Violence against women in life: study among Primary Care users. / Violência contra a mulher na vida: estudo entre usuárias da Atenção Primária.

This article aims to estimate the prevalence and factors associated with intimate partner violence among primary care users. Cross-sectional study with women aged 20 to 59 years. Physical, sexual and psychological violence was screened by the World Health Organization instrument. Poisson regression was used for crude and adjusted analysis. Nine hundred ninety-one women participated in the study. The prevalence of violence throughout the lifespan was: psychological 57.6% (95%CI 54.6-60.7); physical 39.3% (95%CI 36.2-42.3) and sexual 18.0% (95%CI 15.7-20.5). Women with up to eight years of schooling, divorced or separated, whose mothers suffered intimate partner violence, who reported drug use and experienced sexual violence in childhood showed a higher prevalence of the three types of violence. Religion was associated with psychological and sexual violence and the use of cigarettes to physical and psychological violence. Participants with lower household income had a higher prevalence of physical violence. A high prevalence of intimate partner violence was identified among users. Worse socioeconomic conditions, risk behaviors and a history of assault are associated with greater occurrence of this problem.

Violence against women and its association with the intimate partner's profile: a study with primary care users. / Violência contra a mulher e sua associação com o perfil do parceiro íntimo: estudo com usuárias da atenção primária.

OBJECTIVE: To verify the association between the history of violence against women and the socio-demographic and behavioral characteristics of intimate partners. METHODS: A cross-sectional study was carried out with 938 women using basic health care, aged between 20 and 59 years, who at the time of the interview had an intimate partner. Information about the sociodemographic and behavioral characteristics of the intimate partner were collected, as well as the WHO VAW Study instrument for tracking the psychological, physical and sexual violence experienced in the past year. A bivariate analysis was performed using the Pearson c2 test and multivariate analysis using Poisson regression with robust variance. RESULTS: The highest prevalences of psychological, physical and sexual violence were significantly associated with partners who had no occupation and who refused to use condoms in sexual relationships. Men who were considered controllers and who consumed alcoholic beverages were associated with greater perpetration of psychological and physical violence (p < 0.05). Partners with up to eight years of schooling present a higher frequency of psychological violence (PR = 1.32, 95%CI 1.05 - 1.66), while sexual violence was significantly higher among women whose partners smoked: 1.94, 95%CI 1.11 - 3.38). CONCLUSIONS: These data highlight the importance of health professionals, work together in other sectors such as education and safety, dealing with alcohol and other drugs, as well as addressing issues of gender.

OBJETIVO: Verificar associação entre a história de violência contra a mulher e características sociodemográficas e comportamentais do parceiro íntimo. MÉTODOS: Estudo transversal realizado com 938 mulheres usuárias da atenção básica de saúde, com idade entre 20 e 59 anos e que no momento da entrevista possuíam parceiro íntimo. Foram coletadas informações sobre as características sociodemográficas e comportamentais, do parceiro íntimo, bem como foi aplicado o instrumento World Health Organization Violence Against Woman (WHO VAW Study) para o rastreamento da violência psicológica, física e sexual vivenciada no último ano. Foi realizada análise bivariada, por meio do teste do c2 de Pearson, e multivariada usando regressão de Poisson com variância robusta. RESULTADOS: As maiores prevalências de violência psicológica, física e sexual estiveram significativamente associadas aos parceiros que não possuíam ocupação e que recusaram o uso do preservativo nas relações sexuais. Homens que foram considerados controladores e que ingeriam bebida alcoólica estiveram associados a maior perpetração de violência psicológica e física (p < 0,05). Parceiros com até 8 anos de escolaridade apresentam maior frequência de prática de violência psicológica (RP = 1,32; IC95% 1,05 - 1,66), enquanto a violência sexual foi significativamente maior entre as mulheres cujos parceiros fumavam (RP = 1,94; IC95% 1,11 - 3,38). CONCLUSÕES: Esses dados evidenciam a importância de os profissionais de saúde atuarem juntamente a outros setores, tais como educação e segurança, no enfrentamento ao álcool e outras drogas, bem como na abordagem das questões de gênero.

Factors associated with having mammography examinations in primary health care users in Vitória, Espírito Santo, Brazil. / Fatores associados à realização de mamografia em usuárias da atenção primária à saúde em Vitória, Espírito Santo.

OBJECTIVES: to estimate prevalence and factors associated with having mammography examinations among adult women aged 40 to 59 years old in primary health care services. METHODS: a cross-sectional study was performed in 26 health centers in Vitória, Espírito Santo, Brazil; data were collected from March to September 2014; the independent variables described sociodemographic, behavioral and reproductive characteristics, having mammography performed every two years as the outcome. RESULTS: 400 users participated, 57.8% of whom undergo mammography every two years; having the examination was more prevalent among women aged 50-59 years (PR=1.48 - 95%CI 1.25;1.75), those belonging to economic class A/B (PR=1.81 - 95%CI 1.22;2.68) and those who no longer menstruate (PR=1.31 - 95%CI 1.08;1.60). CONCLUSION: although the proportion of mammography examinations performed is in keeping with recommended levels, a higher frequency was found among the 50-59 age group belonging to class A/B, suggesting unequal access to this examination.

