Resumo Objetivos: analisar os fatores associados à participação das gestantes em atividades educativas e sua indicação à maternidade de referência ao parto durante o pré-natal. Métodos: estudo longitudinal multicêntrico realizado em três maternidades. Utilizou-se entrevista realizada logo após o parto e os desfechos avaliados foram a participação em atividade educativa no pré-natal e a indicação da maternidade de referência ao parto. Utilizou-se Regressão de Poisson na análise do modelo hierárquico proposto. Resultados: das 3438participantes, 23,2%participaram de atividades educativas e 61,2% tiveram o parto referenciadoà uma maternidade. As mulheres com maior renda familiar (RP= 1,36; IC95%= 1,04–1,77), com aumento em um ano na idade RP= 1,02; IC95%= 1,01–1,04), primeira gestação RP= 1,84; IC95%= 1,56–2,17) e que praticavam atividade física RP= 1,28; IC95%= 1,09–1,50) tiveram maior prevalência de participação nas atividades educativas. A indicação da maternidade foi mais frequente entre as mulheres com maior renda familiar RP= 1,15; IC95%= 1,01–1,30), escolaridade (RP= 1,01; IC95%=1,00–1,02), não tabagistas (RP= 1,31; IC95%= 1,07–1,61) e usuárias de drogas (RP= 1,44; IC95%= 1,17–1,77). Conclusões: apesar da ampla cobertura, o pré-natal ainda apresenta falhas nas ações educativas e na indicação da maternidade de referência. Objetivos prénatal. prénatal pré natal. natal Métodos maternidades Utilizouse Utilizou se proposto Resultados 3438participantes participantes 232participaram participaram 23 2 612 61 61,2 RP (RP 1,36 136 1 36 IC95 IC IC95% 1,04–1,77, 104177 1,04–1,77 , 04 77 1,04–1,77) 1,02 102 02 1,01–1,04, 101104 1,01–1,04 01 1,01–1,04) 1,84 184 84 1,56–2,17 156217 56 17 1,28 128 28 1,09–1,50 109150 09 50 1,15 115 15 1,01–1,30, 101130 1,01–1,30 30 1,01–1,30) 1,01 101 IC95%=1,00–1,02, IC95100102 IC95%=1,00–1,02 00 IC95%=1,00–1,02) 1,31 131 31 1,07–1,61 107161 07 1,44 144 44 1,17–1,77. 117177 1,17–1,77 . 1,17–1,77) Conclusões cobertura 6 61, 1,3 13 3 IC9 10417 1,04–1,7 0 7 1,0 10 10110 1,01–1,0 1,8 18 8 1,56–2,1 15621 5 1,2 12 1,09–1,5 10915 1,1 11 10113 1,01–1,3 IC9510010 IC95%=1,00–1,0 1,07–1,6 10716 1,4 14 4 11717 1,17–1,7 1, 1041 1,04–1, 1011 1,01–1, 1,56–2, 1562 1,09–1, 1091 IC951001 IC95%=1,00–1, 1,07–1, 1071 1171 1,17–1, 104 1,04–1 1,01–1 1,56–2 156 1,09–1 109 IC95100 IC95%=1,00–1 1,07–1 107 117 1,17–1 1,04– 1,01– 1,56– 1,09– IC9510 IC95%=1,00– 1,07– 1,17– 1,04 1,56 1,09 IC951 IC95%=1,00 1,07 1,17 1,5 IC95%=1,0 IC95%=1, IC95%=1

