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SUMMARY OBJECTIVE: Violence in the workplace has been an alarming phenomenon around the world. The aim of this study was to analyze the frequency of violence against health personnel in urgent and emergency departments, before and during the COVID-19 pandemic. METHODS: This is an exploratory cross-sectional study including a structured online survey with the approval of the Research Ethics Committee. The sample was composed of health personnel over 18 years old who work in urgent and emergency departments. The survey was structured with sections: sociodemographic data, detailing of occupational data, and a survey of physical, verbal, sexual, and racial violence. Descriptive statistics included absolute frequencies and percentages for categorical variables and means with standard deviation for continuous variables. RESULTS: A total of 114 participants, aged between 20 and 60 years, answered the questionnaire; 68.4% of them were women. Most of them were white (71.9%), married or living with a partner (70.2%), residing in the south or southeast regions (85.1%) of Brazil, 56.1% doctors, 11.4% nurses, and 12.3% nursing technicians. The incidence of violence before the COVID-19 pandemic was 60%. During the pandemic, the incidence suffered low variation, being 57.9%. Only 37.7% said that their workplace offers some procedure/routine to report acts of violence suffered at work. Verbal violence was the most reported among the participants. Anxiety, tiredness, fear, low self-esteem, loss of concentration, and stress are the most frequent consequences of aggression. CONCLUSION: Our results suggest that the COVID-19 pandemic did not potentiate the episodes of violence; however, episodes of violence continue to occur, and so management and prevention measures must be implemented.

Resumo Objetivo Analisar tendência e os impactos causados pela regionalização nos atendimentos de emergência por causas externas efetuados pelo Serviço de Atendimento Móvel de Urgência (SAMU), antes, durante e depois do processo de regionalização. Métodos Estudo ecológico de tendência dos atendimentos do SAMU. Os períodos foram separados em 2010 a 2012 (pré-regionalização), 2013 a 2015 (transição) e 2016 a 2018 (consolidação). Foram coletadas as variáveis causas do atendimento, dia da semana, horário, local da ocorrência, recurso encaminhado e caracterização da vítima (sexo, idade, uso de álcool e desfecho do atendimento) totalizando 17.533 ocorrências. Foram excluídos os atendimentos que não se classificaram como causas externas. Foram realizadas estatística descritiva, tendência e teste de associação do qui-quadrado. Adotou-se nível de significância de 5% (p-valor ≤0,001). Resultados A maioria das vítimas era do sexo masculino, com maior prevalência na faixa etária de 30 a 59 anos. Houve diminuição do óbito no local de 41,7% após a regionalização. Observou-se aumento de atendimento de causas externas nas ambulâncias de Suporte Básico de Vida no ano de 2015 em relação a 2010 (47%), além de diminuição de aproximadamente 50% do número de atendimentos do Suporte Avançado de Vida. O número de atendimento conjunto das duas ambulâncias aumentou aproximadamente 390%. Conclusão A regionalização apresentou impacto importante na qualidade dos atendimentos prestados à população, resultando na diminuição da mortalidade no local da ocorrência.

RESUMO Objetivos: analisar as tendências da mortalidade por câncer colorretal em mulheres no Brasil, Estados e Regiões. Métodos: estudo ecológico, de séries temporais, com análise de tendência dos óbitos por câncer colorretal de mulheres, no período de 2008 a 2019. Para análise de tendência, foi utilizado o modelo de regressão polinomial. Resultados: analisaram-se 48.225 óbitos de mulheres por câncer colorretal. Houve tendência crescente da mortalidade em mulheres brasileiras, com diferenças regionais, em razão das desigualdades nos padrões socioeconômicos, políticos e culturais. Destacando um aumento na Região Sul, com as maiores taxas, de 7,32 em 2008 para 8,65 em 2019, seguida pela Região Sudeste, com taxas de mortalidade por câncer colorretal de 6,72 e 9,05 em 2008 e 2019, respectivamente. Conclusões: observa-se um aumento das taxas de mortalidade por câncer colorretal, demonstrando a necessidade do incremento das políticas públicas direcionadas às estratégias de rastreamento e diagnóstico precoce do câncer colorretal em mulheres.

Objectives: to analyze the ergonomics of two models of breastfeeding bras. Methods: descriptive study carried out with 152 infants in a Brazilian university hospital. The prototypes were separated into two groups (A and B). To compare the two bra models, the Odds Ratio (OR) was used as a measure of the strength of the association. In subjective perceptions, the Modified Borg Scale, and the chi-square test of independence (χ2) were used. To compare the two prototypes, the Z test and logistic regression analysis were performed. A significance level of 5% was considered. Results: the bra in group B was more suitable for ergonomics of physical and psycho-aesthetic comfort than the bra in group A (p < 0.0001), according to the logistic regression tests. Conclusions: modeling B was ergonomically adequate, with usability and evaluation criteria centered on breastfeeding women. RESUMEN Objetivos: analizar la ergonomía de dos modelados de sostén para lactancia materna. Métodos: estudio descriptivo realizado con 152 lactantes en un hospital universitario brasileño. Los prototipos fueron separados en dos grupos (A y B). Para comparar los dos modelados de sostén, fue utilizado la Odds Ratio (OR) como una medida de intensidad de la asociación. En las percepciones subjetivas, se utilizaron la Escala de Borg Modificada y el test chi-cuadrado de independencia (χ2). Para comparar los dos prototipos, se realizó el test Z y análisis de regresión logística. Se consideró un nivel de significación de 5%. Resultados: el sostén del grupo B fue el más adecuado para ergonomía de conforto físico y psicoestético del que el del grupo A (p < 0,0001), segundo los testes de regresión logística. Conclusiones: el modelado B fue ergonómicamente adecuado, con criterios de usabilidad y evaluación centrada en las lactantes. RESUMO Objetivos: analisar a ergonomia de duas modelagens de sutiãs para amamentação. Métodos: estudo descritivo realizado com 152 lactantes em um hospital universitário brasileiro. Os protótipos foram separados em dois grupos (A e B). Para comparar as duas modelagens de sutiãs, foi utilizado a Odds Ratio (OR) como uma medida de intensidade da associação. Nas percepções subjetivas, utilizaramse a Escala de Borg Modificada e o teste qui-quadrado de independência (χ2). Para comparar os dois protótipos, realizou-se o teste Z e análise de regressão logística. Considerou-se um nível de significância de 5%. Resultados: o sutiã do grupo B foi o mais adequado para ergonomia de conforto físico e psicoestético do que o do grupo A (p < 0,0001), segundo os testes de regressão logística. Conclusões: a modelagem B foi ergonomicamente adequada, com critérios de usabilidade e avaliação centrada nas lactantes.

Introduction: The COVID-19 pandemic stressed the importance of healthcare personnel. However, there is evidence of an increase in violence against them, which brings consequences, such as anxiety. The aim of this study was to analyze the anxiety levels of health professionals who have or not suffered violence during the COVID-19 pandemic, and verify the variables associated with the risk of starting to take medication for anxiety.Methods: We assessed the anxiety profile of health professionals in Brazil through an online questionnaire, using the Generalized Anxiety Disorder 7-item Scale (GAD-7), in relation to groups of participants who have or not suffered violence during the COVID-19 pandemic. We used Cronbach's alpha reliability coefficient to check the consistency of the responses, and the effect size using the r coefficient. Principal Component Analysis was used to verify the differences in anxiety scores between the two groups. Logistic regression analysis was also used to verify the variables associated with the risk of starting medication for anxiety and considered statistically significant when p < 0.05.Results: A total of 1,166 health professionals participated in the study, in which 34.13% had a normal anxiety profile, 40.14% mild, 15.78% moderate, and 9.95% severe. The mean score of the sum of the GAD-7 was 7.03 (SD 5.20). The group that suffered violence had a higher mean (8.40; SD 5.42) compared to the group that did not (5.70; SD 4.60). In addition, the median between both groups was significantly different (7.0 vs. 5.0; p < 0.01). Approximately 18.70% of the participants reported having started taking medication to treat anxiety during the pandemic. The factors that increased the chances of these professionals starting medication for anxiety p < 0.05 were having suffered violence during the pandemic (OR 1.97; 95% CI 1.42–2.77), being nurses (OR 1.61; 95% CI 1.04–2.47) or other types of health professionals (OR 1.58; 95% CI 1.04–2.38), and having a mild (OR 2.11; 95% CI 1.37–3.34), moderate (OR 4.05; 95% CI 2.48–6.71) or severe (OR 9.08; 95% CI 5.39–15.6) anxiety level.Conclusion: Brazilian healthcare professionals who have suffered violence during the pandemic have higher anxiety scores and higher risk to start taking anxiety medication.

