Actions developed at the Instituto de Medicina Integral Prof. Fernando Figueira to confront the COVID-19 pandemic / Ações desenvolvidas no Instituto de Medicina Integral Prof. Fernando Figueira para enfrentamento à pandemia da COVID-19

Abstract The COVID-19 pandemic has brought countless challenges to the health institutions around the world, especially those located in countries such as Brazil, with large territorial dimensions and many social and economic differences. This technical report aims to publish the actions carried out and the products developed at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) before and during the pandemic - from January 31st to September 4th, 2020 - facing it efficiently and effectively, seeking institutional sustainability. The mobilization of the professional staff at the institution was fundamental to create protocols ofas-sistance, adapt the physical structures in the hospital and outpatient care, care for the health professionals, offer teaching and research activities in the distance mode, articulate management members to make decisions based on systematically collected data on the pandemic situationat real time. All actions were carried out with a single objective of assisting all the patients affected by COVID-19 admitted at the institution.

Resumo A pandemia da COVID-19 trouxe incontáveis desafios para as instituições de saúde de todo o mundo, em especial as localizadas em países como o Brasil, com grande dimensão territorial e muitas diferenças sociais e econômicas. Este informe técnico tem como objetivo publicizar as ações realizadas e os produtos desenvolvidos no Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) antes e durante a pandemia - no período de 31 de janeiro até 04 de setembro de 2020 - enfrentando-a com eficiência e eficácia, buscando a sustentabilidade institucional. A mobilização do corpo profissional da instituição foi fundamental para a construir protocolos de atendimento, adaptar as estruturas físicas na assistência ao paciente em âmbito hospitalar e ambulatorial, cuidar dos profissionais de saúde, ofertar as atividades de ensino e pesquisa na modalidade à distância, articular os membros da gestão para tomar decisões baseadas em dados sistematicamente coletados sobre a situação da pandemia em tempo real. Todas as ações foram realizadas com um uníssono objetivo de atender a todos os pacientes acometidos pela COVID-19 admitidos na instituição.

Self-reported occupational accidents and affecting factors among the adult population / Acidentes de trabalho autorreferidos e fatores que afetam a população adulta

Abstract Introduction As official occupational accident records are insufficient in developing countries such as Turkey, self-reported numbers are a better reflection of the real scope of occupational accidents among Turkish workers. Objective This study aims to determine the factors affecting occupational accidents in Turkey. Method This cross-sectional study re-evaluated data from a total of 42,360 participants, were obtained from the 'Occupational Accidents and Occupational Health Problems' module of the Household Labor Force Survey conducted by TurkStat. Results The prevalence of occupational accidents in the prior 12 months was 2.1%. The probability of an occupational accident for men was 1.78 times higher than for women (95% CI: 1.38-2.30). Workers who had not completed primary education [OR=1.91 (95% CI: 1.09-3.3)] and those who were divorced [OR=2.26 (95% CI: 1.40-3.63)] were more likely to have an accident at work, when compared to university graduates and unmarried employees, respectively. Conclusion Male gender, low educational level, and divorced marital status can be considered risk factors and require more attention and a control program to prevent the loss of labor due to occupational accidents in Turkey. This is the first, most comprehensive, and up-to-date study using extensive national data to examine the factors that affect occupational accidents in Turkey.

