[Evaluation of a supplementary nutrition program]

The objective of this study was to evaluate the impact of a feeding supplementation program on the growth of undernourished children younger than 5 years in the city of Guariba, state of São Paulo, Brazil. The sample consisted of 469 malnourished children enrolled in a feeding supplementation program sponsored by the State Health Secretariat. The children were divided into four groups according to how long they had been enrolled in the program: in group 1, the children had been enrolled for up to 12 months; in group 2, from 12 to 24 months; in group 3 from 24 to 36 months; and in group 4 the children had been enrolled for more than 35 months. Percentiles for weight/age, height/age and weight/height were calculated for each child. To assess the impact of the program, reference curves for the anthropometric profile were constructed based on expected variations in population percentiles. The changes observed in each group were analyzed statistically (McNemar). Groups 1 and 2 presented weight recovery and gains in the weight/height ratios for the most severely malnourished children; in group 3, the weight/height ratio was maintained and there was a discrete tendency towards weight recovery, which was reversed in group 4, in which the weight was again low in relation to height. The feeding supplementation program temporarily minimized severe nutritional deficiencies but was not sufficient to recover and maintain normal growth.

[Perinatal health: methodology and characteristics of the studied population]

OBJECTIVE

To describe the methodological procedures and some sociodemographic and medical care characteristics of the population studied in a research project on perinatal health developed in the Ribeirão Preto county, SP, in 1994, in order to make historical comparisons with the indicators of mother-child health of a similar study conducted 15 years before in the same municipality.

MATERIAL AND METHOD

All the hospital births that occurred in Ribeirão Preto from June 1978 to May 1979 were studied by interviewing the mothers and obtaining data about maternal and paternal habits, social situation of the family, medical care during pregnancy and delivery, duration of pregnancy, and anthropometric and mortality data about the newborn children. A new study was conducted in 1994 using the same methodology to collect data about a sample of 1/3 of the births that had occurred in the municipality in that year (all the hospital births observed during a period of 4 months), and also about the mortality of this group up to one year after the termination of birth data collection. The interviews were held after delivery and infant weight and length were measured immediately after birth. Infant mortality was evaluated by surveying the data referring to all deaths of infants born during the year of the study and up to 1 year after its termination. The data were obtained from the Municipal Health Secretariat to which copies of all death certificates emitted in the registry offices of the county are sent obligatorily.

RESULTS

An investigation was made into 3,663 births, 3,579 of which were singletons; of these, 2,846 were from the municipality. Comparison with the data obtained in the previous study showed an increase in the frequency of some indicators such as adolescent mothers, prematurity, low birth weight and cesarian section; on the other hand, there was a 50% decrease in the mortality rate and its components.

Trends in low birth weight: a comparison of two birth cohorts separated by a 15-year interval in Ribeirão Preto, Brazil

The incidence and some determinants of low birth weight (LBW) were studied in two population-based cohorts of singletons born live to families in Ribeirão Preto, São Paulo State, Brazil. The first cohort comprised infants born between June 1978 and May 1979 (6750 births--population survey) and the second, infants born between May and August 1994 (2990 births--sample survey). The incidence of LBW was 7.2% in 1978-79 and 10.6% in 1994. After adjustment for confounding factors, the following determinants remained significant in 1978-79: female sex, maternal age > or = 35 years, preterm delivery, < four antenatal health visits, maternal smoking, lower level of maternal education, and manual work/unemployment. In 1994, the significant determinants were preterm delivery, maternal smoking and caesarean section. The adjusted percentage population attributable risk (PAR%) fell for the majority of risk factors but increased for caesarean section, preterm birth, multiparity (> or = 5), primiparity and non-cohabitation. The increase in the rate of LBW from 1978-79 to 1994 was higher for families with more qualified occupations, and occurred only for infants delivered at 36-40 weeks' gestational age and weighing 1500-2499 g, i.e. those most likely to be born by elective caesarean section. The caesarean section rate rose from 30.3% in 1978-79 to 51.1% in 1994. The increase in LBW was probably due to iatrogenic practices associated with elective caesarean section.

[Consumption of psychoactive substances by school-age adolescents of Ribeirão Preto, SP (Brazil). II--Distribution of consumption by social levels]

INTRODUCTION

Many of the epidemiological studies on the consumption of legal and illegal psychoactive substances have included the evaluation of the influence of social context on the levels of prevalence of this consumption using indirect social indicators such as family income, and educational and housing levels in an attempt to identify individuals or groups in different social contexts. The present study investigates the distribution of consumption of psychoactive substances according to social class in a sample of teenage pupils in Ribeirão Preto, SP, Southeastern Brazil.

MATERIAL AND METHOD

A self-applicable questionnaire duly adapted and submitted to a reliability test was applied to a proportional sample of 1,025 teenagers enrolled in the 8th, 9th, 10th and 12th grades in public and private city schools. The questionnaires contained questions about the use of ten classes of psychoactive substances, demographic questions and validation information, as well as questions about the perception and intrinsic behavior related to drug consumption. The adaptation of a model that identifies 5 social class strata (business middle class, managerial middle class, lower middle class, proletariat and subproletariat) on the basis of indicators that situate the individuals within the social relations of production, was used.

RESULTS

The 3 middle class strata were more often represented, whereas the proletariat and subproletariat were less frequently represented in this teenage pupil population than in the population in general. There was no difference in alcohol or tobacco consumption according to social class, although prevalence tended to be higher at the two extremes of the social ladder. In contrast, the consumption of illegal substances was higher in the middle class and lower in the proletariat.