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Objective: to analyze the trend of hospitalization rates and mortality due to Diabetes Mellitus in children and adolescents in Brazil. Method: temporal series study, hospitalization rates and diabetes mortality in children and adolescents. Data were obtained from the Hospital Information System and Mortality Information System, from 2005-2015, with analysis performed by polynomial regression modeling. Results: 87,100 hospitalizations and 1,120 deaths from diabetes were analyzed. Hospitalizations rates increased for both genders and all age groups, with an increase for adolescents aged 10-14 years. The mortality rate declined, except for the 15-19-year age group. In the overall mortality trend in Brazil, the South and Southeast showed a decrease, whereas for hospitalizations only the Center-West remained constant, while the others increased. Conclusion: however, there was a decrease in infant mortality and increase in hospitalizations.

Objective To analyze the diagnostic accuracy of predictive models of breast cancer risk for the Brazilian population. Method A cross-sectional, study was conducted in a sample of 382 women aged 35-69 years who were users of the Unified Health System (SUS) residing in a municipality in southern Brazil. Results The results showed that the Tyrer-Cuzick model had the highest mean risk values and estimates (proportion) for predicting the 5-year risk of breast cancer, reaching a maximum risk of ±1.63% in the 60-64 year age group. For the 90-year risk, a maximum risk of ±12.8% was predicted for the 50-54 year age group using this model. The 5-year risk calculated by the three tools increased progressively with increasing age, where the mean risk was ±0.8% in women aged 35-39 and reached ±1.50% in women aged 65-69. The 90-year risk declined with increasing age only in the Tyrer-Cuzick model, from ±10.8% to ±9%. The BRCAPRO model presented a greater sensitivity compared to the Gail and Tyrer-Cuzick models. And, the model that presented greater specificity was Gail. Conclusion The Tyrer-Cuzick model presented the highest risk estimates for 5 years and 90 years in the studied population, however, this data is not enough to validate this tool, since when analyzing the sensitivity and specificity the BRCAPRO and Gail have the highest values respectively.

Objetivo: Analisar a violação dos direitos das crianças e adolescentes no estado do Paraná, no período de 2009 a 2015. Método: Estudo descritivo, retrospectivo de corte transversal, com técnicas de análise espacial. Os dados foram coletados junto ao Sistema de Informação para a Infância e Adolescência (SIPIA). Realizada a distribuição espacial da violação dos direitos, através do software GeoDa versão 0.9.5-i. Calculada a autocorrelação espacial, utilizando o índice (I) de Moran global (univariado e bivariado) e realizados Mapas coropléticos. Resultados: A família nuclear foi o agente violador predominante (88,67%), e o principal direito violado foi à convivência familiar e comunitária, com 41,02% dos episódios. A análise univariada mostrou autocorrelação positiva. Os “clusters” alto-alto e baixo-alto da criança e do adolescente, se concentraram na região Sul e Centro Oeste. Houve significância entre as taxas de violação dos direitos e as variáveis socioeconômicas: analfabetismo, Gini, renda e grau de urbanização. Conclusão: A violação dos direitos das crianças e adolescentes está presente na sociedade paranaense. Observaram-se ainda dificuldades e fragilidades do Sistema de Informação para a Infância e Adolescência (SIPIA) e a subnotificação em muitos municípios mesmo com a presença dos Conselhos Tutelares.

Objetivo: Avaliar o comportamento da COVID-19 em municípios de pequeno porte. Métodos: Estudo transversal, retrospectivo, com dados de fichas de notificação do sistema Notifica COVID-19 da 14° Regional de Saúde do estado do Paraná, entre março de 2020 e maio de 2021, após os dados foram analisados em planilhas eletrônicas, com cálculo de prevalência e incidência. O projeto foi aprovado pelo Comitê de Ética em Pesquisa. Resultados: Das 86.848 fichas analisadas, 21.061 eram pacientes com diagnóstico positivo para COVID-19. Destes, 16.114 eram pacientes recuperados, 4.504 com doença ativa e 443 óbitos. Quanto à incidência de casos, maiores em 2021, nos meses de fevereiro, março e maio. Os óbitos ocorreram em maiores de 20 anos, 42% tinham comorbidades, destacando-se: Hipertensão arterial, Diabetes Mellitus e Obesidade. Conclusões: A regional analisada, mesmo não sendo uma das mais populosas, apresentou prevalência, incidência e mortalidade e o estudo contribuiu para alertar as autoridades sanitárias no controle de transmissão e intensificação das restrições.

Objetivo: Analisar os fatores que permeiam o processo de doação de órgãos e tecidos para transplantes em crianças e adolescentes. Métodos: Trata-se de uma pesquisa descritiva, transversal, retrospectiva acerca da doação de órgãos e tecidos para transplantes em crianças e adolescentes que foram a óbito no estado do Paraná, Sul do Brasil, no período de janeiro de 2011 a dezembro de 2015. Resultados: Foram analisados relatórios de 302 crianças e adolescentes, sendo 216 (71,6%) óbitos por morte encefálica e 86 (28,4%), por parada cardiorrespiratória. A causa de óbito mais frequente entre os não doadores de órgãos em crianças e adolescentes foi a neurológica 139 (89,6%) destes, 81 (53,3%) foram causadas por traumatismo crânio encefálico. Foram empregadas a estatística descritiva e tabelas de contingência utilizando teste qui-quadrado ou teste exato de Fisher. Conclusão: A recusa familiar foi responsável por grande parte das não doações de órgãos de tecidos para transplantes e esteve ligada a motivos religiosos e à não compreensão do diagnóstico de morte encefálica.

Global suicide rates have increased in recent decades becoming a serious social and public health problem. In Brazil, rates have been increasing annually. We aimed to analyze the correlation between suicide mortality rates and global economic and political crisis periods of 2008 and 2014 in Brazil. The analysis of suicide mortality in Brazil was done using a time-series segmented linear regression model that estimated the trend of rates over time. To obtain the model, changes in the trend of both abrupt and gradual suicide rates were investigated. The results indicate statistically significant changes showing an upward trend of suicide rates during the world economic crisis (2008-2013) and during the economic and political crisis in Brazil (2014-2017) compared to previous periods, especially at the extremes of schooling (3 8 years). Among white and parda, there were significant trend rates increases in both periods and in different regions. In the Northeast and South regions, we observed a significant increase in the trend rate for males after the Brazilian economic and political crisis (2014 to 2017). We can conclude that the national suicide rates were influenced by the economic and political instability that our country has been going through since 2008, affecting each region differently. Further studies are needed to explore the reasons for interregional differences and the relation of suicide with unemployment rates and possible economic predictors., Highlights • Both groups, with low and high educational level, became vulnerable in the face of a financial crisis. • Race characteristics represented risk factors for suicide in economic downturns times. • Males showed an increasing trend in suicide rates after economic and political crisis times. • Socioeconomic difficulties might contribute to rising suicide rates.

Objective: To analyze the management of bullying by the managers of elementary schools. Methods: Descriptive, exploratory research carried out through semi-structured interviews with 17 school counselors from a city in the South of Brazil, randomly selected from different geographical sectors. The interviews were recorded with participants’ consent and, after transcription and checking, were discarded. The interviews covered the following subjects: sociodemographic characterization of subjects, school functioning, comprehension, recognition and management of bullying cases by counselors. Data analysis was performed using the Bayesian network associated with content analysis. Results: The majority of subjects were females, between 30 and 50 years old. Fifteen subjects were graduated in pedagogy, and all had postgraduate degrees. Most of them worked as counselor for less than three years. Only two subjects, between 30 and 50 years old, understood the term bullying. Case recognition was lower in this age group. Having a degree influenced positively the recognition of bullying. The higher the number of students in the school, the lower the recognition of cases by managers. All subjects managed cases by addressing children, families, staff, and involving professionals and support groups. Conclusions: The understanding and recognition of bullying was given by a few interviewees. All managers reported similar management actions in the cases. Given the scarcity of studies on bullying management in schools, more studies in this area could improve the approach of cases and contribute to their reduction.

