Search PubMed⌕ Search

Biomedical subjects

C G Victora

Publications and source records attributed to C G Victora.

At least 91 records · Page 5Linked to original sources
PubMed1995

Chronic bronchitis and the type of cigarette smoked.

BACKGROUND: Smoking is a well known primary risk factor for chronic bronchitis. However, little is known about the relationship between different types of cigarettes smoked and chronic bronchitis. OBJECTIVE: To determine the association between chronic bronchitis and the type of cigarette smoked. METHODS: A cross-sectional prevalence study was conducted in an urban area (Pelotas) of Southern Brazil. A total of 1053 subjects aged > or = 40 years were interviewed about respiratory symptoms and some risk factors for chronic bronchitis. RESULTS: After adjustment for confounding factors, the number of daily cigarettes smoked was strongly associated with the risk of chronic bronchitis (odds ratio [OR] = 8.10, 95% CI: 4.46-14.71 for smokers of > or = 20 cigarettes per day compared to non-smokers). Among smokers, maize leaf cigarettes showed the highest risk (OR = 5.43 compared to non-smokers, 95% CI: 2.65-11.13) and filter cigarettes the lowest (OR = 2.19, 95% CI: 1.19-4.03). CONCLUSIONS: In addition to the number of cigarettes smoked, the use of maize leaf cigarettes was shown to have an important independent association with chronic bronchitis.

Adult↗
PubMed1995

Twenty-four-hour recall overestimates the dietary intake of malnourished children.

Food intake and morbidity are the two main proximal determinants of childhood malnutrition. Intake is usually assessed through the 24-h recall method. Few studies, however, have evaluated the accuracy of this method; in particular, it is not known whether accuracy varies according to the child's nutritional status. The intake of 50 children (< 2 y old), of whom 25 were underweight (weight-for-age more than 2 SD below the National Center for Health Statistics reference), as evaluated through weighing of all foods (gold standard) and through recall. The overall intakes of energy, fat and protein were significantly greater according to the recall method than by weighing. The trend towards overestimation was more marked for malnourished children than for well-nourished children. The possibility of such bias should be taken into account in future studies.

Body Weight↗
PubMed1995

The impact of lactation centres on breastfeeding patterns, morbidity and growth: a birth cohort study.

The influence of lactation centres on breastfeeding patterns, morbidity and nutritional status was assessed through a longitudinal study from birth up to the age of 6 months among 605 mothers and newborns in Guarujá, São Paulo, Brazil. Children recruited in the perinatal period who subsequently attended the lactation centres (54%) were exclusively breastfed significantly more at 4 months (43 versus 18%) and at 6 months of age (15 versus 6%), than non-attenders, even after adjusting for confounders. Also, attenders presented less diarrhoea in the last fortnight than non-attenders (10 versus 17%), and their weight for age was significantly better (mean z-scores of 0.26 and 0.02, respectively). Lactation centres are effective in promoting breastfeeding, and their use in areas with short breastfeeding duration should be considered. This is the first report of a significant impact of a breastfeeding promotion programme on children's morbidity and growth.

Brazil↗
PubMed1995

Use of pacifiers is associated with decreased breast-feeding duration.

OBJECTIVE: To determine the relationship between pacifier use at 1 month of age to the duration of breast-feeding to 6 months of age. DESIGN: Longitudinal study of infants from birth to 6 months of age. POPULATION: Six hundred five rooming-in infants born at the largest hospital in Guarujá, São Paulo, Brazil, during January and February 1993. MAIN OUTCOME MEASURES: Prevalence of breast-feeding (exclusive, predominant, and complementary) at 1, 4, and 6 months of age. RESULTS: Relative risk for weaning between 1 and 6 months of age was 3.84 (95% confidence interval 2.65-5.50) for pacifier users at 1 month of age, compared with nonusers. When an adjustment was made for possible confounding variables through Cox regression analysis, the relative risk dropped to 2.87 (95% confidence interval 1.97-419). CONCLUSION: Pacifier use is highly correlated with early weaning, even after controlling for possible confounders. Until it is determined if pacifier use is causally related to weaning or is a marker for other undetermined causes, pacifier use probably should not be recommended for breast-fed infants.

Breast Feeding↗
PubMed1994

The Latin American Multicenter Trial on psychosocial support during pregnancy: methodology and baseline comparability. Latin American Network for Perinatal and Reproductive Research (LANPER).

