[Patterns of variation in the infant mortality rate in Rio Grande do Sul State, Brazil: comparison of empirical Bayesian and fully Bayesian approaches]. / Visualização dos padrões de variação da taxa de mortalidade infantil no Rio Grande do Sul, Brasil: comparação entre as abordagens Bayesiana Empírica e Totalmente Bayesiana.

Infant mortality is considered a sensitive health indicator, and knowledge of its geographical profile is essential for formulating appropriate public health policies. Disease mapping aims to describe the geographical distribution of disease incidence and mortality rates. Due to the heavy instability of crude rates in small areas, methods involving Bayesian smoothing of rates are used, drawing on information for the whole area or neighborhood to estimate the event rate. The current study compares empirical Bayesian (EB) and fully Bayesian (FB) methods for infant mortality rates (accumulated data from 2001 to 2004) in Rio Grande do Sul State, Brazil. This study highlights the advantages of Bayesian estimators for viewing and interpreting maps. For the problem at hand, EB and FB methods showed quite similar results and had the great advantage of easy use by health professionals, since they evenly highlight the main spatial patterns in the mortality rate in the State during the target period.

Visualização dos padrões de variação da taxa de mortalidade infantil no Rio Grande do Sul, Brasil: comparação entre as abordagens Bayesiana Empírica e Totalmente Bayesiana / Patterns of variation in the infant mortality rate in Rio Grande do Sul State, Brazil: comparison of empirical Bayesian and fully Bayesian approaches

A mortalidade infantil é um sensível indicador de saúde. Conhecer o seu perfil geográfico auxilia na formulação de estratégias de saúde pública. O mapeamento de doenças tem por objetivo descrever a distribuição geográfica das taxas de mortalidade ou incidência de doenças por intermédio de mapas. Em razão da alta instabilidade das taxas brutas quando há pequenas áreas, utilizam-se os métodos de suavização bayesiana, que se valem de informações de toda a região ou da vizinhança para estimar as taxas. O artigo faz a comparação entre os métodos Bayesiano Empírico e Totalmente Bayesiano para as taxas de mortalidade infantil (dados acumulados de 2001 a 2004) no Rio Grande do Sul, Brasil. O trabalho aponta as vantagens do uso dos estimadores bayesianos na visualização espacial dos mapas. Os métodos Bayesianos Empíricos apresentaram resultados muito semelhantes aos dos métodos Totalmente Bayesianos e possuem a grande vantagem de ser de fácil utilização por profissionais da área de saúde, destacando igualmente os principais padrões espaciais da taxa de mortalidade no Rio Grande do Sul no período estudado.

Infant mortality is considered a sensitive health indicator, and knowledge of its geographical profile is essential for formulating appropriate public health policies. Disease mapping aims to describe the geographical distribution of disease incidence and mortality rates. Due to the heavy instability of crude rates in small areas, methods involving Bayesian smoothing of rates are used, drawing on information for the whole area or neighborhood to estimate the event rate. The current study compares empirical Bayesian (EB) and fully Bayesian (FB) methods for infant mortality rates (accumulated data from 2001 to 2004) in Rio Grande do Sul State, Brazil. This study highlights the advantages of Bayesian estimators for viewing and interpreting maps. For the problem at hand, EB and FB methods showed quite similar results and had the great advantage of easy use by health professionals, since they evenly highlight the main spatial patterns in the mortality rate in the State during the target period.

[Comparison of simple and multiple imputation methods using a risk model for surgical mortality as example]. / Comparação de métodos de imputação única e múltipla usando como exemplo um modelo de risco para mortalidade cirúrgica.

INTRODUCTION: It is common for studies in health to face problems with missing data. Through imputation, complete data sets are built artificially and can be analyzed by traditional statistical analysis. The objective of this paper is to compare three types of imputation based on real data. METHODS: The data used came from a study on the development of risk models for surgical mortality. The sample size was 450 patients. The imputation methods applied were: two single imputations and one multiple imputation and the assumption was MAR (Missing at Random). RESULTS: The variable with missing data was serum albumin with 27.1% of missing rate. The logistic models adjusted by simple imputation were similar, but differed from models obtained by multiple imputation in relation to the inclusion of variables. CONCLUSIONS: The results indicate that it is important to take into account the relationship of albumin to other variables observed, because different models were obtained in single and multiple imputations. Single imputation underestimates the variability generating narrower confidence intervals. It is important to consider the use of imputation methods when there is missing data, especially multiple imputation that takes into account the variability between imputations for estimates of the model.