Abstract Objectives: to evaluate the associated factors in the participation of educational activities and the indication of maternity reference of the birth given for the women during prenatal. Methods: A multicenter longitudinal study was conducted in three maternity hospitals. The interview was carried out soon after the childbirth and the outcomes evaluated were the participation of educational activities during the prenatal and the indication of birth maternity reference. The Poisson regression was used in the analysis of the proposed hierarchical model. Results: Of the 3438 women, 23.2% participated in the educative activities and 61.2% had the childbirth linked to a reference maternity. The women with higher household income (PR= 1.36; CI95%= 1.04–1.77), increase in age by one year (PR= 1.02; CI95%= 1.01–1.04), first pregnancy (PR= 1.84; CI95%= 1.56–2.17), and who practiced physical activity (PR= 1.28; CI95%= 1.09–1.50) had higher prevalence in the participation on the educational activities. The indication of maternity reference was more frequent between the women with higher household income (PR= 1.15; CI95%= 1.01–1.30), education (PR= 1.01; CI95%= 1.00–1.02), non-smoker (PR= 1.31; CI95%= 1.07–1.61), and drug user (PR= 1.44; CI95%= 1.17–1.77). Conclusions despite the wide coverage, the prenatal still has flaws in the actions of education and in the indication of the reference maternity hospital. Objectives Methods hospitals model Results 343 232 23 2 23.2 612 61 61.2 PR= PR (PR 1.36 136 1 36 CI95 CI CI95% 1.04–1.77, 104177 1.04–1.77 , 04 77 1.04–1.77) 1.02 102 02 1.01–1.04, 101104 1.01–1.04 01 1.01–1.04) 1.84 184 84 1.56–2.17, 156217 1.56–2.17 56 17 1.56–2.17) 1.28 128 28 1.09–1.50 109150 09 50 1.15 115 15 1.01–1.30, 101130 1.01–1.30 30 1.01–1.30) 1.01 101 1.00–1.02, 100102 1.00–1.02 00 1.00–1.02) nonsmoker non smoker 1.31 131 31 1.07–1.61, 107161 1.07–1.61 07 1.07–1.61) 1.44 144 44 1.17–1.77. 117177 1.17–1.77 . 1.17–1.77) coverage hospital 34 23. 6 61. 1.3 13 3 CI9 10417 1.04–1.7 0 7 1.0 10 10110 1.01–1.0 1.8 18 8 15621 1.56–2.1 5 1.2 12 1.09–1.5 10915 1.1 11 10113 1.01–1.3 10010 1.00–1.0 10716 1.07–1.6 1.4 14 4 11717 1.17–1.7 1. 1041 1.04–1. 1011 1.01–1. 1562 1.56–2. 1.09–1. 1091 1001 1.00–1. 1071 1.07–1. 1171 1.17–1. 104 1.04–1 1.01–1 156 1.56–2 1.09–1 109 100 1.00–1 107 1.07–1 117 1.17–1 1.04– 1.01– 1.56– 1.09– 1.00– 1.07– 1.17– 1.04 1.56 1.09 1.00 1.07 1.17 1.5

Resumo Objetivos: investigar a relação entre a idade da menarca com o ganho de peso gestacional. Métodos: estudo transversal com 2609 mulheres do Projeto VIVER “Desfechos em saúde nos períodos perinatal e neonatal”, tendo como desfecho o ganho de peso gestacional e como variável independente a idade da menarca. Análise descritiva com apresentação da prevalência (IC95%). Para testar a associação entre ganho de peso e menarca, aplicou-se regressão de Poisson. Resultados: menarca precoce (< 12 anos) ocorreu em 21,9% da amostra (IC95%= 20,3-23,4). No grupo com menarca precoce, 43,7% apresentaram sobrepeso pré-gestacional, 85,6% sobrepeso pós-gestacional e 36,8% tiveram ganho de peso gestacional excessivo. Menarca precoce aumentou o ganho de peso gestacional excessivo em 33% (RPa= 1,33; IC95%= 1,05-1,69). Conclusões: menarca precoce está relacionada ao ganho de peso gestacional excessivo. Ações educativas de prevenção ao sobrepeso nas consultas de pré-natal devem ser priorizadas, principalmente entre mulheres com menarca precoce. Objetivos Métodos 260 Desfechos neonatal, neonatal , neonatal” IC95%. IC95 IC IC95% . (IC95%) aplicouse aplicou se Poisson Resultados < ( 1 anos 219 21 9 21,9 (IC95% 20,323,4. 203234 20,3 23,4 20 3 23 4 20,3-23,4) 437 43 7 43,7 prégestacional, prégestacional pré gestacional, pré-gestacional 856 85 6 85,6 pósgestacional pós 368 36 8 36,8 33 RPa= RPa (RPa 1,33 133 1,051,69. 105169 1,05 1,69 05 69 1,05-1,69) Conclusões prénatal natal priorizadas 26 IC9 2 21, (IC95 323 20,323,4 20323 203 20, 234 23, 20,3-23,4 43, 85, 36, 1,3 13 051 1,051,69 10516 105 1,0 169 1,6 0 1,05-1,69 (IC9 32 20,323, 2032 20,3-23, 1, 1,051,6 1051 10 16 1,05-1,6 (IC 20,323 20,3-23 1,051, 1,05-1, 20,32 20,3-2 1,051 1,05-1 20,3- 1,05-

