[Prevention of sexually transmitted diseases in women: association with socioeconomic and demographic variables]. / Prevenção de doenças sexualmente transmissíveis em mulheres: associação com variáveis sócio-econômicas e demográficas.

Sexually transmitted diseases (STDs) have been a subject of discussion both among scientists and in the mass media, especially because of their association with the human immunodeficiency virus (HIV). We studied the adoption of specific protective behaviors for the prevention of STDs among women, as well as the associations between these behaviors and socioeconomic and demographic variables. This was a descriptive study based on secondary data from a previous study carried out in Campinas, São Paulo State, Brazil. A total of 635 women were selected using the social network ("snowball") technique. Subjects were classified into four groups: adolescents and adults of upper middle and lower socioeconomic status, respectively. Condoms were the STD prevention method most frequently mentioned by interviewees. A negative association was observed between having a steady partner and condom use in all the groups. The main reason mentioned for not using condoms was "having a single partner and trusting him". Among adolescents, a positive association was observed between schooling above the 8th grade and condom use, and a negative association was observed between age and condom use. Among adults, only condom use in general was also positively associated with socioeconomic status.

[Reflections on the measurement of maternal mortality]. / Reflexões sobre a mensuração da mortalidade materna.

The maternal mortality rate is a highly sensitive indicator for the health level of both women and the general population in a given geographical area. There is extensive variability among different countries, and rates are high in underdeveloped or developing areas, as in Brazil. Health authorities from various countries have launched programs aimed at reducing maternal deaths and have thus needed to estimate the actual rates to allow for a proper assessment and to control the programs' progress. However, there are many obstacles and difficulties in obtaining the real values of these measures, mainly because of incomplete data. The aim of this paper is to present some of the proposed methodologies for estimating maternal mortality rates and to call attention to the limits and biases of these methods. Based on the Brazilian case, the article also recommends an improvement in the quality and coverage of the Civil Registry, the official source of data on births and deaths.

[Mortality among Japanese migrants living in the State of Parana, Brazil]. / Mortalidade em migrantes japoneses residentes no Paraná, Brasil.

INTRODUCTION: Taking as a premise that the study concerning the morbimortality of migrant populations may make a contribution to a better understanding of the epidemiology of diseases, mainly the chronic-degenerative ones and their related risk factors, the aim of this study is an analysis of the mortality experience of a population of migrants born in Japan, but living in the State of Paraná, Brazil, and a comparison of their pattern of mortality with those of Japan and Paraná. METHODS: The population studied was composed of the Japanese migrants - Issei - living in the State of Parana, Brazil, of more than 50 years of age, identified in the X General Brazilian Census of 1st September, 1991. Information on deaths which occurred between 1st March 1990 and 28th February, 1993, was obtained through the Ministry of Health data base. The main causes of death were analysed after the calculation of the age-adjusted death rates, using the world standard population older than 50 years old, for each sex, for the Issei, the inhabitants in Japan and in Paraná. Standardized Risk Ratio - SRR - and respective 95% confidence interval were estimated for selected causes among Issei versus the population living in Japan and Issei versus persons living in Paraná. RESULTS: Among the main results, it was observed that the female Issei mortality rate was in an intermediary position when compared to Japan's and Paraná's rates, while men showed figures quite close to the Japanese rates. Concerning the specific causes, it was observed that among male Issei, when compared to the Japanese population, the rates were significantly lower for stomach, but higher for diabetes and ischaemic heart diseases. Regarding the female Issei aged 50 or more years old, only the death rate for lung cancer was itself significantly lower than that of Japanese women. When compared to the Paraná pattern, the male Issei rates were lower regarding ischaemic heart and cerebrovascular diseases. Concerning stomach and lung cancer, there was no statistical difference. The female Issei rates were lower for lung cancer and ischaemic heart diseases. Regarding diabetes and cerebrovascular diseases, no significant difference among rates was detected. CONCLUSIONS: The results obtained make it possible to assert a deviation in the Issei pattern of mortality from that of their country of origin (Japan) and a perseptible approximation to the pattern of their new homeland (Paraná). Such observations suggest the influence of socio-cultural factors, mainly dietary habits, on their morbi-mortality.

[Epidemiologic study of birth weight from birth certificates]. / Estudo epidemiológico do peso ao nascer a partir da Declaração de Nascido Vivo.

