Nelson Fernandes de Oliveira

Impact of the Family Health Program on Infant Mortality in Brazilian Municipalities

OBJECTIVES We evaluated the effects of the Family Health Program (FHP), a strategy for reorganization of primary health care at a nationwide level in Brazil, on infant mortality at a municipality level. METHODS We collected data on FHP coverage and infant mortality rates for 771 of 5561 Brazilian municipalities from 1996 to 2004. We performed a multivariable regression analysis for panel data with a negative binomial response by using fixed-effects models that controlled for demographic, social, and economic variables. RESULTS We observed a statistically significant negative association between FHP coverage and infant mortality rate. After we controlled for potential confounders, the reduction in the infant mortality rate was 13.0%, 16.0%, and 22.0%, respectively for the 3 levels of FHP coverage. The effect of the FHP was greater in municipalities with a higher infant mortality rate and lower human development index at the beginning of the study period. CONCLUSIONS The FHP had an important effect on reducing the infant mortality rate in Brazilian municipalities from 1996 to 2004. The FHP may also contribute toward reducing health inequalities.

Estrutura fatorial e consistência interna do Self-Reporting Questionnaire (SRQ-20) em população urbana

This study focused on the psychometric properties of the Self-Reporting Questionnaire (SRQ-20) among workers, evaluating internal consistency criteria for the components scales and construct validity. Evaluation of the SRQ-20 performance used data from a cross-sectional study of a representative sample of workers from Feira de Santana, Bahia State, Brazil. The construct validity was estimated by means of an exploratory factor analysis of tetrachoric correlations and multiple correspondence analysis. The Kuder-Richardson formula (KD-20) was used to evaluate the instruments internal consistency. Factor analysis of tetrachoric correlations revealed the extraction of four factors. Cumulative explanation of variance was 59.6%. Multiple correspondence analysis identified categories according to the groupings of variables comprising the questionnaire. Overall and standardized internal consistency coefficient was 0.80. The study indicated an acceptable performance by the SRQ-20 for evaluating common mental disorders, for use in mental health screening in the workplace.

Associação entre distúrbios psíquicos e aspectos psicossociais do trabalho de professores

OBJECTIVE To investigate the association between work-related psychosocial factors and the prevalence of mental disorders among pre-school and elementary school teachers. METHODS This cross-sectional study was undertaken with 1,024 teachers from municipal public schools and from the ten largest private schools in Vitória da Conquista, Bahia State (Northeastern Brazil) in 2001. The main independent variable was based on the demand-control model, which classifies individuals according to their job pressures. The dependent variable was the incidence of mental disorders as evaluated by a self-reporting questionnaire. The measure of frequency was prevalence, and the measure of association was the prevalence ratio. A logistic regression model was used as the main statistical technique. RESULTS There was a 44% prevalence of mental disorders among teachers. Evidence suggests that these were associated with work-related demands and control issues, after controlling for confounding variables such as sex, geographic region and social support. The prevalence of mental disorders among high-strain teachers was 1.5 times greater than that among low-strain teachers. CONCLUSIONS The prevalence of mental disorders was high among teachers of the municipality. There was evidence that this was associated with job demands.

Estimating adjusted prevalence ratio in clustered cross-sectional epidemiological data

BackgroundMany epidemiologic studies report the odds ratio as a measure of association for cross-sectional studies with common outcomes. In such cases, the prevalence ratios may not be inferred from the estimated odds ratios. This paper overviews the most commonly used procedures to obtain adjusted prevalence ratios and extends the discussion to the analysis of clustered cross-sectional studies.MethodsPrevalence ratios(PR) were estimated using logistic models with random effects. Their 95% confidence intervals were obtained using delta method and clustered bootstrap. The performance of these approaches was evaluated through simulation studies. Using data from two studies with health-related outcomes in children, we discuss the interpretation of the measures of association and their implications.ResultsThe results from data analysis highlighted major differences between estimated OR and PR. Results from simulation studies indicate an improved performance of delta method compared to bootstrap when there are small number of clusters.ConclusionWe recommend the use of logistic model with random effects for analysis of clustered data. The choice of method to estimate confidence intervals for PR (delta or bootstrap method) should be based on study design.

C-reactive Protein and Metabolic Syndrome in Youth: A Strong Relationship?

Retraction: Note from the Editor‐in‐Chief: This paper is retracted

Fatores preditivos da interrupção do aleitamento materno exclusivo no primeiro mês de lactação

OBJECTIVE: To investigate factors associated with discontinuation of exclusive breastfeeding in the first month of lactation, in the city of Feira de Santana, Brazil. METHODS: Cohort study with follow-up of 1,309 mother-child pairs selected from all maternities in the municipality. Data were collected in hospital and in home visits during the first month of life. Logistic regression analysis was used to examine the relationship between outcome and variables of interest. RESULTS: Lack of prior breastfeeding experience (PR 1.24; 95%CI 1.75-1.43), cracked nipples (PR 1.25; 95%CI 1.09-1.43), use of fixed breastfeeding schedules (PR 1.42; 95%CI 1.09-1.84) and pacifier use (PR 1.53; 95%CI 1.34-1.76) were identified as factors predicting discontinuation of exclusive breastfeeding. CONCLUSIONS: Measures to prevent early discontinuation of exclusive breastfeeding must focus on women without breastfeeding experience and include prevention of nipple trauma, encourage breastfeeding on demand, and discourage the use of pacifiers.

