12 Blass EM, Smith BA. Differential effects of sucrose, fructose, glucose, and lactose on crying ... more 12 Blass EM, Smith BA. Differential effects of sucrose, fructose, glucose, and lactose on crying in 1-to 3-day-old human infants: qualitative and quantitative considerations. Dev Psychol 1992;28:804-10. 13 Ramenghi LA, Griffith GC, Wood CM, Levene MI. Effect of non-sucrose sweet tasting solution on neonatal heel prick responses. Arch Dis Child 1996;74:F129-31. 14 Skogsdal Y, Eriksson M, Schollin J. Analgesia in newborns given oral glucose. Acta Paediatr 1997;86:217-20. 15 Stevens B, Taddio A, Ohlsson A, Einarson T. The efficacy of sucrose for relieving procedural pain in neonates-a systematic review and meta-analysis. Abstract Objectives To estimate the incidences of caesarean sections in Latin American countries and correlate these with socioeconomic, demographic, and healthcare variables. Design Descriptive and ecological study. Setting 19 Latin American countries. Main outcome measures National estimates of caesarean section rates in each country.
Victora GV (Department of Social Medicine, Universidade Federal de Pelotas, CP 464, 96100 Pelotas... more Victora GV (Department of Social Medicine, Universidade Federal de Pelotas, CP 464, 96100 Pelotas, RS, Brazil), Barros FC, Vaughan JP and Teixeira AMB. Birthweight and infant mortality: a longitudinal study of 5914 Brazilian children. Internationa/Journal of ...
Finalmente, a todos os bolsistas que participaram ativamente de todas as fases deste projeto, e q... more Finalmente, a todos os bolsistas que participaram ativamente de todas as fases deste projeto, e que foram fundamentais para o sucesso na coleta e preparo dos dados:
Background Middle-income countries will need to drastically reduce neonatal deaths to achieve the... more Background Middle-income countries will need to drastically reduce neonatal deaths to achieve the Millennium Development Goal for child survival. The evolution of antenatal and perinatal care indicators in the Brazilian city of Pelotas from 1982 to 2004 provides a useful case study of potential challenges.
This paper describes the main methodological aspects of a cohort study, with emphasis on its rece... more This paper describes the main methodological aspects of a cohort study, with emphasis on its recent phases, which may be relevant to investigators planning to carry out similar studies. In 1993, a population based study was launched in Pelotas, Southern Brazil. All 5,249 newborns delivered in the city's hospitals were enrolled, and sub-samples were visited at the ages of one, three and six months and of one and four years. In 2004-5 it was possible to trace 87.5% of the cohort at the age of 10-12 years. Sub-studies are addressing issues related to oral health, psychological development and mental health, body composition, and ethnography. Birth cohort studies are essential for investigating the early determinants of adult disease and nutritional status, yet few such studies are available from low and middle-income countries where these determinants may differ from those documented in more developed settings.
The current international growth reference, the National Center for Health Statistics (NCHS) refe... more The current international growth reference, the National Center for Health Statistics (NCHS) reference, is widely used to compare the nutritional status of populations and to assess the growth of individual children throughout the world. Recently, concerns were raised regarding the adequacy of this reference for assessing the growth of breast-fed infants. We used the NCHS reference to evaluate infant growth in one of the most developed areas of Brazil. Infants who were exclusively or predominantly breast-fed for the first 4-6 mo, and partially breastfed thereafter, grew more rapidly than the NCHS reference in weight and length during the first 3 mo, but appeared to falter thereafter. The average growth of all infants, regardless of feeding pattern, was faster than the NCHS reference until Ç6 mo, after which their growth became slower than that of the NCHS sample. To substantiate this finding, the NCHS growth curves were then compared with growth data of breast-fed infants in developed countries from pooled published studies, formula-fed North American and European infants and predominantly bottle-fed U.S. infants monitored by the Centers for Disease Control and Prevention (CDC) Pediatric Surveillance System. In all three cases, weights showed the same pattern as the Brazilian infants-higher than NCHS in the early months but an apparent decline thereafter. The pattern for length gain was similar but less marked. Breastfed infants showed more pronounced declines than those who were predominantly bottle-fed. These findings suggest that the infancy portion of the NCHS reference does not adequately reflect the growth of either breastfed or artificially fed infants. This probably results from characteristics of the original sample and from inadequate curve-fitting procedures. The development of an improved international growth reference that reflects the normal infant growth pattern is indicated.