Objective: Analyze the number of discards of organs and tissues from patients with Brain Death in the state of Paraná and estimate the financial costs for the health system. Methods: Exploratory cross-sectional retrospective study. All deaths occurred in the state of Paraná, Brazil, from 2011 to 2015. Results: A total of 1,013 patients were studied; the number of donors for single organs was 1,013, and the number of donors for paired tissues/organs was 2,026. Approximately 34.5% of transplant costs were associated with discards. Discards of corneas (30.0%) and eyeballs (93.5%) increased over the course of the study period. Heart, lung, and pancreas discards remained relatively stable. There was a 100% increase in liver discards, and the number of discarded kidneys increased from 9 in 2011 to 60 in 2015. The heart had the lowest discard percentage (0.8%). Conclusion: Discards of corneas and eyeballs were high, especially in older age groups, suggesting that procurement could have been avoided. Liver and kidney discards increased considerably. Studies of this nature should be carried out to evaluate the quality and effectiveness of the donation and transplantation processes, as well as the outcomes in terms of financial costs to the public system.

Introdução: A população brasileira passa por intenso envelhecimento e consequente aumento de multimorbidade impactando os serviços de saúde. Em 2011 o Ministério da Saúde criou o programa “Melhor em Casa” com o intuito de promover o internamento domiciliar como possibilidade de expandir leitos hospitalares ao domicílio do cliente e assim, humanizar o atendimento e diminuir custos. Objetivos: Analisar internamentos domiciliares do Sistema Único de Saúde (SUS) no período de 2008-2019 e correlacionar com custo de internação, variáveis clínicas e epidemiológicas. Método: Estudo quantitativo baseado em dados do Sistema de Internação Hospitalar do Sistema Único de Saúde (SIH/SUS) no período de 2008 a 2019, disponíveis na plataforma eletrônica do Departamento de Informática do SUS (DATASUS). Para análise de tendência foi utilizado o teste de Mann-Kendall e para análise do efeito de intervenção foram ajustados modelos ARIMA, considerando os dados de 2008-2011 sem intervenção e de 2012-2019 com intervenção. Resultados: Houve tendência crescente no número de internamentos domiciliar de 2008 a 2019 ( =0,152 e p=0,537), assim como do custo médio por internamento ( =0,061 e p=0,837) e do sexo feminino sobre o masculino ( =0,606 e p =0,007). Houve tendência decrescente da média de dias por internamento ( =-0,576 e p=0,011) e da taxa de mortalidade ( =0,212 e p=0,373). Conclusão: com custo inferior a 10% do valor diário de um internamento hospitalar, a atenção domiciliar diminui mortalidade e média de dias de internamento. Portanto, com o envelhecimento populacional, programas de internamento domiciliar como o “Melhor em Casa” tornam-se fundamentais.

BACKGROUND Gestational trophoblastic disease is a pregnancy anomaly that represents a series of invasive diseases that can metastasize or lead to death. Risk factors are genetic, racial, nutritional, and social. OBJECTIVE Analyze the number of cases of gestational trophoblastic disease, the incidence and risk factor among all patients hospitalized in Brazil from 2012 to 2017. METHODS Data collected from all hospitalizations across Brazil for hospitalized by gestational trophoblastic disease from 2012 to 2017. The incidences were calculated based on data from live births and mortality with data obtained from the Brazilian public health system. Risk factor were statistically analyzed based in race, region and age of the patients. RESULTS There were 20,534 cases of gestational trophoblastic disease with an incidence of 1.17 per 1000 live births in this period. The highest incidence was among “Asians” race (3.73 per 1000 live births; P CONCLUSIONS The incidence found was similiar to North America and Europe. A higher incidence among "Asian" race and confirmation of higher incidence in the young and older women.

Objetivo: Analisar a tendência de mortalidade por suicídio de idosos no Paraná, na região noroeste do estado e cidade de Maringá. Métodos: estudo ecológico de séries temporais. Foram avaliados óbitos por suicídio no período de 2009 a 2018. Os dados foram coletados do Sistema de Informação sobre Mortalidade do Departamento de Informática do Sistema Único de Saúde. Resultados: entre 2009 e 2018 houve 1113 óbitos por suicídio no estado,165 na região noroeste e 23 em Maringá. A mortalidade por suicídio mostrou tendência crescente no Estado nas faixas de 60-69 e 70-79 anos e constante na faixa de 80 anos e mais. Na região noroeste a tendência foi crescente para as faixas de 60- 69 e 70- 79 anos e decrescente em 80 anos e mais. Em Maringá a tendência foi decrescente em todas as faixas etárias. Conclusão: Não houve padrão uniforme nas tendências de suicídio de idosos nas regiões estudadas.

Brazil is in a critical situation due to the COVID-19 pandemic. Healthcare workers that are in the front line face challenges with a shortage of personal protective equipment, high risk of contamination, low adherence to the social distancing measures by the population, low coronavirus testing with underestimation of cases, and also financial concerns due to the economic crisis in a developing country. This study compared the impact of COVID-19 pandemic among three categories of healthcare workers in Brazil: physicians, nurses, and dentists, about workload, income, protection, training, feelings, behavior, and level of concern and anxiety. The sample was randomly selected and a Google Forms questionnaire was sent by WhatsApp messenger. The survey comprised questions about jobs, income, workload, PPE, training for COVID-19 patient care, behavior and feelings during the pandemic. The number of jobs reduced for all healthcare workers in Brazil during the pandemic, but significantly more for dentists. The workload and income reduced to all healthcare workers. Most healthcare workers did not receive proper training for treating COVID-19 infected patients. Physicians and nurses were feeling more tired than usual. Most of the healthcare workers in all groups reported difficulties in sleeping during the pandemic. The healthcare workers reported a significant impact of COVID-19 pandemic in their income, workload and anxiety, with differences among physicians, nurses and dentists.

Ovarian cancer is the eighth cause of death by cancer in women worldwide. The objective of this study was to analyze trends in the Brazilian ovarian cancer mortality and the relation to age, schooling, and race. Data was collected in the Brazilian Mortality Information System (SIM), from 2006 to 2016. The polynomial regression model was used for the trends analysis, a significant trend was considered when the estimated model obtained a p-value

Introdução: A violência praticada por parceiro íntimo refere-se ao comportamento de parceiros ou ex-parceiros íntimos que resulta em dano físico, sexual ou psicológico, incluindo agressão física, coerção sexual, abuso psicológico e comportamento controlador. Sabe-se que o etilismo está associado ao aumento de tal violência. Objetivo: Analisar se a acompanhante do paciente em abstinência alcoólica referia menor índice de violência nesse período em relação ao tempo em que o mesmo fazia abuso de álcool. Métodos: Estudo observacional transversal no qual foram selecionados homens ex-etilistas atendidos no CAPSad de Maringá e suas parceiras. Foi utilizado um questionário para violência contra parceiro (HITS) composto de 4 perguntas objetivas, cuja pontuação varia de 4 até 20. Valores iguais ou superiores a 10 indicam violência. Resultados: Foram entrevistadas 53 mulheres de diversas faixas etárias e escolaridades. Desse total, 84,9% das participantes apresentaram pontuações menores no teste com o parceiro em abstinência em relação ao período em que o mesmo estava em uso/abuso de álcool. Das mulheres 15,1% não notaram diferença no nível de violência do acompanhante, estivesse ele em uso ou em abstinência alcoólica. Conclusões: Demonstrou-se claramente que o fato de cessar o consumo de bebidas alcoólicas reduziu o índice de violência infligida pelo parceiro.

