Child sexual abuse in southern Brazil and associated factors: a population-based study.

BACKGROUND: The prevalence of child sexual abuse (CSA) in the population has been poorly described in developing countries. Population data on child sexual abuse in Brazil is very limited. This paper aims to estimate lifetime prevalence of child sexual abuse and associated factors in a representative sample of the population aged 14 and over in a city of southern Brazil. METHODS: A two-stage sampling strategy was used and individuals were invited to respond to a confidential questionnaire in their households. CSA was defined as non-consensual oral-genital, genital-genital, genital-rectal, hand-genital, hand-rectal, or hand-breast contact/intercourse between ages 0 and 18. Associations between socio-demographic variables and CSA, before and after age 12, were estimated through multinomial regression. RESULTS: Complete data were available for 1936 respondents from 1040 households. Prevalence of CSA among girls (5.6% 95%CI [4.8;7.5]) was higher than among boys (1.6% 95%CI [0.9;2.6]). Boys experienced CSA at younger ages than girls and 60% of all reported CSA happened before age 12. Physical abuse was frequently associated with CSA at younger (OR 5.6 95%CI [2.5;12.3]) and older (OR 9.4 95%CI [4.5;18.7]) ages. CSA after age 12 was associated with an increased number of sexual partners in the last 2 months. CONCLUSION: Results suggest that CSA takes place at young ages and is associated with physical violence, making it more likely to have serious health and developmental consequences. Except for gender, no other socio-demographic characteristic identified high-risk sub-populations.

Dental caries in 0- to 5-year-old Brazilian children: prevalence, severity, and associated factors.

OBJECTIVE: This cross-sectional study investigated the prevalence and severity of dental caries and their association with demographic and socio-economic variables in Brazilian preschoolers. METHODS: The study population comprised 1487 0- to 5-year-old children attending government nurseries in Canoas, southern Brazil. Questionnaires regarding information related to the independent variables (age, gender, maternal level of education, and family income) were completed by the parents. Clinical examinations were carried out by five trained examiners and results were expressed using the deft index (World Health Organization criteria), including white spots. The outcomes considered in this study were caries occurrence (deft > 0) and caries severity (deft). RESULTS: Forty per cent of the children (589/1487) presented dental caries [mean deft (SD): 1.53 (2.75)]. Deft increased with age (P < 0.001) and was significantly higher in children from mothers with low educational level (P = 0.001) and low family income (P = 0.001). The greatest increase in caries prevalence and severity occurred between age groups of 1 and 2 years. Logistic regression demonstrated higher odds of dental caries with mother's completing < 4 years education, after adjusting for confounding. CONCLUSION: These findings indicate the need for preventive programmes, which should begin in the first year of life, with special attention given to families with mothers presenting low education levels.

Gender differences in self-reported morbidity: evidence from a population-based study in southern Brazil / Diferenças na morbidade referida entre sexos: evidências de um estudo de base populacional no Sul do Brasil

This paper aims to assess variations in self-reported morbidity between men and women using six different measures of reported illness. The cross-sectional study was conducted in the municipality of Rio Grande, southern Brazil. Demographic, socioeconomic, and morbidity data were collected from a probabilistic sample of 1,260 persons aged 15 years or over, using a specific questionnaire. Statistical analysis included a multivariate Poisson regression analysis. Prevalence Ratios (PR) with 95 percent confidence intervals (95 percentCI) were calculated. After adjusting for some confounding variables (age, race, unemployment, marital status, income, social class, and education), women showed greater risk of any symptom (PR = 3.21; 95 percentCI: 2.71-3.83), three or more symptoms (PR = 4.22; 95 percentCI: 2.97-5.98), potentially serious symptoms (PR = 1.75; 95 percentCI: 1.31-2.34), poor/fair health (PR = 1.78; 95 percentCI: 1.37-2.32), and minor psychiatric disorders (PR = 1.76; 95 percentCI: 1.31-2.37). The study revealed dissimilarity in self-reported morbidity between men and women in southern Brazil, but with different degrees depending on type of morbidity. This excess can be explained by gender difference in health-seeking behavior for perceiving or reporting health problems.

