Hillegonda Maria Dutilh Novaes

Bio: Hillegonda Maria Dutilh Novaes is an academic researcher from University of São Paulo. The author has contributed to research in topics: Population & Health care. The author has an hindex of 25, co-authored 114 publications receiving 2349 citations. Previous affiliations of Hillegonda Maria Dutilh Novaes include National Council for Scientific and Technological Development.

Association between ambient air pollution and birth weight in São Paulo, Brazil

Abstract: Objectives: Previous studies have implicated air pollution in increased mortality and morbidity, especially in the elderly population and children. More recently, associations with mortality in infants and with some reproductive outcomes have also been reported. The aim of this study is to explore the association between exposure to outdoor air pollution during pregnancy and birth weight. Design: Cross sectional study using data on all singleton full term live births during a one year period. For each individual birth, information on gestational age, type of delivery, birth weight, sex, maternal education, maternal age, place of residence, and parity was available. Daily mean levels of PM 10 , sulphur dioxide, nitrogen dioxide, carbon monoxide, and ozone were also gathered. The association between birth weight and air pollution was assessed in regression models with exposure averaged over each trimester of pregnancy. Setting: Sao Paulo city, Brazil. Results: Birth weight was shown to be associated with length of gestation, maternal age and instruction, infant gender, number of antenatal care visits, parity, and type of delivery. On adjusting for these variables negative effects of exposure to PM 10 and carbon monoxide during the first trimester were observed. This effect seemed to be more robust for carbon monoxide. For a 1 ppm increase in mean exposure to carbon monoxide during the first trimester a reduction of 23 g in birth weight was estimated. Conclusions: The results are consistent in revealing that exposure to air pollution during pregnancy may interfere with weight gain in the fetus. Given the poorer outlook for low birthweight babies on a number of health outcomes, this finding is important from the public health perspective.

[Evaluation of health programs, services and technologies].

Abstract: The field of program, services and technology evaluation in general, and in health care in particular, is going through an important growth and conceptual and methodological diversification. It is also the object of an increasing demand for its participation as an effective supportive instrument in the decision-making process, and a constant need in the dynamics of health systems and services. In this paper, based on literature review, nuclear criteria involved in the organization of all evaluation processes are identified, and articulated with the existing institutionalized evaluation practices in developed countries, that is, program evaluation, quality assessment and management and technology assessment. In conclusion, the incipient development of a methodological evaluation output in Brazil is analyzed.

Prevalência de transtornos mentais comuns em populações atendidas pelo Programa Saúde da Família (QUALIS) no Município de São Paulo, Brasil

Abstract: The prevalence of common mental disorders has increased in many countries. Cases are often not identified and adequately treated because traditional health care services are rarely prepared to deal with this problem. The Family Health Program (FHP) has been implemented in Brazil since 1995-1996 and provides a new primary health care model with the potential for better care for these patients. This study investigates common mental disorders prevalence according to FHP coverage and associated socio-demographic factors. A large health and health care survey was conducted from January to March 2001 in areas partly covered by the FHP in a peripheral area of the city of Sao Paulo and included common mental disorders screening in 2,337 individuals > 15 years of age. There was no significant difference in common mental disorders prevalence according to FHP. Common mental disorders prevalence was significantly higher among females (PR = 1.34), elderly (PR = 1.56), and individuals with lower income (PR = 2.64) or less schooling (PR = 2.83). Common mental disorders was associated with indicators of social disadvantage, implying the need to focus on specific health problems and risk groups to improve the impact of care.

Utilização de serviços de saúde em áreas cobertas pelo programa saúde da família (Qualis) no Município de São Paulo

