Orientadores: Andre Moreno Morcillo, Maria de Lurdes Zanolli / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-07T09:03:05Z (GMT). No. of bitstreams: 1 Carniel_EmiliadeFaria_M.pdf: 3329761 bytes, checksum: 2b3ef9dd422095dee80229098a1ab317 (MD5) Previous issue date: 2006 / Resumo: Os Sistemas de Informação em Saúde são fundamentais para o conhecimento da situação de saúde da população e o direcionamento das políticas de saúde. O Sistema de Informações sobre Nascidos Vivos (SINASC) do Ministério da Saúde, cujo instrumento de coleta de dados é a Declaração de Nascido Vivo (DNV), foi implantado com o intuito de obter informações para subsidiar propostas para o grupo materno-infantil. Por meio de estudo transversal, que analisou 14.444 DNVs de Campinas (SP) em 2001, estudou-se a viabilidade da utilização dos dados do SINASC para descrever o perfil de mães e recém-nascidos (RNs) e determinar fatores de risco para baixo peso de nascimento (BPN), parto cesáreo e gravidez na adolescência. Este perfil foi identificado por: local de ocorrência do parto, características sociodemográficas maternas, gestacionais, do parto e dos RNs. Os fatores de risco foram determinados pela correlação entre as variáveis, utilizando análise de regressão logística. A proporção de captação do SINASC foi de 99,1%, e as DNVs foram preenchidas em quase 100% dos itens. A maioria dos nascimentos ocorreu em hospitais, sendo o maior percentual de filhos de moradoras das áreas dos Distritos de Saúde (DS) Noroeste e Sudoeste (com baixas condições de vida), onde ocorreram os piores resultados. O percentual de mães adolescentes foi de 17,8%; a maior concentração de nascimentos foi para mulheres com 20 a 34 anos; 60,6% não trabalhavam fora, 35,9% não tinham companheiro, 37,8% tinham até sete anos de escolaridade e 47,1%, de oito a onze anos. A paridade foi variável, sendo a maior ocorrência entre mulheres sem filhos ou com um; 99,6% compareceram pelo menos uma vez ao pré-natal; 74,4% realizaram mais de seis consultas. Associou-se à gravidez na adolescência: morar em DS com baixas condições de vida, não ter ocupação ou companheiro. As adolescentes grávidas apresentaram risco de pré-natal inadequado. A maioria das gestações foram únicas, a termo, com RNs masculinos, brancos, com pequena proporção de hipóxia e com 1,0% de anomalias. O percentual de prematuridade foi de 7,1%. Houve alta incidência de cesarianas, sendo maior o risco nas gestações duplas e nos partos prematuros e para mulheres com companheiro, as maiores de 20 anos, as com melhor escolaridade, as trabalhadoras fora do lar, as moradoras em DS com melhores condições, as com mais consultas, as primíparas, com um ou dois filhos. A média de peso ao nascer foi 3.142g; 25,7% dos RNs nasceram com peso insuficiente e 9,1% com baixo peso. Associou-se ao BPN: prematuridade, baixa escolaridade materna, menos de sete consultas e RNs femininos. A configuração da DNV não permitiu identificar partos da rede pública ou da rede privada e incluir adequadamente as mulheres em união consensual. Os agrupamentos do número de consultas de pré-natal não estão de acordo com o parâmetro do Ministério da Saúde. Este estudo mostrou que há viabilidade da utilização dos dados do SINASC para o planejamento de ações de saúde. Além disso, a distribuição dos resultados, pelos diferentes DS, mostrou que o perfil do grupo materno-infantil não é homogêneo na cidade / Abstract: Health Information Systems are fundamental to the knowledge of health status of the population and to manage health policies. The Information System on Live Births (SINASC) was developed by the Brazilian Health Ministry and designed to improve quality of information on newborns and on pregnant women, in order to support health proposals to infant-maternal group. This system has been implemented since 1990 and Live Birth Certificate (LBC) is the document to collect data. Throughout a cross-sectional study 14,444 LBC from the city of Campinas, SP, in 2001, were analysed in order to determine SINASC's viability. Mothers' and newborns' profiles were described and risk factors for low birth weight (LBW), caesarean-sections and pregnancy in adolescence were showed. The profiles were described according to mothers¿ social-demographic characteristics and those related to their pregnancies and to the newborns. The assessment of the association among variables was performed through logistic regression. The study showed excellent coverage of the SINASC (99.1%) and almost 100% of the variables were filled. Most of the births