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Preval?ncia e fatores associados ? morbidade materna: inqu?rito populacional em Natal/RNRosendo, Tatyana Maria Silva de Souza 05 June 2014 (has links)
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Previous issue date: 2014-06-05 / A morbidade materna grave, tamb?m conhecida como near miss materno, tem sido utilizada como alternativa ao estudo da mortalidade materna, pois al?m de ser mais frequente, compartilha os mesmos determinantes e possibilita a implementa??o da vigil?ncia epidemiol?gica dos casos. Desde ent?o, auditorias em hospitais t?m sido realizadas a fim de determinar as taxas de near miss materno, suas principais causas e seus fatores associados. Mais recentemente, inqu?ritos populacionais a partir da morbidade auto-referida tamb?m t?m sido apresentados como vi?veis na identifica??o desses casos. OBJETIVO: O objetivo deste estudo foi determinar a preval?ncia de near miss materno e de complica??es no per?odo grav?dico-puerperal no munic?pio de Natal/RN e estudar seus fatores associados. M?TODO: Trata-se de um estudo seccional, de base populacional realizado no munic?pio de Natal/RN, Brasil, que tem como popula??o-alvo as mulheres de 15 a 49 anos que engravidaram nos ?ltimos cinco anos. Realizou-se um processo de amostragem probabil?stico com desenho de amostras complexas, no qual foram sorteados 60 setores censit?rios distribu?dos em tr?s estratos (norte, sul-leste e oeste). Em seguida sortearam-se os domic?lios que deveriam ser inclu?dos na pesquisa a fim de obter uma amostra de 1.135 mulheres eleg?veis nas quais foi aplicado um question?rio. Nas an?lises descritivas e de associa??es bivariadas aplicando o teste Qui-quadrado, calculando a Raz?o de Preval?ncia (RP) com intervalo de confian?a de 95% e considerando os pesos e efeitos do delineamento. A an?lise de regress?o de Poisson, tamb?m com signific?ncia de 5% e IC de 95%, foi utilizada para as an?lises dos fatores associados RESULTADOS: Foram entrevistadas 848 mulheres das 1.132 mulheres eleg?veis identificadas em 8.227 domic?lios percorridos, totalizando uma taxa de n?o-resposta de 7%. A preval?ncia de near miss materno foi de 41/1.000NV, sendo a interna??o em UTI (19/1.000NV) o marcador mais referido. A preval?ncia de complica??es no per?odo grav?dico puerperal foi de 21,2%, sendo a hemorragia (10,7%) e a infec??o urin?ria (10,7%) as condi??es cl?nicas mais relatadas e a perman?ncia no hospital por mais de uma semana ap?s o parto a interven??o mais frequente (5,4%). Quanto aos fatores associados, a an?lise bivariada mostrou associa??o entre o maior n?mero de complica??es nas mulheres da ra?a preta/parda (RP=1,23; IC95%=1,04-1,46) e com pior situa??o socioecon?mica (RP=1,33; IC95%=1,12-1,58), nas mulheres que fizeram o pr?-natal no servi?o p?blico (RP=1,42; IC95%=1,16-1,72), que n?o foram orientadas durante o pr?-natal sobre lugar onde deveriam fazer o parto (RP=1,24; IC95%=1,05-1,46), que fizeram o parto no servi?o p?blico (RP=1,63; IC95%=1,30-2,03), que percorreram mais de um hospital para realizar o parto (RP=1,22; IC95%=1,03-1,45) e que n?o tiveram acompanhante durante o parto (RP=1,19; IC95%=1,01-1,41) ou em todos os momentos da assist?ncia ao parto - antes, durante e depois do parto - (RP=1,25; IC95%=1,05-1,48). Al?m disso, o n?mero de dias de interna??o p?s-parto foi maior nas mulheres que tiveram mais complica??es (RP=1,59; IC95%=1,36-1,86). No modelo final da regress?o tanto o local do parto (RP=1,21; IC95%=1,02-1,44) como a condi??o socioecon?mica (RP=1,54; IC95%=1,25-1,90) mantiveram a associa??o. CONSIDERA??ES FINAIS: A realiza??o de inqu?ritos populacionais utilizando a defini??o pragm?tica de near miss ? fact?vel e pode acrescentar informa??es importantes sobre esse evento. Foi poss?vel perceber a express?o das iniquidades em sa?de relacionadas ? sa?de materna tanto na an?lise das condi??es socioecon?micas como na quest?o da utiliza??o dos servi?os de sa?de. / INTRODUCTION:
Severe maternal morbidity
, also known as maternal
near miss
, has
been used as an alternative to
the
study of maternal mortality
,
since
being more frequent
shares the same determinants and enables the implementati
on of epidem
iological
surveillance of cases
. Since then,
hospital
audits ha
ve
been carried out to determine the
rates of maternal near miss, its mai
n causes and associated factors
.
