[The pregnancy during adolescence as a risk factor for low birth weight, Brazil]. / Gravidez na adolescência como fator de risco para baixo peso ao nascer no Município do Rio de Janeiro, 1996 a 1998.

OBJECTIVE: To identify the role of pregnancy during adolescence as a risk factor to low birth weight (LBW). METHODS: A stratified sample of live births from the Information System of Live Births in the municipality of Rio de Janeiro, in the period 1996-98, was selected. The risk factors of LBW were analyzed for the two strata composed by the mother age, 15-19 and 20-24 years old. For the statistical analysis, odds ratios and correspondent confidence intervals were estimated. Logistic regression procedures were used. RESULTS: The LBW was significantly greater among the adolescent mothers group than the 20-24 years one. Regarding prenatal care, adolescents had a lower number of appointments and a higher percentage of no attendance. More than 50% of the older mothers completed high school, but only 31.5% among the younger mothers had the same level of instruction. The percentage of premature live births in this group was significantly greater. Differences were observed by type of hospital (public or private) and there was a predominant use of public hospitals by the adolescents. The logistic regression analysis showed a significant effect of the mother age on LBW, even when controlled for other variables. CONCLUSIONS: The results suggest that further investigation on the mechanisms that underlie the association between LBW and pregnancy during adolescence should be carried out, taking into consideration sociocultural factors such as poverty and social deprivation, as well as biological and nutritional factors during pregnancy.

[Epidemiological characterization of meningococcal disease in a metropolitan area in Southeastern Brazil, 1976-1994]. / Caracterização epidemiológica da doença meningocócica na área metropolitana do Rio de Janeiro, Brasil, 1976 a 1994.

INTRODUCTION: Meningococcal disease continues to warrant assessment as to its endemic and epidemic multicausality and temporal trends in various locations. MATERIAL AND METHOD: Based on a standardization of epidemiological investigation of meningococcal disease in the municipality of Rio de Janeiro county, Southeastern Brazil, as from epidemic of the 1970s a study to characterized the epidemiological characteristics of the disease, was realized. The total of 4,155 cases reported between 1976 and 1994 were analyzed in a retrospective, descriptive, and analytical study, using the epidemiological investigation forms issued by the Municipal Health Secretariat. Statistical analysis was performed using the chi 2, Wilcoxon-Mann-Whitney, and Kruskal-Wallis tests. RESULTS: The study resulted in the definition of three periods, classified as post-epidemic (1976-79), endemic (1980-86), and epidemic (1987-94), differentiated by the incidence rates and the predominant meningococcal serogroup. The mean incidence rates per period in the municipality were 3.51, 1.67, and 6.53 cases/ 100,000 inhabitants, respectively. Serogroups A and C predominated during the post-epidemic period, B and A in the endemic, and B in the epidemic. CONCLUSION: The mean case fatality rate remained virtually unchanged over time, but it varied by hospital, and during all three periods was lower in the State government reference hospital than in the other hospitals, whether public or private. The highest incidence and case fatality rates were associated with patients under one year of age, and the risk of acquiring the disease was greater among males. The highest incidence coefficients tended to occur in the same areas of the county during the three epidemiological periods, and the shanty-town population was at twice the risk of acquiring the disease.

Risk factors for hospitalization and death from diarrhea in a public pediatric hospital in Rio de Janeiro, Brazil.

OBJECTIVE: This study was carried out in a public pediatric hospital located in the city of Rio de Janeiro, Brazil, with the aim of identifying risk factors for hospitalization and/or death due to diarrhea in children. MATERIAL AND METHODS: The study included 406 children under three years of age who were seen or admitted for diarrhea from January 1987 to February 1988. The main variable of interest was the outcome of clinical evaluation and subsequent hospitalization, which was classified as follows: 1) outpatient treatment; 2) hospitalization and survival; and 3) death during hospitalization. The chi-square test was used to identify variables (p = < 0.05) that were significantly related to the treatment outcome. RESULTS: The group was composed by 60.6% males and 39.4% females. A proportion of 26.8% of children was under two months of age, 24.9% was 3-5 months old, 25.9% was 6-11 months old, and 22.4% was 12 months or older. The variables most significantly related to the risk of hospitalization from diarrhea were age, current nutritional status (weight-for-age percentile), and concomitant illness. Variables most significantly associated with risk of death from diarrhea were low birth weight and past hospitalization. CONCLUSIONS: Use of this study's results by health services could make a substantial contribution to reducing children's hospitalization and death due to diarrhea in the city of Rio de Janeiro.

[Maternal perception of dehydration in children with diarrhea. A study on agreement with clinical diagnosis]. / Percepção materna da desidratação em crianças com diarréia. Estudo de concordância com diagnóstico médico.

The mother's perception of signs and symptoms of dehydration in children under three years of age was studied and compared with the medical classification. The study was carried out in a children's hospital in the city of Rio de Janeiro, among children hospitalized with diarrhoea between January, 1987 and February, 1988. The number of excretions and of vomitings, thirst and condition of eyes constituted the signs and symptoms most frequently reported by mothers. However, they had difficulty in judging the amount of urine, humidity of mouth and tongue and turgidity of the skin. These signs were almost always regarded as normal or, at most, as indicating only slight alteration. Those mothers who tended to underestimate the severity of the dehydration indicated by the physician were of a lower educational level and had more severely undernourished children and greater difficulty of access to the hospital. On the other hand, those who tended to overestimate it belonged to a higher educational level, had better-nourished children, greater ease of access to the hospital and were attended to by a smaller number of health care services before reaching the hospital surveyed. Those who agreed with the medical diagnosis were in an intermediate situation, although they tended to be closer to those who underestimated the gravity of the dehydration. Those mothers whose children had already gone through a dehydration episode did not present a more intense agreement with the physician's diagnosis, thus evidencing that the information afforded at the health care service was either non-existent or inadequate.