ABSTRACT OBJECTIVE This study aims to assess the degree of adequacy of prenatal care (PNC) in the state of Rio Grande do Sul (RS) and in its 7 macro-regions considering the time of PNC initiation and the number of appointments attended. It also aims to verify the mode of delivery prevalence and the factors associated with PNC adequacy by mode of delivery. METHODS Sub analysis from a cross-sectional study conducted among 13,432 childbearing women aged 15–49 years assisted in 66 maternity hospitals of the Unified Health System (SUS) and private associated facilities from September 2017 to October 2019. A standardized form was used to collect sociodemographic data, and information about PNC and delivery from the childbearing women’s prenatal cards, hospital records, and medical reports. RESULTS The PNC coverage was (98.4%), but only 57.5% of the participants had an adequate PNC defined as the one initiated until the 12th gestational week, with attendance of at least 6 appointments. The cesarean rate was 57.2%. Among women who performed vaginal delivery, multivariate analysis showed that for each 1-year increase in the age of the parturient, the chance of having an adequate PNC increased by 5%. White parturients with higher education and fewer deliveries residing in the macro-region of Valleys were more likely to have an adequate PNC when compared with non-white parturients, who were illiterate and/or had incomplete elementary school, with 3 or more deliveries and who resided in other macro-regions. During pregnancy, 96.0% of the women performed at least one anti-HIV test, 55.8% a rapid test for syphilis, and 75.0% a Venereal Disease Research Laboratory test (VDRL). CONCLUSIONS Despite the almost universal PNC coverage in RS, the PNC offered by the SUS was adequate for just half of the population, therefore public health policies targeted at women receiving care in this setting shall be revisited.

ABSTRACT OBJECTIVE This study aims to assess the degree of adequacy of prenatal care (PNC) in the state of Rio Grande do Sul (RS) and in its 7 macro-regions considering the time of PNC initiation and the number of appointments attended. It also aims to verify the mode of delivery prevalence and the factors associated with PNC adequacy by mode of delivery. METHODS Sub analysis from a cross-sectional study conducted among 13,432 childbearing women aged 15–49 years assisted in 66 maternity hospitals of the Unified Health System (SUS) and private associated facilities from September 2017 to October 2019. A standardized form was used to collect sociodemographic data, and information about PNC and delivery from the childbearing women’s prenatal cards, hospital records, and medical reports. RESULTS The PNC coverage was (98.4%), but only 57.5% of the participants had an adequate PNC defined as the one initiated until the 12th gestational week, with attendance of at least 6 appointments. The cesarean rate was 57.2%. Among women who performed vaginal delivery, multivariate analysis showed that for each 1-year increase in the age of the parturient, the chance of having an adequate PNC increased by 5%. White parturients with higher education and fewer deliveries residing in the macro-region of Valleys were more likely to have an adequate PNC when compared with non-white parturients, who were illiterate and/or had incomplete elementary school, with 3 or more deliveries and who resided in other macro-regions. During pregnancy, 96.0% of the women performed at least one anti-HIV test, 55.8% a rapid test for syphilis, and 75.0% a Venereal Disease Research Laboratory test (VDRL). CONCLUSIONS Despite the almost universal PNC coverage in RS, the PNC offered by the SUS was adequate for just half of the population, therefore public health policies targeted at women receiving care in this setting shall be revisited.

ABSTRACT BACKGROUND: Endometrial polyps are common in postmenopausal women, and the effect of tamoxifen use (a risk factor for endometrial polyps) on their pathogenesis is unclear. OBJECTIVES: To evaluate the expression of hormone receptors and markers for proliferation/apoptosis (Ki-67 and Bcl-2) in endometrial polyps in postmenopausal users and nonusers of tamoxifen. DESIGN AND SETTING: Cross-sectional analytical study in a tertiary-level academic hospital. METHODS: 46 women (14 tamoxifen users and 32 nonusers) with postmenopausal bleeding underwent hysteroscopic resection of endometrial polyps. Polyp samples were immunohistochemically assessed for detection of Ki-67, Bcl-2 and estrogen and progesterone receptors. RESULTS: Analysis on the glandular component of the polyps revealed progesterone receptor expression in the polyps of 96.9% of the nonusers of tamoxifen, and 92.3% of the tamoxifen users (P = 0.499). All polyps in nonusers and 92.3% of those in users were also positive for estrogen receptors (P = 0.295). Ki-67 was expressed in 75% of the polyps in the tamoxifen users and 82.8% of those in the nonusers. All endometrial polyps expressed Bcl-2. CONCLUSIONS: The immunohistochemical analysis on endometrial polyps demonstrated that, although tamoxifen is considered to be a risk factor for endometrial polyps, there were no significant differences in the expression of hormone receptors between users and nonusers of tamoxifen. There were no between-group differences in Ki-67 and Bcl-2 expression, and all patients displayed inhibition of apoptosis by Bcl-2, thus supporting the theory that polyps develop due to inhibition of apoptosis, and not through cell proliferation.

