Comparative Analysis of Mortality due to Breast Cancer and Mammography Uptake in the Federative Units of Brazil-2015 to 2021.

Objective: Compare the breast cancer mortality rate and the rate of mammograms with socioeconomic factors, in Brazilian´s Federative Units, during the period of 2015 to 2021. Methods: This is an ecological study, of a descriptive nature, which covers the 27 Brazilian federative units, using secondary data extracted from the DATASUS System. The information analyzed was mammography data, breast cancer mortality, demographic and economic data of the resident population and women over 20 years of age. Results: There is a direct relationship between mortality rate and mammograms rates in the Federative Units. The data obtained for Brazil presents a total of 133,048 deaths from breast cancer and 17,324,526 mammography exams in the period from 2015 to 2021. In other words, Brazil presents a standardized mortality rate value, 19.25 deaths per 100,000 women. Regarding the mammography rate, the value of the exam-specific mammography rate was 2,506.55 per 100,000 women. In relation to socioeconomic data by mortality rate group, higher mortality rates from breast cancer present higher rates in the variables: income rate by State (2,594.86), people with income (63.5), average percentage of women with more over 50 years old (29.5%), women with average years of education (6.64), white population (55.1%) and mammography exam rate (2873.20). When analysing the highest rates of mammography exam rates, higher rates are observed income rate by State (2,161.47), people with income (62.5%), average percentage of women over 50 years old (28.6%), women with an average number of years of education (5.8). Conclusion: Brazil has a high mortality rate due to breast cancer, when compared to other countries. The reasons are diverse, such as the modern, industrialized and populous lifestyle. The Federative Units with the highest mortality rate also have high rates of mammograms, that is, in the Federative Units with "better" sociodemographic conditions, the South and Southeast.

Lethal violence against women in southern Brazil: Spatial analysis and associated factors.

OBJECTIVE: estimate the risk for the occurrence of lethal violence against women and to identify the associated factors in the state of Paraná. METHOD: ecological study of deaths of women aged between 15 and 59 years, victims of aggression. The units of analysis were the cities of Paraná. Latent Bayesian Gaussian models with negative binomial probability distribution were used. The modeling considered intercept, spatial random effects and covariates, performed with the deterministic Integrated Nested Laplace Approximations approach. RESULTS: There was a positive association between lethal violence against women and the percentage of mothers who were heads of households. Finally, male homicide rates, rates of non-lethal violence against women and the cities with women mayors and councilors were also associated. CONCLUSION: This type of violence was associated with low education, structural violence and the participation of women in politics.

Post-acute COVID and long-COVID among adults and older adults in the State of Paraná, Brazil: protocol for an ambispective cohort study.

INTRODUCTION: Since 2020, the world has been going through a viral pandemic with a high morbidity and mortality rate along with the potential to evolve from an acute infection to post-acute and long-COVID, which is still in the process of elucidation. Diagnostic and prognostic research is essential to understand the complexity of factors and contexts involving the illness's process. This protocol introduces a study strategy to analyse predictors, sequelae, and repercussions of COVID-19 in adults and older adults with different disease severities in the State of Paraná, Brazil. METHODS AND ANALYSIS: A mixed-methods sequential explanatory design. The quantitative data will be conducted by an ambispective cohort study, which will explore the manifestations of COVID-19 for 18 months, with nearly 3000 participants with confirmed diagnoses of COVID-19 (reverse transcription-PCR test) between March and December of 2020, retrieved from national disease reporting databases, over 18 years old, living in a Brazilian State (Paraná) and who survived the viral infection after being discharged from a health service. Data collection will be conducted through telephone interviews, at two different occasions: the first will be a recall 12 months after the acute phase as a retrospective follow-up, and the second will be another prospective interview, with data of the following 6 months. For the qualitative step, Grounded Theory will be used; participants will be selected from the cohort population. The first sample group will be composed of people who were discharged from the intensive care unit, and other sample groups will be composed according to theoretical saturation. The qualitative data will follow the temporal design and classification of the disease provided for in the cohort. ETHICS AND DISSEMINATION: Ethics approval was granted by the State University of Maringá, under opinion number: 4 165 272 and CAAE: 34787020.0.0000.0104 on 21 July 2020, and Hospital do Trabalhador (Worker's Hospital), which is accountable for the Health Department of the State of Paraná, under opinion number: 4 214 589 and CAAE: 34787020.0.3001.5225 on 15 August 2020. The participants will verbally consent to the research, their consent will be recorded, and the informed consent form will be sent by mail or email. Outcomes will be widely disseminated through peer-reviewed manuscripts, conference presentations, media and reports to related authorities.