Abstract: OBJETIVO: O Programa de Saude da Familia se constitui em estrategia de reorganizacao do sistema de atencao a saude para o Sistema Unico de Saude. O objetivo do estudo foi verificar mudancas no perfil de utilizacao de servicos de saude apos implantacao do Programa, identificando fatores associados as mudancas observadas. METODOS: Foram analisados dados de utilizacao de servicos e procura por assistencia em duas amostras definidas por conglomerados e representativas da populacao coberta (n=1.865) e nao coberta pelo Programa de Saude da Familia (n=2.036) de dois distritos do Municipio de Sao Paulo. Os dados fazem parte de inquerito populacional realizado em 2001. Foi empregada a analise estatistica propria para conglomerados. RESULTADOS: Na utilizacao de servicos, nas areas cobertas pelo Programa de Saude da Familia, nao foram observadas razoes de prevalencia significantemente diferentes segundo escolaridade e renda, e nas areas nao cobertas as razoes de prevalencia foram mais elevadas para maior escolaridade e renda. Na procura por assistencia em pessoas com episodios de morbidade, nas areas cobertas pelo Programa a razao de prevalencia foi maior em pessoas com grau de limitacao intenso, e nas areas nao cobertas a razao de prevalencia foi mais elevada para maior escolaridade e menor para os inativos. CONCLUSOES: Nas areas estudadas, na populacao coberta pelo Programa de Saude da Familia a renda e escolaridade nao se constituem em fatores que diferenciam de forma significativa o perfil de utilizacao de servicos de saude e de procura por assistencia, indicando que o programa pode estar contribuindo para maior equidade nessas condicoes.

Fatores de risco para mortalidade neonatal precoce

Abstract: OBJETIVO: Avaliar os fatores de risco da mortalidade neonatal precoce. METODOS: Estudo caso-controle de base populacional com 146 obitos neonatais precoces e amostra de 313 controles obtidos entre os sobreviventes ao periodo neonatal, na regiao sul do municipio de Sao Paulo, no periodo de 1/8/2000 a 31/1/2001. As informacoes foram obtidas por meio de entrevistas domiciliares e prontuarios hospitalares. Foi realizada analise hierarquizada em cinco blocos com caracteristicas: 1) socioeconomicas das familias e das maes; 2) psicossociais maternas; 3) biologicas e da historia reprodutiva materna; 4) do parto; 5) do recem-nascido. RESULTADOS: Os fatores de risco para a mortalidade neonatal precoce foram: Bloco 1: baixa escolaridade do chefe da familia (OR=1,6; IC 95%: 1,1;2,6); domicilio em favela (OR=2,0; IC 95%: 1,2;3,5), com ate um comodo (OR=2,2; IC 95%: 1,1;4,2); Bloco 2: maes com uniao recente (OR=2,0; IC 95%: 1,0;4,2) e sem companheiro (OR=1,8; IC 95%: 1,1;3,0), presenca de maus tratos (OR=2,7;1,1-6,5); Bloco 3: presenca de intercorrencia na gravidez (OR=8,2; IC 95%: 5,0;13,5), nascimento previo de baixo peso (OR=2,4; IC 95%: 1,2;4,5); pre-natal ausente (OR=16,1; IC 95%: 4,7;55,4) ou inadequado (OR=2,1; IC 95%: 2,0;3,5); Bloco 4: presenca de problemas no parto (OR=2,9; IC 95%: 1,4;5,1), maes que foram ao hospital de ambulância (OR=3,8; IC 95%: 1,4;10,7); Bloco 5: baixo peso ao nascer (OR=17,3; IC 95%: 8,4;35,6), nascimento de pre-termo (OR=8,8; IC 95%: 4,3;17,8). CONCLUSOES: Alem dos fatores proximais (baixo peso ao nascer, gestacoes de pre-termo, problemas no parto e intercorrencias durante a gestacao), identificou-se a participacao de variaveis que refletem exclusao social e de fatores psicossociais. Esse contexto pode afetar o desenvolvimento da gestacao e dificultar o acesso das mulheres aos servicos de saude. A assistencia pre-natal adequada poderia minimizar parte do efeito dessas variaveis.

Health effects of fine particulate air pollution: lines that connect

Abstract: Efforts to understand and mitigate the health effects of particulate matter (PM) air pollution have a rich and interesting history. This review focuses on six substantial lines of research that have been pursued since 1997 that have helped elucidate our understanding about the effects of PM on human health. There has been substantial progress in the evaluation of PM health effects at different time-scales of exposure and in the exploration of the shape of the concentration-response function. There has also been emerging evidence of PM-related cardiovascular health effects and growing knowledge regarding interconnected general pathophysiological pathways that link PM exposure with cardiopulmonary morbidity and mortality. Despite important gaps in scientific knowledge and continued reasons for some skepticism, a comprehensive evaluation of the research findings provides persuasive evidence that exposure to fine particulate air pollution has adverse effects on cardiopulmonary health. Although much of this research has been motivated by environmental public health policy, these results have important scientific, medical, and public health implications that are broader than debates over legally mandated air quality standards.