A64 J Epidemiol Community Health 2004;58(Suppl I):A64–A125 J Epidemiol Community Health: first published as on 14 July 2004. Downloaded from proportions and by univariate and multiple logistic regression analysis Poster sessions to determine the independent variables related to the caesarean deliveries. Results: The rates of caesarean delivery were 18.9% and 84.3% at 001 TELECONSULTATION FOR ACCOMPLISHMENT OF A and B, respectively. Maternity A presented higher proportions of more INTRAVENOUS THROMBOLYSIS IN ACUTE unfavourable indicators such as adolescent mothers (27.6% versus MYOCARDIAL INFARCTION AT LOCAL EMERGENCY 5.4%), low maternal educational level (77.9% versus 19.4%), mothers LEVEL IN RIO DE JANEIRO, BRAZIL without a cohabiting companion (68.3% versus 15.3%), those with a larger number of children, and those with a greater proportion of L. Abreu, C. Escosteguy, W. Amaral, M. Ypiranga. Ministe´rio da Sau´de, obstetric diseases compared with Maternity B. A strong association was Hospital dos Servidores do Estado, Rio de Janeiro, Brazil detected between caesarean section and coverage by private health insurance at maternity B, with higher rates for women of higher Introduction: We previously described a loss of opportunity for educational level and progressively increasing with age at both thrombolytic use in acute myocardial infarction (AMI) in Rio de hospitals. The highest proportion of caesarean deliveries was observed Janeiro, Brazil. among patients who had received prenatal care and had been delivered Objective: To describe the experience of a teleconsultation by the same doctor who provided the prenatal care. The convenience of programme (TIET) for evaluating intravenous thrombolytic indica- a programmed surgical delivery for the doctor was demonstrated at tion at small local level emergency units and subsequent transfer Maternity B by the distribution of deliveries at well defined times to a reference coronary care unit (CCU), as part of a programme (daylight hours) and on weekdays, with a marked reduction during to decrease thrombolytic use in the public health system of Rio de weekends. Janeiro. Conclusions: These findings suggest the idea that surgical Methods: We studied a cohort of 618 AMI patients consecutively deliveries were mostly performed without a medical indication at admitted in the reference CCU from July 1999 to November 2003. The Maternity B. teleconsultation system consisted of fax analysis of the electrocardiogram sent by the local clinical unit, together with a standard form. The local unit was encouraged to initiate thrombolysis as soon as possible. We performed descriptive statistical analysis and multivariate logistic 003 CONSUMPTION OF OLIVE OIL AND INCIDENCE OF regression, with estimation of odds ratio (OR) and 95% confidence HYPERTENSION: THE SUN STUDY intervals (95% CI). Results: Of the 517 patients with ST segment elevation, in hospital A. Alonso1, E. Ferna´ndez-Jarne2, C. Fuente1, R. M. Pajares1,A.Sa´nchez- mortality was 13%; among 101 AMI cases without ST elevations, 3 1 1 mortality was 4%. Of the 359 patients admitted through the TIET Villegas , M. A. Martı´nez-Gonza´lez . University of Navarra, Department of Epidemiology and Public Health, Pamplona, Spain; 2University of Navarra, programme (58.1% of the total group), 317 had acute ST elevation. The 3 mortality among these 317 patients was 10.4%, versus 17% in the Department of Cardiology, University Clinic, Pamplona, Spain; University of 200 non-TIET group with ST elevation in AMI (OR 0.6;95% CI 0.3 to Las Palmas, Division of Preventive Medicine and Public Health, Las Palmas de 0.98; p = 0.04 favouring TIET). Among the TIET group with ST elevation Gran Canaria, Spain in AMI, 41.3% received thrombolytics, versus 25% in the non-TIET group (OR 2.1; 95% CI 1.4 to 3.1; p = 0.0001). Among the 181 patients who Introduction: The intake of some fatty acids has been associated with a received intravenous thrombolytics, 47% were treated at the local unit. A decrease in blood pressure. Particularly, n-3 polyunsaturated fatty acids smaller mortality (7.1%) was associated with patients receiving and monounsaturated fatty acids (MUFA) have shown a beneficial effect http://jech.bmj.com/ thrombolytics at the first attendance level (versus 11.5% in those who on blood pressure. MUFA rich olive oil is the major fat source in received the treatment in CCU). The logistic regression showed a Mediterranean diets. However, the relationship between olive oil tendency to a smaller mortality associated with thrombolytic use consumption and the risk of hypertension has not been evaluated in (adjusted OR 0.5; 95% CI 0.3 to 1.09; p = 0.08). This tendency was large cohort studies. more evident for thrombolysis at the local level (adjusted OR 0.3; 95% CI Objective: We evaluated the association between olive oil consump- 0.1 to 1; p = 0.06) than for thrombolysis