Objective: To conduct a geospatial analysis of suicide deaths among young people in the state of Paraná, southern Brazil, and evaluate their association with socioeconomic and spatial determinants. Methods: Data were obtained from the Mortality Information System and the Brazilian Institute of Geography and Statistics. Data on suicide mortality rates (SMR) were extracted for three age groups (15-19, 20-24, and 25-29 years) from two 5-year periods (1998-2002 and 2008-2012). Geospatial data were analyzed through exploratory spatial data analysis. We applied Bayesian networks algorithms to explore the network structure of the socioeconomic predictors of SMR. Results: We observed spatial dependency in SMR in both periods, revealing geospatial clusters of high SMR. Our results show that socioeconomic deprivation at the municipality level was an important determinant of suicide in the youth population in Paraná, and significantly influenced the formation of high-risk SMR clusters. Conclusion: While youth suicide is multifactorial, there are predictable geospatial and sociodemographic factors associated with high SMR among municipalities in Paraná. Suicide among youth aged 15-29 occurs in geographic clusters which are associated with socioeconomic deprivation. Rural settings with poor infrastructure and development also correlate with increased SMR clusters.

Cancer patients are at higher risk for the development of COVID-19 disease in its most severe form. Objective: to analyze mortality from breast cancer associated with COVID-19 in Brazilian women. Methodology: This is a quantitative study. Data were collected on the Open Data SUS website, from January to August 2020. Descriptive statistics were used for data analysis. Results: breast cancer associated with COVID-19 caused 69 deaths in this period, the ages with the highest number of deaths were in the age ranges 45-49 (14.5%), 60-64 (14.5%) and 65-69 years (14.5%). Regarding race, (56.52%) were white, followed by brown (31.88%). Only (31.88%) had 8 years or more of education and (49.27%) were married. Regarding the underlying cause of death, he presented ICD B34.2 (Infection by Coronavirus of unspecified location) in greater numbers, with a frequency of 52 (75.36%) and ICD C50.9 (Malignant breast cancer, unspecified) had a frequency of 17 (24.64%). The city with the highest number of deaths from breast cancer associated with COVID-19, which reached 14 (20.29%) of cases, was Rio de Janeiro (RJ), followed by the city of São Bernardo do Campo (SP) with 5 (7.25 %). Conclusion: The increase in breast cancer mortality during the COVID-19 pandemic in Brazil can be attributed to the immunosuppression of these women and the COVID-19 coping measures, which reduced the demand for health care, access and availability of diagnostic services. Los pacientes con cáncer tienen un mayor riesgo de desarrollar la enfermedad COVID-19 en su forma más grave. Objetivo: analizar la mortalidad por cáncer de mama asociado a COVID-19 en mujeres brasileñas. Metodología: Este es un estudio cuantitativo. Los datos se recopilaron en el sitio web Open Data SUS, de enero a agosto de 2020. Se utilizaron estadísticas descriptivas para el análisis de los datos. Resultados: el cáncer de mama asociado a COVID-19 causó 69 muertes en este período, las edades con mayor número de muertes se ubicaron en los rangos de edad 45-49 (14.5%), 60-64 (14.5%) y 65-69 años ( 14,5%). En cuanto a la raza, (56,52%) eran blancos, seguidos de los morenos (31,88%). Solo (31,88%) tenía 8 años o más de educación y (49,27%) estaban casados. En cuanto a la causa subyacente de muerte, presentó la CIE B34.2 (Infección por Coronavirus de ubicación no especificada) en mayor número, con una frecuencia del 52 (75,36%) y la CIE C50.9 (Cáncer maligno de mama, no especificado) tuvo una frecuencia de 17 (24,64%). La ciudad con mayor número de muertes por cáncer de mama asociado a COVID-19, que alcanzó el 14 (20,29) de los casos, fue Río de Janeiro (RJ), seguida de la ciudad de São Bernardo do Campo (SP) con un 5 (7,25%). Conclusión: El aumento de la mortalidad por cáncer de mama durante la pandemia COVID-19 en Brasil se puede atribuir a la inmunosupresión de estas mujeres y las medidas de afrontamiento del COVID-19, que redujeron la demanda de atención médica, el acceso y la disponibilidad de servicios de diagnóstico. Pacientes oncológicos possuem riscos mais elevados para o desenvolvimento da doença por COVID-19 em sua forma mais severa. Objetivo: analisar a mortalidade por câncer de mama associada a COVID-19 em mulheres brasileiras. Metodologia: Trata-se de um estudo quantitativo. Os dados foram coletados no site do Open Data SUS, no período de janeiro a agosto de 2020. Utilizou-se estatística descritiva para análise dos dados. Resultados: o câncer de mama associado ao COVID-19 causou 69 óbitos nesse período, as idades que tiveram maior número de óbitos foram nos intervalos de idade 45-49 (14.5%), 60-64 (14.5%) e 65-69 anos (14.5%). Sobre a raça, (56,52%) eram brancos, seguida da cor parda (31,88%). Apenas (31,88%) apresentaram 8 anos ou mais de estudos e (49.27%) eram casadas. Em relação a causa básica da morte, o CID B34.2 (Infecção pelo Coronavírus de localização não especificada) se apresentou em maior número, com uma frequência de 52 (75.36%) e o CID C50.9 (Neoplasia maligna de mama, não especificada) teve uma frequência de 17 (24.64%). A cidade com maior número de óbitos por câncer de mama associada a COVID-19 no qual atingiu (20,29%) dos casos foi o Rio de Janeiro (RJ), seguida pela cidade de São Bernardo do Campo (SP) com (7.25%). Conclusão: O aumento da mortalidade por câncer de mama no período da pandemia do COVID-19 no Brasil pode estar atribuído à imunossupressão dessas mulheres e as medidas de enfrentamento ao COVID-19, no qual reduziu a procura por cuidados de saúde, acesso e disponibilidade de serviços de diagnóstico.

Background: Health professionals must interview index tuberculosis (TB) cases to identify and examine their contacts, because human interaction favors disease transmission. Revealing their contacts implies the disclosure of their health condition to close friends and family. The aim of this study was to evaluate the influence of the identification of contacts of TB index cases on the outcomes of TB treatment. Methods: This observational, cross-sectional, epidemiological study was conducted using data provided by SINAN-Net on subjects diagnosed with TB between 2008 and 2012 in Paraná, Brazil. The inclusion criteria were new cases of pulmonary TB in individuals older than 15 years. Results: A total of 9867 new cases of TB were identified. In total, 29% of adult cases did not have their contacts examined, and of these, 61.8% were smear-positive. The adults whose contacts were not examined underwent fewer tests and presented a lower cure rate and higher rates of treatment dropout and death. Conclusions: The detection of the contacts of index cases constitutes an epidemiological and public health strategy for the surveillance and control of TB. The health professionals who promote patient adherence to treatment and the involvement of their families in the fight against TB achieve better results regarding the identification of contacts of index cases, adherence to treatment, and cure. Keywords: Tuberculosis, Contact tracing, Infectious diseases, Epidemiological surveillance

Objective This study aimed to analyze the trend in cervical cancer (ICD C53) mortality in Brazilian regions in women who are who are screened and not screened from 1996 to 2015. Methods An epidemiological study, of time series of mortality from cervical cancer performed in 90,856 women under 24 years old (343 women), between 25 and 64 years old (32,703 women), and over 65 years old (10,909 women). The data from this research were collected from the DATASUS, from the SIM Health Surveillance Secretariat files, captured through TABNET selecting the resident population by gender and age group and ICD 10 C53 from 1996 to 2015. Results Among women, 43.8% were white, and 76% had less than eight years of formal education. Polynomial regression showed an increasing trend in cervical cancer mortality in Brazil for women aged 15 - 24 years (p=0.01). Between 25 - 64 and 65 years or older it remained constant, but high (p=0.07; 0.99). The Northeast region pointed a growing trend in women aged 15 to 24 (p=0.01), 25 to 64 years (p=0.01) and 65 or older (p=0.001). The Northeast presented the highest average growth per year. In the Southeast, South and Midwest regions, decreasing trends were observed despite the high rates. The Joinpoint regression showed a 95% confidence interval, and that mortality from cervical cancer in the North region increased throughout the period analyzed. an increasing trend was observed from 1996 to 1998, whereas in the Midwest region, the trend remained stable throughout the period analyzed. The Federal District presented an upward trend from 1996 to 2015. In Brazil, an upward trend was observed throughout the whole period analyzed. Conclusions Cervical cancer mortality in younger women is becoming more predominant, in addition to the high rate observed for women aged 65 or older. .

