During the latest decade Somali-born women with experiences of long-lasting war followed by migration have increasingly encountered Swedish maternity care, where antenatal care midwives are assigned to ask questions about exposure to violence. The overall aim in this thesis was to gain deeper understanding of Somali-born women’s wellbeing and needs during the parallel transitions of migration to Sweden and childbearing, focusing on maternity healthcare encounters and violence. Data were obtained from medical records (paper I), qualitative interviews with Somali-born women (II, III) and Swedish antenatal care midwives (IV). Descriptive statistics and thematic analysis were used. Compared to pregnancies of Swedish-born women, Somali-born women’s pregnancies demonstrated later booking and less visits to antenatal care, more maternal morbidity but less psychiatric treatment, less medical pain relief during delivery and more emergency caesarean sections and small-for-gestational-age infants (I). Political violence with broken societal structures before migration contributed to up-rootedness, limited healthcare and absent state-based support to women subjected to violence, which reinforced reliance on social networks, own endurance and faith in Somalia (II). After migration, sources of wellbeing were a pragmatic “moving-on” approach including faith and motherhood, combined with social coherence. Lawful rights for women were appreciated but could concurrently risk creating power tensions in partner relationships. Generally, the Somali-born women associated the midwife more with providing medical care than with overall wellbeing or concerns about violence, but new societal resources were parallel incorporated with known resources (III). Midwives strived for woman-centered approaches beyond ethnicity and culture in care encounters, with language, social gaps and divergent views on violence as potential barriers in violence inquiry. Somali-born women’s strength and contentment were highlighted, and ongoing violence seldom encountered according to the midwives experiences (IV). Pragmatism including “moving on” combined with support from family and social networks, indicate capability to cope with violence and migration-related stress. However, this must be balanced against potential unspoken needs at individual level in care encounters.With trustful relationships, optimized interaction and networking with local Somali communities and across professions, the antenatal midwife can have a “bridging-function” in balancing between dual societies and contribute to healthy transitions in the new society.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Hypertension and nutrition: Fat-soluble vitamins A, D and E Weber J1 , Vlcek J1 , Suarez-Varella MM2 1 Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University in Prague, Czech Republic 2 Department of Preventive Medicine and Public Health, Faculty of Pharmacy, University of Valencia, Spain Arterial hypertension (AH) is a disease affecting population globally, and thus considered as a problem of public health and socioeconomic. Studies are trying to identify the connection between diet and the prevalence of arterial hypertension. Objective of the study was to determine possible association between an occurrence of AH and fat-soluble vitamins A, D and E intake. The nested, case-control population study investigation was grounded on database from the Spanish Hortega study, and performed on a random sample of 1,514 people (50.3 % women, 49.7 % men). From this sample we selected those aged ≥ 40 years old and untreated for hypertension and divided them into two groups: non-hypertensive (n = 429; 63.6 %) (controls), and newly diagnosed AH (n = 246; 36.4 %) (cases). Biochemical and anthropometric measurements, data on dietary intakes, education, socioeconomic status, place of residence, health habits, comorbidities, consumption of alcohol and tobacco were used for our...

