Interrelatioship between Diet Quality and Depressive Symptoms in Elderly.

BACKGROUND: Several observational studies have shown association between diet quality and depression, but few studies have explored the interrelationship between these variables. OBJECTIVE: The aim of this study was to assess the interrelationship between diet quality and depressive symptoms in elderly. DESIGN: Cross-sectional study. SETTING: Population based. PARTICIPANTS: 1,378 elderly in the city of Pelotas, Brazil. MEASUREMENTS: The diet quality was assessed by a short food frequency questionnaire and the prevalence of depressive symptoms was estimated by the abbreviated Brazilian version of the Geriatric Depression Scale (GDS). The association between diet quality and depressive symptoms was assessed using logistic regression. RESULTS: The prevalence of depressive symptoms was 15.3%. Elderly with low-quality diet were more likely to experience depressive symptoms, and the association was almost twice higher in males than in females (men OR = 3.8, 95% CI 1.4, 10.6; women OR = 2.1, 95% CI: 1.4, 3.3). On the other hand, depressive elderly had higher odds of consuming a low-quality diet (OR 2.4, 95% CI: 1.7, 3.8). LIMITATIONS: Self-reported data and cross-sectional design limit our conclusions. CONCLUSIONS: The choice of a low-quality diet was associated to a higher risk of depressive symptoms in elderly, and vice-versa. These results highlight the importance of encouraging the choice of healthy food habits, especially in depressed elderly, in order to promote healthy aging.

Validade da fotogrametria computadorizada na detecção de escoliose idiopática adolescente / Validity of computed photogrammetry for detecting idiopathic scoliosis in adolescents

INTRODUÇÃO: A escoliose idiopática adolescente (EIA) é uma alteração tridimensional da coluna vertebral. Sua etiologia é desconhecida e seu início ocorre no início da puberdade, tendo sua progressão associada ao estirão de crescimento. A análise angular de movimento e postura corporal através da imagem estática, conhecida como fotogrametria, permite ao fisioterapeuta quantificar e qualificar sua avaliação da postura/movimento corporal. OBJETIVO: Este estudo foi realizado para avaliar a sensibilidade deste instrumento na detecção da EIA no exame escolar. MÉTODOS: Estudo transversal de base escolar sobre alunos de 5ª a 8ª série do ensino fundamental das redes pública e particular de Pelotas. Foram realizados coleta de imagem digital e exame radiográfico em postura antero-posterior e perfil. A sensibilidade e especificidade da fotogrametria foram verificadas utilizando três e dois graus de margem para desnivelamento da superfície corporal. RESULTADOS: Duzentos e vinte e quatro alunos realizaram o exame de fotogrametria na escola e o exame radiológico padrão. A prevalência de EIA foi de 4,5 por cento (n=10), sendo oito meninas e dois meninos, com média de 13,3º Cobb; média de 1,1 para rotação vertebral (Nash-Moe); 29,5º Cobb para cifose dorsal; 3,6º para ângulo íleo-lombar; e sinal de Risser em 1,6. Para trêsº, a sensibilidade foi de 21,4 por cento e a especificidade de 90,7 por cento. Utilizando dois graus, a sensibilidade foi de 50 por cento e a especificidade de 61,2 por cento. CONCLUSÕES: Com base nestes resultados, verificou-se que a fotogrametria computadorizada não pode ser realizada como screening para detecção de escoliose de grau leve nas escolas.