O estudo teve como objetivo avaliar que diferenças ocorrem na morbidade referida entre homens e mulheres, utilizando seis medidas diferentes de morbidade. O estudo de tipo transversal foi realizado no Município de Rio Grande, Sul do Brasil. Foram coletados dados demográficos, sócio-econômicos de uma amostra probabilística de 1.260 pessoas com 15 anos ou mais. Para fins estatísticos foi utilizada a regressão de Poisson. Após ajustar para variáveis de confusão, observou-se que as mulheres apresentavam maior risco de referir um sintoma (RP = 3,21; IC95 por cento: 2,71-3,83), de ter três ou mais sintomas (RP = 4,22; IC95 por cento: 2,97-5,98), de ter um sintoma potencialmente sério (RP = 1,75; IC95 por cento: 1,31-2,34), de apresentar uma percepção do estado de saúde pobre ou regular (RP = 1,78; IC95 por cento: 1,37-2,32) e de sofrer de distúrbios psiquiátricos menores (RP = 1,76; IC95 por cento: 1,31-2,37). O estudo aponta para a existência de diferenças entre os sexos na morbidade referida, mas com magnitudes diferentes conforme o tipo de medida de morbidade utilizada. Este excesso pode ser explicado pelas variações que ocorrem no comportamento na procura de cuidados em saúde (percepção e/ou informação de problemas de saúde) entre mulheres e homens.

Gender differences in self-reported morbidity: evidence from a population-based study in southern Brazil.

This paper aims to assess variations in self-reported morbidity between men and women using six different measures of reported illness. The cross-sectional study was conducted in the municipality of Rio Grande, southern Brazil. Demographic, socioeconomic, and morbidity data were collected from a probabilistic sample of 1,260 persons aged 15 years or over, using a specific questionnaire. Statistical analysis included a multivariate Poisson regression analysis. Prevalence Ratios (PR) with 95% confidence intervals (95%CI) were calculated. After adjusting for some confounding variables (age, race, unemployment, marital status, income, social class, and education), women showed greater risk of any symptom (PR = 3.21; 95%CI: 2.71-3.83), three or more symptoms (PR = 4.22; 95%CI: 2.97-5.98), potentially serious symptoms (PR = 1.75; 95%CI: 1.31-2.34), poor/fair health (PR = 1.78; 95%CI: 1.37-2.32), and minor psychiatric disorders (PR = 1.76; 95%CI: 1.31-2.37). The study revealed dissimilarity in self-reported morbidity between men and women in southern Brazil, but with different degrees depending on type of morbidity. This excess can be explained by gender difference in health-seeking behavior for perceiving or reporting health problems.

[Prevalence of signs and symptoms, associated sociodemographic factors and resulting actions in an urban center in southern Brazil]. / Prevalência de sinais e sintomas, fatores sociodemográficos associados e atitude frente aos sintomas em um centro urbano no Sul do Brasil.

OBJECTIVE: To determine the prevalence of signs and symptoms in the adult population, the sociodemographic factors associated with them, and the actions taken as a result of these symptoms, according to sex. METHODS: A population-based cross-sectional study was carried out in the city of Rio Grande (state of Rio Grande do Sul), Brazil, in 2000. We interviewed 1 259 people > or = 15 years of age. Data were collected using a structured questionnaire containing 18 symptoms in addition to sociodemographic questions. The prevalence of symptoms and prevalence ratios for sex, age, and socioeconomic status were estimated after alternately adjusting for these variables. The actions resulting from the presence of symptoms were also analyzed for each sex. RESULTS: Mean age was 40.33 years (53.9% were women). The most prevalent symptom was headache (55.4%). Joint pain, insomnia, constipation, high blood pressure, and shortness of breath increased with age. The following were more prevalent among the lower social classes: headache, nervousness, joint and back pain, insomnia and depression, high blood pressure, chest pain, and shortness of breath. A total of 4 424 health problems were reported (an average of 3.25 per person); 60.2% did not generate any action, 31.6% resulted in self-medication, and 8.2% resulted in a visit to a medical facility. Headache, nervousness, joint and back pain, insomnia, depression, constipation, high blood pressure, chest pain, and shortness of breath were significantly higher in women, whereas cough was significantly more prevalent in men. Women and men took similar actions in the presence of signs and symptoms. CONCLUSION: It is necessary to establish health policies that lay an emphasis on mental health and education for self care and on those symptoms that signal the need to go to a health facility. It is also necessary to study the role of social class in determining health behavior and the choice to seek care.