Caesarean sections in Brazil rose from 15 per cent of all births in 1970 to over 30 per cent in 1... more Caesarean sections in Brazil rose from 15 per cent of all births in 1970 to over 30 per cent in 1980. A new policy was introduced by the largest medical care provider (INAMPS) which made the reimbursement fee payable to doctors the same for both vaginal and caesarean section deliveries. However, the caesarean rate has continued to rise. This study analysed the antenatal care and deliveries of over 7000 births which occurred during 1982 in the city of Pelotas in southern Brazil. The organization of health care is discussed in relation to the findings on the utilization of the different antenatal and delivery services available. Utilization is then related to the gestational risk and socio-economic status of the mothers. There were marked differentials between the low and high risk mothers and between those from high and low income families. Doctors clearly concentrated their efforts on the low risk and high income mothers, with 50 per cent of private patients having an operative delivery compared to 13 per cent of uninsured mothers. There was a large demand for tubal ligations to be carried out at the same time as the caesareans. The non-medical and financial reasons for these high rates are discussed and the high extra cost that is being incurred by patients and the insurance schemes is emphasized.
The effect of smoking on breastfeeding duration was investigated in a population-based birth coho... more The effect of smoking on breastfeeding duration was investigated in a population-based birth cohort study of 1,098 Brazilian infants. There were few losses to follow-up (3.2%) in the first 6 months. Maternal smoking was strongly associated with breastfeeding duration, even after adjustment for confounding. Compared with nonsmokers, mothers smoking 20 or more cigarettes daily presented an odds ratio of 1.94 for breastfeeding for less than 6 months. Environmental tobacco smoke was also an independent risk factor. After adjustment for maternal smoking and other confounders, households where more than 10 cigarettes were smoked daily by persons other than the mother presented an odds ratio of 1.48 compared with those without smokers. These results remained unchanged after stratification for maternal smoking. This is the first report of a possible effect of environmental tobacco smoke on breastfeeding duration. Am J Epidemiol 1997;146:128-33. breast feeding; epidemiologic factors; smoking; tobacco smoke pollution
Background Middle-income countries will need to drastically reduce neonatal deaths to achieve the... more Background Middle-income countries will need to drastically reduce neonatal deaths to achieve the Millennium Development Goal for child survival. The evolution of antenatal and perinatal care indicators in the Brazilian city of Pelotas from 1982 to 2004 provides a useful case study of potential challenges.
The impact of oral rehydration therapy (ORT) on the recent decline in diarrhoea mortality in the ... more The impact of oral rehydration therapy (ORT) on the recent decline in diarrhoea mortality in the northeast of Brazil was studied. Proportionate infant mortality fell from 32% in 1980 to 17% in 1989 and infant deaths attributed to diarrhoea dropped from 41 % to 25%, resulting in an overall reduction of 57%. Similar decreases were observed for children aged 1-4 years. Diarrhoea admissions also fell from 57% of infant hospitalizations in 1980 to 30% in 1990. None of the other major causes of death or admissions showed such decline. ORT was introduced in the early 1980s, being used in 35% of all episodes in 1991 and in 62% of those regarded as severe by the mother. Other changes included a worsening of socioeconomic conditions and increases in water supply, vaccine coverage, breastfeeding duration and nutritional status. A simulation model estimated that changes in factors other than ORT would lead to a 21 % reduction in infant diarrhoea mortality, or about one-third of the actual decline. Finally, an ecological analysis showed that ORT use rates were inversely correlated to infant diarrhoea mortality (r= -0.61; p = 0.04). Despite the shortcomings of the available data, these findings suggest an important impact of ORT on diarrhoea mortality. BOO. DO NORTH IWRAfBA PERNAMBUCO 'ALAQOAS SEBtBPE Figure 1. States of the Northeast Region, Brazil by guest on
In a population-based cohort of approximately 6000 Brazilian children, the associations between m... more In a population-based cohort of approximately 6000 Brazilian children, the associations between maternal education and a number of child health outcomes were studied while controlling for potentially confounding variables such as family income and education of the husband.
