Quality of health care Archives - Revista Brasileira de Ginecologia e Obstetrícia
, , , , , Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(9):871-877
, , , , , This study aimed to evaluate the diagnostic profile of breast cancer cases during the coronavirus disease 2019 (COVID-19) pandemic compared with the previous year.
It is a retrospective study of cases diagnosed by a reference service in the public health system of Campinas, SP, Brazil. Two periods were analyzed: March to October 2019 (preCOVID period) and March to October 2020 (COVID-period). All women diagnosed during the periods were included. The Chi-Squared or Fisher exact and Mann-Whitney tests were used.
In the preCOVID and COVID periods, breast cancers were diagnosed, respectively, in 115 vs 59 women, and the mean ages at diagnosis were 55 and 57 years (p = 0.339). In the COVID period, the family history of breast cancer was more observed (9.6% vs 29.8%, p < 0.001), cases were more frequently symptomatic (50.4% vs 79.7%, p < 0.001) and had more frequently palpable masses (56.5% vs 79.7%, p = 0.003). In symptomatic women, the mean number of days from symptom to mammography were 233.6 (458.3) in 2019 and 152.1 (151.5) in 2020 (p = 0.871). Among invasive tumors, the proportion of breast cancers in stages I and II was slightly higher in the COVID period, although not significantly (76.7% vs 82.4%, p = 0.428). Also in the COVID period, the frequency of luminal A-like tumors was lower (29.2% vs 11.8%, p = 0.018), of triple-negative tumors was twice as high (10.1% vs 21.6%, p = 0.062), and of estrogen receptor-positive tumors was lower (82.2% vs 66.0%, p = 0.030).
During the COVID-19 pandemic, breast cancer diagnoses were reduced. Cases detected were suggestive of a worse prognosis: symptomatic women with palpable masses and more aggressive subtypes. Indolent tumors were those more sensitive to the interruption in screening.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(9):871-877
, , , , , This study aimed to evaluate the diagnostic profile of breast cancer cases during the coronavirus disease 2019 (COVID-19) pandemic compared with the previous year.
It is a retrospective study of cases diagnosed by a reference service in the public health system of Campinas, SP, Brazil. Two periods were analyzed: March to October 2019 (preCOVID period) and March to October 2020 (COVID-period). All women diagnosed during the periods were included. The Chi-Squared or Fisher exact and Mann-Whitney tests were used.
In the preCOVID and COVID periods, breast cancers were diagnosed, respectively, in 115 vs 59 women, and the mean ages at diagnosis were 55 and 57 years (p = 0.339). In the COVID period, the family history of breast cancer was more observed (9.6% vs 29.8%, p < 0.001), cases were more frequently symptomatic (50.4% vs 79.7%, p < 0.001) and had more frequently palpable masses (56.5% vs 79.7%, p = 0.003). In symptomatic women, the mean number of days from symptom to mammography were 233.6 (458.3) in 2019 and 152.1 (151.5) in 2020 (p = 0.871). Among invasive tumors, the proportion of breast cancers in stages I and II was slightly higher in the COVID period, although not significantly (76.7% vs 82.4%, p = 0.428). Also in the COVID period, the frequency of luminal A-like tumors was lower (29.2% vs 11.8%, p = 0.018), of triple-negative tumors was twice as high (10.1% vs 21.6%, p = 0.062), and of estrogen receptor-positive tumors was lower (82.2% vs 66.0%, p = 0.030).
During the COVID-19 pandemic, breast cancer diagnoses were reduced. Cases detected were suggestive of a worse prognosis: symptomatic women with palpable masses and more aggressive subtypes. Indolent tumors were those more sensitive to the interruption in screening.
, , , , Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(6):442-451
, , , , To determine the adequacy of compliance with antenatal care (ANC) by pregnant women in Peru and to identify the associated factors.
An analytical cross-sectional study of data from the 2019 Peruvian Demographic and Family Health Survey (Encuesta Demográfica y de Salud Familiar, ENDES, in Spanish) was conducted. The dependent variable was adequate compliance with ANC (provided by skilled health care professionals; first ANC visit during the first trimester of pregnancy; six or more ANC visits during pregnancy; ANC visits with appropriate content) by women aged 15 to 49 years in their last delivery within the five years prior to the survey. Crude and adjusted prevalence ratios and their 95% confidence intervals were calculated using a log-binomial regression model.