Prevalência de sinais e sintomas, fatores sociodemográficos associados e atitude frente aos sintomas em um centro urbano no Sul do Brasil / Prevalence of signs and symptoms, associated sociodemographic factors and resulting actions in an urban center in southern Brazil

OBJETIVO: Determinar a prevalência de sinais e sintomas na população adulta, os fatores sociodemográficos associados e a atitude diante desses sintomas segundo o sexo. MÉTODOS: Um estudo transversal de base populacional foi realizado na Cidade de Rio Grande, Estado do Rio Grande do Sul, no ano de 2000. Foram entrevistadas 1 259 pessoas com 15 anos ou mais. Aplicou-se um questionário estruturado contendo 18 sintomas, além de questões sociodemográficas. Foram calculadas a prevalência dos sintomas e as razões de prevalência para sexo, idade e classe econômica ajustados entre si. Também foi analisada a atitude tomada frente aos sintomas segundo o sexo. RESULTADOS: A idade média foi de 40,33 anos (53,9 por cento mulheres). O problema mais prevalente foi dor de cabeça (55,4 por cento). Dor nas juntas, insônia, prisão de ventre, pressão alta e falta de ar aumentaram com a idade. Tiveram maior prevalência em classes mais baixas: dor de cabeça, nervosismo, dor nas juntas e nas costas, insônia e depressão, tosse, pressão alta, dor torácica e falta de ar. Foram relatados 4 424 problemas de saúde (3,25 por pessoa) e 60,2 por cento não geraram nenhuma atitude, 31,6 por cento levaram à automedicação e 8,2 por cento geraram procura por serviços médicos. Dor de cabeça, nervosismo, dor nas juntas e nas costas, insônia, depressão, prisão de ventre, pressão alta, dor no peito e falta de ar foram significativamente mais prevalentes nas mulheres, enquanto tosse foi significativamente maior entre os homens. As atitudes tomadas frente aos sinais e sintomas foram semelhante entre homens e mulheres. CONCLUSÕES: É necessário estabelecer políticas de saúde que enfatizem a saúde mental e a educação para o auto-cuidado, salientando quais sintomas indicam a necessidade de procurar um serviço de saúde. Também é preciso estudar o papel da classe social na determinação do comportamento em saúde e da procura de cuidados.

OBJECTIVE: To determine the prevalence of signs and symptoms in the adult population, the sociodemographic factors associated with them, and the actions taken as a result of these symptoms, according to sex. METHODS: A population-based cross-sectional study was carried out in the city of Rio Grande (state of Rio Grande do Sul), Brazil, in 2000. We interviewed 1 259 people à 15 years of age. Data were collected using a structured questionnaire containing 18 symptoms in addition to sociodemographic questions. The prevalence of symptoms and prevalence ratios for sex, age, and socioeconomic status were estimated after alternately adjusting for these variables. The actions resulting from the presence of symptoms were also analyzed for each sex. RESULTS: Mean age was 40.33 years (53.9 percent were women). The most prevalent symptom was headache (55.4 percent). Joint pain, insomnia, constipation, high blood pressure, and shortness of breath increased with age. The following were more prevalent among the lower social classes: headache, nervousness, joint and back pain, insomnia and depression, high blood pressure, chest pain, and shortness of breath. A total of 4 424 health problems were reported (an average of 3.25 per person); 60.2 percent did not generate any action, 31.6 percent resulted in self-medication, and 8.2 percent resulted in a visit to a medical facility. Headache, nervousness, joint and back pain, insomnia, depression, constipation, high blood pressure, chest pain, and shortness of breath were significantly higher in women, whereas cough was significantly more prevalent in men. Women and men took similar actions in the presence of signs and symptoms. CONCLUSION: It is necessary to establish health policies that lay an emphasis on mental health and education for self care and on those symptoms that signal the need to go to a health facility. It is also necessary to study the role of social class in determining health behavior and the choice to seek care.