INTRODUCTION: Adolescent idiopathic scoliosis (AIS) is a three-dimensional abnormality of the spine, of unknown etiology. It starts at the beginning of puberty and its progression is associated with the growth spurt. Analysis of angular movement and body posture through the static imaging method known as photogrammetry could allow physical therapists to quantify and qualify their body posture/movement assessments. OBJECTIVE: This study was carried out to evaluate the sensitivity of this instrument for detecting AIS in examinations in schools. METHODS: This was a school-based cross-sectional study among fifth to eighth-grade elementary school students in public and private schools in Pelotas. Digital images were collected and radiographic examinations were performed in the anteroposterior and lateral planes. The sensitivity and specificity of the photogrammetry were investigated using three and two degrees of margin for the body surface asymmetry. RESULTS: Two hundred twenty four students underwent the photogrammetry and standard radiological examinations at the schools. The prevalence of AIS was 4.5 percent (n=10), in eight girls and two boys with mean Cobb of 13.3º; mean vertebral rotation of 1.1 (Nash-Moe); dorsal kyphosis of 29.5º Cobb; iliolumbar angle of 3.6°; and Risser sign of 1.6. With three degrees margin, the sensitivity was 21.4 percent and the specificity was 90.7 percent. With two degrees margin, the sensitivity was 50 percent and the specificity was 61.2 percent. CONCLUSIONS: Based on these results, it was found that computerized photogrammetry could not be used as a screening method for detecting mild scoliosis in schools.

Weight excess of school materials and its risks factors in South Brazil. A cross sectional study.

AIM: There is little information about weight excess of school materials in Brazil. The aim of this study was to determine the prevalence and risk factors of excess weight of school materials in a private and a public school in the city of Pelotas, Brazil. METHODS: A cross-sectional study was performed to examine students' equipment in both a private and a public school. Demographic data were collected and children were weighed and measured. The types of schoolbag, notebook, snack, and other materials taken to school were identified and weighed separately from Monday to Friday. An excess weight of school material was defined for schoolbags weighing more than 10% of each student's weight. RESULTS: The study included 226 (48.8%) students from a private school and 237 (51.2%) students from a public school. From this sample, 38.2% of the total students carried an excess weight of school materials, 68.5% (155 children) of whom were private school students compared to 9.3% (22 children) of public school students, giving a prevalence ratio (PR) of 7.4 (CI95%, 4.9-11.1). After differentiating the sample in terms of school type, the association between weight excess of school material and school bag type (trolley pack), notebook type (hard back or spiral notebook) and transport of snacks were positively reported. CONCLUSION: Due to the higher income of the families of private school children, the type of school equipment carried was more costly and was the heaviest. These data should be considered in educational campaigns in order to reduce school equipment weight.

[Opioid antagonists and alcohol consumption]. / Antagonistas opioides y consumo de alcohol.

INTRODUCTION: Alcoholism is considered a chronic, progressive and frequently mortal disease; it is a primary phenomenon rather than a sign or symptom of other diseases. With the aim to reduce the alcohol consumption and the relapse in alcoholics, several pharmacological strategies have been applied; among them the opioid antagonists have been successfully used. The scope of the present study is to show experimental evidence of the effect of different opioid antagonists on alcohol consumption on the base of their receptor specificity in different pharmacological strategies. DEVELOPMENT: Alcohol consumption increases the release of endogenous opioids; therefore, the opioid receptor blocked apparently decreases the rewarding alcohol effects. On this base, the unspecific antagonists as naloxone and naltrexone are the more used in clinic; these substances bind with different affinity to mu, delta and kappa receptors. Specific opioid receptor antagonists have been studied with the scope to clear up the participation of the different opioid receptors modulating the alcohol intake. Although, there is inconsistency in the findings, these studies suggest that the delta and mainly the mu receptors have an important participation modulating alcohol consumption. CONCLUSION: There is sufficient evidence that the opioid system play an important role in the alcohol dependence; however, it is necessary to study integrally the different neurochemistry systems with the scope to understand the neurophysiologic mechanisms underlying the alcohol addiction.

[Prevalence and associated factors to rural occupational accidents, Brazil]. / Prevalência e fatores associados a acidentes de trabalho em zona rural.

OBJECTIVE: To investigate the frequency of rural occupational accidents and its association with potential risk factors. METHODS: The study was carried out in a urban area of Pelotas, RS, Brazil. A cross-sectional study was conducted. A representative sample of rural workers was selected using a multi-stage sampling. From January to April 1996, a total of 258 rural families were visited and all the 580 rural workers identified in those households answered a standardized questionnaire. RESULTS AND CONCLUSIONS: The prevalence of rural occupational accidents was 11%. After allowing for potential confounders, the main occupational hazards, as shown by logistic regression, were lower socioeconomic status (OR=1.81), non-white skin color (OR=3.50), and poor work satisfaction (OR=2.77).