Breast Cancer Mortality in Young Women in Brazil.

OBJECTIVE: Malignant breast cancer is the leading cause of death by cancer in young women. The study aimed to determine if breast cancer mortality among young women has increased between the period from 1996 to 2017 in Brazil. METHODS: A time-series analysis of breast cancer mortality rate in young women (20-39 years old) was carried out. Mortality data, from 1996 to 2017, were collected from the Mortality Information System of the Health Ministry, and demographic data, from the Brazilian Institute of Geography and Statistics. Trends in mortality were performed by Joinpoint Regression, the spatial distribution of the mortality rate was done with the QGIZ Software version 2.18, and Spearman's correlation coefficient was used to correlate the mortality rates with the Human Development Index. RESULTS: There was an increase in breast cancer mortality rates in young women in the majority of Brazilian states, with an upward trend in all regions. The correlation with the Municipal Human Development Index, income, and education had a significant impact on the mortality rate for women from 30-39 years old in both time frames evaluated and for women from 20-29 years old, only from 1996 to 2000. CONCLUSION: The data obtained in the study, showed that even though the breast cancer mortality rate of young women is lower than women over 40 years old, it has been increasing in all regions of Brazil, mostly for women from 30-39 years old, suggesting that this group should be included in screening programs.

Mortalidad infantil: tendencia y cambios tras la implantación del programa red madre paranaense / Mortalidade infantil: tendência e mudanças após a implantação do programa rede mãe paranaense / Child mortality: trend and changes after the implantation of the rede mãe paranaense program

Introducción: la prevención de la mortalidad infantil es uno de los principales objetivos de las políticas públicas en todo el mundo. El Programa Rede Mãe Paranaence (Red Madre de Paraná) fue creado en el año 2012, en el estado de Paraná - Brasil, proponiendo la organización de la salud materna e infantil en las acciones de prenatal, puerperio y en el acompañamiento del crecimiento y desarrollo de los niños. El objetivo de este estudio fue analizar la tendencia de la mortalidad infantil según macro-regiones de salud del estado de Paraná y cambios tras la aplicación del Programa Rede Mãe Paranaense. Método: estudio ecológico con datos del sistema de información de mortalidad de los años 2000 a 2014. Se calcularon los coeficientes de mortalidad, y se realizó un análisis de la tendencia de los modelos de regresión polinomial. Los óbitos en el trienio pre-implantación del Programa Rede Mãe Paranaense (2009-2011) y el trienio post-implementación (2012-2014) fueron analizados de acuerdo con las variables maternas, de parto y de los niños. Resultados: hubo una reducción de la mortalidad infantil en las macro-regiones de salud en Paraná. Desde el período de pre-implantación hasta el periodo post-implantación del programa, hubo una reducción en el coeficiente de mortalidad infantil en el estado de Paraná, de 12,0 a 11,2 muertes/1.000 nacidos vivos. Hubo un aumento en los coeficientes en seis de las 22 regiones de salud y reducción de la mortalidad de los niños de madres menores de 20 años, menos de ocho años de escolaridad y con niños no blancos. Conclusión: la mortalidad infantil descendió en el estado de Paraná, y después de la implantación del Programa Rede Mãe Paranaense se observó una reducción de la mortalidad en los grupos con los factores comúnmente asociados con la mortalidad infantil