Resumo Introdução Como os registros oficiais de acidentes de trabalho são insuficientes em países em desenvolvimento, como a Turquia, os números autorrelatados refletem melhor o escopo real do acidente ocupacional entre os trabalhadores turcos. Objetivo Este estudo tem como objetivo determinar os fatores que afetam os acidentes de trabalho na Turquia. Método Estudo transversal que reavaliou dados de um total de 42.360 participantes, obtidos no módulo 'Acidentes de trabalho e problemas de saúde ocupacional' da Pesquisa da Força de Trabalho Doméstica realizada pela TurkStat. Resultados A prevalência de acidentes de trabalho nos últimos 12 meses foi de 2,1%. A probabilidade de um acidente de trabalho para homens foi 1,78 vezes maior que para mulheres (IC 95%: 1,38-2,30). Os trabalhadores que não concluíram o ensino fundamental [OR = 1,91 (IC 95%: 1,09-3,3)] e os que se divorciaram [OR = 2,26 (IC 95%: 1,40-3,63)] apresentaram maior probabilidade de sofrer um acidente de trabalho, quando comparados com graduados universitários e empregados solteiros, respectivamente. Conclusão O sexo masculino, o baixo nível educacional e o estado civil divorciado podem ser considerados fatores de risco e requerem mais atenção e um programa de controle para evitar a perda de trabalho devido a acidentes de trabalho na Turquia. Este é o primeiro, mais abrangente e atualizado estudo, a partir de extensos dados nacionais, para examinar os fatores que afetam os acidentes de trabalho na Turquia.

Cervical cancer prevention in Pernambuco: improvements for whom? Inequity scenario in the state of the Northeast Region / Prevenção do câncer do colo do útero: avanços para quem? Um retrato da iniquidade em estado da Região Nordeste

Abstract Objectives: to analyze the access to cervical cancer preventive examination in Pernambuco between 2002 and 2015 by cytopathological exam coverage. Methods: public data from SUS Computer Department were used, then processed by Tabnet and Excel and calculated the slope of the over time coefficient trend by simple regression techniques. Afterwards, they were plotted in thematic maps covering cytopathological exams on Terraview app 4.2.2. Results: Pernambuco State presented an increase of exam coverage trend in all the health regions until 2010. Since that year it started to have stabilization and decreased the tendency. Comparing the coverage of the two first years, in 2002, 42.7% of the cities coverage was below 0.2 and in 2015 the scenario changed, 41.1% of the cities coverage was above 0.6. We emphasize that even in that same year 13.5% of the cities still had a low or too low coverage (less than 0.4). The over time trends in increase and decline were strongly meaningful. Conclusions: this study revealed that all health regions presented a coverage lower than recommended, in some period or in all of them, even with the State growth tendency it demonstrated an unequal and heterogeneous characteristic.

Resumo Objetivos: analisar o acesso ao exame preventivo para o câncer de colo do útero em Pernambuco, entre 2002 e 2015, por meio da cobertura do citopatológico. Métodos: foram utilizados dados de domínio público do Departamento de Informática do SUS, processados no Tabnet e Excel® e calculados os coeficientes de inclinação de tendência temporal, por meio de técnicas de regressão simples. Por fim, foram plotados em mapas temáticos de cobertura de exames citopatológicos no aplicativo Terraview 4.2.2. Resultados: Pernambuco apresentou aumento na tendência de cobertura ao exame para todas as regiões de saúde até 2010. A partir deste ano, apresentou uma tendência de estabilização e diminuição. Ao comparar a cobertura no primeiro e no último ano, em 2002 42,7% dos municípios estavam com cobertura abaixo de 0.2 e em 2015 o cenário muda para 41,1% de municípios com cobertura acima 0.6. Destaca-se que neste mesmo ano 13,5% dos municípios ainda apresentavam uma cobertura baixa e muito baixa (<0.4). Tendências temporais de crescimento e decréscimo tiveram forte significância. Conclusões: todas as regiões de saúde apresentaram cobertura inferior ao preconizado, em algum período ou em todos, mesmo com a tendência estadual de crescimento, demonstrando uma característica heterogênea e desigual.

From big data mining to technical sport reports: the case of inertial measurement units.

The inertial measurement units (IMU) are instruments used to quantify the external load of athletes; they are increasingly common in assessing team and individual sports. This type of instruments has several sensors, such as accelerometers, gyroscopes and magnetometers; this allows access to a large amount of information and analysis possibilities. Due to the complexity of synthesising this data, it is necessary to create a flow for collecting, analysing and presenting the collected data in a simple way and present it as quickly as possible to the technical staff. This report aims to present new methods of reduction of the data and propose a new approach method for the analysis of the IMU's outcomes.

