Geocoding processes in cohort studies: methods applied in the EpiFloripa Aging

OBJECTIVE

To describe the process and epidemiological implications of georeferencing in EpiFloripa Aging samples (2009-2019).

METHOD

The EpiFloripa Aging Cohort Study sought to investigate and monitor the living and health conditions of the older adult population (≥ 60) of Florianópolis in three study waves (2009/2010, 2013/2014, 2017/2019). With an automatic geocoding tool, the residential addresses were spatialized, allowing to investigate the effect of the georeferencing sample losses regarding 19 variables, evaluated in the three waves. The influence of different neighborhood definitions (census tracts, Euclidean buffers, and buffers across the street network) was examined in the results of seven variables: area, income, residential density, mixed land use, connectivity, health unit count, and public open space count. Pearson's correlation coefficients were calculated to evaluate the differences between neighborhood definitions according to three variables: contextual income, residential density, and land use diversity.

RESULT

The losses imposed by geocoding (6%, n = 240) caused no statistically significant difference between the total sample and the geocoded sample. The analysis of the study variables suggests that the geocoding process may have included a higher proportion of participants with better income, education, and living conditions. The correlation coefficients showed little correspondence between measures calculated by the three neighborhood definitions (r = 0.37-0.54). The statistical difference between the variables calculated by buffers and census tracts highlights limitations in their use in the description of geospatial attributes.

CONCLUSION

Despite the challenges related to geocoding, such as inconsistencies in addresses, adequate correction and verification mechanisms provided a high rate of assignment of geographic coordinates, the findings suggest that adopting buffers, favored by geocoding, represents a potential for spatial epidemiological analyses by improving the representation of environmental attributes and the understanding of health outcomes.

Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c

Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance.

Global Effect of Modifiable Risk Factors on Cardiovascular Disease and Mortality

BACKGROUND

Five modifiable risk factors are associated with cardiovascular disease and death from any cause. Studies using individual-level data to evaluate the regional and sex-specific prevalence of the risk factors and their effect on these outcomes are lacking.

METHODS

We pooled and harmonized individual-level data from 112 cohort studies conducted in 34 countries and 8 geographic regions participating in the Global Cardiovascular Risk Consortium. We examined associations between the risk factors (body-mass index, systolic blood pressure, non-high-density lipoprotein cholesterol, current smoking, and diabetes) and incident cardiovascular disease and death from any cause using Cox regression analyses, stratified according to geographic region, age, and sex. Population-attributable fractions were estimated for the 10-year incidence of cardiovascular disease and 10-year all-cause mortality.

RESULTS

Among 1,518,028 participants (54.1% of whom were women) with a median age of 54.4 years, regional variations in the prevalence of the five modifiable risk factors were noted. Incident cardiovascular disease occurred in 80,596 participants during a median follow-up of 7.3 years (maximum, 47.3), and 177,369 participants died during a median follow-up of 8.7 years (maximum, 47.6). For all five risk factors combined, the aggregate global population-attributable fraction of the 10-year incidence of cardiovascular disease was 57.2% (95% confidence interval [CI], 52.4 to 62.1) among women and 52.6% (95% CI, 49.0 to 56.1) among men, and the corresponding values for 10-year all-cause mortality were 22.2% (95% CI, 16.8 to 27.5) and 19.1% (95% CI, 14.6 to 23.6).

CONCLUSIONS

Harmonized individual-level data from a global cohort showed that 57.2% and 52.6% of cases of incident cardiovascular disease among women and men, respectively, and 22.2% and 19.1% of deaths from any cause among women and men, respectively, may be attributable to five modifiable risk factors. (Funded by the German Center for Cardiovascular Research (DZHK); ClinicalTrials.gov number, NCT05466825.).

