Cintia Lombardi

Operacionalização do conceito de classe social em estudos epidemiológicos

Procura-se demonstrar que e possivel operacionalizar o conceito de classe social de forma a utiliza-lo em estudos epidemiologicos. Foi adaptado as caracteristicas da formacao social de Pelotas, RS (Brasil), modelo de classificacao desenvolvido para o Mexico e comparado com o desenvolvido para Ribeirao Preto, SP (Brasil). Mediu-se o poder discriminatorio das duas classificacoes em termos do processo saude-doenca, tendo como variavel dependente o crescimento de 5.384 criancas nascidas em 1982. As duas classificacoes estao associadas com diferencas significativas (P<0,001) no crescimento infantil, mas o modelo do Mexico mostra melhor poder discriminatorio do que a classificacao de Ribeirao Preto. Quando ambas foram incluidas em uma analise multivariada do peso e da altura das criancas, o efeito do modelo do Mexico foi altamente significativo (P<0,001), ao contrario do efeito da classificacao, modelo Ribeirao Preto.

Maternal education in relation to early and late child health outcomes: Findings from a Brazilian cohort study

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. In the crude analyses, maternal education was associated with perinatal and infant mortality, hospital admissions in the first 20 months of life and the three nutritional indicators (length-for-age, weight-for-age and weight-for-length) at mean age 20 months. After adjustment for confounding, the apparent associations with outcomes in early infancy--birthweight and perinatal mortality--were no longer present, while that with infant mortality persisted despite being reduced. Strong associations remained with later outcomes including hospital admissions, length-for-age and weight-for-age at mean age 20 months. Among infants born to women with little or no schooling, deaths due to diarrhoea, pneumonia and other infectious diseases were particularly common. These findings support the hypothesis that maternal education has an effect on child health which is partly independent from that of other socioeconomic factors; they also suggest that maternal care is more important than the biological characteristics of the mothers since stronger effects were observed for the late (postneonatal mortality, hospital admissions and nutritional status) than for the early (birthweight, perinatal mortality) outcomes.

Epidemiologia do consumo de medicamentos em crianças de centro urbano da região sul do Brasil

Foram investigados os padroes do consumo de medicamentos em uma coorte de 4.746 criancas de Pelotas, RS, Brasil e as influencias de variaveis socioeconomicas, biologicas e de utilizacao de servicos de saude. O delineamento foi transversal aninhado em estudo longitudinal e o periodo investigado foi 15 dias. O consumo global alcancou 56% das criancas, sendo mais de 50% em todas as classes sociais. Os medicamentos mais utilizados foram acido acetil salicilico, vitaminas com sais minerais, associacoes antigripais, mebendazole e estimulantes do apetite. Mais de 60,0% dos medicamentos eram indicados por medicos (inclusive dipirona e estimulantes do apetite). Os principais motivos do consumo foram gripe, febre e falta de apetite. Ser primogenito foi fator de risco para o consumo. As criancas com pouco apetite na semana anterior consumiam duas vezes mais do que aquelas com bom apetite. E preocupante o alto consumo de aspirina, principalmente devido a associacao desse produto com a Sindrome de Reye em criancas. Outro ponto a ser questionado a respeito e a mensagem que talvez inadvertida ou inconscientemente possa estar sendo passada a essas criancas: o consumo de medicamentos e uma rotina e a resposta para qualquer problema. Nesse sentido, parece que se estara preparando o terreno para a dependencia de medicamentos e drogas ilicitas.The consumption of medicines among a population-based cohort of 4,746 children born in 1982 in Pelotas, Brazil, was studied when the children were aged 3-4.5 years. Fifty six percent of the mothers reported that their children had taken one or more medicines during a two-week period; 29.5% of the products were fixed combinations of three or more components, (which was taken as an indicator of poor quality). Almost 10% of the children had used a given medicine for one month or more. Aspirin, combinations of vitamins and mineral supplements and cough and cold combinations were the medicines most frequently used. The commonest reasons for taking medicines were colds, fevers and lack of appetite. The latter was the commonest reason for long-term use and also for that of combinations. Physicians prescriptions were responsible for more than 60% of the medicines used (including dipyrone and appetite stimulants). In all social classes the consumption was above 50%. Children classified in the fifth quintile of family income consumed 14% more medicines than the those in the first quintile. Children with two or more older siblings consumed 12% less medicines than the elder ones. Malnourished children, according to weight for age, consumed 30% more medicines than the well-nourished. Children consulting a doctor four times or more during the three-month period before the interview were using two times more medicines than children who had had no consultation during the same period. The frequent use of aspirin is a reason for concern as it has been associated with Reyes syndrome in children. It is also important to stress the danger of poisoning resulting from medicines available at home. Another noteworthy aspect concerns the messages transmitted to the children regarding the use of medicines for almost every conceivable reason which could possibly lead to medicine or illicit drug addiction.

Avaliação da qualidade da informação sobre a causa básica de óbitos infantis no Rio Grande do Sul (Brasil)

The validity of the official information on the cause of infant deaths was studied in the Brazilian cities of Porto Alegre and Pelotas in 1985. Using data collected for a population-based case-control study of infant mortality due to infectious diseases or malnutrition, a comparison was made between the causes of death reported on the death certificates and those obtained after a careful review of case-notes and a medical interview with the parents of the decreased infants. Official death certificates showed an excess of deaths attribute to bronchopneumonia (ICD 485X) and septicemia (ICD 038.9), and an underestimation of the number of deaths due to diarrheal diseases (ICD 009.1) and of sudden infant deaths (ICD 798.0). The overall rate of agreement between official and revised certificates, in terms of groups of causes of death, was only 27.9%. Lower respiratory infections, which were the leading infectious cause of infant death according to official statistics, were superseded by diarrheal diseases after this revision.A partir de dados coletados para um estudo de casos e controles sobre mortalidade infantil por doencas infecciosas e desnutricao realizado em Porto Alegre e Pelotas, RS (Brasil), comparou-se as causas de obito constantes do atestado medico com as causas obtidas atraves de uma revisao detalhada, realizada pela equipe da investigacao. Concluiu-se que as estatisticas oficiais nao sao fidedignas, tendo havido sobre-registro de broncopneumonias (CID 485X) e de septicemias (CID 038.9), e sub-registro de gastroenterites (CID 009.1) e de mortes subitas (CID 798.0). A concordância entre os atestados refeitos e os oficiais, em termos de grupos de causas de obito, foi de apenas 27.9%.

Subsequent pregnancies: who has them and who wants them? Observations from an urban center in Southern Brazil

Subsequent pregnancies in mothers of a birth cohort from Pelotas, Southern Brazil, were studied in relation to maternal and socio-economic factors. Within about 3 1/2 years of the cohort childs birth, 39% of mothers had experienced at least one further pregnancy. This proportion decreased with increasing maternal age, years of schooling and family income. A U-shaped trend was observed with respect to parity. Mothers who had delivered the cohort child by caesarean section were also less likely to have another pregnancy within that time. Logistic regression analysis showed that each of these factors remained significantly associated with further pregnancies after controlling for the remaining variables. Analysis of the first subsequent pregnancy showed that a high proportion of mothers had not wanted the pregnancy. Unwanted pregnancies were also significantly associated with older women, low educational status, higher parity and low family income.