Comparação de métodos de imputação única e múltipla usando como exemplo um modelo de risco para mortalidade cirúrgica / Comparison of simple and multiple imputation methods using a risk model for surgical mortality as example

INTRODUÇÃO: A perda de informações é um problema frequente em estudos realizados na área da Saúde. Na literatura essa perda é chamada de missing data ou dados faltantes. Através da imputação dos dados faltantes são criados conjuntos de dados artificialmente completos que podem ser analisados por técnicas estatísticas tradicionais. O objetivo desse artigo foi comparar, em um exemplo baseado em dados reais, a utilização de três técnicas de imputações diferentes. MÉTODO: Os dados utilizados referem-se a um estudo de desenvolvimento de modelo de risco cirúrgico, sendo que o tamanho da amostra foi de 450 pacientes. Os métodos de imputação empregados foram duas imputações únicas e uma imputação múltipla (IM), e a suposição sobre o mecanismo de não-resposta foi MAR (Missing at Random). RESULTADOS: A variável com dados faltantes foi a albumina sérica, com 27,1 por cento de perda. Os modelos obtidos pelas imputações únicas foram semelhantes entre si, mas diferentes dos obtidos com os dados imputados pela IM quanto à inclusão de variáveis nos modelos. CONCLUSÕES: Os resultados indicam que faz diferença levar em conta a relação da albumina com outras variáveis observadas, pois foram obtidos modelos diferentes nas imputações única e múltipla. A imputação única subestima a variabilidade, gerando intervalos de confiança mais estreitos. É importante se considerar o uso de métodos de imputação quando há dados faltantes, especialmente a IM que leva em conta a variabilidade entre imputações para as estimativas do modelo.

INTRODUCTION: It is common for studies in health to face problems with missing data. Through imputation, complete data sets are built artificially and can be analyzed by traditional statistical analysis. The objective of this paper is to compare three types of imputation based on real data. METHODS: The data used came from a study on the development of risk models for surgical mortality. The sample size was 450 patients. The imputation methods applied were: two single imputations and one multiple imputation and the assumption was MAR (Missing at Random). RESULTS: The variable with missing data was serum albumin with 27.1 percent of missing rate. The logistic models adjusted by simple imputation were similar, but differed from models obtained by multiple imputation in relation to the inclusion of variables. CONCLUSIONS: The results indicate that it is important to take into account the relationship of albumin to other variables observed, because different models were obtained in single and multiple imputations. Single imputation underestimates the variability generating narrower confidence intervals. It is important to consider the use of imputation methods when there is missing data, especially multiple imputation that takes into account the variability between imputations for estimates of the model.

Modelo preditivo de óbito a partir de dados do Sistema de Informações Hospitalares / Mortality prediction model using data from the Hospital Information System