Introdução: a prevenção da mortalidade infantil é um dos principais objetivos das políticas públicas mundiais. O Programa Rede Mãe Paranaense foi criado no ano de 2012, em um Estado do Paraná - Brasil, propondo a organização da saúde materno-infantil nas ações do pré-natal, puerpério e no acompanhamento do crescimento e desenvolvimento das crianças. O objetivo do estudo foi analisar a tendência da mortalidade infantil segundo macrorregionais de saúde do Estado do Paraná e mudanças após a implantação do Programa Rede Mãe Paranaense. Método: trata de um estudo ecológico com dados do Sistema de Informação sobre Mortalidade dos anos de 2000 a 2014. Foram calculados coeficientes de mortalidade e a análise de tendência foi realizada a partir de modelos de regressão polinomial. Os óbitos no triênio pré-implantação do Programa Rede Mãe Paranaense (2009-2011) e no triênio pós-implantação (2012-2014) foram analisados segundo variáveis maternas, do parto e das crianças. Resultados: houve redução da mortalidade infantil nas macrorregionais de saúde e no Paraná. Do período pré-implantação para o período pós-implantação do Programa observou-se redução do coeficiente de mortalidade infantil no Estado do Paraná, de 12,0 para 11,2 óbitos/mil nascidos vivos. Houve aumento dos coeficientes em seis das 22 regionais de saúde e redução dos óbitos de crianças de mães com idade menor que 20 anos, escolaridade menor que oito anos e de crianças não brancas. Conclusão: a mortalidade infantil reduziu no Estado do Paraná e, após a implantação do Programa Rede Mãe Paranaense, observou-se redução dos óbitos nos grupos com os fatores comumente associados à mortalidade infantil

Introduction: the prevention of infant mortality is one of the main objectives of global public policies. The Rede Mãe Paranaense Program was established in 2012 in the State of Paraná Brazil, recommending the management of mother and child health in the prenatal, puerperal and follow-up of children's growth and development. The objective of the study was to analyze the trend of infant mortality according to macroregional health in the State of Paraná and changes after the implantation of the Rede Mãe Paranaense Program. Method: this is an ecological study with data from the Mortality Information System from 2000 to 2014. Mortality coefficients were calculated, and trend analysis was performed using polynomial regression models. Deaths in the pre-implantation trimester of the Rede Mãe Paranaense Program (2009-2011) and in the post-implantation triennium (2012-2014) were analyzed according to maternal, childbirth and child variables. Results: there was a reduction in infant mortality in macroregional health and in the state of Paraná. From the pre-implantation period for the post-implantation period of the Program, there was a reduction in the infant mortality rate in the State of Paraná, from 12.0 to 11.2 deaths/thousand live births. There was an increase in the coefficients in six of the 22 regional health and in the reduction of deaths among children and mothers under 20 years of age, schooling less than eight years and non-white children. Conclusion: infant mortality declined in the State of Paraná and, after implementation of the Rede Mãe Paranaense Program, there was a reduction in deaths in the groups with factors commonly associated with infant mortality

Fatores associados à pressão arterial inadequada de pessoas com hipertensão* / Factors associated with inappropriate blood pressure in hypertensive patients / Factores asociados a la presión arterial inadecuada de personas con hipertensión

Objetivo: avaliar os fatores associados à pressão arterial inadequada em pessoas com hipertensão acompanhadas pela Estratégia Saúde da Família. Método: estudo transversal, realizado com 417 pessoas, no município de Maringá, Paraná. A coleta de dados foi realizada no primeiro semestre de 2016, por meio do instrumento satisfação do usuário com hipertensão arterial com os serviços prestados pela Atenção Primária à Saúde, utilizando as questões referentes ao perfil sociodemográfico, nutricional e clínico. Na análise dos dados, aplicou-se estatística descritiva e inferencial. Resultados: a maioria dos entrevistados, 62,4% era idoso, 67,8% do sexo feminino e 55,2% aposentado/pensionista. Houve associação da pressão arterial inadequada com pessoas de idade superior a 59 anos, aposentados/pensionistas, moderadamente ativos, não praticantes de atividades físicas e fragilidade nas orientações sobre a doença. Conclusão: os resultados sinalizam a necessidade de reorganização do processo de trabalho, com o fortalecimento das orientações e educação em saúde às pessoas com hipertensão arterial (AU).

