Prevalência e fatores associados a utilização de serviços de saúde na população adulta da cidade de Rio Grande

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Episiotomy in Southern Brazil: prevalence, trend, and associated factors

OBJECTIVE To identify and analyze the prevalence, trend, and factors associated with episiotomy in Rio Grande, in the state of Rio Grande do Sul, Southern Brazil. METHODS A single, standardized questionnaire was applied to all pregnant women, residents in the municipality of Rio Grande, who had children in local hospitals between January 1 and December 12 of the years 2007, 2010, 2013, 2016 e 2019. Demographic and socioeconomic characteristics were investigated, as well as the assistance received during pregnancy and delivery. Chi-square test was used to compare proportions and Poisson regression with robust variance adjustment was used for multivariable analysis. Prevalence ratio (PR) was used as effect measure. RESULTS Among the 12,645 births that occurred in the five years, 5,714 (45.2%) were vaginal delivery. Of these mothers, 2,930 (51.3%; 95%CI: 50.0%–52.6%) underwent episiotomy. Over this period, the episiotomy rate decreased from 70.9% (68.4–73.5) in 2007 to 19.4% (17.1–21.7) in 2019. Adjusted analysis showed a high PR of episiotomy occurrence among women who were young (PR = 2.23; 95%CI: 1.89–2.63), had higher education (PR = 1.21; 95%Cl: 1.03–1.42), had a higher family income (PR = 1.25; 95%CI: 1.10–1.41), were primiparous (PR = 3.41; 95%CI: 2.95–3.95), had prenatal care in the private sector (PR = 1.25; 95%CI: 1.07–1.46), had oxytocin-induced labor (PR = 1.18; 95%CI:1.09–1.27), underwent forceps (PR = 1.32; 95%CI: 1.16–1.50), and whose newborn weighed 4,000 g or more (PR = 1.43; 95%CI: 1.14–1.80). CONCLUSION Although the prevalence of episiotomy fell sharply within the studied period, its occurrence is more likely among women at lower risk of birth complications

Fatores associados à utilização de serviços ambulatoriais: estudo de base populacional

OBJECTIVE: To identify factors that lead people to visit a doctor in Brazil and assess differences between socioeconomic groups. METHODS: A cross-sectional study comprising 1,260 subjects aged 15 or more was carried out in southern Brazil. Demographic, socioeconomic, health needs and regular source of care data were analyzed concerning visits to a doctor within two months from the interview. Adjusted prevalence ratios and 95% confidence intervals were calculated using Poisson regression. RESULTS: Adjusted PR showed that women having stressful life events, health insurance, and a regular doctor increased the outcome. A dose-related response was found with self-reported health, and the probability of visiting a doctor increased with health needs. Analysis in the chronic disease group revealed that uneducated lower income subjects had a 62% reduction in the chance of visiting a doctor compared to uneducated higher income ones. However, as it was seen a significant interaction between income and education, years of schooling increased utilization in this group. CONCLUSIONS: Results suggest the existence of health inequity in the poorest group that could be overcome with education. Specific measures reinforcing the importance of having a regular doctor may also improve access in the underserved group.OBJETIVO: Identificar os fatores que levam uma pessoa a consultar o médico no Brasil e avaliar as diferenças entre grupos socioeconômicos. MÉTODOS: Foi realizado um estudo transversal com 1.260 pessoas de 15 anos ou mais no sul do Brasil. Foram analisados dados demográficos, socioeconômicos, de necessidade em saúde e de fonte definida para consulta quanto a visita ao médico nos últimos dois meses. Foram calculadas as razões ajustadas de prevalência (RP) e os Intervalos de Confiança de 95% (IC 95%), utilizando a regressão de Poisson. RESULTADOS: As RP ajustadas mostraram que mulher, eventos estressantes, seguro de saúde e médico de referência aumentaram a probabilidade do desfecho. Foi encontrada uma relação de tipo dose-resposta com auto-avaliação do estado de saúde, e a probabilidade de consultar aumentou a medida que a necessidade em saúde também aumentou. A análise no grupo com doença crônica evidenciou que o grupo de menor renda e sem escolaridade teve uma redução de 62% na probabilidade de visitar o médico em comparação com o grupo de maior renda e sem estudo. Contudo, como ocorreu interação significativa entre renda e educação, o tempo de estudo melhorou a utilização nesse grupo. CONCLUSÕES: Os resultados sugerem a existência de iniqüidade no grupo mais pobre que pode ser modificada pela educação. Medidas específicas reforçando a importância de ter um médico de referência podem também melhorar o acesso dos mais pobres

