cross-sectional studies Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(10):297-304
DOI 10.1590/S0100-72032011001000005
PURPOSE: To evaluate the quality of health care assistance during childbirth in the hospitals of Goiânia, in Brazil. METHODS: Thirteen hospitals were appraised from April to December 2007, and a random sample of 404 normal births was studied. Data were obtained from interviews with mothers after delivery and by consulting their medical records. The quality of assistance at birth was evaluated by using the Bologna score and by comparing the procedures used in those hospitals to standard recommended practices. RESULTS: The Bologna score presented an average value of 1.04 (95%CI=0.9-1.1). The elective caesarian rate was 30%, the emergency caesarian rate was 10%, and the rate of induced childbirth was 1.6% The percentage of childbirths attended by health care professionals was 100%, but pediatricians in the delivery room were present only in 30% of the time. During labor, half of the women had no evaluation of the uterine dynamics and 29% had no auscultation fetal monitoring. The partogram was used for only 28.5% of the women, whereas the use of oxytocin was 45.8%. CONCLUSIONS: The results indicate a poor quality of childbirth care with low values of the Bologna score, high elective and emergency caesarians rates, a high number of unnecessary and potentially harmful interventions, and an insufficient frequency of beneficial interventions.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(10):297-304
DOI 10.1590/S0100-72032011001000005
PURPOSE: To evaluate the quality of health care assistance during childbirth in the hospitals of Goiânia, in Brazil. METHODS: Thirteen hospitals were appraised from April to December 2007, and a random sample of 404 normal births was studied. Data were obtained from interviews with mothers after delivery and by consulting their medical records. The quality of assistance at birth was evaluated by using the Bologna score and by comparing the procedures used in those hospitals to standard recommended practices. RESULTS: The Bologna score presented an average value of 1.04 (95%CI=0.9-1.1). The elective caesarian rate was 30%, the emergency caesarian rate was 10%, and the rate of induced childbirth was 1.6% The percentage of childbirths attended by health care professionals was 100%, but pediatricians in the delivery room were present only in 30% of the time. During labor, half of the women had no evaluation of the uterine dynamics and 29% had no auscultation fetal monitoring. The partogram was used for only 28.5% of the women, whereas the use of oxytocin was 45.8%. CONCLUSIONS: The results indicate a poor quality of childbirth care with low values of the Bologna score, high elective and emergency caesarians rates, a high number of unnecessary and potentially harmful interventions, and an insufficient frequency of beneficial interventions.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(2):93-98
DOI 10.1590/S0100-72032011000200007
PURPOSE: to estimate the prevalence and risk factors associated with seropositivity for Toxoplasma gondii in pregnant women. METHODS: a cross-sectional retrospective study based on the records of women screened for toxoplasmosis by the Pregnancy Protection Program in 2008, living in Goiânia (GO). These records were connected to records from the database of the National Information System on Live Births from the State of Goiás. The process occurred in three phases, with 10,316 records being paired for analysis, among the 12,846 initial records. The following variables were evaluated in this process: woman's name, age, date of birth, estimated date of delivery, date of infant birth and household information. Anti-Toxoplasma gondii antibodies were detected with the Q-Preven Toxo IgG and IgMin tests in dried blood samples collected on filter paper. The χ2 test and χ2 test for trend were used for data analysis, and the odds ratio (OR) was used to estimate the chance of association between exposure and outcome. RESULTS: the prevalence of infection was 67.7%, with 0.7% of the samples presenting anti-Toxoplasma gondii IgM and IgG reagents. Out of these, only three did not undergo confirmatory testing in venous blood. The median interval between the screening and the new collection of venous blood was of 12.5 days, and from screening to confirmatory test and avidity it was of 20 days. The variables associated with exposure were: age 20-30 years, OR=1.6 and >31 years, OR=1.8; brown skin color, OR=1.4, and black skin color, OR=1.6; and education of 8-11 years, OR=0.7, and >12 years of education, OR=0.6. CONCLUSION: a high prevalence of infection was estimated among the studied pregnant women. The associated factors that were found found should be considered during prenatal care, along with educational activities for the prevention of infection and assessment of serological status of seronegative pregnant women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(2):93-98