More recently,
population surveys
based on
self
-
reported morbidity have als
o been presented as vi
able in
identifying these cases
.
OBJECTIVE:
The aim of this study was to determine the
prevalence
and associated factors
of maternal
near miss
and complications during
pregnancy and puerperal period in Natal/RN.
METHODS:
A
cross
-
secti
onal
population
-
based study was
conducted in Natal
/RN
, Brazil, which has as its target population women
aged 15 to 49 years who
were
pregnant in the last five years.
It was carried out a
probabilistic sam
pling design
based on a multi
-
stage complex sample
,
in which 60 census
tracts
were selected
from
three strata (north
,
south
-
east
and
west).
Afterwards, domiciles
were visited
in order to obtain a sample of the
908
eligible women in whom a
questionnaire was applied.
The
descriptive analyzes and bivariate ass
ociations
were
performed using the
Chi
-
square test
and the estimate of
the prevalence ratio (PR
) with
95%
confidence interval
(CI)
and considering
the weights and design effects
.
The Poisson
regression analysis
, also with 5% significance and 95% CI,
was us
ed for analyzes of
associated
factors.
RESULTS:
848 women
were
identified
and interviewed after
visits in
8.227 households
corresponding to a response
rate of
93
.
4
%. The prevalence
of maternal
near miss was 41
.
1
/1
000NV,
being
the
Intensive Care Unity stay
i
ng (19
.
1
/1
000
LB
)
and
eclampsia (13
.
5/1000LB)
the most important
marker
s
. The prevalence of complications in
the puerperal peri
od was 21
.
2
%, and hemorrhage (10
.
7%) and urinary tract infection
(10
.
7%) the most frequently reported clinical conditions and rema
in
ing
in the hospital for
over a week after delivery the mo
st frequent intervention (5.4%)
.
Regarding associated
factors
, the bivariate analysis showed an association between the increased number of
complications in
women of black/brown race
(
PR=
1
.
23; CI95
%
:
1
.
04
-
1
.
46) and lower
socioeconomic status (
PR=
1
.
33; CI95%: 1
.
12
-
1
.
58) in women who had
pre
natal care in
public service (
PR=
1
.
42; CI95%: 1
.
16 to 1
.
72
)
and that
were not
advised
during prenatal
about where
they
should do the d
elivery (PR=
1
.
24; CI95%: 1
.
05
-
1
.
46), made
the del
ivery
in the public service (PR=
1
.
63; CI95%: 1
.
30
-
2
.
03),
had to search for
more than one
hospital for delivery (PR=1
.
22; CI95%:
1
.
03
-
1
.
45) and had no companion during
childbirth (
PR
=1
.
19; CI95%: 1
.
01
-
1
.
41) or at all times of childbirth c
are
-
before, during
and after childbirth
-
(
PR=
1
.
25, CI95%: 1
.
05
-
1
.
48)
. Moreover, the number of days
postpartum hospitalization was higher in women who had more complications (P
R=
1
.
59
;
CI95%:
1
.
36
-
1
.
86).
In the final regression model
for
both birth
place
(P
R=
1
.
21
;
CI 95%
:
1
.
02 to 1
.
44
) and socioeconomic status (PR
=
1.54
;
CI95%: 1
.
25
-
1
.
90
) the association
remained.
CONCLUSION
:
Conducting population surveys using the pragmatic definition
of near miss is feasible and may add importa
nt information about this ev
ent
. It was
possible to
find
the expression of health inequalities related to maternal health
in the
analysis of
both socioeconomic conditions
and
on the utilization of health services.