A total of 18,386 women were analyzed, 35.0% of whom adequately complied with ANC. The lowest proportion of compliance was found with the content of ANC (42.6%). Sociodemographic factors and those related to pregnancy, such as being in the age groups of 20 to 34 years and 35 to 49 years, havingsecondaryor higher education, belonging to a wealth quintile of the population other than the poorest, being from the Amazon region, not being of native ethnicity, having a second or third pregnancy, and having a desired pregnancy, increased the probability of presenting adequate compliance with ANC.
Only 3 out of 10women in Peru showed adequate compliancewith ANC. Compliance with the content of ANC must be improved, and strategies must be developed to increase the proportion of adequate compliance with ANC.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(6):442-451
, , , , To determine the adequacy of compliance with antenatal care (ANC) by pregnant women in Peru and to identify the associated factors.
An analytical cross-sectional study of data from the 2019 Peruvian Demographic and Family Health Survey (Encuesta Demográfica y de Salud Familiar, ENDES, in Spanish) was conducted. The dependent variable was adequate compliance with ANC (provided by skilled health care professionals; first ANC visit during the first trimester of pregnancy; six or more ANC visits during pregnancy; ANC visits with appropriate content) by women aged 15 to 49 years in their last delivery within the five years prior to the survey. Crude and adjusted prevalence ratios and their 95% confidence intervals were calculated using a log-binomial regression model.
A total of 18,386 women were analyzed, 35.0% of whom adequately complied with ANC. The lowest proportion of compliance was found with the content of ANC (42.6%). Sociodemographic factors and those related to pregnancy, such as being in the age groups of 20 to 34 years and 35 to 49 years, havingsecondaryor higher education, belonging to a wealth quintile of the population other than the poorest, being from the Amazon region, not being of native ethnicity, having a second or third pregnancy, and having a desired pregnancy, increased the probability of presenting adequate compliance with ANC.
Only 3 out of 10women in Peru showed adequate compliancewith ANC. Compliance with the content of ANC must be improved, and strategies must be developed to increase the proportion of adequate compliance with ANC.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(8):349-356
DOI 10.1590/S0100-72032013000800003
PURPOSE: To characterize prenatal care and to evaluate the association of its adequacy with maternal, socioeconomic and environmental sanitation characteristics, as well as the influence of these factors on the birth weight of the children. METHODS: The eligible population for the study consisted of all women who had children during 2009 and lived in the city of Queimadas at the time of data collection. Information was collected with a questionnaire applied to the mothers in Family Health Basic Units or in their residence. The prenatal care adequacy index (outcome variable) was defined as adequate when the mother attended six or more prenatal visits and began monitoring during the first trimester of pregnancy (<20 weeks). Hierarchical logistic regression was performed to estimate the odds ratios for inadequate prenatal care and a multiple linear regression model was used to estimate the effect of adequacy of prenatal care and maternal, socioeconomic and environmental sanitation variables on birth weight. The statistical program used was Rv2.10.0, with the level of significance set at p <5%. RESULTS: Of a total of 199 women studied, 78.4% were classified as having received adequate prenatal care. After adjustment for other predictors, maternal age of 19 years or less remained as an explanatory variable of inadequate prenatal care (OR 4.27, 95%CI 1.10 - 15.89). Even after controlling for variables, child's birth weight was negatively associated with water supply from a well/spring and burnt/buried garbage, accounting for weight reductions of the order of 563.8, 262.0 and 951.9 g, respectively. CONCLUSION: Adequate prenatal care can alleviate the influence of socioeconomic disparities related to health care. Even in this situation, teenage mothers are more likely to receive inadequate prenatal care and low birth weight is favored by improper sanitation conditions (such as water supply and garbage disposal).
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(8):349-356
DOI 10.1590/S0100-72032013000800003
PURPOSE: To characterize prenatal care and to evaluate the association of its adequacy with maternal, socioeconomic and environmental sanitation characteristics, as well as the influence of these factors on the birth weight of the children. METHODS: The eligible population for the study consisted of all women who had children during 2009 and lived in the city of Queimadas at the time of data collection. Information was collected with a questionnaire applied to the mothers in Family Health Basic Units or in their residence. The prenatal care adequacy index (outcome variable) was defined as adequate when the mother attended six or more prenatal visits and began monitoring during the first trimester of pregnancy (<20 weeks). Hierarchical logistic regression was performed to estimate the odds ratios for inadequate prenatal care and a multiple linear regression model was used to estimate the effect of adequacy of prenatal care and maternal, socioeconomic and environmental sanitation variables on birth weight. The statistical program used was Rv2.10.0, with the level of significance set at p <5%. RESULTS: Of a total of 199 women studied, 78.4% were classified as having received adequate prenatal care. After adjustment for other predictors, maternal age of 19 years or less remained as an explanatory variable of inadequate prenatal care (OR 4.27, 95%CI 1.10 - 15.89). Even after controlling for variables, child's birth weight was negatively associated with water supply from a well/spring and burnt/buried garbage, accounting for weight reductions of the order of 563.8, 262.0 and 951.9 g, respectively. CONCLUSION: Adequate prenatal care can alleviate the influence of socioeconomic disparities related to health care. Even in this situation, teenage mothers are more likely to receive inadequate prenatal care and low birth weight is favored by improper sanitation conditions (such as water supply and garbage disposal).
