Use of health services by the population living in contaminated areas in the region of the Santos and São Vicente estuarine system, Brazil.

Objective: To relate the socio-demographic profile with access to health services of the population living in environmentally degraded areas in an estuary region.Study design: A sectional field study of 8819 people, evaluating three contaminated areas of São Vicente.Methods: Households were divided by studied area. A structured and pre-tested questionnaire was applied to obtain the data. A probabilistic sample was used. The prevalence of each of the outcomes of interest by area was calculated. To verify the existence of an association between the outcomes of interest and other variables (qualitative), by area, a descriptive analysis and to compare percentages and a comparison test was used between two proportions, a Chi-square test and/or a Fisher's exact test and a Kruska-wallis and Dunn multiple comparison were used as well. The significance level was 5%.Results: Most residents (94%) reported the use of public health services at least once a year (p < 0.001), mainly through the Basic Health Units (BHU) (p < 0.001). Most of the studied population (65%) did not have private health insurance and their schooling was basically restricted to primary education (p < 0.001). The predominant family income (70%) in the three areas was between one and five minimum wages (p < 0.001), with a higher incidence of people receiving one to three minimum wages at the time. The demand for health services was not associated with education or income.Conclusion: The population of the regions analysed heavily rely on the Unified Health System - SUS, but there was no association between income and frequency of health services and there was also no association between education and use of health services.

Influence of environmental contamination on pregnancy outcomes.

This study aims to compare pregnancy outcomes in four contaminated areas to those observed in a non-contaminated area of similar socioeconomic status. A cross-sectional study was carried out. A structured and pre-tested questionnaire was administered to population-based samples of 788-920 families in each of the five studied areas. The exposure assessment used was an ecological measure. Using logistic regression, odds of several pregnancies outcomes (pregnancy occurrence, miscarriage, stillbirth, prematurity, low birth weight, congenital malformation, and multiple births) were estimated after adjustment for potential confounders such as socioeconomic, demographic, and substance abuse factors. We adopted a statistical significance level of 5 %. In three of the four exposed areas, pregnancy occurrence was reduced in comparison to the control area (Area 2, odds ratio (OR) = 0.68, 95 % CI = 0.54-0.86; Area 3, OR = 0.76, 95 % CI = 0.60-0.97; Area 4, OR = 0.71, 95 % CI = 0.56-0.90). Also, a significantly increased odds of miscarriage for living in Area 3 (OR = 1.83, 95 % CI = 1.07-3.12) was found. The other pregnancy outcomes were not significantly elevated in the exposed areas. In conclusion, this study shows evidence of reduced pregnancy occurrence and increased miscarriage occurrence in some of the contaminated areas, compared to the control area.

Pregnancy outcomes in contaminated areas, SP, Brazil.

OBJECTIVE: Estimate and compare prevalence of events related to pregnancy (pregnancy, low birth weight, premature delivery, spontaneous abortion, stillbirth, congenital malformation, and multiple births) in populations exposed and non-exposed to environmental contaminants in Santos and São Vicente Estuary. METHODS: This study was part of a large project financed by CNPq, which aimed to estimate health effects associated with environmental area, contaminants exposure among individuals of the Baixada Santista region. This cross-sectional study evaluated two neighborhoods of São Vicente near a contaminated area, and one neighborhood of Bertioga, the control area. A structured and previously tested questionnaire was applied at 236 households in São Vicente and 251 households in Bertioga in order to obtain the data. The chi-square test or Fisher's exact test were used to evaluate associations between area and qualitative variables; Student's t test or two proportion comparison test were used to evaluate differences between variables; and a significance level of 5% adopted. RESULTS: There was significant association between living in Bertioga (p = 0.01) and number of pregnancies in the past five years. In São Vicente, 64 (28.3%) childbearing age women became pregnant whereas in Bertioga there where 109 (38.8%). There were no statistical significant associations between living in any area and others pregnancy outcomes evaluated. CONCLUSION: Although no significant association was found, prevalence of low birth weight, preterm delivery and spontaneous abortion and prevalent odds ratio were higher in contaminated area. This study's evidence of a reduced number of pregnancies in contaminated area strengthens the need for additional more in-depth studies in Santos and São Vicente Estuary.

Desfechos relacionados à gravidez em áreas contaminadas, SP, Brasil / Pregnancy outcomes in contaminated areas, SP, Brazil

OBJETIVO: Estimar e comparar a prevalência dos eventos relacionados à gravidez (engravidar, baixo peso de nascimento, parto prematuro, aborto espontâneo, natimortalidade, malformações congênitas e gemelaridade) em populações exposta e não-exposta aos contaminantes ambientais na região do estuário de Santos e São Vicente. MÉTODOS: O estudo fez parte de um amplo projeto financiado pelo CNPq, que teve como objetivo estimar os efeitos à saúde associados à exposição aos contaminantes ambientais entre os moradores da Baixada Santista. O estudo transversal avaliou dois bairros do município de São Vicente, próximos a uma área contaminada, e um bairro no município de Bertioga, área controle. Para a obtenção dos dados foi aplicado um questionário estruturado e pré-testado em 236 domicílios em São Vicente e 251 domicílios em Bertioga. Para avaliar associações entre a área e as variáveis qualitativas utilizouse o teste qui-quadrado ou teste exato de Fisher; para avaliar as diferenças entre as variáveis, o teste t de Student ou o teste de comparação de duas proporções, e adotado nível de significância de 5 por cento. RESULTADOS: Houve associação significativa entre morar em Bertioga (p = 0,01) e o número de gestações ocorridas nos últimos cinco anos. Em São Vicente, 64 (28,3 por cento) mulheres em idade fértil engravidaram, enquanto em Bertioga foram 109 (38,8 por cento). Não houve associações estatísticas significativas nas áreas com os demais desfechos da gravidez avaliados. CONCLUSÕES: As prevalências e as razões de chances prevalentes de baixo peso ao nascer, nascimentos prematuros e abortos espontâneos foram maiores nas áreas contaminadas, sem associações significativas. A evidência do estudo de diminuição do número de gestações na área contaminada reforça a necessidade de aprofundamento de estudos na região do estuário de Santos e São Vicente.

OBJECTIVE: Estimate and compare prevalence of events related to pregnancy (pregnancy, low birth weight, premature delivery, spontaneous abortion, stillbirth, congenital malformation, and multiple births) in populations exposed and non-exposed to environmental contaminants in Santos and São Vicente Estuary. METHODS: This study was part of a large project financed by CNPq, which aimed to estimate health effects associated with environmental area, contaminants exposure among individuals of the Baixada Santista region. This cross-sectional study evaluated two neighborhoods of São Vicente near a contaminated area, and one neighborhood of Bertioga, the control area. A structured and previously tested questionnaire was applied at 236 households in São Vicente and 251 households in Bertioga in order to obtain the data. The chi-square test or Fisher's exact test were used to evaluate associations between area and qualitative variables; Student's t test or two proportion comparison test were used to evaluate differences between variables; and a significance level of 5 percent adopted. RESULTS: There was significant association between living in Bertioga (p = 0.01) and number of pregnancies in the past five years. In São Vicente, 64 (28.3 percent) childbearing age women became pregnant whereas in Bertioga there where 109 (38.8 percent). There were no statistical significant associations between living in any area and others pregnancy outcomes evaluated. CONCLUSION: Although no significant association was found, prevalence of low birth weight, preterm delivery and spontaneous abortion and prevalent odds ratio were higher in contaminated area. This study's evidence of a reduced number of pregnancies in contaminated area strengthens the need for additional more in-depth studies in Santos and São Vicente Estuary.