reports of data from original research.• Review Papers -comprehensive, authoritative, reviews within the journal's scope.• Short Reports -brief reports of data from original research.• Methodology Papers -Papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.• Policy Case Studies -brief articles on policy development at a regional or national level.• Study Protocols -articles describing a research protocol of a study.
Objetivo: Analisar a qualidade da Atenção Primária à Saúde a partir dos indicadores de desempenho do Previne Brasil. Métodos: Trata-se de um estudo observacional, de caráter descritivo e analítico no período de 2021-2023, utilizando dados do SISAB e do SISAPS. Resultados: A proporção de gestantes com pelo menos seis consultas pré-natais aumentou de 36% em 2021 para 44,7% em 2023, tendo a mesorregião do Marajó apresentado os piores resultados. O rastreamento de sífilis e HIV teve evolução satisfatória, alcançando 79% em 2023, destacando-se como o de melhor desempenho. Em 2023, o serviço odontológico apresentou 62,5% das gestantes atendidas. A coleta de citopatológico apresentou apenas 12 municípios atendendo a meta em 2023. Quanto à vacinação, apenas 4 municípios alcançaram a meta em 2023. O monitoramento de doenças crônicas também revela deficiências, com poucos municípios alcançando os objetivos em 2023. Conclusão: Assim, houve progresso, porém, concomitantemente, a maioria ainda dos indicadores ainda está aquém das metas estabelecidas. A mesorregião do Marajó destaca-se como uma área especialmente vulnerável, refletindo os impactos das desigualdades socioeconômicas e estruturais na saúde da população.
rEsumo A melhoria da qualidade dos cuidados pre-natais e dos cuidados intensivos neonatais resultaram, nas ultimas decadas, numa continuada diminuicao da morbilidade e da mortalidade perinatais e infantis, particularmente de recem-nascidos muito pre-termo. No entanto, ha uma grande variabilidade entre unidades de saude na decisao sobre procedimentos e intervencoes, quer a nivel nacional quer internacional, que se pode refletir em desigualdades nos resultados em saude e que importa aBstract In the last decades, the improvement of antenatal and neonatal care led to a continued decrease in perinatal and infant morbidity and mortality, particularly for very preterm infants. However, there is a great variability in medical procedures and interventions across health units, both at national and international levels, which can result in avoidable inequalities in health outcomes. This study intends to describe (1) the European project Effective Perinatal Intensive Care in Europe (EPICE), designed to identify and understand such variation; (2) the pilot study conducted in the Northern Region of Portugal to test the protocol and the questionnaire for data collection and (3) the recruitment and final sample of the EPICE-Portugal cohort. The EPICE project includes 19 regions from 11 EU Member states and aims to explore how scientific knowledge is effectively applied to monitor very preterm infants, using both quantitative and qualitative methodologies. In Portugal, this study involves all the public maternity and neonatal intensive care units from Northern and Lisbon and Tagus Valley
Smoking during pregnancy is a major public health issue. The aim of this study isto describe the smoking habits of women during pregnancy and its association with clinically significant depressive and anxiety symptoms. 382 women answered to a socio-demographic questionnaire, the Hospital Anxiety Depression Scale (HADS) and the Edinburgh Postnatal Depression Scale (EPDS) at 33 weeks of gestation. Among pregnant woman, 284 are non-smokers, 38 are smokers and 60 quitted smoking during pregnancy. There was a significant association between maternal smoking status and marital status, education level and family income per month. Among smokers, the rate of quitters was quite similar among partnered and unpartnered women and higher in women with university degree and with higher family monthly income. There was a significant association between maternal smoking status and clinically significant anxious symptoms [χ2(2)=8.535, p=0.014]. Among mothers with non-university education, smokers are more likely to have clinically significant anxiety symptoms than quitters (53.6% vs 24.3%) while among mothers in higher income families, smokers are more likely to have clinically significant depressive symptoms than quitters (100% vs 11.1%). This study provides important data to inform effective public health strategies directed to pregnant women.
Multi-country studies assessing the quality of maternal and newborn care (QMNC) during the COVID-19 pandemic, as defined by WHO Standards, are lacking.Women who gave birth in 12 countries of the WHO European Region from March 1, 2020 - March 15, 2021 answered an online questionnaire, including 40 WHO Standard-based Quality Measures.21,027 mothers were included in the analysis. Among those who experienced labour (N=18,063), 41·8% (26·1%- 63·5%) experienced difficulties in accessing antenatal care, 62% (12·6%-99·0%) were not allowed a companion of choice, 31·1% (16·5%-56·9%) received inadequate breastfeeding support, 34·4% (5·2%-64·8%) reported that health workers were not always using protective personal equipment, and 31·8% (17·8%-53·1%) rated the health workers' number as "insufficient". Episiotomy was performed in 20·1% (6·1%-66·0%) of spontaneous vaginal births and fundal pressure applied in 41·2% (11·5% -100%) of instrumental vaginal births. In addition, 23·9% women felt they were not treated with dignity (12·8%-59·8%), 12·5% (7·0%-23·4%) suffered abuse, and 2·4% (0·1%-26·2%) made informal payments. Most findings were significantly worse among women with prelabour caesarean birth (N=2,964). Multivariate analyses confirmed significant differences among countries, with Croatia, Romania, Serbia showing significant lower QMNC Indexes and Luxemburg showing a significantly higher QMNC Index than the total sample. Younger women and those with operative births also reported significantly lower QMNC Indexes.Mothers reports revealed large inequities in QMNC across countries of the WHO European Region. Quality improvement initiatives to reduce these inequities and promote evidence-based, patient-centred respectful care for all mothers and newborns during the COVID-19 pandemic and beyond are urgently needed.The study was financially supported by the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy.ClinicalTrials.gov Identifier: NCT04847336.
Mother-child discrepancies frequently occur in reports of child physical abuse. Such report discrepancies raise important challenges for interpreting and integrating data from multiple informants in forensic and clinical settings.
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