Showing papers in "Cadernos De Saude Publica in 2009"

Internações por condições sensíveis à atenção primária: a construção da lista brasileira como ferramenta para medir o desempenho do sistema de saúde (Projeto ICSAP - Brasil)

Abstract: Ambulatory care sensitive hospitalizations are a set of conditions for which access to effective primary care can reduce the likelihood of hospitalization. These hospitalizations have been used as an indicator of primary care performance in several countries and in three Brazilian states, but there is little consensus on which conditions should be included in this indicator. This paper presents a description of the steps undertaken to construct and validate a list for Brazil. The final list includes 20 groups of diagnostic conditions that represented 28.3% of a total of 2.8 million hospitalizations in the National Unified Health System in 2006. Gastroenteritis and complications, congestive heart failure, and asthma represented 44.1% of all ambulatory care sensitive hospitalizations. From 2000 to 2006, ambulatory care sensitive hospitalizations decreased by 15.8%, and this reduction was more significant than that observed in all other hospitalizations. The article concludes with potential applications and limitations of the proposed Brazilian list.

Inappropriate use of emergency services: a systematic review of prevalence and associated factors

Abstract: This systematic review aimed to measure the prevalence of inappropriate emergency department (ED) use by adults and associated factors. The review included 31 articles published in the last 12 years. Prevalence of inappropriate ED use varied from 20 to 40% and was associated with age and income. Female patients, those without co-morbidities, without a regular physician, without a regular source of care, and those not referred to the ED by a physician also showed more inappropriate ED use, with the relative risk varying from 1.12 to 2.42. Difficulties in accessing primary health care (difficulties in setting appointments, longer waiting periods, and short business hours at the primary health care service) were also associated with inappropriate ED use. Thus, primary care requires fully qualified patient reception and efficient triage to promptly attend cases that cannot wait. It is also necessary to orient the population on situations in which they should go to the ED and on the disadvantages of consulting the ED when the case is not really urgent.

Dengue: twenty-five years since reemergence in Brazil

Abstract: This article revisits the epidemiology of dengue in Brazil, 25 years after its reemergence in the country, discussing the main determinants and implications for its control. The authors emphasize the clinical and epidemiological peculiarities of this viral disease in Brazil, which leads the world in both the number of cases reported and risk of occurrence of the disease. The article presents the changes occurring in the dengue epidemiological pattern in recent years, like the sudden age shift in the incidence of dengue hemorrhagic fever, and discusses possible associated factors. The article focuses specifically on the epidemic in Rio de Janeiro in 2008, this episode's impact on the international community, and the fear that the disease could spread to Europe. The authors conclude that the current situation emphasizes the need for the international scientific community to renew its efforts to generate knowledge allowing improvement and progress in the development of new tools and strategies for dengue prevention.

Dengue in Southeast Asia: epidemiological characteristics and strategic challenges in disease prevention

Abstract: Dengue emerged as a public health burden in Southeast Asia during and following the Second World War and has become increasingly important, with progressively longer and more frequent cyclical epidemics of dengue fever/dengue hemorrhagic fever. Despite this trend, surveillance for this vector-borne viral disease remains largely passive in most Southeast Asian countries, without adequate laboratory support. We review here the factors that may have contributed to the changing epidemiology of dengue in Southeast Asia as well as challenges of disease prevention. We also discuss a regional approach to active dengue virus surveillance, focusing on urban areas where the viruses are maintained, which may be a solution to limited financial resources since most of the countries in the region have developing economies. A regional approach would also result in a greater likelihood of success in disease prevention since the large volume of human travel is a major factor contributing to the geographical spread of dengue viruses.

Revisão das dimensões de qualidade dos dados e métodos aplicados na avaliação dos sistemas de informação em saúde

Abstract: In Brazil, quality monitoring of data from the various health information systems does not follow a regular evaluation plan. This paper reviews quality evaluation initiatives related to the Brazilian information systems, identifying the selected quality dimensions and the method employed. The SciELO and LILACS databases were searched, as were the bibliographical references from articles identified in the search. 375 articles were initially identified, leaving a final total of 78 after exclusions. The four most frequent dimensions in articles totaled approximately 90% of the analyses. The studies prioritized certain quality dimensions: reliability, validity, coverage, and completeness. Half of the studies were limited to data from Rio de Janeiro and Sao Paulo. The limited number of studies on some systems and their unequal distribution between regions of the country hinder a comprehensive quality assessment of Brazil's health information systems. The importance of accurate information highlights the need to implement a data management policy for health information systems in Brazil.