# Publicado en: J Pediatr (Rio J) 2002;78:97-104 Endereço para correspondência: Dra. Sílvia Strin... more # Publicado en: J Pediatr (Rio J) 2002;78:97-104 Endereço para correspondência: Dra. Sílvia Stringari Fonseca-. Endereço: Hospital Escola-UFPEL; Rua Professor Araújo 538; telefone (53) 2277944 -ramal 246. Email:silviasf@terra.com.br 2 Resumo OBJETIVO: Medir os principais fatores de risco relacionados à ocorrência de injúrias acidentais, na faixa etária entre quatro e cinco anos de idade. MÉTODOS: Foi estudada uma coorte prospectiva de 620 crianças, na qual a ocorrência de acidentes e injúrias foi registrada, em um diário, durante um período de um mês. Esta foi uma subamostra sistemática proveniente da coorte de nascimentos de 1993, que ainda residiam na área urbana de Pelotas, RS. O desfecho em estudo foi o número de injúrias acidentais relatadas por criança-mês. A análise multivariada, utilizando Regressão de Poisson, foi usada para controlar fatores de confusão. RESULTADOS: A incidência mensal de acidentes foi de 53,8%, e 48,4% das crianças sofreram pelo menos uma injúria acidental. As crianças do sexo masculino tiveram 30% mais chance de se lesionarem do que aquelas do sexo feminino e as crianças brancas tiveram um risco 70% maior do que as crianças não brancas. Renda familiar, escolaridade dos pais e trabalho materno não se associaram à ocorrência de injúrias. Após ajuste para variáveis socioeconômicas e ambientais, as crianças que possuíam um ou mais irmãos menores apresentavam taxa 30% maior de injúrias acidentais. Crianças residentes em casa de tijolo apresentaram uma incidência de injúrias cerca de 40% superior. CONCLUSÕES: Poucos fatores de risco modificáveis foram associados a um aumento na freqüência de injúrias acidentais. Destes fatores, a presença de crianças mais jovens em casa merece especial atenção, sendo necessário instruir os pais sobre o aumento no risco observado por ocasião do nascimento de um irmão menor. Abstract OBJECTIVE: To measure the main risk factors associated to the occurrence of accidental injuries in children aged 4-5 years.
Brazilian infant and child mortality levels are not compatible with the country's economi... more Brazilian infant and child mortality levels are not compatible with the country's economic potential. In this paper, we provide a description of levels and trends in infant mortality due to perinatal causes and malformations and assess the likely impact of changing intermediate-level determinants, many of which are amenable to direct interventions through the health or related sectors. Review paper. Two main sources of mortality data were used: indirect mortality estimates based on censuses and surveys, and rates based on registered deaths. The latter were corrected for under-registration. Combination of the two sources of data allowed the estimation of cause-specific mortality rates. Data on current coverage of preventive and curative interventions were mostly obtained from the 1996 Demographic and Health Survey. Other national household surveys and Ministry of Health Statistics were also used. A thorough review of the Brazilian literature on levels, trends and determinants of infant mortality led to the identification of a large number of papers and books. These provided the background for the analyses of risk factors and potential interventions. The indirect infant mortality rate estimate for 1995-97 is of 37.5 deaths per thousand live births, about six times higher than in the lowest mortality countries in the world. Perinatal causes account for 57 % of all infant deaths, and congenital malformations are responsible for 11.2 % of these deaths. Mortality levels are highest in the Northeast and North, and lowest in the South and Southeast; the Center-West falls in between. Since surveys of the North region do not cover rural areas, mortality for this region may be underestimated. A first priority for the further reduction in infant mortality in Brazil is to improve equality among regions, since the North and Northeast, and particularly rural areas, still show very high death rates. Further reductions in infant mortality will largely depend on decreasing deaths due to perinatal causes. Improvements in the coverage and particularly in the quality of antenatal and delivery care are urgently needed. Another intervention with a potential important impact on infant mortality is the promotion of family planning. Improving birth weight might lead to an 8 % reduction in infant mortality but the efficacy of available interventions is low.
