Utilizando-se como estratégia geral o estudo das mudanças na estrutura da mortalidade infantil (MI), o presente trabalho visa aproximar-se dos determinantes da evolução deste indicador na cidade de São Paulo. O estudo centra-se no periodo de 1973 a 1983, caracterizado pela queda acelerada e ininterrupta da variável. Compararou-se o nível e a estrutura (por idade e por causas) da MI, no município, no início da década de 70, com valores hipotéticos, calculados para essa realidade, constatando-se excesso de mortalidade por diarréia em crianças de 7 dias a 6 meses. Relacionou-se esta situação com os baixos índices de amamentação existentes na época. Estes antecedentes e a elaboração de um marco teórico da determinação da mortalidade por diarréia em crianças menores de 6 meses forneceram a base para hipóteses referentes à evolução da MI e de seus determinantes no período de 1973 a 1983. A partir de informações de registros oficiais e de pesquisas conduzidas no municipio, avaliou-se a coerência entre a evolução das variáveis (dependente e independentes) e as hipóteses propostas. Observou-se que 40 por cento da queda da MI se deveu ao declínio das causas diarréicas e que a intensidade da redução destas aumentou em razão inversa à idade. Entre os determinantes, o abastecimento de água mostrou a maior variação e a mais clara concomitência com a evolução da mortalidade por diarréia. Menos evidenter o aleitamento materno e o atendimento à sadde também mostraram particularmente após 1980. Descarta-se a possibilidade de serem as variáveis sócio-econômicas e demográficas, determinantes fundamentais da queda da MI no período. Argumenta-se a favor de uma compensação dos efeitos negativos do desmame sobre a diarréia em crianças menores através do acesso à água. Como decorrência, discute-se: a) a possibilidade de que a generalização do desmame precoce - em situação de baixa cobertura da água - tenha sido importante deteminante da elevação da MI na década de 60 em São Paulo e em outras áreas subdesenvolvidas, e b) a possibilidade de que o acesso à água tenha seus efeitos auffientados sobre a diarréia infantil em populações onde o desmame precoce é prática muito frequente. / This study seeks to create an approach to the identification of the causal factors behind the recent trend in infant mortality (IM) in the city of São Paulo by an analysis of the structure of and changes in the age and causes of infant deaths. The levels and structure (by age and causes of death) of IM in São Paulo at the beginning of the period are compared with the values \"expected\" for this context. An excess of diarrhoeal mortality in infants aged from 7 days to 6 months was verified and is understood to be related to the fact that the practice of breast-feeding was extremely uncommon in the city. These antecedents, together with an analytical framework proposed for diarrhoeal mortality in children under 6 months of age, have provided a basis for hypothesis relating to changes in IM and its determinant factors during the period 1973-1983. The basic information for the study was drawn from official registration records and surveys. It was found that 40 per cent of the decline in IM was due to the reduction in diarrhoeal causes, which is inversely related to age. Among the determinants, water supply showed the greatest variation and it was clearly concomitant to infant diarrhoeal mortality. Though less evidently, the practice of breast-feeding and the action of the health services seem to have made a positive contribution, particularly after 1980. Socioeconomic and demographic variables are shown not to be main determinants of the decline in IM in the period under study. It is argued that the accessibility of watersupply may have counterbalanced the negative effects of early weaning on diarrhoeal mortality in younger infants. The following corollaries are discussed: a) where the water supply is uncertain wide-spread early weaning may haye been an important cause of the increase in IM in São Paulo, in the sixties, as also in other underdeveloped areas; b) access to water supply may have had increased beneficial effect on infat diarrhoeal mortality in those populations where early weaning is widespread.