Autopercepção negativa da audição e depressão em idosos: um estudo de base populacional

OBJETIVO: Estimar a associação entre a autopercepção negativa da audição e a depressão em idosos do sul do Brasil. MÉTODOS: Trata-se de um estudo transversal realizado com dados da terceira onda do estudo EpiFloripa Idoso 2017/19, de coorte de base populacional de idosos (60+). Participaram desta onda 1.335 idosos. A variável dependente foi a depressão autorreferida e a exposição principal foi a autopercepção auditiva (negativa; positiva). Tanto para a análise bruta (bivariada) quanto para a ajustada, a odds ratio (OR) foi utilizada como medida de associação e estimada por meio da análise de Regressão Logística Binária. A variável de exposição foi ajustada pelas covariáveis sociodemográficas e de saúde. Adotou-se o valor de p < 0,05 como estatisticamente significativo. RESULTADOS: A prevalência da autopercepção negativa da audição e depressão foi de 26,0% e 21,8%, respectivamente. Na análise ajustada, idosos com autopercepção negativa da audição apresentaram 1,96 vezes mais chance de referirem depressão quando comparados aos idosos com autopercepção positiva da audição (p = 0,002). CONCLUSÃO: A associação encontrada entre a autopercepção negativa auditiva e a depressão reflete a importância de rever as ações de atenção à saúde do idoso, incorporando questões relacionadas à audição para a garantia da atenção integral a esta parcela crescente da população.

Diminishing benefits of urban living for children and adolescents' growth and development

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1-6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5-19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m-2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified.

Self-reported hearing loss and cognitive impairment: a cross-sectional analysis of the EpiFloripa Aging study

This study aimed to investigate the association between self-reported hearing loss and cognitive impairment in older adults in a city in Southern Brazil. In this cross-sectional, population-based cohort study of older adults, data were collected in the third wave of the EpiFloripa Aging study (2017/2019), which had been performed since 2009 in the city of Florianópolis, Santa Catarina State. Cognitive impairment was the dependent variable analyzed by the Mini-Mental State Examination (MMSE), and self-reported hearing loss, which was included in the cohort only in the last wave, was the main exposure variable. Logistic regression analyses were conducted, considering the study design and sample weights. Data from 1,335 older adults were evaluated. The prevalence was 20.5% for cognitive impairment and 10.7% for hearing loss. Older adults with hearing loss were 2.66 (95%CI: 1.08-6.54) times more likely to have cognitive impairment than older adults without hearing loss. The association between hearing loss and cognitive impairment highlights the need to integrate the early identification of these problems into primary care, as both are risk factors for healthy aging and potentially preventable and/or treatable conditions.

Association between healthy food environment and metabolic syndrome, waist circumference, and systolic blood pressure in older adults in Southern Brazil

The aim of this study was to investigate the association between healthy food outlet proximity, metabolic syndrome (MS), and two of its components, waist circumference (WC) and systolic blood pressure (SBP), in older adults (63-107 years old, median age 73 years) living in Florianópolis, South Brazil in 2013-2014. This is a cross-sectional analysis of the second wave of the EpiFloripa Aging Cohort Study. Individual-level data on MS, WC, SBP, and socio-demographic and health-related characteristics were collected from face to face interviews. The healthy food environment was assessed via the number and types of establishments present. The residences of older adult participants were georeferenced using Geographical Information System (GIS) software. The number of each type of food establishment in a 500 m buffer around the each residence was determined. Multivariate linear regression was used to test association between food outlet proximity and continuous outcomes (SBP and WC), and multiple logistic regression was used to examine the relations between the predictor variables and the dichotomous outcome of MS (yes/no). The study revealed that greater frequency of supermarkets and restaurants in the neighborhood was associated with a lower likelihood of having MS. WC was lower in individuals living in places with greater availability of greengrocers' shops and restaurants. The results demonstrated that the number of establishments in a neighborhood is associated with cardiometabolic outcomes, and the likelihood of MS and increased WC is lower for older adults who live in neighborhoods with more access to establishments that sell foundational components of a healthy diet.