in the reference CCU (adjusted tion and the incidence of hypertension in the SUN Study. OR 0.7; 95% CI 0.3 to 1.6; p = 0.43). Methods: The SUN (Seguimiento Universidad de Navarra) Study is an Conclusions: The results suggest that the programme favoured a more open enrolment cohort currently comprising 13 500 university gradu- ates, recruited and followed up through biennial mailed questionnaires. precocious and safe intervention at the first emergency attendance level, on September 28, 2021 by guest. Protected copyright. with a possible benefit on survival. The programme proved to be simple Diet was evaluated at baseline with a semiquantitative food frequency and without additional cost for the healthcare system. questionnaire, previously validated in Spain. In the initial questionnaire, information about other risk factors for hypertension and cardiovascular disease was collected, as well as the presence of these conditions. In the first follow up questionnaire, information about a new diagnosis of 002 FACTORS ASSOCIATED WITH CAESAREAN SECTION hypertension made by a physician was requested. To assess the IN BRAZIL relationship between olive oil consumption and risk of hypertension, a Cox proportional hazards model was used, considering quintiles of S. Almeida1, H. Bettiol1, M. A. Barbieri1, A. A. M. Silva2, V. M. Azenha1. energy-adjusted olive oil intake as the main exposure and a new 1Faculty of Medicine of Ribeira˜o Preto/USP, Department of Paediatrics, diagnosis of hypertension as the outcome. Hazard ratios (HR) and their Ribeira˜o Preto, SP, Brazil; 2Federal University of Maranha˜o, Department of 95% confidence interval (CI) for quintiles of energy adjusted olive oil Public Health, Sa˜o Luı´s, MA, Brazil consumption were calculated considering the first quintile as the reference category. Introduction: Brazil has one of the highest rates of caesarean section in Results: The follow up rate for a median of 28.5 months was 88.4% the world. The determinants of caesarean section are related to maternal after five mailings. We identified 118 new cases of hypertension among and fetal conditions and also to non-medical reasons such as physician 4825 participants included in this analysis, accounting for a total study and maternal convenience. base of 11 003 person years. The HR (95% CI) of incident hypertension Objective: The objective of the present investigation was to study for the second, third, fourth and fifth quintiles were 0.60 (0.34 to 1.04). maternal, social, and medical hospital variables in an attempt to identify 0.70 (0.41 to 1.18). 0.48 (0.27 to 0.86), and 0.79 (0.48 to 1.32) the factors responsible for the discrepancy in caesarean section rates in respectively after adjusting for gender, age, physical activity, body mass the city of Ribeira˜o Preto, located in the wealthiest area of southeast index, total energy intake, sodium intake, alcohol intake, and other Brazil. dietary exposures. There was no linear trend among categories of olive Methods: The study design used was a retrospective analysis of all oil consumption. When the four upper quintiles were merged in a single single live births at two hospitals in 1999, corresponding to almost 70% category, the HR (95% CI) of hypertension was 0.63 (0.42 to 0.96) of all the deliveries in the city (5800/8330). Maternity A exclusively compared with the lowest quintile. provides care for pregnant women covered by the public health system Conclusions: Moderate olive oil consumption is inversely associated and Maternity B provides care for women belonging to the private with the risk of hypertension in a Spanish cohort of university graduates. system, including patients covered by private health insurance. Data Our data suggest a threshold effect in the dose2response relationship were analysed statistically by the x2 test for the comparison of between olive oil intake and the risk of hypertension. www.jech.com IEA/EEF abstracts A65 004 CHILD HEALTH CARE: MATERNAL AND HEALTH PROFESSIONAL ATTITUDES IN VIANA DO CASTELO Table 1 Comparison of mortality rates for different DISTRICT, PORTUGAL socioeconomic groups according to sex J Epidemiol Community Health: first published as on 14 July 2004. Downloaded from O. Alves1, D. Mendonc¸a2, A. Maciel-Barbosa3. 1Nursing School, Mental Males Females and Public Health, Viana do Castelo, Portugal; 2Biomedical Institute–ICBAS/ Year Rate I RR 95% CI Rate I RR 95% CI Porto University, Population Studies/Biometry Unit, Porto, Portugal; 3Local Health Authority, Alto Minho Public Health Services, Viana do Castelo, 1990 800.2 1.10 1.06 to 1.14 477.9 1.00 0.93 to 1.07 Portugal 1991 802.7 1.16 1.12 to 1.21 490.6 1.06 0.98 to 1.13 1992 756.1 1.12 1.08 to 1.17 478.4 1.04 0.97 to 1.12 Introduction: The first years of life are considered a prime period for the 1993 747.0 1.21 1.16 to 1.25 487.1 1.02 0.95 to 1.09 detection of health problems.