Prevalence of having a regular doctor, associated factors, and the effect on health services utilization: a population-based study in Southern Brazil.

In order to assess the prevalence of having a regular doctor, associated factors, and the effects on health services utilization, a cross-sectional study was performed in Rio Grande, Brazil, from January to May 2000. A total of 1,260 individuals 15 years or over were interviewed. Adjusted prevalence ratios and 95% confidence intervals were calculated, using a Poisson regression model. Some 37% of the sample had a regular doctor. Adjusted analysis revealed a direct and linear association with income. Female gender, age, private health insurance coverage, and chronic health problems were also associated with the outcome. Having a regular physician was associated with a 51% increase in clinical breast examination and a 62% increase in cervical cancer screening during the previous year, as well as a 98% increase in prostate cancer screening in the previous year in men 40 years or over. The study concluded that the prevalence of having a regular doctor in Brazil is low and is directly associated with socioeconomic factors. Individuals with a regular physician tend to have better access to health services. The promotion of consultation with a regular doctor among the population may improve health care quality and health services access, particularly in the poorest groups.

Prevalence of having a regular doctor, associated factors, and the effect on health services utilization: a population-based study in Southern Brazil

In order to assess the prevalence of having a regular doctor, associated factors, and the effects on health services utilization, a cross-sectional study was performed in Rio Grande, Brazil, from January to May 2000. A total of 1,260 individuals 15 years or over were interviewed. Adjusted prevalence ratios and 95 percent confidence intervals were calculated, using a Poisson regression model. Some 37 percent of the sample had a regular doctor. Adjusted analysis revealed a direct and linear association with income. Female gender, age, private health insurance coverage, and chronic health problems were also associated with the outcome. Having a regular physician was associated with a 51 percent increase in clinical breast examination and a 62 percent increase in cervical cancer screening during the previous year, as well as a 98 percent increase in prostate cancer screening in the previous year in men 40 years or over. The study concluded that the prevalence of having a regular doctor in Brazil is low and is directly associated with socioeconomic factors. Individuals with a regular physician tend to have better access to health services. The promotion of consultation with a regular doctor among the population may improve health care quality and health services access, particularly in the poorest groups

Prevalence of alcohol use disorders and associated factors: a population-based study using AUDIT in southern Brazil.

AIMS: To assess the prevalence of potential alcohol use disorders and associated factors using the Alcohol Use Disorders Identification Test (AUDIT). DESIGN: Cross-sectional study. SETTING: A town in southern Brazil. PARTICIPANTS: A representative sample of 1260 people aged 15 and over. MEASUREMENTS: Demographic, socioeconomic, smoking habit and mental health data were collected. Logistic regression was used in the multivariate analysis, and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. FINDINGS: Overall prevalence of alcohol use disorder was 7.9%, with 14.5% prevalence among men and 2.4% among women. The risk of alcohol misuse increased across social class (P linear trend = 0.03) and compared with the highest classes (A and B), groups C through E had ORs of 1.48, 1.51 and 2.36, respectively. Males had an OR of 6.89 (CI 3.61-13.16) compared with women. A linear trend was found (P = 0.001) between smoking categories, and smokers (OR 3.27; CI 1.91-5.58) and ex-smokers (OR 1.30; CI 0.56-2.98) were at higher risk than non-smokers. Those with minor psychiatric disorders had a 2.48 OR (CI 1.35-4.56) of presenting a positive test. CONCLUSIONS: The AUDIT detected a high prevalence of potential alcohol use disorders in the population sampled. Those identified are potential targets for preventive measures implemented through health policies.

Outpatient health service utilization and associated factors: a population-based study.

OBJECTIVE: To identify factors that lead people to visit a doctor in Brazil and assess differences between socioeconomic groups. METHODS: A cross-sectional study comprising 1,260 subjects aged 15 or more was carried out in southern Brazil. Demographic, socioeconomic, health needs and regular source of care data were analyzed concerning visits to a doctor within two months from the interview. Adjusted prevalence ratios and 95% confidence intervals were calculated using Poisson regression. RESULTS: Adjusted PR showed that women having stressful life events, health insurance, and a regular doctor increased the outcome. A dose-related response was found with self-reported health, and the probability of visiting a doctor increased with health needs. Analysis in the chronic disease group revealed that uneducated lower income subjects had a 62% reduction in the chance of visiting a doctor compared to uneducated higher income ones. However, as it was seen a significant interaction between income and education, years of schooling increased utilization in this group. CONCLUSIONS: Results suggest the existence of health inequity in the poorest group that could be overcome with education. Specific measures reinforcing the importance of having a regular doctor may also improve access in the underserved group.