OBJETIVO: Desenvolver um modelo preditivo de óbito hospitalar com base nos dados do Sistema de Informações Hospitalares do Sistema Único de Saúde. MÉTODOS: Estudo transversal com dados de 453.515 autorizações de internação de 332 hospitais do Rio Grande do Sul no ano de 2005. A partir da razão entre óbitos observados e óbitos esperados elaborou-se um ranking ajustado dos hospitais que foi comparado ao ranking bruto da taxa de mortalidade. Utilizou-se regressão logística para desenvolvimento do modelo preditivo de probabilidade para óbito hospitalar segundo sexo, idade, diagnóstico e uso de unidade de terapia intensiva. Foram obtidos os intervalos com 95 por cento de confiança para 206 hospitais com mais de 365 internações por ano. RESULTADOS: Obteve-se um índice de risco para mortalidade hospitalar. A ordenação dos hospitais utilizando apenas a taxa de mortalidade bruta diferiu da ordenação quando se utiliza o ranking ajustado pelo modelo preditivo de probabilidade. Dos 206 hospitais analisados, 40 hospitais apresentaram mortalidade observada significativamente superior à esperada e 58 hospitais com mortalidade significativamente inferior à esperada. Uso de unidade de terapia intensiva apresentou maior peso para a composição do índice de risco, seguida pela idade e diagnóstico. Quando os hospitais atendem pacientes com perfis muito diferentes, o ajuste de risco não resulta numa indicação definitiva sobre qual prestador é o melhor. Os hospitais de grande porte apresentaram, no conjunto, maior número de óbitos do que seria esperado de acordo com as características das internações. CONCLUSÕES: O índice de risco de óbito hospitalar mostrou-se preditor adequado para o cálculo dos óbitos esperados, podendo ser aplicado na avaliação do desempenho hospitalar. Recomenda-se que, ao comparar hospitais, seja utilizado o ajuste pelo modelo preditivo de probabilidade de risco, estratificando-se pelo porte do hospital.

Mortality prediction model using data from the Hospital Information System.

OBJECTIVE: To develop a hospital mortality prediction model based on data from the Hospital Information System of the Brazilian National Health System. METHODS: This was a cross-sectional study using data from 453,515 authorizations for hospital admission relating to 332 hospitals in Rio Grande do Sul, Southern Brazil in the year 2005. From the ratio between observed and expected deaths, the hospitals were ranked in an adjusted manner, and this was compared with the crude ranking of the mortality rate. Logistic regression was used to develop a predictive model for the likelihood of hospital mortality according to sex, age, diagnosis and use of an intensive care unit. Confidence intervals (95%) were obtained for the 206 hospitals with more than 365 hospital admissions per year. RESULTS: An index for the risk of hospital mortality was obtained. Ranking the hospitals using only the crude mortality rate differed from the ranking when it was adjusted according to the predictive likelihood model. Among the 206 hospitals analyzed, 40 of them presented observed mortality that was significantly greater than what was expected, while 58 hospitals presented mortality that was significantly lower than expected. Use of an intensive care unit presented the greatest weight in making up the risk index, followed by age and diagnosis. When the hospitals attended patients with widely differing profiles, the risk adjustment did not result in a definitive indication regarding which provider was best. Among this group of hospitals, those of large size presented greater numbers of deaths than would be expected from the characteristics of the hospital admissions. CONCLUSIONS: The hospital mortality risk index was shown to be an appropriate predictor for calculating the expected death rate, and it can be applied to evaluate hospital performance. It is recommended that, in comparing hospitals, the adjustment using the predictive likelihood model for the risk should be used, with stratification according to hospital size.

Relação entre habilidades de processamento auditivo e funções neuropsicológicas em adolescentes / Relation between auditory processing abilities and neuropsychological process in teenagers

OBJETIVO: averiguar a existência de relações entre o desempenho em testes de processamento auditivo e em tarefas cognitivas. MÉTODOS: participaram 12 adolescentes com desenvolvimento típico, estudantes de terceiro ano do Ensino Médio de escolas privadas do estado do Rio Grande do Sul, Brasil, examinados com uma bateria de testes de PA(C) e com o Instrumento de Avaliação Neuropsicológica Breve Neupsilin. Foram realizadas análises de correlação de Pearson e análises qualitativas intertestes para comparação do desempenho na avaliação do PA(C) e na avaliação neuropsicológica. RESULTADOS: da bateria de testes PA(C), os Testes SSI - MCI - Teste de Sentenças Sintéticas com mensagem competitiva ipsilateral, SSW - Teste de Dissílabos Alternados e o teste Dicóticos de Dígitos apresentaram correlação forte significativa positiva (coeficiente de correlação de Pearson) com os subtestes do Neupsilin: atenção - contagem inversa, percepção de faces, linguagem oral automática e repetição, memória verbal episódica e memória de trabalho - span auditivo de palavras em sentenças. Alguns testes do PA(C) apresentaram maior frequência de dissociações com subtestes neuropsicológicos. As correlações encontradas indicam que os testes de PA(C) e as tarefas neuropsicológicas parecem examinar algumas habilidades cognitivas subjacentes em comum. As dissociações observadas sugerem que os processamentos auditivo e neuropsicológico são relativamente independentes e a análise intertestes do desempenho dos participantes na avaliação do PA(C), comparada ao desempenho na avaliação neuropsicológica, confirma os resultados encontrados para as questões anteriores. CONCLUSÃO: ressalta-se a necessidade de se pensar o contexto da administração dos testes de PA(C), considerando-se a relação de complementaridade da avaliação neuropsicológica e do exame de processamento auditivo.