INTRODUCTION: Based on the fact that there is evidence of an association between low birth weight and neonatal and infant morbi-mortality, the World Health Organization considered birth weight as the main isolated factor associated with infant's survival. A study was undertaken to identify risk factors associated with low birth weight, using epidemiological and demographic variables present on the Birth Certificates, the source of data for the System of Information on Newborn Infants of the Brazilian Ministry of Health, for the purpose of motivating the use and the analysis of data currently generated in hospitals. METHOD: The distribution, by birth weight, of 14,784 single hospital newborn infants from five cities of the State of S. Paulo, Brazil, in an observation period of six months (1992), was analysed. Statistical analysis was based on point estimates (average, median and standard deviation) measures of association and confidence intervals (95%) of the prevalence ratios. RESULTS AND CONCLUSIONS: The highest proportion (10.4%) of low birth weight infants (weight less than 2,500 g) occurred in Itararé, the city with the highest infant mortality rate in the State, the overall proportion being 7.5%. Significant statistical associations between low birth weight and sex (female), gestational age (less than 37 weeks), mother's age (adolescent and 35 or more years of age) and parity were detected. The use of Birth Certificates in epidemiological and public health studies is highly recommended because of their validity, great importance and high coverage.

[Energy expenditure in adolescent students in night school]. / Dispêndio energético de adolescentes estudantes do período noturno.

OBJECTIVE: It is well-known that energy expenditure provides a feasible way to measure the individual's energy needs. The final aim of this paper was to discover the level of physical activity and to quantify the energy expenditure of adolescents who either participated, otherwise, in the labor market. METHODS: This paper focussed on the evaluation of the energy expenditure of 273 students of both sexes attending the evening period of six schools belonging to the State School Network of Santo André, State of S. Paulo, Brazil, through a self-applied questionnaire dealing with their physical, occupational and discretionary activities. RESULTS: Data revealed that the students who were employed worked from 40 to 50 hours a week, earning a monthly salary varying from 1 to 3 Brazilian minimum wages. Watching television was the discretionary activity most frequently referred to. The energy expenditure of these students was 3,000 and 2,100 calories for boys and girls, respectively. CONCLUSIONS: The results found indicated that the students who were on the labor market did not expend more energy than those who were not.

[Analysis of registries of live births in an urban area of Southern Brazil]. / Análise dos registros de nascimentos vivos em localidade urbana no Sul do Brasil.

Live births which occurred in the period from April to September of 1994 were analysed, using the two copies of the Birth Declaration-BD-(the white copy coming from the hospital where the child was born and the yellow copy sent by the Legal Registry Office where the birth was registered) received by the Londrina Municipal Health Service. After the "cross matching" of both copies (for each child), household interviews were performed in cases without matched pairs (only a white or only a yellow copy indicating possible unregistered or home deliveries). Results showed that the proportion of births not legally registered was of from 5.3 to 6.6% of the hospital births. Cost, negligence and legitimacy were the main reasons given for not registering births legally. The average time taken to make the registration was 26.5 days (standard deviation of 52 days) and 88.7% of the families did it by the 60th day from the date of the birth. A statistical association was detected between the act of registration and the period within which registration is required (within 60 days from birth) and type of delivery, maternal age and education. The official proportion of home deliveries was 0.5%; however, after the research the value was found to be somewhere between 0.13 and 0.3% of all the registered births--only 36.8% were really born at home. Reasons for home deliveries were: option, "there wasn't a means of transport to take the pregnant woman to hospital" and "there wasn't enough time to get to a hospital".

[A computer software system for dental caries rates: databases and statistical analysis]. / Sistema computacional para índices de cárie dentária: banco de dados e análise estatística.