Actions developed at the Instituto de Medicina Integral Prof. Fernando Figueira to confront microcephaly by Zika virus / Ações desenvolvidas no Instituto de Medicina Integral Prof. Fernando Figueira para enfrentamento à microcefalia pelo Zika vírus

Abstract Objectives: to publicize by inserting institutionally to the context of microcephaly care by Zika virus in the Northeast of Brazil and to describe the activities developed during the epidemic outbreak that occurred in the country in 2015. Methods: analysis on technical documents and institutional announcements in newspapers, on television and radio was carried out from August 2015 to July 2016. Results: the Central Nucleus to Monitor and Study Microcephaly at Instituto de Medicina Integral Prof. Fernando Figueira (IMIP); took part in elaborating a Clinical and Epidemiological protocol for Professionals at Maternity Hospitals and Referral Services from the State Health Department of Pernambuco (SES/PE); IMIP became a National Referral Center in elaborating protocols to identify and monitor children with microcephaly, and a Benchmark Assistance for the State Health Department of Pernambuco. Technical meetings took place with the participation of clinical and medical professionals, researchers, professors and institutional managers, forums, training sessions and workshops along with national and international institutions, technical visits of international organizations and development of studies on Zika virus and microcephaly. Conclusions: the impact by notifying microcephaly cases caused mobilization of services at IMIP, reorganization of work processes and research developments.

Resumo Objetivos: publicizar a inserção institucional no contexto da atenção à microcefalia pelo vírus Zika na Região Nordeste do Brasil e descrever as atividades desenvolvidas durante o surto epidêmico ocorrido no país em 2015. Métodos: realizada análise de documentos técnicos e de divulgação institucionais e de registros da mídia impressa, televisiva e de rádio no período de agosto de 2015 a julho de 2016. Resultados: instituído o Núcleo Central de Monitoramento e Estudo da Microcefalia do Instituto de Medicina Integral Prof. Fernando Figueira (IMIP); participação na elaboração de Protocolo Clínico e Epidemiológico para Profissionais de Maternidades e Serviços de Referência pela Secretaria Estadual de Saúde de Pernambuco (SES/PE); IMIP tornou-se Centro de Referência Nacional na Elaboração de Protocolos para Identificação e Acompanhamento de Crianças com Microcefalia e Referência Assistencial para a SES/PE. Realizadas reuniões técnicas com a participação dos profissionais clínicos, pesquisadores, docentes e gestores da instituição, fóruns, treinamentos e oficinas de trabalho com instituições nacionais e internacionais, visita técnica de organismos internacionais e desenvolvimento de estudos sobre vírus Zika e microcefalia. Conclusões: o impacto causado pela notificação dos casos de microcefalia provocou mobilização dos serviços do IMIP, reorganização dos processos de trabalho e desenvolvimento de pesquisas.

Leishmaniasis cutánea americana en Venezuela, bienio 2008-2009 / American cutaneous leishmaniasis in Venezuela, biennium 2008-2009