Neighbourhood walkability and mental health in older adults: A cross-sectional analysis from EpiFloripa Aging Study

This study aims to analyse the association between walkability index and depressive symptoms and cognitive impairment and test the mediating role of moderate-vigorous physical activity (MVPA) in this relationship among older adults from Florianópolis, Brazil. This is cross-sectional research with data from the third wave of the EpiFloripa Aging cohort study, conducted in 2017–2019. Depressive symptoms were assessed using the short version of the Geriatric Depression Scale (GDS), and cognitive impairment, using the Mini-Mental State Examination (MMSE) scales. The neighbourhood environment was assessed using a walkability index, which considered 500-m network buffers around the participants’ homes. Binary logistic regression analysis the association between the walkability index (quartile) and mental health outcomes (yes vs. no). Structural equation modelling evaluated the mediation between the walkability index and cognitive impairment by MVPA with an estimator of dichotomous variables. 1,162 people participated in the study (61.5% women, average age = 73.1). Older adults residing in places with a high and highest walkability index were 38% and 44% less likely to have cognitive impairment, respective. There was no association between depressive symptoms and walkability index in crude nor adjusted analysis. Engaging in MVPA had a partial but not significant effect (14%; p = 0.087), showing a tendency for this relationship to be partially explained by the greater engagement in physical activities in places with greater walkability. Policy planning to prevent and reduce the risks of cognitive impairment should consider factors of the physical environment as determinants in older adults.

Metabolic syndrome and its association with changes in modifiable risk factors: Epifloripa aging study

Purpose

To estimate the prevalence of Metabolic Syndrome (MetS) and its association with changes in modifiable risk factors in older adults from southern Brazil.

Methods

A longitudinal study was performed with data from EpiFloripa Aging study. We defined MetS by the existence of three or more of the following risk factors for cardiovascular disease (CVD): waist circumference (WC) (≥ 92 cm in men and ≥ 87 cm in women); fasting glucose (≥100 mg/dl); decreased HDL cholesterol (<40 mg/dl in men and <50 mg/dl in women); hypertriglyceridemia (≥150 mg/dl) and blood pressure (≥130/85 mmHg). We evaluated the changes in modifiable risk factors (smoking, alcohol consumption, fruit and vegetable consumption, physical activity, and body mass index) between the two moments of the study (2009/10 and 2013/14). Directed acyclic graph and logistic regression models were used.

Results

Among the 599 participants, the prevalence of MetS was 64.0% (95% CI, 58.7-68.9). In the adjusted analysis, those who remained or became persons who are overweight (OR = 4.59; 95% CI: 3.05-6.89) and those who remained or became insufficiently active (OR = 1.92; 95% CI: 1.23-2.98) were more likely to present MetS.

Conclusion

Our findings suggest that being or becoming overweight and being or becoming insufficiently active are modifiable factors associated with MetS. These results highlight the need for developing preventive strategies for the observed risk indicators to mitigate the prevalence of MetS in older adults.

Association between the consumption of omega-3-rich fish and depressive symptoms in older adults living in a middle-income country: EpiFloripa Aging cohort study

This study aimed to verify the association between the consumption of omega-3-rich (n-3) fish and depressive symptoms in older adults living in Southern Brazil. This is a cross-sectional analysis with data from the second wave of the EpiFloripa Aging cohort study (2013/2014) including 1,130 individuals aged 60 years or older. The presence of depressive symptoms was measured by the 15-items Geriatric Depression Scale (GDS-15), and the consumption of n-3-rich fish by a question of weekly frequency. The minimum set of variables for adjustment was defined using directed acyclic graph (DAG). Poisson regression with robust error variance was applied (adjusted by Model 1: demographic and socioeconomic variables, Model 2: added behavioral variables, Model 3: added health variables). We identified the prevalence of depressive symptoms in 19% of older adults and 51.8% reported eating n-3-rich fish once a week. Models 1 and 3 showed an inverse association between n-3-rich fish and depressive symptoms. However, the association was reduced when behavioral factors (leisure-time physical activity) were included in Model 2. These findings suggest that n-3-rich fish intake tends to be associated with depressive symptoms in older adults. However, other factors, such as physical exercise, are as pivotal as n-3 fatty acids in preventing the development of depressive symptoms.

