Brazilian multicenter study on prevalence of preterm birth and associated factors

<p>Abstract</p> <p>Background</p> <p>The occurrence of preterm birth remains a complex public health condition. It is considered the main cause of neonatal morbidity and mortality, resulting in a high likelihood of sequelae in surviving children. With variable incidence in several countries, it has grown markedly in the last decades. In Brazil, however, there are still difficulties to estimate its real occurrence. Therefore, it is essential to establish the prevalence and causes of this condition in order to propose prevention actions. This study intend to collect information from hospitals nationwide on the prevalence of preterm births, their associated socioeconomic and environmental factors, diagnostic and treatment methods resulting from causes such as spontaneous preterm labor, prelabor rupture of membranes, and therapeutic preterm birth, as well as neonatal results.</p> <p>Methods/Design</p> <p>This proposal is a multicenter cross-sectional study plus a nested case-control study, to be implemented in 27 reference obstetric centers in several regions of Brazil (North: 1; Northeast: 10; Central-west: 1; Southeast: 13; South: 2). For the cross sectional component, the participating centers should perform, during a period of six months, a prospective surveillance of all patients hospitalized to give birth, in order to identify preterm birth cases and their main causes. In the first three months of the study, an analysis of the factors associated with preterm birth will also be carried out, comparing women who have preterm birth with those who deliver at term. For the prevalence study, 37,000 births will be evaluated (at term and preterm), corresponding to approximately half the deliveries of all participating centers in 12 months. For the case-control study component, the estimated sample size is 1,055 women in each group (cases and controls). The total number of preterm births estimated to be followed in both components of the study is around 3,600. Data will be collected through a questionnaire all patients will answer after delivery. The data will then be encoded in an electronic form and sent online by internet to a central database. The data analysis will be carried out by subgroups according to gestational age at preterm birth, its probable causes, therapeutic management, and neonatal outcomes. Then, the respective rates, ratios and relative risks will be estimated for the possible predictors.</p> <p>Discussion</p> <p>These findings will provide information on preterm births in Brazil and their main social and biological risk factors, supporting health policies and the implementation of clinical trials on preterm birth prevention and treatment strategies, a condition with many physical and emotional consequences to children and their families.</p

The family as a determinant of stunting in children living in conditions of extreme poverty: a case-control study

BACKGROUND: Malnutrition in children can be a consequence of unfavourable socioeconomic conditions. However, some families maintain adequate nutritional status in their children despite living in poverty. The aim of this study was to ascertain whether family-related factors are determinants of stunting in young Mexican children living in extreme poverty, and whether these factors differ between rural or urban contexts. METHODS: A case-control study was conducted in one rural and one urban extreme poverty level areas in Mexico. Cases comprised stunted children aged between 6 and 23 months. Controls were well-nourished children. Independent variables were defined in five dimensions: family characteristics; family income; household allocation of resources and family organisation; social networks; and child health care. Information was collected from 108 cases and 139 controls in the rural area and from 198 cases and 211 controls in the urban area. Statistical analysis was carried out separately for each area; unconditional multiple logistic regression analyses were performed to obtain the best explanatory model for stunting. RESULTS: In the rural area, a greater risk of stunting was associated with father's occupation as farmer and the presence of family networks for child care. The greatest protective effect was found in children cared for exclusively by their mothers. In the urban area, risk factors for stunting were father with unstable job, presence of small social networks, low rate of attendance to the Well Child Program activities, breast-feeding longer than six months, and two variables within the family characteristics dimension (longer duration of parents' union and migration from rural to urban area). CONCLUSIONS: This study suggests the influence of the family on the nutritional status of children under two years of age living in extreme poverty areas. Factors associated with stunting were different in rural and urban communities. Therefore, developing and implementing health programs to tackle malnutrition should take into account such differences that are consequence of the social, economic, and cultural contexts in which the family lives

Prevalence of hazardous alcohol use among pharmacy students at nine U.S. schools of pharmacy

Hazardous use of alcohol continues to be recognized as a problem at the university level. Knowledge regarding alcohol consumption in healthcare professional students is limited, especially in regards to pharmacy students. Much of the information available focuses on pharmacy student drinking patterns in specific geographic regions or is simply outdated.Objectives: This study was designed to assess levels of alcohol consumption and estimate the level of hazardous drinking among pharmacy students in a larger sample size that is representative of US pharmacy schools.Methods: An anonymous survey regarding alcohol usage was offered to students at nine school of pharmacy across the United States. The survey consisted of demographic questions, the World Health Organization Alcohol Use Disorders Identification Test (AUDIT), and questions that assess particular alcohol-induced behaviorsResults: More than 25% of 1161 respondents had a total AUDIT score = 8, which indicates a risk of alcohol-related problems. Students that were male, in their first or second professional year of school, not married, and without children were statistically more likely to have AUDIT scores in the hazardous drinking range. Grade point average and student housing did not statistically affect student’s AUDIT scores.Conclusion: These results indicate that over one-fourth of pharmacy students surveyed have indicators of harmful alcohol use. Pharmacy schools should continue to address and confront hazardous alcohol use on campuses in order to curtail heavy alcohol consumption and reduce the risk of alcohol-related problems in pharmacy students

Body size, estrogen use and thiazide diuretic use affect 5-year radial bone loss in postmenopausal women

Understanding factors associated with more rapid bone mineral loss among aging women is important for establishing preventive strategies for intervention. This study reports factors associated with the 5-year change in radial bone mineral density (BMD) determined prospectively in 435 women aged 55–80 years at baseline. The baseline study included measurement of radial BMD (gm/cm 2 ) by single photon densitometry and personal interview. The baseline protocol was replicated 5 years later in a follow-up study. Women with a lower baseline weight or Quetelet index, smaller triceps skinfold and less arm muscle area had significantly greater 5-year bone loss ( p =0.001). Current users of estrogens had less radial bone loss (2.8% vs 7.3%, p =0.0005) than women not currently using estrogens. Current users of estrogen had significantly less 5-year loss if use had been for 5 years or longer (−1.0% vs −6.9%, p =0.05). Current users of the thiazide class of medications had less 5-year radial bone loss (5.0% vs 7.4%, p =0.0035) than women without current thiazide use. Baseline dietary calcium, alcohol consumption and smoking were not associated with BMD change. This suggests that greater body size, and current use of estrogens or thiazide antihypertensives are associated with less radial bone mass loss in a 5-year period among postmenopausal women.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45913/1/198_2005_Article_BF01637317.pd