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BACKGROUND: Postpartum depression is a common condition in the pregnancy and postpartum cycle. The development of this condition is multifactorial and can be influenced by previous traumas. This study sought to verify whether there is an association between having been exposed to mistreatment during childbirth and presenting symptoms suggestive of postpartum depression. METHODS: This is a cross-sectional study, with the inclusion of 287 women without complications in childbirth, randomly selected from two maternity hospitals of Porto Alegre, southern Brazil, in 2016. Four weeks after delivery, the postpartum women answered a face-to-face interview about socioeconomic aspects, obstetric history, health history, and childbirth experience (practices and interventions applied) and completed the Edinburgh Postnatal Depression Scale (EPDS). From the perception of women regarding the practices performed in the context of childbirth care, a composite variable was created, using item response theory, to measure the level of mistreatment during childbirth. The items that made up this variable were: absence of a companion during delivery, feeling insecure and not welcome, lack of privacy, lack of skin-to-skin contact after delivery, not having understood the information shared with them, and not having felt comfortable to ask questions and make decisions about their care. To define symptoms suggestive of postpartum depression, reflecting on increased probability of this condition, the EPDS score was set at ≥ 8. Poisson Regression with robust variance estimation was used for modeling. RESULTS: Women who experienced mistreatment during childbirth had a higher prevalence of symptoms suggestive of postpartum depression (PR 1.55 95% CI 1.07-2.25), as well as those with a history of mental health problems (PR 1.69 95% CI 1.16-2.47), while higher socioeconomic status (A and B) had an inverse association (PR 0.53 95% CI 0.33-0.83). CONCLUSIONS: Symptoms suggestive of postpartum depression seem to be more prevalent in women who have suffered mistreatment during childbirth, of low socioeconomic status, and with a history of mental health problems. Thus, qualifying care for women during pregnancy, childbirth and postpartum and reducing social inequalities are challenges to be faced in order to eliminate mistreatment during childbirth and reduce the occurrence of postpartum depression.

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The objective of this study was to structure a proposal for an instrument to measure the mistreatment level of women during childbirth, through item response theory, based on the birth experience of postpartum women. A cross-sectional study was conducted, with the inclusion of 287 women who did not suffer complications during childbirth, randomly selected from two maternity hospitals in the capital of Rio Grande do Sul-Brazil, in 2016. Approximately 30 days after delivery, the women answered questions in a face-to-face interview about their birth experience (practices and interventions applied) and were inquired about their perception of having suffered disrespect, mistreatment or humiliation by health professionals. The set of practices was included in the item response theory model to design the instrument. Of the 36 items included in the model, 21 dealt with practices applied exclusively to women who went into labor, therefore two instruments were developed. The instrument including all women, containing 09 items, identified 23.7% prevalence of mistreatment to women during childbirth, while the instrument for women going into labor included 11 items and identified 22% prevalence. The items with the highest discrimination were: not having had a companion during labor (2.05; and 1.26), not feeling welcome (1.81; and 1.58), and not feeling safe (1.59; and 1.70), for all women and for those who went into labor, respectively. For those who went into labor, the items, did not have a companion during labor (1.22; PE 0.88) and did not feel comfortable asking questions and participating in decisions (1.20; PE 0.43) also showed greater discrimination. In contrast, when directly questioned, only 12.5% of women said they had experienced disrespect or mistreatment, suggesting that harmful practices are often not recognized as violent. Standardizing the measurement of mistreatment of women during childbirth can create more accurate estimates of its prevalence and contribute to the proposal of strategies to eliminate obstetric violence.

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This article aims to identify factors associated with full satisfaction with prenatal care in health services in Porto Alegre (RS), Brazil. This is a cross-sectional study with 287 women that attended prenatal care in the state capital. Women were randomly selected at two large maternity hospitals (public and private) and interviewed at their homes around 30 days after delivery, from January to August 2016. Satisfaction was measured by a Likert scale (very satisfied to very unsatisfied). Prevalence ratios (PR) were estimated by Poisson regression with robust variance, using a hierarchical model. Factors associated with greater satisfaction were higher education (PR=1.49; 95% CI: 1.08-2.06); multiprofessional care (PR=1.29; 95% CI: 1.00-1.66); receiving information about breastfeeding (PR=1.33; 95% CI: 1.05-1.68) and place of delivery (PR=1.56; 95% CI: 1.12-2.17); and women feeling comfortable asking questions and participating in decisions (PR=5.17; 95% CI: 1.79-14.96). The findings suggest that prenatal care services that offer multiprofessional care, provide guidance, and make pregnant women feel comfortable asking and deciding about their care may generate greater satisfaction.

