Jorge Umberto Béria

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.

Stressful life events and minor psychiatric disorders : An estimate of the population attributable fraction in a Brazilian community-based study

Objective: A population-based survey was conducted in Pelotas, southern Brazil, to assess the specific and the combined contribution of life events and socioeconomic factors on the overall prevalence of minor psychiatric disorders (MPD). Methods: The study covered a representative sample of the population aged fifteen years or older living in the urban area of the city. Using multi-stage sampling, a total of thirty census tracts and 600 households were selected. A standardized questionnaire assessed the presence of MPD (using the Self-Reporting Questionnaire—SRQ-20), the occurrence of life events (death of a relative, a relative with a chronic disease, loss of employment, divorce, migration, accident, and robbery/assault), and socioeconomic factors. Results: The prevalence of MPD was 22.7 percent (17.9% males and 26.5% females) and increased with age. Significant linear relationships with education and income were observed: the less education and income, the higher the prevalence of MPD. All life events, except migration and accident, were positively associated with MPD. People who experienced divorce in the last year had a prevalence of MPD three times higher than those who had not. The likelihood of MPD increased linearly with the number of life events. The highest proportion of Population Attributable Fraction for any life events was 24 percent. Conclusions: These data suggest that life events can explain a substantial proportion of MPD and with socioeconomic factors may be related to the onset of MPD.

Autopercepção de vulnerabilidade às doenças sexualmente transmissíveis e Aids em mulheres

OBJETIVO: Investigar comportamentos de risco e autopercepcao de vulnerabilidade as doencas sexualmente transmissiveis (DST) e a Sindrome de imunodeficiencia adquirida (Aids) em mulheres. METODOS: Dos 281 setores censitarios existentes na cidade de Pelotas, RS, foram selecionados 48 a partir de amostragem sistematica. Foi entrevistada uma amostra de 1.543 mulheres, de 15 a 49 anos, por meio de questionario composto de tres partes (informacoes socioeconomicas, perguntas aplicadas em entrevista, questionario auto-aplicado). Para tabulacao dos dados, foi utilizado o programa Epi-Info, versao 6.0. Para analise estatistica dos dados foram usados o teste de Kappa e a razao de odds. RESULTADOS: Na amostra, 64% das mulheres achavam impossivel ou quase impossivel adquirir DST/Aids. Os principais comportamentos de risco foram o nao uso de preservativo na ultima relacao antes do depoimento (72%); inicio das relacoes sexuais com menos de 18 anos (47%); uso de alcool ou drogas pelo parceiro (14%) ou pela mulher (7%) antes da ultima relacao; dois ou mais parceiros nos tres meses que antecederam o depoimento (7%) e sexo anal na ultima relacao (3%); 44% das mulheres apresentaram dois ou mais comportamentos de risco. A sensibilidade da autopercepcao, usando como padrao o escore de risco igual ou superior a dois, foi de 41 %. Sua especificidade de 67%. CONCLUSOES: A autopercepcao de vulnerabilidade nao e um bom indicador, pois as mulheres nao identificam corretamente seu nivel de risco.

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.

Birthweight, socio-economic status and growth of Brazilian infants

A population-based cohort of 1458 Brazilian infants was followed from birth to 9-15 months of age to investigate the effects of birthweight and family income on subsequent growth. There was a strong association between birthweight and attained weight and length, while virtually no malnutrition among children who weighed more than 3000 g at birth; Children with lower birthweights tended to put on less weight during the first year, but these differences were no longer significant after controlling for family income. As a result, infants of lower birthweights tended to remain behind those of higher birthweights. Children from the wealthiest families gained 20% more weight than low-income infants, irrespective of birthweight. Low birthweight infants from high-income families were therefore likely to approach the standard weight at one year old while those from poor families lagged behind.

Prevalence of having a regular doctor, associated factors, and the effect on health services utilization: a population-based study in Southern Brazil

In order to assess the prevalence of having a regular doctor, associated factors, and the effects on health services utilization, a cross-sectional study was performed in Rio Grande, Brazil, from January to May 2000. A total of 1,260 individuals 15 years or over were interviewed. Adjusted prevalence ratios and 95% confidence intervals were calculated, using a Poisson regression model. Some 37% of the sample had a regular doctor. Adjusted analysis revealed a direct and linear association with income. Female gender, age, private health insurance coverage, and chronic health problems were also associated with the outcome. Having a regular physician was associated with a 51% increase in clinical breast examination and a 62% increase in cervical cancer screening during the previous year, as well as a 98% increase in prostate cancer screening in the previous year in men 40 years or over. The study concluded that the prevalence of having a regular doctor in Brazil is low and is directly associated with socioeconomic factors. Individuals with a regular physician tend to have better access to health services. The promotion of consultation with a regular doctor among the population may improve health care quality and health services access, particularly in the poorest groups.