Fatores associados à realização de mamografia em usuárias da atenção primária à saúde em Vitória, Espírito Santo / Factores asociados a la realización de mamografía en usuarias de la atención primaria de salud en Vitória, Espírito Santo, Brasil / Factors associated with having mammography examinations in primary health care users in Vitória, Espírito Santo, Brazil

Objetivo: analisar a prevalência e os fatores associados à realização da mamografia em mulheres com idade de 40 a 59 anos, usuárias da atenção primária à saúde, em Vitória, Espírito Santo, Brasil. Métodos: estudo transversal, em 26 unidades de saúde; os dados foram coletados de março a setembro de 2014; as variáveis independentes descreveram características sociodemográficas, comportamentais e reprodutivas, com o desfecho de realização de mamografia a cada dois anos. Resultados: participaram 400 usuárias, das quais 57,8% realizaram a mamografia a cada dois anos; a realização do exame foi mais prevalente entre mulheres de 50 a 59 anos (RP=1,48 - IC95%1,25;1,75), da classe econômica A/B (RP=1,81 - IC95%1,22;2,68) e que não menstruam (RP=1,31 - IC95%1,08;1,60). Conclusão: apesar de a proporção de realização da mamografia estar conforme o recomendado, no grupo de 50 a 59 anos, observa-se maior frequência na classe A/B, o que sugere desigualdade no acesso ao exame.

Objetivo: estimar la prevalencia y los factores asociados a la realización de mamografía en mujeres adultas, entre 40 y 59 años, usuarias de la atención primaria de salud. Métodos: estudio transversal, en 26 unidades de salud de Vitória, Espírito Santo, Brasil; los datos fueron recolectados de marzo a septiembre de 2014; las variables independientes describieron características sociodemográficas, comportamentales y reproductivas, con desenlace de realización de mamografía a cada dos años. Resultados: participaron 400 usuarias, de las cuales 57,8% realizaron mamografía a cada dos años; el examen fue más prevalente entre mujeres de 50 a 59 años (RP=1,48 - IC95%1,25;1,75), de classe económica A/B (RP=1,81 - IC95%1,22;2,68) y que ya no menstrúan (RP=1,31 - IC95%1,08;1,60). Conclusión: a pesar de la proporción de realización de la mamografía estar dentro de lo recomendado, en el grupo de 50 a 59 años, se observa mayor frecuencia en la clase A/B, lo que sugiere desigualdad de acceso al examen.

Objectives: to estimate prevalence and factors associated with having mammography examinations among adult women aged 40 to 59 years old in primary health care services. Methods: a cross-sectional study was performed in 26 health centers in Vitória, Espírito Santo, Brazil; data were collected from March to September 2014; the independent variables described sociodemographic, behavioral and reproductive characteristics, having mammography performed every two years as the outcome. Results: 400 users participated, 57.8% of whom undergo mammography every two years; having the examination was more prevalent among women aged 50-59 years (PR=1.48 - 95%CI 1.25;1.75), those belonging to economic class A/B (PR=1.81 - 95%CI 1.22;2.68) and those who no longer menstruate (PR=1.31 - 95%CI 1.08;1.60). Conclusion: although the proportion of mammography examinations performed is in keeping with recommended levels, a higher frequency was found among the 50-59 age group belonging to class A/B, suggesting unequal access to this examination.

An empirical assessment of the Healthy Early Childhood Program in Rio Grande do Sul State, Brazil.

We investigate the effect of a family-based primary health care program (Healthly Early Childhood Program) on infant mortality in the state of Rio Grande do Sul, Brazil. We estimate infant mortality's counterfactual trajectories using the differences-in-differences approach, combined with the use of longitudinal data for all municipalities in the state of Rio Grande do Sul. Our main result is that the program reduced the number of deaths caused by external causes. The length of exposure to the program seems to potentiate the effects. For the number of deaths by general causes, there is no evidence of impact. Our findings are consistent with the nature of the program that aims to improve adults care with children. The Healthly Early Childhood Program is effective in reducing the number of avoidable deaths in infants.

An empirical assessment of the Healthy Early Childhood Program in Rio Grande do Sul State, Brazil / Uma avaliação empírica do Programa Primeira Infância Melhor no Estado do Rio Grande do Sul, Brasil / Una evaluación empírica del programa Primera Infancia Mejor en el estado de Río Grande do Sul, Brasil

Abstract: We investigate the effect of a family-based primary health care program (Healthly Early Childhood Program) on infant mortality in the state of Rio Grande do Sul, Brazil. We estimate infant mortality's counterfactual trajectories using the differences-in-differences approach, combined with the use of longitudinal data for all municipalities in the state of Rio Grande do Sul. Our main result is that the program reduced the number of deaths caused by external causes. The length of exposure to the program seems to potentiate the effects. For the number of deaths by general causes, there is no evidence of impact. Our findings are consistent with the nature of the program that aims to improve adults care with children. The Healthly Early Childhood Program is effective in reducing the number of avoidable deaths in infants.

Resumo: Investigamos o efeito de um programa de atenção primária de base familiar, o Programa Primeira Infância Melhor, sobre a mortalidade infantil no Estado do Rio Grande do Sul, Brasil. Estimamos as trajetórias contrafactuais da mortalidade infantil, usando a técnica das diferenças nas diferenças, combinada com o uso de dados longitudinais para todos os municípios do Estado do Rio Grande do Sul. O principal resultado é que o programa reduziu o número de óbitos por causas externas. O tempo de exposição ao programa parece potencializar os efeitos. Não há evidências de impacto sobre o número de óbitos por causas gerais. Nossos achados são compatíveis com a natureza do programa, que procura melhorar a saúde tanto dos adultos quanto das crianças. O Programa Primeira Infância Melhor mostra eficácia na redução do número de mortes evitáveis em lactentes.

