Behavioural characteristics and abdominal obesity among Brazilian shift working women.

OBJECTIVE: To explore the association between behavioural characteristics with the prevalence of abdominal obesity (AO) among a population of Southern Brazilian shift working women. DESIGN: A cross-sectional study was conducted. AO was estimated using waist circumference (WC), and it was used to classify women as having AO (WC ≥ 88 cm). Prevalence ratios were estimated using Poisson regression with robust variance. SETTING: A large plastic utensils company in Southern Brazil. PARTICIPANTS: 450 female shift workers. RESULTS: The prevalence of the AO in the women shift workers was 44·5 % (95 % CI 40·0, 49·2 %). In night shift workers, the prevalence of AO was 56·1 % compared with 40·9 % among hybrid shift workers. After adjustments for covariates, women who were current smokers had a decrease in the prevalence of AO compared with those who never smoked. Women who had three or fewer meals per day had a 46 % increase in the AO prevalence compared with those eating more frequent meals. Night shift work was associated with increase in AO prevalence compared with hybrid shift (PR 1·33; 95 % CI: 1·08, 1·64). CONCLUSIONS: Our findings indicate that behavioural characteristics are associated with a high prevalence of AO in female shift workers, thus suggesting that behavioural modifications among women working shifts, such as increase in meal frequency and physical activity, may reduce AO.

Prevalence, mortality and risk factors associated with very low birth weight preterm infants: an analysis of 33 years / Prevalência, mortalidade e fatores de risco associados ao prematuro de muito baixo peso ao nascer: uma análise de 33 anos

Abstract Objective: To assess the prevalence, mortality and risk factors associated with the birth of very low birth weight preterm infants over a period of 33 years. Methods: Four cross-sectional studies were analyzed, using data from perinatal interviews of birth cohorts in the city of Pelotas collected in 1982, 1993, 2004, and 2015. Based on perinatal questionnaires, anthropometric measurements of newborns and death certificates were analyzed to obtain the prevalence rate, neonatal mortality, and risk factors (maternal age, income and type of delivery) for very low birth weight. Results: A total of 19,625 newborns were included in the study. In the years 1982, 1993, 2004, and 2015, there were, respectively, 5909, 5232, 4226, and 4258 births. The prevalence of very low birth weight was, respectively, 1.1% (n = 64), 0.9% (n = 46), 1.4% (n = 61), and 1.3% (n = 54). There was no statistical evidence of an increasing trend over time (p = 0.11). Among the risk factors, family income in the three poorest quintiles was associated with prevalence rates that were approximately twice as high as in the richest quintile (p = 0.003). Mortality per 1000 live births for neonates weighing <1500 g decreased from 688 to 259 per thousand from 1982 to 2015 (p < 0.001), but still represented 61% of neonatal deaths in the latter year. Conclusion: Although mortality in very low birth weight decreased by more than 60% in recent years, this group still contributes with more than half of neonatal deaths. Low family income remains an important risk factor in this scenario.

Resumo Objetivo: Verificar a prevalência, mortalidade e fatores de risco associados aos nascimentos de prematuros de muito baixo peso ao nascer (MBPN) ao longo de 33 anos. Métodos: Série de quatro estudos transversais com o uso de dados das entrevistas perinatais das coortes de nascimento da cidade de Pelotas coletados em 1982, 1993, 2004 e 2015. A partir de questionários perinatais, medidas antropométricas dos recém-nascidos e certidões de óbito, foram analisadas a prevalência, a mortalidade neonatal e os fatores de risco (idade materna, renda e tipo de parto) para prematuros de muito baixo peso ao nascer. Resultados: Foram incluídos no estudo 19.625 recém-nascidos. Em 1982, 1993, 2004 e 2015 ocorreram, respectivamente, 5.909, 5.232, 4.226 e 4.258 nascimentos. A prevalência de prematuros de muito baixo peso ao nascer naqueles anos foi, respectivamente, de 1,1% (n = 64), 0,9% (n = 46), 1,4% (n = 61) e 1,3% (n = 54). A tendência de aumento durante o período não alcançou significância estatística (p = 0,11). Entre os fatores de risco, a renda familiar nos três quintis mais pobres esteve associada a prevalências cerca de duas vezes mais altas do que no quintil mais rico (p = 0,003). A mortalidade por 1.000 nascidos vivos para os neonatos com peso < 1500 g caiu de 688 para 259 por mil ao longo dos anos (p < 0,001), mas ainda representa 61% dos óbitos neonatais em 2015. Conclusão: Embora a mortalidade nos prematuros de muito baixo peso ao nascer tenha diminuído em mais de 60% nos últimos anos, esse grupo ainda contribui com mais da metade dos óbitos neonatais. A baixa renda familiar continua a ser fator de risco importante nesse cenário.