DOI 10.1590/S0100-72032011000200007
PURPOSE: to estimate the prevalence and risk factors associated with seropositivity for Toxoplasma gondii in pregnant women. METHODS: a cross-sectional retrospective study based on the records of women screened for toxoplasmosis by the Pregnancy Protection Program in 2008, living in Goiânia (GO). These records were connected to records from the database of the National Information System on Live Births from the State of Goiás. The process occurred in three phases, with 10,316 records being paired for analysis, among the 12,846 initial records. The following variables were evaluated in this process: woman's name, age, date of birth, estimated date of delivery, date of infant birth and household information. Anti-Toxoplasma gondii antibodies were detected with the Q-Preven Toxo IgG and IgMin tests in dried blood samples collected on filter paper. The χ2 test and χ2 test for trend were used for data analysis, and the odds ratio (OR) was used to estimate the chance of association between exposure and outcome. RESULTS: the prevalence of infection was 67.7%, with 0.7% of the samples presenting anti-Toxoplasma gondii IgM and IgG reagents. Out of these, only three did not undergo confirmatory testing in venous blood. The median interval between the screening and the new collection of venous blood was of 12.5 days, and from screening to confirmatory test and avidity it was of 20 days. The variables associated with exposure were: age 20-30 years, OR=1.6 and >31 years, OR=1.8; brown skin color, OR=1.4, and black skin color, OR=1.6; and education of 8-11 years, OR=0.7, and >12 years of education, OR=0.6. CONCLUSION: a high prevalence of infection was estimated among the studied pregnant women. The associated factors that were found found should be considered during prenatal care, along with educational activities for the prevention of infection and assessment of serological status of seronegative pregnant women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(1):39-46
DOI 10.1590/S0100-72032010000100007
PURPOSE: to evaluate the prevalence of HPV infection and associated factors among women living in the "Baixada Fluminense", state of Rio de Janeiro, Brazil. METHODS: a cross-sectional study conducted on a sample of 2,056 women aged 25-59 years covered by the Family Health Program in the municipalities of Duque de Caxias and Nova Iguaçu, state of Rio de Janeiro, southeastern Brazil. All women were submitted to the Papanicolaou and HPV detection tests in a single session by second-generation hybrid capture from December 2001 to July 2002. The prevalence of HPV was stratified by age, place of residence, schooling, smoking habit, and sexual and reproductive history. The prevalence rates associated with the studied variables were calculated by Multivariate Poisson regression. RESULTS: the prevalence of HPV was 12.3% and 5.0% for high-risk and low-risk HPV types, respectively. A reduction in high-risk HPV prevalence was observed with aging, with an increase in the 55-59 year age range. After adjusting for age, schooling, smoking, early sexual initiation and parity, high-risk HPV infection was associated with not living with a partner (1.4; 95%CI=1.1-1.8) and having more than one sexual partner (an increase of 1.4%; 95%CI=1.1-1.6, for each lifetime sexual partner). CONCLUSIONS: the prevalence of HPV was lower than that reported in other Brazilians studies, most likely because our sample was population-based. HPV infection was associated only with factors related to sexual behavior, but the potential association between HPV infection and smoking still needs to be better understood. Further studies are needed to explore these issues, as well as postmenopausal increased infection rates, and to identify the most prevalent HPV types in the Brazilian population.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(1):39-46
DOI 10.1590/S0100-72032010000100007