Resumen: Hemos investigado los efectos de un programa de atención primaria a la salud basado en la familia, denominado Primera Infancia Mejor, sobre la mortalidad infantil en el estado de Río Grande do Sul, Brasil. Estimamos las trayectorias comparativas de la mortalidad infantil, utilizando la técnica diferencias en diferencias, combinándola con el uso de información longitudinal para todos los municipios en el estado de Río Grande do Sul. Nuestro resultado más significativo es que el programa redujo el número de muertes debidas a causas externas. La duración de exposición al programa pareció potenciar sus efectos. Para el número de muertes debidas a causas generales, no hay evidencia de impacto. Nuestros hallazgos son consistentes con la naturaleza del programa, cuyo objetivo es mejorar el cuidado de niños por parte de los adultos. El programa Primera Infancia Mejor es efectivo en la reducción del número evitable de muertes en niños.

Genomic ancestry and education level independently influence abdominal fat distributions in a Brazilian admixed population.

We aimed to identify the independent associations of genomic ancestry and education level with abdominal fat distributions in the 1982 Pelotas birth cohort study, Brazil. In 2,890 participants (1,409 men and 1,481 women), genomic ancestry was assessed using genotype data on 370,539 genome-wide variants to quantify ancestral proportions in each individual. Years of completed education was used to indicate socio-economic position. Visceral fat depth and subcutaneous abdominal fat thickness were measured by ultrasound at age 29-31y; these measures were adjusted for BMI to indicate abdominal fat distributions. Linear regression models were performed, separately by sex. Admixture was observed between European (median proportion 85.3), African (6.6), and Native American (6.3) ancestries, with a strong inverse correlation between the African and European ancestry scores (ρ = -0.93; p<0.001). Independent of education level, African ancestry was inversely associated with both visceral and subcutaneous abdominal fat distributions in men (both P = 0.001), and inversely associated with subcutaneous abdominal fat distribution in women (p = 0.009). Independent of genomic ancestry, higher education level was associated with lower visceral fat, but higher subcutaneous fat, in both men and women (all p<0.001). Our findings, from an admixed population, indicate that both genomic ancestry and education level were independently associated with abdominal fat distribution in adults. African ancestry appeared to lower abdominal fat distributions, particularly in men.

Violence against women, Espírito Santo, Brazil.

OBJECTIVE: To estimate the prevalence and factors associated with psychological, physical and sexual violence in women victims of intimate partner violence assisted in the primary care services. METHODS: This is a cross-sectional study, conducted in 26 health units in Vitória, State of Espírito Santo, from March to September 2014. We interviewed 991 women aged 20-59 years. To classify the psychological, physical and sexual violence, the World Health Organization instrument on violence against women was used and a questionnaire to investigate the sociodemographic, behavioral characteristics, and the women's family and life history was developed. The statistical analyzes used were Poisson regression, Fisher's exact test and Chi-square. RESULTS: The prevalence we observed were psychological 25.3% (95%CI 22.6-28.2); physical 9.9% (95%CI 8.1-11.9) and sexual 5.7% (95%CI 4.3-7.3). Psychological violence remained associated with education, marital status, maternal history of intimate partner violence, sexual violence in childhood and drug use, while physical assault was related to age, education, marital status and maternal history of intimate partner violence. Sexual violence occurred the most among women with low income, and victims of sexual violence in childhood. CONCLUSIONS: Psychological, physical and sexual violence showed highly frequency among women assisted by primary care services. Sociodemographic and behavioral factors, personal experiences, and maternal violence influence the phenomenon. OBJETIVO: Estimar a prevalência e os fatores associados às violências psicológica, física e sexual nas mulheres vítimas de violência perpetrada pelo parceiro íntimo atendidas nos serviços de atenção primária. MÉTODOS: Estudo transversal, realizado em 26 unidades de saúde do município de Vitória, no Espírito Santo, de março a setembro de 2014. Foram entrevistadas 991 usuárias de 20 a 59 anos. Para classificar as violências psicológica, física e sexual foi utilizado o instrumento da Organização Mundial de Saúde sobre violência contra a mulher e um questionário foi elaborado para investigar as características sociodemográficas, comportamentais e de história familiar e de vida da mulher. As análises estatísticas utilizadas foram: regressão de Poisson, teste exato de Fisher e Qui-quadrado. RESULTADOS: As prevalências observadas foram: psicológica 25,3% (IC95% 22,6-28,2); física 9,9% (IC95% 8,1-11,9) e sexual 5,7% (IC95% 4,3-7,3). A violência psicológica manteve-se associada à escolaridade, situação conjugal, histórico materno de violência por parceiro íntimo, violência sexual na infância e ter feito uso de drogas, enquanto a agressão física esteve relacionada à idade, escolaridade, situação conjugal e a história materna de violência por parceiro íntimo. A violência sexual foi mais frequente nas mulheres de menor renda e que sofreram abuso sexual na infância. CONCLUSÕES: As violências psicológica, física e sexual apresentaram alta magnitude entre as mulheres usuárias dos serviços de atenção primária de saúde. Fatores sociodemográficos, comportamentais e experiências pessoal e materna de violência influenciam a ocorrência do fenômeno.

