Revista de saude publica最新文献

Objective: To investigate the impact of prenatal care on the reduction of maternal-child mortality in Brazilian municipalities following the new primary health care financing model, the Previne Brasil program.

Methods: This study comprised a nationwide cross-sectional observational analysis, utilizing secondary data from Departamento de Informática do Sistema Único de Saúde (Datasus - Information Technology Department of the Unified Health System), Sistema de Informação sobre Mortalidade (SIM - Mortality Information System), Sistema de Informação sobre Nascidos Vivos (Sinasc - Live Birth Information System), Sistema de Informação em Saúde para a Atenção Básica (Sisab - Primary Health Care Information System), and Instituto Brasileiro de Geografia e Estatística (IBGE - Brazilian Institute of Geography and Statistics). Medians of maternal mortality, infant mortality, and prenatal care rates were calculated for Brazilian municipalities from 2016 to 2022. Logistic regression analyses were conducted to assess associations between independent variables (primary care coverage, population size, Gross Domestic Product, and Gini index) and outcomes (variations in maternal and infant mortality rates). Both crude and adjusted odds ratios were estimated, with a significance level of 5%.

Results: Prenatal care rates increased by 86.7%, while maternal mortality rates decreased by 30.9%, with no association between them. Region, primary care coverage, municipal Gross Domestic Product, and population size were associated with variations in maternal mortality rates. The Southern region had a higher likelihood of reducing maternal mortality. No association was found between increased prenatal care rates and reduced infant mortality. Regional location, primary care coverage, population size, and the Gini index were associated with variations in infant mortality rates, with greater reductions observed in more populous municipalities and in the Northeast, Southeast, and Midwest.

Conclusion: The Previne Brasil program led to an increase in prenatal care consultations in Brazilian municipalities but did not significantly impact the reduction of maternal-child mortality.

Objective: To evaluate the efficacy of auricular acupuncture in reducing insomnia symptoms among individuals with depression compared with non-specific auricular acupuncture, at four weeks, six weeks, and three months after the intervention began.

Methods: A randomized, blinded clinical trial assessed sleep quality using the Pittsburgh Sleep Quality Index in 74 adults equally divided into two groups: specific auricular acupuncture and non-specific auricular acupuncture. Both groups underwent 12 auricular acupuncture sessions performed twice a week.

Results: After three months, the intention-to-treat analysis found no statistically significant difference in achieving good sleep quality between groups (33.3% versus 26.1%, p > 0.05). However, a trend toward statistical significance occurred after 4 weeks, with 50% of participants in the experimental group and 24.1% in the control group achieving good sleep quality (p = 0.057).

Conclusions: We observed no statistically significant difference in sleep quality between individuals with depressive symptoms undergoing specific auricular acupuncture compared with non-specific after three months. However, a significant trend (p = 0.057) confirmed by the per-protocol analysis (p = 0.038) indicated that participants receiving specific auricular acupuncture had a 69% higher chance of achieving good sleep quality after four weeks. These findings should be interpreted with caution, as they did not reach statistical significance; rather, they reflect a trend toward significant improvement and are subject to the study's limitations.

Objective: To estimate the prevalence and co-occurrence profile of obstetric violence among women hospitalized for childbirth in the state of Rio de Janeiro, as well as its distribution according to demographic, socioeconomic, and current pregnancy-related characteristics.

Methods: This is a perinatal cohort study. Data were obtained from the second telephone follow-up of the Nascer no Brasil II Study referring to the state of Rio de Janeiro. Obstetric violence (physical abuse; psychological abuse; neglect; stigma and discrimination; and inappropriate vaginal examinations) was assessed using a culturally adapted version of a World Health Organization-endorsed questionnaire. Prevalence and co-occurrence profile (Venn diagram) of the types of obstetric violence were estimated.

Results: The overall prevalence of obstetric violence was 65.3%. The most prevalent types were inappropriate vaginal examinations (46.2%), neglect (31.5%), and psychological abuse (21.7%). Socioeconomic factors such as low educational level, unemployment, receipt of government benefits, and delivery under public healthcare financing were more frequent among women who experienced various types of obstetric violence. Other characteristics such as age ≥ 35 years, having gone into labor, and being a primipara were also associated with higher prevalence. The co-occurrence of the four most common types of obstetric violence (psychological abuse, neglect, stigma and discrimination, and inappropriate vaginal examinations) was 3%.

