The association between infant feeding habits and infant mortality from diarrhea was investigated in a population-based case-control study in two urban areas in southern Brazil during 1985. Each of 170 infants who died due to diarrhea was compared with two neighborhood controls. After allowance was made for confounding variables, infants who received powdered milk or cow's milk, in addition to breast milk, were at 4.2 times (95% confidence interval (CI) 1.7-10.1) the risk of death from diarrhea compared with infants who did not receive artificial milk, while the risk for infants who did not receive any breast milk was 14.2 times higher (95% CI 5.9-34.1). Similar results were obtained when infants who died from diarrhea were compared with infants who died from diseases that were presumed to be due to noninfectious causes. Each additional daily breast feed reduced the risk of diarrhea death by 20% (95% CI 2-34%), but the increase in risk associated with each bottle feed was not significant after allowance was made for the number of breast feeds. The only other consumption variable associated with diarrhea mortality was the frequency with which tea, water, or juice were drunk with each feed (increase in risk, 42% (95% CI 4-93%]. The odds ratios associated with nonbreast milk were highest in the first two months of life. Possible biases were investigated, including the interruption of breast-feeding as an early consequence of the terminal illness, but the strong protective effect of breast-feeding persisted after these adjustments.
Neste estudo sintetizam-se achados epidemiológicos sobre acidentes de trabalho fatais e não-fatais para populações brasileiras, entre 1994 e 2004, período pós II Conferência Nacional de Saúde do Trabalhador. Os estudos foram identificados em pesquisa nas bases Scielo e Medline, limitando-se a trabalhos completos disponíveis. Verificou-se que embora o coeficiente de mortalidade por acidentes de trabalho seja elevado, entre 1990 e 2003 caiu 56,5%. Todavia, a letalidade aumentou (0,18% em 1970 para 1,07%) até 1999, quando passou a declinar (0,70% em 2003). A incidência cumulativa anual de acidentes de trabalho não-fatais também vem reduzindo, mas discretamente, em especial, para os menos graves. Não houve alteração para os acidentes incapacitantes. Pesquisas populacionais mostram que a incidência cumulativa anual varia entre 3% e 6%. Trabalhadores rurais têm o dobro do risco do que os de área urbana. A construção civil, indústria da celulose, serviços domésticos estão entre os grupos de maior risco para acidentes não-fatais. A subnotificação de óbitos se concentrou entre 70% e 90%. Indica-se a necessidade de uma redefinição das políticas de proteção ao trabalhador tomando como base o conhecimento produzido sobre este evitável problema de saúde.
O presente artigo identifica e discute alguns desafios e perspectivas relativos à implantação de um Sistema de Informações em Saúde do Trabalhador (SIST) no âmbito do Sistema Único de Saúde (SUS). Os desafios para a coleta, produção e a análise de dados e a disseminação continuada de informações sobre o estado de saúde dos trabalhadores e seus determinantes são revisados. Há destaque para a necessidade de investimentos em capacitação de recursos humanos, articulação e harmonização das bases de dados de interesse à saúde do trabalhador, implantação de infra-estrutura de informática nos níveis locais e da coleta das informações na rede de serviços do SUS, e integração e articulação interministerial. A realização da 3ª Conferência Nacional de Saúde do Trabalhador e a recém aprovada Política Nacional de Segurança e Saúde do Trabalhador representam reforços importantes para o debate sobre a implantação do SIST e sua prioridade na agenda do SUS. A relativa sintonia entre as agendas de técnicos, pesquisadores, trabalhadores e lideranças sindicais na defesa comum de um sistema de informações também é vista como um apoio à implantação do SIST e seu efetivo controle social.
The impact of oral rehydration therapy (ORT) on the recent decline in diarrhoea mortality in the northeast of Brazil was studied. Proportionate infant mortality fell from 32% in 1980 to 17% in 1989 and infant deaths attributed to diarrhoea dropped from 41% to 25%, resulting in an overall reduction of 57%. Similar decreases were observed for children aged 1-4 years. Diarrhoea admissions also fell from 57% of infant hospitalizations in 1980 to 30% in 1990. None of the other major causes of death or admissions showed such decline. ORT was introduced in the early 1980s, being used in 35% of all episodes in 1991 and in 62% of those regarded as severe by the mother. Other changes included a worsening of socioeconomic conditions and increases in water supply, vaccine coverage, breastfeeding duration and nutritional status. A simulation model estimated that changes in factors other than ORT would lead to a 21% reduction in infant diarrhoea mortality, or about one-third of the actual decline. Finally, an ecological analysis showed that ORT use rates were inversely correlated to infant diarrhoea mortality (r=-0.61; p=0.04). Despite the shortcomings of the available data, these findings suggest an important impact of ORT on diarrhoea mortality.
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