Fall-related mortality and admission rates increased in Brazil but varied by gender and state of residence. The results of this study do not only monitor the problem over time but may also help plan technological and human resources to prevent and control falls.
Objective:Identifying factors associated to Caesarean sections among the residents of Maringá-PR, according to the financing source for delivery. Methods: A crosssectional study with data from 920 postpartum women interviewed between October 2013 and February 2014. Association analysis was performed by logistic regression. Results: Caesarean section rates were 55.5% in the Unified Healthcare System (SUS) and 93.8% in the private system. Factors associated with Caesarean section in the SUS were: previous Caesarean section (OR=8.9; CI=4.6-16.9), desire for Caesarean section early in pregnancy (OR=2.0; CI=1.1-3.6), pregestational overweight/obesity (OR=1.8; CI=1.1-2.8), and per capita family income higher than one minimum wage (OR=2.1; CI=1.3-3.4). In the private system, desire for Caesarean section early in pregnancy (OR=25.3) and a previous Caesarean section (OR=11.3) were strongly associated to its performance. Conclusion: It is necessary to properly orientate all pregnant women who desire a Caesarean delivery, from both the SUS and the private system, about the inherent risks of the surgical procedure without indication. In the public health sector, guidelines should be focused on pregnant women with previous Caesarean delivery, with a per capita income higher than one minimum wage and those who are overweight or obese, as these women are more likely to have a Caesarean section.
Objective:to investigate differences with regard to foot self-care and lifestyle between men and women with diabetes mellitus.Method: cross-sectional study conducted in a sample of 1,515 individuals with diabetes mellitus aged 40 years old or older. Poisson regression models were used to identity differences in foot self-care deficit and lifestyle between sexes, adjusting for socioeconomic and clinical characteristics, smoking and alcohol consumption.Results: foot self-care deficit, characterized by not regularly drying between toes; not regularly checking feet; walking barefoot; poor hygiene and inappropriately trimmed nails, was significantly higher among men, though men presented a lower prevalence of feet scaling and use of inappropriate shoes when compared to women. With regard to lifestyle, men presented less healthy habits, such as not adhering to a proper diet and taking laboratory exams to check for lipid profile at the frequency recommended. Conclusion: the nursing team should take into account gender differences concerning foot self-care and lifestyle when implementing educational activities and interventions intended to decrease risk factors for foot ulceration.
This cross-sectional study focused on motorcycle couriers (work profile, work conditions, and traffic accidents) IntroduçãoNo Brasil, nos últimos anos, observa-se o crescimento da frota de motocicletas e de sua utilização nos serviços de entrega de mercadorias, o que pode contribuir para o aumento de acidentes envolvendo motociclistas no país 1 . Os motociclistas que realizam entregas de produtos ou prestam pequenos serviços, popularmente conhecidos como motoboys, atendem às necessidades de rapidez e agilidade da sociedade contemporânea de consumo, e sua presença e tendência de crescimento parecem irreversíveis a curto e médio prazo 2 .A crescente utilização da motocicleta como instrumento de trabalho pode ser explicada, talvez, pelo aumento do desemprego observado entre jovens no Brasil na última década. Durante os anos 1990, com a estabilização da inflação e queda do nível de atividade econômica, houve aumento da taxa de desemprego, especialmente entre os trabalhadores mais jovens 3 . Contribuíram ainda para esse quadro as privatizações e inovações tecnológicas e a abertura comercial, resultando no aumento da informalidade e da flexibilização das relações de trabalho 4,5 .Estudos realizados em Londrina e em Maringá, Estado do Paraná, apontam os motociclistas como as principais vítimas de acidentes de trân-sito nos dois municípios. Em Londrina, em 1996, os motociclistas corresponderam a 44,4% das 3.643 vítimas 6 . Outra investigação, no mesmo ARTIGO ARTICLE Silva DW et al.