[Smoking among teenagers in an urban area in Southern Brazil]. / Tabagismo em adolescentes de área urbana na região Sul do Brasil.

OBJECTIVE: To evaluate the prevalence of tobacco smoking and its determinants among adolescents. METHODS: A cross-sectional study, using a multiple stage sampling, was carried out in 1997 and a sample of adolescents aged between 12 and 18 years who were living in the urban area of Pelotas, Brazil, was studied. Those who reported having smoked at least one cigarette per week during the last month were considered smokers. Chi-square test was used to compare proportions and conditional logistic regression was applied in the multivariate analysis. RESULTS/ CONCLUSIONS: Six hundred and thirty-two adolescents were interviewed, among which 38 were non-respondents. Of those interviewed, 11.1% were smokers at time of the study, 6.8% were former smokers and 82.1% had never smoked. Prevalence of tobacco smoking was directly related to the age. Even after adjusting for confounding factors, those who had left or failed at school, their parents were divorced or reported alcohol abuse in the last month showed a higher odds ratio for smoking.

[Oral contraceptive and breast cancer: a case-control study]. / Contraceptivos orais e câncer de mama: estudo de casos e controles.

OBJECTIVE: To investigate the association between breast cancer and the duration of use of oral contraceptives (OC), and age it started to be used in a population of Pelotas, Southern Brazil. METHODS: There were identified 250 incident cases of breast cancer in patients aged 20 to 60 years from records of pathology laboratories and there were enrolled 1,020 controls drawn from hospital and neighbourhood population. For 90 cases identified in Pelotas, 270 hospital controls and 270 neighbourhood controls were selected, for another 78 cases in Pelotas, 234 controls were selected, and for 82 cases from other municipalities, 246 hospital controls were selected. Controls were matched by age. Adjusted analysis was performed using conditional logistic regression. RESULTS: No association between oral contraceptive use and breast cancer was found (OR=1.1;CI95% 0.7 - 1.6 for hospital controls, and OR=0.9;CI95% 0.6 - 1.6 for neighbourhood controls) neither for different duration of use or starting age. To increase the test power, 250 cases and all 1020 controls were analyzed together, and an odds ratio of 1.6 (CI95% 1.0 - 2.4) was found for women older than 45 years of age who had been using oral contraceptives for five years or more. CONCLUSIONS: No evidence was found of a general association between oral contraceptive use and breast cancer. When analyzing the whole date set, with all neighbourhood and hospital controls together, for women older than 45 years of age who had been using oral contraceptives for more than 5 years, it was found an increased risk almost statistically significant (p=0.05).

The epidemiological transition in maternal and child health in a Brazilian city, 1982-93: a comparison of two population-based cohorts.

