ABSTRACT
BACKGROUND: Maternal mortality is a significant public health concern, with varying impacts across different regions in Brazil, particularly affecting women from lower-income social classes with limited access to social resources. The aim of this study is to describe the trends in maternal mortality in São Paulo, Brazil, from 2009 to 2019. MATERIALS AND METHODS: This study employed an ecological approach utilizing a time-series design to examine maternal deaths. Secondary data from the Mortality Information System (SIM) and the Live Births Information System (SINASC) from 2009 to 2019 were utilized. The analysis included all maternal deaths among women aged 10 to 49 years residing in the state of São Paulo. Time-series data for maternal mortality ratios were constructed for the seven regions within São Paulo State. Joinpoint regression analysis was applied to characterize the maternal mortality ratio. The study estimated the annual percentage variation, the average annual percentage variation, and their respective 95% confidence intervals. RESULTS: In São Paulo, a total of 3075 maternal deaths were reported, resulting in a mortality ratio of 45.9 deaths per 100,000 live births. The leading causes of maternal death were eclampsia (7.13%), gestational hypertension (6.09%), and postpartum hemorrhage (5.89%). The analysis of the annual percentage change in the maternal mortality ratio for São Paulo State and its six clusters showed stationarity. CONCLUSIONS: The assessment of the maternal mortality ratio in the state of São Paulo, Greater São Paulo, and Baixada Santista revealed an increase in the maternal death ratio over the studied period.
ABSTRACT
BACKGROUND AND PURPOSE: The development of public policies must be guided by full knowledge of the health-disease process of the population. Aerobic exercises are recommended for rehabilitation in stroke patients, and have been shown to improve heart rate variability (HRV). Our aim was to compare the cardiac autonomic modulation of elderly stroke patients with that of healthy elderly people during and after an acute bout of aerobic exercise. METHODS: A total of 60 elderly people participated in the study (30 in the control group, mean age of 67 ± 4 years; 30 in the stroke group, mean age of 69 ± 3 years). HRV was analyzed in rest-10 min of rest in supine position; exercise-the 30 min of peak exercise; and recovery-30 min in supine position post-exercise. RESULTS: Taking rest and exercises together, for SDNN, RMSSD, pNN50, RRTri, and TINN, there was no difference between the stroke and control groups (p = 0.062; p = 0.601; p = 0.166; p = 0.224, and p = 0.059, respectively). The HF (ms2) was higher and the LF/HF ratio was lower for the stroke group than the control group (p < 0.001 and p = 0.007, respectively). The SD2 was lower for the stroke group than for the control group (p = 0.041). CONCLUSION: Stroke patients present reduced variability at rest, sympathetic predominance during exercise, and do not return to baseline after the 30 min of recovery, with similar responses found in the healthy elderly group.