Physical activity and sedentary behavior as multimorbidity discriminators among elderly Brazilians: a cross-sectional study

BACKGROUND

Associations between behaviors and individual chronic diseases have been demonstrated. However, the relationship between time spent on sedentary behavior and multimorbidity remains less clear.

OBJECTIVE

To identify the predictive power of various intensities of physical activity versus sedentary behavior, as discriminatory factors for cardiometabolic multimorbidity (cardiovascular diseases and diabetes) in the elderly.

DESIGN AND SETTING

Cross-sectional study in different residential census tracts and residential households in Florianópolis (SC).

METHODS

The participants were 425 elderly people (65% women) from the EpiFloripa Aging study in 2014. Sociodemographic variables and self-reported incidence of cardiovascular diseases and diabetes were obtained via a questionnaire. Light physical activity (LPA), moderate-to-vigorous physical activity (MVPA) and sedentary behavior (SB) were measured using accelerometers. The analyses were stratified according to sex and included a diagnosis for interpretation. Behaviors were taken into consideration if their predictive power in terms of area under the receiver operating characteristic (ROC) curve was greater than 0.50. The time cutoff point was defined from sensitivity and specificity.

RESULTS

For older adult men with diabetes, the predictive value of MVPA for absence of multi-morbidity was an area of 0.75 (95% confidence interval, CI: 0.538-0.962), and a cutoff of 17 minutes per day. Older adult women with diabetes had an area of 0.71 (95% CI: 0.524-0.866) and a cutoff of 10 minutes per day. LPA and SB did not present predictive values.

CONCLUSION

The time spent on MVPA is a predictor of absence of multimorbidity in elderly people with diabetes, for both sexes.

Association between chronic diseases, multimorbidity and insufficient physical activity among older adults in southern Brazil: a cross-sectional study

BACKGROUND

Being active has been shown to have beneficial effects for the health of individuals with chronic diseases. However, data on the association between multimorbidity and physical activity are limited.

OBJECTIVE

To investigate the association between chronic diseases, multimorbidity and insufficient physical activity among older adults in southern Brazil, according to sex.

DESIGN AND SETTING

Cross-sectional population-based and household-based study derived from the second wave (2013-2014) of the EpiFloripa Aging Cohort Study.

METHODS

Insufficiency of physical activity (outcome) was ascertained using the long version of the International Physical Activity Questionnaire (≤ 150 minutes/week). Eleven self-reported chronic diseases were identified. Multimorbidity was defined from the number of chronic diseases (none; 2 or 3; or 4 or more). The adjustment variables were age, schooling, marital status, income, smoking, alcohol consumption and cognition. Additionally, each chronic disease was adjusted for the others. Associations were tested using logistic regression (crude and adjusted).

RESULTS

Among the 1197 participants (≥ 63 years), women (54.0%) were more likely than men (39.6%) to be insufficiently active. In the adjusted analysis, women and men with depressive symptoms, and men with diabetes, were more likely to be insufficiently active than those without symptoms. Multimorbid women were more likely to be insufficiently active, and the magnitude of the effect was strongest for 4 or more diseases.

CONCLUSION

This study indicates that the associations were sex-specific. Depressive symptoms and multimorbidity were associated with insufficient physical activity among women, while diabetes was associated with insufficient physical activity among men.

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular risk-changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.