A computer software system developed ICADAPLUS, is presented in order to create and tabulate data bases, calculate the DMF rate, perform statistical comparison of two populations, and calculate confidence intervals. The system offers a simplified method for health services in the area of dentistry, using dental records to carry out epidemiological surveys of tooth decay. The system's main feature is that it does not require specialists either in the area of dentistry or computing, demanding of the user only basic data-entry typing skills, since it presents simple menus, and standardized reports, with no possibility of error. The system comprises four steps: Data-entry, Processing, Reports and Utilities. In Data-entry the regions, towns and institutions supplying the data are initially registered, once only. Each record receives a code number, and it is this code which is available to the user through a Function Key, by means of which the code is transferred to the desired data field. Furthermore, there is a choice of type of dental chart: Klein and Palmer's DMF; the DMF proposed by the WHO; Klein, Palmer and Knutson's DMF surfaces; or Gruebbel's def. It is possible to include, alter and exclude records in each option. In Processing, it is necessary, first of all, to organise the indexes, totalize the data, and remit them to the data base, where no further alteration or exclusion occurs. From this stage on, reports can be prepared from the proposed indexes, grouped according to age, or age and gender. The system was validated by comparison with other methods. This comparison justifies the recommendation of its implementation.

Duration of larval and pupal development stages of Aedes albopictus in natural and artificial containers.

Aedes albopictus were reared in different containers: a tree hole, a bamboo stump and an auto tire. The total times from egg hatching to adult emergence were of 19.6, 27.3 and 37.5 days, respectively, according to the container. The first, second and third-instar larvae presented growth periods with highly similar durations. The fourth-instar larvae was longer than the others stages. The pupation time was longer than the fourth-instar larvae growth period. The temperature of the breeding sites studied, which was of 18 degrees C to 22 degrees C on average, was also taken into consideration. The mortality of the immature stages was analysed and compared as between the experimental groups; it was lower in the natural containers than in the discarded tire. The average wing length of adult females emerging from tree hole was significantly larger (p < 0.05) than that of those emerging from the tire.

[An information system on live births and the use of its data in epidemiology and health statistics]. / Avaliação do sistema de informação sobre nascidos vivos e o uso de seus dados em epidemiologia e estatísticas de saúde.

The Brazilian Ministry of Health implemented, in 1990, a System of Information of Live Births (SINASC) which introduced a Birth Certificate with a view to obtaining the total number of these events and their distribution according to epidemiological, demographic and clinical characteristics. It was decided to evaluate the System according to its coverage and the quality of information obtained, two years after its initial implementation. The population of this study consists of 15,142 hospital live births which occurred in five cities of the State of São Paulo, Brazil, in 1992. Birth Certificates and the corresponding maternal and child hospital records were examined visually with a view to checking data recorded on the Birth Certificate. It was seen that the system achieved a high degree of completeness (99.5%) and obtained a very accurate report for most of the items, though rather poor reporting for Apgar Score, length of gestation, mother's schooling, parity and father's name. This study allows suggestions to be made for the reformulation of some items and regarding the necessity for retraining the hospital personnel involved in the filling in of the certificates. Overall this study confirms that the Birth Certificate data are adequate for a valid analysis of aspects of maternal and child health research. The data showed high percentages of adolescent mothers (17.5%) and deliveries by cesarian section (48.4%). The percentage of low birth weight was 8.5%.

[Probability of dying in the first year of life in an urban area of southern Brazil]. / Probabilidade de morrer no primeiro ano de vida em área urbana da região sul, Brasil.

A birth-cohort of 4,876 children born alive in hospital were selected and followed through up to the age of one year with a view to estimating the risk of dying in the first year of life. All of them were born in 1989, in one of the seven hospitals of an urban area of Southern Brazil and the only requirement for belonging to the cohort was that of residence on the area. The selected variables were: sex, birthweight, age at moment of death, underlying cause of death, and maternal age. The estimated probability of dying in the first year was of 19.9 per 1,000 (77.3% of the deaths occurred during the neonatal period). Perinatal causes and congenital malformations contributed to 80% of the deaths, and infectious diseases were the underlying cause of death in only 1.1% of the losses. The risk of dying in the first year of life due to afections arising during the perinatal period was higher among vaginally delivered babies (20.3 per 1,000) than it was for those born by cesarean section (9 per 1,000). A higher probability of death was present among infants born to adolescent mothers, and those with low birthweight (less than 2,500g). The results brought out the need for improving the quality of prenatal and infant care. They also suggested the hypothesis of a possible association between higher infant mortality and lower socio-economic level.

