenciais em cada município relacionados com fatores ambientais como: substâncias químicas, água, ar e fauna, a evidência sobre a existência de um efeito por estes fatores deriva-se da presencia de morbilidade e mortalidade em diferentes eventos em saúde.

Determinantes sociales de la mortalidad infantil por causas reducibles en la Argentina, 2009-2011

bjetivo: identificar los determinantes sociales de la mortalidad infantil, según el criterio de reducibilidad, en tres niveles de determinación (individual, familiar y poblacional).Métodos: se realizó un estudio transversal para el análisis de las características de la mortalidad infantil en partidos y departamentos de la República Argentina, y de los determinantes sociales de la mortalidad infantil, en tres niveles de análisis. Para el primero y el segundo nivel, se utilizaron variables relacionadas con los fallecidos que están disponibles en los informes estadísticos de defunción. Para el tercer nivel se utilizaron los datos poblacionales provenientes del Censo Nacional de Población y Viviendas del 2010.Resultados: de los determinantes sociales de la salud considerados, las variables que presentaron asociación estadísticamente significativa con la mortalidad infantil por causas reducibles fueron: edad del fallecido al momento de la muerte, la edad gestacional, lugar de ocurrencia de la muerte, haber tenido atención o no, el nivel de instrucción de la madre, la situación laboral, primaria incompleta y hacinamiento.Conclusión: existe una influencia de factores tanto del nivel individual, como del nivel familiar y poblacional sobre la mortalidad infantil y en mayor proporción sobre las muertes por causas reducibles.

he objective of this project is to identify the social determinants of infant mortality according to the criteria of reducibility and to investigate the association between the infant mortality and its determinants on multiple levels.Methods: A cross-sectional study analyzed the characteristics of infant mortality in parties and departments of Argentina and the social determinants of infant mortality in three levels of analysis.Results: The variables that showed a statistically significant association with infant mortality due to avoidable causes were: age of the deceased at the time of death, gestational age, place of occurrence of death, having attention or not, the level of instruction of the mother, employment status, overcrowding, and incomplete primary care.Conclusions: The factors that influence infant mortality exists as much at an individual level as they do at the family and population levels, and a large proportion of deaths are from preventable causes.

Características epidemiológicas del embarazo en la adolescencia / Epidemiological Characteristics of Adolescent Pregnancy

Introducción: el embarazo en la adolescencia constituye un problema social, económico y de salud pública en todo el mundo. En los últimos años ha aumentado la preocupación por su incremento a nivel mundial. Objetivo: determinar las características epidemiológicas del embarazo en la adolescencia. Métodos: estudio descriptivo, retrospectivo, transversal realizado desde el 1º de enero de 2016 hasta el 31 de diciembre de 2016 a 45 gestantes en edades comprendidas entre 12 y 19 años en la Urbanización Augusto Malavé Villalba de Boca de Río, Península de Macanao, Venezuela. Se analizaron las siguientes variables: edad, escolaridad, estado civil, paridad, utilización de métodos anticonceptivos y enfermedades asociadas al embarazo. A todas se les aplicó una encuesta anónima. La investigación se realizó teniendo en cuenta consideraciones éticas establecidas. A las pacientes se les solicitó la disposición de participar en la investigación. Resultados: la edad de mayor predominio en la casuística fue la comprendida entre 17 y 19 años. Las pacientes adolescentes con nivel escolar secundario y sin pareja fueron las de más incidencia. En más de la mitad del universo de estudio, predominó la mala situación económica. Conclusiones: se constató poco uso de la anticoncepción. También se corroboró que las adolescentes con alguna paridad anterior predominaron considerablemente(AU)

Introduction: Adolescent pregnancy is a social, economic and public health problem throughout the world. In recent years, there has been growing concern about its increase worldwide. Objective: Determine the epidemiological characteristics of pregnancy in adolescence. Methods: A descriptive, retrospective, cross-sectional study was carried out from January 1, 2016 to December 31, 2016, in 45 pregnant women aging 12 to 19 years at Augusto Malavé Villalba Urbanization in Boca de Río, Macanao Peninsula, Venezuela. The following variables were analyzed: age, schooling, marital status, parity, use of contraceptive methods and diseases associated with pregnancy. They were all subjected to an anonymous survey. The investigation was carried out taking into account established ethical considerations. The patients were asked to participate in the research. Results: The greatest age predominance in casuistry ranged 17 and 19 years. Adolescent patients with secondary school level and without a partner were the most frequent. Bad economic situation predominated in more than half of the universe of study. Conclusions: The majority of adolescents were between 17 and 19 years of age with a secondary level, without a steady partner, they are from poor socioeconomic environments and with a predominance of cervicovaginal infections and urinary infection. There was little use of contraception. Adolescents with some previous parity predominated considerably, as it was also confirmed(AU)

High risk pregnancies and factors associated with neonatal death / Gestación de alto riesgo y factores asociados con la defunción neonatal / Gestação de alto risco e fatores associados ao óbito neonatal