Objective To assess the association between duration of breast feeding and measures of adiposity ... more Objective To assess the association between duration of breast feeding and measures of adiposity in adolescence.
are much more likely to have severe diseases or die in the first year of life. This study's objec... more are much more likely to have severe diseases or die in the first year of life. This study's objective was to compare occurrence of low birthweight, preterm births, and intrauterine growth retardation in two cohorts born in the years 1982 and 1993 in Pelotas, Southern Brazil. All hospital births (corresponding to over 99% of total births) were evaluated for both years. Low birthweight increased from 9. 0% in 1982 to 9.8% in 1993 (p=0.2), preterm births increased from 5.6% to 7.5% (p<0.01), and intrauterine growth retardation increased from 15. 0% in 1982 to 17.5% in 1993 (p<0.05). In the two years under study, family income was inversely associated with low birthweight and intrauterine growth retardation, but not with preterm births. Compared to 1982, mothers in the 1993 birth cohort had better socioeconomic and nutritional status, as well as better coverage of prenatal care. However, these improvements were not expressed as a decrease in low birthweight. On the contrary, after the possible confounding effects of socioeconomic and nutritional variables were controlled, risk of low birthweight in 1993 was 33% higher than that of 1982 (p<0.01). Resumo As crianças com baixo peso ao nascer (menos de 2.500 g) apresentam um risco muitas
Perinatal health problems are a public health priority in Latin America. Among the identified ris... more Perinatal health problems are a public health priority in Latin America. Among the identified risk factors, psychological and social conditions play a crucial role. However, care during pregnancy
The deaths of children aged 1-4 years were studied in a cohort of 5914 Brazilian liveborns. A tot... more The deaths of children aged 1-4 years were studied in a cohort of 5914 Brazilian liveborns. A total of 29 early childhood deaths were recorded (cumulative mortality risk of approximately 6 per 1000), 17 of which (59%) were due to infectious diseases. The death rate was highest in the second year. Deaths were highly concentrated in children from low income (&lt; US $50/month) families, where the cumulative risk of early childhood death was about 10 per 1000; on the other hand, there were no deaths among the 616 children from families with a monthly income of US $300 or more. Birthweight was also associated with mortality: the cumulative risk of children weighing less than 2000 g at birth was 21 per 1000, compared to 4 per 1000 among those with birthweights of 3500 g or more. Simultaneous adjustment for income and birthweight did not substantially change these differentials. These findings confirm the strong association between early childhood mortality and socioeconomic conditions, but also make evident the long-term effects of low birthweight.
To investigate the relationship between social and biological conditions experienced in very earl... more To investigate the relationship between social and biological conditions experienced in very early life and dental caries in children aged 6 years. The design was a dental caries cross-sectional study nested in a birth cohort study started in Pelotas, Brazil, in 1993. The cross-sectional study was carried out in 1999. A random sample of 400 6-year-old children was selected from among 5249 live births in 1993. The World Health Organization (1997) criteria were used to diagnose dental caries. Results from the oral health study were linked to the data concerning perinatal and childhood health and illnesses and family social conditions collected at birth, 1, 3, 6 and 12 months, and in the sixth year of life. Dental caries was the outcome measured at two levels of severity (very low: dmft &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 1; high: dmft &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 4). Unconditional univariate and multiple logistic regression analysis were performed. Self-employed and employees/unemployed, fathers with &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;8 years of education at time child was born, child&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s height deficit for age at 12 months; child who did not attend day care centre in sixth year of life; brushing teeth less than once a day, and children with sweet consumption of at least once a day at 6 years were risk factors for high dental caries after controlling for possible confounders. Harmful social and biological risk factors accumulated in early life contributed to the development of a high level of dental caries in childhood.