PIP: A birth cohort of 4876 children born alive in 7 hospitals in an urban area of southern Brazil was selected and followed through up to the age of one year, with a view to estimating the risk of dying in the first year of life. Information on death was collected from death certificates. A total of 103 deaths were located in Maringa, of which 97 occurred in 1989. All of them were born in 1989, and the only requirement for belonging to the cohort was that of residence in the area. The selected variables were: sex, birth weight (low, adequate, and normal), age at moment of death (neonatal, late neonatal, and post neonatal) underlying cause of death (according to the International Classification of Diseases--9th Revision), and maternal age. The estimated probability of dying in the first year was of 19.9 per 1000 (77.3% of the deaths occurred during the neonatal period) in contrast with the official rate of 22.6/1000. The probability of dying in late infancy was 4.5/1000 compared to 15.4 in neonatal age. Perinatal causes and congenital malformations contributed to 80% of the deaths, and infectious diseases were the underlying cause of death in only 1.1% of the losses. 63.8% of infant deaths were caused by ailments acquired in the perinatal period, yielding a probability of death of 12.3/1000. The risk of a female infant dying was 1.4 higher than that of a male. The risk of dying in the fist year of life owing to ailments arising during the perinatal period was higher among vaginally delivered babies (20.3 per 1000) than it was for those born by caesarian section (9 per 1000). A higher probability of death was present among infants born to adolescent mothers, and those with low birth weight (less than 2500 g). The results signify the need to improve the quality of prenatal and infant care, and suggest the possible association between high infant mortality and lower socioeconomic level.

[Under-registration of hospital live births in a urban area of the southern region of Brazil, in 1989]. / Sub-registro de nascimentos vivos hospitalares em área urbana da regiäo sul do Brasil, em 1989.

With a view to evaluating the real situation of the vital statistics as regards their completeness in the city of Maringá, Paraná State, Brazil, 4,876 hospital live births which occurred during 1989 were studied. The rate of under-registration was estimated as 9.1%, varying according to maternal age, parity and financial condition. The results lead to the hypothesis of an association between under registration and lower socioeconomical levels. The study also describes all the necessary steps to establish the link between the two sets of events, live birth and legal registration.

Ethnicity and cancer risk in São Paulo, Brazil.

Data from the São Paulo Cancer Registry (Brazil) for the period 1969-1974 are used to investigate ethnic differentials in cancer risk. Risks for specific cancers were estimated for mulattos and blacks relative to whites, using a case-control approach with other cancers as controls. For both sexes, blacks and mulattos are at higher risk than whites for cancer of the esophagus, stomach, and liver and for myeloma; for prostate cancer in males; and for gall bladder, pancreas, and cervix uteri cancers in females. Blacks and mulattos are at lower risk than whites for cancer of the colon, lung, larynx (males only), bladder, bone, testis, breast, and corpus uteri and for melanoma and leukemia. Except for lung and colon cancers, for which life-style habits are the main risk factors, these ethnic differences are similar to those observed in the United States.

Proportional cancer incidence according to selected sites--comparison between residents in the city of S. Paulo, Brazil: Japanese and Brazilian/Portuguese descent.

The percentual distributions of selected sites of cancer cases according to origin, sex and age are compared. Data were obtained from the Registry of Cancer of S. Paulo (School of Public Health of the University of S. Paulo, Brazil). The reference period for inhabitants of Japanese descent was 1969/78 and for those of Brazilian descent, the period was 1969/75. Standardized Proportionate Incidence Ratios (SPIR) with approximate 95% Confidence Intervals (CI) were evaluated using age specific Incidence Ratios of S. Paulo, 1973, as standards. The results agree with findings of previous works on mortality, but show different patterns according to origin. The well known fact that some sub-groups of a population may be different from the overall group is once again brought to the fore. Attention should be drawn to the differences detected for stomach, skin and prostate, in males, and for stomach, skin, cervix and uterus in females.

[Mortality among Japanese migrants residing in the municipality of São Paulo, Brazil, 1990]. / Mortalidade em migrantes--japoneses residentes no município de São Paulo, Brasil, 1990.