Tradicionalmente o planejamento de provisão de internações baseia-se em comparações nacionais e internacionais em vez da eficácia de políticas de curta e de longa permanência. Estudos sobre as causas e consequências das internações psiquiátricas de longa permanência têm uma relação direta ao tamanho e provisão de instalações que têm um maior impacto sobre como os recursos são utilizados.Objetivo:Identificar fatores de exposição associados ao tempo de permanência prolongado em internações psiquiátricas.Metodologia: estudo caso controle realizado no hospital psiquiátrico de Uberaba. Os casos foram todos os pacientes com internações com permanência superior a 60 dias contínuos no período de janeiro de 2014 a dezembro de 2014. Os controles escolhidos aleatoriamente, pareados por sexo e idade. Características epidemiológicas e sociodemográficas relacionadas às internações psiquiátricas de longa permanência foram descritas e realizadas comparações entre as diversas variáveis. Análise multivariada por regressão logística foi realizada para determinar variáveis preditoras de internação psiquiátrica de longa permanência.Resultados:selecionou-se 216 pacientes, 72 casos (5,5% do total de internações) e 144 controles; 63,9% do sexo masculino; a média de idade foi de 44,4 anos (DP±11,9); a procedência distribuiu-se entre 53% do próprio município de Uberaba e o restante entre 43 outros; o tempo de permanência foi de 84,8 dias (DP±31,4; IC95%: 77,4-92,2) entre os casos e de 33,2 dias (DP±10,8; IC95%: 31,5-35,1) entre os controles (p<0,05). A média do tempo de permanência para pacientes com motivo de internação com risco para si ou terceiros foi de 38,7 dias (DP±24,1) e para os com motivo sem tal risco foi de 59,3 dias (DP±33,7) (p<0,05). Houve associação com o desfecho, em análises univariadas e multivariadas por regressão logística do motivo da internação por incapacidade de autocuidado e/ou falência do suporte familiar e/ou social (OR 3,61; [IC95%: 1,91-6,82]). Conclusão:os resultados do estudo concordam com a literatura internacional. Em nosso país não existem estudos de custo-eficácia deste tema. Recomenda-se mais estudos analíticos que investiguem a qualidade de vida de pessoas que tenham internações psiquiátricas de longa permanência, visando tanto o processo de planejamento da alta e o pós alta, utilizando critérios amplos sem focalizar categorias definidas de doenças. / Background:Traditionally, hospitalisation planning is based on national and international comparisons rather than the effectiveness of short-term and longterm policies. Studies on the causes and consequences of long-stay psychiatric hospitalisations have a direct relationship to the size and provision of facilities that have a greater impact on how the resources are used. Objective: To identify exposure factors associated with long stay in psychiatric hospitalizations. Methods: a case control study performed at the psychiatric hospital of Uberaba, Minas Gerais. Cases were all patients with hospitalisations with stay over 60 continuous days from January 2014 to December 2014. The randomly chosen controls, matched by sex and age. Epidemiological and sociodemographic characteristics related to long-stay psychiatric hospitalisations were described and comparisons were made between the several variables. Multivariate analysis by logistic regression was performed to determine predictors of long-stay psychiatric hospitalisation. Results: 216 patients were selected, 72 cases (5.5% of all hospitalisations) and 144 controls; 63.9% male; the mean age was 44.4 years (± 11.9); the origin was distributed between 53% of Uberaba itself and the rest among 43 other cities; the length of stay was 84.8 days (± 31.4; CI95%: 77,4-92,2) between the cases and 33.2 days (± 10.8; CI95%: 31,5-35,1) between the controls (p <0.05). The mean length of stay for patients with risk for themselves or others was 38.7 days (± 24.1) and for those without that risk was 59.3 days (± 33.7) (p <0, 05). There was an association with the outcome in univariate and multivariate analyzes by logistic regression of the reason for hospitalisation due to incapacity for selfcare and/or family and/or social support failure (OR 3.61; 95% CI: 1.91-6.82 ]). Conclusions: the results of the study agree with the international literature. In our country there are no cost-effectiveness studies of this topic. More analytical studies are recommended that investigate the quality of life of people with longstay psychiatric hospitalisations, aiming at both discharge process and postdischarge planning, using broad criteria without focusing on defined categories of diseases.

