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OBJETIVO: O melanoma tem incidência crescente, sendo que a prevalência dos tumores malignos epiteliais é alta, e o diagnóstico precoce contribui significativamente para a redução da morbimortalidade dessas doenças. O objetivo da pesquisa é medir a prevalência das lesões cutâneas pré-malignas e malignas e determinar a sensibilidade e a especificidade de um rastreamento para essas lesões. MÉTODOS: Foi realizado um estudo transversal de base populacional com escolha aleatória de 48 setores censitários da zona urbana de Pelotas, RS, Brasil. Um total de 2.112 domicílios foram visitados, sendo entrevistadas 1.292 pessoas de 50 anos de idade ou mais. O rastreamento possuía questões específicas sobre o surgimento de lesões de pele nos últimos seis meses e/ou a presença de lesões em áreas expostas. Os que responderam afirmativamente foram encaminhados ao exame médico. Também foi examinada uma subamostra daqueles que haviam respondido negativamente às questões do rastreamento. RESULTADOS: A prevalência corrigida das lesões cutâneas pré-malignas e malignas foi de 20,7%. A sensibilidade do rastreamento foi de 20,1%, a especificidade, de 86,9%, o valor preditivo positivo, de 29%, o valor preditivo negativo, de 80,4%, e acurácia, de 72,9%. Com diferentes pontos de corte, o valor máximo da sensibilidade atingiu 38,8%, e a especificidade não se alterou significativamente. CONCLUSÕES: O estudo demonstrou alta prevalência de lesões cutâneas pré-malignas e malignas em adultos. O rastreamento para essas lesões mostrou baixa sensibilidade e especificidade inferior ao desejado, independentemente dos pontos de corte.

INTRODUCTION: Although there was a considerable reduction in infant mortality in Pelotas, Rio Grande do Sul in the last decade, its perinatal causes were reduced only by 28%. The associated factors of these causes were analised. MATERIAL AND METHOD: All hospital births and perinatal deaths were assessed by daily visits to all the maternity hospitals in the city, throughout 1993 and including the first week of 1994. RESULTS: The perinatal mortality rate was 22.1 per thousand births. The multivariate analysis showed the following risk factors: low socioeconomic level, male sex and maternal age above 35 years . Among multigravidae women, the fetal mortality rate was significantly increased for mothers with a previously low birthweight and a previous stillbirth. For early neonatal mortality the risk was significantly increased by a smaller number of antenatal visits than 5 and low birthweight. CONCLUSIONS: Main risk factors for perinatal mortality: low socioeconomic level, maternal age above 35 years and male sex. For early neonatal mortality the risk was significantly increased by a smaller number of antenatal visits than 5 and low birthweight.

OBJETIVO: Avaliar as mudanças na prevalência de tabagismo durante a gravidez na cidade de Pelotas, RS, Brasil, com base nos estudos da população materno-infantil realizados nos anos de 1982 e 1993. METODOLOGIA: Estudo transversal, tendo sido identificados 6.011 e 5.304 recém-nascidos, cujas famílias residiam na área urbana da cidade de Pelotas, respectivamente em 1982 e 1993. RESULTADOS: O tabagismo materno durante a gestação apresentou uma discreta redução de 35,7%, em 1982, para 33,5% em 1993 (p < 0,05). O hábito de fumar esteve inversamente relacionado com a renda e o número de consultas no pré-natal.