occured in health services of the city and the higher proportion was of babies from women who lived in Health District (HD) Northwest and Southwest (in low conditions of life), where the worst results occured. The percentage of adolescent mothers were 17.8%; the highest proportion of births was among women between 20 and 34 years old; 60.6% of all mothers didn't have jobs, 35.9% were single; 37.8% studied until seven years and 47.1% studied for about eight and eleven years. The number of children were variable, but the higher concentration was on women with no children or just one. Almost all women at least had one prenatal care appointment; 74.4% had more than six medical visits. Pregnancy in adolescence was associated with women living in low conditions of life, without husbands or incomes and who had inadequate prenatal care. Most of the gestations were single and the babies were mature, most of them were male, white, born with a low proportion of hipoxia and 1% of them showed malformations. The percentage of premature babies were 7.1%. The incidence of caesarean-sections was very high (54.9%) and the risk factors for them were: twin gestations, premature birth and women with husbands, having better education level, with jobs, living in good places, having more prenatal care visits, with no children and with one or two. The average birth weight was 3,142g; 25.7% of the babies were born weighing between 2,500g and 2,999g and 9.1% of them weighing less than 2,500g. The risk factors for LBW were: premature birth, low educational level, less than seven prenatal care visits and female baby. This study showed the viability of SINASC to help plan health activities for the infant maternal group. Furthermore, the results in different HD, showed that the mothers¿ and newborns¿ characteristics are different in the city / Mestrado / Saude da Criança e do Adolescente / Mestre em Saude da Criança e do Adolescente

Background: In Sweden, annually, approximately 1,5% out of 115 000 newborns are twins. Itis widely documented that multiple gestation pregnancy contributes to an increased risk of maternal morbidity. Nevertheless, the direct impact of multiple gestation on some maternal complications remains debated. The expected difference in maternal characteristics between populations may also contribute to divergent conclusions. Objective: The aim of this study is to assess the risk of maternal complications and the occurrence of different mode of delivery during pregnancy and childbirth in nulliparous women with multiple gestation. Study design: A population-based cohort study based on data from the Swedish Medical Birth Register between 1999 and 2017.Results: In total 13 014 nulliparous women with multiple gestation and 850 021 nulliparous women with single gestation were included in the study. Women with multiple gestation were slightly older and more often gave birth prematurely than single gestation counterparts. Pregnancy through IVF were almost five times as common in the multiple gestation group. These women suffered a four times increased risk of both preeclampsia and severe forms of preeclampsia. Multiple gestation in nulliparous women was, in this cohort, associated with nearly six times elevated risk of developing ICP, relative to single gestation counterparts. Intrapartal bleeding and post-partum hemorrhage were also more common in women with multiple gestation. The majority of the nulliparous women with multiple gestation had a caesarean section, elective or acute, while nulliparous women with single gestation more often delivered vaginally. An increased risk for placenta previa and GDM, as a consequence of multiple gestation, could, however, not be observed in this study. Conclusion: Multiple gestation is associated with increased risk of several obstetric complications. It is important that healthcare professionals become fully aware of these risks in the encounter with the woman in order to be able convey appropriate information and take appropriate preventive measures. Continued work to reduce multiple gestation caused by IVF is also recommended. / Bakgrund: I Sverige föds ca 115 000 barn årligen och av dessa är knappt 1,5% tvillingar. Flerbördsgraviditet innebär ökad risk för maternell morbiditet, men forskningen går isär gällande flerbörds inverkan på somliga komplikationer. Dessutom kan variationer i maternella karakteristika skilja sig åt mellan populationer. Syfte: Syftet med denna uppsats är att studera risken för maternella komplikationer samt förekomst av olika