Wladithe Organ de Carvalho

Risk factors for infant mortality in a municipality in southern Brazil: a comparison of two cohorts using hierarchical analysis

This study compared risk factors for infant mortality in 2000-2001 and 2007-2008 in Londrina, Paraná State, Brazil. Data on live births and infant deaths were linked in a single database, and a hierarchical regression model was used. Distal risk factors for infant mortality in 2000-2001 were maternal age < 20 or ≥ 35 years and lower maternal schooling. In 2007-2008, maternal age ≥ 35 or < 20 years were risk factors, while low schooling appeared as a protective factor. The following intermediate factors were associated with increased infant mortality in 2000-2001: multiple pregnancy, history of stillbirth, and insufficient number of prenatal visits, while cesarean delivery was a protective factor. Multiple pregnancy was the only intermediate risk factor in 2007-2008. All of the proximal factors were associated with higher infant mortality in 2000-2001, but only gestational age and 5-minute Apgar in 2007-2008. The risk factors for infant mortality changed from the first to the second cohort, which may be related to the expansion of social policies and primary care and changes in the reproductive and social patterns of Brazilian women.

Breastfeeding prevalence before and after the implementation of a children's morbid mortality reduction program in the municipality of Campo Mourão, Paraná State

Health services evaluation contributes to the reformulation and establishment of new health practices and improvement of health indicators. The purpose of this study was to describe breastfeeding prevalence in the sixth month in children who were born before and after the implementation of a childrens morbid mortality reduction program, in the municipality of Campo Mourão, Paraná State, and to verify the scope of actions to support breastfeeding. One hundred ninety-seven mothers, who had a child born before and after the implementation of the program, were interviewed. In their sixth month of life exclusive breastfeeding prevalence was 34.0% and 36.5%, respectively, for those born before and after the implementation. As for coverage, 16.2% of women took part in at least one educational lecture, 87.8% were interviewed by the group during admission to puerperium, 79.7% received educational material and 77.2% received material for the newly-born care. This study provided evidence of low impact of the program on breastfeeding prevalence. Other evaluative studies are suggested, so that the planning of actions and procedures of the program achieve their goal which is to provide a better care for the woman and child.

Health surveys and use of maternal and child health care services in three municipalities within the São Paulo metropolitan area

OBJECTIVES To describe the changes in the use of maternal and child health care services by residents of three municipalities-Embu, Itapecerica da Serra, and Taboão da Serra-in the São Paulo metropolitan area, 12 years after the implementation of the Unified Health System (SUS) in Brazil, and to analyze the potential of population-based health care surveys as sources of data to evaluate these changes. METHODS Two population-based, cross-sectional surveys were carried out in 1990 and 2002 in municipalities located within the São Paulo metropolitan area. For children under 1 year of age, the two periods were compared in terms of outpatient services utilization and hospital admission; for the mothers, the periods were compared in terms of prenatal care and deliveries. In both surveys, stratified and multiple-stage conglomerate sampling was employed, with standardization of interview questions. RESULTS The most important changes observed were regarding the location of services used for prenatal care, deliveries, and hospitalization of children less than 1 year of age. There was a significant increase in the use of services in the surrounding region or hometown, and decrease in the utilization of services in the city of São Paulo (in 1990, 80% of deliveries and almost all admissions for children less than 1 year versus 32% and 46%, respectively, in 2002). The use of primary care units and 24-hour walk-in clinics also increased. All these changes reflect care provided by public resources. In the private sector, there was a decrease in direct payments and payments through company-paid health insurance and an increase in payments through self-paid health insurance. CONCLUSIONS The major changes observed in the second survey occurred simultaneous to the changes that resulted from the implementation of the SUS. Population-based health surveys are adequate for analyzing and comparing the utilization of health care services at different times.

Má Oclusão, Hábitos Bucais e Aleitamento Materno: Estudo de Base Populacional em um Município de Pequeno Porte

Resumen pt: Objetivo: Estimar a prevalencia de ma oclusao na denticao decidua e avaliar sua associacao com habitos bucais e tempo de aleitamento materno. Metodo: Est...

Poor Relationships and Physical Violence at School Are Associated With More Forms of Psychological Violence Among Brazilian Teachers: A Cross-Sectional Study

Our purpose was to identify individual and work-related factors that are associated with psychological violence (PV) and are related to a higher number of PV forms among teachers. This cross-sectional study included 789 elementary and high school teachers in a municipality in southern Brazil. Data were obtained through interviews and a self-administered questionnaire. PV was characterized by reports of insults from students, humiliation by colleagues or teachers, and threats in the 12 months preceding the study. Factors associated with the number of PV forms were also investigated. Poisson regression models were used for the analyses. More than half (64.1%) of the teachers reported at least one event of PV, 38.3% reported only one form, 21.5% reported two forms, and 4.3% reported all three surveyed forms. After adjustments, poor relationships with superiors or students and having suffered physical violence at school remained associated with at least one PV episode. The same variables were associated with the number of forms of PV, as were age (inverse relationship) and violence outside of school. The higher the number of aggregated factors, the more estimated forms of PV, particularly among the younger teachers. These results highlight the importance of adopting strategies that promote a nonviolent and safe school environment for teachers, which will in turn improve work conditions, the quality of education, and teachers’ health.