Se presenta el reporte epidemiológico de la Leishmaniasis Cutánea Americana (LCA) en Venezuela para los años 2008-2009. Se describen las características epidemiológicas generales, junto a algunos aspectos clínico-inmunológicos de sus diferentes formas clínicas. Esto se logro a través del análisis de la base de datos del registro nacional de leishmaniasis del Instituto de Biomedicina. La información fue analizada con Epi Info 3.5.1 y Excel. Un total de 4.640 casos de las diferentes formas clínicas de leishmaniasis cutánea fueron diagnosticados en el periodo 2008-2009, una media de 2.320 casos por año, con una tasa promedio anual de 8,25 por 100.000 habitantes. Predomina el sexo masculino con una razón de masculinidad de 1,84 para el periodo en estudio. Casos en todas las edades, con predominio numérico en el grupo de 5 a 34 años, edad promedio fue de 31,09 y 33,91 años para 2008 y 2009 respectivamente. En cuanto a la ocupación 22,39 % corresponde a personas del sector agropecuario, seguido de estudiantes con 20,88% de los casos. Se registraron casos en todas las entidades federales menos en Nueva Esparta, en este periodo los estados con mayor número de casos fueron, Lara con 910 (19,61%), Miranda con 650 (14,01%) y Táchira con 488 (10,52%). En cuanto a las formas clínicas se observó un predominio franco de la leishmaniasis cutánea localizada con 97,84% de los casos (4.540/4.640). Mientras que las formas localizadas están distribuidas por todo el territorio nacional, las formas difusas predominan en el estado Lara (63,64%, 7/11), las formas Mucosas en los estados Bolívar (21,74%, 10/46), Portuguesa (15,22%, 7/46) y Miranda, Táchira, Zulia (10,87%, 5/46 c/u) y finalmente las formas intermedias en los estados Monagas (30,23%, 13/43), Miranda (18,60%, 8/43) y Táchira (13,95%, 6/43). Las características clínicas e inmunológicas estudiadas variaron de acuerdo con las diferentes formas clínicas. En promedio más del 90 % (93,39 % en el 2008 y 89,81 % en el 2009) de los casos fueron diagnosticados con frotis directo. 88,86 % de los casos recibieron como tratamiento de primera elección inmunoterapia. En conclusión se hace una descripción clínico-epidemiológica de la LCA en Venezuela para el periodo 2008-2009 y se compara con el patrón descrito con anterioridad.

The epidemiological report of American Cutaneous Leishmaniasis (ACL) in Venezuela for the years 2008-2009 is presented. It describes the general epidemiological characteristics, together with some clinical and immunological aspects of its different clinical forms. This was performed by analyzing the database of the leishmaniasis national registry of the Instituto de Biomedicina. The data was analyzed using Epi Info 3.5.1 and Excel. A total of 4,640 cases of different clinical forms of cutaneous leishmaniasis were diagnosed during 2008-2009, i. e. 2,320 cases per year with an average annual rate of 8.25 per 100,000 inhabitants. It is predominant in males, with a sex ratio of 1.84 for the period under study. Cases in all ages, with numerical predominance in the group of 5 to 34 years, mean age were 31.09 and 33.91 years for 2008 and 2009 respectively. Regarding the occupation, 22.39% are people of the agricultural sector, followed by students with 20.88% of cases. Cases were recorded in all states but Nueva Esparta, the states with the largest number of cases were Lara with 910 (19.61%), Miranda 650 (14.01%) and Táchira with 488 (10.52%). In terms of clinical forms, clear predominance was observed of localized cutaneous leishmaniasis with 97.84 % (4,540) cases. While localized forms are distributed nationwide, diffuse forms predominate in the Lara State (63.64%, 7/11), muco-cutaneous forms predominate in the States of Bolivar (21.74%, 10/46), Portuguesa (15.22%, 7/46) and Miranda, Táchira, Zulia (10.87%, 5/46 each one) and finally, the intermediate forms in the States of Monagas (30.23%, 13/43), Miranda (18.60%, 8/43) and Táchira (13.95%, 6/43). The clinical and immunological characteristics studied varied according to the different clinical forms. In average, more than 90% (93.39% in 2008 and 89.81% in 2009) of the cases were diagnosed with direct smear. 88.86% of the patients received immunotherapy as first choice treatment. In conclusion, a clinical-epidemiological description of the ACL in Venezuela for the period 2008-2009 was made and compared with the pattern previously described.

Tubo-ovarian abscess after tubal ligation.

Tubo-ovarian abscess usually results from ascending infection of the lower genital tract. In a few cases it can occur as a result of direct contamination at the time of tubal sterilization. We describe a case that presented seven years after post partum tubal sterilization, showing both acute and chronic components.