This article presents the methodology and baseline findings of a large multicenter trial involving four countries from Latin America (Argentina, Brazil, Cuba, and Mexico). The study was a randomized, controlled, single-masked trial to investigate the impact of social support during pregnancy on perinatal outcomes. Pregnant women with gestational ages between 15 and 22 weeks were screened in health facilities in the four countries. Those presenting with one or more risk factors for having a low-birthweight baby were invited to join the trial. A total of 2235 women--between 500 and 600 in each country--were randomized into an intervention (n = 1110) or a control (n = 1125) group. Both groups were comparable in terms of nearly all baseline variables. The intervention group received a minimum of four visits at home by a trained health worker who provided direct emotional support, health education, and an attempt to enhance the woman's social support network. Over 90% of all women were evaluated at 36 weeks of pregnancy and soon after delivery, and 85% at the 40th day postpartum. The outcomes under study included intrauterine growth retardation, gestational age, perinatal and maternal morbidity and mortality, labor interventions, psychological distress and characteristics of the social support network, among others. This trial showed that it was possible to select, screen, randomize, visit, and evaluate a large number of women in four Latin American countries using a standardized methodology.

Adolescent↗
PubMed1994

Prevalence and risk factors for chronic bronchitis in Pelotas, RS, Brazil: a population-based study.

BACKGROUND: Chronic bronchitis causes high morbidity and mortality throughout the world. It is basically a preventable disease. However, few population based studies of chronic bronchitis have been carried out in less developed countries. METHODS: A population based cross sectional survey was conducted to determine the prevalence of chronic bronchitis and associated risk factors in an urban area (Pelotas) of southern Brazil. 1053 subjects aged 40 years and over (90.3% of eligible subjects) were interviewed using the ATS-DLD-78 questionnaire. RESULTS: Of the subjects interviewed 12.7% were classified as having chronic bronchitis. In univariate analyses a significant increase in the relative odds of chronic bronchitis was seen in men (OR = 2.17, 95% CI 1.50 to 3.13), low family income (OR = 2.60, 95% CI 1.47 to 4.47 for lowest quartile), low schooling (OR = 4.65, 95% CI 2.36 to 9.18 for those with no schooling), smoking habits (OR = 6.92, 95% CI 4.22 to 11.36 for smokers of 20 or more cigarettes per day), high occupational exposure to dust (OR = 2.48, 95% CI 1.56 to 3.94), inadequate housing (OR = 2.09, 95% CI 1.22 to 3.58), high level of indoor air pollution (OR = 1.86, 95% CI 1.16 to 2.99), and reported childhood respiratory illnesses (OR = 2.08, 95% CI 1.25 to 3.49). Multiple logistic regression resulted in the identification of the following independent risk factors: family income (OR = 1.99, 95% CI 1.04 to 3.81 for subjects in the lowest quartile compared with those in the highest quartile), schooling (OR = 5.60, 95% CI 2.52 to 12.45 for subjects with no schooling compared with those with nine or more years), smoking (OR = 8.10, 95% CI 4.46 to 14.71 for smokers of 20 or more cigarettes per day compared with non-smokers), and history of major respiratory illnesses in childhood (OR = 2.16, 95% CI 1.20 to 3.85). CONCLUSIONS: Low family income, poor schooling, smoking, and childhood respiratory illnesses were significantly associated with chronic bronchitis.

Adult↗
PubMed1994

Quality assurance of a diarrhoea control programme in northeastern Brazil.

In this study quality assurance methods were used in an evaluation of a programme for Control of Diarrhoeal Diseases (CDD) in northeastern Brazil. Seventy-eight randomly selected public primary care facilities in four states were assessed by trained surveyors. Problems observed in the facilities were lack of information on target population and coverage, lack of equipment to permit rehydration in the premises, and frequent unavailability of trained professionals. Health workers showed deficiencies in history taking, physical examination and knowledge on diarrhoea management. Many caretakers had difficulties in recalling information given to them in the health facilities. Eighty-four percent of the cases were treated with oral rehydration, but 90% were sent home immediately and not kept in the facilities to practice rehydration under guidance as recommended by the national CDD programme. An overuse of the medical treatment was observed. More than two-thirds of health professionals gave wrong indications for use of antibiotics. The study showed that oral rehydration therapy is well established in the government health services in the region but that the CDD programme needs to take early action to correct deficiencies in logistics, case management and health education.

Brazil↗
PubMed1994

[Systemic arterial hypertension in a urban area of southern Brazil: prevalence and risk factors].

Knowledge of the prevalence of systemic arterial hypertension and its risk factors can be of great value to health policy and planning activities. A cross-sectional study was carried out in Pelotas, southern Brazil, for the purpose of discovering the prevalence of hypertension and selected risk factors. A representative sample of 1,675 adults were studied. The prevalence of hypertension was of 19.8%. The following variables were significantly associated with hypertension after adjustment for confounding variables: black race, advanced age, low educational level, paternal and maternal history of hypertension, use of additional salt on cooked foods, and obesity. The strong association between social class and hypertension found by bivariant analysis was reduced in the multivariate analysis after adjustment for age, sex and race.