Conclusion: Findings indicate that obstetric violence is a significant public health issue in the state of Rio de Janeiro, and its occurrence reflects inequalities in care for specific subgroups of postpartum women.

Objective: To describe the care for labor and delivery in the state of Rio de Janeiro, Brazil, according to hospital location and type of funding for delivery, and to verify the social, geographic, and care factors associated with going into labor and having a vaginal delivery.

Methods: This is a cross-sectional hospital-based study ("Birth in Brazil Research II: national survey on abortion, delivery, and birth") conducted in 29 hospitals located in the state of Rio de Janeiro. Women with live births and/or stillbirths with gestational age ≥ 22 weeks or ≥ 500 g weight were eligible, totaling 1,762 women. Interviews were conducted in the hospitals, in the immediate postpartum period. Data were extracted from the prenatal card and maternal medical records. Multiple logistic regression was performed for labor and delivery, using a hierarchical model, with estimated odds ratios and specific confidence intervals.

Results: The frequency of going into labor was 54% and of vaginal delivery, 41.0%. The following aspects were associated with going into labor: provision of care in hospitals located in the municipality of Rio de Janeiro, with public source of funding, being nulliparous or multiparous with previous delivery, preferring vaginal delivery at the end of pregnancy, not being obese and without complications during pregnancy. For vaginal delivery, we observed an association with low level of education, having no partner, being nulliparous or multiparous with previous delivery, having access to good practices as for going into labor and delivery, and use of analgesia during labor, regardless of the type of funding and hospital location.

Conclusions: We observed advances in labor care in the state of Rio de Janeiro, although the frequency of labor and vaginal delivery is still low, as well as good practices, but with better results for the municipality of Rio de Janeiro. All good practices were associated with vaginal delivery, especially the use of analgesia and the presence of doulas. Vaginal delivery was more frequent in socially vulnerable women.

Objective: To investigate the association between hospital practices and breastfeeding and exclusive breastfeeding at two months of age, and the main reasons for pre-lacteal feeding.

Methods: This is an analysis of the state of Rio de Janeiro, 2021-2023, from Pesquisa Nascer no Brasil II, a hospital-based cohort. We collected data during hospitalization for delivery and at two months of age. Logistic regression was used to analyse factors associated with breastfeeding and exclusive breastfeeding.

Results: 959 mothers and babies were included and calibrated to represent 1,537 puerperal women at baseline. Around 60% of women breastfed at first hour of life, and almost 90% breastfed in the first 24 hours and practiced exclusive breastfeeding at hospital discharge. Around 95% of women were breastfeeding at two months, 61.4% exclusively. The chance of breastfeeding was significantly higher among women who had given birth in BFHI hospitals (OR = 2.35), had ≥ 12 years of schooling (OR = 1.96), had ≥ 3 previous births (OR = 4.35), intended to breastfeed for ≥ 1 year (OR = 1.58) and felt supported after discharge (OR = 6.91). While the chance of exclusive breastfeeding was higher among women with public funding for childbirth (OR = 1.33), with ≥ 16 years of schooling (OR = 2.27), who lived with a partner (OR = 1.33), and who intended to breastfeed for ≥ 1 year (OR = 1.49). Pre-lacteal feeding PLF at hospital discharge was negatively associated with breastfeeding (OR = 0.04) and exclusive breastfeeding (OR = 0.15), and was more frequent in the private sector (20.4%), among "early-term" (18.3%), and caesarean sections (15.6%).

Conclusion: Breastfeeding promotion policies have been effective in almost universalizing breastfeeding at two months of age. However, in order to increase the prevalence of exclusive breastfeeding, it is necessary to expand and qualify support, management and information on exclusive breastfeeding, focus on vulnerable populations, reduce caesarean sections and improve hospital practices such as regulating the use of pre-lacteal feeding.

Objective: To analyze the prevalence and interrelationship of symptoms of depression, anxiety, and birth-related post-traumatic stress disorder.

Methods: Data from a cohort of postpartum women from the Nascer no Brasil II study, representative of births that occurred in the state of Rio de Janeiro between 2021 and 2023, were analyzed. Participants were interviewed face-to-face in the immediate postpartum period and again by telephone two months after birth. Women who responded to all questions on the Edinburgh Postnatal Depression Scale, Generalized Anxiety Disorder 7, and City Birth Trauma Scale were included, whereas pregnancies that ended in miscarriage or stillbirth were excluded, resulting in a total of 1,752 postpartum women. To test the homogeneity of proportions, the chi-square test (χ²) was used, with p-values below 5% considered statistically significant. The analysis of the interrelationships among the three symptoms was conducted using structural equation modeling (SEM), employing the weighted least squares mean and variance adjusted (WLSMV) estimator and theta parameterization.