The objective of this study was to analyze the pattern of health service use of aged patients enrolled with the public health services of Guarapuava, Paraná, Brazil. Home interviews were performed with 359 aged individuals, who were selected using stratified proportional sampling. The interviews were conducted in the period between January and April of 2010 at the homes of the aged participants, using sections I and III of the BOAS (Brazil Old Age Schedule). Association analysis was performed using the χ² test. The health services most used by the aged subjects over the last three months were medical appointments (49.6%) and clinical exams (38.4%). Women used health services more often (p=0.0240); 55.6% of the aged participants reported not seeking dental care. In conclusion, the aged population is a large user of health services and the city's public health network must be organized in view of an increasing demand for therapeutic diagnostic procedures.
OBJETIVO: Analisar a confiabilidade dos diagnósticos registrados nos formulários de autorização de internação hospitalar(AIH). MÉTODO: Foram estudadas 1.595 internações referentes a uma amostra representativa das internações ocorridas nos 8 hospitais gerais do Município de Maringá, PR. Os diagnósticos registrados nos prontuários médicos foram comparados aos registrados nas AIH correspondentes. Foi utilizada a estatística Kappa, com intervalo de confiança de 95%. RESULTADOS: Foram obtidas concordâncias que variaram de k=0,79 (doenças do aparelho geniturinário) a k=0,98 (complicações da gravidez, parto e puerpério) e k=0,79 (fraturas) a k=0,97 (causas obstétricas diretas) para os 5 grupos e agrupamentos da Classificação Internacional de Doenças - 9 (CID9) mais freqüentes, respectivamente. CONCLUSÕES: Alguns fatores como a falta de treinamento para a codificação dos diagnósticos e o sistema de pagamento das internações hospitalares, são apresentados como possíveis razões de discordância. Evidenciou-se a possibilidade de utilização do banco de dados SIH-SUS (Sistema de Internação Hospitalar do Sistema Único de Saúde) para o Município de Maringá, em 1992, com certo grau de confiabilidade segundo grupos de diagnósticos, lembrando que segundo os agrupamentos poderá haver maior variabilidade.
The objective was to analyze the impact of the Brazilian Traffic Code and the Law Against Drinking and Driving on mortality from traffic accidents in the State of Paraná, Brazil, from 1980 to 2014. This was an ecological time series study on mortality from traffic accidents in residents 15 to 49 years of age, stratified by the sex, age, and categories of victims, with data from the Mortality Information System. The time trend study used a segmented linear regression model and the Cochrane-Orcutt iterative procedure. The assumption of independence of residuals was verified by correlograms and the Box-Pierce test. The highest mortality rates during the period were in males 20 to 29 years of age. After enactment of the Brazilian Traffic Code, there was a decrease of 9.69 deaths/100,000 inhabitants per year for all categories of traffic accidents (p < 0.001), 6.90 for pedestrians (p = 0.001), and 1.96 for vehicle occupants (p < 0.001). As for age bracket, the greatest impact on mortality was in pedestrians 15 to 19 years of age (p < 0.001) and all victims 20 to 29 years of age (p < 0.001). Following enactment of the Drinking and Driving Law, the data displayed variability and the trends were not significant. However, there was a decrease in overall and pedestrian mortality. The rates for motorcyclists and vehicle occupants stabilized. The results showed an impact on traffic accident mortality after enactment of the new Brazilian Traffic Code and Drinking and Driving Law, followed by an increase in the rates. The study evidenced the need for more effective enforcement and progress with public policies in order to avoid a reversal of the gains achieved.
We analyzed morbidity and mortality rates due to external causes among elderly persons in a city in the South of Brazil. Data about deaths, from 1979 to 1998, and about hospital admissions, from 1995 to 1998, were obtained from the Mortality Information System and the Hospital Information System of the Brazilian Ministry of Health. Population data were based on the national demographic census. Mortality rates due to external causes decreased 16.2%, but levels increased in advanced ages, especially for women. Falls, pedestrian accidents and other road accidents were the most important external causes of death in this population. In the last three years of this study, mortality rates were higher for pedestrian accidents among men and for falls among women (64.8 and 58.3 per 100.000 inhabitants, respectively). Hospital admissions due to injuries and intoxications decreased in the period. Among the 146 admissions in 1998, 45.9% were due to falls. The community has to recognize that elderly persons are exposed to accidents and that preventive measures are needed.
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