Objective: To analyze near miss cases among newborns hospitalized in the Intensive Care Unit. Methods: An observational, cross-sectional, retrospective study using the STROBE guideline. Data were collected from 1,101 records of live births (newborns). Statistical analysis used the Epi-Info program 3.3.2 and Chi-square and Fisher’s exact tests. Results: A total of 162 newborns were hospitalized, of which 63 had at least one criterion of near miss. The variables that remained associated with neonatal near miss were weight

Purpose To analyze the number of discarded donated corneas and the causes associated with discard in southern Brazil. Methods This retrospective, cross-sectional, and analytic study of donor corneal discards and their associated factors and geospatial distribution was based on a macroregional strategy conducted from 2011 to 2015 in Parana, southern Brazil. The dataset included all cornea donations from patients who died of cardiac arrest at ages between 3 and 70 years. Results A total of 9290 donor corneas were identified from 4645 donor patients; of these corneas, 4235 (45.6%) were discarded and 5055 (54.4%) transplanted. Mean age of the donors was 51.13 ± 14.30 years. The main causes of discard were positive serology (49.6%), corneal viability (19.8%), corneal tissue quality (8.5%), and others (16.0%). The discard rate was higher in the 50 to 64 year age group. Conclusions The corneal discard rate was high in all macroregions studied, with positive serology, viability, and quality of the donated corneas being the main causes of discard. Discards were more prevalent in older age groups (50-64 years and 65 or above age groups). Considering the presented results, the assessment process of potential cornea donors should be changed to reduce losses and costs.

Background The increase in violence against health professionals in the COVID-19 pandemic makes it necessary to identify the predictors of violence, in order to prevent these events from happening. Objective Evaluating the prevalence and analyzing the variables involved in the occurrence of violence against health professionals during the COVID-19 pandemic in Brazil. Method This is a cross-sectional study conducted online involving Brazilian health professionals during the COVID-19 pandemic. The data were collected through a structured questionnaire (Google Online Form) sent to health professionals on social networks and analyzed through logistic regression by using sociodemographic variables. The set of grouped variables was assigned to the final model when p Results The predictors of violence in the adjusted regression model were the following: being a nursing technician / assistant; having been working for less than 20 years; working for over 37 hours a week; having suffered violence before the pandemic; having been contaminated with COVID-19; working in direct contact with patients infected by the virus; and having family members who have suffered violence. The network created with professionals who suffered violence demonstrated that the aggressions occurred mainly in the workplace, with an indication of psycho-verbal violence. In cases in which the aggressors were close people, aggressions were non-verbal and happened both in public and private places. The assaults practiced by strangers occurred in public places. Conclusions Violence against health professionals occurs implicitly and explicitly, with consequences that can affect both their psychosocial well-being and the assistance given to their patients and families.

Objetivo: Investigar as internações por estresse nos estados do Sul do Brasil no período de janeiro de 2009 a dezembro de 2018. Metodologia: Foram coletados registros dos arquivos do SIH/SUS (Sistema Internação Hospitalar do Sistema único de Saúde) na plataforma eletrônica do Departamento de Informática do Sistema Único de Saúde (DATASUS), referente às internações cujo diagnóstico principal contido no capítulo V do CID – 10 pertencessem à categoria F43 “Reações ao “stress” grave e transtornos de adaptação” e subcategorias. A tendência temporal foi avaliada por regressão joinpoint (versão 3.4.2.) e a análise geoespacial por meio do software Quantum Gis (QGIS), versão 2.16. Resultados: Paraná, Santa Catarina e Rio Grande do Sul apresentaram tendência decrescente com valores de Annual Percentage Change (APC) de -14.7, -6.2 e -15.8, respectivamente. O gênero feminino foi mais incidente, com exceção de 2013 e 2017. Separando as internações F43 em subcategorias, a F43.0 (Reação aguda ao “stress”) foi a principal causa de internação por estresse (4.27). A análise espacial apresentou 57 municípios High-High (p

Objetivo: Analisar a idade materna, associação com intercorrências na gestação e a influência na determinação do parto. Método: Estudo observacional, retrospectivo, transversal com puérperas cujos partos ocorreram no ano de 2016, em hospital do interior paulista. Resultados: De 1130 prontuários analisados, 22,2% apresentaram 35 o parto vaginal foi mais frequente e independente da idade a intercorrência gestacional mais frequente foi a infecção do trato urinário.

Objetivo: Rastrear as Doenças Crônicas Não Transmissíveis como Diabetes Mellitus, Hipertensão Arterial e Obesidade em população sem cobertura de Estratégia Saúde da Família. Método: Pesquisa observacional transversal, de abordagem quantitativa com dados primários. A amostra foi composta por 62 indivíduos maiores de 18 anos, moradores de um bairro localizado na zona rural de Sarandi-PR. Os dados foram coletados através da aferição da pressão arterial, verificação da glicemia capilar e levantamento das medidas antropométricas. Os dados foram tabulados com a utilização de planilhas do Microsoft Excel e após isso realizou-se uma análise descritiva para caracterizar os indivíduos, utilizando a frequência absoluta e a porcentagem para as variáveis categóricas. Resultados: Dos sujeitos da pesquisa, 74,2% apresentaram IMC alterado, sendo 76,0% com companheiro fixo e 24,0% sem. Quanto ao risco cardiovascular 59 (96,7%) apresentaram risco elevado. A proporção entre homens e mulheres quanto aos riscos cardiovasculares foi de 1,95:2. 66,1% dos morados apresentaram alteração da pressão e 29,0% apresentaram alteração na glicemia capilar tanto em jejum como pós-prandial. Conclusão: Conclui-se que a população investigada apresenta maior prevalência de DCNTs com relação a população geral brasileira. Apontando uma necessidade de intervenção focada nos comportamentos modificáveis, que pode ser realizada pela Atenção Primária em Saúde por meio da Estratégia Saúde da Família.

Background: To investigate the prevalence of and factors associated with performance of annual mammography by women above 40 years of age. Materials and Methods: This cross-sectional retrospective study was conducted at an oncology reference service in Southern Brazil from October 2013 to October 2014 with 525 women aged 40 years or older. Results: The prevalence of annual mammography was 54.1%; annual mammographic screening was performed for women without private medical insurance, who were under hormone replacement therapy and who had used contraception in the past. An association was found between non-performance of breast clinical and self-examination and non-performance of mammographic screening. Conclusions: Use of mammography for breast cancer screening in the public health care setting proved to be accessible; nevertheless, the proportion of screened women was low, and they exhibited poor adherence to the basic measures of care recommended for breast assessment. Thus, control of breast cancer requires implementing actions targeting the population most vulnerable to non-adherence to screening in addition to continuously monitoring and assessing that population to reduce the prevalence of this disease.

Cardiovascular diseases are the leading cause of deaths globally. Machine learning studies predicting mortality rates for ischemic heart disease (IHD) at the municipal level are very limited. The goal of this paper was to create and validate a Heart Health Care Index (HHCI) to predict risk of IHD based on location and risk factors. Secondary data, geographical information system (GIS) and machine learning were used to validate the HHCI and stratify the IHD municipality risk in the state of Paraná. A positive spatial autocorrelation was found (Moran’s I = 0.6472, p-value = 0.001), showing clusters of high IHD mortality. The Support Vector Machine, which had an RMSE of 0.789 and error proportion close to one (0.867), was the best for prediction among eight machine learning algorithms after validation. In the north and northwest regions of the state, HHCI was low and mortality clusters patterns were high. By creating an HHCI through ML, we can predict IHD mortality rate at municipal level, identifying predictive characteristics that impact health conditions of these localities’ guided health management decisions for improvements for IHD within the emergency care network in the state of Paraná.