A Leishmaniose Visceral Canina é uma doença na qual o ciclo de transmissão envolve a interação de vetores, parasitas, reservatórios e hospedeiros além de componentes ambientais, sociais, e biológicos, que tornam complexa a compreensão da dinâmica desta doença nas regiões endêmicas. Este estudo epidemiológico transversal de tipo caso controle objetivou a identificação de fatores sociodemográficos, socioeconômicos, ambientais, da dinâmica populacional canina e do estilo de vida dos cães, associados à ocorrência de Leishmaniose Visceral Canina no município de Panorama, estado de São Paulo, Brasil. Para a identificação destes fatores foi realizada um inquérito epidemiológico nos domicílios com cães positivos e negativos a Leishmaniose Visceral diagnosticados por sorologia no anos 2012 e 2013. Mediante um modelo de regressão logística foram considerados como fatores de risco para a ocorrência de Leishmaniose Visceral Canina: cães não castrados, cães que dormem fora de casa, famílias com renda inferior a três salários mínimos, presença de vegetação próximo do domicilio, não ter vidro na janela, ter vasos com plantas, ter arvores no quintal e aquisição de um cão no último ano. O desenvolvimento deste trabalho auxilia no programa de prevenção e controle da Leishmaniose Visceral Canina do Município de Panorama, mediante a identificação dos principais fatores de risco determinantes para a manutenção da doença. Este estudo demonstrou a presença de fatores de risco sujeitos a modificações por parte da população e das autoridades sanitárias que poderiam contribuir para a redução do risco de transmissão da doença em Panorama, sendo elas: a ordenação do ambiente no peri-domicílio pela redução de matéria orgânica e entulho que poderiam servir como local para reprodução e abrigo da população vetora, a modificação da relação com os cães de modo a aumentar a supervisão e a promoção do uso de medidas de proteção individual (coleira, repelentes, vacina) para a proteção da população canina nesta localidade. / Canine Visceral Leishmaniasis is a disease in which the transmission cycle involves the interaction of vectors, parasites, as well as reservoir hosts and environmental, social, and biological factors, making it very complex to understand the dynamic of this disease in endemic regions. This cross-sectional case-control epidemiological study aimed to identify risk factors for the occurrence of Canine Visceral Leishmaniasis in the city of Panorama, São Paulo, Brazil. An epidemiological survey was done to identify sociodemographic, socioeconomics, environmental, canine population dynamics and dogs life style factors, in households with positive and negative dogs diagnosed by serology in the years 2012 and 2013 in the city of Panorama. A logistic regression model was developed to take into account risk factors for the occurrence of Canine Visceral Leishmaniasis: intact dogs, dogs sleeping away from home, families with lower income, vegetation near the households, windows with no glass panels, potted plants, the presence of trees in the yard and the acquisition of a dog in the last year. The development of this work helps in the prevention and control program of Canine Visceral Leishmaniasis in the city of Panorama by the management of the determinant risk factors that maintain the disease. This study demonstrated the presence of some risk factors that are subject to modifications by the population and the health authorities and that could produce a reduction in the risk of disease transmission in Panorama: environmental ordination in areas around the houses with reduction of organic matter and rubbish that could serve as a place for the reproduction and shelter of the vector population, and the modification of the relationship with dogs promoting the use of individual protective measures (collar, repellents, vaccine etc.) to contribute to the protection of the dog population in this locality.