['Judicialization' of public health policy for distribution of medicines].

Abstract: The supply of medicines in response to court orders or injunctions has become a common practice in the State of Sao Paulo, Brazil. This 'judicialization' of the health system clashes with basic principles of the Brazilian Unified National Health System (SUS), such as equal opportunity to access health services. The aim of this paper is to analyze the legal action used to obtain medicines through the Sao Paulo State Health Department, from two main angles: judicialization of public policies and breach of the equity principle. This is a descriptive study of legal action taken to obtain medicines through the Sao State Health Department, as listed in the Electronic Court Docket System for the year 2006. Most cases were filed through private attorneys; 47% of the patients had obtained their prescriptions through private care; and 73% of the cases involved patients from the three wealthiest areas in the city of Sao Paulo. The data demonstrate that such legal action violates key principles of the SUS such as equity, thereby privileging individuals with higher purchasing power and more access to information.

Prevalence of burnout syndrome in nursing staff in a large hospital in south of Brazil

Abstract: Burnout syndrome is a chronic adaptive disorder that affects workers and is characterized by three forms of psychological distress: emotional exhaustion, depersonalization, and a sense of low personal fulfillment. A cross-sectional quantitative design was used to apply questionnaires including socio-cultural data and the Maslach Burnout Inventory in 151 nurses and nurse technicians, representing 54.1% of this professional category in a large general hospital in Tubarao, Santa Catarina State, Brazil. Mean scores were: emotional exhaustion (17), depersonalization (7.79), and low personal fulfillment (36.6). According to the criterion proposed by Ramirez et al., no cases of burnout were diagnosed. According to the criteria by Grunfeld et al., 35.7% of the interviewees displayed burnout. The standard profile of workers with burnout identified in the study was: nurse technicians, female gender, age 26-35 years, married, with no children, and with five or more years in the profession. Hospital wards or areas with the highest proportion of nursing staff with burnout were the grouped hospital sectors (42.6%), ICU (25.9%), and neonatal ICU (18.5%). There was no statistically significant association between ward or hospital area and burnout.

Health related quality of life among the elderly: a population-based study using SF-36 survey

Abstract: As life expectancy continues to rise, one of the greatest challenges of public health is to improve the quality of later years of life. The aim of this present study was to analyze the quality of life profile of the elderly across different demographic and socioeconomic factors. A cross-sectional study was carried out in two stages, involving 1,958 individuals aged 60 years or more. Health related quality of life (HRQOL) was assessed using the SF-36 questionnaire. The lowest scores were found among measures for vitality, mental health and general health and the highest among factors including social functioning and role limitations due to emotional and physical factors. HRQOL was found to be worse among women, in individuals at advanced ages, those who practiced evangelical religions and those with lower levels of income and schooling. The greatest differences in SF-36 scores between the categories were observed in functional capacity and physical factors. The results suggest that healthcare programs for the elderly should take into account the multi-dimensionality of health and social inequalities so that interventions can target the most affected elements of HRQOL as well as the most vulnerable subgroups of the population.

Effect of psychological stress on blood pressure increase: a meta-analysis of cohort studies

Abstract: Studies have suggested that chronic exposure to stress may have an influence on increased blood pressure. A systematic review followed by a meta-analysis was conducted aiming to assess the effect of psychological stress on blood pressure increase. Research was mainly conducted in Ingenta, Psycinfo, PubMed, Scopus and Web of Science. Inclusion criteria were: published in any language; from January 1970 to December 2006; prospective cohort design; adults; main exposure psychological/emotional stress; outcome arterial hypertension or blood pressure increase > 3.5mmHg. A total of 2,043 studies were found, of which 110 were cohort studies. Of these, six were eligible and yielded 23 comparison groups and 34,556 subjects. Median follow-up time and loss to follow-up were 11.5 years and 21%. Results showed individuals who had stronger responses to stressor tasks were 21% more likely to develop blood pressure increase when compared to those with less strong responses (OR: 1.21; 95%CI: 1.14-1.28; p < 0.001). Although the magnitude of effect was relatively small, results suggest the relevance of the control of psychological stress to the non-therapeutic management of high blood pressure.

