Introdução - A diarréia ainda se apresenta como uma das principais causas de morbimortalidade em crianças menores de um ano de idade em países em desenvolvimento. Disparidades nas taxas globais de morbimortalidade entre regiões têm sido observadas em todo o mundo. Estudos recentes apontam redução na mortalidade associada à diarréia. Entretanto, a morbidade pela doença não seguiu a mesma tendência. Considerando a existência de poucos estudos em território nacional a respeito do comportamento da mortalidade e internações por diarréia, considerou-se oportuna a análise da tendência das diarréias sob este ponto de vista. Objetivo - Analisar a tendência das internações e da mortalidade por diarréia em crianças menores de um ano, nas capitais do Brasil, no período de 1995 a 2005, e encontrar possíveis padrões no comportamento dos indicadores. Métodos - Foi realizado um estudo ecológico de séries temporais utilizando dados secundários do Sistema de Informação Hospitalar (SIH) e do Sistema de Informação sobre Mortalidade (SIM) do Ministério da Saúde. Para as análises das tendências das taxas de internações e de mortalidade foram utilizados modelos de regressão polinomial. Resultados - O Brasil e treze capitais brasileiras apresentaram redução tanto nas internações por diarréia quanto na mortalidade infantil por diarréia. Oito capitais tiveram queda somente na mortalidade por diarréia enquanto que três capitais apresentaram decréscimo somente nas taxas de internação por diarréia. Na análise conjunta dos indicadores de diarréia e dos indicadores gerais, observou-se que somente no Brasil e em quatro capitais houve um decréscimo em todas as séries históricas. Conclusões Os resultados encontrados indicam que as medidas empregadas para prevenção e controle da diarréia parecem ter efeito positivo na internação e mortalidade por esta doença em algumas das capitais brasileiras e no Brasil como um todo, necessitando, ainda, de reforço nas ações de prevenção. / Introduction The diarrhea still is presented as one of main causes of morbidity and mortality in children under one year old in developing countries. Differences in the global morbidity and mortality rates among regions have been observed in the whole world. Recent global studies point out a reduction in the mortality associated with the diarrhea. However, the morbidity for the illness did not follow the same trend. There are few studies witches analyzing the trends of the hospitalization and mortality rates by diarrhea in Brazil. Objectives To analyze the trend of hospital admission rates and mortality rates for diarrhea in children under one year old in Brazil as a whole and in its capitals between 1995 and 2005 and to find standards behaviors. Methods This was an ecological study using time-series analysis. The date of hospital admission and mortality rates were collected from Ministry of Health\'s Hospitalization Data System (SIH-SUS) and from Mortality Data System (SIM-MS). Trends were estimated using polynomial regression models. Results Trends for hospital admission rates as well as mortality rates for Brazil as a whole and in thirteen capitals had decreased. Eight capitals had only had reduction in diarrhea mortality rates whereas three capitals had only presented decrease in diarrhea hospitalization rates. The combined analysis of diarrhea indicators and general indicators revealed that only in Brazil as a whole and in four capitals there was a decrease in all the historical series. Conclusions The results indicate that the official measures for prevention and control of the diarrhea seem to have positive effect in the hospital admission rates and mortality rates for the disease in some of the Brazilian capitals and in Brazil as a whole.