O objetivo deste artigo é identificar fatores associados à plena satisfação com a atenção pré-natal em serviços de saúde de Porto Alegre, Rio Grande do Sul. Estudo transversal, com 287 mulheres que realizaram pré-natal na capital gaúcha. As mulheres foram selecionadas aleatoriamente em duas maternidades de grande porte (pública e privada) e entrevistadas nos seus domicílios, cerca de 30 dias após o parto, entre janeiro e agosto de 2016. A satisfação foi aferida por meio de escala Likert (muito satisfeita a muito insatisfeita). Foram estimadas razões de prevalência (RP) por regressão de Poisson com estimação robusta da variância, utilizando modelo hierarquizado. Os fatores associados à plena satisfação foram: ingresso no ensino superior (RP=1,49; IC95%:1,08-2,06); atendimento multiprofissional (RP=1,29; IC95%:1,00-1,66); recebimento de orientações sobre amamentação (RP=1,33; IC95%:1,05-1,68) e sobre local do parto (RP=1,56; IC95%:1,12-2,17); e sentimento da mulher de estar à vontade para fazer perguntas e participar das decisões (RP=5,17; IC95%:1,79-14,96). Os achados sugerem que serviços de pré-natal que oferecem cuidado multiprofissional, que dão orientações, e que oportunizam às gestantes o sentimento de estar à vontade para questionar e decidir sobre seu cuidado, proporcionam maior satisfação.

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Resumo O objetivo deste artigo é identificar fatores associados à plena satisfação com a atenção pré-natal em serviços de saúde de Porto Alegre, Rio Grande do Sul. Estudo transversal, com 287 mulheres que realizaram pré-natal na capital gaúcha. As mulheres foram selecionadas aleatoriamente em duas maternidades de grande porte (pública e privada) e entrevistadas nos seus domicílios, cerca de 30 dias após o parto, entre janeiro e agosto de 2016. A satisfação foi aferida por meio de escala Likert (muito satisfeita a muito insatisfeita). Foram estimadas razões de prevalência (RP) por regressão de Poisson com estimação robusta da variância, utilizando modelo hierarquizado. Os fatores associados à plena satisfação foram: ingresso no ensino superior (RP=1,49; IC95%:1,08-2,06); atendimento multiprofissional (RP=1,29; IC95%:1,00-1,66); recebimento de orientações sobre amamentação (RP=1,33; IC95%:1,05-1,68) e sobre local do parto (RP=1,56; IC95%:1,12-2,17); e sentimento da mulher de estar à vontade para fazer perguntas e participar das decisões (RP=5,17; IC95%:1,79-14,96). Os achados sugerem que serviços de pré-natal que oferecem cuidado multiprofissional, que dão orientações, e que oportunizam às gestantes o sentimento de estar à vontade para questionar e decidir sobre seu cuidado, proporcionam maior satisfação.

Abstract This article aims to identify factors associated with full satisfaction with prenatal care in health services in Porto Alegre (RS), Brazil. This is a cross-sectional study with 287 women that attended prenatal care in the state capital. Women were randomly selected at two large maternity hospitals (public and private) and interviewed at their homes around 30 days after delivery, from January to August 2016. Satisfaction was measured by a Likert scale (very satisfied to very unsatisfied). Prevalence ratios (PR) were estimated by Poisson regression with robust variance, using a hierarchical model. Factors associated with greater satisfaction were higher education (PR=1.49; 95% CI: 1.08-2.06); multiprofessional care (PR=1.29; 95% CI: 1.00-1.66); receiving information about breastfeeding (PR=1.33; 95% CI: 1.05-1.68) and place of delivery (PR=1.56; 95% CI: 1.12-2.17); and women feeling comfortable asking questions and participating in decisions (PR=5.17; 95% CI: 1.79-14.96). The findings suggest that prenatal care services that offer multiprofessional care, provide guidance, and make pregnant women feel comfortable asking and deciding about their care may generate greater satisfaction.