Food consumption of children younger than 6 years according to the degree of food processing / Consumo alimentar de crianças menores de seis anos conforme o grau de processamento

Abstract: Objective: To evaluate food intake according to the degree of processing, stratified by family income and age, in a representative sample of children younger than 6 years in the city of Pelotas, RS, Brazil. Methods: Cross-sectional population-based study carried out with 770 children aged 0-72 months of age living in the urban area of Pelotas. The dietary intake of children was assessed by 24-h recall administered to mothers or guardians. The energy intake was estimated and each food item was classified according to the food processing degree. Food consumption was stratified by age (younger than 24 months; 24 months or older) and associations between quintiles of family income and relative contribution of each food to total energy were performed by linear regression. The Wald test was applied to test linear trend across groups. Results: The mean energy intake was 1725.7 kcal/day. The mean contribution of processed and ultraprocessed foods was 19.7% among children younger than 24 months and 37% in those aged 24 months or older, while the mean consumption of natural and minimally processed food was 61% and 44%, respectively. Among children aged 24 months or older, a greater consumption of canned foods, cheese and sweets was observed as family income quintiles increased, while breads were more consumed by those children belonging to the lower income quintiles. Conclusion: A high caloric contribution of ultraprocessed foods in detriment to a lower consumption of natural and minimally processed foods was observed in the diet of children younger than 6 years.

Resumo: Objetivo: Avaliar o consumo alimentar conforme o grau de processamento, segundo a renda e a faixa etária, em uma amostra representativa de crianças menores de 6 anos de Pelotas (RS), Brasil. Métodos: Estudo transversal conduzido com 770 crianças até 72 meses residentes na zona urbana de Pelotas. O consumo alimentar das crianças foi avaliado por recordatório de 24 horas, aplicado às mães ou aos responsáveis, e o consumo calórico dos alimentos foi estimado de acordo com o grau de processamento. O consumo alimentar foi estratificado por faixa etária (menos de 24 meses; 24 meses ou mais) e as associações entre renda familiar e a participação relativa dos alimentos no total de calorias diárias foram conduzidas por regressão linear simples. Fez-se o teste de Wald para avaliar tendência linear entre os grupos. Resultados: A média de consumo foi 1.725,7 Kcal/dia. A participação calórica proveniente do grupo de alimentos ultraprocessados foi de 19,7% nas crianças com menos de 24 meses e 36,1% naquelas com 24 meses ou mais, enquanto que a contribuição do grupo de alimentos in natura e minimamente processados foi de 61,2% e 44,1%%, respectivamente. Nas crianças com 24 meses ou mais observou-se maior consumo de doces conforme o aumento da renda familiar, enquanto que os pães foram mais consumidos entre as crianças pertencentes aos menores quintis de renda. Conclusão: Observou-se elevada participação calórica de alimentos ultraprocessados em detrimento do menor consumo de alimentos in natura e minimamente processados na alimentação de crianças menores de 6 anos.

Food consumption of children younger than 6 years according to the degree of food processing.

OBJECTIVE: To evaluate food intake according to the degree of processing, stratified by family income and age, in a representative sample of children younger than 6 years in the city of Pelotas, RS, Brazil. METHODS: Cross-sectional population-based study carried out with 770 children aged 0-72 months of age living in the urban area of Pelotas. The dietary intake of children was assessed by 24-h recall administered to mothers or guardians. The energy intake was estimated and each food item was classified according to the food processing degree. Food consumption was stratified by age (younger than 24 months; 24 months or older) and associations between quintiles of family income and relative contribution of each food to total energy were performed by linear regression. The Wald test was applied to test linear trend across groups. RESULTS: The mean energy intake was 1725.7kcal/day. The mean contribution of processed and ultraprocessed foods was 19.7% among children younger than 24 months and 37% in those aged 24 months or older, while the mean consumption of natural and minimally processed food was 61% and 44%, respectively. Among children aged 24 months or older, a greater consumption of canned foods, cheese and sweets was observed as family income quintiles increased, while breads were more consumed by those children belonging to the lower income quintiles. CONCLUSION: A high caloric contribution of ultraprocessed foods in detriment to a lower consumption of natural and minimally processed foods was observed in the diet of children younger than 6 years.

Violence against women, Espírito Santo, Brazil / Violência contra a mulher em Vitória, Espírito Santo, Brasil

ABSTRACT OBJECTIVE To estimate the prevalence and factors associated with psychological, physical and sexual violence in women victims of intimate partner violence assisted in the primary care services. METHODS This is a cross-sectional study, conducted in 26 health units in Vitória, State of Espírito Santo, from March to September 2014. We interviewed 991 women aged 20-59 years. To classify the psychological, physical and sexual violence, the World Health Organization instrument on violence against women was used and a questionnaire to investigate the sociodemographic, behavioral characteristics, and the women’s family and life history was developed. The statistical analyzes used were Poisson regression, Fisher’s exact test and Chi-square. RESULTS The prevalence we observed were psychological 25.3% (95%CI 22.6–28.2); physical 9.9% (95%CI 8.1–11.9) and sexual 5.7% (95%CI 4.3–7.3). Psychological violence remained associated with education, marital status, maternal history of intimate partner violence, sexual violence in childhood and drug use, while physical assault was related to age, education, marital status and maternal history of intimate partner violence. Sexual violence occurred the most among women with low income, and victims of sexual violence in childhood. CONCLUSIONS Psychological, physical and sexual violence showed highly frequency among women assisted by primary care services. Sociodemographic and behavioral factors, personal experiences, and maternal violence influence the phenomenon.