Two studies carried out in 1982 and 1993 in the city of Pelotas, Southern Brazil, provide a unique opportunity for assessing the impact on maternal and child health of the economic and health care changes, which took place in Brazil in this period. The cohorts of mothers and infants of 1982 and 1993 were studied from the time of delivery. In both years, all mothers identified in the city's maternity hospitals answered a standardised questionnaire and their infants were examined. Over 99% of all children born in the city in each of the 2 years were included in the cohorts. Deaths occurring among these children were monitored prospectively, as well as all hospital admissions in the 1993 cohort. In the 1982 study, attempts were made to locate a 25% sample of the children at the mean age of 12 months using the addresses collected at the hospital (82% of the children were located), and all of the cohort children at the mean age of 20 months and 42 months, through a city census (87% were located in both follow-ups). In the 1993 study, 20% of all children plus all low birthweight infants were sought at 12 months of age, using the addresses collected at the hospital, and 95% were successfully traced. There was a 12% fall in the number of births occurring in 1993 (5,304 births), in comparison with 1982 (6,011 births), in spite of the increase in the population of reproductive age in the city during the decade. There was a marked difference in maternal height and weight at the beginning of pregnancy, with women giving birth in 1993 being, on average, 3.4 cm taller and 2.5 kg heavier than those who gave birth in 1982. The proportion of preterm babies (<37 weeks), measured by the date of last menstrual period, increased from 5.6% in 1982 to 7.5% in 1993. The median duration of breast feeding increased from 3.1 months in 1982 to 4.0 months in 1993. At 12 months of age, the prevalence of deficit of weight for age decreased from 5.4% in 1982 to 3.7% in 1993. The prevalence of deficit of height for age, however, increased from 5.3% to 6.1%. The perinatal mortality rate dropped 31%, from 32.2 per 1,000 births in 1982 to 22.1 deaths per 1,000 births in 1993. There was also a marked reduction in the infant mortality rate, from 36.4 per 1,000 livebirths in 1982 to 21.1 per 1,000 livebirths in 1993. The findings of the study indicate that there were improvements in the decade for most of the indicators evaluated, with the exception of birthweight and gestational age. It appears that improvements in perinatal and infant mortality rates are largely due to improvements in the health care sector.

[Depression in adolescence treated at primary care centres: size of a hidden problem of general health]. / Depresión en la adolescencia en centros de atención primaria: importancia de un problema oculto en salud colectiva.

OBJECTIVES: To investigate the prevalence of depression and its relationship to the reason for the consultation and to the medical diagnosis. DESIGN: Descriptive, cross-sectional design. SETTING: Primary care units of a community in Brazil. PATIENTS AND OTHER PARTICIPANTS: Individuals between 13 and 19 years old, who attended 10 primary care units to consult with a non-psychiatric doctor between October 1997 and January 1998 (n = 463). MAIN MEASUREMENTS AND RESULTS: The CET-DE (Alonso-Fernández, 1986) was used to measure depression, jointly with a questionnaire for evaluating social and demographic details and data pertinent to the consultation. Prevalence ran at 26.5% (95% CI: 22.6-30.4%). 99.2% cases of depression had not been identified. Complaints were spread over the somatic field (61.1%), or were sex-related (49.5%), mainly pregnancy (31.7%), especially among the cases of depression (p < 0.001). There were few psychiatric-social complaints (1.5%). Diagnoses often coincided with complaints: 59.9% somatic, 38.4% sex-related (pregnancy = 21.6%) and 1.7% psychiatric-social. CONCLUSIONS: Adolescent depression is common in primary care, but is not usually identified. The reason for this may be the kind of depression, which is usually light or focused on just one dimension of human vitality; the doctors tendency to centre his/her attention on the complaint without broadening the clinical spectrum; or even because the adolescent expresses his/her emotional problems poorly, which often contributes to the depression not being diagnosed.

[Rural work-related accidents in Pelotas, Rio Grande do Sul State, Brazil: a population-based cross-sectional study]. / Acidentes de trabalho na zona rural de Pelotas, Rio Grande do Sul, Brasil: um estudo transversal de base populacional.

Epidemiological literature on occupational accidents among rural workers is scarce in Brazil. This population-based cross-sectional study was designed to investigate the characteristics of farming accidents occurring in the rural area of Pelotas, Southern Brazil. A multi-stage sampling scheme was used to select a representative sample of farms. From January to April 1996, a total of 258 rural families were visited, and all 580 rural workers identified in these families answered a standardized questionnaire. Sixty-three rural workers (11%) reported at least one work-related accident in the previous twelve months. There were 82 accidents during the study period, mainly related to the use of hand farm tools (29%) and handling farm animals (27%). The main types of injuries were cuts (50%), bruises (13%), and burns (9%). The body areas most frequently involved were hands (34%), feet (29%), and legs (18%). Among the injured rural workers, only 32% used health services to treat the resulting lesions (46% went to primary health care facilities and 36% to emergency services).