Introdução: A prevalência de nascimento pré-termo vem aumentando nos últimos anos e é atualmente um problema de saúde pública mundial, sendo responsável por significante mortalidade neonatal e morbidades infantil e na vida adulta. As causas são multifatoriais e estão relacionadas às dimensões socioeconômica, psicossocial e biológica que se interrelacionam e se sobrepõem. Os fatores de risco diferem entre as populações e grupos étnicos, no entanto, ainda não estão claros quais e como os determinantes etiológicos estão envolvidos. As estratégias de cuidado pré-natal desenvolvidas tem sido insuficientes para a prevenção. Objetivo: estudar os fatores de risco para o nascimento pré-termo em crianças nascidas de partos hospitalares de mães residentes no município de Campina Grande/PB, Brasil. Métodos: O desenho foi um caso-controle de base populacional, que foi realizado no período de junho de 2008 a maio de 2009. Os casos foram nascidos com menos de 37 semanas gestacionais e os controles os nascidos com 37 semanas ou mais. A idade gestacional foi definida em semanas utilizando-se critérios de seleção baseados na acurácia da estimativa. Foram realizadas entrevistas com as mães e coleta de registros hospitalares. Foram selecionados 341 casos e 424 controles. A análise foi baseada em modelo de regressão múltipla hierarquizada. Resultados: os fatores de risco para nascimento pré-termo foram: filho anterior pré-termo (OR=2,32; IC 95%: 1,25-4,29), assistência pré-natal inadequada (categoria II três ou mais prérequisitos negativos) (OR=2,15; IC 95%: 1,40-3,27), ganho ponderal materno insuficiente (OR=2,33; IC 95%: 1,45-3,75), dano físico materno durante a gestação (OR=2,10; IC 95%: 1,22-3,60), hipertensão arterial na gestação com eclâmpsia (OR=17,08; IC 95%: 3,67-79,43) e sem eclâmpsia (OR=6,42; IC 95%: 3,50-11,76), internação durante a gestação (OR=5,64; IC 95%: 3,47-9,15), alteração do volume amniótico (OR=2,28; IC 95%: 1,32-3,95); sangramento vaginal (OR=1,54; IC 95%: 1,01-2,34) e gestação múltipla (OR=22,65; IC 95%: 6,22-82,46). Segundo o mesmo modelo, a renda familiar per capita menor que um salário mínimo foi fator protetor (OR=0,63; IC 95%: 0,39-0,99). Conclusão: Os fatores de risco foram semelhantes ao observado em outros estudos nacionais e internacionais, a não ser para o resultado da variável do nível socioeconômico. A elevada prevalência da pobreza e baixa escolaridade, maior que em estudos realizados na Região Sul, tanto nos casos como nos controles, pode ter contribuído para esse resultado. Estudos adicionais são necessários para o aprofundamento do conhecimento sobre a complexidade das cadeias causais no parto pré-termo, em diferentes contextos e a diferenciação pelos subtipos, espontâneo e indicado / Introduction: The prevalence of preterm birth has increased in recent years and it is currently a worldwide public health problem, being responsible for significant neonatal mortality and morbidity in childhood and adulthood. The causes are multifactorial and related to socioeconomic, psychosocial and biological factors that interrelate and overlap. Risk factors differ between ethnic groups and populations, however, it is not yet clear which are and how the etiological determinants are involved. Strategies for prenatal care have been developed enough for prevention. Objective: To study the risk factors for preterm birth in newborn of hospital deliveries by mothers, residents in the city of Campina Grande/PB, Brazil. Methods: The study design was a case-control population-based, which was conducted from June 2008 to May 2009. Cases were born at less than 37 weeks of gestation and controls, at 37 weeks or more. Gestational age in weeks was defined using selection criteria based on the accuracy of the estimate. Interviews were conducted with mothers and collection of hospital records. It was selected 341 cases and 424 controls. The analysis was based a logistic multiple regression model, based on a hierarchized conceptual modelling approach. Results: The risk factors for preterm birth were: previous preterm birth (OR=2,32; 95%CI: 1,25-4,29), inadequate prenatal care (category II three or more negative prerequisites) (OR=2,15; 95%CI: 1,40- 3,27), inadequate maternal weight gain (OR=2,33; 95%CI: 1,45-3,75), physical damage to the mother during pregnancy (OR=2,10; 95%CI: 1,22-3,60), hypertension pressure (OR=17,08; 95%CI: 3,67-79,43), hospitalization during pregnancy (OR=5,64; 95%CI: 3,47-9,15), amniotic fluid volume changes (OR=2,28; 95%CI: 1,32-3,95), vaginal bleeding (OR=1,54; 95%CI: 1,01-2,34) and multiple gestation (OR=22,65; 95%CI: 6,22-82,46). According to the model, the per capita income less than the minimum wage was a protective factor (OR=0,63; 95%CI: 0,39-0,99). Conclusion: The risk factors were similar to those observed in other national and international studies, except for the result of varying socioeconomic level. The high prevalence of poverty and low educational level, higher than in studies in the South in both outcomes, may have contributed to this result. Further studies are needed on the complexity of causal chains in preterm delivery in different contexts and differentiation by subtypes, spontaneous and indicated