RESUMO OBJETIVO Estimar a prevalência e os fatores associados às violências psicológica, física e sexual nas mulheres vítimas de violência perpetrada pelo parceiro íntimo atendidas nos serviços de atenção primária. MÉTODOS Estudo transversal, realizado em 26 unidades de saúde do município de Vitória, no Espírito Santo, de março a setembro de 2014. Foram entrevistadas 991 usuárias de 20 a 59 anos. Para classificar as violências psicológica, física e sexual foi utilizado o instrumento da Organização Mundial de Saúde sobre violência contra a mulher e um questionário foi elaborado para investigar as características sociodemográficas, comportamentais e de história familiar e de vida da mulher. As análises estatísticas utilizadas foram: regressão de Poisson, teste exato de Fisher e Qui-quadrado. RESULTADOS As prevalências observadas foram: psicológica 25,3% (IC95% 22,6–28,2); física 9,9% (IC95% 8,1–11,9) e sexual 5,7% (IC95% 4,3–7,3). A violência psicológica manteve-se associada à escolaridade, situação conjugal, histórico materno de violência por parceiro íntimo, violência sexual na infância e ter feito uso de drogas, enquanto a agressão física esteve relacionada à idade, escolaridade, situação conjugal e a história materna de violência por parceiro íntimo. A violência sexual foi mais frequente nas mulheres de menor renda e que sofreram abuso sexual na infância. CONCLUSÕES As violências psicológica, física e sexual apresentaram alta magnitude entre as mulheres usuárias dos serviços de atenção primária de saúde. Fatores sociodemográficos, comportamentais e experiências pessoal e materna de violência influenciam a ocorrência do fenômeno.

[Trends and inequalities in risk behaviors among adolescents: a comparison of birth cohorts in Pelotas, Rio Grande do Sul State, Brazil]. / Tendências e desigualdades nos comportamentos de risco em adolescentes: comparação das coortes de nascimentos de Pelotas, Rio Grande do Sul, Brasil.

This study focuses on trends and inequalities in health risk behaviors among adolescents. A cross-sectional study compared two birth cohorts in the city of Pelotas, Rio Grande do Sul State, Brazil. The sample included 1,281 adolescents from the 1982 cohort and 4,106 from the 1993 cohort, followed in 2001 and 2011, respectively. The study recorded alcohol intake, illegal drug use, smoking, sexual initiation < 16 years, lack of condom use, and multiple sex partners. Total prevalence rates were calculated for each cohort, stratified by gender and per capita income, besides absolute and relative measures of inequality. There was a decrease from 2001 to 2011 in prevalence rates for trying alcohol, illegal drug use, smoking, and lack of condom use, and an increase in the number of sex partners. The gap between boys and girls increased for non-use of condoms and decreased for the other behaviors. The gap between income groups decreased for sexual initiation before 16 years of age and increased for episodes of intoxication. Socioeconomic inequalities persist, despite the downward trend in prevalence of risk behaviors.

Retorno social domiciliar da alfabetização: análise da associação com o tabagismo de analfabetos corresidentes no Brasil / Social impact of literacy in the household: analysis of the association with smoking in illiterate co-residents in Brazil

RESUMO Objetivo Investigar o retorno social da alfabetização em relação ao tabagismo em analfabetos que residem com indivíduos alfabetizados. Método Estudo transversal que utilizou dados da Pesquisa Nacional por Amostra de Domicílios (PNAD) de 2008. Foram considerados fumantes aqueles que relataram consumir algum produto de tabaco em frequência diária ou menor que diária. O perfil de alfabetização de indivíduos residentes no domicílio foi identificado. Foram realizadas regressões de Poisson ajustadas para cor da pele, idade e nível máximo de instrução no domicílio. As análises foram separadas em quatro grupos: homens da zona rural; homens da zona urbana; mulheres da zona rural; e mulheres da zona urbana. Resultados Para os homens da zona urbana, observou-se que a presença de apenas mulheres alfabetizadas nos domicílios foi fator de proteção contra o tabagismo (razão de prevalência, RP: 0,77; IC95%: 0,71 a 0,82) em relação aos domicílios onde todos os homens eram analfabetos. Esse mesmo efeito protetor foi encontrado para os homens da zona rural (RP: 0,79; IC95%: 0,73 a 0,85). Já a presença de apenas homens alfabetizados convivendo com analfabetos homens não surtiu efeito de proteção ao tabagismo em nenhum caso (RP: 0,93; IC95%: 0,83 a 1,03 para a subamostra de residência urbana; e RP: 0,99; IC95%: 0,88 a 1,11 para a subamostra de residência rural). Mulheres analfabetas se beneficiaram da alfabetização tanto de homens (RP: 0,77; IC95%: 0,71 a 0,84 na subamostra de residência urbana; e RP: 0,78; IC95%: 0,69 a 0,89 na subamostra de residência rural) quanto de mulheres (RP: 0,81; IC95%: 0,72 a 0,92 na subamostra de residência urbana; e RP: 0,75; IC95%: 0,60 a 0,93 na subamostra de residência rural). Conclusões A alfabetização de mulheres parece ter beneficiado os analfabetos de ambos os sexos residentes no domicílio. Esse resultado corrobora relatos anteriores da literatura que apontam amplas vantagens da escolarização de mulheres.