Fatores de risco para cesárea segundo tipo de serviço

OBJETIVO: Analizar la tasa de cesárea y factores asociados a su ocurrencia según servicio de salud utilizado, público o privado. MÉTODOS: fue realizado estudio transversal entre 1? de enero y 31 de diciembre de 2007 con todas las gestantes que dieron a luz en los hospitales de la ciudad de Rio Grande, Sur de Brasil. Las gestantes fueron entrevistadas, utilizándose un cuestionario testado y pre-codificado con preguntas sociodemográficas, obstétricas y relacionadas al recién nacido. Fueron desarrollados dos modelos de predicción, uno para las gestantes internadas por el Sistema Único de Salud (público) y otro para las gestantes internadas en servicios privados. En cada modelo fue realizado un análisis multivariado utilizando la regresión de Poisson, calculándose las razones de prevalencia y sus respectivos intervalos con 95% de confianza. RESULTADOS: La tasa de cesárea para el grupo público fue 43% mientras que en el grupo privado fue 86%. Los factores sociodemográficos y el parto gemelar fueron más importantes en el modelo público, así como el número de embarazos (reducción de 25% vs. 13% en el grupo privado) y cesárea previa (incremento de 86% vs. 24% en el privado). Consultas de prenatal e internaciones afectaron el resultado solamente en el grupo público. CONCLUSIONES: Las tasas de cesárea fueron elevadas en los dos grupos, siendo el doble en el servicio privado. Los factores de riesgo son diferentes en magnitud, según el tipo de gestante.OBJECTIVE: To analyze the rate of cesarean section and differences in risk factors by category of health service, either public or private. METHODS: A cross-sectional study was carried out including all pregnant women in labor admitted to hospitals in the city of Rio Grande, Southern Brazil, between January 1 and December 31, 2007. A pre-coded and pre-tested questionnaire was used to collect on social, demographic, obstetric and newborn care information. Two regression models were constructed: one for public users and the other one for private ones. Poisson regression was used in each model in the multivariate analysis. Prevalence rates and 95% confidence intervals were calculated for each adjusted factor. RESULTS: The rate of cesarean section was 43% and 86% among public and private users. Sociodemographic factors and twin births have a more significant impact among public users as well as number of pregnancies (25% vs. 13% reduction in public and private users, respectively) and previous cesarean section (86% vs. 24% increase in public and private users, respectively). Prenatal care visits and hospital admissions affected the outcome only in women users of public services. CONCLUSIONS: Cesarean section rates were high in both groups studied, but it was twice as high among women cared in the private sector. Associated factors differ in magnitude by category of service used.OBJETIVO: Analisar a taxa de cesárea e fatores associados à sua ocorrência segundo serviço de saúde utilizado, público ou privado. MÉTODOS: Foi realizado estudo transversal entre 1º de janeiro e 31 de dezembro de 2007 com todas as gestantes que deram à luz nos hospitais da cidade de Rio Grande, RS. As gestantes foram entrevistadas, utilizando-se um questionário testado e pré-codificado com questões sociodemográficas, obstétricas e relacionadas ao recém-nascido. Foram desenvolvidos dois modelos de predição, um para as gestantes internadas pelo Sistema Único de Saúde (público) e outro para as gestantes internadas em serviços privados. Em cada modelo foi realizada uma análise multivariada utilizando a regressão de Poisson, calculando-se as razões de prevalência e seus respectivos intervalos com 95% de confiança. RESULTADOS: A taxa de cesárea para o grupo público foi 43% enquanto no grupo privado foi 86%. Os fatores sociodemográficos e o parto gemelar foram mais importantes no modelo público, assim como o número gravidezes (redução de 25% vs. 13% no grupo privado) e cesárea prévia (incremento de 86% vs. 24% no privado). Consultas de pré-natal e internações afetaram o desfecho somente no grupo público. CONCLUSÕES: As taxas de cesárea foram elevadas nos dois grupos, sendo o dobro no serviço privado. Os fatores de risco são diferentes em magnitude, segundo o tipo de gestante

Initial stage of cross-cultural adaptation to Portuguese of Brazil of the HIV Knowledge Questionnaire (HIV-K-Q)