Para verificar a contribuição da audiometria em altas freqüências (9 a 20 kHz) e das emissões otoacústicas - produto de distorção para a identificação de alterações auditivas em indivíduos com desordem pigmentar do tipo vitiligo, 30 indivíduos portadores de vitiligo foram avaliados audiologicamente, e comparados a um grupo controle. Tanto para as altas freqüências (9 a 20 kHz) como para as emissões otoacústicas foram observadas diferenças significantes entre os grupos, que não foram evidenciadas na audiometria convencional (0,25 a 8 kHz). Os resultados sugerem prejuízo nas funções auditivas para o grupo com desordem pigmentar do tipo vitiligo. / In order to verify the contribution of the high frequency audiometry (9 to 20 kHz) and distortion product- otoacoustic emissions for the identification of auditory impairments in individuals with pigmentary disorder type vitiligo, 30 individuals with vitiligo were evaluated, and compared with a control group. As much for the high frequencies (9 the 20 kHz) as for the otoacoustic emissions, significant differences were observed between the groups, that were not evidenced in the conventional audiometry (0,25 the 8 kHz). The results suggest damage in the auditory functions for the group with pigmentary disorder type vitiligo

Introdução: A prematuridade resulta de diferentes fatores inter-relacionados, que podem variar em diferentes culturas. Os avanços tecnológicos têm provido melhores condições de atendimento e sobrevida das crianças que nasceram prematuramente, porém, as causas desses nascimentos ainda são pouco conhecidas. Objetivo: Identificar fatores maternos e neonatais associados à prematuridade no município de Porto Alegre. Método: Estudo do tipo caso-controle de base populacional. Os casos foram recém-nascidos com menos de 37 semanas de gestação, e os controles foram os recém-nascidos com 37 semanas ou mais. Os dados provieram dos registros de nascimentos do município de Porto Alegre referentes ao ano de 2012 que constam no Sistema de Informações sobre Nascidos Vivos da Secretaria Municipal da Saúde. Foram alocados 767 casos e 1.534 controles, em um desenho de um caso para dois controles (1:2), mediante randomização simples. As variáveis estudadas foram alocadas em três blocos, representando diferentes níveis de hierarquia: variáveis sociodemográficas, história reprodutiva e fatores gestacionais e de nascimento. A análise de Regressão Logística Hierárquica multivariada foi utilizada. Resultados: No modelo final, foi encontrada associação estatisticamente significante ao nascimento prematuro para as seguintes variáveis: no Bloco 1, idade materna menor que 19 anos (OR=1,32; IC 95%: 1,02 – 1,71) e >34 anos (OR=1,39; IC 95%: 1,12 – 1,72) e escolaridade materna inadequada para a idade (OR=2,11; IC 95%: 1,22 – 3,65); no Bloco 2, nenhuma variável permaneceu associada à prematuridade; no Bloco 3, gravidez múltipla (OR=1,14; IC 95%: 1,01 – 1,29), cesariana (OR=1,15; IC 95%: 1,03 – 1,29), peso ao nascer menor a 2.500g (OR=4,04; IC 95%: 3,64 – 4,49), Índice de Apgar no 5° minuto de zero a três (OR=1,47; IC 95%: 1,12 – 1,91) e pré-natal inadequado (OR=1,18; IC 95%: 1,02 – 1,36). Conclusão: O aumento da prevalência da prematuridade é um evento que preocupa gestores de saúde em todo o país. Em razão da grande pluralidade da população brasileira, acredita-se que seja necessário o desenvolvimento de estudos populacionais regionalizados. Lembrando o importante papel da prematuridade na mortalidade infantil, é imprescindível que continuem as pesquisas com esta temática para elucidar as causas da prematuridade, a fim de auxiliar no planejamento de ações preventivas e no seu combate, assim diminuindo a mortalidade infantil. / Introduction: Premature birth results from different inter-related factors, which may vary in different cultures. Technological advances have provided better conditions of assistance to and survival of prematurely born children, but the causes