PIP: This paper presents the case of a 32-year-old woman who developed a tubo-ovarian abscess 7 years following tubal ligation via minilaparotomy. Symptoms experienced included pain, which was exacerbated by walking, and mild deep dyspareunia. Abdominal and pelvic examinations revealed pain in the left iliac fossa, cervical excitation tenderness, and an ill-defined left adnexal mass. Sonographic evaluation of the pelvis showed an irregularly shaped, cystic mass (8.0 x 4.5 x 5.3 cm) with thickened internal septations and solid parts. A left tubo-ovarian multilobulated complex mass adherent to the omentum and the pelvic side was found upon laparotomy. There was pus in the Pouch of Douglas, and the uterus was 10 weeks in size with symmetrical enlargement. The previously ligated right fallopian tube and the ovary were unremarkable. Management includes left adnexectomy, omental biopsy, and 5-day course of antibiotics against Staphylococcus aureus, which was cultured from the purulent material in the Pouch of Douglas. Tubo-ovarian abscess should be considered in diagnosing patients presenting symptoms of pelvic inflammatory disease.

Protecting a marine wonderland.

PIP: This article reports on the condition of the Belize reef system and how the government takes the initiative to protect its wondrous beauty. The Belize reef system is located along the coast between Belize City and Punta Gorda, which is considered to be the largest barrier reef in the Western Hemisphere. Despite the appearance of a remarkably empty coastline, a glance to the Maya Mountains in the west will show that most of the development is taking place in the coastal areas. The earliest attempts to protect Belize¿s reefs focused on the establishment of protected areas and from this resulted in a remarkably ambitious marine protection program. Based on an integrated coastal zone management, a Coastal Zone Management Unit was established in 1990. This program encouraged the sharing of information, contribution to the creation of feasible government policies, plans and programs, identification of technical problems and provision of advice on a variety of issues. In addition, a steering committee was established in 1993, which is responsible for overseeing the implementation of the program and ensuring inter-ministerial coordination. Furthermore, public participation is also taking place in more direct ways, particularly with fishermen and dive operators. In order to achieve self-sufficiency, the program requires financial sustainability, a sufficient national capacity for management and political will, and public support.^ieng

Neonatal size and infant mortality at high altitude in the western Himalaya.

A prospective study was undertaken in Ladakh, India, a high-altitude region of the Himalaya, to investigate the effects of small average birth size on neonatal mortality. While such studies exist from high-altitude regions of the New World and shed light on the adaptive status of high-altitude-dwelling populations there, this is the first to examine this relationship in the Himalaya. In a sample of 168 newborns, birthweight and other anthropometric measurements were reduced relative to Andean and Tibetan newborns. Logistic regression and hazard analysis showed that neonatal biological characteristics such as weight, fatness, and circumferences were important predictors of survival probabilities of infants, especially in the neonatal period. Low Rohrer's Ponderal Index (PI) was particularly strongly related to poor survival outcome. Males and females showed no significant differences in mortality risk. Data derived from reproductive histories revealed that neonatal mortality accounted for 70-80% of total infant mortality in Ladakh. Compared to other high-altitude studies, small newborn size in Ladakh was associated with much higher mortality risks; mortality risk rose dramatically with birthweights below the mean (2,764 grams), which characterized 50% of all newborns. It is argued that newborns in Ladakh are subject to strong directional selective forces that favor higher birthweights that incur lower risks of neonatal mortality, while Andean infants are subject to relatively mild selection pressure at both ends of the birthweight distribution. Given the overall small size at birth of Ladakhi newborns and the poor survival outcomes of newborns below the mean, it is suggested that this population is less well adapted in a biological sense to the stresses inherent in this high-altitude environment than are Andean populations, perhaps due to the relatively recent colonization of the area and the substantial genetic admixture that has occurred in the past.

Cutaneous leishmaniasis in subtropical Ecuador: popular perceptions, knowledge, and treatment.