Outpatient health service utilization and associated factors: a population-based study

OBJETIVO: Identificar os fatores que levam uma pessoa a consultar o médico no Brasil e avaliar as diferenças entre grupos socioeconômicos. MÉTODOS: Foi realizado um estudo transversal com 1.260 pessoas de 15 anos ou mais no sul do Brasil. Foram analisados dados demográficos, socioeconômicos, de necessidade em saúde e de fonte definida para consulta quanto a visita ao médico nos últimos dois meses. Foram calculadas as razöes ajustadas de prevalência (RP) e os Intervalos de Confiança de 95por cento (IC 95por cento), utilizando a regressäo de Poisson. RESULTADOS: As RP ajustadas mostraram que mulher, eventos estressantes, seguro de saúde e médico de referência aumentaram a probabilidade do desfecho. Foi encontrada uma relaçäo de tipo dose-resposta com auto-avaliaçäo do estado de saúde, e a probabilidade de consultar aumentou a medida que a necessidade em saúde também aumentou. A análise no grupo com doença crônica evidenciou que o grupo de menor renda e sem escolaridade teve uma reduçäo de 62por cento na probabilidade de visitar o médico em comparaçäo com o grupo de maior renda e sem estudo. Contudo, como ocorreu interaçäo significativa entre renda e educaçäo, o tempo de estudo melhorou a utilizaçäo nesse grupo. CONCLUSOES: Os resultados sugerem a existência de iniqüidade no grupo mais pobre que pode ser modificada pela educaçäo. Medidas específicas reforçando a importância de ter um médico de referência podem também melhorar o acesso dos mais pobres

Breastfeeding and breast cancer: a case-control study in Southern Brazil.

To investigate the relationship between breastfeeding and breast cancer in Southern Brazil, a case-control design was employed, with two age-matched control groups. A total of 250 cases of breast cancer were identified in women from 20 to 60 years of age, with 1,020 hospital and community controls. The main study variables were occurrence of breastfeeding and duration of breastfeeding. A multivariate conditional logistic regression analysis was employed. According to the results, breastfeeding did not have a protective effect against breast cancer. The odds ratio (OR) for women who breastfed was 0.9 (95% CI: 0.8-1.2) compared to women who did not breastfeed. For women who breastfed for six months or less, the OR was 1.0 (95% CI: 0.6-1.8). In pre-menopausal women who breastfed for more than 25 months, the OR was 0.95 (95% CI: 0.5-3.5), and in post-menopausal women OR was 1.27 (95% CI: 0.5-3.1), compared to women who had not breastfeed.

[Self-assessment of STD/AIDS vulnerability among women, Brazil]. / Autopercepção de vulnerabilidade às doenças sexualmente transmissíveis e Aids em mulheres.

OBJECTIVE: To investigate risk behaviors and self-assessment of the vulnerability to sexually transmitted diseases (STD) and acquired immunodeficiency syndrome (AIDS) among women. METHODS: A systematic sample including 48 of 281 census tracts in the urban area of Pelotas, Brazil, was selected. There were interviewed 1,543 women, aged between 15 and 49 years, who had ever been sexually active. Risk behaviors were assessed using a confidential questionnaire that consisted of three sections: socioeconomic profile, interviewers' and self-administered questions. Data analysis was conducted using Epi-Info software, version 6.0. Statistical analysis was carried out using Kappa test and odds ratio. RESULTS: Of all women in the sample, 64% considered impossible or almost impossible for them to acquire an STD or AIDS. The main risk behaviors were non-use of condoms in their last intercourse (72%); onset of sexual activity before age 18 years (47%); drug or alcohol use by the partner (14%) or the woman (7%) before their last intercourse; two or more partners in the last three months (7%); and anal sex in the last intercourse (3%); 44% reported two or more risk behaviors. Using a risk score of two or more points as the gold standard, sensitivity and specificity of self-assessment were 41% and 67%, respectively. CONCLUSIONS: Self-assessment of vulnerability is not an adequate indicator of STD and AIDS vulnerability since women do not have an appropriate perception of their risks.