A obesidade tem aumentado drasticamente nos últimos anos, tornando-se um grave problema de saúde pública. Este estudo objetivou analisar o ganho de peso durante a gestação, os fatores associados e seus desfechos. Estudo descritivo, transversal, realizado com mulheres em pós-parto mediato, em uma maternidade de referência do município de Maringá-PR, no período de 1 a 30 de março de 2018. A coleta de dados foi realizada por meio dos registros no cartão da gestante, prontuários da mulher e do recém-nascido e por um questionário estruturado. As variáveis associadas ao ganho de peso durante a gestação foram número de gestações (p=0,003) e paridade (p=0,041). Mulheres com obesidade prévia à gestação obtiveram maior prevalência de ganho de peso excessivo durante a gestação. Com base nos resultados do presente estudo, conclui-se que o ganho de peso excessivo durante a gestação foi maior entre mulheres primíparas e primigestas. Sugere-se novos estudos sobre a temática para que forneça subsídios para ao planejamento de ações voltadas ao controle do ganho de peso durante a gestação.

A Simulação Realística é uma ferramenta que vem sendo amplamente utilizada no ensino na Área de Saúde, desenvolvendo habilidades como: trabalho em equipe, tomada de decisões e comunicação. Contribui para o aprendizado por permitir ao aluno experimentar a realidade, em ambiente seguro e pedagogicamente planejado. Objetivo: Comparar o aprendizado de Atenção Primária em Saúde entre acadêmicos de Medicina que receberam/assistiram/frequentaram aula expositiva e os que foram submetidos à Simulação Realística. Método: Pesquisa quase-experimental, realizada com acadêmicos de graduação em Medicina. A amostra foi composta por 144 alunos que foram organizados em dois grupos: controle e experimental. A pesquisa teve três etapas: pré-teste, desenvolvimento da aula (expositiva ou Simulação Realística) e pós-teste. A coleta de dados aconteceu no período de agosto à setembro de 2019. Foi utilizado um instrumento de coleta de dados, composto por questões fechadas. Resultados: A média de acertos no pré-teste foi de 7,05 e 7,35 nos grupos experimental e controle, respectivamente. A média de acertos entre no pós-teste foi de 7,62 e 8,05 nos grupos experimental e controle, respectivamente. Conclusão: O aprendizado cognitivo foi semelhante com a utilização da técnica de Simulação Realística quando comparado com a metodologia de ensino tradicional, porém a Simulação Realística desenvolve outras habilidades, como autoconfiança e raciocínio crítico, trabalho em equipe, liderança, além de poder ser um incentivo aos alunos para o autoaprendizado.

Introducao: O atendimento a pessoa em crise psiquiatrica, quando ocorre fora do hospital ou Unidade Basica de Saude publica, e feito pelo Servico de Atendimento Movel de Urgencia. O objetivo deste trabalho foi analisar o perfil epidemiologico dos atendimentos psiquiatricos realizados pelo Samu em uma regiao metropolitana do Parana, ano de 2018. Metodologia: Pesquisa observacional transversal com dados secundarios. Os dados foram coletados nas fichas de atendimento do Samu e analisados por estatistica descritiva e testes de associacao entre variaveis. Resultados: No ano de 2018 foram atendidas 326 ocorrencias pelo Samu Norte Novo no municipio de Maringa, envolvendo suicidio, ideacao suicida e tentativa de suicidio. A idade media da populacao atendida foi de 33,4 anos (DP ± 14,3). Idade minima de 10 anos e maxima de 78. A maioria dos atendimentos ocorreu na faixa etaria de 18 a 29 anos e envolveu mulheres (53,7%) Discussao: O atendimento por tentativa de suicidio foi o mais prevalente incidindo mais em mulheres. Ja o suicidio acometeu mais os homens, em uma proporcao de 4:1. O desfecho mais comum foi o encaminhamento para a UPA. Houve pouca recusa de atendimento, o que mostra a gravidade do evento nos aspectos fisicos, emocionais e sociais. O atendimento do Samu as urgencias e emergencias psiquiatricas na regiao metropolitana de Maringa mostrou uma realidade semelhante a de outros estudos brasileiros e internacionais. Conclusoes: Pesquisa qualitativas sao indicadas para compreender a logica que rege esse comportamento auto destrutivo.

Background Traffic accidents are a major global public health problem with an impact on morbidity and mortality. Objective The aim of this study was to analyze the mortality trend from road accidents among young adults. Method An ecological time-series study was performed of the deaths of young (15-24 years old) in traffic accidents in the state of Parana, Brazil from 1996 to 2013. Mortality data was obtained from the Mortality Information System. Mortality rates were calculated and the trend analysis was performed through polynomial regression models. A trend was considered significant when the estimated model obtained a p-value

Objective: to analyze the perception of postgraduate students about nursing theories in professional training and practice. Methods: it was a qualitative research with 22 students enrolled in the Theoretical Foundations of Nursing Care class of a postgraduate nursing course. Results: the lack of teaching of nursing theories at the undergraduate level and the need to insert this object of study in the curricula of the courses were verified, since they support and guide nurses’ actions, corroborating the relationship between theory and practice. The theories conferred scientific thinking and added value to professional performance, ensuring quality and recognition to the profession. Conclusion: the contact with the theories in undergraduate studies is limited and resuming the thematic in postgraduation is indicated as opportune. In the perception of the postgraduate students, the knowledge on nursing theories allows professionals to extract their essence, scientifically strengthen their practice and, thus, recognize them as work guidelines. Objetivo: analisar a percepção de pós-graduandos acerca das teorias de enfermagem na formação e na prática profissional. Métodos: pesquisa qualitativa, com 22 alunos matriculados na disciplina Fundamentos Teóricos do Cuidado em Enfermagem de um curso de pós-graduação em enfermagem. Resultados: evidenciaram-se a carência do ensino das teorias de enfermagem na graduação e a necessidade de inserção deste objeto de estudo nos currículos dos cursos, uma vez que elas sustentam e norteiam as ações do enfermeiro, respaldando a relação entre teoria e prática. As teorias conferiram pensamento científico e agregaram valor ao fazer profissional, assegurando qualidade e reconhecimento à profissão. Conclusão: o contato com as teorias na graduação é limitado, e a retomada da temática na pós-graduação é apontada como oportuna. Na percepção dos pós-graduandos, o conhecimento das teorias de enfermagem permite ao profissional extrair sua essência, fortalecer cientificamente sua prática e, assim, reconhecê-las como norteadoras do trabalho.

After obtaining certification of the absence of transmission of the Trypanosoma cruzi by Triatoma infestans in 2006, other native species of protozoan vectors have been found in human dwellings within municipalities of the State of Paraná, Southern Brazil. However, the spatial distribution of T. cruzi vectors and how climatic and landscape combined variables explain the distribution are still poorly understood. The goal of this study was to predict the potential distribution of T. cruzi vectors as a proxy for Chagas disease transmission risk using Ecological Niche Models (ENMs) based on climatic and landscape variables. We hypothesize that ENM based on both climate and landscape variables are more powerful than climate-only or landscape-only models, and that this will be true independent of vector species. A total of 2,662 records of triatomines of five species were obtained by community-based entomological surveillance from 2007 to 2013. The species with the highest number of specimens was Panstrongylus megistus (73%; n = 1,943), followed by Panstrongylus geniculatus (15.4%; 411), Rhodnius neglectus (6.0%; 159), Triatoma sordida (4.5%; 119) and Rhodnius prolixus (1.1%; 30). Of the total, 71.9% were captured at the intradomicile. T. cruzi infection was observed in 19.7% of the 2,472 examined insects. ENMs were generated based on selected climate and landscape variables with 1 km2 spatial resolution. Zonal statistics were used for classifying the municipalities as to the risk of occurrence of synanthropic triatomines. The integrated analysis of the climate and landscape suitability on triatomines geographical distribution was powerful on generating good predictive models. Moreover, this showed that some municipalities in the northwest, north and northeast of the Paraná state have a higher risk of T. cruzi vector transmission. This occurs because those regions present high climatic and landscape suitability values for occurrence of their vectors. The frequent invasion of houses by infected triatomines clearly indicates a greater risk of transmission of T. cruzi to the inhabitants. More public health attention should be given in the northern areas of the State of Paraná, which presents high climate and landscape suitabilities for the disease vectors. In conclusion, our results–through spatial analysis and predictive maps–showed to be effective in identifying areas of potential distribution and, consequently, in the definition of strategic areas and actions to prevent new cases of Chagas' disease, reinforcing the need for continuous and robust surveillance in these areas., Author summary Trypanosoma cruzi, the etiologic agent of Chagas' disease (CD), circulates among humans, vectors and domestic and wild reservoirs. Frequent invasion of housing by infected triatomines may present a risk of vector transmission from T. cruzi to humans. The objective of this study was to predict the potential distribution of triatomines in the State of Paraná and to infer potential high risk areas for T. cruzi vector transmission. Five distinct species of three different genera of triatomines were collected, the majority of which were Panstrongylus megistus (73% of occurrences). More than half of collected specimens (54.8%) were captured intradomicile. The infection rate was 24.7%, which may represent a risk of occurrence of new cases of CD by vector transmission. Ecological Niche Models indicated suitable areas to triatomine occurrence in municipalities of Northwest, North and Northeast of Paraná state. Thus, more effective management actions are needed to ensure epidemiological surveillance of CD. P. megistus is the main species that colonizes the intradomicile, reinforcing the importance of the maintenance of surveillance for directing vector control actions of the CD in the local health systems in this and similar regions, mainly in the northern region of the State of Paraná, with the intensive participation of the community and also of municipal agents.

