Rebeca de Souza e Silva

Gravidez na adolescência, pré-natal e resultados perinatais em Montes Claros, Minas Gerais, Brasil

The aim of the present study was to measure the proportion of adolescent pregnancies in Montes Claros, Minas Gerais, Brazil. From a total of 7,672 live births in 2001, the estimated proportion of births by adolescent mothers was 21.5%. In addition to the limited presence of adequate frequency in prenatal visits, especially in the 10-14-year bracket (12.0%), the study identified an increase in the number of complications, inversely related to age, and these differences were significant in relation to prematurity and low birth weight, which did not occur with the 5-minute Apgar score. Confirming the hypothesis of greater frequency of these complications when the number of prenatal visits was inadequate, the outcomes also signal an age-associated risk, particularly in early adolescence (10-14 years). These results, together with the data on an increase in adolescent pregnancy in the region from 1997 to 2001, point to teenage pregnancy as a public health problem.

Fatores associados à sintomatologia depressiva numa coorte urbana de idosos

INTRODUCTION: The process of population aging in Brazil has been fast and intense, increasing the prevalence of chronic diseases and psychological and mental problems, mainly depression, which is associated with functional losses of the aged one. OBJECTIVE: To analyse the association between depressive symptomatology and other indicators of functional capacity, and with mortality after 15 years of follow-up, in an urban cohort of elderly. METHODS: 1667 aged (> 65 years-old) residents in Clementino Village in Sao Paulo city were studied through a multidimensional evaluation of the functional capacity, as well as the death certificate of the deaths occurred between 1991 (beginning of the study) and April of 2006. In univaried analysis we calculated odds ratio and its significance statistics was evaluated by the reliable interval (95%). The logistic regression was used in the multiple analysis. RESULTS: 21,1% of the elderly were depressed in 1991. In univaried analysis the highest ratios of depressed people were found in the feminine sex, aged older than 80 years-old, illiterates, widowers or bachelors, high level of physical dependence, cognitive deficit, users of more medicines and among those who died in the period of 15 years. In multivaried analysis, controlling by sex and age, physical dependence and the users of more medicines are associated to depression. CONCLUSIONS: The worse levels of disability answer, by an expressive way, to the occurrence of depressive symptomatology between the aged ones.

Diabetes mellitus auto-referido no Município de São Paulo: prevalência e desigualdade

This report analyzes characteristics of self-reported diabetes mellitus in the city of Sao Paulo, Brazil. The data were obtained from the Brazilian Multicenter Study on Prevalence of Diabetes Mellitus, a household survey performed in 1986-88. The Sao Paulo sample consisted of 2,007 individuals aged 30-69 years, of both sexes, selected from three areas with distinct socio-economic levels. The estimated prevalence using a 75g glucose load and measurement of two-hour capillary glycemia was 9.7%. Prevalence of self-reported diabetes was 4.7% and increased with age and presence of family history of diabetes. There was a significant difference between sexes (3.5% in men and 5.7% in women), with higher rates of self-reported diabetes at higher economic levels among men and higher rates at lower socio-economic levels among women.

Prevalência do uso de medicamentos na gravidez e relações com as características maternas

INTRODUCAO: Ha no Brasil crescente utilizacao de medicamentos industrializados, inclusive durante o ciclo reprodutivo feminino. Na gestacao os efeitos dos medicamentos no feto pode resultar em toxicidade com possiveis lesoes irreversiveis. Nesse sentido, foi verificada a prevalencia do uso de medicamentos, durante a gravidez, na populacao estudada e sua relacao com as caracteristicas maternas, grupos farmacologicos e fonte de indicacao. METODOS: Foram avaliadas, quanto ao uso de medicamentos, 1.620 mulheres que deram a luz em cinco hospitais de atendimento publico, privado ou conveniado, da cidade de Sao Paulo, de julho a setembro de 1993. Os dados referentes ao uso de medicamentos e de outras variaveis foram coletados, por meio de entrevista estruturada, no intervalo de 30 dias consecutivos junto as puerperas. RESULTADOS E CONCLUSOES: A relacao entre escolaridade materna e atendimento hospitalar revelou desigualdade social no acesso aos diversos tipos de servico de assistencia ao parto. A prevalencia do uso de pelo menos um medicamento foi de 97,6%, com media de 4,2 medicamentos por mulher. A prevalencia do uso de medicamentos por indicacao medica e por automedicacao foi de 94,9% e 33,5%, respectivamente. As medicacoes mais usadas, excluindo-se as vitaminas, sais minerais e vacinas, foram os analgesicos, antiacidos, antiemeticos e antiespasmodicos. Usuarias com maior uso de medicamentos tiveram as seguintes caracteristicas: acima de 29 anos de idade, casadas, terceiro grau completo, atividade remunerada e acesso aos servicos privados de saude. A assistencia medica desempenhou papel facilitador no acesso ao uso de medicamentos durante o periodo gestacional. As mulheres deveriam ser conscientizadas dos riscos em potencial a que expoem seus fetos ao fazerem uso de tantas medicacoes. O pre-natalista deveria repensar seu papel diante desta problematica.