RESUMO Introdução: O conhecimento do comportamento sexual de risco entre jovens tem sido amplamente reconhecido como ferramenta-chave para controlar a propagação do HIV. Este artigo tem o objetivo de retratar o comportamento de risco dos conscritos do Exército brasileiro à infecção pelo HIV segundo as macrorregiões brasileiras. Métodos: Foram utilizados dados de 37.282 conscritos, entre 17 e 22 anos, durante apresentação ao Exército em 2016. Estimaram-se as prevalências de HIV autorreferida e medida por exame laboratorial, além de indicadores de comportamento de risco, por macrorregiões geográficas. Resultados: Dos conscritos que compuseram a amostra, 75% relatou já ter iniciado atividade sexual, e a média de idade de início foi de aproximadamente 15 anos. O uso do preservativo variou de acordo com o tipo de parceria sexual, sendo menor na relação com parceiros(as) fixos(as) e maior nas parcerias menos estáveis. A prevalência da infecção pelo HIV medida através do diagnóstico laboratorial foi de 0,12% no Brasil, sendo mais prevalente na região Norte (0,24%). O consumo de álcool e drogas ilícitas foi maior na região Sul. Discussão: O estudo permitiu observar o monitoramento do comportamento de risco à infecção pelo HIV entre os jovens brasileiros. O menor uso de preservativo quando a parceria sexual é considerada estável pode estar contribuindo para aumentar o número de indivíduos infectados pelo HIV. Conclusão: Os resultados sugerem a necessidade de campanhas de divulgação para os jovens sobre práticas de sexo seguro, além da ampliação da oferta de testagem nessa população.

ABSTRACT Introduction: Knowledge about risky sexual behavior among young people has been widely acknowledged as a key tool to controlling the spread of HIV. This article aimed at presenting the risk behavior of Brazilian Army conscripts toward HIV infection according to the country’s geographic regions. . Method: We collected data from 37,282 conscripts, aged 17 to 22, during enlistment in the Brazilian Army in 2016. The prevalence of HIV infection, both self-reported and measured through laboratory results, and risk behavior factors were estimated by region. Results: 75% of the sample of conscripts reported to have already started sexual activity, and the average age of their sexual initiation was 15. Condom use varied according to the type of sexual relationship, being lower among steady partners and greater among less stable relationships. HIV prevalence assessed by laboratory tests was 0.12% across the country and the highest prevalence was observed in the North region (0.24%). Alcohol and illicit drug usage was higher in the South region. Discussion: The study allowed the observation of risk behavior monitoring for HIV infection among young Brazilians. Lower condom usage among steady partners may be contributing to an increase in the number of HIV-infected individuals. Conclusion: Results suggest the need to intensify prevention campaigns to disseminate safe sex practices among young people, in addition to the expansion of testing offer to this population.

RESUMO Introdução: O conhecimento do comportamento sexual de risco entre jovens tem sido amplamente reconhecido como ferramenta-chave para controlar a propagação do HIV. Este artigo tem o objetivo de retratar o comportamento de risco dos conscritos do Exército brasileiro à infecção pelo HIV segundo as macrorregiões brasileiras. Métodos: Foram utilizados dados de 37.282 conscritos, entre 17 e 22 anos, durante apresentação ao Exército em 2016. Estimaram-se as prevalências de HIV autorreferida e medida por exame laboratorial, além de indicadores de comportamento de risco, por macrorregiões geográficas. Resultados: Dos conscritos que compuseram a amostra, 75% relatou já ter iniciado atividade sexual, e a média de idade de início foi de aproximadamente 15 anos. O uso do preservativo variou de acordo com o tipo de parceria sexual, sendo menor na relação com parceiros(as) fixos(as) e maior nas parcerias menos estáveis. A prevalência da infecção pelo HIV medida através do diagnóstico laboratorial foi de 0,12% no Brasil, sendo mais prevalente na região Norte (0,24%). O consumo de álcool e drogas ilícitas foi maior na região Sul. Discussão: O estudo permitiu observar o monitoramento do comportamento de risco à infecção pelo HIV entre os jovens brasileiros. O menor uso de preservativo quando a parceria sexual é considerada estável pode estar contribuindo para aumentar o número de indivíduos infectados pelo HIV. Conclusão: Os resultados sugerem a necessidade de campanhas de divulgação para os jovens sobre práticas de sexo seguro, além da ampliação da oferta de testagem nessa população.