Objective: assess the factors associated with inappropriate blood pressure in hypertensive patients monitored in the Family Health Strategy. Method: cross-sectional study, involving 417 people in Maringá, Paraná. The data were collected in the first semester of 2016, using the instrument satisfaction of hypertensive users with Primary Health Care services; using the questions related to the sociodemographic, nutritional and clinical profile. In the data analysis, descriptive and inferential statistics were applied. Results: most interviewees, 62.4% were elderly, 67.8% female and 55.2% retired/pensioner. Inappropriate blood pressure was associated with people over 59 years of age, retired/pensioners, moderately active, without practicing physical exercise and weakly oriented about the disease. Conclusion: the results signal the need to reorganize the work process, strengthening the orientations and health education for arterial hypertension patients (AU).

Objetivo: El propósito del estudio fue evaluar los factores asociados a la presión arterial inadecuada en personas con hipertensión acompañadas por la Estrategia Salud de la Familia. Método: Fue un estudio trasversal, realizado con 417 personas, en el municipio de Maringá, Paraná. La obtención de datos ocurrió en el primer semestre de 2016, por medio del instrumento de satisfacción del usuario con hipertensión arterial con los servicios prestados por la Atención Primaria a la Salud, utilizando las cuestiones referentes a los perfiles socio demográfico, nutricional y clínico. En el análisis de los datos, se aplicó estadística descriptiva e inferencial. Resultados: La mayoría de los entrevistados, 62,4%, era de ancianos, 67,8% del sexo femenino y 55,2% jubilado/pensionado. Hubo asociación de la presión arterial inadecuada con edades superiores a 59 años, jubilados/pensionados, moderadamente activos, no practicantes de actividades físicas y la debilidad de orientaciones acerca de la enfermedad. Conclusión: Se concluye que hay la necesidad de reorganizar el proceso de trabajo y perfeccionar las orientaciones y la educación en salud de las personas con hipertensión arterial (AU).

The inner state differences of preterm birth rates in Brazil: a time series study.

BACKGROUND: Preterm birth is a serious public health problem, as it is linked to high rates of neonatal and child morbidity and mortality. The prevalence of premature births has increased worldwide, with regional differences. The objective of this study was to analyze the trend of preterm births in the state of Paraná, Brazil, according to Macro-regional and Regional Health Offices (RHOs). METHODS: This is an ecological time series study using preterm births records from the national live birth registry system of Brazil's National Health Service - Live Birth Information System (Sinasc), for residents of the state of Paraná, Brazil, between 2000 and 2013. The preterm birth rates was calculated on a yearly basis and grouped into three-year periods (2000-2002, 2003-2005, 2006-2008, 2009-2011) and one two-year period (2012-2013), according to gestational age and mother's Regional Health Office of residence. The polynomial regression model was used for trend analysis. RESULTS: The predominance of preterm birth rate increased from 6.8 % in 2000 to 10.5 % in 2013, with an average increase of 0.20 % per year (r(2) = 0.89), and a greater share of moderate preterm births (32 to <37 weeks), which increased from 5.8 % to 9 %. The same pattern was observed for all Macro-regional Health Offices, with highlight to the Northern Macro-Regional Office, which showed the highest average rate of prematurity and average annual growth during that period (7.55 % and 0.35 %, respectively). The trend analysis of preterm birth rates according to RHO showed a growing trend for almost all RHOs - except for the 7(th) RHO where a declining trend was observed (-0.95 a year); and in the 20(th), 21(st) and 22(nd) RHOs which remained unchanged. In the last three-year of the study period (2011-2013), no RHO showed preterm birth rates below 7.3 % or prevalence of moderate preterm birth below 9.4 %. CONCLUSIONS: The results show an increase in preterm births with differences among Macro-regional and RHOs, which indicate the need to improve actions during the prenatal period according to the specificities of each region.