Abstract OBJECTIVE To identify the factors associated with intra-hospital neonatal mortality based on the individual characteristics of at-risk pregnant mothers, delivery and newborns. METHOD This was a cross-sectional epidemiological study of live newborns delivered by women attended at the high-risk outpatient unit of a philanthropic hospital in Maringá, Paraná, Brazil between September 2012 and September 2013. RESULTS Six hundred and eighty-eight women participated in the study. The neonatal mortality coefficient found was 17.7/1,000 live births, most in the early neonatal phase. Premature labor, fetal malformation and multiple gestations were associated with neonatal death. Premature, very low birth weight newborns and those with an Apgar score of less than seven, five minutes after birth were at high risk of death. CONCLUSION Identifying risk factors can help plan actions to consolidate the perinatal network. Specific programs should be incentivized in other countries, in the search for significant perinatal results such as reducing neonatal mortality.

Resumen OBJETIVO Identificar los factores asociados con la mortalidad neonatal intrahospitalaria con base en las características individuales de gestantes de riesgo, del parto y del recién nacido. MÉTODO Estudio epidemiológico del tipo transversal, realizado con niños nacidos vivos de partos hospitalarios de mujeres seguidas en el ambulatorio de alto riesgo de un hospital filantrópico de Maringá, Paraná, Brasil, en el período de septiembre de 2012 a septiembre de 2013. RESULTADOS Hicieron parte de la investigación 688 mujeres. El coeficiente de mortalidad neonatal fue de 7,7 defunciones/1.000 nacidos vivos, siendo su mayoría en el período neonatal precoz. Trabajo de parto prematuro, malformación fetal y gestación múltiple fueron los sucesos asociados con la defunción neonatal. Recién nacidos prematuros, con muy bajo peso al nacer e Índice de Apgar menor que siete el quinto minuto de vida presentaron riesgo elevado de muerte. CONCLUSIÓN La identificación de factores de riesgo puede auxiliar la planificación de acciones para consolidación de la red perinatal. Se deben incentivar programas específicos en otros países, en la búsqueda por resultados perinatales considerables, como la reducción de la mortalidad neonatal.

RESUMO OBJETIVO Identificar os fatores associados à mortalidade neonatal intra-hospitalar com base nas características individuais de gestantes de risco, do parto e do recém-nascido. MÉTODO Estudo epidemiológico do tipo transversal, realizado com crianças nascidas vivas de partos hospitalares de mulheres acompanhadas pelo ambulatório de alto risco de um hospital filantrópico de Maringá, Paraná, Brasil, no período de setembro de 2012 a setembro de 2013. RESULTADOS Fizeram parte da pesquisa 688 mulheres. O coeficiente de mortalidade neonatal foi de 17,7 óbitos/1.000 nascidos vivos, sendo sua maioria no período neonatal precoce. Trabalho de parto prematuro, malformação fetal e gestação múltipla foram as intercorrências associadas ao óbito neonatal. Recém-nascidos prematuros, com muito baixo peso ao nascer e Índice de Apgar menor que sete no quinto minuto de vida apresentaram risco elevado de morte. CONCLUSÃO A identificação de fatores de risco pode auxiliar no planejamento de ações para consolidação da rede perinatal. Programas específicos devem ser incentivados em outros países, na busca de resultados perinatais expressivos, como a redução da mortalidade neonatal.

Qualidade de vida das mulheres com prolapso de órgão pélvico após tratamento cirúrgico / Quality of life in women with pelvic organ prolapse after surgical treatment