nÃo hà / As mortes desencadeadas em crianÃas menores de um ano de vida sÃo influenciadas por fatores biolÃgicos, culturais, demogrÃficos, socioeconÃmicos e assistenciais. Este trabalho teve como objetivo avaliar a evitabilidade dos Ãbitos infantis ocorridos na Secretaria Executiva Regional VI em Fortaleza-CE, em 2008 e 2009. Trata-se de um estudo do tipo ecolÃgico, descritivo e quantitativo, tendo como desfecho a ocorrÃncia do Ãbito infantil. Foram estudados 192 Ãbitos, de uma populaÃÃo de 240. As variÃveis foram agrupadas de acordo com as caracterÃsticas sociodemogrÃficas e maternas. Analisaram-se as mÃdias, medianas e IC95% de variÃveis quantitativas. Para avaliaÃÃo da evitabilidade dos Ãbitos, foram usados os critÃrios propostos pela Lista Brasileira de Mortes EvitÃveis no Sistema Ãnico de SaÃde, apÃs anÃlise pelo Comità Regional de PrevenÃÃo do Ãbito Infantil e Fetal. Em 2008,54% e 2009,52% dos Ãbitos em menores de um ano foram considerados evitÃveis pelo ComitÃ. Comprovou-se que 30% dos Ãbitos de menores de um ano ocorridos em 2008 sÃo reduzÃveis por aÃÃes adequadas de diagnÃstico e tratamento; 26% por adequada atenÃÃo à mulher na gestaÃÃo; 22% por aÃÃes adequadas de promoÃÃo à saÃde; 12% reduzÃveis por adequada atenÃÃo ao recÃm-nascido; 8% por adequada atenÃÃo à mulher no parto, e 2% reduzÃveis por aÃÃes de imunoprevenÃÃo. Dos Ãbitos evitÃveis em 2009, 44% foram classificados como reduzÃveis por adequada atenÃÃo à mulher na gestaÃÃo; 33% por aÃÃes adequadas de diagnÃstico e tratamento; 10% por adequada atenÃÃo ao recÃm-nascido; 7% por aÃÃes adequadas de promoÃÃo à saÃde; e 6% reduzÃveis por adequada atenÃÃo à mulher no parto. Os resultados encontrados podem ser utilizados para o direcionamento de intervenÃÃes efetivas que visem a diminuir a mortalidade infantil, tanto no Ãmbito da Secretaria Executiva Regional VI, como nas demais secretarias do municÃpio de Fortaleza. / Deaths triggered in children less than one year of life are influenced by biological, cultural, demographic, socio-economic and assistance factors. This study describes the epidemiology profile of infant deaths that happened in the 6th Regional Executive Office in Fortaleza-CE, Brazil, in 2008 and 2009 and assesses its avoidability according to the results of the Regional Committee for the Prevention of Infant and Fetal Death (CRPOIF). This is an ecological, descriptive and quantitative study, with the outcome of the occurrence of infant death. 192 deaths were studied in a population of 240. Variables were grouped according to maternal socio-demographic characteristics. For data processing we used the Epi-Info software version 3.5.1, with analysis of means, medians of some variables and adopted the Confidence Interval of 95%. To assess the avoidability of deaths, we used the criteria proposed by the Brazilian List of Preventable Deaths in the National Health System after being reviewed by the committee. In 2008 (54%) and 2009 (52%) of deaths in children under one year of life were considered preventable by the CRPOIF based on this list, and following the classification adopted to analyze the deaths. It was concluded that 30% of deaths of children under one year old in 2008 are avoidable by appropriate actions of diagnosis and treatment, 26% by appropriate care to women in pregnancy, 22% by appropriate actions for health promotion, 12% are avoidable by appropriate care to newborns, 8% by appropriate care to women during childbirth, and 2% reduced through actions of vaccine prevention. From the avoidable deaths in 2009, 44% were reduced through appropriate care to women in pregnancy, 33% by appropriate actions for diagnosis and treatment, 10% by appropriate care to newborns, 7% by appropriate actions to health promotion and 6% reduced through appropriate care to women in childbirth. These results can be used to address effective interventions that aim to reduce infant mortality, both within the 6th Regional Executive Office, as in the other offices of this city.