Estudou-se a aplicação do conceito de \"risco\" na área materno-infantil, partindo da proposta da Organização Mundial de Saúde relativa ao \"enfoque de risco\" na organização dos serviços de saúde. O estudo concentrou-se mais no desenvolvimento de instrumentos de identificação de grupos de alto risco de óbito infantil, seja no período neonatal, seja no período pós-neonatal. O trabalho baseou-se em um estudo de caso-controle, onde o grupo de casos correspondeu a óbitos registrados de menores de um ano de idade, ocorridos nos anos de 1984 e 1985, de pais residentes nos municípios de Cotia e Vargem Grande Paulista, totalizando 149 óbitos (casos). O grupo controle foi formado por uma amostra probabilística de 216 crianças nascidas em 1984, filhas de pais residentes em Cotia e Vargem Grande Paulista e que sobreviveram ao primeiro ano de vida. As mães de ambos os grupos responderam a um questionário, através de entrevistas domiciliárias para a identificação de variáveis independentes associadas ao óbito infantil. As variáveis que mostraram associação estatisticamente significante foram então agrupadas de forma a constituírem quatro escalas de risco: a primeira para uso em pré-natal, a segunda para uso por ocasião do parto, a terceira para uso no período neonatal e a quarta para uso em puericultura após o período neonatal. As variáveis participaram nas escalas ponderadas pelos valores das razões dos produtos cruzados. As escalas apresentam diferentes pontos de corte e a cada um deles corresponde uma dada sensibilidade, especificidade e poder preditivo. As características específicas do sistema de saúde nos municípios estudados e a tendência de alguns indicadores de saúde infantil nesta área indicam a oportunidade e o potencial da aplicação da estratégia de enfoque de risco no setor materno-infantil. Os instrumentos preditivos propostos neste estudo são possivelmente adequados a esta estratégia, uma vez que foram desenvolvidos a partir dos dados locais. No entanto, a sua efetiva utilidade só poderá ser melhor avaliada após sua aplicação em um programa concreto de atenção materno-infantil, baseado no enfoque de risco. / It was studied the application of the concept of \"risk\" in maternal and child health, the starting point being the World Health Organization proposal of \"risk approach\" in health services. The study was concerned with the development of a scoring system for identification of high risk groups of death in the first year of life, whether in the neonatal or in the post-neonatal periods, and was based on a case control study. The case group was the registered death of children under one year of life, during the years of 1984 and 1985, whose parents lived in Cotia and Vargem Grande Paulista. It was studied 149 cases. The control group was a probabilistic sample of 216 children born in 1984, which survived the first year of life and whose parents lived in the study area (Cotia and Vargem Grande Paulista). All the mothers were interviewed according to a questionnaire for the identification of independent variables associated to infant death. The statistically associated variables were grouped in four scales; the first one to be used in the antenatal period, the second to be used before the delivery, the third to be used in the neonatal period and the fourth to be used in the post neonatal period. The variables were weighted in the scales by the values of the odds ratio, and they have different cut points, each one having its own sensibility, specificity and predictive value. The health system and the trends of the infant health indicators of the study area show the opportunity and the potencial for the use of the strategy of \"risk approach\" in maternal and child health care. The predictive scales of this study are, possibly, appropriated to the risk strategy, once they were developed with local data. Nevertheless, its efficiency will be better evaluated only with its real use in a maternal and child health programme, based on the \"risk approach\".

Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-05-10T18:26:23Z No. of bitstreams: 1 SocorroBalby.pdf: 315511 bytes, checksum: c1f47a1c7db1d45ceb259f0e8dffe033 (MD5) / Made available in DSpace on 2017-05-10T18:26:23Z (GMT). No. of bitstreams: 1 SocorroBalby.pdf: 315511 bytes, checksum: c1f47a1c7db1d45ceb259f0e8dffe033 (MD5) Previous issue date: 2012-07-02 / Introduction: Higher than the national average and regional levels, the infant mortality rate in São Luís still shows the early neonatal and post neonatal components, and its decrease has occurred more slowly in the south, southeast and northeast. The present study aims to estimate rates, and to identify factors associated with infant mortality in São Luís, MA, in 2010. Methodology: This is a transversal study which identified all deaths of live births occurring in the period from January to June 2010, the death certificates of the SIM, the Municipal Health Secretary of São Luís. Infant mortality was divided in early neonatal, late neonatal and post-neonatal mortality, and the studied variables were: sex, birth weight, mother’s age, child's age, length of gestation, type of birth, place of death, basic cause of death. The selection of the basic cause of death was carried out according to the WHO criteria for classification of infant mortality and tabulated according to the 10th. CID review. The causes were divided into five major groups: perinatal causes, congenital anomalies, pneumonias, diarrheas and others. Results: It was evaluate 126 death certificates in the period from January to June, 2010. The infant mortality rate for the period studied was 14.75 per thousand, 65 in the early neonatal period, 19 late neonatal and 42 in the post-neonatal period. Related to maternal age, 20.6% had less than 19 years, 75% from 19 to less than 35 years and 5.5% over 35 years. About the weight, 35% had weight below 1000g, 27.2% had weight between 1000g and less than 2500g and 29.3%, more than 2500g. The gestational age, 48.4% had less than 22-36 weeks and 35.7% 37-41 weeks, and 10.31%, less than 22 weeks. Vaginal delivery was predominant 62.7%. Causes: DMH (31%), neonatal infection (28%) and malformations (24%). Conclusion: The early neonatal mortality rate remains high, with associated factors that demonstrate attention to deficiency in pregnancy and childbirth in the city of São Luís. / Introdução: O Coeficiente de Mortalidade Infantil em São Luís ainda apresenta os componentes neonatal precoce e pós-neonatal, superiores à média nacional e regional, e o seu decréscimo tem se dado de forma mais lenta que nas regiões Sul, Sudeste e outras cidades do Nordeste. Metodologia: Trata-se de um estudo transversal onde foram identificados todos os óbitos de nascidos vivos, ocorridos no período de janeiro a junho de 2010, nas declarações de óbitos do Sistema de Informação de Mortalidade (SIM), da Secretaria Municipal de Saúde de São Luís. A mortalidade infantil foi dividida em neonatal precoce, neonatal tardio e pósneonatal, sendo as variáveis estudadas: sexo, peso ao nascer, idade da mãe, idade da criança, duração da gestação, tipo de parto, local de óbito, causa básica do óbito, escolaridade materna. A seleção da causa básica do óbito foi realizada de acordo com os critérios da OMS para classificação da mortalidade infantil e tabulada de acordo com a 10a revisão da CID. As causas foram distribuídas em 5 grandes grupos: causas perinatais, anomalias congênitas, pneumonias, diarréias e outras. Resultados: Foram avaliadas 126 declarações de óbitos, no período de janeiro a junho de 2010. O coeficiente de mortalidade infantil para o período estudado foi 14,75 por mil nascidos vivos, sendo 65 no período neonatal precoce, 19 neonatal tardio e 42, no período pós-neonatal. Em relação à idade materna, 20,6% tinham menos que 20 anos, 75% de 20 a 35 anos ou mais. Quanto ao peso, 35% tinham peso abaixo de 1000g, e 29,3%, mais que 2.500g. Quanto à idade gestacional, 48,4% tinham de 22-36 semanas e 35,7% de 37-41 semanas. O parto vaginal foi predominante (62,7%). As causas mais frequentes foram Doença de Membrana Hialina (31%), infecção neonatal (28%) e malformações (24%). Conclusão: O coeficiente de mortalidade infantil teve como principal componente o coeficiente neonatal precoce, que permanece elevado, tendo como fatores associados o baixo peso ao nascer e a duração da gestação.

We study whether the \"China shock\'\", defined as China\'s rapid emergence in global markets, caused environmental impacts in Brazilian municipalities, since previous evidence points to effects on real wages and formal sector employment over the period of 2000 to 2010. Building on recent theoretical developments, we implement a shift-share strategy to explore variation in economic specialization between municipalities and find that China\'s direct influence on the deforestation of the Amazon and Cerrado was on average insignificant, which is supported by the literature. On the other hand, China\'s demand for commodities seemed to increase pollution-related mortality of children in mining municipalities, a result obtained by comparing it to mortality caused by other factors. However, we show that this is most likely explained by a municipality\'s degree of specialization in mining activities rather than its exposure to trade with China. We conclude that the environmental effects of the China shock on Brazilian municipalities were small, if not negligible. / Investigamos se o \"choque China\'\", definido como a rápida ascensão da China nos mercados internacionais, causou impactos ambientais em municípios brasileiros, uma vez que estudos anteriores identificaram efeitos sobre o salário real e emprego formal ao longo do período de 2000 a 2010. Orientados por avanços recentes na teoria, nós usamos uma estratégia shift-share para explorar diferenças na especialização econômica de municípios e encontramos que a influência direta da China sobre o desmatamento da Amazônia e do Cerrado foi na média insignificante, o que vai ao encontro da literatura. Por outro lado, a demanda por commodities da China pareceu elevar a mortalidade infantil causada por doenças relacionadas à poluição em municípios mineradores, um resultado obtido ao se compará-la com mortes por outras causas. Todavia, nós mostramos que a explicação mais provável é o grau de especialização do município em atividades de mineração, e não o quanto ele estava exposto ao comércio com a China. Concluímos que os impactos ambientais do choque China sobre municípios brasileiros foram pequenos, senão negligenciáveis.