of premature births are still little known. Objective: To identify maternal and neonatal factors associated with premature births in Porto Alegre. Method: population-based, case-control study. The cases involved children born before 37 weeks of pregnancy, and the group of controls consisted of children born at 37 weeks of pregnancy or later. Data were obtained from 2012 birth certificates of the city of Porto Alegre found in the Live Birth Registration System of the Department of Health. The study comprised 767 cases and 1534 controls in a one-to-two design through simple randomization. The studied variables were divided into three blocks standing for different hierarchical levels: social-demographic variables; reproduction-related data; and pregnancy and birth factors. Hierarchical Multiple Logistic Regression analysis was performed. Results: In the final model, there was statistically significant association between premature birth and the following variables: in Block 1, mother younger than 19 years (OR=1.32; IC 95%: 1.02 – 1.71) and older than 34 (OR=1.39; IC 95%: 1.12 – 1.72), and mother’s educational level lower than expected for age (OR=2.11; IC 95%: 1.22 – 3.65); in Block 2, no variable was associated with premature birth; in Block 3, multiple pregnancy (OR=1,14; IC 95%: 1.01 – 1.29), Caesarean operation (OR=1.15; IC 95%: 1.03 – 1.29), birth weight lower than 2500g (OR=4.04; IC 95%: 3.64 – 4.49), Apgar scores of 0-3 at five minutes (OR=1.47; IC 95%: 1.12 – 1.91) and inadequate prenatal care (OR=1.18; IC 95%: 1.02 – 1.36). Conclusion: Health managers from all over the country are concerned with the increased prevalence of premature births. The great plurality of Brazilian population may require the development of regionalized population studies. Considering the important role played by premature birth in child mortality, researches into this subject are fundamental to explain the causes of premature birth, thus contributing to both the planning of prevention actions and the fight for reduction of child mortality.

Objectifs : Les cancers de la thyroïde représentent environ 2% de l‘ensemble des cancers dans les pays développés mais sont les cancers les plus fréquents des glandes endocrines. L’incidence des cancers de la thyroïde se caractérise par de fortes variations géographiques dans le monde, les taux les plus élevés étant observés en Nouvelle-Calédonie, et par une augmentation régulière au cours des dernières décennies dans les pays occidentaux. Cette augmentation d’incidence est en grande partie attribuée à l’évolution des pratiques médicales mais pourrait aussi être en partie liée à une évolution des modes de vie et/ou à des expositions environnementales. En dehors de l’exposition aux radiations ionisantes dans l’enfance, les facteurs de risque de cancer de la thyroïde restent très mal connus. L’objectif de ce travail était d’étudier le rôle des antécédents familiaux de pathologie de la thyroïde, des caractéristiques de la vie hormonale et reproductive, des caractéristiques anthropométriques et des expositions environnementales et professionnelles dans l’étiologie des cancers de la thyroïde. Méthode : Les analyses reposent principalement sur une étude cas-témoins en population menée en France métropolitaine (étude CATHY). Nous avons également utilisé les données d’une étude cas-témoins menée en Nouvelle-Calédonie pour étudier le rôle des antécédents familiaux dans cette zone géographique de forte incidence. L’étude CATHY repose sur 621 cas diagnostiqués dans trois départements français (Calvados, Marne, Ardennes) entre 2002 et 2007 et sur 706 témoins, appariés par fréquence aux cas sur l’âge, le sexe et le département de résidence. L’étude cas-témoins en Nouvelle-Calédonie repose sur 332 cas diagnostiqués entre 1985 et 1999, et sur 412 témoins appariés par fréquence aux cas sur l’âge et le sexe. Résultats : Les résultats montrent une augmentation du risque de cancer de la thyroïde chez les individus ayant des apparentés de premier degré atteints de cancer de la thyroïde ou de goitre multinodulaire, en France métropolitaine comme en Nouvelle-Calédonie. Parmi les facteurs hormonaux et reproductifs, un âge tardif aux premières règles, une ménopause précoce et une parité élevée étaient associés à une augmentation du risque de cancer de la thyroïde. Une relation dose-effet inverse était observée