Epidemiologia do aborto inseguro em uma população em situação de pobreza Favela Inajar de Souza, São Paulo

Procurou-se, neste trabalho, comparar os Resultados de Pesquisa recente, realizada em Sao Paulo, Brasil, pais em que o aborto e ilegal em quase todas as circunstâncias, com dados referentes a Cuba, pais onde o aborto e legal e seguro, dispondo de registros confiaveis. Essa pesquisa foi sediada em uma comunidade da Zona Norte da cidade de Sao Paulo, Favela Inajar de Souza: um estudo transversal que teve por objetivo estimar a frequencia de Abortos Inseguros, bem como determinar as caracteristicas sociodemograficas e a morbidade associadas a tal ocorrencia, em uma populacao em situacao de pobreza. Foram entrevistadas todas as mulheres entre 15 e 54 anos residentes na comunidade (Censo). Na analise dos dados foram empregados o teste exato de Fisher e o teste qui-quadrado para as variaveis categoricas, e a analise de variância (ANOVA) para as variaveis numericas. Em toda a analise adotou-se um nivel de significância de 5%, com p < 0,05. Encontrou-se, na populacao estudada, Favela Inajar, um alto numero de abortos inseguros e alta porcentagem de complicacoes pos-aborto. Em comum com Cuba, quanto ao Aborto Induzido foi observada semelhanca de perfil somente em relacao a Idade e ao Estado Civil. Nos Resultados foram constatadas tambem - contrariamente ao que ocorre em Cuba - associacoes estatisticamente significativas entre Aborto Inseguro e Renda/Escolaridade (baixas), Aborto Inseguro e Etnia/Cor, Aborto Inseguro e Nao Apoio do Parceiro, e Aborto Inseguro e Migracao Interna - o que torna essa populacao especialmente vulneravel ao aborto inseguro frente as violencias estruturais, geradoras de iniquidade, vigentes no Brasil. O aborto legal e seguro, tal como em Cuba, transformaria essa realidade. A legalizacao do aborto beneficiaria, sobretudo, as mulheres pobres.

Brief motivational interview and educational brochure in emergency room settings for adolescents and young adults with alcohol related problems: a randomized single blind clinical trial

OBJECTIVE To evaluate the effectiveness of brief motivational interviewing and an educational brochure when delivered in emergency room to reduce alcohol abuse and related problems among adolescents and young adults. METHOD A randomized single-blind clinical trial with a three-month follow-up was carried out at three emergency rooms from October 2004 to November 2005; subjects assessed were 16-25 years old treated for alcohol related events up to 6 hours after consumption. Socio-demographic data, quantity, frequency and negative consequences of alcohol consumption, motivation to change habits and future risk perception were evaluated. Statistical analysis was performed on subjects who completed follow-up (completers). ANCOVA model was used to analyze the difference between the intervention groups with statistical significance level α = 5% and confidence interval (CI) of 95%. RESULTS 186 subjects formed the initial sample, being 175 included and randomized to the educational brochure group (n = 88) or motivational interviewing group (n = 87). Follow-up assessment was performed in 85.2% of the sample. No significant difference between groups was observed. However, significant reductions (p < 0.01) in related problems and alcohol abuse were found in both groups. CONCLUSION In this sample a reduction of alcohol use and related problems was observed. Preliminary data indicate that controlled clinical trials with motivational interviewing, educational brochure and nonintervention should be of future interest among Brazilian adolescent populations.

Unsafe abortion: social determinants and health inequities in a vulnerable population in São Paulo, Brazil

This cross-sectional population-based study in a peripheral low-income community in São Paulo, Brazil, aimed to estimate the prevalence of unsafe abortion and identify the socio-demographic characteristics associated with it and its morbidity. The article discusses the studys results, based on univariate and multiple multinomial logistic regression analyses. The final regression models included: age at first intercourse < 16 years (OR = 4.80); > 2 sex partners in the previous year (OR = 3.63); more live born children than the womans self-reported ideal number (OR = 3.09); acceptance of the abortion due to insufficient economic conditions (OR = 4.07); black ethnicity/color (OR = 2.67); and low schooling (OR = 2.46), all with p < 0.05. The discussion used an approach to social determinants of health based on the concept and model adopted by the WHO and the health inequities caused by such determinants in the occurrence of unsafe abortion. According to the findings, unsafe abortion and socio-demographic characteristics are influenced by the social determinants of health described in the study, generating various levels of health inequities in this low-income population.

