Access to emergency care services: a transversal ecological study about Brazilian emergency health care network.

OBJECTIVES: Studies of health geography are important in the planning and allocation of emergency health services. The geographical distribution of health facilities is an important factor in timely and quality access to emergency services; therefore, the present study analyzed the emergency health care network in Brazil, focusing the analysis at the roles of small hospitals (SHs). STUDY DESIGN: Cross-sectional ecological study. METHODS: Data were collected from 9429 hospitals of which 3524 were SHs and 5905 were high-complexity centers (HCCs). For analytical purposes, we considered four specialties when examining the proxies of emergency care capability: adult, pediatrics, neonatal, and obstetric. We analyzed the spatial distribution of hospitals, identifying municipalities that rely exclusively on SHs and the distance of these cities from HCCs. RESULTS: More than 14 and 30 million people were at least 120 km away from HCCs with an adult intensive care unit (ICU) and pediatric ICU, respectively. For neonatal care distribution, 12% of the population was more than 120 km away from a health facility with a neonatal ICU. The maternities situation is different from other specialties, where 81% of the total Brazilian population was within 1 h or less from such health facilities. CONCLUSION: Our results highlighted a polarization in distribution of Brazilian health care facilities. There is a concentration of hospitals in urban areas more developed and access gaps in rural areas and the Amazon region. Our results demonstrate that the distribution of emergency services in Brazil is not facilitating access to the population due to geographical barriers associated with great distances.

Child labor and health: problems and perspectives.

Child labor remains a widespread problem. Although it can have positive effects, in some situations it has negative effects on health and development of the children. Although mainly a problem in developing countries, it is also possible to find child workers, some working in hazardous activities, in developed countries. The authors describe the child labor profiles in developed and developing countries, the principal occupations of children, and their concomitant hazards. They summarize the epidemiologic evidence for a greater impact of some occupational exposures on the health of children as compared with adults, and the theoretical concerns about the impact of child labor on health, and suggest policies that can be used to combat harmful child labor.

[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.

The Brazilian cohort of pulp and paper workers: the logistic of a cancer mortality study.

The International Agency for Research on Cancer (IARC) proposed this international historical cohort study trying to solve the controversy about the increased risk of cancer in the workers of the Pulp and Paper Industry. One of the most important aspects presented by this study in Brazil was the strategies used to overcome the methodological challenges, such as: data access, data accuracy, data availability, multiple data sources, and the large follow-up period. Through multiple strategies it was possible to build a Brazilian cohort of 3,622 workers, to follow them with a 93 percent success rate and to identify in 99 percent of the cases the cause of death. This paper, has evaluated the data access, data accuracy and the effectiveness of the strategies used and the different sources of data.

[Measuring the impact of promoting breastfeeding in primary health care services in Pelotas, Rio Grande do Sul, Brazil]. / Medindo o impacto da promoção do aleitamento materno em serviços de atenção primária à Saúde em Pelotas, Rio Grande do Sul, Brasil.

All mothers with children enrolled in the Program for Child Growth and Development at primary care units belonging to the Federal University of Pelotas (UFPel) in the state of Rio Grande do Sul, Brazil, were interviewed with a standardized questionnaire. This research aimed to assess the impact of the "Groups of Expecting Mothers" in the promotion of breastfeeding. The family income of almost half of the 347 children studied was two times the minimum wage. About 1/4 of the children's mothers had spent less than four years in school, and these were the mothers who attended the Groups most frequently. Most of the mothers received prenatal care and nearly half of then participated in the Groups. In contrast, 1/3 of the children were weaned at the age of three months and almost 80% received tea in the early months of life. The results show that the Groups of Expecting Mothers suffer serious limitations in promoting breastfeeding and in postponing the introduction of foods other than breast milk in the children's diet. Data obtained in this study are intended to help strengthen action under current programs and to show that with minimum resources and a rather simple methodology it is possible to assess the quality of health services available to the population.

Drug usage in southern Brazilian hospitals.

A drug usage survey was carried out in 14 hospitals in the southernmost region of Brazil in the year 1979. The average number of drugs prescribed per patient was 8.6, and antimicrobials, followed by analgesics, vitamins and sedatives-tranquilizers were the most often employed drug categories. Among the antimicrobials, ampicillin was the first, followed by chloramphenicol, but the overall leading drug was an analgesic-antipyretic, dipyrone. Some possible distortions in drug usage are discussed.

[The worker model and perception of occupational and environmental risks: the optimal use of a descriptive study]. / Modelo operário e percepção de riscos ocupacionais e ambientais: uso exemplar de estudo descritivo.

An attempt was made to identify the risks resulting from exposure to the chemicals to which workers are exposed as well as from the poor working conditions to which they are subject in a chemical and pharmaceutical factory. A descriptive study based on the "workers model"--a methodological approach developed in Italy in the 60's, was carried out. Such a study requires direct contact with the workers and has the advantage of overcoming the difficulty of gaining access to their work-place. The activities of the different departments of the plant were reconstructed and the main chemicals used, the main physical complaints, the potential harms and the main environmental risks identified. The report on the harmful working conditions produced was used by the workers as a means of pressing the authorities into carrying out an inspection of the plant concerned to verify its accuracy. The report's findings have been confirmed and demonstrate the usefulness of the methodological approach adopted. The workers' publicizing of the study's findings through the means of mass communication have helped to build up greater public awareness of the occupational and environmental risks of that particular industrial activity.

[Use of outpatient services in an urban area of Southern Brazil: place and frequency]. / Utilização de serviços ambulatoriais em Pelotas: onde a população consulta e com que freqüência.

OBJECTIVE: The objective was determine the use of health services by the adult population in Pelotas, RS, Brazil. METHODS: A cross-sectional study was made on the basis of a population sample. One thousand six hundred and fifty-seven persons we interviewed during the months of March and June, 1992. A percentage of 9.7 of the sample was lost. RESULTS: Two dependents variables. One the type of service as determined by type of payment. The other the number of medical visits made during the previous year. The type of service was seen to be associated with the following social variables: social class, level of schooling and place of residence. The frequency of medical visits was associated with sex, risk factors and reasons for the visit. CONCLUSION: It was concluded that choice of the type of service depends more heavily in social class than other variables associated with the severity of the disease in question.

[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.

[Workers' perception of exposure to workload and risks of accidents in a southern Brazilian city]. / Percepção de exposição a cargas de trabalho e riscos de acidentes em Pelotas, RS (Brasil).

OBJECTIVE: The study of the association between workers' perceptions of occupational hazards and the risk of occupational accidents. DESIGN: Case control study. POPULATION: The cases were 264 workers who presented a "typical" occupational accident, registered at the National Institute of Social Security in the city of Pelotas, between January and July, 1996. Fatal accidents (two) were excluded, as were those leading to an absence of less than seven days from work. The cases were interviewed in their homes with a standard questionnaire. For each case, three controls were chosen: a fellow-work, a neighbor and a population control. Controls were matched to the cases by age (+/- 5 years) and sex; workers who had suffered an occupational accident in the preceding month were excluded from the control group. All cases and controls were formally employed and lived in the urban area. The data were analyzed using conditional logistic regression. RESULTS AND CONCLUSIONS: The risk of occupational accidents was found to double among workers who reported having faced emergency situations at work, working in high places, facing constant danger or noisy environments. Working in uncomfortable positions or intense physical activities were associated with a 50% increase in risk. The remaining occupational hazards under study were not significantly associated with the risk of accidents. All of the above results were adjusted for confounding factors.