PURPOSE: to check if there is a relation between the performance in auditory processing tests and in cognitive tasks. METHODS: the sample was made up by 12 teenagers in typical development, all of them high-school students (third year) in private schools from Rio Grande do Sul, Brazil. They were evaluated through an auditory processing battery as well as with the Brazilian Brief Neuropsychological Assessment Battery NEUPSILIN. Data analyses included Person's correlation and qualitative interests interpretation towards a comparison of the performance in (C)AP's battery and in the neuropsychological assessment. RESULTS: regarding (C)AP's battery, SSI - MCI - Synthetic Sentence Test with ipsilateral competitive message, SSW - Test of Alternated Disyllables and Digit Dicotics tests showed a significant strong positive correlation with NEUPSILIN's subtests that follows: attention - reverse counting, face perception, oral language - automated language and repetition, episodic verbal memory and working memory - auditory word span in sentences. Some (C)AP's tests presented a greater frequency of dissociation when compared to neuropsychological tasks. Correlation index suggest that (C)AP's tests and neuropsychological tasks seem to evaluate some common basic cognitive abilities. The observed dissociation suggest that auditory and neuropsychological processing are partially independent on each other. The interests analysis confirms these results. CONCLUSION: there is a need to rethink about the administration of (C)AP's tests, when it comes to the addition relation between neuropsychological assessment and auditory processing examination.

[Utilization of fully Bayesian modeling to detect patterns in relative risk variation for infant mortality in Rio Grande do Sul State, Brazil]. / Utilização da modelagem inteiramente bayesiana na detecção de padrões de variação de risco relativo de mortalidade infantil no Rio Grande do Sul, Brasil.

The infant mortality rate is one of the key indicators used to measure a population's quality of life. The State of Rio Grande do Sul has a social and economic indicator called the Socioeconomic Development Index (IDESE). Most studies analyze the infant mortality rate in relation to risk factors, visually aided by maps. This study presents the methodology and an application of a Spatial Epidemiology method called the ecological correlation, using hierarchical Bayesian procedures. The article discusses the main problems found in ecological correlations, such as spatial autocorrelation and the estimator's instability for small areas. To overcome these difficulties, the relative risk estimate obtained by spatial regression analysis using fully Bayesian estimation is presented. The infant mortality rate is analyzed in all 496 municipalities of Rio Grande do Sul for the years 2001 to 2004. Several models with spatial component and different variables from the IDESE/2003 were compared. The model using spatial structure along with the variable 'education' was considered the best choice. With this methodology, it was possible to obtain a more interpretable pattern of infant mortality risk in Rio Grande do Sul.

Utilização da modelagem inteiramente bayesiana na detecção de padrões de variação de risco relativo de mortalidade infantil no Rio Grande do Sul, Brasil / Utilization of fully Bayesian modeling to detect patterns in relative risk variation for infant mortality in Rio Grande do Sul State, Brazil

Neste artigo são analisados os fatores possivelmente associados à mortalidade infantil nos 496 municípios do Rio Grande do Sul, Brasil, com base em dados acumuladas entre os anos de 2001 a 2004, obtidos pela análise de regressão utilizando modelagem inteiramente bayesiana como alternativa para superar a autocorrelação espacial e a instabilidade dos estimadores clássicos, como a taxa bruta e a SMR (Standardised Mortality Ratio). Foram comparadas diferentes especificações de componente espacial e covariáveis, provenientes dos blocos do Índice de Desenvolvimento Sócio-econômico da Fundação de Economia e Estatística (IDESE/FEE-2003). Verificou-se que o modelo que utiliza a estrutura espacial além da covariável educação apresenta melhor desempenho, quando comparado pelo critério DIC (Deviance Information Criterion). Comparando as estimativas das SMR com os riscos relativos obtidos pela modelagem inteiramente bayesiana, foi possível observar um ganho substancial na interpretação e na detecção de padrões de variação do risco de mortalidade infantil nos municípios do Rio Grande do Sul ao utilizar essa modelagem. A região da Serra Gaúcha destacou-se com baixo risco relativo e estimativas muito homogêneas.