PURPOSE: to evaluate the prevalence of HPV infection and associated factors among women living in the "Baixada Fluminense", state of Rio de Janeiro, Brazil. METHODS: a cross-sectional study conducted on a sample of 2,056 women aged 25-59 years covered by the Family Health Program in the municipalities of Duque de Caxias and Nova Iguaçu, state of Rio de Janeiro, southeastern Brazil. All women were submitted to the Papanicolaou and HPV detection tests in a single session by second-generation hybrid capture from December 2001 to July 2002. The prevalence of HPV was stratified by age, place of residence, schooling, smoking habit, and sexual and reproductive history. The prevalence rates associated with the studied variables were calculated by Multivariate Poisson regression. RESULTS: the prevalence of HPV was 12.3% and 5.0% for high-risk and low-risk HPV types, respectively. A reduction in high-risk HPV prevalence was observed with aging, with an increase in the 55-59 year age range. After adjusting for age, schooling, smoking, early sexual initiation and parity, high-risk HPV infection was associated with not living with a partner (1.4; 95%CI=1.1-1.8) and having more than one sexual partner (an increase of 1.4%; 95%CI=1.1-1.6, for each lifetime sexual partner). CONCLUSIONS: the prevalence of HPV was lower than that reported in other Brazilians studies, most likely because our sample was population-based. HPV infection was associated only with factors related to sexual behavior, but the potential association between HPV infection and smoking still needs to be better understood. Further studies are needed to explore these issues, as well as postmenopausal increased infection rates, and to identify the most prevalent HPV types in the Brazilian population.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(5):248-255
DOI 10.1590/S0100-72032008000500007
PURPOSE: to describe the socio-demographic characteristics of deaths caused by uterine cervix cancer in women living in Recife, Pernambuco, Brazil, from 2000 to 2004. METHODS: a transversal populational study, including 323 deaths by uterine cervix cancer, among which 261 were recorded in the Information System about Mortality and 62 were identified after investigation on deaths by cancer at non-specified sites of the uterus. Mortality rate for all the variables was obtained and statistics for central tendency and variance were calculated. The χ2 test was performed to obtain the mortality coefficient concerning the living place and age range of the patients. RESULTS: death among women under 60 (54.7%), black (60.5%), single (67.6%), housewives (71.2%) and the ones living in poor neighborhood (53.3%) preponderated. Most of deaths occurred in hospitals (85.1%) and 90.2% of them occurred inside national health system hospitals. The mortality coefficient varied from 0.3 (among women under 30) to 54.9/100.00 (among women over 80). Significant statistical differences (p<0.05) were evidenced when death linked to age range and sanitary district was compared to characteristics of the female population living in the city. CONCLUSIONS: in Recife, death by cervix cancer are more frequent among adult, black, single, housewives, women living in poor neighborhoods and attended to at national health system hospitals, with differences in death risk among age ranges and living place.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(5):248-255
DOI 10.1590/S0100-72032008000500007
PURPOSE: to describe the socio-demographic characteristics of deaths caused by uterine cervix cancer in women living in Recife, Pernambuco, Brazil, from 2000 to 2004. METHODS: a transversal populational study, including 323 deaths by uterine cervix cancer, among which 261 were recorded in the Information System about Mortality and 62 were identified after investigation on deaths by cancer at non-specified sites of the uterus. Mortality rate for all the variables was obtained and statistics for central tendency and variance were calculated. The χ2 test was performed to obtain the mortality coefficient concerning the living place and age range of the patients. RESULTS: death among women under 60 (54.7%), black (60.5%), single (67.6%), housewives (71.2%) and the ones living in poor neighborhood (53.3%) preponderated. Most of deaths occurred in hospitals (85.1%) and 90.2% of them occurred inside national health system hospitals. The mortality coefficient varied from 0.3 (among women under 30) to 54.9/100.00 (among women over 80). Significant statistical differences (p<0.05) were evidenced when death linked to age range and sanitary district was compared to characteristics of the female population living in the city. CONCLUSIONS: in Recife, death by cervix cancer are more frequent among adult, black, single, housewives, women living in poor neighborhoods and attended to at national health system hospitals, with differences in death risk among age ranges and living place.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(8):485-492
DOI 10.1590/S0100-72032005000800009