Adult↗
PubMed1994

[Promotion of breast-feeding in urban localities of southern Brazil: a randomized intervention study].

A randomized intervention trial to promote breast-feeding was carried out in southern Brazil. A group of 450 mothers and babies was visited at home 5, 10 and 20 days after birth and compared to a non-visited control group of the same size. Ninety-two per cent of the families visited received the three home visits planned. The evaluation of breast-feeding patterns and reasons for weaning took place 6 months after birth for both groups. Ninety-four per cent of the group visited and 92% of the non-visited controls group were traced on the occasion of the assessment. The intervention increased the duration of breast-feeding (median duration of 120 days in the group visited and 105 days in the controls; p = 0.03) and delayed the introduction of milk bottles (median age of introduction of 90 days in the group visited and 60 days in the controls; p = 0.01). Causes of weaning were classified as underlying, intermediate and immediate. The most common underlying cause of weaning was "the baby cried too much", which suggests that mothers should be taught about normal patterns of infant behaviour in the first weeks of life, particularly the need for crying, and the fact that this not necessarily reflects hunger.

Adult↗
PubMed1994

[The use of pacifiers in children: fecal contamination and association with diarrhea].

A cross-sectional study of 354 children under two years of age was carried out in two periurban slums, with poor sanitary and socioeconomic conditions, located in Pelotas, southern Brazil. Most (79%) of the children studied were current users of pacifiers, 15% had never used one and the remaining 6% were ex-users. Among current users, 38% sucked a pacifier most of the time ("constant users"). Of the pacifiers in constant use, 93% were cultured for evidence of fecal contamination. Fecal coliforms were present in 49% of these. Diarrhoea was reported in 35% of all the children in the two weeks preceding the survey. Among constant pacifiers users, 40% had had diarrhoea in the preceding fortnight; this proportion was 32% for occasional users and 37% for non-users. These differences were not statistically significant.

Brazil↗
PubMed1994

[Health status of children in an area of southern Brazil, 1980-1992: temporal trends and spatial distribution].

Although vital statistics are of paramount importance for health planning and program evaluation, few Brazilian states have vital registration systems with either sufficient coverage or agility to achieve these goals. The present analyses, based on data from the state of Rio Grande do Sul, describes time trends and the geographical distribution of infant and child health indicators, including infant mortality rates, proportionate infant mortality, low birthweight and vaccine coverage. From 1980 to 1992, marked reductions were observed for the infant mortality rate (from 39.0 to 19.3 per thousand) and in proportionate infant mortality (from 13.9% to 5.9% of all deaths). On the other hand, the prevalence of low birthweight remained stable between 8 and 10%, with a slight increase up to 1991. DPT vaccine coverage oscillated from year to year, ranging from 79 to 99%. There was close geographical correlation between the indices of low birthweight and infant mortality in the 17 health districts. The four indicators were combined into a single score for the purpose of identifying those health districts with the greater need for intervention. The southern districts, characterized by large land holdings presented the worst health indicators.

Brazil↗
PubMed1994

Risk factors for pneumonia among children in a Brazilian metropolitan area.

OBJECTIVE: To investigate risk factors for pneumonia for infants < 2 years of age. DESIGN: Hospital-based, case-control study with neighborhood control subjects. SETTING: Urban area in southern Brazil. SUBJECTS: Five hundred ten infants with radiologically confirmed pneumonia who were admitted to a pediatric hospital. One age-matched neighborhood control subject was selected for each case. RESULTS: Multiple conditional regression modeling was used to control for confounding, taking into account the hierarchical relationships between risk factors. The incidence of radiologically confirmed pneumonia was associated with low paternal education, the number of persons in the household, young maternal age, attendance at day-care centers, low birth weight and weight-for-age, lack of breast-feeding and of non-milk supplements, and a history of previous pneumonia or wheezing. Day-care center attendance showed the highest risk, with an adjusted odds ratio of 11.75. CONCLUSIONS: In addition to continued efforts toward appropriate case management, actions directed against the above risk factors may help prevent the major cause of deaths of children younger than 5 years.

Acute Disease↗
PubMed1993

Use of pacifiers and breastfeeding duration.

Pacifiers are widely used in many developing countries. Although their use is not recommended for breastfeeding infants, there have been no published reports on the association between pacifier use and risk of early weaning. In a study of 354 infants in Brazil, mothers were asked about pacifier use at age 1 month, duration of breastfeeding, and introduction of other foods. Among 249 children still breastfed at 1 month, the risk that a child would be weaned at any age between 1 and 24 months was higher in pacifier users than in non-users (hazard ratio 3.0, 95% CI 2.0-4.6). The association remained even after adjustment for the child's age, sex, birthweight, socioeconomic status, and age at introduction of bottle-feeding.