Living in counties where manufacturers release environmental toxins, such as those tracked by the Environmental Protection Agency's (EPA) toxic release inventory (TRI), may elevate infants' health risks. Because infant mortality (IM) is a strong indicator of a population's health status, it is an important topic in public health research. The purpose of this research was to examine the potential relationships between IM, community size, and factors related to mothers' SES in counties where more than 25,000 pounds of annual toxic air releases occur. The dependent variable was IM per 1,000 live births in a given community for each of the 3 years included in this analysis (1987, 1995, and 2004). The independent variables included county size and factors related to mother's SES (education, age, ethnicity, and marital status). The theoretical framework consisted of Mosley and Chen's framework for exploring child survival. Archival, publicly available data were pulled from (a) the EPAs TRI data, and (b) linked birth and infant death files from the National Center for Health Statistics. The researcher followed a quantitative, retrospective cross-sectional design and conducted 3 linear regression models to test the research questions. Results indicated that an increase in community size was significantly associated with an increase in IM. Regarding the relationships between IM and the 4 different maternal characteristics (education, age, ethnicity, and marital status) included in the analysis, findings were mixed for the 3 years examined. Despite these unexpected findings, the overall results from this investigation, when considered alongside findings from previous research on IM, indicate that policy changes and interventions are needed to reduce socioeconomic disparities in IM, and to save the lives of more infants.

The length of human pregnancy, arguably the most natural of physiological processes, is undergoing subtle but consequential modification in order to adapt to modern societal demands. The gestational age distribution of births in the United States has been shifting to lower gestational ages over the past two decades, parallel to a concomitant rise in obstetrical intervention in pregnancy. The result has been an increase in elective deliveries at 37-38 weeks (early term). A population-based retrospective cohort study of over 616,000 live-born full-term singleton infants was conducted to investigate the association between elective early term delivery and subsequent infant morbidity, mortality, and health care utilization in the first year of life. Data were examined from a statewide, multi-year, clinically-enhanced database created by linking birth certificate records to maternal and infant hospital discharge records, and to infant death certificates, for all infants born to Florida-resident mothers from 2005-09. All infants delivered to mothers with an established medical condition that could have justified early delivery were excluded from the study, as it would not be possible to determine if an early delivery in those cases was elective or medically-necessary. Based on the timing and reason for delivery initiation, the study population was categorized into four exposure groups: 1) early electively induced delivery at 37-38 weeks (EED-I), 2) early elective cesarean delivery at 37-38 weeks (EED-CS), 3) early spontaneous delivery at 37-38 weeks (ESD), 4) early medically-indicated delivery at 37-38 weeks (EID). The comparison group consisted of all expectantly managed infants who were full term deliveries (FTD) at ≥39 weeks. Adverse infant outcomes in the first year of life included respiratory morbidities, neonatal sepsis, feeding difficulties, admission to the neonatal intensive care unit, the frequency and duration of hospital encounters, and infant mortality. Multivariable generalized linear mixed models were used to estimate odds ratios (OR) or rate ratios (RR) and 95% confidence intervals (CI) between exposure and each outcome, adjusting for maternal, infant, and hospital characteristics and accounting for the correlation among infants born at the same facility. Infants who were delivered by EED-I or EED-CS comprised 13% of the study population, and 40% of infants born in the early term period. Infants who were delivered by EED-I experienced the lowest likelihoods of respiratory morbidities, neonatal sepsis, and admission to the NICU when compared to FTD infants. In contrast, infants delivered by EED-CS had significantly increased risks several adverse birth outcomes, with magnitudes ranging from a 9% to 40% increase. Only 8.3% of all infants were re-admitted to the hospital after birth. Despite having the lowest likelihood of the birth morbidities studied, infants delivered by EED-I had a small 10-15% increased odds of being re-hospitalized in the first year of life, compared to FTD infants. These infants also had a slightly higher mean number of visits and combined LOS during post-birth hospitalizations, although the absolute differences from other exposure groups was small. Elective early term cesarean infants actually had a slightly lower risk of re-hospitalization, particularly re-hospitalizations that occurred between weeks 3-52 of life. Neonatal and post-neonatal deaths were rare events (0.3 and 1.3 deaths per 1,000 live births, respectively) in this comparatively low-risk study population. There were no differences in survival when comparing the EED-I and EED-CS groups to the FTD group. The results of this study raise the concern that these public health efforts to reduce elective early term inductions have been based on biased evidence from a limited number of studies in which artificially elevated risks for early electively-induced infants were reported. In stark contrast to the current dogma, this study found that when a methodologically appropriate comparison group was used (i.e., expectant management), elective induction prior to 39 weeks was NOT associated with an increased risk of any adverse infant outcomes in early life. In contrast, our findings do support the avoidance of purely elective cesarean sections prior to 39 weeks in lieu of expectant management. The evidence presented in this large, methodologically-sound study should caution against a general avoidance of ALL elective early term deliveries, and foster support for continued research in this still relatively new arena.