Em 1982, todos os nascimentos ocorridos na cidade de Pelotas, RS - Brasil, foram estudados e essas crianças foram acompanhadas prospectivamente durante os primeiros anos de vida. Em 1993, repetiu-se o estudo com metodologia similar, com a finalidade de avaliar as eventuais mudanças no nível de saúde materno-infantil, ocorridas durante esses onze anos. Todas as cinco maternidades da cidade foram visitadas diariamente e os 5.304 nascimentos ocorridos foram incluídos no estudo. As crianças foram pesadas e medidas, sendo sua idade gestacional avaliada através do método de Dubowitz. As mães foram examinadas e entrevistadas sobre um grande número de fatores de risco. A mortalidade dessas crianças foi monitorizada por visitas regulares a hospitais, cemitérios e registros de óbito, e todas as internações hospitalares foram acompanhadas. Dois estudos aninhados de casos e controles foram realizados para investigar fatores de risco para mortalidade e hospitalizações. Uma amostra sistemática de 655 crianças foram examinadas em casa com um e três meses de idade, e essas mesmas crianças, acrescidas de outras 805 (que incluíram todos os recém-nascidos de baixo peso) foram também acompanhadas aos seis e doze meses de idade. O desenvolvimento psicomotor dessas amostras foi também avaliado. As perdas de acompanhamento aos doze meses foram de apenas 6,6%. Em relação aos dados de 1982, a pesquisa de 1993 mostrou redução de cerca de 30% na mortalidade perinatal e de quase 50% na mortalidade infantil, assim como aumento de um mês na duração mediana da amamentação. Por outro lado, não houve qualquer alteração nas prevalências de baixo peso ao nascer e de déficit de comprimento/idade aos doze meses. O artigo a que se refere este resumo descreve a metodologia do estudo, ao qual se segue uma série de outras publicações.

OBJECTIVE: To analyze the association between mental health problems and smoking in adolescents. METHODS: A total of 4,325 adolescents aged 15 from the 1993 birth cohort of the city of Pelotas, Southern Brazil, was studied. Smoking was defined as having smoked one or more cigarettes in the previous 30 days. Mental health was assessed according to the total score of the Strengths and Difficulties Questionnaire. Score = 20 points was considered positive. Data were analyzed using Poisson regression with adjustment for robust variance. RESULTS: Smoking prevalence was 6.0% and about 30% of the adolescents presented some mental health problem. In the crude analysis, the prevalence ratio for smoking was 3.3 (95%CI 2.5; 4.2). After the adjusted analysis (for sex, age, skin color, family income, mother's level of schooling, group of friends who smoke, employment in the previous year, school failure, physical activity during leisure time and experimental use of alcohol), it decreased to 1.7 (95%CI 1.2; 2.3) among those with mental health problem. CONCLUSIONS: Mental health problems in adolescence may be related to tobacco consumption. [ABSTRACT FROM AUTHOR]

Objectives: To explore the association between adiposity, major depressive disorder and generalized anxiety disorder, and to assess the role of inflammation, diet quality and physical activity in this association., Methods: We used data from 2,977 individuals from the 1993 Pelotas Cohort (Brazil) who attended the 18- and 22-year follow-ups. We assessed general obesity using body mass index, fat mass index, and abdominal obesity using waist circumference. Major Depressive Disorder and generalized anxiety disorder were assessed using the mini-international neuropsychiatric interview. C-reactive protein and interleukin-6 (IL-6) levels were used as a measure of inflammation; diet quality was estimated using the revised diet quality index, and physical activity was assessed by the International physical activity questionnaire (IPAQ, min/day). The association between adiposity and major depressive disorder and generalized anxiety disorder was assessed using logistic regression, and the natural indirect effect via the mediators was estimated using G-computation., Results: General obesity assessed by body mass index (OR: 2.3; 95% CI:1.13; 4.85), fat mass index (OR: 2.6; 95%CI: 1.37; 4.83), and abdominal obesity (OR: 2.5; 95%CI: 1.18; 5.39) were associated with higher odds of major depressive disorder, whereas major depressive disorder was only associated with obesity assessed by body mass index (OR=1.9; 95% CI: 1.09; 3.46). Obesity and generalized anxiety disorder were not associated. C-reactive protein, diet quality and physical activity did not mediate the effect of obesity on major depressive disorder, and C-reactive protein mediated about 25% of the effect of major depressive disorder on adiposity., Conclusions: Depression, but not generalized anxiety disorder, is associated with adiposity in both directions, with a stronger evidence for the direction obesity-depression. Inflammation explains part of the effect of major depressive disorder on obesity but not the other way around. Further research should explore other mechanisms that could be involved in the association between obesity and depression.