Abstract Objectives: to investigate the relation between age at menarche and gestational weight gain. Methods: cross-sectional study, with 2609 women from “Projeto VIVER: desfechos em saúde nos períodos perinatal e neonatal” (VIVER Project: “Health outcomes in the perinatal and neonatal periods). Outcome: gestational weight gain; independent variable: age at menarche. Descriptive analysis with prevalence presentation (CI95%). To test the association between weight gain and menarche, Poisson regression was applied. Results: early menarche (< 12 years) occurred in 21.9% of the sample (CI95%=20.3-23.4). In the group with early menarche, 43.7% presented pre-gestational overweight, 85.6% post-pregnancy overweight and 36.8% had excessive gestational weight gain. Early menarche increases the risk of excessive gestational weight gain by 33% (aPR= 1.33; CI95% = 1.05-1.69). Conclusions: early menarche is related to excessive gestational weight gain. Educational actions to prevent overweight in prenatal consultations should be prioritized, especially among women with early menarche. Objectives Methods crosssectional cross sectional study 260 Projeto VIVER Project Health periods. periods . periods) Outcome variable CI95%. CI95 CI (CI95%) applied Results < ( 1 years 219 21 9 21.9 CI95%=20.323.4. CI95203234 CI95%=20.3 23.4 20 3 23 4 (CI95%=20.3-23.4) 437 43 7 43.7 pregestational pre 856 85 6 85.6 postpregnancy post pregnancy 368 36 8 36.8 33 aPR= aPR (aPR 1.33 133 1.051.69. 105169 1.05 1.69 05 69 1.05-1.69) Conclusions prioritized 26 CI9 (CI95% 2 21. 323 CI95%=20.323.4 CI9520323 CI95203 CI95%=20. 234 23. (CI95%=20.3-23.4 43. 85. 36. 1.3 13 051 1.051.69 10516 105 1.0 169 1.6 0 1.05-1.69 (CI95 32 CI95%=20.323. CI952032 CI9520 CI95%=20 (CI95%=20.3-23. 1. 1.051.6 1051 10 16 1.05-1.6 (CI9 CI95%=20.323 CI952 CI95%=2 (CI95%=20.3-23 1.051. 1.05-1. (CI CI95%=20.32 CI95%= (CI95%=20.3-2 1.051 1.05-1 (CI95%=20.3- 1.05- (CI95%=20.3 (CI95%=20. (CI95%=20 (CI95%=2 (CI95%=

ABSTRACT OBJECTIVE To assess the quality of the health care provided to children aged under one year old performed by primary health services in the South and Northeast regions of Brazil. METHODS This is a cross-sectional, population-based study carried out in 2010 with 7,915 children aged from one to four years, whose homes are located in the areas of health service coverage. We described the prevalence of procedures and guidelines, such as weight and height measurement, vaccination, newborn blood spot screening, evaluation of umbilical cord, instruction on breastfeeding and introduction of new food, and their respective 95% confidence intervals. The differences were analyzed using the chi-square test of heterogeneity and linear trend. We considered the main outcome of high-quality infant care if the child had received all recommended procedures and guidelines in the first year of life. For this analysis, we used the Poisson regression considering hierarchical model. RESULTS There was low prevalence for the instruction on breastfeeding in the first week of life (58.8%, 95%CI 57.5–60.0) and on the introduction of new food in the fourth month care. The prevalence of high-quality in childcare was 42.0% (95%CI 40.5–43.5). The adjusted analysis according to hierarchical model indicated greater probability of this outcome in the Northeast region (PR = 1.17, 95%CI 1.09–1.26), in smaller municipalities (PR = 1.17, 95%CI 1.03–1.33), and in municipalities with 50,000 and 99,000 inhabitants (PR = 1.20, 95%CI 1.09–1.34). CONCLUSIONS The Northeast region has higher-quality infant care services, which can be explained by the consolidation of the Family Health Strategy in that region.