[Diagnosis of overweight in adolescents: comparative study of the performance different criteria for body mass index]. / Diagnóstico de sobrepeso em adolescentes: estudo do desempenho de diferentes critérios para o Indice de Massa Corporal.

OBJECTIVE: In an attempt to simplify the screening process for detecting obesity in adolescence, the performance of different cutoff values for body mass index (BMI) was assessed in a population-based cohort in Southern Brazil. METHODS: A total of 493 adolescents aged 15-16 years who lived in the city of Pelotas, Brazil, were studied. Obesity was defined according to the WHO criteria taking into account age and sex (a BMI equal to or greater than the 85th percentile of the NHANES I reference, plus subscapular and triceps skinfold equal to or greater than the 90th percentile of the same reference). Different BMI cutoff values were used to assess their specificity and sensitivity. RESULTS: For boys, BMI>/=25 kg/m(2) showed the best performance for detecting obesity, with a sensitivity of 90% and only 5% of false positives. The Brazilian proposed criteria that was used had 100% sensitivity but up to 23% of false positives. Higher cutoff values were also tested, but there was a slight increase in specificity, accompanied by a marked reduction in sensitivity. CONCLUSIONS: The BMI cutoff of 25 kg/m(2) presented the best performance for screening obesity in the studied sample, and it is recommended for adolescents aged 15 and more in populations with similar characteristics. It provides a single cutoff value to be used in primary health services, eliminating the need for age and sex-specific values and skinfold measurements, and it is also consistent with the cutoff value proposed to identifying overweight adults.

Explaining trends in inequities: evidence from Brazilian child health studies.

There is considerable international concern that child-health inequities seem to be getting worse between and within richer and poorer countries. The "inverse equity hypothesis" is proposed to explain how such health inequities may get worse, remain the same, or improve over time. We postulate that as new public-health interventions and programmes initially reach those of higher socioeconomic status and only later affect the poor, there are early increases in inequity ratios for coverage, morbidity, and mortality indicators. Inequities only improve later when the rich have achieved new minimum achievable levels for morbidity and mortality and the poor gain greater access to the interventions. The hypothesis was examined using three epidemiological data sets for time trends in child-health inequities within Brazil. Time trends for inequity ratios for morbidity and mortality, which were consistent with the hypothesis, showed both improvements and deterioration over time, despite the indicators showing absolute improvements in health status between rich and poor.

Alcohol treatment during lactation produces an advance in the onset of puberty in female rats.

It has been described that alcohol treatment after weaning produces a delay in the onset of puberty and a decrease in the body weight of female rats; however, during development, there are periods with different sensitivity to endogenous and exogenous substances. In this study, two daily doses of 2.5 g/kg of ethanol each administered to female pups during days 13-18 of postnatal age produced an advance in the age at vaginal opening but induced no effect on the body weight; however, the onset of sexual behavior was not advanced. Fertility and reproduction measures were not significantly impaired by this treatment. It is supported that, in this period, alcohol can produce different effects - even opposite to those described in other developmental stages - which seems to represent a critical period for alcohol action.

Tobacco smoking, occupational exposure and chronic respiratory disease in an Italian industrial area.

Tobacco smoking and occupational exposure are the major factors responsible for chronic obstructive pulmonary disease (COPD) worldwide. The prevalence of this disease and its main risk factors were investigated in an area characterized by a high density of iron- and steelworking factories in North Italy. A total of 1,497 subjects (50% male) aged 40-59 yrs underwent an interview and a physical assessment, and 1,244 of them also underwent spirometry. The prevalences of COPD and asthma were 16.1 and 5.2% among males and 4.4 and 4.0% among females. COPD and respiratory symptoms were associated with both smoking and occupational exposure in males: the odds ratios for having been occupationally exposed among males were 2.3 (95% confidence interval 1.4-3.7) for COPD and 1.7 (1.2-2.6) for respiratory symptoms. No association was found between asthma and tobacco smoking or occupational exposure. The forced expiratory volume in one second and forced vital capacity were associated negatively with smoking and not associated with occupational exposure. In females, lesser effects of cigarette smoking on both self-reported respiratory diseases and lung function tests were found. The attributable risks of chronic obstructive pulmonary disease for smoking and occupational exposure among males were 52.9 and 8.8%, respectively, and 60.3% when considered together, whereas 18.8% of chronic obstructive pulmonary disease cases among females were attributable to smoking.