Objective: To estimate the prevalence of wheezing in the chest among adults, and to explore the effect of some variables on the prevalence of this condition., Methods: This was a prospective cohort study on individuals born in the city of Pelotas (Southern Brazil) in 1982. A total of 4,297 subjects was traced in 2004-5, representing 77.4% of the original cohort. Data were collected by means of interviews using the ISAAC (International Study of Asthma and Allergies in Childhood Steering Committee) questionnaire. Associations between the outcome 'occurrence of wheezing in the chest within the 12 months prior to the interview' and the variables of socioeconomic, demographic and birth characteristics were tested by means of multivariable analyses, using Poisson regression., Results: The prevalence of wheezing over the preceding year was 24.9%. Among the individuals reporting wheezing, 54.6% reported difficulty in sleeping, and 12.9% reported difficulty in speaking due to wheezing. The prevalence of wheezing in the chest was significantly higher among women. This association was maintained in analyses adjusted for non-white skin color, family history of asthma and low socioeconomic level. Among men, there was no significant association in the analyses adjusted for skin color and family income at birth. Family histories of asthma and poverty throughout life presented significant associations with wheezing in the chest. For both sexes, there were no associations with the variables of birth weight and breastfeeding duration., Conclusions: The prevalence of wheezing in the chest was high, and subjects with low family income at birth were more likely to have had wheezing in the chest over the preceding year.

Objective: To assess smoking prevalence in adolescents and young adults of a population-based birth cohort., Methods: Prospective birth cohort study of infants born in 1982, in the city of Pelotas, Southern Brazil, and interviewed in 1997, 2000-2001 and 2005. In the 1997 and 2000-2001 follow-up visits, the outcome studied was smoking, defined as the consumption of at least one cigarette in the previous week. In the 2005 follow-up visit, the dependent variable was current smoking. Adjusted analysis was performed using Poisson regression., Results: Smoking prevalences among males were 5.9%, 20.2% and 27.6% in the 1997, 2000-2001 and 2005 follow-up visits, respectively. Among females, respective values were 9.3%, 27.5% and 23.6%. Mean age of smoking onset was 15.1 years (SD=2.5). In the multivariate analysis, lower maternal level of education, low income level in 1982, poverty during the follow-up period and maternal smoking were significantly associated with higher smoking prevalences in both sexes. Being non-white was associated with higher risk of smoking among females exclusively. Breastfeeding was not associated with smoking. Among females, smoking was inversely associated with birth weight in the crude analysis, but lost its significance in the adjusted analysis., Conclusions: Higher incidence of smoking in poorer groups suggests that behavior such as avoiding smoking during pregnancy and increasing cigarette prices can have an important population impact.

Objective: To estimate the prevalence of habitual snoring and obstructive sleep apnea and their factors associated., Methods: Cross-sectional study with a representative sample comprising 3,136 adults (>20 years) living in the city of Pelotas, Southern Brazil, in 2005. A questionnaire was used to collect information on demographic, socioeconomic, behavioral and anthropometric variables and outcomes. Crude and adjusted statistical analysis using Fisher exact test and chi-square test for linear trend and a multivariate analysis through Poisson regression model were carried out, respectively., Results: The prevalence of habitual snoring was 50.5% (95% CI: 48.1;52.8) and obstructive sleep apnea was 9.9% (95% CI: 8.7;11.2). After adjustment, the risk of habitual snoring was greater in males (prevalence ratio [PR]=1.25, 95% CI: 1.16;1.34), elderly people (PR=1.62, 95% CI: 1.46;1.80), current smokers (PR=1.15, 95% CI: 1.07;1.25), alcohol users (PR=1.17, 95% CI: 1.03;1.31) and obese people (PR=1.71, 95% CI: 1.55;1.88). The risk of obstructive sleep apnea was greater in males (PR=2.05, 95% CI: 1.67;2.52), elderly people (PR=2.23, 95% CI: 1.64;3.03), current smokers (PR=1.60, 95% CI: 1.25;2.05) and obese people (PR=2.61, 95% CI: 1.97;3.47)., Conclusions: In the studied population, habitual snoring and obstructive sleep apnea were common symptoms. Well-known risk factors such as male gender and age between 40 and 60 years are not modifiable. However, smoking, alcohol use and obesity need to be identified and treated in general population.