Popular perceptions and knowledge about cutaneous leishmaniasis and its treatment were studied in an endemic area of subtropical Northwest Ecuador. Although most of the adults surveyed were familiar with the disease, the vector, and traditional treatments, many showed a lack of knowledge about transmission of the disease, ulcer healing, and conventional treatment. Gender was found to have a significant impact on disease risk, perceptions, and treatment knowledge. Males experienced a risk of contracting cutaneous leishmaniasis that was almost triple that of women. Men were also more likely to perceive that the disease seriously diminished the victim's capacity to work. Women, on the other hand, were more prone to perceive that cutaneous leishmaniasis was a serious disease that significantly decreased self-esteem. Although 80% of the subjects knew at least one method of treating the disease, women tended to know more methods than men. Most of 150 different therapies reported involved the use of indigenous plants, chemicals, acids, antibiotics, heat treatments, or petroleum by-products. Some of these treatments could have clinical value. However, only 7% of the subjects knew about pentavalent antimonials. Almost 70% of the subjects with a past or present infection history were treated solely by traditional methods; only 12% received a full course of Glucantime, while 7.5% got an incomplete course. The findings indicate that it will be important to consider the identified gaps in knowledge and gender perceptions regarding the disease and its treatment when planning future control programs.

PIP: In 1989-1991, a study of 466 children and adults (i.e., = or 18 years) living in 26 small agricultural villages in the remote subtropical forest of Northwest Pichincha Province on the western slope of the Andes Mountains in Ecuador examined perceptions and knowledge of cutaneous leishmaniasis and local methods used to treat it. 13% of all adult subjects had active cutaneous leishmaniasis. Men were 2.83 times more likely to have cutaneous leishmaniasis than women (p = .037), perhaps due to increased occupational exposure (i.e., agricultural work in the rain forest) and social exposure (i.e., outside during times of maximum vector activity). They were more likely to consider it to have a negative effect on the affected person's capacity to work (77.3% vs. 61.2%; p = .025). Women were more likely than men to perceive it as a severe disease (85.2% vs. 68%; p = .015) that reduced the victim's self- esteem (89.9% vs.75.7%; p = .017). 97.3% of subjects were familiar with the sandfly vector, yet less than 10% knew it was responsible for cutaneous leishmaniasis. 80% of adults knew at least 1 treatment option. Women could name more treatment methods than men (1.6 vs. 1.2; p .05). The adults named more than 150 treatment options, most of which were traditional methods involving the application of topical preparations or objects to the ulcers (e.g., herbs, trees, or other plants and homemade rum, wood alcohol, iodine, menthol, methiolate, and sulfur). Just 7% were familiar with antimonial drugs. Most adults and children who had either active cutaneous leishmaniasis or a history of past infection (68%) had been treated with traditional methods. 8.5% received both traditional treatments and Glucantime. Just 12% received the full course of Glucantime therapy. 7.5% received an incomplete course of glucantime therapy. These results show that public health officials need to consider the gaps in knowledge and gender perceptions of cutaneous leishmaniasis and in its treatment when they plan control programs.

Cultural change, polygyny, and fertility among the Shipibo of the Peruvian Amazon.