ABSTRACT Introduction: Knowledge about risky sexual behavior among young people has been widely acknowledged as a key tool to controlling the spread of HIV. This article aimed at presenting the risk behavior of Brazilian Army conscripts toward HIV infection according to the country’s geographic regions. . Method: We collected data from 37,282 conscripts, aged 17 to 22, during enlistment in the Brazilian Army in 2016. The prevalence of HIV infection, both self-reported and measured through laboratory results, and risk behavior factors were estimated by region. Results: 75% of the sample of conscripts reported to have already started sexual activity, and the average age of their sexual initiation was 15. Condom use varied according to the type of sexual relationship, being lower among steady partners and greater among less stable relationships. HIV prevalence assessed by laboratory tests was 0.12% across the country and the highest prevalence was observed in the North region (0.24%). Alcohol and illicit drug usage was higher in the South region. Discussion: The study allowed the observation of risk behavior monitoring for HIV infection among young Brazilians. Lower condom usage among steady partners may be contributing to an increase in the number of HIV-infected individuals. Conclusion: Results suggest the need to intensify prevention campaigns to disseminate safe sex practices among young people, in addition to the expansion of testing offer to this population.

Abstract INTRODUCTION: Group B Streptococcus (GBS), a source of neonatal infection, colonizes the gastrointestinal and genitourinary tracts of pregnant women. Routine screening for maternal GBS in late pregnancy and consequent intrapartum antibiotic prophylaxis have reduced the incidence of early-onset GBS neonatal infection. The aim of this study was to evaluate the performance of PCR, compared to culture (gold standard), in GBS colonization screening of pregnant women, and to establish the prevalence of GBS colonization among this population. METHODS: Vaginal introitus and perianal samples were collected from 204 pregnant women, between the 35th and 37th weeks of pregnancy, at the Obstetrics and Gynecology Unit of the University of Caxias do Sul General Hospital between June 2008 and September 2009. All samples were cultured after enrichment in a selective medium and then assayed by culture and PCR methods. RESULTS: The culture and PCR methods yielded detection rates of vaginal/perianal GBS colonization of 22.5% and 26%, respectively (sensitivity 100%; specificity 95.6%; positive and negative predictive values 86.8% and 100%, respectively). A higher prevalence of GBS colonization was detected in the combined vaginal and perianal samples by both culture and PCR assay analyses. CONCLUSIONS: PCR is a faster and more efficient method for GBS screening, allowing for optimal identification of women who should receive intrapartum antibiotic prophylaxis to prevent newborn infection.

CONTEXTO E OBJETIVO: A osteoporose é uma alteração esquelética caracterizada pela redução e pela alteração da microarquitetura óssea, que resultam em aumento da fragilidade e maior predisposição a fraturas. A idade e a baixa massa óssea são os principais fatores de risco não modificáveis para fraturas osteoporóticas. Os fatores modificáveis incluem sedentarismo, inadequada ingestão de cálcio, excessivo consumo de álcool e/ou cafeína, tabagismo e baixo peso corporal. O objetivo foi avaliar associação entre baixa massa óssea e ingestão de cálcio e cafeína por mulheres climatéricas no Sul do Brasil. TIPO DE ESTUDO E LOCAL: Estudo transversal realizado em Porto Alegre e Canoas, Rio Grande do Sul, Brasil. MÉTODOS: Mulheres (n = 155) com idade média de 53,6 ± 9,5 anos foram avaliadas em um estudo transversal na região Sul do Brasil. Foram utilizados questionários de frequência alimentar, avaliação da massa óssea por ultrassonometria de calcâneo e avaliação antropométrica. RESULTADOS: A preval ência de sobrepeso foi de 67,7%. No rastreamento de massa óssea, 30,3% apresentou baixa massa óssea e 4,5%, osteoporose. A ingestão mediana de cálcio foi de 574,94 mg/dia e de cafeína foi de 108,11 mg/dia. Não foi encontrada associação entre massa óssea e os parâmetros antropométricos, ingestão de cálcio ou de cafeína. Verificou-se que 38,4% das mulheres apresentaram perda de massa óssea. CONCLUSÕES: Não foi encontrada associação entre a ingestão de cálcio e cafeína com a massa óssea. Foi observada alta prevalência de baixa massa óssea.