[The rural labor process and health in the Southern Brazilian mountains: a descriptive study]. / Processo de produção rural e saúde na serra gaúcha: um estudo descritivo.

This cross-sectional study among rural workers in the mountainous region of the southernmost Brazilian State of Rio Grande do Sul was designed to identify the characteristics of work performed on family farms. The research focused on the socio-demographic profiles of rural workers, identifying the characteristics of rural labor and describing the prevalence of some disease entities in such populations. Some 1479 rural workers from 495 farms were interviewed. In this sample, 87% of the individuals were members of the farm-owning family, mean age was 41 years, 56% were males, and mean schooling was 5 years. Farms had a mean area of 37 hectares, 50% had at least one type of farm machinery, and fruits constituted the main crop. About 75% of workers handled several types of pesticides, while 12% reported at least one lifetime episode of pesticide poisoning. Prevalence of minor psychiatric disorders was 36%, and annual frequency of occupational injuries was 10%. There was a wide variety of activities and occupational risks. The high prevalence of health problems identified in the study calls attention to the need for measures to promote and protect rural workers' health.

Etiology of hepatocellular carcinoma in Italian patients with and without cirrhosis.

We performed a case-control study to assess the role of hepatitis B virus (HBV), hepatitis C virus (HCV), GB virus C/hepatitis G virus (HGV), TT virus, alcohol intake, and tobacco smoking as risk factors for hepatocellular carcinoma (HCC) in the presence or absence of cirrhosis. We prospectively recruited 174 patients with a first diagnosis of HCC admitted to the main hospitals in Brescia, North Italy. On the basis of histological, clinical, and radiological criteria, the presence of cirrhosis was established in 142 cases, excluded in 21 cases, and remained undefined in 11 cases. Among the HCC cases without cirrhosis, a histological picture of normal liver was found in a single patient, chronic viral hepatitis was found in 11 patients, alcoholic hepatitis was found in 5 patients, nonspecific reactive hepatitis was found in 3 patients, and hemochromatosis was found in 1 patient. As controls, we also included 610 subjects unaffected by hepatic diseases and admitted to the same hospitals as cases. The odds ratios for having HCC according to positivity for HCV RNA, HBsAg and/or HBV DNA, and alcohol intake > 80 g/day (95% confidence interval) were as follows, in the presence and absence of cirrhosis, respectively: (a) 33.5 (17.7-63.4) and 19.7 (6-64.8) for HCV RNA; (b) 17.6 (9.0-34.4) and 20.3 (5.7-72.6) for HBsAg; and (c) 5.5 (3.1-9.7) and 4.6 (1.5-13.8) for alcohol intake. No association was found with HGV or TT virus infections or tobacco. This study has shown that most HCC cases arising in the area are due to HBV, HCV, or alcohol intake, in both the presence and absence of cirrhosis.

[A cross-sectional study about mental health of farm-workers from Serra Gaucha (Brazil)]. / Estudo transversal sobre saúde mental de agricultores da Serra Gaúcha (Brasil).

OBJECTIVE: In view of the shortage of population-based rural studies, this research project evaluated the associations between the characteristics of rural work and the occurrence of minor psychiatric disorders (MPD). METHODS: A cross sectional study was carried out on the 1,282 farm workers of 446 farms. Information about the farms (land extension, agricultural activities, technology and pesticide use) was collected. Demographic and socioeconomic data, characteristics of the work process and mental health indicators were obtained from the workers. RESULTS: MPD were found in 37.5% of the farm workers. The risk was higher on farms with a land extension of from 26 to 50 hectares, and lower where there was an increased level of job technology and schooling. The prevalence of MPD was higher among bean producers and lower among apple producers. Despite the impossibility of defining the direction of the causal link, pesticide poisoning was strongly associated with MPD. CONCLUSION: The results call attention to the dimension of the problem and to the importance of adopting new policies for the protection of farm workers' mental health.