The infant mortality rate is one of the key indicators used to measure a population's quality of life. The State of Rio Grande do Sul has a social and economic indicator called the Socioeconomic Development Index (IDESE). Most studies analyze the infant mortality rate in relation to risk factors, visually aided by maps. This study presents the methodology and an application of a Spatial Epidemiology method called the ecological correlation, using hierarchical Bayesian procedures. The article discusses the main problems found in ecological correlations, such as spatial autocorrelation and the estimator's instability for small areas. To overcome these difficulties, the relative risk estimate obtained by spatial regression analysis using fully Bayesian estimation is presented. The infant mortality rate is analyzed in all 496 municipalities of Rio Grande do Sul for the years 2001 to 2004. Several models with spatial component and different variables from the IDESE/2003 were compared. The model using spatial structure along with the variable "education" was considered the best choice. With this methodology, it was possible to obtain a more interpretable pattern of infant mortality risk in Rio Grande do Sul.

Relationship between oral clinical conditions and daily performances.

The aim of this study was to assess the impact of oral status on the daily performances of civil servants from the Public Works and Waste Management Department of the city of Porto Alegre, located in Southern Brazil. A cross-sectional study was conducted on a representative sample composed of 276 civil servants with ages ranging from 35 to 44 years. The Oral Impacts on Daily Performances index developed was employed to measure impacts caused by oral clinical conditions. Oral examinations were performed after the interviews. Multinomial Logistic Regression Analysis was used. After adjusting for sex and educational level, the results showed that the subjects with high DMFT scores were 5.8 times (95% CI = 2.1-16.1) more likely to have high impacts on their everyday life than those with low DMFT scores. Subjects that presented some coronal caries were 4.3 times (95% CI = 1.9-9.8) more likely to have high impacts on their everyday life than those with no coronal caries. Dental status assessed through the DMFT index and coronal caries are important indicators of impacts on the everyday life of the studied population.

[Multiple imputations for missing data: a simulation with epidemiological data]. / Uso da imputação múltipla de dados faltantes: uma simulação utilizando dados epidemiológicos.

In situations with missing data, statistical analyses are usually limited to subjects with complete data. However, such estimates may be biased. The method of 'filling in' missing data is called imputation. This article aimed to present a multiple imputation method. From a data set of 470 surgical patients, logistic models were developed for death as the outcome. Two incomplete data sets were generated: one with 5% and another with 20% of missing data in a single variable. Logistic models were fitted for the complete and incomplete data sets and for the data set completed by multiple imputations. Estimates obtained for the data set with missing data were different from those observed in the complete data set, mainly in the situation with 20% of missing data. The multiple imputation used here appeared efficient, producing very similar results to those obtained with the complete data set. However, one coefficient became non-significant. The analysis using multiple imputations was considered superior to using the data sets that excluded incomplete cases from the analysis.

Uso da imputação múltipla de dados faltantes: uma simulação utilizando dados epidemiológicos / Multiple imputations for missing data: a simulation with epidemiological data

Em situações com dados faltantes, é comum restringir-se à análise dos sujeitos com dados completos. Porém, as estimativas com apenas esses sujeitos podem tornar-se viesadas. A prática de preenchimento de dados faltantes é a chamada técnica de imputação. Este trabalho tem como objetivo divulgar o método de imputação múltipla. Em um conjunto de dados de 470 pacientes cirúrgicos, foram ajustados modelos logísticos para o desfecho óbito. Foram gerados dois conjuntos de dados incompletos: um com 5 por cento e outro com 20 por cento de dados faltantes para uma variável. Foram ajustados modelos para o conjunto completo, com dados faltantes e para o conjunto completado por imputação múltipla. As estimativas obtidas pela análise dos conjuntos com dados faltantes e com o conjunto completo foram diferentes, principalmente as do conjunto com 20 por cento de dados faltantes. A imputação múltipla utilizada pareceu eficiente, pois os resultados conseguidos com o banco completado por imputações foram próximos dos obtidos com o conjunto completo. Porém, um coeficiente deixou de ser estatisticamente significativo. A imputação múltipla se mostrou superior à análise do conjunto com dados faltantes, que desconsiderou os casos incompletos.