Use of Medications by Breastfeeding Women in the 2015 Pelotas (Brazil) Birth Cohort Study.

Background: This study describes medication use by women up to 3 months postpartum and evaluates the association between medication use by women who were still breastfeeding at 3 months postpartum and weaning at 6 and 12 months. Methods: Population-based cohort, including women who breastfed (n = 3988). Medications were classified according to Hale's lactation risk categories and Brazilian Ministry of Health criteria. Duration of breastfeeding was analysed using Cox regression models and Kaplan-Meier curves, including only women who were still breastfeeding at three months postpartum. Results: Medication use with some risk for lactation was frequent (79.6% regarding Hale's risk categories and 12.3% regarding Brazilian Ministry of Health criteria). We did not find statistically significant differences for weaning at 6 or 12 months between the group who did not use medication or used only compatible medications and the group who used medications with some risk for lactation, according to both criteria. Conclusions: Our study found no association between weaning rates across the different breastfeeding safety categories of medications in women who were still breastfeeding at three months postpartum. Therefore, women who took medications and stopped breastfeeding in the first three months postpartum because of adverse side-effects associated with medications could not be addressed in this analysis.

Prevalence, mortality and risk factors associated with very low birth weight preterm infants: an analysis of 33 years.

OBJECTIVE: To assess the prevalence, mortality and risk factors associated with the birth of very low birth weight preterm infants over a period of 33 years. METHODS: Four cross-sectional studies were analyzed, using data from perinatal interviews of birth cohorts in the city of Pelotas collected in 1982, 1993, 2004, and 2015. Based on perinatal questionnaires, anthropometric measurements of newborns and death certificates were analyzed to obtain the prevalence rate, neonatal mortality, and risk factors (maternal age, income and type of delivery) for very low birth weight. RESULTS: A total of 19,625 newborns were included in the study. In the years 1982, 1993, 2004, and 2015, there were, respectively, 5909, 5232, 4226, and 4258 births. The prevalence of very low birth weight was, respectively, 1.1% (n=64), 0.9% (n=46), 1.4% (n=61), and 1.3% (n=54). There was no statistical evidence of an increasing trend over time (p=0.11). Among the risk factors, family income in the three poorest quintiles was associated with prevalence rates that were approximately twice as high as in the richest quintile (p=0.003). Mortality per 1000 live births for neonates weighing <1500g decreased from 688 to 259 per thousand from 1982 to 2015 (p<0.001), but still represented 61% of neonatal deaths in the latter year. CONCLUSION: Although mortality in very low birth weight decreased by more than 60% in recent years, this group still contributes with more than half of neonatal deaths. Low family income remains an important risk factor in this scenario.

The association between disrespect and abuse of women during childbirth and postpartum depression: Findings from the 2015 Pelotas birth cohort study.

BACKGROUND: This study examined the association between disrespect and abuse of women during facility-based childbirth and postpartum depression (PD) occurrence. METHODS: We used data from the 2015 Pelotas (Brazil) Birth Cohort, a population-based cohort of all live births in the city. We assessed 3065 mothers at pregnancy and 3-months after birth. Self-reported disrespect and abuse experiences included physical abuse, verbal abuse, denial of care, and undesired procedures. We estimate the occurrence of each disrespect and abuse type, one or more types and disrespect and abuse score. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess PD. EPDS scores ≥13 and ≥15 indicated at least moderate PD and marked/severe. Odds ratios (OR) were calculated by logistic regression. RESULTS: The prevalence of at least moderate PD and marked/severe PD was 9.4% and 5.7%, respectively. 18% of the women experienced at least one type of disrespect and abuse. Verbal abuse increased the odds of having at least moderate PD (OR = 1.58; 95%CI 1.06-2.33) and marked/severe PD (OR = 1.69; 95%CI 1.06-2.70) and the effect among women who did not experience antenatal depressive symptoms was greater in comparison to those who did (OR = 2.51; 95%CI 1.26-5.04 and OR = 4.27; 95%CI 1.80-10.12). Physical abuse increased the odds of having marked/severe PD (OR = 2.28; 95%CI 1.26-4.12). Having experienced three or more mistreatment types increased the odds of at least moderate PD (OR = 2.90; 95%CI 1.30 - 35.74) and marked/severe PD (OR=3.86; 95%CI 1.58-9.42). LIMITATIONS: Disrespect and abuse experiences during childbirth were self-reported. CONCLUSIONS: Disrespect and abuse during childbirth increased the odds of PD three months after birth. Strategies to promote high quality and respectful maternal health care are needed to prevent mother-child adverse outcomes.

Efficacy of Regular Exercise During Pregnancy on the Prevention of Postpartum Depression: The PAMELA Randomized Clinical Trial.