Sarcopenia, bone mineral density, and vitamin D: EpiFloripa aging study 2013/2014

OBJECTIVE: To verify associations between osteopenia/osteoporosis and vitamin D and sarcopenia in the older adult population of Florianopolis, Brazil. METHODS: A cross-sectional population-based study, with 604 older adults (60 years and over). The appendicular muscle mass index (AMMI) was used to identify sarcopenia, with cutoffs of AMMI (Kg/m2) < 7.26 kg/m2 for men and < 5.50 kg/m2 for women indicating inadequate values (sarcopenia). The independent variable osteopenia/osteoporosis was measured using bone mineral density (BMD, g/cm2): T-Scores for whole body BMD, lumbar spine BMD, and femoral neck BMD, categorized as normal (BMD ≥ -1 SD) or osteopenia/osteoporosis (BMD < -1 SD from the mean of the young adult reference population). Fasting serum samples were collected and assayed using the microparticle chemiluminescence (CMIA)/Liaison method. Vitamin D concentrations of < 30 ng/mL were defined as hypovitaminosis. Crude and adjusted logistic regression analyses were performed. RESULTS: Osteopenia/osteoporosis in the lumbar spine and femoral neck were associated with higher odds of sarcopenia in women and men. Osteopenia/osteoporosis in the whole body was associated with sarcopenia in women only. Vitamin D was not associated with sarcopenia in either sex. CONCLUSIONS: Having osteopenia/osteoporosis is associated with sarcopenia in the older adult population.

Incidence and prevalence of diabetes self-reported on elderly in south of Brazil: results of EpiFloripa Ageing Study

Abstract This study investigated the prevalence and incidence of diabetes self-referred in the elderly. Longitudinal population-based study (EpiFloripa Ageing Study), with 1.702 elderly in 2009/10 and 1.197 in 2013/14 of Florianópolis, SC. Self-reported and anthropometric data were collected at home. The prevalence of diabetes self-referred in 2009/10 was 22.1% (95%CI 20.1-24.1). The characteristics were: no formal schooling (2.30; CI95% 1.32-4.00); 5 to 8 years of schooling (OR = 1.70, CI95% 1.07-2.69); increased waist circumference (OR = 3.31, CI95% 2.05-5.34) and hypertension (OR = 2.38, CI95%: 1.68-3.36). The incidence of diabetes self-reported after four years of follow-up was 8.3% (95% CI, 6.7-10.3). After adjustment: increased waist circumference (OR= 2.23, CI95% 1.09-4.57) at baseline was associated with the incidence of diabetes. The prevalence and incidence of diabetes were high among the elderly. Interventions must be performed especially with elderly with low and without formal schooling, with increased waist circumference and hypertension, thus they were the subgroups with higher odds ratio of reporting and developing diabetes.

Association of objectively measured sedentary behavior and physical activity with cardiometabolic risk markers in older adults

Objective

The aim of this study was to examine the associations between sedentary behavior and different intensities of physical activity with cardiometabolic risk, and to analyze the simultaneous effect of excess sedentary behavior and recommended levels of physical activity on cardiometabolic risk markers in older adults.

Methods

We conducted a population-based cross-sectional study on a sample of older adults (60+) living in Florianopolis, Brazil. The objectively measured predictors were sedentary time, light physical activity and moderate to vigorous physical activity, and the outcomes were markers of cardiometabolic risk. Data were considered valid when the participant had used the accelerometer for at least four days per week.

Results

The sample included 425 older adults (59.8% women), with a mean age of 73.9 years (95%CI: 73.5–74.4). Sedentary behavior was associated with lower systolic blood pressure levels (β = -0.03; 95%CI: -0.05; -0.01) and lower HDL cholesterol (β = -0.02; 95%CI: -0.02; -0.01). Light physical activity was not associated with any cardiovascular risk markers after adjustment. Each minute spent in moderate to vigorous physical activity was associated with lower waist circumference (β = -0.15; 95%CI: -0.24; -0.05), systolic blood pressure (β = -0.18; 95%CI: -0.32; -0.04) and plasma glucose (β = -0.18; 95%CI: -0.33;-0.02), and with higher HDL cholesterol (β = 0.10; 95%CI: 0.01; 0.18). Moreover, physically inactive and sedentary individuals had a greater mean waist circumference and lower HDL cholesterol than physically active and non-sedentary subjects.