12 Blass EM, Smith BA. Differential effects of sucrose, fructose, glucose, and lactose on crying ... more 12 Blass EM, Smith BA. Differential effects of sucrose, fructose, glucose, and lactose on crying in 1-to 3-day-old human infants: qualitative and quantitative considerations. Dev Psychol 1992;28:804-10. 13 Ramenghi LA, Griffith GC, Wood CM, Levene MI. Effect of non-sucrose sweet tasting solution on neonatal heel prick responses. Arch Dis Child 1996;74:F129-31. 14 Skogsdal Y, Eriksson M, Schollin J. Analgesia in newborns given oral glucose. Acta Paediatr 1997;86:217-20. 15 Stevens B, Taddio A, Ohlsson A, Einarson T. The efficacy of sucrose for relieving procedural pain in neonates-a systematic review and meta-analysis. Abstract Objectives To estimate the incidences of caesarean sections in Latin American countries and correlate these with socioeconomic, demographic, and healthcare variables. Design Descriptive and ecological study. Setting 19 Latin American countries. Main outcome measures National estimates of caesarean section rates in each country.
Victora GV (Department of Social Medicine, Universidade Federal de Pelotas, CP 464, 96100 Pelotas... more Victora GV (Department of Social Medicine, Universidade Federal de Pelotas, CP 464, 96100 Pelotas, RS, Brazil), Barros FC, Vaughan JP and Teixeira AMB. Birthweight and infant mortality: a longitudinal study of 5914 Brazilian children. Internationa/Journal of ...
Finalmente, a todos os bolsistas que participaram ativamente de todas as fases deste projeto, e q... more Finalmente, a todos os bolsistas que participaram ativamente de todas as fases deste projeto, e que foram fundamentais para o sucesso na coleta e preparo dos dados:
Background Middle-income countries will need to drastically reduce neonatal deaths to achieve the... more Background Middle-income countries will need to drastically reduce neonatal deaths to achieve the Millennium Development Goal for child survival. The evolution of antenatal and perinatal care indicators in the Brazilian city of Pelotas from 1982 to 2004 provides a useful case study of potential challenges.
This paper describes the main methodological aspects of a cohort study, with emphasis on its rece... more This paper describes the main methodological aspects of a cohort study, with emphasis on its recent phases, which may be relevant to investigators planning to carry out similar studies. In 1993, a population based study was launched in Pelotas, Southern Brazil. All 5,249 newborns delivered in the city's hospitals were enrolled, and sub-samples were visited at the ages of one, three and six months and of one and four years. In 2004-5 it was possible to trace 87.5% of the cohort at the age of 10-12 years. Sub-studies are addressing issues related to oral health, psychological development and mental health, body composition, and ethnography. Birth cohort studies are essential for investigating the early determinants of adult disease and nutritional status, yet few such studies are available from low and middle-income countries where these determinants may differ from those documented in more developed settings.
The current international growth reference, the National Center for Health Statistics (NCHS) refe... more The current international growth reference, the National Center for Health Statistics (NCHS) reference, is widely used to compare the nutritional status of populations and to assess the growth of individual children throughout the world. Recently, concerns were raised regarding the adequacy of this reference for assessing the growth of breast-fed infants. We used the NCHS reference to evaluate infant growth in one of the most developed areas of Brazil. Infants who were exclusively or predominantly breast-fed for the first 4-6 mo, and partially breastfed thereafter, grew more rapidly than the NCHS reference in weight and length during the first 3 mo, but appeared to falter thereafter. The average growth of all infants, regardless of feeding pattern, was faster than the NCHS reference until Ç6 mo, after which their growth became slower than that of the NCHS sample. To substantiate this finding, the NCHS growth curves were then compared with growth data of breast-fed infants in developed countries from pooled published studies, formula-fed North American and European infants and predominantly bottle-fed U.S. infants monitored by the Centers for Disease Control and Prevention (CDC) Pediatric Surveillance System. In all three cases, weights showed the same pattern as the Brazilian infants-higher than NCHS in the early months but an apparent decline thereafter. The pattern for length gain was similar but less marked. Breastfed infants showed more pronounced declines than those who were predominantly bottle-fed. These findings suggest that the infancy portion of the NCHS reference does not adequately reflect the growth of either breastfed or artificially fed infants. This probably results from characteristics of the original sample and from inadequate curve-fitting procedures. The development of an improved international growth reference that reflects the normal infant growth pattern is indicated.