Importance: Interventions to reduce postpartum depression have mainly focused on enhancing screening to increase treatment rates among women. Preventive approaches are timely from a population health perspective, particularly in low- and middle-income countries where access to mental health services is limited. Objective: To assess the efficacy of regular exercise during pregnancy on the prevention of postpartum depression. Design, Setting, and Participants: This randomized clinical trial examines a prespecified secondary outcome of the Physical Activity for Mothers Enrolled in Longitudinal Analysis (PAMELA) Study, a parallel-group, randomized clinical trial. This trial was nested in the 2015 Pelotas (Brazil) Birth Cohort Study. Between August 27, 2014, and March 14, 2016, pregnant women between 16 and 20 weeks of gestation with no contraindications to exercise were randomized 1:2 to the intervention group or control group via computer-generated randomization using a block size of 9. Data were analyzed from March 7 to May 2, 2018. Interventions: Participants assigned to the intervention were engaged in a 16-week supervised exercise program including aerobic and resistance training delivered in 60-minute sessions 3 times per week. Main Outcomes and Measures: Postpartum depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale 3 months after birth. A score of 12 or greater was defined as screening positive for postpartum depression. Primary analysis was performed on a complete case basis (90% of participants who had the primary end point ascertained). Results: A total of 639 participants (mean [SD] age, 27.1 [5.1] years; mean gestational age, 16.5 [1.5] weeks) were randomly assigned to the intervention group (n = 213) or control group (n = 426). Compliance with the protocol, defined as having engaged in at least 70% of exercise sessions, was low (40.4%). There was no significant difference in mean (SD) scores for postpartum depression between the intervention group (4.8 [3.7]) and the control group (5.4 [4.1]) (mean difference, -0.6; 95% CI, -1.3 to 0.1). There was also no significant difference in rates of postpartum depression between the intervention group (12 of 192 [6.3%]) and the control group (36 of 387 [9.3%]) (odds ratio, 0.65; 95% CI, 0.33-1.28). Instrumental variable analysis indicated that noncompliance may have attenuated the effect estimates obtained in the primary analysis. Conclusions and Relevance: Moderate-intensity exercise during pregnancy did not lead to significant reductions in postpartum depression. However, noncompliance to the intervention protocol was substantial and may have led to underestimations of the possible benefits of exercise. The point estimates for this study are in the same direction as the previous randomized clinical trial on this topic. Future studies on how to promote regular exercise during pregnancy to improve compliance, particularly targeting young and less educated women, are warranted before further trials are undertaken. Trial Registration: ClinicalTrials.gov Identifier: NCT02148965.

Changes in leisure-time physical activity among Brazilian pregnant women: comparison between two birth cohort studies (2004 - 2015).

BACKGROUND: Low levels of leisure-time physical activity (LTPA) during pregnancy have been shown in studies conducted worldwide. Surveillance is extremely important to monitor the progress of physical activity patterns over time and set goals for effective interventions to decrease inactivity among pregnant women. The aim of this study was to evaluate time changes in LTPA among Brazilian pregnant women in an 11-year period (2004-2015) by comparing data from two birth cohort studies. METHODS: Two population-based birth cohort studies were carried out in the city of Pelotas, southern Brazil, in 2004 and 2015. A total of 4244 and 4271 mothers were interviewed after delivery. Weekly frequency and duration of each session of LTPA in a typical week were reported for the pre-pregnancy period and for each trimester of pregnancy. Trends in both recommended LTPA (≥150 min/week) and any LTPA (regardless of weekly amount) were analysed overtime. Changes were also calculated separately for subgroups of maternal age, schooling, family income, parity, pre-pregnancy body mass index and pre-pregnancy LTPA. RESULTS: The proportion of women engaged in recommended levels of LTPA pre-pregnancy increased from 11.2% (95%CI 10.0-12.2) in 2004 to 15.8% (95%CI 14.6-16.9) in 2015. During pregnancy, no changes were observed over the period for the first (10.6 to 10.9%) and second (8.7 to 7.9%) trimesters, whereas there was a decrease from 3.4% (95%CI 2.9-4.0) to 2.4% (95%CI 1.9-2.8) in the last trimester. Major decreases in LTPA in the last trimester were observed among women who were younger, with intermediate to high income, high schooling, primiparous, pre-pregnancy obese and, engaged in LTPA before pregnancy. Changes in any LTPA practice followed the same patterns described for recommended LTPA. CONCLUSIONS: Despite the increase in the proportion of women engaged in LTPA before pregnancy between 2004 and 2005, LTPA levels remained stable during the first and second trimesters of pregnancy and declined during the third gestational trimester over the period. Interventions to encourage the maintenance of LTPA practice throughout pregnancy are urgently needed.

Antenatal depressive symptoms among pregnant women: Evidence from a Southern Brazilian population-based cohort study.