Factors predicting early discontinuation of exclusive breastfeeding in the first month of life.

OBJECTIVE To investigate factors associated with discontinuation of exclusive breastfeeding in the first month of lactation, in the city of Feira de Santana, Brazil. METHODS Cohort study with follow-up of 1,309 mother-child pairs selected from all maternities in the municipality. Data were collected in hospital and in home visits during the first month of life. Logistic regression analysis was used to examine the relationship between outcome and variables of interest. RESULTS Lack of prior breastfeeding experience (PR 1.24; 95%CI 1.75-1.43), cracked nipples (PR 1.25; 95%CI 1.09-1.43), use of fixed breastfeeding schedules (PR 1.42; 95%CI 1.09-1.84) and pacifier use (PR 1.53; 95%CI 1.34-1.76) were identified as factors predicting discontinuation of exclusive breastfeeding. CONCLUSIONS Measures to prevent early discontinuation of exclusive breastfeeding must focus on women without breastfeeding experience and include prevention of nipple trauma, encourage breastfeeding on demand, and discourage the use of pacifiers.

Preditores do retardo de crescimento linear em pré-escolares: uma abordagem multinível

This study focuses on the determinants of linear growth deficit in under-five children using multilevel modeling. The sample included 3,746 preschoolers from 15 Brazilian municipalities (ten from the State of Bahia and five from Sao Paulo), with a three-tier analysis (municipalities, households, and children). Municipal data were obtained from the 1991 National Census. Individual and household data were collected from 1999 to 2001 using structured questionnaires and measuring childrens weight and height. Analysis used the MLwiN software. In the final multilevel model, low HDI and prenatal care at the municipal level, poor environmental and economic conditions and maternal schooling at the household level, and low birth weight, incomplete immunization, prior history of malnutrition, and no report of breastfeeding at the individual level were strongly associated with linear growth deficit. Total variability of deficit explained by the model was 27.4%, of which 51.3%, 33%, and 15.7% were explained, respectively, by individual, household, and municipal variables.

Aspectos psicossociais do trabalho e dor musculoesquelética em professores

This study aimed to investigate the association between work-related psychosocial factors and musculoskeletal pain (MP) among primary schoolteachers in the public school system in Salvador, Bahia State, Brazil. A cross-sectional epidemiological study included all 4,496 teachers from the system. A self-applied mail questionnaire was used to collect information on complaints of musculoskeletal pain in the upper limbs, lower limbs, and back (dependent variables), demand-control model quadrants (independent variables), and covariables. Multivariate logistic regression showed that teachers in high-stress jobs presented the highest MP rates, and that those with low-stress jobs had the lowest rates in all three body segments. Teachers in active jobs presented higher MP rates than those in low-stress jobs, particularly in the upper limbs and back. Higher MP prevalence rates were associated with heavier psychological demand in all three body segments and with limited job control in the upper limbs only.

Desenvolvimento neuropsicomotor: o teste de Denver na triagem dos atrasos cognitivos e neuromotores de pré-escolares

O objetivo deste estudo foi verificar a prevalencia e fatores associados no que se refere ao desempenho anormal do desenvolvimento neuropsicomotor de criancas matriculadas na educacao infantil publica em Feira de Santana, Bahia, Brasil, em 2009 (n = 438). Esta e uma pesquisa epidemiologica de corte transversal, com amostragem por conglomerado e sorteio das escolas e criancas. Foram verificados os fatores associados por meio de aplicacao de questionario as maes e de teste Denver II ao filho. A analise estatistica realizou o teste χ2 com intervalo de 95% de confianca e α = 5%. A prevalencia de desempenho anormal do desenvolvimento foi 46,3%. Na analise de regressao logistica, as variaveis estatisticamente significantes associadas foram: sexo masculino (RP = 1,43; p = 0,00), cinco anos de idade (RP = 1,42; p = 0,00), nao realizacao de pre-natal (RP = 1,41; p = 0,00), inicio do pre-natal > 3 meses (RP = 1,25; p = 0,00) e consumo alcoolico na gestacao (RP = 1,55; p = 0,00). A prevalencia foi elevada, apontando a necessidade de pre-natal precoce, alertando sobre o consumo alcoolico, e de vigilância nos primeiros anos de vida, visando a prevenir ou tratar precocemente as alteracoes.