Conclusion

The results suggest that moderate to vigorous physical activity have a positive impact on cardiometabolic risk markers in older adults. Light physical activity does not appear to have a beneficial effect on the cardiometabolic markers, and despite the benefits provided by the different intensities of physical activity, the simultaneous presence of sedentary behavior and low physical activity level was associated with poor cardiometabolic risk markers.

Modelos de assistência obstétrica na Região Sul do Brasil e fatores associados

Os objetivos do estudo foram identificar modelos de assistência obstétrica em gestantes de risco habitual na Região Sul do Brasil, estimar os fatores associados a esses modelos e os desfechos maternos e neonatais. Realizou-se estudo seccional a partir da pesquisa Nascer no Brasil, de base hospitalar, que envolveu puérperas e recém-nascidos. Foram identificadas 2.668 gestantes de risco habitual. Procedeu-se a uma análise exploratória, com a utilização da proporção de práticas por hospital, entre elas o desencadeamento do trabalho de parto, a presença de acompanhante, a cesárea e o contato pele a pele, para a obtenção de modelos de assistência obstétrica denominados Boas Práticas, Intervencionista I e Intervencionista II. Em seguida, realizou-se uma análise inferencial das características associadas. Os resultados mostraram que o acesso ao financiamento público ou privado, os fatores culturais e a atuação dos profissionais de saúde apresentaram associações com os modelos de assistência. A assistência pública apresentou diferentes contextos: um primeiro, alicerçado em políticas públicas e na prática baseada em evidência; um segundo, baseado na intencionalidade pelo parto vaginal, sem considerar os princípios de humanização. Já a assistência privada é padronizada e centrada no profissional médico, com maiores níveis de intervenção. Conclui-se que há predomínio dos modelos de assistência obstétrica intervencionistas na Região Sul do Brasil, uma assistência na contramão das melhores evidências, e que as mulheres assistidas em hospitais públicos possuem mais chance de serem beneficiadas com as boas práticas.

Medical students' personal choice for mode of delivery in Santa Catarina, Brazil: a cross-sectional, quantitative study

BACKGROUND

The increase in overall rates of cesarean sections (CS) in Brazil causes concern and it appears that multiple factors are involved in this fact. In 2009, undergraduate students in the first and final years of medical school at the University of Santa Catarina answered questionnaires regarding their choice of mode of delivery. The aim of the study was to evaluate whether the education process affects decision-making regarding the way of childbirth preferred by medical students.

METHODS

A cross-sectional, quantitative study was conducted based on data obtained from questionnaires applied to medical students. The questions addressed four different scenarios in childbirth, as follows: under an uneventful pregnancy; the mode of delivery for a pregnant woman under their care; the best choice as a healthcare manager and lastly, choosing the birth of their own child. For each circumstance, there was an open question to explain their choice.

RESULTS

A total of 189 students answered the questionnaires. For any uneventful pregnancy and for a pregnant woman under their care, 8.46% of the students would opt for CS. As a healthcare manager, only 2.64% of the students would recommend CS. For these three scenarios, the answers of the students in the first year did not differ from those given by students in the sixth year. In the case of the student's own or a partner's pregnancy, 41.4% of those in the sixth year and 16.8% of those in the first year would choose a CS. A positive association was found between being a sixth year student and a personal preference for CS according to logistic regression (OR = 2.91; 95%CI: 1.03-8.30). Pain associated with vaginal delivery was usually the reason for choosing a CS.

CONCLUSIONS

A higher number of sixth year students preferred a CS for their own pregnancy (or their partner's) compared to first year students. Pain associated with vaginal delivery was the most common reason given for haven chosen a CS. The students' preference for childbirth changed over time during their graduation in favor of cesarean sections. This finding deserves considerable attention when structuring medical education in Obstetrics.