Introduction The aim of this study was to determine the prevalence of GBS colonization in pregnant women in a public health service. Methods A study of 496 pregnant women at 35-37 gestational weeks was conducted from September 2011 to March 2014 in 21 municipalities of the 18th Health Region of Paraná State. Vaginal and anorectal samples of each woman were plated on sheep blood agar, and in HPTH and Todd-Hewitt enrichment broths. Results Of the 496 pregnant women, 141 (28.4%) were positive for GBS based on the combination of the three culture media with vaginal and anorectal samples. The prevalence was 23.7% for vaginal samples and 21.9% for anorectal ones. Among the variables analyzed in this study, only urinary infection was a significant factor (0.026) associated with GBS colonization in women. Conclusions Based on these results, health units should performs universal screening of pregnant women and hospitals should provide adequate prophylaxis, when indicated.

Objetivo: Estimar a prevalência e os fatores associados à realização de mamografia e exame citopatológico em mulheres da cidade de Maringá, Paraná. Métodos: Estudo transversal, de base populacional, feito com 345 mulheres com idade superior a 20 anos, no período de março de 2011 a abril de 2012. Realizou-se entrevista por meio de um questionário proposto pelo Ministério da Saúde, o qual abordava aspectos sociodemográficos, fatores de risco para doenças crônicas não transmissíveis e questões relacionadas ao rastreamento mamográfico e citopatológico. Os dados foram analisados mediante análise bivariada, análise bruta mediante Odds Ratio (OR) e qui-quadrado por meio do programa Epi Info 3.5.1, e análise multivariada por meio da regressão logística, realizada com o programa Statistica 7.1, com nível de significância de 5% e intervalo de confiança de 95%. Resultados: A média de idade das mulheres foi de 52,19 (±5,27) anos. A maioria (56,5%) apresentou de 0 a 8 anos de estudo. Além disso, 84,6% (n=266) das mulheres realizaram o exame de Papanicolau e 74.3% (n=169), a mamografia. Foram associadas à menor realização de Papanicolau as mulheres com escolaridade entre 9 e 11 anos de estudo (p=0,01), e quanto à mamografia, tiveram menor adesão as mulheres sem plano de saúde privado (p

Several outcomes of pregnancy after bariatric surgery are currently being studied. This cross-sectional, retrospective study evaluated the obstetric and perinatal outcomes of pregnancies in 19 women who underwent bariatric surgery, as well as the growth and development of their children, in the Southern Brazil. Among these women, 11 children were born prior to surgery and 32 were born post-surgery. The mean time between the surgery and the first pregnancy was 42.96 months. Preterm newborns were more common among the pre-surgery childbirths. Regarding growth, normal weights were observed in 27.3 % of the children in the pre-surgery births and obesity was observed in 54.5 %. In contrast, normal weights were observed in 59.4 % of the children born during the postoperative period and obesity was observed in 31.2 %. The average excess weight that the women lost prior to pregnancy was 64.88. Speech delays were found in three male children evaluated using the Denver Developmental Screening Test II. A statistical association was found between the interval from the surgery to the pregnancy and the outcome of the questionable Denver II test results (p = 0.011). Except for the large index of low birth weight, it can be concluded that pregnancy after bariatric surgery is safe. The growth rate was found to be adequate in the children born after the surgery, with reduced obesity. Although changes in speech development were detected, no factors were supported an association with pregnancy after bariatric surgery.

Background: The purpose of the article was to analyze the years of potential life lost (YPLL) of women who died from breast and cervical cancer in the State of Parana, Southern Brazil. This was a temporal trend study (2000 to 2010) about the coefficients of mortality and the years of potential life lost in women aged 20 to 70 years. Materials and Methods: Data were obtained through the database of the Department of the Unified Health System (DATASUS) and the National Mortality Information System. Results: There was a loss of 125.075 YPLL due to breast cancer, with an average of 11.370 YPLL. Regarding cervical cancer, the figure obtained was 91.625 YPLL from 2000 to 2010, with an average of 8.329 YPLL. Increased risk of death from breast cancer was observed for women aged 50 to 59 years, with a significant increase among those in the age group from 40 to 49 years. There was an increased rate of cervical cancer among women 40 to 69 years. Conclusions: The risk of death grows with increasing age, being higher from 40 years. Prevention is paramount for both cancers. Thus, preventive measures are required and a reassessment of political strategies should be adopted.

Candidíase vulvovaginal (CVV) em mulheres infectadas pelo HIV contribuiu substancialmente para a diminuição da sua qualidade de vida. O objetivo deste estudo foi avaliar o efeito do uso de terapia anti-retroviral altamente ativa (HAART) no isolamento de Candida spp. vaginais em mulheres HIV positivas comparado às não infectadas por HIV. Este estudo transversal incluiu 178 mulheres infectadas pelo HIV (grupo HIV) e 200 mulheres não infectadas (grupo controle) acompanhadas no Serviço de Assistência Especializada (SAE) para as doenças sexualmente transmissíveis (DST)/AIDS da cidade de Maringá/Brasil, de 1 abril a 30 de outubro de 2011. As leveduras foram isoladas e identificadas por métodos fenotípicos e moleculares. A susceptibilidade in vitro aos antifúngicos fluconazol, itraconazol, nistatina e anfotericina B foi avaliada pelo método de referência de microdiluição. Nós encontramos maior frequência de isolamento vaginal total de Candida spp. no grupo HIV do que no grupo controle. Entretanto, foi observada frequência similar de colonização e CVV entre os dois grupos. Apesar de C. albicans ser a mais frequente e sensível a azólicos e polienos em mulheres infectadas pelo HIV e não infectadas, foi detectada emergente resistência de C. glabrata a AMB nas mulheres infectadas pelo HIV. Embora tenha sido observada maior frequência de isolamento vaginal de Candida spp. nas mulheres infectadas pelo HIV do que nas não infectadas, colonização e CVV apresentaram frequência similar em ambos os grupos, o que indica que HAART parece proteger contra colonização vaginal e CVV. Vulvovaginal candidiasis (VVC) in HIV-infected women contributed to the impairment of their quality of life. The aim of this study was to evaluate the effect of highly active antiretroviral therapy (HAART) use on the vaginal Candida spp. isolation in HIV-infected compared to HIV-uninfected women. This cross-sectional study included 178 HIV-infected (HIV group) and 200 HIV-uninfected women (control) that were studied at the Specialized Assistance Service (SAE) for sexually transmitted diseases (STD)/AIDS of the city of Maringá, Brazil, from April 1 to October 30, 2011. The yeasts were isolated and identified by phenotypic and molecular methods. The in vitro antifungal susceptibility to fluconazole, itraconazole, nystatin and amphotericin B was tested by the reference microdilution method. Higher frequencies of total vaginal Candida spp. isolation were found in the HIV-infected group than in the control group. However, both groups showed a similar frequency of colonization and VVC. Although C. albicans was the most frequent and sensitive to azolics and polyenes in both HIV-infected and uninfected women, the emerging resistance of C. glabrata to amphotericin B in the HIV-infected women was observed. Although higher frequency of vaginal Candida spp. isolation had been observed in the HIV-infected than in HIV-uninfected women, colonization and VVC showed similar frequency in both groups, indicating that HAART appears to protect against vaginal colonization and VVC.