|
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Insufici?ncia card?aca, sa?de autorreferida e pr?tica de exerc?cio f?sico no Brasil: estudo de preval?ncia com dados da Pesquisa Nacional de Sa?de, 2013Nogueira, Ivan Daniel Bezerra 01 September 2017 (has links)
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Previous issue date: 2017-09-01 / Introdu??o: A insufici?ncia card?aca (IC) ? um dos mais importantes desafios cl?nicos atuais na ?rea da sa?de mundial, com perfil epid?mico em progress?o. Nesse sentido, a sa?de autorreferida (SAR), bem como o exerc?cio f?sico (EF), t?m sido utilizados como medidas de monitora??o do estado de sa?de e tratamento dessa enfermidade, respectivamente. A SAR ? um preditor de morbimortalidade e para an?lise ? categorizada em sa?de autorreferida boa (SAR B) e prec?ria (SAR P). Por outro lado, o EF surgiu como um dos pilares no manejo da IC, mas apesar das elevadas evid?ncias sobre seus benef?cios, a ader?ncia a essa pr?tica estima-se que ? baixa no Brasil. Objetivo: Estimar a preval?ncia de IC e associa??o com SAR e pr?tica de EF no Brasil. M?todos: Estudo transversal que utilizou dados da Pesquisa Nacional de Sa?de (PNS) realizada em 2013, com dados v?lidos para 59.655 adultos (? 18 anos). A preval?ncia de IC, avaliada pela pergunta ?Algum m?dico j? lhe deu o diagn?stico de IC??, relacionou-se ?s caracter?sticas sociodemogr?ficas, percep??o do estado de sa?de (SAR, percep??es de sa?de f?sica e mental), diagn?stico de depress?o, pr?tica de EF e as barreiras ao EF. Foram realizadas as an?lises descritiva, bivariada e multivariada. O modelo final da associa??o entre IC e SAR P foi testado pela regress?o de Poisson com vari?ncia robusta. Para a pr?tica de EF utilizou-se o comando svy, a fim de considerar os pesos amostrais e expandir os resultados para a popula??o brasileira. Resultados: O diagn?stico de IC foi referido por 1,1% dos entrevistados. Observou-se que ter o diagn?stico m?dico de IC aumenta em quatro vezes a chance de ter pior percep??o de sa?de (OR = 4,17; IC95% 3,65?4,76), contudo essa medida reduz para menos da metade, quando ajustado por faixa et?ria e percep??o da sa?de f?sica (OR = 1,78; IC95% 1,52?2,08). Os indiv?duos com IC tiveram mais de 80% de chance de n?o praticar EF nos ?ltimos 3 meses. Os aposentados praticaram mais EF que os n?o aposentados (2,77 %; IC95% 1,51?4,04). Quanto ? participa??o dos indiv?duos com IC em um programa p?blico de EF, a preval?ncia dos que n?o participaram foi 15% maior em rela??o aos indiv?duos que participaram desse programa. Observou-se que a principal barreira foi a de sa?de/incapacidade, seguida da barreira f?sica e posteriormente, da barreira comportamental. Conclus?o: A associa??o entre IC e SAR P revela a forma como essa doen?a influencia a qualidade de vida dos brasileiros com tal mol?stia. Destaca-se a baixa preval?ncia da pr?tica de EF e, dentre os que praticaram, os aposentados s?o a maioria. Observou-se que a principal barreira neste estudo foi a de problemas de sa?de/incapacidade. / Background: Heart failure (HF) is one of the most important current clinical challenges in the area of global health, with epidemic profile in progress. In this sense, self-rated health (SRH), as well as physical exercise (PE), have been used as measures of health monitoring and treatment of this disease, respectively. SRH is a predictor of morbidity and mortality and to analysis is categorized into good self-rated health (SRH G) and poor (SRH P). On the other hand, PE emerged as one of the pillars in the handling of the HF, but despite the high evidence on their benefits, the adherence to this practice estimated that is low in Brazil. Objective: To estimate the prevalence of HF and association with SRH and PE practice in Brazil. Methods: Cross-sectional study that used data from the National Health Survey (NHS) held in 2013, with valid data to 59,655 adults (? 18 years). The prevalence of HF, assessed by question "Some doctor gave you the diagnosis of HF?", related to sociodemographics, health perception (SRH, perceptions of physical and mental health), diagnosis of depression, practice of PE and PE barriers. Descriptive analyses were performed, bivariate and multivariate. The final model of the association between HF and SRH P was tested by Poisson regression with robust variance. For PE svy command was used, in order to consider the sample weights and expand the results for the brazilian population. Results: The diagnosis of HF was referenced by 1.1% of respondents. It was observed that having the medical diagnosis of HF increases by four times the chance of having worse perception of health (OR = 4.17; 95%CI 3.65?4.76), however this measure reduces to less than half, when adjusted for age and perception of physical health (OR = 1.78; 95%CI 1.52?2.08). Individuals with HF have had over 80% chance of not practicing PE in the last 3 months. Retirees have done more PE than non-retirees (2.77%; 95%CI 1.51?4.04). On the participation of individuals with HF in a public program of PE, the prevalence of which did not participate in was 15% higher in relation to individuals who participated in this program. It was observed that the main barrier to health/disability, followed by the physical barrier and the behavioral barrier.
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