ABSTRACT OBJECTIVE To assess the quality of the health care provided to children aged under one year old performed by primary health services in the South and Northeast regions of Brazil. METHODS This is a cross-sectional, population-based study carried out in 2010 with 7,915 children aged from one to four years, whose homes are located in the areas of health service coverage. We described the prevalence of procedures and guidelines, such as weight and height measurement, vaccination, newborn blood spot screening, evaluation of umbilical cord, instruction on breastfeeding and introduction of new food, and their respective 95% confidence intervals. The differences were analyzed using the chi-square test of heterogeneity and linear trend. We considered the main outcome of high-quality infant care if the child had received all recommended procedures and guidelines in the first year of life. For this analysis, we used the Poisson regression considering hierarchical model. RESULTS There was low prevalence for the instruction on breastfeeding in the first week of life (58.8%, 95%CI 57.5–60.0) and on the introduction of new food in the fourth month care. The prevalence of high-quality in childcare was 42.0% (95%CI 40.5–43.5). The adjusted analysis according to hierarchical model indicated greater probability of this outcome in the Northeast region (PR = 1.17, 95%CI 1.09–1.26), in smaller municipalities (PR = 1.17, 95%CI 1.03–1.33), and in municipalities with 50,000 and 99,000 inhabitants (PR = 1.20, 95%CI 1.09–1.34). CONCLUSIONS The Northeast region has higher-quality infant care services, which can be explained by the consolidation of the Family Health Strategy in that region.

Resumo O objetivo do estudo foi analisar a tendência temporal da taxa de mortalidade feminina por agressão no Brasil, regiões e estados no período de 2002 a 2012. Estudo ecológico de série temporal com dados secundários de mulheres na faixa etária de 20 a 59 anos mortas por agressão. As taxas de mortalidade foram analisadas por regressão linear simples, estratificadas por região, Índice de Gini e Índice de Desenvolvimento Humano (IDH). Evidenciou-se no país tendência estável na taxa de mortalidade feminina por agressão, com diferenças entre estados e regiões. O Centro-Oeste apresentou maiores taxas e tendência de estagnação. Observou-se tendência de aumento nas regiões Norte, Nordeste e Sul e diminuição na região Sudeste. Os estados pertencentes ao tercil com maior IDH apresentam tendência de declínio e estabilização nos 1º e 2º tercis. Foi observado aumento da taxa de mortalidade nos estados com maior desigualdade social. Apesar do comportamento de estabilização no país os resultados apontam para a necessidade de políticas sociais adequadas às especificidades dos estados e regiões.

Abstract This study aimed to analyze time trend of female mortality due to assault in Brazil, regions and states from 2002 to 2012. This is an ecological times series study with secondary data from women aged 20-59 years who died due to assault. Mortality rates were analyzed by simple linear regression and stratified by region, Gini Index and Human Development Index (HDI). The trend of female rate of mortality due to assault was stable in the country, with differences between states and regions. The Midwest had the highest rates and stagnation trend. There was an increased trend in the North, Northeast and South and a decreased trend in the Southeast. The states of the tertile with the highest HDI evidenced a declining trend and stabilization in the first and second tertiles. An increased mortality rate was recorded in states with greater social inequality. Notwithstanding the national stabilization behavior, results point to the need for social policies appropriate to the specificities of states and regions.