entre la durée cumulée des cycles menstruels au cours de la vie et le risque de cancer de la thyroïde. La prise d’une contraception orale était associée à une diminution du risque de cancer de la thyroïde, avec une relation dose-effet inverse entre la durée de la contraception orale et le risque de cancer de la thyroïde. La taille, l’indice de masse corporelle et la surface corporelle étaient positivement associés au risque de cancer de la thyroïde. Une augmentation du risque de cancer de la thyroïde était observée dans certains secteurs d’activité professionnelle comme l’industrie du papier, l’industrie du caoutchouc et des plastiques, le travail du bois, la réparation automobile et la métallurgie. / Objectives: Thyroid cancer accounts for 2% of all cancers in industrialized countries but is the most common endocrine cancer. There is a marked worldwide geographic variation in thyroid cancer incidence, the highest incidence rates being observed in New Caledonia, and a constant increase of thyroid cancer incidence has been observed during the past several decades. Although the evolution in medical practice probably accounts for some of the increase, other factors such as environmental and/or lifestyle factors may also play a role. However, there are few established risk factors of thyroid cancer apart from ionizing radiation exposure in childhood. We aimed to investigate the etiologic role of a family history of thyroid cancer, of hormonal and reproductive factors, anthropometric factors and environmental and occupational exposures in thyroid cancer. Methods: Analyses mainly rely on a population-based case-control study conducted in metropolitan France (“CATHY study”). Data of a case-control study conducted in New-Caledonia were also used to investigate the role of a family history of thyroid cancer as a risk factor for thyroid cancer in this area where thyroid cancer incidence is very high. The CATHY study is based on 621 cases diagnosed from 2002 to 2007 in three administrative areas: the Calvados, the Marne and the Ardennes, and 705 controls matched to cases by age, sex and residence area. The New Caledonian case-control study is based on 332 cases diagnosed form 1985 to 1999 and 412 controls matched to cases by age and sex. Results: A family history of thyroid cancer or multinodular goiter in first degree relatives was associated with an increased risk of thyroid cancer in France as well as in New Caledonia. Among hormonal and reproductive factors, a later age at menarche, a younger age at menopause and a elevated number of full-term pregnancies were associated with an increased risk of thyroid cancer. An inverse relationship was observed between the cumulative number of menstrual cycles and risk of thyroid cancer. Oral contraceptive use was associated with a lower risk of thyroid cancer, and an inverse relationship was observed between oral contraceptive use duration and risk of thyroid cancer. Height, body mass index and body surface area were positively associated with thyroid cancer risk. Analyses by occupation showed a higher risk of thyroid cancer for workers in leather industry, in plastics and rubber industry, in papermaking, in wood manufacturing, in automotive repair and in metallurgy.

Introdução: Nascimento de pré-termo é o que ocorre com menos de 37 semanas completas de gestação, e é tido como um dos principais fatores de risco de morbimortalidade neonatal. Sua etiologia é complexa e envolve inúmeros fatores. Objetivo: Identificar os fatores de risco associados aos nascimentos pré-termo. Método: Estudo populacional tipo caso-controle. Foram estudados nascidos vivos hospitalares de mães residentes em Londrina (PR) entre junho de 2006 e março de 2007. Os casos foram 328 nascimentos com idade gestacional inferior a 37 semanas (pré-termo) e os controles uma amostra (369) representativa de nascimentos com 37 semanas ou mais de idade gestacional. Os dados foram obtidos por meio de entrevistas com as mães no hospital e dos prontuários da mãe e do recém nascido. As variáveis estudadas foram agrupadas em cinco blocos, representando diferentes níveis de hierarquia: características socioeconômicas; características pré-concepcionais e historia reprodutiva materna; condições da gestação; agravos maternos na gestação e características fetais. Foi realizada análise de regressão logística múltipla