Propaganda de álcool e associação ao consumo de cerveja por adolescentes

OBJETIVO: Analisar a associacao entre propaganda de alcool e o consumo de cerveja por adolescentes. METODOS: Foram entrevistados 1.115 estudantes de 7o e 8o anos de tres escolas publicas de Sao Bernardo do Campo, SP, em 2006. As variaveis independentes foram: atencao prestada as propagandas de alcool, crenca na veracidade das propagandas, resposta afetiva as propagandas, uso previo de cigarro, entre outras. A variavel dependente foi consumo de cerveja nos ultimos 30 dias. Analises de regressoes logisticas univariada e multipla foram realizadas. Idade, importância dada a religiao e ter banheiro em casa foram utilizadas como controle. RESULTADOS: O consumo de cerveja nos ultimos 30 dias esteve associado ao uso de cigarro (OR = 4,551), ter uma marca preferida de bebida alcoolica (OR = 5,150), nao ser monitorado pelos pais (OR = 2,139), achar que as festas que frequentam parecem-se com as de comerciais (OR = 1,712), prestar muita atencao aos comerciais (OR = 1,563) e acreditar que os comerciais falam a verdade (OR = 2,122). Essa associacao manteve-se mesmo na presenca de outras variaveis associadas ao seu consumo. CONCLUSOES: As propagandas de bebidas alcoolicas associam-se positivamente ao consumo recente de cerveja, por remetem os adolescentes a propria realidade ou por faze-los acreditar em sua veracidade. Limitar a veiculacao de propagandas de bebidas alcoolicas pode ser um dos caminhos para a prevencao do uso e abuso de alcool por adolescentes.OBJECTIVE To analyze the association between alcohol advertising and beer drinking among adolescents. METHODS A total of 1,115 students enrolled in the 7th and 8th grades of three public schools in São Bernardo do Campo, Southeastern Brazil, were interviewed in 2006. The independent variables were as follows: attention paid to alcohol advertisements, belief in the veracity of advertisements, affective response to advertisements and previous tobacco use, among others. The dependent variable was beer drinking in the last 30 days. Univariate and multiple logistic regression analyses were made. Age, importance given to religion and the presence of a bathroom in the home were used as control. RESULTS Beer drinking in the last 30 days was associated with tobacco use (OR = 4.551), having a favorite alcoholic beverage brand (OR = 5.150), poor parental supervision (OR = 2.139), considering parties one goes to as similar to those seen in commercials (OR = 1.712), paying more attention to advertisements (OR = 1.563) and believing that advertisements tell the truth (OR = 2.122). This association remained, even in the presence of other variables associated with beer drinking. CONCLUSIONS Alcohol advertisements are positively associated with recent beer drinking, because they remind adolescents of their own reality or make them believe in their veracity. Alcohol advertisement restrictions can be one way to prevent alcohol use and abuse by adolescents.

Frequency and characteristics of induced abortion among married and single women in São Paulo, Brazil

This article presents the results of a study in the city of São Paulo, Brazil, aimed at estimating the frequency of induced abortion among women 15 to 49 years of age. The objective was to characterize the occurrence of induced abortion by comparing the ideal number of children, age, and contraceptive use between married and single women. Based on random sampling, 1,749 interviews were held, including 764 married women, 658 single women, and 327 with other marital status. The analysis included: mean number of abortions per woman by analysis of variance and proportions of abortions and pregnancy, using the chi-square test. The mean abortion rate for married women (45 per thousand) did not differ statistically from that of single women. However, the pregnancy rate was much lower in single women, and when single women became pregnant they used abortion more frequently; while fewer than 2% of pregnancies in married women ended in induced abortions, among single women the abortion rate exceeded 18%. Therefore, the priority in the reproductive health field should be to invest in the supply and dissemination of appropriate contraceptive methods for womens early sexually active life.

The effect of the new traffic law on drinking and driving in São Paulo, Brazil☆

OBJECTIVE To present data on drinking and driving in the city of São Paulo, Brazil, and the effects of the new traffic law (Law 11,705) introduced in 2008. METHODS A cross-sectional study was performed using a questionnaire and passive breath test data to study the prevalence of drinking and driving and the association of drinking and driving with background characteristics and drinking patterns on two separate occasions. The data were gathered from 2007 to 2009 through roadside surveys conducted on busy public roads. Four thousand two-hundred thirty-four (4234) drivers were approached, before and after prohibition, from the south, north, east, and west regions of the city of São Paulo, located in southeastern Brazil, including cars, motorcycles, and utility vehicles. A total of 3854 (91%) consented to participate in the survey and answered the questionnaire. Out of this group, 3229 (84%) agreed to take the passive breathalyzer test. RESULTS Logistic regression analyses controlling for gender and age was used to predict a positive breath test (above 0.2g/l) and the impact of the new law. These analyses indicated that, after the passage of the new traffic law, there was a 45% decrease in driver behavior with positive breathalyzer results. Having a pattern of alcohol consumption of at least once a week and the habit of drinking and driving are risks for a positive breathalyzer. CONCLUSIONS Despite the decline in the frequency of motorists driving under the influence of alcohol, traffic-related injuries and deaths, after the new law, other measures for a public policy related to alcohol should be considered based on scientific evidence, consistency of action, clear goals, community support, and greater reliability in the laws.