CONTEXT AND OBJECTIVE: Osteoporosis is a skeletal abnormality characterized by reduction and alteration of bone microarchitecture that results in increased fragility and greater predisposition to fractures. Age and low bone mass are the main non-modifiable risk factors for osteoporotic fractures. The modifiable factors include sedentary lifestyle, inadequate calcium intake, excessive alcohol and/or caffeine consumption, smoking and low body weight. The aim here was to evaluate the association between low bone mass and calcium and caffeine intake among perimenopausal women in Southern Brazil. DESIGN AND SETTING: Cross-sectional study conducted in Porto Alegre and Canoas, Rio Grande do Sul, Brazil. METHODS: Women (n = 155) of mean age 53.6 ± 9.5 years were evaluated through a cross-sectional study in Southern Brazil. Food frequency questionnaires, bone mass evaluation using calcaneal ultrasound and anthropometric assessment were used. RESULTS: The prevalence of overweight was 67.7%. In the bone mass screening, 30.3% had low bone mass and 4.5% had osteoporosis. The median calcium intake was 574.94 mg/day and the caffeine intake was 108.11 mg/day. No association was found between bone mass and anthropometric parameters, calcium intake or caffeine intake. It was found that 38.4% of the women had low bone mass. CONCLUSIONS: No association was found between calcium and caffeine intake and bone mass. High prevalence of low bone mass was observed.

A mortalidade infantil é um sensível indicador de saúde. Conhecer o seu perfil geográfico auxilia na formulação de estratégias de saúde pública. O mapeamento de doenças tem por objetivo descrever a distribuição geográfica das taxas de mortalidade ou incidência de doenças por intermédio de mapas. Em razão da alta instabilidade das taxas brutas quando há pequenas áreas, utilizam-se os métodos de suavização bayesiana, que se valem de informações de toda a região ou da vizinhança para estimar as taxas. O artigo faz a comparação entre os métodos Bayesiano Empírico e Totalmente Bayesiano para as taxas de mortalidade infantil (dados acumulados de 2001 a 2004) no Rio Grande do Sul, Brasil. O trabalho aponta as vantagens do uso dos estimadores bayesianos na visualização espacial dos mapas. Os métodos Bayesianos Empíricos apresentaram resultados muito semelhantes aos dos métodos Totalmente Bayesianos e possuem a grande vantagem de ser de fácil utilização por profissionais da área de saúde, destacando igualmente os principais padrões espaciais da taxa de mortalidade no Rio Grande do Sul no período estudado.

Infant mortality is considered a sensitive health indicator, and knowledge of its geographical profile is essential for formulating appropriate public health policies. Disease mapping aims to describe the geographical distribution of disease incidence and mortality rates. Due to the heavy instability of crude rates in small areas, methods involving Bayesian smoothing of rates are used, drawing on information for the whole area or neighborhood to estimate the event rate. The current study compares empirical Bayesian (EB) and fully Bayesian (FB) methods for infant mortality rates (accumulated data from 2001 to 2004) in Rio Grande do Sul State, Brazil. This study highlights the advantages of Bayesian estimators for viewing and interpreting maps. For the problem at hand, EB and FB methods showed quite similar results and had the great advantage of easy use by health professionals, since they evenly highlight the main spatial patterns in the mortality rate in the State during the target period.

A mortalidade infantil é um sensível indicador de saúde. Conhecer o seu perfil geográfico auxilia na formulação de estratégias de saúde pública. O mapeamento de doenças tem por objetivo descrever a distribuição geográfica das taxas de mortalidade ou incidência de doenças por intermédio de mapas. Em razão da alta instabilidade das taxas brutas quando há pequenas áreas, utilizam-se os métodos de suavização bayesiana, que se valem de informações de toda a região ou da vizinhança para estimar as taxas. O artigo faz a comparação entre os métodos Bayesiano Empírico e Totalmente Bayesiano para as taxas de mortalidade infantil (dados acumulados de 2001 a 2004) no Rio Grande do Sul, Brasil. O trabalho aponta as vantagens do uso dos estimadores bayesianos na visualização espacial dos mapas. Os métodos Bayesianos Empíricos apresentaram resultados muito semelhantes aos dos métodos Totalmente Bayesianos e possuem a grande vantagem de ser de fácil utilização por profissionais da área de saúde, destacando igualmente os principais padrões espaciais da taxa de mortalidade no Rio Grande do Sul no período estudado.

Infant mortality is considered a sensitive health indicator, and knowledge of its geographical profile is essential for formulating appropriate public health policies. Disease mapping aims to describe the geographical distribution of disease incidence and mortality rates. Due to the heavy instability of crude rates in small areas, methods involving Bayesian smoothing of rates are used, drawing on information for the whole area or neighborhood to estimate the event rate. The current study compares empirical Bayesian (EB) and fully Bayesian (FB) methods for infant mortality rates (accumulated data from 2001 to 2004) in Rio Grande do Sul State, Brazil. This study highlights the advantages of Bayesian estimators for viewing and interpreting maps. For the problem at hand, EB and FB methods showed quite similar results and had the great advantage of easy use by health professionals, since they evenly highlight the main spatial patterns in the mortality rate in the State during the target period.