Modelo do estudo: Transversal. Objetivo do estudo: Adaptar o HIV Knowledge Questionnaire (HIVK-Q) do inglês para o português do Brasil. Metodologia: A Adaptação Transcultural seguiu os passos metodológicos definidos por Reichenheim e constou das seguintes etapas: equivalência conceitual e de itens, equivalência semântica e equivalência operacional. A validade aparente e a validade de conteúdo foram avaliadas por seis juízes. A validade de conteúdo foi calculada pelo Coeficiente de Validade de Conteúdo de cada item (CVCc) e para o questionário como um todo (CVCt). Foi realizada uma aplicação dialogada por meio de grupos focais com 15 universitários e 15 usuários de centros comunitários. Resultados: Dos 45 itens do instrumento original, quatro apresentaram baixa validade de conteúdo (CVCc<0,80), sendo que dois itens (25 e 31) foram retirados. O CVCt foi 0,82 para clareza da linguagem, 0,93 para pertinência prática e 0,90 para relevância teórica. Para os critérios de amplitude e equilíbrio foram iguais a 0,90. Os itens que apresentaram problemas de compreensão foram devidamente retificados de acordo com as sugestões dos juízes e dos grupos focais. Conclusão: A versão proposta apresenta itens satisfatórios e apropriados para utilizações em avaliações psicométricas futuras, as quais permitirão demonstrar dados sobre a aplicabilidade do questionário para avaliar o conhecimento sobre o HIV/AidsStudy design: cross-sectional. Objective: to adapt the HIV Knowledge Questionnaire (HIV-KQ) from English to Portuguese of Brazil. Methodology: the Cross-Cultural Adaptation followed the methodological steps defined by Reichenheim and consisted of the following steps: conceptual and items equivalence, semantic equivalence and operational equivalence. The apparent validity and content validity was assessed by six judges. The content validity was calculated by Content Validity coefficient for each item (CVCc) and for all questionnaire (CVCt). The dialogued application was carried out by focus groups with 15 college students and 15 users of community centers. Results: Of the 45 items of the original instrument, four present lower content validity (CVCc <0.80), being that two items (25 and 31) were removed. The CVCt was 0.82 to clarity of language, 0.93 to practice relevance and 0.90 theoretical relevance. For amplitude and balance criteria were equal to 0.90. Items that showed understanding problems were corrected according to suggestions of judges and focal groups. Conclusion: The proposed version presents satisfactory items and suitable for use in psychometric assessments in the future, which will demonstrate data about the applicability of the questionnaire to evaluate the knowledge about HIV/AID

Prevalence and associated factors with depression and anxiety in prisoners in South of Brazil

Background: Brazil has the third largest prison population in the world. Research in the world has confirmed a high prevalence of mental disorders in this population. Objective: To identify prevalence and associated factors with depression and anxiety in prisoners of the closed prison system. Methods: This is a cross-sectional study with 643 prisoners were interviewed in six prisons in Rio Grande do Sul, Brazil. To evaluate depression and anxiety, the Mini International Neuropsychiatric Interview 5.0 (MINI) was used and sociodemographic, inprisonment and lifestyle habits variables were also collected. Results: The prevalence of depression found in the study was 20.6% (95% CI: 17.5-23.8) and of anxiety was 19.9% (95% CI: 16.8-23.0). The following were identified as risk factors for depression: being female, having a history of mental illness, non-white skin color, having a religion, not receiving visits, smoking, using drugs and not performing physical activities. Risk factors for anxiety were: being female, having a history of mental illness, a family history of mental illness, smoking and using drugs. Discussion: The study confirmed the high rates of depression and anxiety in the population deprived of liberty. In addition, women were twice as likely to have both disorders compared to men

Pre- and postoperative evaluation of the effect of reconstructive surgery on patient quality of life and self-esteem: a prospective study of 52 patients

Introduction: Benign and malignant skin lesions can affect patients' quality of life and self-esteem; thus, reconstructive plastic surgery is important for these individuals. The objective is to assess the effect of reconstructive plastic surgery on the quality of life (QoL) and self-esteem in patients with benign or malignant skin lesions. Methods: This quasi-experimental "pre-post study" measured QoL using the 36-Item Short Form Health Survey (SF-36) questionnaire. For the measure of self-esteem, the Rosenberg Self-Esteem Scale was used. The changes in scores of both instruments were measured before and after surgery, and the statistical significance of the difference was evaluated using a paired sample t test. The proportion of individuals with an increased QoL score and self-esteem according to sociodemographic variables, lesion or disease characteristics, surgical treatment classification, and stressful events was measured, whereas the statistical significance was assessed using the chi-square test. Results: Fifty-two patients were interviewed. After the surgical intervention, significant improvement in QoL score in most SF-36 domains (emotional, physical, social, pain, general health, and mental health aspects) and improvement in the Rosenberg Self-Esteem Scale score were noted. The factors associated with a higher probability of improvements in QoL and self-esteem after surgery were age =60 years, white skin color, higher education level, occurrence of a stressful event, and malignant neoplasia. Conclusions: Reconstructive surgery positively affected several domains of QoL and self-esteem, showing other improvements in patient health beyond its technical and clinical benefits