BACKGROUND: Antenatal depression (AD) is a major public health issue but evidence regarding its prevalence and associated factors in low and middle-income countries (LMICs) is limited. The aim of the study was to estimate the prevalence and identify risk factors for AD among Brazilian pregnant women. METHODS: All women living in the urban area of the city of Pelotas, Southern Brazil, with confirmed pregnancy and estimated delivery date in the year 2015, were invited to take part. Eligible pregnant women were recruited from health services. Symptoms of antenatal depression were assessed using the Edinburgh Postnatal Depression Scale (EPDS) by face-to-face interviews. A cutoff-point of 13 or more was used to define probable AD. RESULTS: EPDS scores were available for 4130 women. The prevalence of AD was 16% (95%CI 14·9-17·1). After adjustment for potential confounders, the factors most strongly associated with higher EPDS scores were a previous history of depression (PR 2·81; 95%CI 2·44-3·25), high parity (PR 1·72; 95%CI 1·38-2·15 - ≥2 children vs. 1 child) and maternal education (PR 5·47; 95%CI 4·22-7·09 - 0-4 vs. ≥12 years of formal education). LIMITATIONS: EPDS was administered through face-to-face interviews rather than questionnaires and some women may have felt uncomfortable reporting their symptoms leading to underreporting and consequently underestimation of the prevalence found. CONCLUSION: AD prevalence is substantially higher in Brazil than in high-income countries (HICs) but similar to other LMICs. Our study identified relevant risk factors that may be potential targets to plan interventions, particularly a history of depression.

Physical activity during pregnancy and maternal-child health (PAMELA): study protocol for a randomized controlled trial.

BACKGROUND: Preterm birth is associated with most cases of neonatal deaths and negative health outcomes, and hypertensive disorders. Hypertension is influenced by maternal behavior, such as physical activity. Physical activity is associated with better outcomes for mother and fetus, besides healthier weight gains during pregnancy. Few women are physically active during pregnancy and few clinical trials have been carried out with pregnant women. The aim of this paper is to describe the protocol of a controlled trial evaluating whether regular exercise during pregnancy may result in improved maternal-child health and neonatal outcomes. METHODS/DESIGN: The PAMELA (Physical Activity for Mothers Enrolled in Longitudinal Analysis) trial is a randomized controlled trial nested in a birth cohort study. Eligible women belonging to the birth cohort will be invited (between the 16th and 20th week of gestation) to enroll in the trial. Baseline data (blood and urine samples, anthropometry and pulmonary function) will be collected at enrollment. The same assessments will be repeated eight and 16 weeks after baseline. After randomization, women will be allocated into either one of these groups: control, 426 women who will be advised to keep their usual daily activities; and intervention, 213 women who will engage in an exercise program, three sessions a week. At least 70 % attendance over 16 weeks will be required to be considered compliant to the intervention. Exercise protocol will include aerobics, strength and flexibility training. Maternal and child outcomes will be measured at the 36th week of gestation, at birth and at three, 12, 24 and 48 months postpartum. An intention-to-treat analysis will be performed. DISCUSSION: Few women are active during pregnancy and a vast majority decrease their activities or even quit exercising. We present a population-based regular exercise intervention focused on the prevention of hypertension, pre-eclampsia and preterm birth. Data on the underlying cohort will allow future analysis using different outcomes with low probability of recall bias or misclassification of exposure status. Results will potentially influence prenatal care counseling in regards to physical activity. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT02148965 , registered on 22 May 2014.

Association between childhood trauma and loss of functionality in adult women with fibromyalgia.

OBJECTIVE: To investigate whether history of childhood trauma is associated with loss of functionality in adult women with fibromyalgia (FM). A secondary objective was to assess the presence of differences between depressed and non-depressed adult women with FM in a regression model for functionality. METHODS: A total of 114 adult women with FM according to the American College of Rheumatology diagnostic criteria answered the Childhood Trauma Questionnaire and the Fibromyalgia Impact Questionnaire. All subjects were interviewed by trained psychiatrists and evaluated for depression using the Mini International Neuropsychiatric Interview (MINI) - Brazilian version 5.0.0. Correlation and regression models were used to investigate associations between childhood trauma and loss of functionality among patients with FM. The sample was stratified by presence and absence of clinical depression. RESULTS: Overall, childhood trauma was associated with of loss of functionality in adult women with FM. When stratified by depression, the regression model significantly increased the association among non-depressed patients, even after adjustment for age and use of psychotropic medications. CONCLUSIONS: Childhood trauma showed a clinically important association with loss of functionality among adult women with FM. The associations were more pronounced among subjects without comorbid depression.

