O objetivo deste estudo retrospectivo de base hospitalar foi descrever as condições de saúde e estimar a sobrevida de 252 pacientes, com diagnóstico prévio de câncer de mama, tratadas e acompanhadas no Ambulatório de Mastologia do Hospital Universitário de Santa Maria, Rio Grande do Sul, Brasil, no período de 1980 a 2000. Para a análise estatística foram utilizados o estimador de Kaplan-Meier e o modelo de Cox. A idade média das pacientes foi 54 anos, sendo que 73,4% apresentaram diagnóstico histológico de carcinoma ductal invasor, 63,9% não apresentaram comprometimento dos linfonodos regionais e 57,6% encontravam-se no estadiamento clínico II. Ao final do estudo, 64,7% das mulheres estavam vivas e sem câncer de mama, e 5,1% morreram por outra causa. A sobrevida estimada em 5 anos, foi de 87,7%, sendo os fatores prognósticos associados: tamanho do tumor (RR = 12,03; > 5cm), comprometimento (RR = 3,08; N1) e número de linfonodos ressecados (RR = 4,66; Nenhum), receptor de estrógeno (RR = 0,34) e c-erbB-2 (RR = 2,51). Com base nos achados deste estudo, destaca-se a importância de ações intensivas de orientação para implementar o rastreamento do câncer de mama, levando a diagnósticos em estádios precoces dessa neoplasia.

OBJECTIVE:To analyze neonatal mortality determinants using multilevel logistic regression and classic hierarchical models. METHODS:Cohort study including 138,407 live births with birth certifi cates and 1,134 neonatal deaths recorded in 2003, in the state of Rio Grande do Sul, Southern Brazil. The Information System on Live Births and mortality records were linked for gathering information on individual-level exposures. Sociodemographic data and information on the pregnancy, childbirth care and characteristics of the children at birth were collected. The associated factors were estimated and compared by traditional and multilevel logistic regression analysis. RESULTS:The neonatal mortality rate was 8.19 deaths per 1,000 live births. Low birth weight, 1-and 5-minute Apgar score below eight, congenital malformation, pre-term birth and previous fetal loss were associated with neonatal death in the traditional model. Elective cesarean section had a protective effect. Previous fetal loss did not remain signifi cant in the multilevel model, but the inclusion of a contextual variable (poverty rate) showed that 15% of neonatal mortality variation can be explained by varying poverty rates in the microregions. CONCLUSIONS:The use of multilevel models showed a small effect of contextual determinants on the neonatal mortality rate. There was found a positive association with the poverty rate in the general model, and the proportion of households with water supply among preterm newborns.

The Beck Depression Inventory (BDI), a scale that measures the latent trait intensity of depression symptoms, can be assessed by the Item Response Theory (IRT). This study used the Graded-Response model (GRM) to assess the intensity of depressive symptoms in 4,025 individuals who responded to the BDI, in order to efficiently use the information available on different aspects enabled by the use of this methodology. The fit of this model was done in PARSCALE software. We identified 13 items of the BDI in which at least one response category was not more likely than others to be chosen, so that these items had to be categorized again. The items with greater power of discrimination were sadness, pessimism, feeling of failure, dissatisfaction, self-hatred, indecision, and difficulty of work. The most serious items were weight loss, suicidal ideas, and social withdrawal. The group of 202 individuals with the highest levels of depressive symptoms was comprised by 74% of women and almost 84% had a diagnosis of a psychiatric disorder. The results show gains resulting from use of IRT in the analysis of latent traits.

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