<p>Adverse birth outcomes like preterm birth and infant mortality are unevenly distributed across socio-economic groups. Risks are usually lowest in groups with high socio-economic status and increase with decreasing status.</p><p>The general aim of this thesis was to contribute to the understanding of the relation between socio-economic status and birth outcomes, focussing on maternal education and class, studying a range of birth outcomes. More specific aims were to investigate the relation between maternal education and infant health, to study the combined influence of maternal childhood and adult social class on inequalities in infant health and to explore the contribution of maternal working conditions to class inequalities in birth outcomes. The studies are population based, focussing on singletons births 1973-1990. During the period under study, educational differences in birth outcomes increased, especially between those with the lowest and highest education. The low birth weight paradox emerged, suggesting that the distribution of determinants for low birthweight infants differs for these groups.</p><p>Further, an independent association was found between maternal childhood social class and low birthweight and neonatal mortality, but not for postneonatal mortality. Since this was found for the two outcomes closest to birth, this indicates that the association is mediated through the maternal body.</p><p>Finally, there is a contribution of maternal working conditions to class inequalities in birth outcome. Lower job control, higher job hazards and higher physical demands were all to some degree related to increased risk of the following adverse birth outcomes: infant mortality, low birthweight, very low birthweight, foetal growth, preterm birth, very and extremely preterm birth. Working conditions demonstrated disparate associations with the birth outcomes, indicating a high complexity in these relationships.</p>

<p>This study aim at investigating whether income inequality ceteris paribus is a determinant of population health measured by infant mortality rate and average expected lifetime. Earlier research has found results pointing in different directions but the income inequality hypothesis suggests that income inequality alone is something bad for the population. The study uses data on income distribution from the Luxembourg Income Study (LIS) and the World Income Inequality Database (WIID). Data on economic development and health indicators comes from the OECD database. An econometric model which applies country fixed effects is specified and the results indicates no effect from income inequality on infant mortality rate but some indications of a negative effect on average expected lifetime.</p>

Adverse birth outcomes like preterm birth and infant mortality are unevenly distributed across socio-economic groups. Risks are usually lowest in groups with high socio-economic status and increase with decreasing status. The general aim of this thesis was to contribute to the understanding of the relation between socio-economic status and birth outcomes, focussing on maternal education and class, studying a range of birth outcomes. More specific aims were to investigate the relation between maternal education and infant health, to study the combined influence of maternal childhood and adult social class on inequalities in infant health and to explore the contribution of maternal working conditions to class inequalities in birth outcomes. The studies are population based, focussing on singletons births 1973-1990. During the period under study, educational differences in birth outcomes increased, especially between those with the lowest and highest education. The low birth weight paradox emerged, suggesting that the distribution of determinants for low birthweight infants differs for these groups. Further, an independent association was found between maternal childhood social class and low birthweight and neonatal mortality, but not for postneonatal mortality. Since this was found for the two outcomes closest to birth, this indicates that the association is mediated through the maternal body. Finally, there is a contribution of maternal working conditions to class inequalities in birth outcome. Lower job control, higher job hazards and higher physical demands were all to some degree related to increased risk of the following adverse birth outcomes: infant mortality, low birthweight, very low birthweight, foetal growth, preterm birth, very and extremely preterm birth. Working conditions demonstrated disparate associations with the birth outcomes, indicating a high complexity in these relationships.

This study aim at investigating whether income inequality ceteris paribus is a determinant of population health measured by infant mortality rate and average expected lifetime. Earlier research has found results pointing in different directions but the income inequality hypothesis suggests that income inequality alone is something bad for the population. The study uses data on income distribution from the Luxembourg Income Study (LIS) and the World Income Inequality Database (WIID). Data on economic development and health indicators comes from the OECD database. An econometric model which applies country fixed effects is specified and the results indicates no effect from income inequality on infant mortality rate but some indications of a negative effect on average expected lifetime.