Association between childhood trauma and loss of functionality in adult women with fibromyalgia / Associação entre trauma na infância e perda de funcionalidade em mulheres adultas com fibromialgia

OBJECTIVE: To investigate whether history of childhood trauma is associated with loss of functionality in adult women with fibromyalgia (FM). A secondary objective was to assess the presence of differences between depressed and non-depressed adult women with FM in a regression model for functionality. METHODS: A total of 114 adult women with FM according to the American College of Rheumatology diagnostic criteria answered the Childhood Trauma Questionnaire and the Fibromyalgia Impact Questionnaire. All subjects were interviewed by trained psychiatrists and evaluated for depression using the Mini International Neuropsychiatric Interview (MINI) - Brazilian version 5.0.0. Correlation and regression models were used to investigate associations between childhood trauma and loss of functionality among patients with FM. The sample was stratified by presence and absence of clinical depression. RESULTS: Overall, childhood trauma was associated with of loss of functionality in adult women with FM. When stratified by depression, the regression model significantly increased the association among non-depressed patients, even after adjustment for age and use of psychotropic medications. CONCLUSIONS: Childhood trauma showed a clinically important association with loss of functionality among adult women with FM. The associations were more pronounced among subjects without comorbid depression

OBJETIVO: Investigar se a presença de história de trauma na infância está associada com perda de funcionalidade em mulheres adultas com fibromialgia (FM). Um segundo objetivo foi avaliar a presença de diferenças entre mulheres adultas deprimidas e não deprimidas com FM utilizando um modelo de regressão para funcionalidade. MÉTODOS: Um total de 114 mulheres adultas com FM de acordo com os critérios diagnósticos do American College of Rheumatology responderam o Childhood Trauma Questionnaire e o Questionário de Impacto da Fibromialgia. Todos os indivíduos foram entrevistados por psiquiatras treinados e avaliados para depressão utilizando o Mini International Neuropsychiatric Interview (MINI) - versão brasileira 5.0.0. Modelos de correlação e regressão foram utilizados para investigar associações entre trauma na infância e perda de funcionalidade em pacientes com FM. A amostra foi estratificada pela presença e ausência de depressão clínica. RESULTADOS: Em geral, o trauma na infância esteve associado com perda de funcionalidade em mulheres adultas com FM. Quando estratificadas por depressão, o modelo de regressão aumentou significativamente a associação em pacientes não deprimidos, mesmo após ajuste para idade e uso de medicação psicotrópica. CONCLUSÕES: Trauma na infância esteve associado de forma clinicamente importante à perda de funcionalidade em mulheres adultas com FM. As associações foram mais pronunciadas nos indivíduos sem depressão comórbida

Racial inequalities in access to women's health care in southern Brazil / Desigualdades raciais no acesso à saúde da mulher no Sul do Brasil

The aim of this population-based cross-sectional study was to investigate access by 20 to 60 year-old women - both black and white - to early detection (pap-smear) exams for breast and cervical cancer in two towns - São Leopoldo and Pelotas - in Rio Grande do Sul State, southern Brazil. Estimates of the association between race/color and access to pap-smear and breast exams were adjusted for income, education, economic class and age. Of the 2,030 women interviewed, 16.1 percent were black and 83.9 percent, white. Black women were significantly less likely to have had a pap-smear and/or breast exam than white women. Racial inequalities in access to cancer early detection exams persisted after controlling for age and other socioeconomic factors. Racial differentials in access to early detection (pap-smear) exams for breast and cervical cancers might result from racial and socioeconomic inequalities experienced by black women in access to reproductive health care services and programs.

O objetivo da pesquisa foi investigar o acesso de mulheres negras e brancas aos exames de detecção precoce de câncer de mama e colo de útero (citopatológico), em duas cidades no Sul do Brasil. Foi realizado um estudo transversal de base populacional realizado com mulheres de 20-60 anos, residentes em São Leopoldo e Pelotas, Rio Grande do Sul, Brasil. As análises foram ajustadas por renda, escolaridade, classe econômica e idade para verificar a associação entre raça/cor e acesso aos exames. Foram entrevistadas 2.030 mulheres, sendo que 16,1 por cento eram negras e 83,9 por cento brancas. A probabilidade das mulheres não realizarem os exames citopatológico e de mama foi significantemente maior nas negras. A desigualdade racial no acesso aos exames de detecção precoce de câncer persistiu após controle para idade e variáveis socioeconômicas. O diferencial na realização dos exames de detecção precoce pode ser um reflexo das desigualdades raciais e socioeconômicas vividas por mulheres negras no acesso aos serviços e ações de atenção à saúde reprodutiva.

Racial inequalities in access to women's health care in southern Brazil.