Avaliação do cuidado prestado a pacientes diabéticos em nível primário

OBJECTIVE The characterization of diabetic patients seen at a primary health care clinic. METHODS The case notes of 3,024 families were searched by means of a cross-sectional study for patients 30 to 75 years of age with a diagnosis of diabetes mellitus who had had a medical consultation during the previous five years. These patients were interviewed at their homes and were asked to come to the health center for physical examination and a plasma glucose test using glucosylated hemoglobin (GH). RESULTS The prevalence of diabetes was 4%. The typical diabetic patient was a white women, > or = 50 years of age, from a family with a monthly income < or = 3 minimum wages. Compliance with GH was observed in 70% of the patients. Diet therapy was followed by less than one third of the patients and only one fifth were engaged in regular exercise. Nearly 70% were undergoing drug therapy (oral hypoglicemic agents or insulin); of these, only 15% used insulin. Most of the patients (66%) who agreed to have the GH test showed normal or fair glucose blood levels. CONCLUSIONS Great efforts should be made by health teams to enhance diabetic patient education in order to promote compliance with recommendations regarding diet and exercise.

Epidemiologia do consumo de medicamentos no primeiro trimestre de vida em centro urbano do Sul do Brasil

INTRODUCTION The few studies on the use of medicines in children point to excessive use, and in these studies, physicians are those mainly responsible for the prescription of medicines. In order to get to know the patterns of consumption medicines better, a study was made in children in their first three months of life, according to social biological, food pattern and use of health services of variables. METHOD The patterns of the use of medicines during the first three months of life in 655 urban children born in Pelotas, Brazil, in 1993, were described. Information on the use of medicines was collected during a two-week period in the first and third month of life. RESULTS The use of medicines was reported by 65% of mothers at the 1st and 69% at the 3rd month of life. Seventeen per cent of children consumed three or more different medicines during those periods. Fixed combinations of three or more components-which was taken as an indicator of the poor of medicines quality-were consumed by 14% of the children at the 1st and 19% at the 3rd months of life. At the latter age, 20% of children had used a given medicine for one month or more. At the first month follow-up, Benzalkonium Chloride + Normal Saline Solution (nasal drops), Nystatin Mixture and Dimethicone + Homotropine were the most frequently used medicines. At the third month they were, Aspirin, Benzalkonium Chloride + Normal Saline Solution and Dimethicone + Homatropine. The main reasons for taking medicines were cramps at the first month and colds at the third. At the first month follow-up, children with three or more siblings used 64% less medicines than the older ones. Children who were not breast-fed at the end of the first month showed a 75% greater risk of use of medicines. Similar results were observed at the third month follow-up. Some of the medicines used were not recommendable for children. CONCLUSION Since early age children are submitted to an intense use of medicines for almost every conceivable reason, with the risk of potential side-effects and the possible lead to medicine or other drugs addiction.INTRODUCAO: Os poucos estudos existentes apontam para o consumo abusivo de medicamentos em criancas, sendo os medicos os principais responsaveis pela indicacao. Para conhecer melhor os padroes de consumo de medicamentos, foi feito estudo em criancas no primeiro trimestre de vida, segundo variaveis sociais, biologicas, padroes alimentares e ultilizacao de servicos de saude. METODO: Estudou-se uma amostra de 655 criancas nascidas em 1993, residentes na zona urbana de Pelotas, Brasil. Informacoes sobre o consumo de medicamentos na quinzena precedente a entrevista foram coletadas ao final do primeiro e do terceiro mes. RESULTADOS: Com um mes, 65% das criancas consumiam medicamentos e com tres meses, 69%. Tres ou mais medicamentos foram consumidos por 17% das criancas em cada acompanhamento. Combinacoes de tres ou mais farmacos (um indicador de ma qualidade do medicamento) foram usadas por 14% no primeiro mes e por 19% no terceiro mes. Aos tres meses, 20% das criancas consumiam medicamentos cronicamente. Com um mes, os medicamentos mais consumidos foram Cloreto de Benzalconio + Soro Fisiologico, Dimeticona + Homatropina e Nistatina solucao. Aos tres meses foram Acido Acetil Salicilico, Cloreto de Benzalconio + Soro Fisiologico e Dimeticona + Homatropina. O principal problema referido como motivo de uso foi colica no primeiro acompanhamento e resfriado, no segundo. Na analise ajustada, o consumo de medicamentos no primeiro mes foi 64% menor para as criancas que tinham tres ou mais irmaos menores do que para primogenitos. Criancas nao amamentadas ao final do primeiro mes apresentaram um risco 75% maior de haver consumido medicamentos. Resultados semelhantes foram observados para o consumo no terceiro mes. CONCLUSAO: Desde a mais tenra idade, as criancas sao habituadas a conviver com uma medicalizacao exagerada de sintomas corriqueiros. Nao estaria assim sendo preparado o terreno para futuras dependencias de medicamentos ou outras drogas?