In situations with missing data, statistical analyses are usually limited to subjects with complete data. However, such estimates may be biased. The method of "filling in" missing data is called imputation. This article aimed to present a multiple imputation method. From a data set of 470 surgical patients, logistic models were developed for death as the outcome. Two incomplete data sets were generated: one with 5 percent and another with 20 percent of missing data in a single variable. Logistic models were fitted for the complete and incomplete data sets and for the data set completed by multiple imputations. Estimates obtained for the data set with missing data were different from those observed in the complete data set, mainly in the situation with 20 percent of missing data. The multiple imputation used here appeared efficient, producing very similar results to those obtained with the complete data set. However, one coefficient became non-significant. The analysis using multiple imputations was considered superior to using the data sets that excluded incomplete cases from the analysis.

Relationship between oral clinical conditions and daily performances

The aim of this study was to assess the impact of oral status on the daily performances of civil servants from the Public Works and Waste Management Department of the city of Porto Alegre, located in Southern Brazil. A cross-sectional study was conducted on a representative sample composed of 276 civil servants with ages ranging from 35 to 44 years. The Oral Impacts on Daily Performances index developed wasemployed to measure impacts caused by oral clinical conditions. Oral examinations were performed after the interviews. Multinomial Logistic Regression Analysis was used. After adjusting for sex and educational level, the results showed that the subjects with high DMFT scores were 5.8 times (95% CI = 2.1-16.1) more likely to have high impacts on their everyday life than those with low DMFT scores. Subjects that presented some coronal caries were 4.3 times (95% CI = 1.9-9.8) more likely to have high impacts on their everyday life than those with no coronal caries. Dental status assessed through the DMFT index and coronal caries are important indicators of impacts on the everyday life of the studied population.

Brazilian version of the Protocole Montréal d'Evaluation de la Communication (Protocole MEC): normative and reliability data.

The lack of standardized instruments to evaluate communication disorders related to the right hemisphere was verified. A new evaluation tool was developed: Protocole Montréal d'Evaluation de la Communication--Protocole MEC, adapted to Brazilian Portuguese--Bateria Montreal de Avaliação da Comunicação--Bateria MAC (Montreal Evaluation of Communication Battery). The purpose was to present stratified normative data by age and educational level, and to verify the reliability parameters of the MEC Battery. 300 individuals, between the ages of 19 and 75 years, and levels of formal education between 2 and 35 years, participated in this study. They were divided equally into six normative groups, according to three age categories (young adults, intermediary age, and seniors) and two educational levels (low and high). Two procedures were used to check reliability: Cronbach alpha and reliability between evaluators, Results were established at the 10th percentile, and an alert point per task for each normative group. Cronbach's alpha was, in general, between .70 and .90 and the average rate of agreement between evaluators varied from .62 to .94. Standards of age and education were established. The reliability of this instrument was verified. The psychometric legitimization of the MEC Battery will contribute to the diagnostic process for communicative disorders.

Biomonitoring of genotoxicity using micronuclei assay in native population of Astyanax jacuhiensis (Characiformes: Characidae) at sites under petrochemical influence.