The mortality patterns of Japanese migrants (issei) and their descendants (nissei/sansei) resident in the City of S. Paulo, Brazil, are compared with those of their native country (Japan) and their place of adoption (S. Paulo), in 1980. The mortality data were obtained from death certificates for the issei and nissei/sansei populations and from official tabulations for deaths in Japan and S. Paulo. The population estimates were based upon the S. Paulo and Japanese censuses. The age-standardized populations were calculated according to the Jowett method. The five leading causes of death were basically the same for these populations under study. S. Paulo residents had the highest age-standardized mortality rates, except as regards deaths due to neoplasms, higher in Japan. The issei population (both sexes) presented intermediate values for deaths due to endocrine, nutritional, and metabolic diseases and diseases of the respiratory system; the female migrants also showed an intermediate rate for deaths due to diseases of the circulatory system. For the other causes, the lowest risk of dying was that registered for the issei population. The comparisons of the rates for cancers of stomach, breast, prostate, diabetes mellitus, ischaemic heart diseases, cerebrovascular diseases, homicide and suicide resulted in the detection of a possible transition experienced by the issei population, leading to the belief that the issei pattern of mortality is showing a deviation from the Japanese pattern and resembles that of S. Paulo. Since social and cultural changes are thought to be occurring among the migrants, one might argue that the role of environmental factors (including diet) is more important than the role of genetic factors in the incidence of and mortality due to these diseases.

Cancer incidence rates among Japanese immigrants in the city of São Paulo, Brazil, 1969-78.

Cancer incidence rates among first-generation Japanese immigrants in the city of São Paulo, Brazil, were estimated from the data of the São Paulo Cancer Registry during the years 1969 to 1978. From all registered cases, 2,179 cancer cases of Japan-born residents (1,288 males, 891 females) were selected and age-specific and summary age-adjusted incidence rates (AAIR) were calculated for the selected sites of cancer. The AAIR for all sites except non-melanoma skin cancer was 195.2 per 100,000 population (95 percent confidence interval: 176.4-214.1) in males and 147.3 (134.6-160.0) in females. Stomach cancer had the highest incidence rate of all cancers in both sexes (males, 69.3; females, 32.0). This was followed by cancer of the lung (22.5), esophagus (10.2), colon (8.3), and prostate (7.1) in males; and by breast (24.0), cervix (18.0), colon (8.4), and lung (7.2) in females. When these rates were compared with those among Japanese in Japan, cancer of the stomach and rectum revealed significantly lower rates, while non-melanoma skin cancer, and prostate and breast cancer showed higher rates. No significant increase of colorectal cancer was recognized among Japanese immigrants in São Paulo, contrary to the remarkably high rates of colorectal cancer being observed among Japanese immigrants in the US.

Cancer mortality among Japanese residents of the city of São Paulo, Brazil.

Death certificates of Japanese residents of the city of São Paulo, Brazil from 1979 to 1981 were analyzed for cancer deaths by means of the standardized mortality ratio (SMR) and the standardized proportional mortality ratio (SPMR). Compared with residents of Japan, a significantly higher SMR value was obtained from Japan-born residents of São Paulo for prostate cancer, whereas lower values were obtained for cancer of the liver and gall-bladder in both sexes, of the esophagus and rectum in males, and of the lung in females. SMR values were higher for cancer of the stomach in both sexes but lower for those of the esophagus and prostate in males and of the gall-bladder and breast in females, when compared with the general population of São Paulo. Among Japan- and Brazil-born residents, stomach cancer in women revealed a significant stepwise decrease by generation when SPMR was used as an indicator. The high proportion of stomach cancer in males, however, was as high among the Brazil-born generation as in Japan. The SPMR of liver cancer decreased to the low level of the general population of São Paulo, even among the first generation. These changes in cancer patterns are discussed in relation to those among Japanese residents in the United States.

Mortality and cause of death among first-generation Japanese in São Paulo, Brazil.

The death certificates of first-generation Japanese in the city of São Paulo, Brazil, were analysed for underlying causes of death, and standardized mortality ratio (SMR) values were calculated using the age-specific mortality rates for Japan and São Paulo. Mortality rates for all causes were lower than those of the general population in São Paulo for all age groups and both sexes, and were almost equal to those in Japan. Compared with the mortality in Japan, significantly higher SMR values were obtained for diabetes mellitus, ischaemic heart disease, respiratory diseases (females), motor vehicle accidents, and homicide (males), whereas SMR values were low for all causes (males), other heart diseases, cerebrovascular disease, chronic liver diseases (males), suicide, and malignant neoplasms (males). On the other hand, compared with the mortality for São Paulo, SMR values were significantly low for most causes of death. The potential cultural and social factors contributing to these changes in mortality pattern are discussed.