Results: The prevalence of symptoms of depression, anxiety, and birth-related post-traumatic stress disorder was 17.9, 16.3, and 7.7%, respectively. A positive score on at least one of the scales was found in 24.6% of participants, and the simultaneous occurrence of two or three comorbidities was 12% and 3.7%, respectively. Low educational attainment and a history of mental disorders were significantly more prevalent in all three conditions analyzed. Structural equation modeling (SEM) revealed a significant and positive association among the three scales, and all latent variables in the model showed items with factor loadings greater than 0.5.

Conclusion: The postpartum period is critical for the diagnosis of mental disorders and may involve complex conditions in which symptoms of depression, anxiety, and stress overlap. It is important that healthcare professionals be aware of the occurrence and co-occurrence of these disorders, as well as their potential consequences for the health of both the woman and the newborn.

Objective: To evaluate the adequacy of prenatal care (PNC) in the state of Rio de Janeiro (SRJ) according to the type of childbirth funding.

Methods: A cross-sectional, hospital-based study conducted from 2021 to 2023 through interviews with postpartum women and collection and analysis of data from prenatal cards and medical records in public and private hospitals. Overall adequacy and adequacy of various PN components were estimated based on care guidelines from the World Health Organization and the Brazilian Ministry of Health, using 95% as the standard for adequacy.

Results: PN coverage was 98.5%, with 98.6% of women having received a prenatal card. Among the 1,325 women with an available card, 79,3% began PNC by the 12th gestational week; 75.5% had the adequate number of consultations for gestational age at delivery; 64.7% had documentation of all first routine PN tests, and 18.9% of the second; 31.6% received adequate immunization for tetanus and hepatitis B; 29.4% received iron and folic acid supplementation; and 17.6% received counseling on delivery types, reference maternity hospital, and were asked about alcohol use and smoking. A decrease in PN adequacy was observed when all components were considered, with less than 1% of women achieving overall adequacy. Women with publicly financed births had greater social vulnerability and lower PN coverage and adequacy in terms of timing, number of consultations, tests, and counseling.

Conclusion: PNC was found to be inadequate in SRJ, with lower adequacy among women with public financing, who represent a group with higher social vulnerability, increasing the likelihood of adverse outcomes in this population. It is essential to develop and implement strategies to improve PN adequacy and to ensure the best care for those who need it most.

Objective: To estimate the use and adequacy of prenatal care services and to verify the structure of the maternity hospital to meet the needs of health care during childbirth in the Brazilian Unified Health System.

Methods: This is a cross-sectional, hospital-based study conducted in the state of Rio de Janeiro, Brazil. 1,073 puerperae were eligible, whose delivery took place in public and mixed hospitals. The interviews were conducted in the hospital, and data were extracted from the prenatal card and maternal medical records. To evaluate the hospital structure, managers were interviewed. Sociodemographic, obstetric and prenatal care characteristics of the puerperae were described according to obstetric risk. The evaluation of the structure of the maternity hospital included: human resources, medicines, emergency equipment, and support services, according to the complexity level. Moreover, the distribution of puerperae classified as at obstetric risk was analyzed according to the complexity of the hospital structure.

Results: The highest prevalence of high obstetric risk was observed in hospitals located in small cities, among white women, aged 35 years or over, with up to 11 years of formal study, multiparous, and obese. Prenatal care adequacy, control of hypertension, diabetes, and nutritional evaluation were low, and traveling for delivery was significant. Hospitals with ICU/NICU presented better levels of adequacy in all structure dimensions evaluated. At the state level, 30.5% of women at high obstetric risk were seen in maternity hospitals without ICU/NICU; and 40.4% women at normal risk, in maternity hospitals with ICU/NICU.

Conclusions: We highlight the need to improve prenatal care and the implementation of an articulated network of services that integrate the Brazilian Unified Health System (SUS), centered on maternity hospitals that guarantee the structure conditions for quality and safety in obstetric and neonatal care, both in good practices at normal risk and in the management of complications at high obstetric risk, in such a way to impact the considerable outcomes of maternal and neonatal morbidity and mortality.