There is a well-established connection between adult mortality and the conditions an individual is exposed to while in utero. There is a wealth of research that connects conditions such as asthma and allergies, mortality due to heart disease and diagnoses of schizophrenia to conditions during an individual?s early life and even their time in utero. The aim of this dissertation is to see if this same connection can be made to infant mortality, and further will there be any connection in contemporary cohorts? I use the Linked Birth/Infant Death dataset available from the Centers for Disease Control (CDC) for the years 2000 to 2004. This dissertation specifically uses the dependent variable "cause specific infant death" with various measures of the time the infant was born or was in utero. I undertake three multinomial logistic regression models with the dependent variable "cause specific infant death." I then proceed to a multilevel multinomial logistic regression model using state-level climate measures at the second level. I conclude with the construction of maps displaying the spatial relationship between infant mortality and climate. The first analysis uses the independent variable of interest "month of birth," the second analysis uses the independent variable of interest "months of first trimester," and the last level-one analysis uses the independent variable of interest "months of third trimester." After running all three models, I determined that the most effective independent variable of interest is "month of birth," which I use in a multilevel logistic regression model. The multilevel model uses the month of birth variable at level-one and incorporates state level measures of climate at the second level. I find that the humidity index and the temperature index are negatively associated with the month of birth variable and cause specific infant death variables, meaning that the higher these indices, the more the benefit to an infant's chances of survival. The wind index is consistently positive, meaning that the interaction of wind with cause specific infant death and month of birth is detrimental to an infant's survival. The last methods chapter shows the spatial relationship between infant mortality and climate. In this chapter I find that infant mortality in the United States is concentrated in the Southern U.S., which is also where there is a concentration of high temperature states. The connections between wind and humidity with the infant mortality rate are less consistent.

Infant mortality is viewed as an important indicator of the health and social conditions of a population. However, the infant mortality rate in the United States is estimated to be much lower than those of other developed nations. This dissertation analyzes the hazard of fetal and infant death for twins and triplets in the United States between the years of 1995 and 2000. This dissertation had two main objectives: first, to examine the effects of the birthweight and gestational age on the hazards of fetal, neonatal, postneonatal, and infant death; and second, to better understand the timing of mortality among multiples during their early life. I show that after controlling for relevant characteristics of the mother and child, gestational age and birthweight significantly influence the hazard of mortality for twins and triplets. The major finding in this dissertation shows that there is a higher hazard for twins than triplets. The unexpected higher hazard of mortality for twins compared to triplets may well be due to the social and demographic characteristics of parents of twins and triplets, particularly the possible use of Assisted Reproductive Technologies.

Heterogeneity within the Hispanic population in the United States (US) has important implications for health. Despite the empirical work examining heterogeneity in Hispanic health and mortality by nativity, generational status, and country of origin, relatively little research has been devoted to understanding if and how racial identification impacts Hispanic health outcomes. Racial differences in health and mortality are well documented throughout the literature, particularly for non-Hispanic blacks and non-Hispanic whites. Meanwhile, current socio-demographic and health literature commonly compares US non-Hispanic racial groups with people who claim Hispanic ethnicity, the latter of whom are comprised of multiple racial groups. Thus, this dissertation examines the racial heterogeneity of the Hispanic population and the implications of race for physical health among Hispanics. Using the National Health Interview Survey and the National Centers for Health Statistics Linked Birth/Infant Death Cohort Files, the key findings of this dissertation are (1) racial identity is associated with socioeconomic status among Hispanics, (2) infants born to Hispanic black mothers displayed statistically significant higher odds of being born with low birth weight when compared to infants born to Hispanic white mothers, (3) there is evidence of weathering in the infant health of Hispanics, as measured using birth weight, (4) black-white disparities in the risk of infant mortality exist within the Hispanic population, (5) both Hispanic blacks and those of other races have greater odds of functional limitations than Hispanic whites and for Hispanic blacks; moreover, this disadvantage increases with age, (6) I show no race differences in the odds of hypertension or poorly self-assessed health status. In short, the results of this dissertation suggest that the social experience for Hispanic blacks and whites is different and that this difference affects health outcomes. It is imperative that future research and health policy recognize the racial heterogeneity of this population, in both empirical analyses and policy decisions regarding social influences on physical health. / text

Thesis equivalent (M.P.H.)--University of Michigan, 1947.

Thesis (M.S.P.H.)--University of Michigan, 1945.

Thesis (M.P.H.)--University of Michigan, 1946.

Thesis (M.S.P.H.)--University of Michigan, 1945.

Thesis (M.P.H.)--University of Michigan, 1946.