Estudo longitudinal das crianças nascidas em 1982 em Pelotas, RS, Brasil: metodologia e resultados preliminares

A cohort of 6,011 urban children born in 1982 in the hospitals of Pelotas, Rio Grande do Sul, was followed up so that their morbidity, mortality and growth could be assessed. These children accounted for over 99% of all births in the city. A 30% sample of the children were visited at home when approximately 12 months old, and the whole population was visited at about 20 months of age. It was possible to locate 81% of the children at 12 months. This proportion increased to 86% at 24 months, due to a change in the logistics of the field work which then included visiting all 69,000 households in the city to locate children whose families had moved within the urban area. The methodology and main difficulties encountered are discussed, and the characteristics at birth of children who were located at the first follow-up visit was compared to those of children lost to follow-up. Children who were not located tended to come from poorer families but the overall differences were not very marked, with more than 75% of children in any of the major socio-economic subgroups being located. The potential use of the large amount of information available on each child is demonstrated by the study of the relationships between birthweight, family income and nutritional status at 9-15 months of age. Birthweight is shown to be a very strong predictor of weight for age, length for age and, to a lesser extent, weight for length, there being virtually no malnutrition among children born with more than 3,000 g. Birthweight is also shown to be closely associated with weight at 9-15 months within all five family income groups, with a given absolute difference in weight at birth persisting to the end of the first year. However, due to the important effects of income on weight gain, a child born with 2,500 g in the lowest income group would be on average 1,200 g below the standard NCHS weight at 12 months, whereas a child with the same birthweight from the highest income group would have caught up with the standard. This study has shown that it is possible to identify a population based cohort of children and to follow them up for two years in a medium-sized Brazilian city.Tentou-se acompanhar a morbi-mortalidade e o crescimento de uma coorte de 6.011 criancas urbanas nascidas em 1982 nos hospitais de Pelotas, RS, atraves de visitas domiciliares aos 12 meses (para uma amostra de 30% das criancas) e aos 20 meses (para toda a populacao). Estas criancas representaram mais de 99% de todos os nascimentos urbanos naquele ano. Foi possivel localizar 81% das criancas aos 12 meses e 86% aos 20 meses, devido a uma mudanca na estrategia de trabalho de campo. A metodologia empregada e as principais dificuldades encontradas sao descritas e as caracteristicas ao nascer das criancas localizadas no acompanhamento sao comparadas com as caracteristicas das criancas nao localizadas. A potencialidade de uso dos dados coletados e exemplificada atraves de alguns resultados preliminares mostrando as associacoes entre o peso ao nascer, a renda familiar e o estado nutricional aos 12 meses. O estudo mostra que e possivel acompanhar, com uma perda relativamente pequena, uma coorte de criancas com base populacional em uma cidade brasileira de tamanho medio.

Breastfeeding and breast cancer: a case-control study in Southern Brazil

To investigate the relationship between breastfeeding and breast cancer in Southern Brazil, a case-control design was employed, with two age-matched control groups. A total of 250 cases of breast cancer were identified in women from 20 to 60 years of age, with 1,020 hospital and community controls. The main study variables were occurrence of breastfeeding and duration of breastfeeding. A multivariate conditional logistic regression analysis was employed. According to the results, breastfeeding did not have a protective effect against breast cancer. The odds ratio (OR) for women who breastfed was 0.9 (95% CI: 0.8-1.2) compared to women who did not breastfeed. For women who breastfed for six months or less, the OR was 1.0 (95% CI: 0.6-1.8). In pre-menopausal women who breastfed for more than 25 months, the OR was 0.95 (95% CI: 0.5-3.5), and in post-menopausal women OR was 1.27 (95% CI: 0.5-3.1), compared to women who had not breastfeed.