förlossningssätt under graviditet och förlossning vid flerbörd hos förstföderskor. Metod: En populationsbaserad kohortstudie utifrån data från Medicinska födelseregistret mellan åren 1999–2017.Resultat: Totalt ingick 13 014 förstföderskor gravida med flerbörd i studien och 850 021enkelbörd. Flerbördsgruppen var något äldre än de i enkelbördsgruppen och de födde oftare prematurt. Graviditet genom IVF var nästan fem gånger så vanligt i flerbördsgruppen. Preeklampsi och svår preeklampsi var fyra gånger så stor i flerbördsgruppen och risken för ICP var nästan sex gånger så stor. Även intrapartal blödning och PPH var betydligt vanligare hos kvinnorna i flerbördsgruppen. Majoriteten av personerna i flerbördsgruppen förlöstes medkejsarsnitt, planerat eller akut, medan förstföderskorna i enkelbördsgruppen i större utsträckning födde vaginalt. Ökad risk för placenta praevia och GDM kunde ej observeras. Slutsats: Att vänta flerbörd är förenat med en ökad risk för flera obstetriska komplikationer. Denna risk är viktigt att vårdpersonal är medvetna om i mötet med kvinnan för att kunna informera, förebygga och behandla. Även ett fortsatt arbete att minska flerbörd som uppkommit genom IVF rekommenderas.

No description available.

De två viktigaste händelserna i varje man jordliv är födelse och död. Varje av dessa händelser händer en gång i en livtid. Varje individ kommer in i världen på en bestämd tid på en särskild dag. På samma sätt lämnar varje person denna värld på en särskild dag på en bestämd tid. Växelverkan av dessa två viktiga händelser definierar, till en stor grad, totalityen av den globala befolkningen på någon given tidsperiod. Huruvida det finns befolkningboom/explosionen, eller kollapsen i världen beror i sin helhet på dessa två naturliga källor. Några demographers, klassificerar emellertid flyttning (dvs. emigration och invandring eller inflyttning och ut-flyttning) som delen av källorna av befolkningtillväxt.Antecknar dessa händelser, som och, när de uppstår, inte för gyckel eller en avsluta till honom, men ganska som hjälpmedel till en avsluta. Befolkningen påverkar varje aspekt av människoliv, namely: ekonomiskt, politiskt, lagligt, socialt, kulturellt, miljö-, vård-, Etc. Det är för dessa, och annat lika viktigt resonerar att folk av vision liksom John Graunt (1620-1674); Thomas Malthus (1766-1834); Herrn James Steuart (1713-1780); William Godwin (1756-1836); och något liknande sökte, i de tidig sortdagar, att ge erkännande till befolkningen utfärdar. Detta upprättar faktumet att, även om de formella sätter in av demography, är en förhållandevis ny innovation, folk long har angå om storleksanpassa och kännetecknen av deras territoriella befolkningar för mycket en lång tid. Trots dess jättelika betydelse, verkar som om det lite tid och resurser kanaliseras in i befolkningledning i samtidaa tider.I Ghana som i många ett u-land mycket lite uppmärksamhet har givits sätta in av på varandra följande regeringar. Denna low-profile inställning in mot befolkning utfärdar, över åren, har motsatt påverkats landets samhällsekonomiska och politiska framsteg. Jag kan inte vara för fel att förutsätta att riktig utveckling har undsluppit mest afrikanska länder och framkallningsvärlden på stort främst, därför att sammanlagt av dessa länder riktig uppmärksamhet inte har varit fallen föra befolkningmaterier. Är det inte riktigt att brist av den riktiga metoden och resurser är det huvudsakligt orsakar av ledare seemingly care-free inställning in mot befolkning utfärdar i dessa ett u-land i förflutnan? Även om det kan verka, att många bevattnar, har passerat under överbrygga, och, att, saker verkar för att ha stupat apart (Chinua Achibe) där är alltid ett fönster av flykten, när alla dörrar är stängda.Informations- och kommunikationsteknologier (ICTs) är den nya utvecklingen av fönster och flyktruttar ut ur många hitherto oöverstigliga problem. Därför i detta te, skulle jag något liknande för att undersöka och undersöka hur ICTs och det berömda nya/sociala massmedia kan hjälpa att lätta problemet av non-registreringen eller den otillräckliga registreringen av livsviktiga händelser i Ghana. / THE two most important events in every man’s Earth life are birth and death. Each of these events happens once in a life time. Every individual comes into the world at a certain time on one particular day. In the same way, every person leaves this world on one particular day at a certain time. The interaction of these two important events define, to a large extent, the totality of global population