The aim of this population-based cross-sectional study was to investigate access by 20 to 60 year-old women--both black and white--to early detection (pap-smear) exams for breast and cervical cancer in two towns--São Leopoldo and Pelotas--in Rio Grande do Sul State, southern Brazil. Estimates of the association between race/color and access to Pap-smear and breast exams were adjusted for income, education, economic class and age. Of the 2,030 women interviewed, 16.1% were black and 83.9%, white. Black women were significantly less likely to have had a Pap-smear and/or breast exam than white women. Racial inequalities in access to cancer early detection exams persisted after controlling for age and other socioeconomic factors. Racial differentials in access to early detection (Pap-smear) exams for breast and cervical cancers might result from racial and socioeconomic inequalities experienced by black women in access to reproductive health care services and programs.

[The user's evaluation of the ophthalmologic service offered by SUS (Brazilian Unified Health System) in an urban center in the south of Brazil]. / Avaliação do usuário sobre o atendimento oftalmológico oferecido pelo SUS em um centro urbano no sul do Brasil.

The user's evaluation is an important component of the quality of the health services. The goal of the present study was to evaluate the user's satisfaction with the ophthalmologic service provided by an accredited service of the Brazilian Unified Health System (SUS) in an urban center of the South of Brazil. It is a transversal study in which a questionnaire was applied about the user's socioeconomic and demographic profile, questions related to the quality of the service and suggestions and/or complaints regarding to the attendance and the service. The sample was calculated in the program EPINFO version 6.0, it had as its base 1200 monthly services, in a total of 355 users. The results showed that 77.1% of the users were satisfied with the medical service. However, 75.4% pointed deficiencies related to the time they had to wait in the place, to the duration of the consultation and at the interpersonal relationship with doctor and other attendants. It was verified that 36.3% considered the ophthalmologic service offered by SUS as terrible and regular. This way, it is fundamental to rethink the professional practices and to intervene on the form of organization of this service, seeking its improvement and the user's satisfaction.

Avaliação do usuário sobre o atendimento oftalmológico oferecido pelo SUS em um centro urbano no sul do Brasil / The user's evaluation of the ophthalmologic service offered by SUS (Brazilian Unified Health System) in an urban center in the south of Brazil

A avaliação do usuário é um importante componente da qualidade dos serviços em saúde. O objetivo deste estudo foi avaliar a satisfação do usuário quanto ao atendimento oftalmológico prestado por um serviço credenciado do SUS num centro urbano do Sul do Brasil. Trata-se de um estudo transversal, no qual se aplicou questionário sobre o perfil socioeconômico e demográfico do usuário, questões relacionadas à qualidade do atendimento e sugestões e/ou reclamações referentes ao atendimento e ao serviço. Calculou-se a amostra no programa EPINFO versão 6.0, tendo como base 1.200 atendimentos mensais, totalizando 355 usuários. Os resultados mostraram que 77,1 por cento dos usuários estavam satisfeitos com o atendimento médico. Entretanto, 75,4 por cento apontaram deficiências relacionadas ao tempo de espera no local, à duração da consulta e à relação interpessoal com médico e atendentes. Verificou-se que 36,3 por cento consideraram o serviço oftalmológico oferecido pelo SUS como péssimo e regular. Desta forma, é fundamental repensar as práticas profissionais e intervir sobre a forma de organização deste serviço, visando ao seu aperfeiçoamento e satisfação do usuário.

The user's evaluation is an important component of the quality of the health services. The goal of the present study was to evaluate the user's satisfaction with the ophthalmologic service provided by an accredited service of the Brazilian Unified Health System (SUS) in an urban center of the South of Brazil. It is a transversal study in which a questionnaire was applied about the user's socioeconomic and demographic profile, questions related to the quality of the service and suggestions and/or complaints regarding to the attendance and the service. The sample was calculated in the program EPINFO version 6.0, it had as its base 1200 monthly services, in a total of 355 users. The results showed that 77.1 percent of the users were satisfied with the medical service. However, 75.4 percent pointed deficiencies related to the time they had to wait in the place, to the duration of the consultation and at the interpersonal relationship with doctor and other attendants. It was verified that 36.3 percent considered the ophthalmologic service offered by SUS as terrible and regular. This way, it is fundamental to rethink the professional practices and to intervene on the form of organization of this service, seeking its improvement and the user's satisfaction.

Cárie dentária em escolares residentes em municípios do Rio Grande do Sul, Brasil, com e sem fluoretação nas águas / Dental caries in schoolchildren living in cities of Rio Grande do Sul, Brazil, with and without water fluoridation

Introdução e objetivo: O objetivo deste trabalho foi estudar a prevalência e a severidade da cárie dentária, analisando a influênciade alguns fatores socioeconômicos e a fluoretação das águas de abastecimento público. Material e métodos: O delineamento dapesquisa foi transversal de base escolar realizado mediante informaçõesdo Levantamento Epidemiológico do Rio Grande do Sul e abrangeu 571 escolares de 12 anos da região norte do Rio Grande do Sul, Brasil.Os resultados foram analisados por intermédio do teste de regressão logística binária. Resultados: Após o ajuste dos dados, os escolares residentes em municípios de pequeno porte tiveram três vezes maischances de apresentar cárie do que os moradores de cidades demédio e grande porte (RC = 2,94; IC95% = 1,86-4,64). Conclusão:O porte demográfico do município foi o principal fator associado àexperiência de cárie dentária nos escolares da região norte do Rio Grande do Sul.