Objective: Migraine is a disease of high prevalence with important impact on people's daily activities. The study aimed at assessing the distribution of migraine in adult population and some of its determinants., Methods: A cross-sectional population-based study was conducted with a multi-stage and probabilistic sampling. A total of 2,715 individuals aged 20 to 64 years old living in the urban area of the city of Pelotas, Southern Brazil, were interviewed. A questionnaire was applied according to the recommendations of the International Headache Society to define the main outcome. Crude and adjusted analysis were performed using Poisson regression., Results: The prevalence of headache and migraine was 71.3% (95% CI: 69.6-73.0) and 10.7% (95% CI: 9.4-12.1) respectively. Women showed a four-fold risk greater than men and white skin people showed 1.4 times greater risk than those non-white. Women taking oral contraceptives or shots against pregnancy showed a risk for migraine 1.3 times greater than those women not taking these medicines. Socioeconomic level and regular menstrual periods in the last three months were not found to be associated with migraine., Conclusions: Migraine is a disease that affects mainly women being associated to the white skin color and use of hormonal contraceptives.

Objective: Lung, laryngeal and esophageal cancers have smoking as one of their main risk factors. The objective of this study was to evaluate the population attributed risk (PAR) of smoking for these forms of cancer., Methods: The study was based in three case-control studies conducted in medium size cities in Brazil. Incident cases of lung cancer, laryngeal cancer and esophageal cancer seen at a hospital setting and diagnosed through biopsy were analyzed; controls were hospitalized patients with another diagnoses. Smoking was the exposure factor measured at three levels: non-smokers, former smokers and smokers, which were defined using a questionnaire applied by trained interviewers. For effect measure, odds ratio was used and the populational attributed risk for smoking was then calculated for a 95% CI., Results: A total of 122 lung cancer cases and 244 controls, 50 cases of laryngeal cancer and 48 cases of esophageal cancer, and 96 controls for both of them were studied. The prevalence of smoking exposure was 34%, which is the overall prevalence of smoking in this city's adult population. Odds ratios (OR) for the PAR analysis were the adjusted OR for confounding variables from each study. Lung cancer PAR was 63% (95% IC, 0.58-0.68) for former smokers and 71% (95%IC, 0.65-0.77) for smokers. Larynx cancer PAR was 74% (95% IC, 0.70-0.78) and 86% (95%IC, 0.81-0.85) for former smokers and smokers, respectively. Esophageal cancer PAR was 54% (95%IC, 0.46-0.62) for smokers., Conclusion: Smoking is an avoidable risk factor and smoking cessation could be responsible for significant reductions in the incidence of these three forms of cancer.

Objective: The incidence of melanoma is increasing worldwide, prevalence of malignant epithelial tumors is high and early diagnosis reduces significantly the morbi-mortality of these diseases. The purpose of the study is to estimate the prevalence of pre-malignant and malignant skin lesions and to determine the sensitivity and specificity of screening tests., Methods: A cross-sectional population-based study was carried out using 48 census tracts randomly selected from urban zone of southern, Brazil. A total of 2,112 dwellings were visited and 1,292 individuals aged 50 years or more were interviewed. The questionnaire consisted of specific questions about new skin lesions in the last six months and/or the presence of lesions on exposed areas. Those who answered affirmatively were referred to the university's outpatient clinic for medical skin examination (gold standard). For assessing specificity the same doctors investigated a sub-sample of those who replied negatively to the questionnaire., Results: The prevalence of pre-malignant and malignant skin lesions was 20.7%. The screening sensitivity was 20.1%, specificity 86.9%, positive predictive value 29%, negative predictive value 80.4%, and accuracy 72.9%. Using different cut-off points, the maximum sensitivity value was 38.8% and specificity remained almost the same., Conclusions: The study showed a high prevalence of skin lesions both pre-malignant and malignant in adults. Skin lesion screening revealed low sensitivity and unsatisfactory specificity, regardless the cut-off points set.