ABSTRACT Objective To investigate the social impact of literacy on the smoking behavior of illiterate individuals who share the household with literate individuals. Method This cross-sectional study employed data from the 2008 Brazilian National Household Survey (Pesquisa Nacional por Amostra de Domicílios, PNAD). Smokers were defined as individuals reporting use of any tobacco product daily or less than daily. The literacy profiles of residents were identified. Poisson regressions adjusted for skin color, age, and maximum level of literacy in the household were performed. Four groups were analyzed: men living in rural areas, men living in urban areas, women living in rural areas, and women living in urban areas. Results For urban men, the presence of literate women only in the household was a protection factor against smoking (prevalence ratio, PR: 0.77; 95%CI: 0.71-0.82) vs. households in which all the males were illiterate. The same protective effect was found for rural men (PR: 0.79; 95%CI: 0.73-0.85). In turn, the presence of literate men only living in the same household with illiterate men did not provide protection against smoking in any case (PR: 0.93; 95%CI: 0.83-1.03 for the urban subsample; and PR: 0.99; 95%CI: 0.88-1.11 for the rural subsample). Illiterate women benefited from the presence of both literate men (PR: 0.77; 95%CI: 0.71-0.84 for the urban sample; and PR: 0.78; 95%CI: 0.69-0.89 for the rural subsample) and literate women (PR: 0.81; 95%CI: 0.72-0.92 for the urban subsample; and PR: 0.75; IC95%: 0.60-0.93 for the rural subsample). Conclusions Literate women seem to have positively affected illiterate co-residents of both sexes. This result is in agreement with reports showing broad advantages of female schooling.

[Effects of social mobility on adult mental health:a systematic review of the literature]. / Efeitos da mobilidade social na saúde mental de adultos: uma revisão sistemática da literatura.

The scope of this study was to identify longitudinal studies evaluating the relationship between social mobility and mental disorders in adults. An electronic review of the literature was conducted in the PubMed/Medline and PsycINFO databases. The bibliographic references of the articles selected for analysis were also examined for eligibility. Cohort studies were selected taking social mobility as exposure category and mental health-related disorders as the outcome. Seven studies were reviewed and their definition and categorization of exposure and outcome were found to be heterogeneous, thus rendering analysis and comparison of the results found in the various studies difficult. Mental health-related disorders were more common in individuals belonging to lower socio-economic classes, regardless of having upward, stable or downward social mobility. Moreover, the influence of individual socio-economic conditions, assessed in adulthood, appears to be greater than the effect of parental economic status on the mental health of individuals. This review indicates that it is possible to find a relationship between socio-economic status during the course of life and mental health in adulthood. However, the direction taken by this relationship remains unclear.

Efeitos da mobilidade social na saúde mental de adultos: uma revisão sistemática da literatura / Effects of social mobility on adult mental health: a systematic review of the literature

Resumo Este estudo teve como objetivo identificar as pesquisas longitudinais que avaliaram a relação entre mobilidade social e transtornos mentais em adultos. Foi realizada uma revisão eletrônica da literatura nas bases de dados PubMed/Medline e PsycINFO, além do rastreamento das referências bibliográficas dos artigos selecionados para análise. Foram selecionados estudos de coorte, tendo como exposição a mobilidade social e os transtornos relacionados à saúde mental como desfecho. A revisão incluiu sete estudos e identificou que há heterogeneidade na definição e na categorização da exposição e do desfecho, dificultando a análise e a comparação dos resultados encontrados nos diferentes estudos. Os transtornos relacionados à saúde mental foram mais comuns em indivíduos das classes socioeconômicas mais baixas, independente de terem mobilidade social ascendente, estática ou descendente. Além disso, a influência das condições socioeconômicas individuais, avaliada na idade adulta, parece ser maior do que o efeito do nível econômico dos pais sobre a saúde mental dos indivíduos. Esta revisão indica que é possível constatar a relação entre a situação socioeconômica ao longo da vida e a saúde mental na idade adulta. No entanto, a direção desta relação não está bem estabelecida.

Abstract The scope of this study was to identify longitudinal studies evaluating the relationship between social mobility and mental disorders in adults. An electronic review of the literature was conducted in the PubMed/Medline and PsycINFO databases. The bibliographic references of the articles selected for analysis were also examined for eligibility. Cohort studies were selected taking social mobility as exposure category and mental health-related disorders as the outcome. Seven studies were reviewed and their definition and categorization of exposure and outcome were found to be heterogeneous, thus rendering analysis and comparison of the results found in the various studies difficult. Mental health-related disorders were more common in individuals belonging to lower socio-economic classes, regardless of having upward, stable or downward social mobility. Moreover, the influence of individual socio-economic conditions, assessed in adulthood, appears to be greater than the effect of parental economic status on the mental health of individuals. This review indicates that it is possible to find a relationship between socio-economic status during the course of life and mental health in adulthood. However, the direction taken by this relationship remains unclear.

Is adductor pollicis muscle thickness a good predictor of lean mass in adults?

BACKGROUND & AIMS: Lean mass (LM) is an important parameter in clinical outcomes, which highlights the necessity of reliable tools for its estimation. The adductor pollicis muscle thickness (APMT) is easily accessible and suffers minimal interference from the adjacent subcutaneous fat tissue. OBJECTIVE: To assess the relationship between the APMT and LM in a sample of Southern Brazilian adults. METHODS: Participants were adults from the 1982 Pelotas (Brazil) Birth Cohort. LM was measured by dual energy X-ray absorptiometry (DXA). LM and lean mass index (LMI - LM divided by the square of height - kg/m(2)) were the outcomes. APMT was measured using a skinfold caliper. The mean of three measurements in the non-dominant hand was used in the analyses. APMT was described according to socio-demographic characteristics and nutritional status. The relationship between APMT and both LM and LMI was evaluated by correlation coefficient and linear regression using APMT as a single anthropometric parameter and also in addition to BMI. RESULTS: APMT was assessed in 3485 participants. APMT was higher in males, non-whites, less-schooled and obese individuals. APMT was moderately correlated to LM and LMI (ranged from 0.44 to 0.57). Correlation coefficients were higher for LMI as outcome and in females (LM: 0.51 and LMI: 0.57). APMT explained 19% and 26% of the variance in LM in males and females, respectively, whereas it explained 26% and 33% of the variance in LMI. APMT increased the prediction for LM in 3 and 4 percentage points in males and females, in comparison to explained by BMI. BMI explained 48% and 59% of the variance of LMI in males and females whereas APMT increased it to 51% and 62% for both sexes, respectively. CONCLUSIONS: Results were not good enough to promote the APMT as a single predictor of LM or LMI in epidemiological studies. APMT has a little predictive capacity in estimating LM or LMI when BMI is also considered.