Sex differences in alcohol drinking patterns during forced and voluntary consumption in rats.

Wistar rats were studied during forced and voluntary alcohol consumption, and continuous or periodic access to ethanol (6%) v/v with different availability of fluids. Absolute volume of alcohol consumption was not different between sexes in any condition; however, females consumed significantly more alcohol than males on a g/kg basis in all conditions. These differences were significantly more extensive during continuous free-choice to alcohol and water than during forced alcohol consumption. Females showed greater alcohol preference than males only during continuous free-choice to alcohol and water. During periodic free-choice to alcohol and water condition, alcohol consumption was distributed during more hours throughout the day in females than males. During periodic free-choice to alcohol and to an isocaloric sweetened solution (ISS), intakes of ISS were very high compared to regular intakes of daily water; nevertheless, alcohol consumption was maintained to similar levels observed in continuous free-choice to alcohol and water and represented almost 50% of regular daily consumes of water in males and females. Free-choice for alcohol and ISS modified the usual pattern of alcohol consumption during the daily light-dark cycle in males and females and reduced the time devoted to drinking alcohol compared to other conditions, in which similar intakes were observed. Results show that the extent of the higher alcohol consumption in females than males and the changes in patterns of alcohol intake were dependent on the nature of the ingestion schedule.

[Prenatal care in Pelotas, Rio Grande do Sul, Brazil, 1993]. / Atenção pré-natal em Pelotas, Rio Grande do Sul, Brasil, 1993.

All 5304 births in the hospitals of Pelotas, Rio Grande do Sul, Brazil in 1993 were studied. Neonates were examined and their mothers were interviewed regarding sociodemographic conditions, family income, reproductive health, and medical care during pregnancy. Ninety-five per cent of women received prenatal care. The mean number of physician visits during pregnancy was 7 and the majority of the women (84.7%) began visits before the fifth month of pregnancy. Women who did not receive prenatal care were from the lowest socioeconomic stratum and were mostly adolescents or over 40 years of age. Incidence of low birth weight in this group was 2.5 times that of the group with more than five visits (p>0.001). Perinatal mortality rate was 50.6/1000 in the group without prenatal care and 15.8/1000 in the group with more than five visits. With regard to utilization of health care, the study shows that twenty-five per cent of women with high gestational risk received inadequate prenatal care. The rate was less than 10% in the group of women with low gestational risk. These results suggest the need for improvement in the quality of prenatal care with special attention for mothers with high gestational risk.

[Risk factors for perinatal mortality in Pelotas, a southern city of Brazil, 1993]. / Fatores de risco para mortalidade perinatal em Pelotas, RS, 1993.

INTRODUCTION: Although there was a considerable reduction in infant mortality in Pelotas, Rio Grande do Sul in the last decade, its perinatal causes were reduced only by 28%. The associated factors of these causes were analysed. MATERIAL AND METHOD: All hospital births and perinatal deaths were assessed by daily visits to all the maternity hospitals in the city, throughout 1993 and including the first week of 1994. RESULTS: The perinatal mortality rate was 22.1 per thousand births. The multivariate analysis showed the following risk factors: low socioeconomic level, male sex and maternal age above 35 years. Among multigravidae women, the fetal mortality rate was significantly increased for mothers with a previously low birthweight and a previous stillbirth. For early neonatal mortality the risk was significantly increased by a smaller number of antenatal visits than 5 and low birthweight. CONCLUSIONS: Main risk factors for perinatal mortality: low socioeconomic level, maternal age above 35 years and male sex. For early neonatal mortality the risk was significantly increased by a smaller number of antenatal visits than 5 and low birthweight.