Neste artigo são analisados os fatores possivelmente associados à mortalidade infantil nos 496 municípios do Rio Grande do Sul, Brasil, com base em dados acumuladas entre os anos de 2001 a 2004, obtidos pela análise de regressão utilizando modelagem inteiramente bayesiana como alternativa para superar a autocorrelação espacial e a instabilidade dos estimadores clássicos, como a taxa bruta e a SMR (Standardised Mortality Ratio). Foram comparadas diferentes especificações de componente espacial e covariáveis, provenientes dos blocos do Índice de Desenvolvimento Sócio-econômico da Fundação de Economia e Estatística (IDESE/FEE-2003). Verificou-se que o modelo que utiliza a estrutura espacial além da covariável educação apresenta melhor desempenho, quando comparado pelo critério DIC (Deviance Information Criterion). Comparando as estimativas das SMR com os riscos relativos obtidos pela modelagem inteiramente bayesiana, foi possível observar um ganho substancial na interpretação e na detecção de padrões de variação do risco de mortalidade infantil nos municípios do Rio Grande do Sul ao utilizar essa modelagem. A região da Serra Gaúcha destacou-se com baixo risco relativo e estimativas muito homogêneas.

The infant mortality rate is one of the key indicators used to measure a population's quality of life. The State of Rio Grande do Sul has a social and economic indicator called the Socioeconomic Development Index (IDESE). Most studies analyze the infant mortality rate in relation to risk factors, visually aided by maps. This study presents the methodology and an application of a Spatial Epidemiology method called the ecological correlation, using hierarchical Bayesian procedures. The article discusses the main problems found in ecological correlations, such as spatial autocorrelation and the estimator's instability for small areas. To overcome these difficulties, the relative risk estimate obtained by spatial regression analysis using fully Bayesian estimation is presented. The infant mortality rate is analyzed in all 496 municipalities of Rio Grande do Sul for the years 2001 to 2004. Several models with spatial component and different variables from the IDESE/2003 were compared. The model using spatial structure along with the variable "education" was considered the best choice. With this methodology, it was possible to obtain a more interpretable pattern of infant mortality risk in Rio Grande do Sul.

Neste artigo são analisados os fatores possivelmente associados à mortalidade infantil nos 496 municípios do Rio Grande do Sul, Brasil, com base em dados acumuladas entre os anos de 2001 a 2004, obtidos pela análise de regressão utilizando modelagem inteiramente bayesiana como alternativa para superar a autocorrelação espacial e a instabilidade dos estimadores clássicos, como a taxa bruta e a SMR (Standardised Mortality Ratio). Foram comparadas diferentes especificações de componente espacial e covariáveis, provenientes dos blocos do Índice de Desenvolvimento Sócio-econômico da Fundação de Economia e Estatística (IDESE/FEE-2003). Verificou-se que o modelo que utiliza a estrutura espacial além da covariável educação apresenta melhor desempenho, quando comparado pelo critério DIC (Deviance Information Criterion). Comparando as estimativas das SMR com os riscos relativos obtidos pela modelagem inteiramente bayesiana, foi possível observar um ganho substancial na interpretação e na detecção de padrões de variação do risco de mortalidade infantil nos municípios do Rio Grande do Sul ao utilizar essa modelagem. A região da Serra Gaúcha destacou-se com baixo risco relativo e estimativas muito homogêneas.

The infant mortality rate is one of the key indicators used to measure a population's quality of life. The State of Rio Grande do Sul has a social and economic indicator called the Socioeconomic Development Index (IDESE). Most studies analyze the infant mortality rate in relation to risk factors, visually aided by maps. This study presents the methodology and an application of a Spatial Epidemiology method called the ecological correlation, using hierarchical Bayesian procedures. The article discusses the main problems found in ecological correlations, such as spatial autocorrelation and the estimator's instability for small areas. To overcome these difficulties, the relative risk estimate obtained by spatial regression analysis using fully Bayesian estimation is presented. The infant mortality rate is analyzed in all 496 municipalities of Rio Grande do Sul for the years 2001 to 2004. Several models with spatial component and different variables from the IDESE/2003 were compared. The model using spatial structure along with the variable "education" was considered the best choice. With this methodology, it was possible to obtain a more interpretable pattern of infant mortality risk in Rio Grande do Sul.