Introduction and objectives: The aim of this research was to study the prevalence and severity of dental caries, analyzing the influenceof some socioeconomic factors and the fluoridation of public water supply. Material and methods: A school-based cross-sectional studywas performed based on data collected through the Oral HealthEpidemiological Survey of Rio Grande do Sul, which included 571 12-year-old schoolchildren from the north of Rio Grande do Sul, Brazil.Data was analyzed through binary logistic regression test. Results:After data adjustment, results showed that schoolchildren living insmall-sized cities had 3 times higher odds of having dental caries thanthe ones who live in big and medium-sized cities (OR = 2.94; IC95%= 1.86-4.64). Conclusion: The demographic size of the city was the main factor associated to the dental caries experience in school children from the north of Rio Grande do Sul, Brazil.

Socioeconomic, demographic and lifestyle factors associated with dietary patterns of women living in Southern Brazil.

This study focused on the association between dietary patterns and socio-demographic and lifestyle factors. A population-based cross-sectional study was performed in 1,026 adult women from Southern Brazil. Dietary patterns were identified using principal components analysis. In the multivariable analysis, a Poisson regression model was used to estimate the prevalence ratio and 95%CI. Wealthier women were more likely to follow healthy diets. A Low Cost Healthy Diet was more prevalent among women with a partner, and a High Cost Healthy Diet was more prevalent among women not currently working and who exercised regularly. Women with lower education levels were less likely to follow a Low Cost Healthy Diet, but more likely to follow the Higher-Risk Low Cost Diet. The Low Cost Higher-Risk Diet was more prevalent among women with a lower income. Low and medium cost healthy diets were positively associated with age. The results showed that women's dietary choices are influenced by socioeconomic factors and are not only dependent on food prices.

Socioeconomic, demographic and lifestyle factors associated with dietary patterns of women living in Southern Brazil / Fatores sócio-econômicos, demográficos e de estilo de vida associados com padrões alimentares de mulheres residentes no Sul do Brasil

This study focused on the association between dietary patterns and socio-demographic and lifestyle factors. A population-based cross-sectional study was performed in 1,026 adult women from Southern Brazil. Dietary patterns were identified using principal components analysis. In the multivariable analysis, a Poisson regression model was used to estimate the prevalence ratio and 95 percentCI. Wealthier women were more likely to follow healthy diets. A Low Cost Healthy Diet was more prevalent among women with a partner, and a High Cost Healthy Diet was more prevalent among women not currently working and who exercised regularly. Women with lower education levels were less likely to follow a Low Cost Healthy Diet, but more likely to follow the Higher-Risk Low Cost Diet. The Low Cost Higher-Risk Diet was more prevalent among women with a lower income. Low and medium cost healthy diets were positively associated with age. The results showed that women's dietary choices are influenced by socioeconomic factors and are not only dependent on food prices.

Para identificar fatores relacionados com padrões alimentares, realizou-se um estudo transversal de base populacional com uma amostra de 1.026 mulheres entre 20 a 60 anos, no Sul do Brasil. Os padrões alimentares foram identificados com análise de componentes principais. Razões de prevalência e intervalos de 95 por cento de confiança foram calculados com regressão de Poisson. Após ajustamento, os padrões alimentares saudáveis foram mais prevalentes em mulheres com melhor escolaridade e classe econômica. Padrão Saudável de Baixo Custo foi mais prevalente entre mulheres casadas/união e Padrão Saudável de Alto Custo naquelas que não trabalhavam e tinham atividade física regular. Mulheres com baixa escolaridade foram menos prováveis de seguir o Padrão Saudável de Baixo Custo, e sim mais prováveis de seguir Padrão de Risco de Baixo Custo. O Padrão de Risco de Baixo Custo também foi mais prevalente entre as mulheres de baixa renda. Padrões alimentares saudáveis de médio e baixo custo foram positivamente associados com a idade. Nossos resultados evidenciam a desigualdade sócio-econômica na escolha feminina do padrão alimentar, mas não apenas definida pelo preço dos alimentos.

[Physical violence and associated factors: a population-based study in Southern Brazil]. / Violência física e fatores associados: estudo de base populacional no sul do Brasil.