Tendências e desigualdades nos comportamentos de risco em adolescentes: comparação das coortes de nascimentos de Pelotas, Rio Grande do Sul, Brasil / Trends and inequalities in risk behaviors among adolescents: a comparison of birth cohorts in Pelotas, Rio Grande do Sul State, Brazil / Tendencias y desigualdades en los comportamientos de riesgo en adolescentes: comparación de las cohortes de nacimientos de Pelotas, Río Grande do Sul, Brasil

Resumo: O objetivo do presente trabalho é descrever tendências e desigualdades nos comportamentos de risco à saúde em adolescentes. Estudo transversal, comparando duas coortes de nascimentos da cidade de Pelotas, Rio Grande do Sul, Brasil. Foram incluídos 1.281 adolescentes da coorte de 1982 e 4.106 da coorte de 1993 acompanhados em 2001 e 2011, respectivamente. Foi avaliado o consumo de álcool, uso de drogas ilícitas, uso de tabaco, iniciação sexual < 16 anos, não uso de preservativo e múltiplos parceiros sexuais. Foram calculadas prevalências totais para cada coorte, estratificadas por sexo e renda per capita, e medidas de desigualdades absoluta e relativa. Houve diminuição, de 2001 para 2011, na prevalência de uso experimental de álcool, uso de drogas, fumo e não uso de preservativos, e aumento no número de parceiros sexuais. O gap na prevalência conforme sexo aumentou para o não uso de preservativo, e para os outros aumentou. O gap entre grupos de renda diminuiu para iniciação sexual < 16 anos e aumentou para episódios de embriaguez. Apesar da tendência de diminuição na prevalência dos comportamentos de risco, as desigualdades socioeconômicas persistiram.

Abstract: This study focuses on trends and inequalities in health risk behaviors among adolescents. A cross-sectional study compared two birth cohorts in the city of Pelotas, Rio Grande do Sul State, Brazil. The sample included 1,281 adolescents from the 1982 cohort and 4,106 from the 1993 cohort, followed in 2001 and 2011, respectively. The study recorded alcohol intake, illegal drug use, smoking, sexual initiation < 16 years, lack of condom use, and multiple sex partners. Total prevalence rates were calculated for each cohort, stratified by gender and per capita income, besides absolute and relative measures of inequality. There was a decrease from 2001 to 2011 in prevalence rates for trying alcohol, illegal drug use, smoking, and lack of condom use, and an increase in the number of sex partners. The gap between boys and girls increased for non-use of condoms and decreased for the other behaviors. The gap between income groups decreased for sexual initiation before 16 years of age and increased for episodes of intoxication. Socioeconomic inequalities persist, despite the downward trend in prevalence of risk behaviors.

Resumen: El objetivo del presente estudio es describir tendencias y desigualdades en los comportamientos de riesgo a la salud en adolescentes. Estudio transversal, comparando dos cohortes de nacimientos de la ciudad de Pelotas, Río Grande do Sul, Brasil. Se incluyeron a 1.281 adolescentes de la cohorte de 1982 y 4.106 de la cohorte de 1993 acompañados en 2001 y 2011, respectivamente. Se evaluó el consumo de alcohol, uso de drogas ilícitas, uso de tabaco, iniciación sexual < 16 años, el no uso de preservativo y múltiples compañeros sexuales. Se calcularon prevalencias totales para cada cohorte, estratificadas por sexo y renta per cápita, y medidas de desigualdades absoluta y relativa. Hubo disminución, de 2001 a 2011, en la prevalencia de uso experimental de alcohol, uso de drogas, tabaco y en el no uso de preservativos, y un aumento en el número de compañeros sexuales. El gap en la prevalencia, según el sexo, aumentó en el caso del no uso de preservativo, mientras que para los otros aumentó. El gap entre grupos de renta disminuyó en iniciación sexual < 16 años y aumentó en episodios de embriaguez. A pesar de la tendencia de disminución en la prevalencia de los comportamientos de riesgo, las desigualdades socioeconómicas persistieron.

Proposal of a short-form version of the Brazilian food insecurity scale.