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Population-based prevalence surveys of Covid-19 contribute to establish the burden of infection, the role of asymptomatic and mild infections in transmission, and allow more precise decisions about reopen policies. We performed a systematic review to evaluate qualitative aspects of these studies, assessing their reliability and compiling practices that can influence the methodological quality. We searched MEDLINE, EMBASE, bioRxiv and medRxiv, and included cross-sectional studies using molecular and/or serological tests to estimate the prevalence of Covid-19 in the general population. Survey quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies. A correspondence analysis correlated methodological parameters of each study to identify patterns related to higher, intermediate and lower risks of bias. The available data described 37 surveys from 19 countries. The majority were from Europe and America, used antibody testing, and reached highly heterogeneous sample sizes and prevalence estimates. Minority communities were disproportionately affected by Covid-19. Important risk of bias was detected in four domains: sample size, data analysis with sufficient coverage, measurements in standard way and response rate. The correspondence analysis showed few consistent patterns for high risk of bias. Intermediate risk of bias was related to American and European studies, municipal and regional initiatives, blood samples and prevalence >1%. Low risk of bias was related to Asian studies, nationwide initiatives, reverse-transcriptase polymerase chain reaction tests and prevalence <1%. We identified methodological standards applied worldwide in Covid-19 prevalence surveys, which may assist researchers with the planning, execution and reporting of future population-based surveys.

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BACKGROUND: Having a positive childbirth experience is an increasingly valued outcome. Few studies evaluated the women's satisfaction with childbirth through face-to-face interviews out of the health service environment. The objective of this study was to identify factors associated with a higher level of satisfaction with the childbirth experience among Brazilian women. METHODS: This cross-sectional study involved 287 women giving birth in two hospitals in southern Brazil. Women who gave birth to healthy newborns at term were randomly selected. Face-to-face interviews were conducted 31-37 days after delivery, at the mothers' homes, using a structured questionnaire. Satisfaction with the childbirth experience was measured using a Likert-type scale ranging from very satisfied to very dissatisfied. Prevalence ratios (PR) were estimated using Poisson regression with robust variance. RESULTS: Following hierarchical multivariate analysis, the following factors remained associated with a higher level of satisfaction with the childbirth experience: being satisfied with antenatal care (PR=1.30; 95% confidence interval [95%CI]=1.06-1.59), understanding the information provided by health professionals during labor and delivery (PR=1.40; 95%CI=1.01-1.95), not having reported disrespect and abuse (PR=1.53; 95%CI=1.01-2.31), and having had the baby put to the breast within the first hour of life (PR=1.63; 95%CI=1.26-2.11). No association was observed with type of delivery or hospital status (public or private). CONCLUSIONS: A higher level of satisfaction with the childbirth experience is related to satisfactory antenatal care, a non-abusive, respectful, and informative environment during childbirth, and to the opportunity to breastfeed the baby within the first hour of life. In clinical practice, greater attention to these basic principles of care during pregnancy and delivery could provide more positive experiences during birth.

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Introdução: O Coeficiente de Mortalidade Infantil, indicador das condições sociais e de saúde da população, tem capacidade para orientar a proposição de políticas públicas, instalação e previsão de recursos humanos em saúde. Territórios com elevada mortalidade infantil tendem a ser mais vulneráveis e a necessitarem de uma atenção primária bem estruturada. Objetivo: Mapear a mortalidade infantil e descrever a distribuição geográfica dos serviços e recursos humanos de atenção primária (concentração e "vazios" assistenciais) em Porto Alegre, nos anos 2010 e 2014. Métodos: Estudo descritivo, delineamento ecológico, com emprego de dados secundários disponíveis em sistemas de informações em saúde. O tratamento dos dados ocorreu pelo framework Enyalius. Resultados: Dos 143 serviços, 65% possuem saúde da família, com cobertura de 36,5% da população. Os usuários adscritos por serviço variam de 700 a 115.673 habitantes; 35% dos serviços possuem menos de 4.000 habitantes adscritos. A distribuição de médicos e enfermeiros variou de 0,14 a 5,71 por 4.000 habitantes. Serviços com elevada densidade populacional possuem modelo operacional tradicional e déficit de profissionais. As regiões das Ilhas e do Extremo Sul, locais com elevada mortalidade infantil, apresentam, em maior área territorial, número adequado de médicos e enfermeiros. Observou-se elevada heterogeneidade na distribuição da mortalidade infantil (zero a 52,63 por 1.000 nascidos vivos) em 2014. Conclusão: Um terço da população de Porto Alegre é assistida pela saúde da família. Locais com elevada mortalidade infantil apresentaram número de médicos e enfermeiros próximo ao preconizado. Esse estudo é gerador de hipótese para futuras investigações epidemiológicas na área de atenção primária.