CONTEXTO: A gravidez e a maternidade são importantes na vida das mulheres, mas podem gerar alterações físicas e emocionais tornando-as vulneráveis. OBJETIVO: Analisar a presença de sintomas de tristeza materna vivenciados por puérperas e seus fatores associados. MÉTODOS: Trata-se de um estudo transversal, quantitativo, realizado com 278 mulheres internadas em uma Maternidade de um município do Noroeste do, Paraná, Sul do Brasil, entre janeiro a junho de 2015. Foram utilizadas a Escala de Depressão de Edimburgo (EPDS) e a Escala de Humor Brasileira (BRAMS) para coleta de dados. RESULTADOS: Escores ≥11 na EPDS apresentaram-se associados estatisticamente à baixa condição econômica, multiparidade, gravidez não planejada, história de depressão e distúrbio do sono. Em relação à BRAMS, mulheres com renda per capta acima de 300,00 reais apresentaram sentimentos de vigor, entretanto, os sentimentos de raiva, depressão e fadiga, mostraram-se associados à multiparidade, gravidez não planejada, história de depressão e distúrbio do sono. CONCLUSÕES: O alto percentual de mulheres que apresentaram sintomas depressivos justifica a importância e necessidade de cuidados com a saúde mental da mulher no período gestacional e puerperal, visto que são períodos de vulnerabilidade e transformação. BACKGROUND: Pregnancy and motherhood are important in women's lives, but they can generate physical and emotional changes making them vulnerable. OBJECTIVE: To analyze the presence of maternal sadness symptoms experienced by postpartum women and their associated factors. METHODS: This is a cross-sectional, quantitative study of 278 women admitted to a Maternity Hospital in the Northwest of Paraná, Southern Brazil, between January and June 2015. The Edinburgh Depression Scale (EPDS) and The Brazilian Humor Scale (BRAMS) for data collection. RESULTS: Scores ≥11 in the EPDS were statistically associated with low economic status, multiparity, unplanned pregnancy, history of depression and sleep disturbance. Regarding BRAMS, women with per capita income above R$ 300.00 reais showed feelings of vigor; however, feelings of anger, depression and fatigue were shown to be associated with multiparity, unplanned pregnancy, history of depression and sleep disturbance. CONCLUSIONS: The high percentage of women who presented depressive symptoms justifies the importance and need of care for women's mental health in the gestational and puerperal periods, since they are periods of vulnerability and transformation. CONTEXTO: El embarazo y la maternidad son importantes en la vida de las mujeres, pero pueden causar cambios físicos y emocionales que los hace vulnerables. OBJETIVO: Analizar la presencia de síntomas de la depresión posparto experimentadas por las madres y sus factores asociados. MÉTODOS: Se trata de un estudio transversal, cuantitativo con 278 mujeres internadas en una maternidad en una ciudad del noroeste, Paraná, sur de Brasil, de enero a junio de 2015. Se utilizó la Escala de Depresión de Edimburgo (EPDS) y Escala brasileña del estado de ánimo (BRAMS) para la recogida de datos. RESULTADOS: Las puntuaciones ≥ 11 en la EPDS se han asociado estadísticamente con bajo nivel económico, la multiparidad, los embarazos no planificados, una historia de depresión y los trastornos del sueño. En cuanto a BRAMS, las mujeres con ingresos per cápita de hasta 300,00 reales tenían sentimientos de vigor; Sin embargo, los sentimientos de ira, la depresión y la fatiga se asociaron con la multiparidad, los embarazos no planificados, una historia de depresión y los trastornos del sueño. CONCLUSIONES: El alto porcentaje de las mujeres que tenían síntomas depresivos justifica la importancia y necesidad de preocuparse por la salud mental de las mujeres durante el embarazo y el puerperio, así como los períodos de vulnerabilidad y transformación.

Background: Cancer is a major public health problem. Early diagnosis and treatment are essential for reducing mortality. This study aimed to analyze factors associated with delay in breast cancer diagnosis and treatment among women attending a reference cancer service. Methods: This retrospective, cross-sectional study was performed with data collected from medical records and interviews conducted with women diagnosed with breast cancer and treated from October 2013 to October 2014 at a cancer reference hospital in Paraná, Southern Brazil. Results: A total of 82 participants were enrolled during the study period; their average age was 58.2 ± 11.5 years. The average time taken for final diagnosis of breast cancer was 102.5 ± 165.5 days. Treatment onset was delayed in the majority of cases, and the average time elapsing from diagnostic biopsy to onset of primary treatment was 72.3 ± 54.0 days. The odds of treatment delay were higher among the women with a low educational level. Conclusions: The results underline the need for proposals aimed at early detection, identification of risk factors and timely provision of treatment by health managers that focus on this group.

Aim To identify the factors associated with bullying and turnover intention among nurses. Background Previous studies have demonstrated an association between leadership, bullying and turnover intention. However, few studies to date have addressed this topic among nurses. Methods A cross-sectional study was conducted using web-based data collection followed by data analysis using logistic regression and multinomial logistic regression models. Results Having more than one job (odds ratio (OR) = 2.9) and a low relationship-oriented leadership style (OR = 5.8) were positively associated with personal and work-related bullying, respectively. A low relationship-oriented leadership style (OR = 4.0), age of 19-29 years (OR = 4.5) and length of employment at the institution of 5-10 years (OR = 4.9) were positively correlated with a high turnover intention. The following variables were correlated with a moderate turnover intention: a low relationship-oriented leadership style (OR = 3.4), having a bachelor's degree (OR = 2.0) and working in a philanthropic institution (OR = 2.5). Working in a private institution (OR = 0.8) was negatively associated with a moderate turnover intention. Conclusions A low relationship-oriented leadership style and social and work factors were associated with bullying and turnover intention. Implications for nurse managers Nurse managers, in addition to developing technical skills, need to develop skills to manage human relationships to prevent bullying and turnover among nurses.

Background: : In 2012, the breast cancer estimate worldwide stood at 1.67 million new cases, these accounting for 25% of all types of cancer diagnosed in women. For 2014, 57,120 new cases are expected, with a risk estimated at 56.1 cases for every 100,000 women. The objective of this study was to analyze the satisfaction regarding the use of external breast prostheses by women undergoing mastectomy. Materials and Methods: This cross-sectional study was conducted with 76 women who used an external breast prosthesis (EBP), registered in the services of the Cuiaba Center for Comprehensive Rehabilitation, Mato Grosso, Brazil, from 2009 to 2012. Data were collected from the records of women who had requested the opening of a process of external breast prosthesis concession. Results: Satisfaction with the EBP was identified in 56.6% of the women. Those satisfied with the EBP reported that its weight was not annoying (p

Objetivo O objetivo deste estudo foi verificar a prevalência e fatores associados à inatividade física no lazer, segundo sexo, em residentes da área urbana de um município do Sul do Brasil.Métodos Os dados foram obtidos da pesquisa de monitoramento de fatores de risco para doenças crônicas não transmissíveis em adultos da cidade de Maringá, Paraná, através de inquérito populacional e amostra de 453 indivíduos. Resultados Foram avaliados 351 mulheres e 102 homens. A taxa de inatividade física no lazer foi de 87,5 % e 86,3 % para as mulheres e homens, respectivamente. Após regressão multivariada, notou-se que as mulheres com idade entre 50 e 59 anos estão fisicamente ativas (p=0,01), e aquelas com 0 a 8 anos de estudo, apresentaram-se inativas no lazer (p=0,02). E relação aos homens, os que declararam ser ex-fumantes, classificaram-se como ativos (p=0,03) e os que reconheceram o estado de saúde como regular, apresentaram-se inativos no lazer (p=0,04).Conclusão Foi possível perceber que embora com variáveis de risco e proteção distintas, a inatividade na população adulta encontra-se presente em ambos os sexos, e logo, por ser um fator de risco modificável, deve integrar-se no rol das medidas de prevenção e controle de doenças, através de estratégias de vigilância e monitoramento do estado de saúde da população.