Resumo O objetivo do estudo foi analisar a tendência temporal da taxa de mortalidade feminina por agressão no Brasil, regiões e estados no período de 2002 a 2012. Estudo ecológico de série temporal com dados secundários de mulheres na faixa etária de 20 a 59 anos mortas por agressão. As taxas de mortalidade foram analisadas por regressão linear simples, estratificadas por região, Índice de Gini e Índice de Desenvolvimento Humano (IDH). Evidenciou-se no país tendência estável na taxa de mortalidade feminina por agressão, com diferenças entre estados e regiões. O Centro-Oeste apresentou maiores taxas e tendência de estagnação. Observou-se tendência de aumento nas regiões Norte, Nordeste e Sul e diminuição na região Sudeste. Os estados pertencentes ao tercil com maior IDH apresentam tendência de declínio e estabilização nos 1º e 2º tercis. Foi observado aumento da taxa de mortalidade nos estados com maior desigualdade social. Apesar do comportamento de estabilização no país os resultados apontam para a necessidade de políticas sociais adequadas às especificidades dos estados e regiões.

Abstract This study aimed to analyze time trend of female mortality due to assault in Brazil, regions and states from 2002 to 2012. This is an ecological times series study with secondary data from women aged 20-59 years who died due to assault. Mortality rates were analyzed by simple linear regression and stratified by region, Gini Index and Human Development Index (HDI). The trend of female rate of mortality due to assault was stable in the country, with differences between states and regions. The Midwest had the highest rates and stagnation trend. There was an increased trend in the North, Northeast and South and a decreased trend in the Southeast. The states of the tertile with the highest HDI evidenced a declining trend and stabilization in the first and second tertiles. An increased mortality rate was recorded in states with greater social inequality. Notwithstanding the national stabilization behavior, results point to the need for social policies appropriate to the specificities of states and regions.

Resumo Objetivos: estimar o acompanhamento incompleto de puericultura e os fatores associados, em municípios do Nordeste e Sul do Brasil. Métodos: estudo transversal, de base populacional, realizado com 7.915 crianças. Considerou-se acompanhamento incompleto da puericultura a ausência em pelo menos um dos sete atendimentos preconizados. Utilizou-se Regressão de Poisson para análise bruta e ajustada. Resultados: a prevalência do acompanhamento incompleto da puericultura foi de 53,6% (IC95%= 52,5-54,7) no Nordeste e de 28,3% (IC95%= 27,3-29,3) no Sul, sendo 91% maior no Nordeste (RP=1,91; IC95% 1,73-2,11). Efeito protetor foi observado: em municípios com 30 a 49 mil habitantes no Nordeste (RP= 0,72; IC95%= 0,64-0,82) e 100 a 999 mil habitantes no Sul (RP=0,69; IC95% 0,57-0,84); pertencer ao maior quartil de renda per capita no Sul (RP=0,77; IC95% 0,63-0,95) e fazer seis ou mais consultas de pré-natal (RP=0,83; IC95%=0,75-0,92) Nordeste e (RP=0,65; IC95%= 0,53-0,79) Sul. Pertencer às classes D e E evidenciou risco no Nordeste (RP=1,41; IC95%= 1,19-1,67) e no Sul (RP=1,67; IC95%=1,37-2,03). Conclusões: as crianças no Nordeste estão mais sujeitas a não seguir o acompanhamento completo de puericultura, sugerindo que o usuário não comparece ou encontra dificuldades nos acesso aos serviços de saúde.

Abstract Objectives: to estimate the incomplete follow-up on child care services and the associated factors in the municipalities in the Northeast and in the South of Brazil. Methods: a population-based cross-sectional study with 7,915 children. The incomplete follow-up on child care regarded the absence of at least one of the seven advocated care services. The Poisson regression was used for crude and adjusted analysis. Results: the prevalence of the incomplete follow-up child care was 53.6% (CI95%= 52.5-54.7) in the Northeast and 28.3% (CI95%= 27.3-29.3) in the South, therefore 91% was greater in the Northeast (PR=1.91; CI95%= 1.73-2.11). Protector effect was observed: in the muni-cipalities with 30 to 49 thousand inhabitants in the Northeast (PR= 0.72; CI95%= 0.64-0.82) and 100 to 999 thousand inhabitants in the South (PR=0.69; CI95%= 0.57-0.84); the South has the greatest income quartile (RP=0.77; CI95%= 0.63-0.95) and has six or more prenatal consultations (PR=0.83; CI95%= 0.75-0.92) in the Northeast and (PR=0.65; CI95%= 0.53-0.79) in the South. Social classes D and E showed risks (PR=1.41; CI95%= 1.19-1.67) in the Northeast and (PR=1.67; CI95%= 1.37-2.03) in the South. Conclusions: children in the Northeast are more likely not to have a complete child care follow-up, implying that the user does not come to be attended or finds difficulties to have access to the health services.