Introduction: The Child Mortality Coefficient, an indicator of the social and health conditions of the population, has the capacity to guide the proposal of public policies, installation and forecasting of human resources in health. Territories with high infant mortality tend to be more vulnerable and require more structured primary care. Objective: To map infant mortality and describe the geographic distribution of primary care services and human resources (concentration and care "gaps") in Porto Alegre, in the years 2010 and 2014. Methods: Descriptive study, ecological design, employing secondary data available in health information systems. Data processing was performed by the Enyalius framework. Results: Of the 143 services, 65% have family health, with coverage of 36.5% of the population. The number of users adjoined per service ranges from 700 to 115,673 inhabitants; 35% of the services have less than 4,000 adjoined inhabitants. The distribution of doctors and nurses ranged from 0.14 to 5.71 per 4,000 inhabitants. Services with a high population density have a traditional operating model and a professional deficit. The regions of the Islands and of the Extreme South, places with high infant mortality, present, in a larger territorial area, an adequate number of doctors and nurses. There was a high heterogeneity in the distribution of infant mortality (zero to 52.63 per 1,000 live births) in 2014. Conclusion: One-third of the Porto Alegre population is assisted by family health. Locations with high infant mortality presented a number of doctors and nurses close to that recommended. This study generates hypotheses for future epidemiological investigations in the primary care area.

Introducción: El Coeficiente de Mortalidad Infantil, indicador de las condiciones sociales y de salud de la población, tiene capacidad para orientar la proposición de políticas públicas, instalación y previsión de recursos humanos en salud. Los territorios con una elevada mortalidad infantil tienden a ser más vulnerables y a necesitar de una atención primaria bien estructurada. Objetivo: Mapear la mortalidad infantil y describir la distribución geográfica de los servicios y recursos humanos de atención primaria (concentración y "vacíos" asistenciales) en Porto Alegre, en los años 2010 y 2014. Métodos: Estudio descriptivo, delineamiento ecológico, con empleo de datos secundarios disponibles en sistemas de información en salud. El tratamiento de los datos ocurrió por el framework enyalius. Resultados: De los 143 servicios, 65% poseen salud de la familia, con cobertura del 36,5% de la población. El número de usuarios adscritos por servicio varía de 700 a 115.673 habitantes; El 35% de los servicios tienen menos de 4.000 habitantes adscritos. La distribución de médicos y enfermeros varió de 0,14 a 5,71 por 4.000 habitantes. Los servicios de alta densidad de población tienen un modelo operativo tradicional y un déficit de profesionales. Las regiones de las Islas y del extremo Sur, ubicadas con elevada mortalidad infantil, presentan, en mayor área territorial, número adecuado de médicos y enfermeros. Se observó una elevada heterogeneidad en la distribución de la mortalidad infantil (cero a 52,63 por 1.000 nacidos vivos) en 2014. Conclusión: Un tercio de la población de Porto Alegre es asistida por la salud de la familia. Los lugares con elevada mortalidad infantil presentaran un número de médicos y enfermeros próximo al previsto. Este estudio es generador de hipótesis para futuras investigaciones epidemiológicas en el área de atención primaria.

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Objetivo: Discutir a formação em residências multiprofissionais como tecnologia educativa que se orienta pelo quadrilátero da formação em saúde. Métodos: Foram analisados questionários de avaliação da ênfase Saúde da Família e Comunidade. As informações foram categorizadas pela análise de conteúdo. Resultados: A análise das avaliações permitiu a identificação de: elevada heterogeneidade entre os campos de formação; enfraquecimento dos espaços de controle social; pouca adesão da equipe na realização de atividades de educação em saúde; crítica acerca da "clínica tradicional", centrada na doença e necessidade de reorganização da atenção por micro-áreas para proporcionar aos residentes o exercício da vigilância do território. Conclusões: A atenção à saúde constitui-se no elemento com maior organização e qualidade. O controle social mostra-se como elemento bastante fragilizado, espaço em que os residentes e preceptores têm empreendido energia para qualifica-lo. A educação em saúde é espaço de intensa participação da residência, mas fragilizado devido à pouca adesão da equipe. A gestão em saúde não foi estudada com profundidade devido à inexistência de um eixo de avaliação específico. (AU)

Purpose: Discuss the training provided in multispecialty residencies as an educational technology steered by the healthcare training quadrangle. Methods: Questionnaires meant to assess family and community healthcare were analyzed. The information was categorized after its contents were analyzed. Results: By analyzing the assessments, we found: high heterogeneity between training fields; weakened society oversight; lack of engagement by the team in the health education activities carried out; criticism about the "conventional practice" focused on disease, and need to reorganize healthcare services per micro areas to allow residents to survey the territory. Conclusions: Healthcare is the most organized, higher quality element. Society oversight has been quite weakened, and residents and instructors have been putting in efforts to improve it. Residents intensely participate in health education, but it has dwindled owing to the team's lack of engagement. Healthcare management was not studied in depth because there is no specific evaluation track. (AU)