Bom Jardim brook is a small stream that flows through an area under the influence of a Petrochemical Complex, demanding control over its quality, so a genotoxic evaluation was performed. This study was conducted in situ, based on previous analysis on the same subject. These were performed both in vitro, with Salmonella typhimurium and human lymphocytes, and in vivo, using bioassays with fish exposed to water from the study area. The purpose of this research was to assess the quality of the aquatic environment and possible effects from petrochemical pollution to surrounding native populations. Micronuclei (MNE) and nuclear abnormalities (NA) frequencies in peripheral blood of Astyanax jacuhiensis, a native fish species collected from the study area, were used as biomarkers. Study period was from summer/99 to spring/2001, using samples obtained seasonally at two ponds upstream from the industrial area (BJN and BJPa) and two sites in Bom Jardim brook (BJ002 and BJ000), which are subject to Complex influence. MNE and NA frequencies found in individuals from BJ002 and BJ000 were similar, showing positive genotoxic responses related to control sites BJN and BJPa. No differential sensitivity could be verified for micronuclei induction between genders of A. jacuhiensis in the studied population. This study showed that sites subject to petrochemical influence were under higher genotoxic impact. Biomarkers adequacy to the case and the sensitivity of A. jacuhiensis for water monitoring could be also inferred.

Right hemisphere damage: Communication processing in adults evaluated by the Brazilian Protocole MEC - Bateria MAC.

Right-brain-damaged individuals may present discursive, pragmatic, lexical-semantic and/or prosodic disorders. OBJECTIVE: To verify the effect of right hemisphere damage on communication processing evaluated by the Brazilian version of the Protocole Montréal d'Évaluation de la Communication (Montreal Communication Evaluation Battery) - Bateria Montreal de Avaliação da Comunicação, Bateria MAC, in Portuguese. METHODS: A clinical group of 29 right-brain-damaged participants and a control group of 58 non-brain-damaged adults formed the sample. A questionnaire on sociocultural and health aspects, together with the Brazilian MAC Battery was administered. RESULTS: Significant differences between the clinical and control groups were observed in the following MAC Battery tasks: conversational discourse, unconstrained, semantic and orthographic verbal fluency, linguistic prosody repetition, emotional prosody comprehension, repetition and production. Moreover, the clinical group was less homogeneous than the control group. CONCLUSIONS: A right-brain-damage effect was identified directly, on three communication processes: discursive, lexical-semantic and prosodic processes, and indirectly, on pragmatic process.

Os indivíduos com lesão vascular de hemisfério direito podem apresentar distúrbios discursivos, pragmáticos, léxico-semânticos e/ou prosódicos. OBJETIVO: Verificar o efeito da lesão de hemisfério direito no processamento comunicativo avaliado pela versão Brasileira do Protocole Montréal d'Évaluation de la Communication ­ Bateria Montreal de Avaliação da Comunicação, Bateria MAC (em português). MÉTODOS: Participaram do estudo um grupo clínico, com 29 adultos lesados de hemisfério direito, e um grupo controle, com 58 adultos sem lesão neurológica. Foram administrados um questionário de dados socioculturais e aspectos da saúde e a Bateria MAC. RESULTADOS: Houve diferenças significativas entre os grupos clínico e controle nas tarefas da Bateria MAC discurso conversacional, evocação lexical livre, com critério ortográfico e semântico, prosódia lingüística repetição, prosódia emocional compreensão, repetição e produção. Além disso, o grupo clínico mostrou-se menos homogêneo do que o controle. CONCLUSÕES: Identificou-se o efeito da lesão de hemisfério direito em três processamentos comunicativos: discursivo, léxico-semântico e prosódico e, indiretamente, no processamento pragmático.

Adolescentes e uso de preservativos: as escolhas dos jovens de três capitais brasileiras na iniciação e na última relação sexual / Teenagers and condom use: choices by young Brazilians from three Brazilian State capitals in their first and last sexual intercourse

O uso de preservativos pelos jovens aumentou, o que não significa que sejam utilizados em todas as relações sexuais; além disso, seu uso varia durante a trajetória afetivo-sexual. Estudou-se a prevalência e fatores associados ao uso de preservativo na iniciação sexual e na última relação sexual, para moças e rapazes de 18-24 anos. Os dados são da Pesquisa GRAVAD, um estudo transversal com amostra probabilística estratificada, através de entrevistas domiciliares, em três capitais brasileiras. Na análise, utilizou-se regressão logística multinomial seguindo modelo hierarquizado. A prevalência de uso de preservativo na iniciação, dentre os usuários de métodos contraceptivos, foi 80,7 por cento pelas moças e 88,6 por cento pelos rapazes. Este uso cai para 38,8 por cento e 56 por cento, respectivamente, na última relação. Nos dois eventos, o uso de preservativo esteve associado, para ambos os sexos, ao pertencimento social e à idade da iniciação. A utilização do preservativo na iniciação determina o uso na última relação (OR = 2,42 para os rapazes e 1,89 para as moças). O maior uso de preservativo entre os jovens não implica uso continuado. As moças utilizaram menos preservativo, comparadas aos rapazes, nos eventos estudados.