at any given time period. Whether there is population boom/ explosion or collapse in the world as a whole depends on these two natural sources. Some demographers, however, classify migration (i.e. emigration and immigration or in-migration and out-migration) as part of the sources of population growth.Recording these events as and when they occur is not for fun or an end to itself, but rather as a means to an end. Population affects every aspect of human life, namely: economic, political, legal, social, cultural, environmental, health, etc. It is for these and other equally important reasons that people of vision such as John Graunt (1620-1674); Thomas Malthus (1766-1834); Sir James Steuart (1713-1780); William Godwin (1756-1836); and the like sought, in those early days, to give recognition to population issues. This establishes the fact that although the formal field of demography is a relatively recent innovation, people have long been concerned about the size and characteristics of their territorial populations for a very long time. In spite of its enormous importance, it appears that little time and resources are channeled into population management in contemporary times.In Ghana, as in many developing countries, very little attention has been given the field by successive governments. This low-profile attitude towards population issues has, over the years, adversely affected the country’s socio-economic and political progress. I may not be too wrong to postulate that true development has eluded most African countries and the developing world at large mainly because in all of these countries proper attention has not been given to population matters. Is it not true that lack of proper method and resources are the main causes of leaders’ seemingly care-free attitude towards population issues in these developing countries in the past? Even though it may seem that many waters have passed under the bridge and that, things seem to have fallen apart (Chinua Achibe) there is always a window of escape when all doors are closed.Information and Communication Technologies (ICTs) are the new generation of windows and escape routes out of many hitherto insurmountable problems. Therefore, in this thesis, I would like to explore and examine how ICTs and the famous new/social media may help alleviate the problem of non-registration or inadequate registration of vital events in Ghana.

The study attempted to identify factors influencing women’s preference for home births in the Mutare District, Zimbabwe. A quantitative, descriptive, exploratory, cross sectional survey, gathering data by conducting structured interviews with 150 women, was used. All 150 women attended antenatal clinics but did not deliver their babies at health care facilities. The research results indicated that home deliveries might decline if: • the hospital/clinic fees were reduced or removed • transport would be available for women in labour to reach hospitals/clinics • shelters were built for pregnant women at hospitals/clinics • clinics were well equipped and had sufficient numbers of midwives • women had received more effective health education on the advantages of institutional deliveries and on the danger signs of pregnancy/labour complications • nurses/midwives would treat patients respectfully. Unless these factors are addressed, the number of home deliveries might not decline, and the high maternal/infant mortality and morbidity rates in this district will persist. / Health Studies / M. Public Health

This study represents an attempt to describe the extent and features of safe haven legislation in the United States, discuss implementation issues, and to examine if the legislation is reaching its intended target audience in order to answer the question, "Is safe haven legislation an efficacious response to infant abandonment?" Safe havens are designated locations where infants can be anonymously abandoned without fear of prosecution or incarceration. As of May of 2006, forty-seven states have passed such legislation, citing the need for an alternative to unsafe infant abandonment leading to an infant's death, and an alternative to infanticide (the killing of an infant within one year of its birth). Since the initial passage of this legislation in Texas in 1999, there have been more unsafe infant abandonments than accounts of safe haven abandonments. As this legislation provides for anonymous infant abandonment researchers cannot study the population of women actually utilizing safe havens. Therefore, the