[Time trend of the rates of cesarean and vaginal delivery according to the source of financing]. / Tendência temporal da via de parto de acordo com a fonte de financiamento.

PURPOSE: To analyze the time trend of the rates of cesarean and vaginal delivery according to the source of financing. METHODS: This was an ecological study of the time series analysis of cesarean and vaginal delivery rates according to the financing source, carried out in Maringá, Paraná State, Brazil, from 2002 to 2012. Information available at the System of Information on Live Births and at the System of Hospital Information of the Brazilian Unified Health System (SUS) was used for data collection. Moving averages were calculated for all mode of delivery rates in order to smooth random fluctuations in the series, dispersion diagrams were designed between the coefficients and years of the study, and polynomial regression models were estimated from the functional relation observed, with the level of significance set at p<0.05. RESULTS: Throughout the 11 years of the study there were 48,210 births, 77.1% by cesarean delivery and only 22.9% by vaginal delivery. A total of 22,366 procedures were financed by SUS, 54.6% of them being cesareans. Trend analysis was significant for all the regression models, demonstrating an ascending trend for cesarean delivery and a descending trend for vaginal delivery for both types of financing. The non-SUS cesarean rates always exceeded 90.0% and were more frequent than the SUS cesarean rates, even with a 36.0% increase of the latter during the study period. CONCLUSION: Based on trend analysis, cesarean deliveries will continue to increase in both health financing sources unless new actions and strategies of reduction are implemented, involving the sociocultural, demographic and obstetric characteristics of women, the training and activity of professionals in the area of obstetrics and an adequate structure of health services for providing vaginal delivery.

Analysis of maternal and child health indicators in an area at paraná state, Brazil.

The aim of this study was to analyze maternal and child health indicators and infant mortality rate (IMR) at the cities located at the 18th Health Division (HD) in Parana State, Brazil. In this ecological study we analyzed all live births and infant deaths which occurred from 2000 to 2009 at the 18th HD, collecting data from the Mortality Information Database and the Live Births Information Database. The variables assessed were grouped into maternal, pregnancy and delivery, and neonatal variables. The analysis was conducted using the mean percentage of each variable and the IMR calculated for both periods: from 2000 to 2004 and from 2005 to 2009. The IMR was reduced considerably, following Brazil's and Paraná State's trend. Maternal indicators went down regarding the mean percentage of teenage mothers and low education, whereas they went up regarding mother with 35 years old or older and mothers without a partner. Pregnancy indicators showed increased prematurity and cesarean birth. Neonatal indicators raised in black/brown skin color and low birth weights percentages. This study provides a better understanding of maternal and child health in the cities located at the 18th HD, supplying grounds to plan actions regarding the real needs of each specific city.

Spatial distribution and autocorrelation of infant mortality for three cities in Paraná state, Brazil.

Infant mortality (IM), defined as deaths among children one year of age or younger, is an indicator of quality of life and of the organisation and quality of health services. IM reduction is one of the main goals of healthcare and improvements in this area would demonstrate an impact of public services and improved living conditions. Knowledge of the geographic distribution of IM can provide support for prevention and health maintenance decisions. The objective of this study was to analyse the spatial distribution and autocorrelation of IM in Maringá, Sarandi and Paiçandu, three cities in the Maringá metropolitan area, Paraná state, Brazil. The coefficients ranged between 6.5 and 18.2, with the highest rates found in the outskirts of the fused cities, particularly in the demographic expansion areas (DEAs) in Sarandi, with a "high-high" correlation for DEAs no. 18 and 19 and a "low-high" for DEA no. 16. In the central area of Maringá, represented by DEAs no. 3, 6 and 7, the correlation was "low-low". Peripheral DEAs generally show inferior socioeconomic and healthcare conditions. These observations make it possible to analyse programme coverage, set priorities, define goals and follow-up future changes.