hierarquizada. Resultados: No modelo final foi identificada associação estatisticamente significante (P<0,05) ao nascimento pré-termo para as seguintes categorias de variáveis: no bloco 1 o local de moradia em favela (OR=1,80; IC 95%:1,02-3,19) e a baixa idade (16 a 29 anos) do chefe da família(1,57; 1,15-2,13); no bloco 2 as mães com IMC<19kg/m2-magras (2,12; 1,40-3,21) ou IMC >= 30 kg/m2 - obesas (1,96; 1,04-3,70), com nascimento anterior pré-termo (3,04; 1,83-5,05) e que realizaram tratamento para engravidar (8,28; 2,70-25,41); no bloco 3 as mães com companheiro há menos de 2 anos (1,44; 1,03-2,00), que relataram preocupações na gestação (1,52; 1,05-2,21), que consumiram bebida alcoólica semanalmente (2,52; 1,19-5,36) e que receberam assistência pré-natal inadequada (3,57; 1,48-8,58), praticar caminhada na gestação foi um fator protetor (0,48; 0,33-0,70); no bloco 4 as mães que apresentaram sangramento (5,19; 2,54-10,60), infecção do trato genital (2,96; 1,09-7,99), alteração do volume amniótico (5,82; 2,32-14,56), hipertensão arterial com eclampsia (8,67; 4,09-18,37) e sem eclampsia (1,9; 1,01-3,61) e internação na gestação (5,55; 2,86-10,77); no bloco 5 apenas gestação gemelar foi fortemente identificada como risco (20,10; 4,44-90,99). Conclusão: Condições socioeconômicas desfavoráveis juntamente com características biológicas maternas, intercorrências da gestação e condições psicossociais adversas constituem-se em risco para nascimentos pré-termo. O aprimoramento da qualidade da atenção pré-natal, incluindo a identificação destes fatores na gestação pode reduzir a prematuridade. / Introduction: Pre-term birth happens when the fetus is born before 37 weeks of pregnancy and is considered one of the main risk factors of neonatal morbidity and mortality. It has a complex etiology and a wide scope. Objective: Identify the risk factors associated with pre-term birth. Method: Population-based case-control study. Children born alive in Londrina hospitals from June 2006 to March 2007 were studied. Cases were analyzed from 328 births with pregnancy length below 37 weeks (pre-term) and checks were studied from a birth representative sample (369) with pregnancy length above 37 weeks or more. Data were obtained from interviews carried out with mothers at the hospital and mothers and newborns medical reports. Variables studied were grouped in five groups, representing different hierarchical levels: socioeconomic characteristics; pre-conceptive characteristics and reproduction history; pregnancy conditions; pregnancy problems and fetus characteristics. A multiple hierarchical logistics regression analysis was carried out. Results: There was a significant relation (P<0.05) between pre-term birth and the following variables: group 1 - place - shanty towns(OR=1.80; CI 95% 1.02,3.19); and head of the family aged between16 and 29 years old (OR=1.57; CI 95% 1.15,2.13); group 2 - mothers presenting a BMI < 19 kg/m2 - thin mothers (OR=2.12; CI 95% 1.40,3.21) or BMI >=30 kg/m2 - obese mothers (OR=1.96; CI 95% 1.04,3.70), history of a pre-term birth (OR=3.04; CI 95% 1.83,5.05) and among women undertaking fertility treatment (OR=8.28; CI 95% 2.70,25.41); group 3 - mothers who have been in a relationship with the same partner for less than two years (OR=1.44; CI 95% 1.03,2.00) , stressed mothers (OR=1.52; CI 95% 1.05,2.21), mothers who consumed alcoholic beverages weekly (OR=2.52; CI 95% 1.19,5.36) and mothers who had not taken appropriate prenatal care (OR=3.57; 1.48-8.58), regular walks during pregnancy was a protector factor (OR=0.48; CI 95% 0.33-0.70); group 4 - mothers with bleeding onset (OR=5.19; CI 95% 2.54,10.60); genital tract infection (OR=2.96; CI 95% 1.09,7.99), amniotic volume alterations (OR=5.82; CI 95% 2.32,14.56), high blood pressure with (OR=8.67; CI 95% 4.09,18.37) and without eclampsia (OR=1.91;CI 95% 1.01,3.61) and hospital admission (OR=5.55; CI 95% 2.86,10.77); group 5 - twin pregnancy was strongly associated with risk (OR=20.10; CI 95% 4.44,90.99). Conclusion: An unfavorable socio-economic condition added to some maternal biological characteristics, pregnancy-related health problems and psychosocial conditions constitute a high risk for pre-term births. An improvement of the pre-natal quality service and the identification of the factors listed above during pregnancy may reduce premature birth.