Caesarean sections in Brazil rose from 15 per cent of all births in 1970 to over 30 per cent in 1... more Caesarean sections in Brazil rose from 15 per cent of all births in 1970 to over 30 per cent in 1980. A new policy was introduced by the largest medical care provider (INAMPS) which made the reimbursement fee payable to doctors the same for both vaginal and caesarean section deliveries. However, the caesarean rate has continued to rise. This study analysed the antenatal care and deliveries of over 7000 births which occurred during 1982 in the city of Pelotas in southern Brazil. The organization of health care is discussed in relation to the findings on the utilization of the different antenatal and delivery services available. Utilization is then related to the gestational risk and socio-economic status of the mothers. There were marked differentials between the low and high risk mothers and between those from high and low income families. Doctors clearly concentrated their efforts on the low risk and high income mothers, with 50 per cent of private patients having an operative delivery compared to 13 per cent of uninsured mothers. There was a large demand for tubal ligations to be carried out at the same time as the caesareans. The non-medical and financial reasons for these high rates are discussed and the high extra cost that is being incurred by patients and the insurance schemes is emphasized.
The effect of smoking on breastfeeding duration was investigated in a population-based birth coho... more The effect of smoking on breastfeeding duration was investigated in a population-based birth cohort study of 1,098 Brazilian infants. There were few losses to follow-up (3.2%) in the first 6 months. Maternal smoking was strongly associated with breastfeeding duration, even after adjustment for confounding. Compared with nonsmokers, mothers smoking 20 or more cigarettes daily presented an odds ratio of 1.94 for breastfeeding for less than 6 months. Environmental tobacco smoke was also an independent risk factor. After adjustment for maternal smoking and other confounders, households where more than 10 cigarettes were smoked daily by persons other than the mother presented an odds ratio of 1.48 compared with those without smokers. These results remained unchanged after stratification for maternal smoking. This is the first report of a possible effect of environmental tobacco smoke on breastfeeding duration. Am J Epidemiol 1997;146:128-33. breast feeding; epidemiologic factors; smoking; tobacco smoke pollution
Background Middle-income countries will need to drastically reduce neonatal deaths to achieve the... more Background Middle-income countries will need to drastically reduce neonatal deaths to achieve the Millennium Development Goal for child survival. The evolution of antenatal and perinatal care indicators in the Brazilian city of Pelotas from 1982 to 2004 provides a useful case study of potential challenges.
The impact of oral rehydration therapy (ORT) on the recent decline in diarrhoea mortality in the ... more The impact of oral rehydration therapy (ORT) on the recent decline in diarrhoea mortality in the northeast of Brazil was studied. Proportionate infant mortality fell from 32% in 1980 to 17% in 1989 and infant deaths attributed to diarrhoea dropped from 41 % to 25%, resulting in an overall reduction of 57%. Similar decreases were observed for children aged 1-4 years. Diarrhoea admissions also fell from 57% of infant hospitalizations in 1980 to 30% in 1990. None of the other major causes of death or admissions showed such decline. ORT was introduced in the early 1980s, being used in 35% of all episodes in 1991 and in 62% of those regarded as severe by the mother. Other changes included a worsening of socioeconomic conditions and increases in water supply, vaccine coverage, breastfeeding duration and nutritional status. A simulation model estimated that changes in factors other than ORT would lead to a 21 % reduction in infant diarrhoea mortality, or about one-third of the actual decline. Finally, an ecological analysis showed that ORT use rates were inversely correlated to infant diarrhoea mortality (r= -0.61; p = 0.04). Despite the shortcomings of the available data, these findings suggest an important impact of ORT on diarrhoea mortality. BOO. DO NORTH IWRAfBA PERNAMBUCO 'ALAQOAS SEBtBPE Figure 1. States of the Northeast Region, Brazil by guest on
In a population-based cohort of approximately 6000 Brazilian children, the associations between m... more In a population-based cohort of approximately 6000 Brazilian children, the associations between maternal education and a number of child health outcomes were studied while controlling for potentially confounding variables such as family income and education of the husband.
