Biomedical subjects

Cynthia Braga da Cunha

Publications and source records attributed to Cynthia Braga da Cunha.

7 recordsLinked to original sources

PubMed2006

Progressive decline in stroke mortality in Brazil from 1980 to 1982, 1990 to 1992, and 2000 to 2002.

BACKGROUND AND PURPOSE: We describe the trends in stroke mortality in Brazil during 3 decades and investigate their differences according to regional disparities, sex, and age distributions. METHODS: Official data on mortality and population estimates were retrieved to calculate standardized mortality rates (with the 1980 Brazilian population as a reference) in 6 age strata and in the 5 political regions for the initial period (3 first years) of the 1980, 1990, and 2000 decades. Data were corrected for undefined causes of death. The Poisson model was used to estimate risk reduction during the 3 decades and to study the interaction between those rates and sex, age strata, and regions. RESULTS: The stroke standardized mortality rate decreased consistently in the last 20 years, from 68.2 to 40.9 per 100,000 habitants. This reduction paralleled a decrease in total cardiovascular mortality rates in the same period, from 208.2 to 126.1 per 100,000 habitants. The reduction in stroke standardized mortality rate was detected in men and women and in all age strata. The reduction was evident in all geopolitical regions of the country, with the wealthiest regions' exhibiting higher initial rates and more marked standardized mortality rate reductions. The risk of dying of stroke in the period 2000 to 2002 was 0.45 (95% CI, 0.44 to 0.45) of that found in the period 1980 to 1982. CONCLUSIONS: The risk of dying of stroke in Brazil declined dramatically between the initial period in the early 1980s and the early 2000s. The decline was especially marked in the most developed regions and may reflect an improvement in general health conditions during the study period.

Adolescent↗

PubMed2006

[Consequences of sociodemographic inequalities on birth weight].

OBJECTIVE: To analyze sociodemographic inequalities in prenatal and childbirth care and their consequences on birth weight. METHODS: The study was based on a sample of 10,072 postpartum women treated at public (those outsourced by the National Health System) and private maternity hospitals in Rio de Janeiro, Brazil, from 1999 to 2001. To test the association between birth weight and maternal sociodemographic and biological characteristics and prenatal care (modified Kotelchuck index), postpartum women were stratified by level of schooling and two multiple linear regressions were performed. The bootstrap technique was used in addition to accurate confidence intervals for the estimated effects. RESULTS: For nearly all of the variables analyzed in the bivariate analysis, birth weight was lower among children of mothers with low schooling. In the multivariate analysis, among women with low schooling, there was a direct association between birth weight and the modified Kotelchuck index and gestational age. The variables black skin color, smoking, and history of premature birth were negatively associated with birth weight, while maternal age and parity showed distinct behaviors from the central range of data at the extremes. In the group with high schooling, only parity, gestational age, and modified Kotelchuck index were significant and directly associated with birth weight. The protective effect of prenatal care was observed, as well as the negative effect of smoking, regardless of the mother's level of schooling. CONCLUSIONS: The variables associated with neonates' birth weight of mothers with high schooling in Rio de Janeiro were biological, in contrast to the social determinants in the group with low schooling.

Adult↗

PubMed2006

[Quality of socioeconomic and demographic data in relation to infant mortality in the Brazilian Mortality Information System (1996/2001)].

This study aimed to evaluate the quality of socioeconomic and demographic data in the Brazilian Mortality Information System (SIM), in relation to infant mortality. The article assesses the system's potential for monitoring inequalities in infant mortality in various States in the country. Accessibility, timeliness, methodological clarity, incompleteness, and consistency were explored as quality indicators. Selected variables were: race, birth weight, gestational age, medical care, parity, and maternal schooling, age, and occupation. The study also reviewed the system's working documentation and the scientific literature on infant mortality. Proportions of data incompleteness were calculated by region and State, identifying factors that might influence (in)completeness using logistic regression. Despite the database's accessibility and the relevance of most of its variables, the system has serious quality problems: confusing instructions in the information manual concerning missing data, misclassification of maternal occupation, lack of data on the informant's race/ethnicity, and high proportions of incomplete information. The system does not appear to be a reliable source for monitoring, evaluating, and planning measures to minimize infant health inequalities.

Brazil↗

PubMed2005

[Racial, sociodemographic, and prenatal and childbirth care inequalities in Brazil, 1999-2001].