PIP: Household interview in 8 Shipibo communities on the Ucayali and Pisqui Rivers in Peru in 1983 and 1984 were conducted in order to obtain reproductive histories of 386 women aged 13 years and older. Polygyny was defined in three ways: as ever experienced, as operant during a specific birth interval, and as the mean length of closed birth intervals and the proportion polygynous. The aim was to determine the effect of the decline in polygyny on increased fertility. The results showed that of 1445 individuals in 8 villages, 585 (over 33%) lived in Paoyhan village. The sex ratio was 104 men to 100 women and varied among the villages. 49.3% were younger than 15 years and 60.3% younger than 20 years. Crude birth rates varied from 42.6 to 89.6/1000. Crude death rates ranged from 14 to 63.8/1000. Infant mortality was 138/1000. The village of 9 de Octubre had the lowest compared fertility and also had the highest rate of polygyny. Irazola village had the highest man completed fertility, and the lowest polygyny. The median reported age at marriage was 14 years; median reported age at menarche was 13 years. Age at menarche was the same regardless of marriage type, but polygynous women tended to marry about a year earlier. First delivery averaged about 15.6 years and was lower for polygynous women. 75 (19.4%) had ever engaged in a polygynous unions. The highest polygynous unions were in 9 de Octubre, Vencedor, Tupac Amaru, and charashmanan villages, and ranged from 56.5% to 5.3%. The proportion of men in polygynous unions ranged from 3.4% in Paoyhan to 21.9% in Vencedor. 84.5% of women aged 15 years and older had had at least one pregnancy. The mean reproductive span was 13 years. The mean age at delivery was 28.8 years. The mean birth interval was 31.5 months; mean interval for women aged 45 years and older was 36.2 years. There was found no correlation between birth interval number and birth interval length, or mother's age at birth interval and length of birth interval. Polygynous unions had a mean birth interval length 4 months longer, and lower fertility: 4.7 births versus 6.0 births. Regression analysis showed a straight line positive correlation between mean birth intervals and polygyny, even excluding Paoyhan, and a negative relationship between the prevalence of polygyny and fertility.^ieng

[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.

Nutrition and function, with emphasis on physical activity.

PIP: Consumption of insufficient quantities of food would result to energy deficiency in children, and this can be prevented by early assessment of changes in physical activity. This paper focuses on the effects of general undernutrition on physical activity and on growth, behavior, and cognitive development in Mexico, Uganda, Colombia, and Guatemala. The paper contains studies investigating the influence of undernutrition on physical activity; total energy expenditure; level of physical fitness; influence of physical activity and growth; and relationship of physical activity with behavior and cognitive development. The level of energy expenditure between nutritional groups could be accounted for the smaller size of the body among undernourished children. On the other hand, physiological potential to physically perform work can be maintained by children with mild or moderate malnutrition, but their smaller size limits their output. Lastly, increased physical activity of children receiving food supplementation was associated with exploratory and behavioral differences compared with nonsupplemented children.^ieng

[Nutrition and population of the third age]. / Nutricion y la popblacion de la tercera edad.

PIP: In old age, muscle mass is lost, while fat increases, and the body contains less water. The loss of muscle mass can be somewhat compensated by physical activities and also depends to a large extent on the state of nutrition. Osteoporosis and the fractures of the neck of the femur are also frequent occurrences in this age. Various chronic circulatory and organ-related diseases also affect this population at an increasingly higher rate than middle age or younger populations. Loneliness, reduced income, the perception of being useless, the inability to enjoy things are other factors that even have an effect on the ingestion of nutrients. In 1980, in Latin America, 6.3% of the total population were people 60 years or older, and by the year 2000 this segment will rise to 7.2% of the total population. In Guatemala, in 1980, this age segment made up 4.5% of the population, whereas by 2000 it is estimated to rise to 5.8%. These figures will increase with time in view of the fact that life expectancy in 1980-85 was 60.7 years in Guatemala, and it will be 68.0 years by 1995-2000. Moreover, biological and chronological age may be very different, since some are vigorous, strong, and independent, while others have chronic diseases, which fact should be addressed by health and nutrition programs.^ieng

[Changes in employment, retirement age and fertility: their effects on economic dependency and per capita income]. / Cambios en el empleo, la edad de jubilacion y la fecundidad: sus repercusiones sobre la dependencia economica y el ingreso per capita.