OBJECTIVE: To propose a short version of the Brazilian Food Insecurity Scale. METHODS: Two samples were used to test the results obtained in the analyses in two distinct scenarios. One of the studies was composed of 230 low income families from Pelotas, RS, Southern Brazil, and the other was composed of 15,575 women, whose data were obtained from the 2006 National Survey on Demography and Health. Two models were tested, the first containing seven questions, and the second, the five questions that were considered the most relevant ones in the concordance analysis. The models were compared to the Brazilian Food Insecurity Scale, and the sensitivity, specificity and accuracy parameters were calculated, as well as the kappa agreement test. RESULTS: Comparing the prevalence of food insecurity between the Brazilian Food Insecurity Scale and the two models, the differences were around 2 percentage points. In the sensitivity analysis, the short version of seven questions obtained 97.8% and 99.5% in the Pelotas sample and in the National Survey on Demography and Health sample, respectively, while specificity was 100% in both studies. The five-question model showed similar results (sensitivity of 95.7% and 99.5% in the Pelotas sample and in the National Survey on Demography and Health sample, respectively). In the Pelotas sample, the kappa test of the seven-question version totaled 97.0% and that of the five-question version, 95.0%. In the National Survey on Demography and Health sample, the two models presented a 99.0% kappa. CONCLUSIONS: We suggest that the model with five questions should be used as the short version of the Brazilian Food Insecurity Scale, as its results were similar to the original scale with a lower number of questions. This version needs to be administered to other populations in Brazil in order to allow for the adequate assessment of the validity parameters.

Proposal of a short-form version of the Brazilian Food Insecurity Scale / Proposta de versão curta da Escala Brasileira de Insegurança Alimentar / Proposta de versão curta da Escala Brasileira de Insegurança Alimentar

OBJECTIVE To propose a short version of the Brazilian Food Insecurity Scale. METHODS Two samples were used to test the results obtained in the analyses in two distinct scenarios. One of the studies was composed of 230 low income families from Pelotas, RS, Southern Brazil, and the other was composed of 15,575 women, whose data were obtained from the 2006 National Survey on Demography and Health. Two models were tested, the first containing seven questions, and the second, the five questions that were considered the most relevant ones in the concordance analysis. The models were compared to the Brazilian Food Insecurity Scale, and the sensitivity, specificity and accuracy parameters were calculated, as well as the kappa agreement test. RESULTS Comparing the prevalence of food insecurity between the Brazilian Food Insecurity Scale and the two models, the differences were around 2 percentage points. In the sensitivity analysis, the short version of seven questions obtained 97.8% and 99.5% in the Pelotas sample and in the National Survey on Demography and Health sample, respectively, while specificity was 100% in both studies. The five-question model showed similar results (sensitivity of 95.7% and 99.5% in the Pelotas sample and in the National Survey on Demography and Health sample, respectively). In the Pelotas sample, the kappa test of the seven-question version totaled 97.0% and that of the five-question version, 95.0%. In the National Survey on Demography and Health sample, the two models presented a 99.0% kappa. CONCLUSIONS We suggest that the model with five questions should be used as the short version of the Brazilian Food Insecurity Scale, as its results were similar to the original scale with a lower number of questions. This version needs to be administered to other populations in Brazil in order to allow for the adequate assessment of the validity parameters. .

OBJETIVO : Propor versão curta da Escala Brasileira de Insegurança Alimentar. Foram analisados dois estudos constituídos por amostra de 230 famílias de baixa renda, de Pelotas, RS, e de 15.575 mulheres com base nos dados da Pesquisa Nacional de Demografia e Saúde, de 2006. MÉTODOS : Foram utilizadas duas amostras para testar os resultados obtidos nas análises em dois cenários distintos. Um dos estudos foi composto por 230 famílias de baixa renda, de Pelotas, RS, e o outro, por 15.575 mulheres, cujos dados foram obtidos na Pesquisa Nacional de Demografia e Saúde de 2006. Foram testados dois modelos, o primeiro contendo sete questões e o segundo as cinco consideradas mais relevantes na análise de concordância. Os modelos foram comparados à Escala Brasileira de Insegurança Alimentar, calculando-se os parâmetros de sensibilidade, especificidade e acurácia e o teste de concordância de kappa. RESULTADOS : Comparando as prevalências de insegurança alimentar entre a Escala Brasileira de Insegurança Alimentar e os dois modelos, as diferenças ficaram em torno de dois pontos percentuais. Na análise de sensibilidade, a versão curta de sete questões obteve 97,8% e 99,5% na amostra de Pelotas e da Pesquisa Nacional de Demografia e Saúde, respectivamente, enquanto a especificidade foi de 100% em ambos os estudos. O modelo de cinco questões mostrou resultados semelhantes (sensibilidade de 95,7% e 99,5% na amostra de Pelotas e da Pesquisa Nacional de Demografia e Saúde, respectivamente). A versão de sete questões apresentou teste de kappa de 97,0% e a versão de cinco questões, de 95,0%, na amostra de Pelotas. Já na amostra da Pesquisa Nacional de Demografia e Saúde, os dois modelos apresentaram kappa de 99,0%. CONCLUSÕES : Sugere-se o modelo com cinco questões para ...

[A comparison between two food security scales]. / Comparação entre duas escalas de segurança alimentar.

The scope of this study was to evaluate the influence of the social determinants and the provision of primary care services in relation to the use of emergency dental care services in a medium-sized municipality. Data recorded for the 57,231 users of emergency care between 2007 and 2009, in accordance with age, gender, date and period of dental care, social exclusion indices of the suburb in which they live and the existence of a benchmark oral health team, were used to perform the analysis. Of the total population, 5.24% on average per year used the service during the period under scrutiny, with the 20-49 year age group (63.84%) showing the highest demand and equality between genders for such care. Surgical procedures (54.90%) were the most prevalent with an increasing trend for restorative procedures (62,8%). Users living in areas of greater social exclusion were 4.15 times more likely to seek dental care (p < 0.05). No statistically significant association was found between gender or the existence of an oral health team of the suburb in which they live and the demand for emergency dental care. In conclusion, there was greater recourse to emergency municipal dental care by individuals living in vulnerable areas, proving the importance of such care in diminishing oral health inequality.