# Publicado en: J Pediatr (Rio J) 2002;78:97-104 Endereço para correspondência: Dra. Sílvia Strin... more # Publicado en: J Pediatr (Rio J) 2002;78:97-104 Endereço para correspondência: Dra. Sílvia Stringari Fonseca-. Endereço: Hospital Escola-UFPEL; Rua Professor Araújo 538; telefone (53) 2277944 -ramal 246. Email:silviasf@terra.com.br 2 Resumo OBJETIVO: Medir os principais fatores de risco relacionados à ocorrência de injúrias acidentais, na faixa etária entre quatro e cinco anos de idade. MÉTODOS: Foi estudada uma coorte prospectiva de 620 crianças, na qual a ocorrência de acidentes e injúrias foi registrada, em um diário, durante um período de um mês. Esta foi uma subamostra sistemática proveniente da coorte de nascimentos de 1993, que ainda residiam na área urbana de Pelotas, RS. O desfecho em estudo foi o número de injúrias acidentais relatadas por criança-mês. A análise multivariada, utilizando Regressão de Poisson, foi usada para controlar fatores de confusão. RESULTADOS: A incidência mensal de acidentes foi de 53,8%, e 48,4% das crianças sofreram pelo menos uma injúria acidental. As crianças do sexo masculino tiveram 30% mais chance de se lesionarem do que aquelas do sexo feminino e as crianças brancas tiveram um risco 70% maior do que as crianças não brancas. Renda familiar, escolaridade dos pais e trabalho materno não se associaram à ocorrência de injúrias. Após ajuste para variáveis socioeconômicas e ambientais, as crianças que possuíam um ou mais irmãos menores apresentavam taxa 30% maior de injúrias acidentais. Crianças residentes em casa de tijolo apresentaram uma incidência de injúrias cerca de 40% superior. CONCLUSÕES: Poucos fatores de risco modificáveis foram associados a um aumento na freqüência de injúrias acidentais. Destes fatores, a presença de crianças mais jovens em casa merece especial atenção, sendo necessário instruir os pais sobre o aumento no risco observado por ocasião do nascimento de um irmão menor. Abstract OBJECTIVE: To measure the main risk factors associated to the occurrence of accidental injuries in children aged 4-5 years.
Brazilian infant and child mortality levels are not compatible with the country&#39;s economi... more Brazilian infant and child mortality levels are not compatible with the country&#39;s economic potential. In this paper, we provide a description of levels and trends in infant mortality due to perinatal causes and malformations and assess the likely impact of changing intermediate-level determinants, many of which are amenable to direct interventions through the health or related sectors. Review paper. Two main sources of mortality data were used: indirect mortality estimates based on censuses and surveys, and rates based on registered deaths. The latter were corrected for under-registration. Combination of the two sources of data allowed the estimation of cause-specific mortality rates. Data on current coverage of preventive and curative interventions were mostly obtained from the 1996 Demographic and Health Survey. Other national household surveys and Ministry of Health Statistics were also used. A thorough review of the Brazilian literature on levels, trends and determinants of infant mortality led to the identification of a large number of papers and books. These provided the background for the analyses of risk factors and potential interventions. The indirect infant mortality rate estimate for 1995-97 is of 37.5 deaths per thousand live births, about six times higher than in the lowest mortality countries in the world. Perinatal causes account for 57 % of all infant deaths, and congenital malformations are responsible for 11.2 % of these deaths. Mortality levels are highest in the Northeast and North, and lowest in the South and Southeast; the Center-West falls in between. Since surveys of the North region do not cover rural areas, mortality for this region may be underestimated. A first priority for the further reduction in infant mortality in Brazil is to improve equality among regions, since the North and Northeast, and particularly rural areas, still show very high death rates. Further reductions in infant mortality will largely depend on decreasing deaths due to perinatal causes. Improvements in the coverage and particularly in the quality of antenatal and delivery care are urgently needed. Another intervention with a potential important impact on infant mortality is the promotion of family planning. Improving birth weight might lead to an 8 % reduction in infant mortality but the efficacy of available interventions is low.