OBJECTIVE: To estimate the prevalence of physical violence and its association with sociodemographic aspects, stressful life events, and the use of health services due to emotional problems. METHODS: A cross-sectional population-based study was conducted with a sample of 1,954 14-year-old or older inhabitants of the city of Canoas (Southern Brazil). They were selected by means of conglomerate sampling according to a pre-established system. Data were obtained in visits to households by means of a confidential semi-structured questionnaire. A bivariate analysis was carried out through multinomial logistic regression, and the multivariate analysis by polytomous logistic regression, categorizing the outcome by age group. RESULTS: The findings show a prevalence of 9.7% (CI 95%: 8.37;11.03) and association with: women 20 years old and older (OR=2.74; CI 95%: 1.52;4.94); higher schooling rate (p<0.03); higher experience of stressful life events at 20 years of age or more (OR=6.61; CI 95%: 2.71;16.1); and doctors' appointments due to emotional problems as of 10 years of age (p>0.001). CONCLUSIONS: The prevalence of physical violence in the population was significant, resulting in important emotional consequences and impact on health services, requiring capacity building of the professionals in the field.

Violência física e fatores associados: estudo de base populacional no sul do Brasil / Physical violence and associated factors: a population-based study in Southern Brazil / Violencia física y factores asociados: estudio de base poblacional en el sur de Brasil

OBJETIVO: Estimar a prevalência de violência física e sua associação com aspectos sociodemográficos, eventos estressantes e utilização de serviços de saúde por problemas emocionais. MÉTODOS: Estudo transversal de base populacional realizado em amostra de 1.954 sujeitos com 14 anos ou mais, residentes em Canoas, RS, 2002-2003. A amostragem por conglomerados seguiu sistemática pré-estabelecida. Os dados foram coletados em visitas domiciliares com questionário semi-estruturado e confidencial. Foram realizadas as análises: bivariada, por meio de regressão logística multinomial e multivariada, por regressão politômica, categorizando o desfecho por faixa etária. RESULTADOS: Foi encontrada prevalência de 9,7 por cento (IC 95 por cento: 8,37;11,03) e associação com: sexo feminino a partir dos 20 anos de idade (OR=2,74; IC 95 por cento: 1,52;4,94), maior escolaridade (p<0,03), maior vivência de eventos estressantes com 20 anos ou mais (OR=6,61; IC 95 por cento: 2,71;16,1) e consulta por problemas emocionais a partir dos 10 anos de idade (p>0,001). CONCLUSÕES: A prevalência da violência física na população foi significativa, com conseqüências emocionais e impacto nos serviços de saúde, requerendo capacitação dos profissionais da área.

OBJECTIVE: To estimate the prevalence of physical violence and its association with sociodemographic aspects, stressful life events, and the use of health services due to emotional problems. METHODS: A cross-sectional population-based study was conducted with a sample of 1,954 14-year-old or older inhabitants of the city of Canoas (Southern Brazil). They were selected by means of conglomerate sampling according to a pre-established system. Data were obtained in visits to households by means of a confidential semi-structured questionnaire. A bivariate analysis was carried out through multinomial logistic regression, and the multivariate analysis by polytomous logistic regression, categorizing the outcome by age group. RESULTS: The findings show a prevalence of 9.7 percent (CI 95 percent: 8.37;11.03) and association with: women 20 years old and older (OR=2.74; CI 95 percent: 1.52;4.94); higher schooling rate (p<0.03); higher experience of stressful life events at 20 years of age or more (OR=6.61; CI 95 percent: 2.71;16.1); and doctors' appointments due to emotional problems as of 10 years of age (p>0.001). CONCLUSIONS: The prevalence of physical violence in the population was significant, resulting in important emotional consequences and impact on health services, requiring capacity building of the professionals in the field.

OBJETIVO: Estimar la prevalencia de violencia física y sua asociacion con aspectos sociodemográfcos, eventos estresantes y utilizacion de servicios de salud por problemas emocionales. MÉTODOS: Estudio transversal de base poblacional realizado en muestra de 1.954 sujetos con 14 anos o mas, residentes en Canoas, sur de Brasil, 2002-2003. La muestra por conglomerados siguio sistemática pré-estabelecida. Los datos fueron tomados en visitas domiciliarias con cuestionário semi-estructurado y confidencial. Fueron realizadas las analisis: bivariada, por meio de regresión logística multinomial y multivariada, por regresión politómica, según grupo etario. RESULTADOS: Fue encontrada prevalencia de 9,7 por ciento (IC 95 por ciento: 8,37;11,03) y asociación con: sexo feminino a partir dos 20 anos de edad (OR=2,74; IC 95 por ciento: 1,52;4,94), mayor escolaridade (p<0,03), mas vivencia de eventos estresantes con 20 anos o mas (OR=6,61; IC 95 por ciento: 2,71;16,1) y consulta por problemas emocionales a partir de los 10 anos de edad (p>0,001). CONCLUSÕES: La prevalencia de la violencia física en la poblacion fue significativa, con consecuencias emocionales e impacto en los servicios de salud, requiriendo capacitación de los profesionales del área.