study of women seeking connection with safe havens in comparison to the population of women who have engaged in infant abandonment resulting in an infant's death is considered one of the sole viable sources of insight into this problem. The scope of the research is exploratory in nature and analyses are considered preliminary due to the lack of data that exists in this area and the relative newness of the legislation.A quantitative analysis of women likely to utilize safe havens reveals that they have a mean age of 19, are unmarried, have entered into prenatal care late, have disclosed their pregnancy to someone, and are currently dating the birthfather. The findings from this analysis were compared to those from a national linked birth and infant death dataset to ascertain if women seeking safe havens have similar biopsychosocial characteristics as those engaging in unsafe abandonment leading to an infant's death. Similar biopsychosocial characteristics were found including mother's age, marital status, late entry into prenatal care, disclosure of pregnancy, and dating status. A regression analysis was used to construct a biopsychosocial profile of women likely to abandon an infant. Findings suggest that legislators and those involved with safe havens have some knowledge of their target population, but are not effectively reaching this audience, nor promoting the existence of safe havens. They also appear to be utilizing research findings on infanticide inappropriately, in order to profile their target audience. This effectively limits the promulgation of education and early identification services that could prevent both safe haven and unsafe infant abandonments. This study concludes with policy reform recommendations.

This study examines the production and the introduction of a fertility treatment which gained great attention both in Sweden and internationally during the 1960s. In the procedure, hormones were extracted from human pituitary glands which had been collected from autopsies. After this, the hormones were purified and injected into the female patients as a treatment for certain kinds of sterility. Carl Gemzell, professor of obstetrics and gynecology at Uppsala University, was a key figure in the development of the treatment. He was described by the media as a medical pioneer and later became one of Sweden’s most famous doctors and scientists. The fertility treatment also gained a lot of attention in the media as ”the miracle drug that made barren women pregnant”, especially since it often resulted in multiple pregnancies. In the 1960s, pregnancies with quadruplets, quintuplets, sextuplets and even septuplets became world sensations. By using the sociology of expectations as theoretical approach, which focuses on the performativity of expectations and visions in science production, this study aims to investigate how expectations of an effective fertility method were articulated in both the scientific sphere and in the media. This of course also relates to how the risks of the multiple pregnancies were dealt with. The analysis is divided into three chapters, where the first chapter examines the politics of science in Sweden during the post-war period and how Gemzell’s work in Uppsala generated expectations of a scientific milieu on the front line of fertility research. The next chapter is focused on the media’s interest in Gemzell and how he became a celebrity. A central argument for the study is that his public status helped to create scientific credibility for the treatment, especially among the public. The final chapter focuses on the media reporting about the multiple pregnancies. They were often treated as sensations, which was somewhat paradoxical as they were hazardous and frequently resulted in the death of the premature children.

本研究旨在探討是否是因女性意識的抬頭，導致台灣生育率下降，還是誠如Peter McDonald(2000)所言，由於婦女運動，導致社會允許女性在教育與就業上擁有等同於男性的機會，其稱之為個人取向制度上的性別平等，但在家庭方面，卻仍是維持男主外、女主內的傳統男性養家者模式思考，認為女性為家庭中的顧老者、護幼者，其稱之為家庭取向制度上的性別不平等，以致於女性要面對家庭照顧與工作壓力的雙重負擔，但這樣的現象並不會對女性的理想子女數造成影響，卻會使實際生育數下降；研究工具為2004年國民健康局「家庭與生育力調查」第九次調查已婚問卷資料，有效樣本數為2,865人。 研究結果發現，擁有較平等的性別角色態度之已婚育齡婦女，的確有較低的理想子女數與實際生育數，但依照描述性統計狀況來看，我國婦女並非不想生育，而是降低了自己的理想子女數與實際生育數；而我國家庭內家務分工不均的狀況，雖不符合研究者假設家務分工平等的女性有較高的實際生育數，但是深入探討發現，我國社會現況確實符合Peter McDonald(2000)所說，因為女性意識覺醒，促使社會處理個人在教育與就業上的制度性別平等，但我國社會家庭制度仍是維持傳統男性養家者模式，要求女性負擔家庭中絕大部分家務工作，欠缺顧老、護幼之協調工作與家庭照顧政策，以至於女性無法負擔工作與家庭衝突，因而降低了自己的生育數。 最後，研究者依研究發現嘗試對政府部門提出相關建議，供未來家庭政策與實務參考。 / The purpose of this study is to know the reason for fertility decline of the married women aged in 20-49 years in Taiwan. Whether it is due to the rise of feminist consciousness, or as the theory Peter McDonald (2000) discussed. Peter McDonald thinks that since women’s movement are springing up, the society allows women to have the same opportunities like men in education and employment. He called it as gender equal in individual-oriented institutions. But in fact, it is still maintaining the traditional male breadwinner model in the family. Female still plays the main role to take care children and elders. He called it as gender inequity in family-oriented institutions. Such institutions lead to fertility decline. The data used for this study were from 2004“the ninth investigation of family and fertility ability in Taiwan ”held by the research Institute of Bureau of health promotion department of health, Taiwan R.O.C. (sample size=2865). The main finding of this study is to prove that the married women in childbearing age, who has more egalitarian gender role attitude, will have lower ideal number of children and the actual number of births. Based on the general statistic condition in Taiwan, the situation are similar to Peter McDonald's thought. But there is something different, the unequal division housework is still within the family, which is not just like the researcher’s assumption: an equal division of housework women have a higher actual number of births. Despite the variable, the reason of fertility decline in Taiwan still confirms Peter McDonald’s theory. The awakening of women’s consciousness accelerate gender equal in individual-oriented and family-oriented institutions. But still, the traditional model asked women to undertake most parts of housework. The deficient in public welfare and family care policy will make female not be able to get the balance between work and family. Such institutions caused fertility decline in Taiwan. Finally, according to the study result, there are several suggestions which can be contributed to future policy and practical advice of family reference for government.

The study attempted to identify factors influencing women’s preference for home births in the Mutare District, Zimbabwe. A quantitative, descriptive, exploratory, cross sectional survey, gathering data by conducting structured interviews with 150 women, was used. All 150 women attended antenatal clinics but did not deliver their babies at health care facilities. The research results indicated that home deliveries might decline if: • the hospital/clinic fees were reduced or removed • transport would be available for women in labour to reach hospitals/clinics • shelters were built for pregnant women at hospitals/clinics • clinics were well equipped and had sufficient numbers of midwives • women had received more effective health education on the advantages of institutional deliveries and on the danger signs of pregnancy/labour complications • nurses/midwives would treat patients respectfully. Unless these factors are addressed, the number of home deliveries might not decline, and the high maternal/infant mortality and morbidity rates in this district will persist. / Health Studies / M. Public Health

O Sistema Único de Saúde (SUS) produz excelentes bases de dados, entre as quais, destacam-se o Sistema de Informação sobre Nascidos Vivos (SINASC) e o Sistema de Informação sobre Mortalidade (SIM). O objetivo desta dissertação é apresentar o VITAIS, uma ferramenta baseada nos aplicativos Access® e Excel® que permite disponibilizar, de forma simplificada, os dados desses sistemas, possibilitando a análise da situação de saúde por parte de gestores, profissionais da saúde, comunidade acadêmica e população em geral. Esta ferramenta permite a geração de relatórios e gráficos automáticos e pré-definidos e faz relacionamentos entre as bases do SIM e do SINASC. Como tal, apresenta vantagens significativas em relação ao tabulador TABWIN. / The Brazilian Health System (SUS) produces excellent data bases such as those for live births (SINASC) and mortality (SIM). The objective of this report is to present VITAIS, a tool based on Access® and Excel® applications that permits presentation of data from these systems in manners facilitating analysis of the health situation of the population of states, municipalities and micro-areas by health managers, health professionals, the academic community and the general population. This tool generates automatic reports and charts, and permits linkage between the SIM and SINASC databases. As such, it presents significant advantages over the TABWIN tabulator.