OBJECTIVE: To analyze social inequalities and inequalities in access to and utilization of health care services according to skin color in a representative sample of postpartum women receiving hospital childbirth care. METHODS: A cross-sectional study was carried out in a sample of 9,633 postpartum women, of whom 5,002 were white (51.9%), 2,796 mulatto (29.0%), and 1,835 black skin color (19.0%), seen in public maternity hospitals, hospitals contracted out by the Unified National Health System, and private hospitals in the period 1999-2001. Data were collected from medical records and through interviews with the mothers in the immediate postpartum period using standardized questionnaires. Statistical analyses were performed using chi(2) tests to assess homogeneity of proportions and Student's t-test for comparison of measures. The analysis was stratified by maternal schooling. RESULTS: A persistent unfavorable situation was seen for mulatto and black women as compared to white women. Mulatto and black women had the highest rates of adolescent mothers, low schooling, unpaid occupation, and not having a partner. History of physical violence, smoking, attempts to interrupt pregnancy, and visits to several hospitals before being admitted were more frequent among black women, followed by mulatto and then white women of low schooling. High schooling group of women showed better indicators but the same pattern was seen. This variability is also seen in the opposite direction in terms of the level of satisfaction with prenatal and childbirth care. CONCLUSIONS: It was distinguished two forms of discrimination, by educational level and skin color, in care delivered by health services to postpartum women in Rio de Janeiro.

Adolescent↗

PubMed2004

[Consistency between data sources and inter-observer reliability in the Study on Neonatal and Perinatal Morbidity and Mortality and Care in the City of Rio de Janeiro].

The objective of this study was to evaluate the quality of data in the research project entitled "Study on Neonatal and Perinatal Morbidity and Mortality and Care in the City of Rio de Janeiro", analyzing the completeness of patient records, inter-observer reliability, and concordance of collected data. The study interviewed a sample of 10,072 post-partum women, corresponding to 10.0% of the deliveries in the City of Rio de Janeiro. This article analyzed the concordance between data on patient records and the reproducibility of questionnaires by mean of rest/ retest, using common and prevalence-adjusted Kappa as well as the intra-class correlation coefficient. Losses totaled 4.5%, and the proportion of unknown data on patient records varied from 3.0 to 90.0%. Lower proportions were concentrated in the neonatal assessment and higher ones in the data on maternal hospital admission. There was a high concordance between the data reported by the mother and that written on the patient record, with the Kappa varying from 0.77 to 0.96. In the test/retest verification, Kappa varied from 0.61 to 0.94. This study demonstrated a high inter-observer reliability as well as reliability between the different data sources (interviewee and patient record).

Brazil↗

PubMed2004

[Use of the modified Kotelchuck index in the evaluation of prenatal care and its relationship to maternal characteristics and birth weight in Rio de Janeiro, Brazil].

The Kotelchuck index (KI) was modified and used to evaluate prenatal care provided in the City of Rio de Janeiro, Brazil, in a sample of 9,920 post-partum women following singleton deliveries. Ordinal logistic regression (OLR) and multivariate linear regression (LMR) were used to estimate the importance of demographic, psychosocial, and obstetric factors for modified KI and the effects on birth weight (BW), respectively. Only 38.5% of the sample was classified as having received adequate or intensive prenatal care. After adjusting for other predictors, the explanatory variables for KI were: mother's schooling, living with the newborn's father, attempted abortion, diabetes mellitus, satisfaction with pregnancy, skin color, parity, age, and place of residence. BW was associated with the modified KI, even after controlling for socio-demographic, behavioral, and biological variables. Adequate utilization of prenatal care in the City of Rio de Janeiro contributed to the prevention of low BW, and the mothers who used prenatal services less presented worse conditions in terms of socioeconomic status, schooling, family support, and obstetric risk.

Adult↗

PubMed2004

[Reliability of birth certificate data in Rio de Janeiro, Brazil, 1999-2001].

The objective of this article is to assess coverage and reliability of data from the Information System on Live Births in the City of Rio de Janeiro, based on an analysis of live birth certificates issued by the various hospitals and compared to information from the "Study on Neonatal and Perinatal Morbidity and Mortality and Care in the City of Rio de Janeiro". A total of 9,608 interviews with post-partum women were paired case-by-case with the respective birth certificates. The statistical analysis consisted of calculating the Kappa index adjusted to the prevalence of categorical variables and the intra-class correlation coefficient for continuous variables, with a 95% significance level. The study showed excellent coverage (96.5%) for hospital births in the City of Rio de Janeiro during the period studied. The variables presenting the highest concordance levels (over 0.90) were the infant's sex, birth weight, mother's age, type of delivery, and type of pregnancy. The variables marital status, mother's schooling, and number of prenatal visits showed lower reliability indices (Kappa < 0.70). The article discusses the importance of data quality in the Information System on Live Births (SINASC) and the system's use as a tool to help define maternal and child health policies.

Birth Certificates↗