PURPOSE: to present an overview of the coverage of the Pap smear in Brazil, emphasizing the determinant factors associated with failure of women to submit to the test. METHODS: the literature was reviewed using the LILACS (Latin-American and Caribbean Literature in Sciences of the Health), MEDLINE - 1966 to 2004 (International Literature in Sciences of the Health), PAHO (Collection of the Library of the Pan-American Organization of Health), and WHOLIS (System of Information of the Library of OMS) databases. The review was enlarged through the search of bibliographical references of relevant studies, request for published and unpublished studies by specialists, and other sources. Articles that fulfilled the following criteria were selected: to be a cross-sectional study, carried out in Brazil, including information about periodicity of the Pap test (some time in life or in the last three years) and/or containing information about factors associated with failure of women to submit to the test. Duplicates and articles without summary were excluded. A total of 13 articles fulfilling these criteria were selected. RESULTS: there are few studies on the coverage of Pap smear in Brazil. Most of them are concentrated in the big cities of the South and Southeast regions of the country. Besides the shortage, little methodological standardization exists in relation to the sampling and profile of the investigated women, which turns difficult the comparison among them. These methodological differences must have contributed to the great variability found in the coverage. However, in spite of all of the problems, a trend of time series increase is observed in the percentage of women who had at least one Pap smear in life. The two studies accomplished in the eighties showed coverage of 55.0 and 68.9% some time in life, while a household survey carried out in 2002 and 2003 presented values that varied from 73.4 to 92.9%; however, two studies of national inclusion presented estimates below 70.0% in the last three years. On the other hand, some variables were associated with the women's failure to submit to the Pap smear: low socioeconomic level, low education, low family income, and to belong to the younger age groups. CONCLUSION: the data here presented point to regional inequalities in the coverage of the Pap smear in the Brazilian female population and to the need of intervention targeted to those factors associated with women's failure to submit to the Pap smear.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(8):485-492
DOI 10.1590/S0100-72032005000800009
PURPOSE: to present an overview of the coverage of the Pap smear in Brazil, emphasizing the determinant factors associated with failure of women to submit to the test. METHODS: the literature was reviewed using the LILACS (Latin-American and Caribbean Literature in Sciences of the Health), MEDLINE - 1966 to 2004 (International Literature in Sciences of the Health), PAHO (Collection of the Library of the Pan-American Organization of Health), and WHOLIS (System of Information of the Library of OMS) databases. The review was enlarged through the search of bibliographical references of relevant studies, request for published and unpublished studies by specialists, and other sources. Articles that fulfilled the following criteria were selected: to be a cross-sectional study, carried out in Brazil, including information about periodicity of the Pap test (some time in life or in the last three years) and/or containing information about factors associated with failure of women to submit to the test. Duplicates and articles without summary were excluded. A total of 13 articles fulfilling these criteria were selected. RESULTS: there are few studies on the coverage of Pap smear in Brazil. Most of them are concentrated in the big cities of the South and Southeast regions of the country. Besides the shortage, little methodological standardization exists in relation to the sampling and profile of the investigated women, which turns difficult the comparison among them. These methodological differences must have contributed to the great variability found in the coverage. However, in spite of all of the problems, a trend of time series increase is observed in the percentage of women who had at least one Pap smear in life. The two studies accomplished in the eighties showed coverage of 55.0 and 68.9% some time in life, while a household survey carried out in 2002 and 2003 presented values that varied from 73.4 to 92.9%; however, two studies of national inclusion presented estimates below 70.0% in the last three years. On the other hand, some variables were associated with the women's failure to submit to the Pap smear: low socioeconomic level, low education, low family income, and to belong to the younger age groups. CONCLUSION: the data here presented point to regional inequalities in the coverage of the Pap smear in the Brazilian female population and to the need of intervention targeted to those factors associated with women's failure to submit to the Pap smear.