Estudo caso controle que objetivou identificar fatores individuais de risco relacionados à transmissão da doença. O grupo caso, composto por 90 pacientes de hanseníase notificados no SINAN entre 2003 e 2006; o grupo controle, constituído por 270 indivíduos sadios, pareados por sexo e faixa etária. Houve associação significativa entre a ocorrência da doença e a presença atual (OR= 2,9) e antiga (OR=5,0) de hanseníase entre parentes co-sangüíneos. Sabendo-se que o exame único dos contatos, no ato do diagnóstico, detecta uma parcela mínima dos casos, propõe-se a realização de exames periódicos dos contatos de hansenianos a fim de detectar os novos casos.

This case-control study aimed to identify individual risk factors regarding the transmission of leprosy. The group case represented by 90 cases of leprosy sick people pontificated at SINAN during 2003 and 2006 and a group control constituted by 270 healthy people, paired by gender and age. There was significant statistical between occurrence of the disease and its current presence (OR: 2,9) and old cases (OR= 5,0) of leprosy among co-sanguine relatives. Knowing that the only exam of the contact in the act of the diagnostic detects a minimum part of the new cases, it is proposed to execute periodical examinations of the contact of leprosy for detecting the new cases.

Estudio caso controle que objetivó identificar factores individuales del riesgo relacionados a transmisión de la enfermedad. El grupo caso, compuesto por 90 pacientes con lepra notificados en el SINAN entre 2003 y 2006; y el grupo controle, constituido por 270 individuos saludables, pareados por sexo y edad. Hubo asociación significativa entre la ocurrencia de la enfermedad y la presencia actual (OR= 2,9) y antigua (OR=5,0) de la lepra entre parientes co-sanguíneos. Sabiéndose que el examen único de los contactos en el acto del diagnóstico detecta una parcela mínima de los casos, se propone a la realización del examen periódico de los contactos de leprosos a fin de detectar los nuevos casos.

This case-control study aimed to identify individual risk factors regarding the transmission of leprosy. The group case represented by 90 cases of leprosy sick people pontificated at SINAN during 2003 and 2006 and a group control constituted by 270 healthy people, paired by gender and age. There was significant statistical between occurrence of the disease and its current presence (OR: 2,9) and old cases (OR= 5,0) of leprosy among co-sanguine relatives. Knowing that the only exam of the contact in the act of the diagnostic detects a minimum part of the new cases, it is proposed to execute periodical examinations of the contact of leprosy for detecting the new cases.

Estudio caso controle que objetivó identificar factores individuales del riesgo relacionados a transmisión de la enfermedad. El grupo caso, compuesto por 90 pacientes con lepra notificados en el SINAN entre 2003 y 2006; y el grupo controle, constituido por 270 individuos saludables, pareados por sexo y edad. Hubo asociación significativa entre la ocurrencia de la enfermedad y la presencia actual (OR= 2,9) y antigua (OR=5,0) de la lepra entre parientes co-sanguíneos. Sabiéndose que el examen único de los contactos en el acto del diagnóstico detecta una parcela mínima de los casos, se propone a la realización del examen periódico de los contactos de leprosos a fin de detectar los nuevos casos.

Estudo caso controle que objetivou identificar fatores individuais de risco relacionados à transmissão da doença. O grupo caso, composto por 90 pacientes de hanseníase notificados no SINAN entre 2003 e 2006; o grupo controle, constituído por 270 indivíduos sadios, pareados por sexo e faixa etária. Houve associação significativa entre a ocorrência da doença e a presença atual (OR= 2,9) e antiga (OR=5,0) de hanseníase entre parentes co-sangüíneos. Sabendo-se que o exame único dos contatos, no ato do diagnóstico, detecta uma parcela mínima dos casos, propõe-se a realização de exames periódicos dos contatos de hansenianos a fim de detectar os novos casos.