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Objetivo: Discutir a formação em residências multiprofissionais como tecnologia educativa que se orienta pelo quadrilátero da formação em saúde. Metodologia: Foram avaliados documentos orientadores, registros de espaços deliberativos e questionários de avaliação da ênfase Saúde da Família e Comunidade. As informações foram categorizadas pela análise de conteúdo. Resultados: A ênfase contempla, nas competências do egresso, habilidades que exigem o exercício da assistência, da gestão, da educação e do controle social. As avaliações permitiram a identificação de: elevada heterogeneidade entre os campos de formação; enfraquecimento dos espaços de controle social; pouca adesão da equipe na realização de atividades de educação em saúde; crítica acerca da “clínica tradicional”, centrada na doença e necessidade de reorganização da atenção por micro-áreas para proporcionar aos residentes o exercício da vigilância do território. Conclusões: A atenção à saúde constitui-se no elemento com maior organização e qualidade. O controle social mostra-se como elemento bastante fragilizado, espaço em que os residentes e preceptores têm empreendido energia para qualificá-lo. A educação em saúde é espaço de intensa participação da residência, mas fragilizado devido a pouca adesão da equipe. A gestão em saúde não foi estudada com profundidade devido à inexistência de um eixo de avaliação específico.

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OBJECTIVES: to evaluate the heterogeneity of biomedical waste (BW) using Nightingale charts. METHOD: cross-sectional study consisting of data collection on wastes (direct observation of receptacles, physical characterisation, and gravimetric composition), development of a Management Information System, and creation of statistical charts. RESULTS: the wastes with the greatest degree of heterogeneity are, in order, recyclable, infectious, and organic wastes; chemical waste had the most efficient segregation; Nightingale charts are useful for quick visualisation and systematisation of information on heterogeneity. CONCLUSION: the development of a management information system and the use of Nightingale charts allows for the identification and correction of errors in waste segregation, which increase health risks and contamination by infectious and chemical wastes and reduce the sale and profit from recyclables. .

OBJETIVO: avaliar a heterogeneidade dos Resíduos de Serviço de Saúde por meio da aplicação de gráficos nightingaleanos. MÉTODO: estudo transversal, que consiste na coleta de dados sobre resíduos (observação direta dos locais de armazenamento, caracterização física e composição gravimétrica), desenvolvimento de um Sistema de Informação Gerencial e construção de gráficos estatísticos. RESULTADOS: os resíduos que apresentam maior grau de heterogeneidade são os recicláveis, infectantes e orgânicos, respectivamente; o resíduo químico atingiu maior eficiência na segregação; os gráficos nightingaleanos são úteis na visualização rápida e na sistematização das informações sobre a heterogeneidade. CONCLUSÃO: o desenvolvimento de um sistema de informação gerencial e a utilização dos gráficos nigthingaleanos permite identificar e corrigir erros na segregação dos resíduos que impactam tanto no aumento de riscos à saúde e de contaminação por resíduos infectantes e químicos como na redução da comercialização e receita com os recicláveis. .

OBJETIVO: evaluar la heterogeneidad de los residuos sanitarios (RS) usando gráficos Nightingale. MÉTODO: estudio transversal que consiste en la recopilación de datos sobre los residuos (observación directa de los recipientes, caracterización física y composición gravimétrica), desarrollo de un Sistema de Información para la Gestión y creación de gráficos estadísticos. RESULTADOS: los residuos con el mayor grado de heterogeneidad son los reciclables, infecciosos, y los residuos orgánicos, respectivamente; la segregación de los residuos químicos fue la más eficiente; los gráficos Nightingale son útiles para la visualización rápida y sistematización de la información sobre la heterogeneidad. CONCLUSIÓN: el desarrollo de un sistema de información para la gestión y el uso de gráficos Nightingale permiten la identificación y corrección de errores en la separación de los residuos; dichos errores aumentan los riesgos de salud y la contaminación por residuos infecciosos y químicos, y reducen la venta y beneficio obtenible de los materiales reciclables. .

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OBJECTIVES: to evaluate the heterogeneity of biomedical waste (BW) using Nightingale charts. METHOD: cross-sectional study consisting of data collection on wastes (direct observation of receptacles, physical characterisation, and gravimetric composition), development of a Management Information System, and creation of statistical charts. RESULTS: the wastes with the greatest degree of heterogeneity are, in order, recyclable, infectious, and organic wastes; chemical waste had the most efficient segregation; Nightingale charts are useful for quick visualisation and systematisation of information on heterogeneity. CONCLUSION: the development of a management information system and the use of Nightingale charts allows for the identification and correction of errors in waste segregation, which increase health risks and contamination by infectious and chemical wastes and reduce the sale and profit from recyclables.

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