CONCLUSION

Although the consumption of legal substances did not differ among social classes, the higher consumption of illegal substances by the wealthier teenagers was probably due to the higher cost of these products as compared those of alcohol and tobacco.

[The consumption of psychoactive substances by adolescents in schools in Ribeiräo Preto, SP (Brazil). I--Prevalence of consumption by sex, age and substance]

INTRODUCTION

Concern over the consumption of psychoactive substances by teenagers has given rise to a great worldwide effort to produce information about this phenomenon. This study set out to investigate the prevalence of consumption of legal and illegal psychoactive substances, its distribution by age, sex and age at first experience of them, among teenage pupils in county, Ribeirão Preto, SP, Southeastern Brazil.

MATERIAL AND METHOD

A self-applicable questionnaire duly adapted and submitted to a reliability test was applied to a proportional sample of 1,025 teenagers enrolled in 8th, 9th, 10th and 11th grades at public and private city schools. The questionnaire contained questions about the use of ten classes of psychoactive substances, demographic questions and validation information, as well as questions about the perception and intrinsic behavior related to drug consumption.

RESULTS

The sample of 88.9% had consumed alcoholic beverages sometime in their lives, 37.7% had used tobacco, 31.1% solvents, 10.5% medicines, 6.8% marihuana, 2.7% cocaine, 1.6% hallucinogens, and 0.3% of the sample had consumed some opiate substance. The rates of consumption increased with age for all substances; however, the use of tobacco and of illegal substances was less intense during the later years of adolescence. As to sex distribution, boys consumed more than girls, except for medicines, with girls consuming barbiturates, amphetamines and tranquilizers in proportions similar to or higher than those observed among boys. Age at first experience showed that access to psychoactive substances occurred at very early ages.

CONCLUSIONS

Experimenting with psychoactive substances, whether legal or illegal, is a frequent phenomenon during adolescence, both among boys and girls, often at very early ages.

[Correlation between maternal age, social class and smoking, and birth weight]

An epidemiological survey was carried out in Ribeirão Preto, Brazil, from June 1978 to May 1979. Interviews were held with mother of singleton live borne children, delivered in hospitals, which accounted for 98% of all births in the area. The higher percentages of low birthweight children related to the offspring of smokers, young mother and women belonging to the working class. The majority of young women were found in the working class and the prevalence of smoking was higher in the group of women below 20 years of age. There was no statistical difference in the smoking habit as between different social classes. A larger number of low birthweight children were observed in nonsmoking women of the working class than among women smokers of the middle class. A log model was adjusted to the data in order to study the possible multiple association of smoking, maternal age and social class with birthweight. The results indicated that maternal smoking, maternal age and social class had independent effects on birthweight. The was no interaction between them. These findings suggest that the higher prevalence of low birthweight in nonsmoking mothers of the working class in relation to smoking mothers of the middle class probably reflects clustering of other risk factors-such as poor education inadequate prenatal care, high parity and differences in reproductive behavior in women of the working class.

[Perinatal health: low birth weight and social class]

A survey was carried out in Ribeirão Preto, S. Paulo State, Brazil, between June 1978 and May 1979 with a view to studying the prevalence of low birth weight and its occurrence among different social classes. Data were collected from 8,878 singleton live births in eight maternity hospitals, accounting for 98% of all births in the area. Social classes were determinated by the use of a model proposed by Singer and modified for epidemiological purposes by Barros. Out of the 8,878 births, 660 (7.5%) were of low birth weight. The prevalence of deficient weight at birth (between 2,500 and 2,999 grams) was of 21.1%. Analysis indicated that 50.6% of children with low birth weight were at term and the majority of them suffered form intrauterine growth retardation. The prevalence of low birth weight according to social class was seen to be lower in the bourgeoisie classes (ranging from 2.8% to 3.9%) and higher in working classes (from 7% up to 9.5%). Low birth weight (defined as less than or equal to 2,500 grams) was used for purposes of comparison with other previous surveys. The percentage was lower in this study (8.3%) than that found in the Interamerican Investigation of Mortality in Childhood (8.7%), carried out in 1968-70. No statistically significant differences in the percentage of low birth weight were found in the case of Ribeirão Preto when these two surveys were compared.

[Perinatal health in Ribeirão Preto, Brazil: distribution of the head circumference measurement of newborn infants]

A sample of 4554 of newborn was used to study the distribution of the head circumference measure shortly after birth. The sample is part of the cohort born in Ribeirão Preto, Brazil, from June 1st, 1978 to May 31st, 1979. It was possible to show that such measure follows a normal distribution for both sex (either separately or together) and to calculate 'normality limits' for practical use.

[Skull growth in children]

The authors review papers and researches about skull growth in newborns and infants: they analysed and correlated anthropometric data with maternal biological and social factors.

[Description of a new endemic focus of schistosomiasis mansoni in São Paulo State, Brazil]

Foi descrito novo foco endêmico de esquistossomose mansônica situado na Cidade de Bebedouro, Estado de São Paulo, Brasil. Foram analisados 221 casos diagnosticados da doença segundo a idade, sexo e origem (autóctone ou não), bem como foram discutidos os fatores envolvidos no aparecimento do foco, alertando-se para a necessidade de medidas de controle.