Introdução: A prevalência do prolapso de órgão pélvico (POP) aumenta com a idade, estimando-se que quase 30% das mulheres têm algum grau de POP. As pesquisas sobre qualidade de vida relacionada à saúde (QVRS) nesta patologia tornaram-se importantes. A QVRS das mulheres com POP é grandemente afetada, incluindo a alteração dos aspectos fisicos e das áreas psicológica e social. Há pouca evidencia sobre os fatores que alteram a QVRS destas mulheres, e que poderiam predizer mudanças após do tratamento. O objetivo desta pesquisa é avaliar a QVRS das mulheres submetidas a cirurgia de correção de POP e conhecer os fatores preditores das mudanças. Método: Estudo longitudinal com desenho analitico, correlacional preditivo em 95 mulheres adultas Chilenas da Região Metropolitana, com diagnóstico de POP e com indicação de cirurgia. Realizou-se avaliação da QVRS em três momentos (basal pré-operatório, um e seis meses após a cirurgia para correção do POP), empregando-se o instrumento Prolapse Quality of Life (PQOL), em sua versão chilena, composto de nove dimensões: percepção geral de saúde (PGS), impacto do prolapso (IP), limitações de papel (LR), fisicas (LF), sociais (LS) e relações pessoais (RP), emoções (E), sono/energia (SE) e medidas de gravidade (MS); Os fatores preditores da QVRS foram colhidos utilizando-se os seguintes instrumentos: dados demográficos e clinicos, Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire-12 versão Chilena (função sexual), Menopause Rating Scale versão Chilena (sintomas menopáusicos), Questionário Geral de Saúde de Golberg (sintomas depressivos) e Modified Body Image Scale (imagem corporal). Os dados foram submetidos as análises descritivas univariadas; análises de medidas repetidas com comparação de médias 2 a 2, usando-se o teste t-Student para comparação de grupos; e análise multivariada utilizando-se o Modelo Linear de Efeitos Mistos, para explicar as variáveis preditoras da QVRS. Além dessas, a Minima Diferença Importante (MID) e o tamanho do efeito foram utilizados para determinar a magnitude das mudanças na QVRS após of tratamento cirúrgico, utilizando-se o Patient Global Impression of Improvement Index. Resultados: A idade média foi 60 anos (DP=10,3); 76% apresentaram nível educacional básico ou médio, com companheiro (61%), com atividade sexual (40%). com menopausa (74,5%); 2,5 procedimentos cirúrgicos para correção do POP em média. A QVRS melhorou após o tratamento cirúrgico, em ambos os seguimentos (p<0.001), e em todas as dimensões. A imagem corporal apresentou diferença significativa (p<0,05) em todos os momentos de avaliação: para cada ponto de piora da imagen corporal, menor mudança na QVRS após a cirurgia. Os sintomas menopáusicos impactaram em menores mudanças na QVRS nas dimensões PGSe E, em todos os tempos, embora a QVRS nas dimensões IP, LF, LS e SE tenha apresentado leve porém significativa melhora após a cirurgia (p<0,05). As mulheres com doença neurológica mostraram menores mudanças na QVRS no pós-operatório comparativamente àquelas sem essa doença nas dimensões LF, E e SE (p<0,05). Outras variáveis preditoras de QVRS foram a atividade sexual, nivel educacional, idade e diabetes mellitus. Obteve-se um efeito de grande magnitude em todas as dimensões e estabeleceu-se MID entre -1,19 e-15 pontos para todas as dimensões de PQOL. Conclusão: A QVRS melhorou após o tratamento cirúrgico, em todas as dimensões, e as variáveis preditoras mais importantes foram a imagen corporal, os sintomas menopausicos e as doenças neurológicas. O estudo contribui para corroborar a necessidade de avaliação integral das mulheres no pré-operatório visando a conhecer as tendências de sua QVRS posteriormente atuando nos fatores modificáveis que podem influir negativamente em sua recuperação pós-operatória.

Introduction: Prevalence of pelvic organ prolapse (POP) increase with age, estimating that almost 30% of women has some POP degree. Research about health related quality of life (HRQL) in this pathology it have gained relevance. HRQL of women with POP is highly affected; including physical impaired, and psychological and social spheres. There is little evidence about factors influence HRQL of these women. The aim of this research was to evaluate HRQL of women submitted to surgical correction of POP and predictors factors of changes. Methods: Llongitudinal study with analytical, correlational, predictive design in 95 Chilean women, of the Metropolitan Area, with POP diagnosis and surgical indication. An evaluation was performed of HRQL in three times (baseline before surgery, and follow up at first and six month after surgery) Instruments applied were Prolapse Quality of Life (PQOL) Chilean version which nine dimensions: General health perception (GHP), prolapse impact (PI), role (RL), physical (LF), socials (LS) and personal limitations, emotions (E), sleep/energy (SE) and, severity measurement (SM): predictors factors of HRQL were obtained using demographic and clinical data, Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire-12 Chilean version (sexual function), Menopause Rating Scale Chilean version (menopause symptoms), Goldberg's General Health Questionnaire (depressive symptoms) and Modified Body Image Scale (Body image). Data analysis included univariate descriptive analysis, repeated measures analysis with media comparison 2 to 2 for group and multivariate analysis with linear mixed effects models to explain predictors variables of HRQL. Also, the minimum important difference (MID) and effect size were used to determine magnitude of change in HRQL after surgical treatment, anchor used was Patient Global Impression of Improvement Index. Results: age average was 60 years (SD: 10.3), 76% primary or secondary educational level, 61% have couple, 40% was active sexually, most of women had menopause (74.5%), average of procedures of POP correction was 2.5. HRQL improved after surgical treatment, in both follow up (p<0.001) in every dimension. Body image had significant difference (p<0.05) without time interaction, every point for worse body image, HRQL get worse. Menopause symptoms had a positive impact on GHP and E, showed fewer score in every time, meanwhile PI, FL, SL and SE had a little but statistical significant improved after surgical treatment (p<0.05). Women with neurological disease showed less change in HRQL after surgery than without disease in FL, E and SE dimension (p<0.05). Other predictive variables after surgery (p<0.05) were sexual activity, educational level, age and diabetes. MID it determined among -1.19 y -15 points for all dimensions of HRQL, considering an large in all dimensions too. Conclusion: HRQL improved after surgery, most important predictive variables were body image, menopause symptoms and neurological disease, therefore integral assessment of women before surgery is important to know HRQL trend after treatment, to support them and improve or maintain modify factors that could have negative impact.