Autopercepçäo de vulnerabilidade às doenças sexualmente transmissíveis e Aids em mulheres / Self-assessment of STD/AIDS vulnerability among women, Brazil

OBJETIVO: Investigar comportamentos de risco e autopercepçäo de vulnerabilidade às doenças sexualmente transmissíveis (DST) e à Síndrome de imunodeficiência adquirida (Aids) em mulheres. MÉTODOS: Dos 281 setores censitários existentes na cidade de Pelotas, RS, foram selecionados 48 a partir de amostragem sistemática. Foi entrevistada uma amostra de 1.543 mulheres, de 15 a 49 anos, por meio de questionário composto de três partes (informaçöes socioeconômicas, perguntas aplicadas em entrevista, questionário auto-aplicado). Para tabulaçäo dos dados, foi utilizado o programa Epi-Info, versäo 6.0. Para análise estatística dos dados foram usados o teste de Kappa e a razäo de odds. RESULTADOS: Na amostra, 64 por cento das mulheres achavam impossível ou quase impossível adquirir DST/Aids. Os principais comportamentos de risco foram o näo uso de preservativo na última relaçäo antes do depoimento (72 por cento); início das relaçöes sexuais com menos de 18 anos (47 por cento); uso de álcool ou drogas pelo parceiro (14 por cento) ou pela mulher (7 por cento) antes da última relaçäo; dois ou mais parceiros nos três meses que antecederam o depoimento (7 por cento) e sexo anal na última relaçäo (3 por cento); 44 por cento das mulheres apresentaram dois ou mais comportamentos de risco. A sensibilidade da autopercepçäo, usando como padräo o escore de risco igual ou superior a dois, foi de 41 por cento. Sua especificidade de 67 por cento. CONCLUSOES: A autopercepçäo de vulnerabilidade näo é um bom indicador, pois as mulheres näo identificam corretamente seu nível de risco

Factors associated with risk behaviors for sexually transmitted disease/AIDS among urban Brazilian women: a population-based study.

BACKGROUND: The proportion of women among persons with sexually transmitted disease (STD)/AIDS in Brazil is increasing rapidly, and studies are needed to understand risk behaviors. GOAL: The goal of this study was to identify factors associated with risk behaviors for acquiring STD/AIDS among women aged 15 to 49 years in Pelotas, Brazil. STUDY DESIGN: A representative sample of women was surveyed by means of interviewer-administered and self-administered confidential questionnaires. Of the women we sought to include, 3.5% refused and 1543 participated. RESULTS: Risk behaviors included nonuse of condoms (72%); first intercourse before the age of 18 years (47%); use of drugs or alcohol by the partner (14%) or by the woman (7%); multiple partners (7%); and anal sex (3%). The risk score was significantly associated with being younger than age 30 years, having <5 years of schooling, being divorced or separated, and being a smoker. CONCLUSION: Preventive strategies should prioritize efforts toward young women, those with little schooling, smokers, and those who are divorced or separated.

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

Objetivo: Investigar a associação entre uso de contraceptivos orais (CO) e câncer de mama. Métodos: Identificaram-se 250 casos incidentes de câncer de mama, com 20 a 60 anos de idade, a partir de laboratórios de patologia, e 1.020 controles-hospitalares e de vizinhança. Os controles foram pareados aos casos por idade. A análise ajustada foi realizada por regressão logística condicional para estimar as razões de odds (RO). Resultados: Não se encontrou associação entre uso de contraceptivos orais e câncer de mama (RO=1,1; IC 95 por cento 0,7-1,6 para controles hospitalares e RO=0,9; IC 95 por cento 0,6-1,6 para controles de vizinhança) e nem para diferentes tempos de uso ou idades de início. Ao separar os casos por idade de diagnóstico do câncer de mama e tempo de uso dos CO, verificou-se que mulheres com mais de 45 anos, que haviam utilizado contraceptivos por cinco anos ou mais, tiveram RO de 1,6 (IC 95 por cento 0,9-3,0) entre controles-hospitalares e de 1,3 (IC 95 por cento 0,7-2,6) entre controles de vizinhança. Para aumentar o poder do estudo, realizou-se análise com os 250 casos e os 1.020 controles, resultando uma RO de 1,6 (IC 95 por cento 1,0-2,4) sem significância estatística. Conclusões: Não foi encontrada associação entre uso de CO e câncer de mama em geral, assim como entre faixas etárias e tempo de uso do CO. Ao analisar todos os casos e controles conjuntamente, evidenciou-se um risco aumentado no subgrupo de mulheres usuárias por mais de cinco anos e com idade superior a 45 anos, porém não houve significância estatística, embora ela estivesse muito próxima (p=0,05)

