ObjectiveThe aim of this observational cross-sectional study was to analyse the spatial distribution of major lower limb amputation (MLLA) rates and associate them to socioeconomic, demographic and public healthcare access-related variables in the State of Paraná, Brazil, from 2012 to 2017.MethodData on MLLA, revascularisation surgeries, diagnostic exams and healthcare coverage were obtained from the Brazilian Public Hospital Information System. Socioeconomic data were obtained from the Brazilian Institute of Geography and Statistics. Spatial autocorrelation of the MLLA rates was tested using Moran’s I method. Multivariate spatial regression models using ordinary least squares regression (OLS) and geographically weighted regression (GWR) were used to identify the variables significantly correlated with MLLA.ResultsA total of 5270 MLLA were included in the analysis. Mean MLLA rates were 24.32 (±18.22)/100 000 inhabitants, showing a positive global spatial autocorrelation (Moran’s I=0.66; p<0.001). Queen contiguity matrix demonstrates that MLLA rates ranged from 7.6 to 46.6/100 000 with five large clusters of high MLLA rates. OLS showed that four of the nine studied variables presented significant spatial correlation with MLLA rates. Colour Doppler ultrasound showed a negative association (p<0.001), while revascularisation surgeries and illiteracy showed a positive correlation (p<0.01). GWR presented the best model (adjusted R2=0.77) showing that the predictors differentially affect the MLLA rates geographically.ConclusionThe high MLLA rates in some regions of the state are influenced by the high rate of illiteracy and low utilisation rate of colour Doppler, indicating a social problem and difficulty in accessing health. On the other hand, the high rates of revascularisation surgeries are related to higher MLLA rates, possibly due to delayed access to specialised hospitals. This indicates that attention must be given to population access to public healthcare in the State of Paraná in order to ensure proper and timely medical attention.

Objective: To know women's health behavior and their reason to seek for care in an emergency service. Methods: Descriptive, exploratory and qualitative study done with 18 women who were attended in a municipal emergency unit in the northwest of Paraná. These data were collected in November of 2015 with a semi-structured interview and subjected to content analysis, in thematic modality. Results: Two empirical categories were identified: "Women behaviors before health complications" shows that the initial conduct of women in situations of illness is self-medication and postponement to seek health services; and "reasons to seek emergency care service", which shows that the demand for this level of service is driven by the perception of better resolution, effectiveness and agility, as well as proximity to home. Conclusion: It is common for women to delay seeking treatment because of gender-related responsibilities, and when they do it, they prefer to choose more resolute services. Descriptors RESUMENObjetivo: Conocer el comportamiento de la salud de las mujeres y la razón de buscar atención en un servicio de emergencia. Métodos: Estudio descriptivo y exploratorio, cualitativo con 18 mujeres que acuden a un servicio municipal listo en el noroeste de Paraná. Los datos fueron recogidos en 11 2015 entrevista semiestructurada y se sometieron a análisis de contenido, modalidad temática. Resultados: Se identificaron dos categorías empíricas: "Mujeres comportamientos ante complicaciones de salud", muestra que el comportamiento inicial de las mujeres en situaciones de enfermedad, son la automedicación y el aplazamiento de buscar los servicios de salud; y "razones para buscar el servicio de atención de emergencia", en donde se encontró que la demanda de este nivel de servicio es impulsado por la percepción de una mejor resolución, eficacia y agilidad, así como la proximidad a la casa. Conclusión: Es común que las mujeres retrasan la búsqueda de tratamiento debido a las responsabilidades relacionadas con el género, y cuando lo hacen, prefieren los servicios más resueltas.