[Teenagers and condom use: choices by young Brazilians from three Brazilian State capitals in their first and last sexual intercourse]. / Adolescentes e uso de preservativos: as escolhas dos jovens de três capitais brasileiras na iniciação e na última relação sexual.

Condom use has increased among Brazilian youth, although condoms are not used in all sexual relations; in addition, their use varies over the course of an individual's affective and sexual history. This study focused on the prevalence and factors associated with condom use during sexual initiation and in the most recent sexual relations in young men and women (18-24 years of age). The data are from the GRAVAD Research Project, a cross-sectional study with a stratified probabilistic sample using household interviews in three Brazilian State capitals. The analysis used multinomial logistic regression with a hierarchical model. Prevalence of condom use in first sexual intercourse among individuals who used any contraceptive method was 80.7% for females and 88.6% for males. This proportion dropped to 38.8% and 56%, respectively, for the most recent intercourse. In both events, and for both genders, condom use was associated with social belonging and age at initiation. Condom use at sexual initiation was correlated with use in the most recent intercourse (OR = 2.42 for males and 1.89 for females). Increased condom use among youth does not mean continuing use. Women used condoms less than men in the events studied here.

Reproductive outcomes in an area adjacent to a petrochemical plant in southern Brazil.

OBJECTIVE: To evaluate possible adverse reproductive outcomes in an area adjacent to a petrochemical plant in southern Brazil. METHODS: A review of 17,113 birth records of the main hospital of the municipality of Montenegro, southern Brazil, from 1983 to 1998 was carried out. Three groups of cases were selected: (1) newborns with major congenital malformations; (2) newborns with low birth weight (<2,500 g); and (3) stillborns (>500 g). A control was assigned to each case. Controls were the first newborns weighing

Reproductive outcomes in an area adjacent to a petrochemical plant in southern Brazil

OBJETIVO: Avaliar os possíveis riscos reprodutivos em uma regiäo próxima a pólo petroquímico situado no Rio Grande do Sul. MÉTODOS: Foram analisados 17.113 registros de nascimentos ocorridos no principal hospital da regiäo, localizado no município de Montenegro, RS, desde 1983 até 1998. Foram selecionados três diferentes grupos de casos: (1) recém-nascidos portadores de malformaçöes congênitas maiores; (2) recém-nascidos com baixo peso ao nascer (<2.500 g); e (3) natimortos (>500 g). Para cada caso, foi atribuído um controle específico, que foi a primeira criança nascida viva, pesando 2.500 g ou mais, com ausência de malformaçöes e tendo o mesmo sexo que o caso em questäo. A residência materna durante a gravidez foi utilizada como um parâmetro para exposiçäo. Para a análise estatística, foram usados os testes qui-quadrado ou Fisher, "odds ratio", nível de significância de 0,05 e intervalo de confiança de 95 por cento. RESULTADOS: Foi encontrada correlaçäo positiva para baixo peso ao nascer e para proximidade geográfica da residência materna ao Pólo Petroquímico ["odds ratio" (OR) = 1,66; 95por cento confidence interval (CI) = 1,01-2,72] ou residência na direçäo preferencial do vento ["odds ratio" (OR) = 1,62; 95 por cento confidence interval (CI) = 1,03-2,56]. Quando outras variáveis foram incluídas na análise de regressäo logística condicional (fumo, doenças crônicas e idade materna), essa associaçäo desapareceu. CONCLUSOES: Apesar de os resultados finais terem sido negativos, o baixo peso ao nascer pode ser um bom parâmetro para medir a contaminaçäo ambiental, mas deve ser monitorado na regiäo estudada