Avaliaçäo do cuidado prestado a pacientes diabéticos em nível primário / Assessment of diabetic patient management at primary health care level

Descreve características de pacientes diabéticos acompanhados em um posto de atençäo primária à saúde. Estudo transversal onde ratrearam-se 3.024 prontuários de família, em busca de pacientes com 30-75 anos, con dignóstico de diabetes, atendidos nos últimos 5 anos. Os pacientes detectados foram entrevistados em seus domicílios, e compareceram ao posto para o exame físico e requisiçäo para dosagem da hemoglobina glicosilada. A prevalência de diabetes foi de 4,2 por cento. A maioria eram mulheres brancas, > 50 anos de idade, com renda familiar mensal < 3 salários-mínimos. Menos de um terço seguia dieta; e, apenas um quinto fazia exercícios regulares. Cerca de 70 por cento estavam em uso de hipoglicemiantes orais ou insulina. Dos que fizeram o exame (adesäo de 70 por cento), a maioria apresentou níveis normais ou aceitáveis de glicemia. Maior esforço deve ser dispendido pelas equipes de saúde de forma a promover a adesäo dos pacientes diabéticos à dieta e ao exercício

Epidemiologia do consumo de medicamentos no primeiro trimestre de vida em centro urbano do Sul do Brasil / Epidemiology of the use of medicines during the first three months of life in an urban area of Southern Brazil

Os poucos estudos existentes apontam para o consumo abusivo de medicamentos em crianças, sendo os médicos os principais responsáveis pela indicaçäo. para conhecer melhor os padröes de consumo de medicamentos, foi feito estudo em crianças no primeiro trimestre de vida, segundo variáveis sociais, biológicas, padröes alimentares e utilizaçäo de serviços de saúde. Estudou-se uma amostra de 655 crianças nascidas em 1993, residentes na zona urbana de Pelotas, Brasil. Informaçöes sobre o consumo de medicamentos na quinzena precedente à entrevista foram coletadas no final do primeiro e do terceiro mês. com um mês, 65 por cento das crianças consumiam medicamentos e com três meses, 69 por cento. Três ou mais medicamentos foram consumidos por 17 por cento das crianças em cada acompanhamento. Combinaçöes de três ou mais fármacos (um indicador de má qualidade do medicamento) foram usadas por 14 por cento no primeiro mês e por 19 por cento no terceiro mês. Aos três meses, 20 por cento das crianças consumiam medicamentos cronicamente. Com um mês, os medicamentos mais consumidos foram Cloreto de Benzalcônio + Soro Fisiológico, Dimeticona + Homatropina e Nistatina soluçäo. Aos três meses foram Acido Acetil Salicílico, Cloreto de Benzalcônio + Soro Fisiológico e Dimeticona + Homatropina. O principal probelma referido como motivo de uso foi cólica no primeiro acompanhamento e resfriado, no segundo. Na análise ajustada, o consumo de medicamentos no primeiro mês foi 64 por cento menor para as crianças que tinham três ou mais irmäos menores do que para primogênitos. Crianças näo amamentadas ao final do primeiro mês apresentaram um risco 75 por cento maior de haver consumido medicamentos. Resultados semelhantes foram observados para o consumo no terceiro mês. Desde a mais tenra idade, as crianças säo habituadas a conviver com uma medicalizaçäo exagerada de sintomas corriqueiros. Näo estaria assim sendo preparado o terreno para futuras dependências de medicamentos ou outras drogas?