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(7):367-374
DOI 10.1590/S0100-72032009000700008
A good quality prenatal assistance is essential to warrant perinatal and maternal health. Nowadays, due to the evolution of diagnostic methods and the change in illness prevalence, such as the increase in diabetes and sexually transmitted diseases, several propedeutic procedures are available. This introduces further difficulty for clinicians to select the most adequate procedures and when to apply them during gestation, assuring the best results for both mother and infant. The present review aimed at evaluating the main prenatal routine tests on the basis of the best scientific evidence presently available.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(7):367-374
DOI 10.1590/S0100-72032009000700008
A good quality prenatal assistance is essential to warrant perinatal and maternal health. Nowadays, due to the evolution of diagnostic methods and the change in illness prevalence, such as the increase in diabetes and sexually transmitted diseases, several propedeutic procedures are available. This introduces further difficulty for clinicians to select the most adequate procedures and when to apply them during gestation, assuring the best results for both mother and infant. The present review aimed at evaluating the main prenatal routine tests on the basis of the best scientific evidence presently available.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(3):148-155
DOI 10.1590/S0100-72032009000300008
Good prenatal care is essential to guarantee maternal and perinatal health. Nowadays, with the constant progress on the diagnostic methods and changes in diseases panorama, like increased frequency of diabetes and sexually transmitted diseases, several diagnostic procedures have been studied. These challenges difficult the selection of prenatal exams by the clinicians, in order to improve maternal and perinatal outcome. This review aimed to evaluate the main prenatal routine exams, according to the best current scientific evidences.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(3):148-155
DOI 10.1590/S0100-72032009000300008
Good prenatal care is essential to guarantee maternal and perinatal health. Nowadays, with the constant progress on the diagnostic methods and changes in diseases panorama, like increased frequency of diabetes and sexually transmitted diseases, several diagnostic procedures have been studied. These challenges difficult the selection of prenatal exams by the clinicians, in order to improve maternal and perinatal outcome. This review aimed to evaluate the main prenatal routine exams, according to the best current scientific evidences.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(9):484-489
DOI 10.1590/S0100-72032007000900008
In Brazil, where 90% of the childbirths occur in hospitals, 67.1% of the cases of maternal death are due to direct obstetric causes, mainly hypertensive disorders, but a quarter of the deaths are due to indirect obstetric causes. As maternal death is a rare event, estimated in 76/100,000, the study of severe maternal morbidity, following international literature, can contribute to qualify obstetrical care. Maternal morbidity is a continuum that ends with death, but there is a separate group, with extreme severity, known as near miss. From the literature review, there are the difficulties to obtain an operational definition of the cases of extremely severe morbidity or near miss. The prevalence ranged from 0.80-8.23%, according to the defining criteria and health care provided at the region. The characterization of severe maternal morbidity and near miss allows for monitoring the process of obstetrical care and could help to qualify treatment of maternal urgencies and emergencies, interrupting the process that can lead to death.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(9):484-489
DOI 10.1590/S0100-72032007000900008
In Brazil, where 90% of the childbirths occur in hospitals, 67.1% of the cases of maternal death are due to direct obstetric causes, mainly hypertensive disorders, but a quarter of the deaths are due to indirect obstetric causes. As maternal death is a rare event, estimated in 76/100,000, the study of severe maternal morbidity, following international literature, can contribute to qualify obstetrical care. Maternal morbidity is a continuum that ends with death, but there is a separate group, with extreme severity, known as near miss. From the literature review, there are the difficulties to obtain an operational definition of the cases of extremely severe morbidity or near miss. The prevalence ranged from 0.80-8.23%, according to the defining criteria and health care provided at the region. The characterization of severe maternal morbidity and near miss allows for monitoring the process of obstetrical care and could help to qualify treatment of maternal urgencies and emergencies, interrupting the process that can lead to death.