Breast Feeding↗
PubMed1993

[Epidemiology of drug consumption in children of a urban center of the southern region of Brazil].

The consumption of medicines among a population-based cohort of 4,746 children born in 1982 in Pelotas, Brazil, was studied when the children were aged 3-4.5 years. Fifty six percent of the mothers reported that their children had taken one or more medicines during a two-week period; 29.5% of the products were fixed combinations of three or more components, (which was taken as an indicator of poor quality). Almost 10% of the children had used a given medicine for one month or more. Aspirin, combinations of vitamins and mineral supplements and cough and cold combinations were the medicines most frequently used. The commonest reasons for taking medicines were colds, fevers and lack of appetite. The latter was the commonest reason for long-term use and also for that of combinations. Physician's prescriptions were responsible for more than 60% of the medicines used (including dipyrone and appetite stimulants). In all social classes the consumption was above 50%. Children classified in the fifth quintile of family income consumed 14% more medicines than the those in the first quintile. Children with two or more older siblings consumed 12% less medicines than the elder ones. Malnourished children, according to weight for age, consumed 30% more medicines than the well-nourished. Children consulting a doctor four times or more during the three-month period before the interview were using two times more medicines than children who had had no consultation during the same period. The frequent use of aspirin is a reason for concern as it has been associated with Reye's syndrome in children. It is also important to stress the danger of poisoning resulting from medicines available at home. Another noteworthy aspect concerns the messages transmitted to the children regarding the use of medicines for almost every conceivable reason which could possibly lead to medicine or illicit drug addiction.

Age Factors↗
PubMed1993

[Determining factors of smoking habit and its cessation during pregnancy in a urban locality in the southern region of Brazil].

A cross-sectional study of 873 pregnant women attending a prenatal care clinic was undertaken in Pelotas (Southern Brazil), over a one-year period (1989-90) for the purpose of identifying possible risk and prognostic factors for smoking during pregnancy. The prevalence of smoking at the beginning of pregnancy was 40.8%. The smoking habits of the woman's mother and partner, as well as her educational level, were associated with smoking at the beginning of pregnancy. Smoking in the partner was associated with an approximately two-fold increase in the risk of smoking. The smoking interruption rate, until the 15th-22nd gestational week, was of 35.6%. Family income, smoking habits of woman's mother and partner, age at starting, duration and intensity of the woman's habit were all associated with the interruption during pregnancy. The above results were not affected by adjustment for confounding variables made through stratified analysis.

Adult↗
PubMed1993

International differences in clinical patterns of diarrhoeal deaths: a comparison of children from Brazil, Senegal, Bangladesh, and India.

Population-based data on deaths due to diarrhoea among children less than 5 years of age were obtained from areas of Brazil (227 deaths), Senegal (531), Bangladesh (236) and India (146). Fatal episodes of diarrhoea were classified as either acute diarrhoea, dysentery, or persistent diarrhoea based on their duration and on the presence or absence of blood in the stools. Persistent diarrhoea accounted for over 60% of infant diarrhoeal deaths in Brazil, 47% in India, 36% in Senegal, and 26% in Bangladesh. In the latter two studies, over one-half of infant diarrhoeal deaths were due to acute watery episodes. Among children 1-4 years old dying from diarrhoea, persistent episodes were the most common in Senegal and India, whereas dysentery was the leading pattern in Bangladesh. These differences may be related to the use of oral rehydration therapy and the utilisation of health care, as well as to environmental characteristics, and are relevant for planning control strategies. Further data are required from other parts of the less developed world.

Bangladesh↗
PubMed1992

Maternal education in relation to early and late child health outcomes: findings from a Brazilian cohort study.

In a population-based cohort of approximately 6000 Brazilian children, the associations between maternal education and a number of child health outcomes were studied while controlling for potentially confounding variables such as family income and education of the husband. In the crude analyses, maternal education was associated with perinatal and infant mortality, hospital admissions in the first 20 months of life and the three nutritional indicators (length-for-age, weight-for-age and weight-for-length) at mean age 20 months. After adjustment for confounding, the apparent associations with outcomes in early infancy--birthweight and perinatal mortality--were no longer present, while that with infant mortality persisted despite being reduced. Strong associations remained with later outcomes including hospital admissions, length-for-age and weight-for-age at mean age 20 months. Among infants born to women with little or no schooling, deaths due to diarrhoea, pneumonia and other infectious diseases were particularly common. These findings support the hypothesis that maternal education has an effect on child health which is partly independent from that of other socioeconomic factors; they also suggest that maternal care is more important than the biological characteristics of the mothers since stronger effects were observed for the late (postneonatal mortality, hospital admissions and nutritional status) than for the early (birthweight, perinatal mortality) outcomes.

Birth Weight↗