PIP: This article provides a very simplified analysis of the impact of changes in unemployment, retirement age, and fertility on economic dependency and per capita income in Latin America. The macroeconomic consequences of variations in age structure have received a little recent attention among Latin American researchers and policymakers, partly because of the lack of simple but rigorous analytical models to orient research. This analysis is simplified in that it focuses on changes in age distribution but does not explicitly consider effects of changes in population size, even though in reality the 2 types of changes are interrelated. The analysis has also been simplified by not taking into account any type of causal interaction between the demographic and economic variables analyzed; only the most elementary accounting relations between them are utilized. The 1st section defines the concept of economic dependency, specifies the effects of changes in its demographic and economic components, and establishes a simple link between the dependency ratio and per capita income. These and other derivations in the following sections permit evaluation of the impact of changes in employment, retirement age, and fertility on the dependency ratio and per capita income. The work concludes with a synthesis and general discussion, including a theoretical consideration of the effects of interactions among components. Only the most important equations are presented in the main text, but all variables, equations, and relations are defined and derived in the appendix. 6 countries were studied to illustrate the relationships in the context of the demographic diversity of Latin America. Argentina and Cuba represented countries in an advanced stage of the demographic transition, Chile and Mexico represented an intermediate phase, and Bolivia and Peru represented countries at the beginning of the transition. Results of decomposition of changes in dependency and income due to each of the factors showed substantial variation between countries in regard to changes in unemployment and fertility, but much less variation in regard to changes in retirement age. A 50% decline in unemployment would have comparatively moderate effects and would increase per capita income by 1-6.5%. Shortterm impacts of fertility decline would be greater, and would vary between 1-8.5%, while an increase of 2 years in the retirement age would produce more uniform increments fluctuating between 6-8%. The analysis indicates that few Latin American countries have reached the stage where small fertility reductions would be detrimental to their dependency burden or per capita income. Some countries with slow growth like Argentina are gradually approaching the stage when efforts of demographic aging will be more important.^ieng

A child-to-child programme in rural Jamaica.

A child-to-child programme was carried out in six rural schools in Jamaica. School children in grades 4 and 5 were taught concepts of nutrition, environmental and personal hygiene, and child development. The children were encouraged to take messages home to their parents and improve the care of their younger siblings. Four hundred and twenty-three children and 90 mothers and guardians from four of the project schools were evaluated and compared with 199 children and 47 parents from two control schools. The project children showed higher scores on a test of knowledge in the topics at the end of the year. They also improved in some practices at home. The mothers improved in knowledge in some areas but not in their practices. We consider the results sufficiently encouraging to justify incorporating the programme into the country's education curriculum for primary schools.

PIP: The evaluation of a child-to-child health education project in Jamaica found for mothers and guardians a small improvement in knowledge and a slight and not significant improvement in behavior about a safe and health environment and nutrition; children's scores were significantly improved over controls. The project was conducted in 7 rural primary grades of all level 4 and 5 children in the parish of St. Thomas and was representative of rural schools in general, but the analysis included the 4 largest schools and 2 control schools nearby. The instructions to 423 children to spread concepts of child health, nutrition, and development to guardians and younger siblings was accomplished with trained teachers, rather than as previously conducted by the investigator. 15 workshops were devoted to training the development of curriculum; action-oriented songs, stories, skits, jingles, games, and pictures were created based on indigenous Jamaican folk music and patois intelligible to children with low literacy levels. Those children with very poor attendance were excluded (33%). The sample included 90 project and 40 control mothers who had no formal education at the secondary level and had large families in overcrowded houses with poor water supplies and sanitation. The evaluation was conducted for children only at the end of the project because of literacy problems, but mothers were administered questionnaires pre- and postproject with 8% absenteeism at the end of the project. Absenteeism for children was 22%, 23%, and 14%. Nutrition knowledge pertained to when and how to breast feed, the advantages of breast feeding, when and how to introduce weaning foods, and composition of food groups. Healthy environment included awareness of the causes and spread of diseases, flies and mosquitoes, how to prevent the spread of disease, food handling, and personal hygiene. Child development issues were the normal growth and development, positive reinforcement rather than physical punishment, how to play with children, what to teach with play, and how to make toys. The success in teaching the children is attributed to the teaching techniques and relevance to their lives. Teachers were highly supportive and motivated. Minimal success with mother's knowledge may be due to quality control issues and Jamaican traditions which interfere with children advising parents. Actions are more difficult to change. The program has been expanded to other schools.