Objective To assess the association between duration of breast feeding and measures of adiposity ... more Objective To assess the association between duration of breast feeding and measures of adiposity in adolescence.
are much more likely to have severe diseases or die in the first year of life. This study's objec... more are much more likely to have severe diseases or die in the first year of life. This study's objective was to compare occurrence of low birthweight, preterm births, and intrauterine growth retardation in two cohorts born in the years 1982 and 1993 in Pelotas, Southern Brazil. All hospital births (corresponding to over 99% of total births) were evaluated for both years. Low birthweight increased from 9. 0% in 1982 to 9.8% in 1993 (p=0.2), preterm births increased from 5.6% to 7.5% (p<0.01), and intrauterine growth retardation increased from 15. 0% in 1982 to 17.5% in 1993 (p<0.05). In the two years under study, family income was inversely associated with low birthweight and intrauterine growth retardation, but not with preterm births. Compared to 1982, mothers in the 1993 birth cohort had better socioeconomic and nutritional status, as well as better coverage of prenatal care. However, these improvements were not expressed as a decrease in low birthweight. On the contrary, after the possible confounding effects of socioeconomic and nutritional variables were controlled, risk of low birthweight in 1993 was 33% higher than that of 1982 (p<0.01). Resumo As crianças com baixo peso ao nascer (menos de 2.500 g) apresentam um risco muitas
Perinatal health problems are a public health priority in Latin America. Among the identified ris... more Perinatal health problems are a public health priority in Latin America. Among the identified risk factors, psychological and social conditions play a crucial role. However, care during pregnancy
The deaths of children aged 1-4 years were studied in a cohort of 5914 Brazilian liveborns. A tot... more The deaths of children aged 1-4 years were studied in a cohort of 5914 Brazilian liveborns. A total of 29 early childhood deaths were recorded (cumulative mortality risk of approximately 6 per 1000), 17 of which (59%) were due to infectious diseases. The death rate was highest in the second year. Deaths were highly concentrated in children from low income (&lt; US $50/month) families, where the cumulative risk of early childhood death was about 10 per 1000; on the other hand, there were no deaths among the 616 children from families with a monthly income of US $300 or more. Birthweight was also associated with mortality: the cumulative risk of children weighing less than 2000 g at birth was 21 per 1000, compared to 4 per 1000 among those with birthweights of 3500 g or more. Simultaneous adjustment for income and birthweight did not substantially change these differentials. These findings confirm the strong association between early childhood mortality and socioeconomic conditions, but also make evident the long-term effects of low birthweight.
To investigate the relationship between social and biological conditions experienced in very earl... more To investigate the relationship between social and biological conditions experienced in very early life and dental caries in children aged 6 years. The design was a dental caries cross-sectional study nested in a birth cohort study started in Pelotas, Brazil, in 1993. The cross-sectional study was carried out in 1999. A random sample of 400 6-year-old children was selected from among 5249 live births in 1993. The World Health Organization (1997) criteria were used to diagnose dental caries. Results from the oral health study were linked to the data concerning perinatal and childhood health and illnesses and family social conditions collected at birth, 1, 3, 6 and 12 months, and in the sixth year of life. Dental caries was the outcome measured at two levels of severity (very low: dmft &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 1; high: dmft &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 4). Unconditional univariate and multiple logistic regression analysis were performed. Self-employed and employees/unemployed, fathers with &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;8 years of education at time child was born, child&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s height deficit for age at 12 months; child who did not attend day care centre in sixth year of life; brushing teeth less than once a day, and children with sweet consumption of at least once a day at 6 years were risk factors for high dental caries after controlling for possible confounders. Harmful social and biological risk factors accumulated in early life contributed to the development of a high level of dental caries in childhood.
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