Reforma sanitária brasileira: contribuição para a compreensão e crítica

Abstract: Jairnilson Silva Paim e professor titular do Instituto de Saude Coletiva da Universidade Federal da Bahia. Os originais do livro foram recebidos pela Editora Fiocruz e aprovados em conselho editorial para publicacao.

Depression during pregnancy: prevalence and risk factors among women attending a public health clinic in Rio de Janeiro, Brazil

Abstract: Depression is the most prevalent psychiatric disorder during pregnancy and is associated with psychosocial and clinical obstetric factors. Despite being an important public health issue, there are few studies about this issue in Brazil. A cross-sectional study was carried out, involving 331 pregnant women attending a public primary health service over a one-year period in Rio de Janeiro city, Brazil. Participants were interviewed about their socio-demographic status, obstetric/medical conditions, life events and violence during pregnancy. Depression was assessed using the Composite International Development Interview. The prevalence of depression during pregnancy was 14.2% (95%CI: 10.7-18.5) and associated factors included: previous history of depression and any psychiatric treatment, unplanned pregnancy, serious physical illness and casual jobs. These data emphasize the need for screening for depression and its risk factors during pregnancy in settings where care is available. Psychosocial interventions and social policies need to be devised for this population.

Irregular water supply, household usage and dengue: a bio-social study in the Brazilian Northeast

Abstract: Despite increased vector control efforts, dengue fever remains endemic in Fortaleza, Northeast Brazil, where sporadic epidemic outbreaks have occurred since 1986. Multiple factors affect vector ecology such as social policy, migration, urbanization, city water supply, garbage disposal and housing conditions, as well as community level understanding of the disease and related practices. This descriptive study used a multi-disciplinary approach that bridged anthropology and entomology. A multiple case study design was adopted to include research in six study areas, defined as blocks. The water supply is irregular in households from both under-privileged and privileged areas, however, clear differences exist. In the more privileged blocks, several homes are not connected to the public water system, but have a well and pump system and therefore irregularity of supply does not affect them. In households from under-privileged blocks, where the water supply is irregular, the frequent use of water containers such as water tanks, cisterns, barrels and pots, creates environmental conditions with a greater number of breeding areas. In under-privileged homes, there are more possible breeding areas and environmental conditions that may improve the chances of Aedes aegypti survival.

Regular use of dental care services by adults: patterns of utilization and types of services

Abstract: O objetivo deste estudo foi avaliar o uso regular de servicos odontologicos entre adultos, identificando grupos nos quais esse comportamento e mais frequente. O estudo foi realizado em Pelotas, Rio Grande do Sul, Brasil, com desenho transversal de base populacional, envolvendo 2.961 individuos, que responderam um questionario estruturado. A prevalencia de uso regular encontrada foi de 32,8%. Estiveram positivamente associadas ao uso de forma regular as seguintes caracteristicas: ser do sexo feminino, ter idade < 60 anos, nao ter companheiro, ter alta escolaridade, ter maior nivel economico, usar servicos privados, ter autopercepcao de saude bucal boa/otima, nao ter autopercepcao de necessidade de tratamento, ter recebido orientacao sobre prevencao e ter manifestado opiniao favoravel ao profissional. O uso regular foi pouco frequente, especialmente entre os menos favorecidos (15%). Restringindo a analise apenas para usuarios do servico publico, observou-se maior utilizacao regular entre os mais escolarizados. Os servicos de saude, em especial o publico, devem trabalhar a fim de incrementar o uso regular e preventivo.

Factor structure and internal consistency of the Self-Reporting Questionnaire (SRQ-20) in an urban population

Abstract: This study focused on the psychometric properties of the Self-Reporting Questionnaire (SRQ-20) among workers, evaluating internal consistency criteria for the components scales and construct validity. Evaluation of the SRQ-20 performance used data from a cross-sectional study of a representative sample of workers from Feira de Santana, Bahia State, Brazil. The construct validity was estimated by means of an exploratory factor analysis of tetrachoric correlations and multiple correspondence analysis. The Kuder-Richardson formula (KD-20) was used to evaluate the instrument's internal consistency. Factor analysis of tetrachoric correlations revealed the extraction of four factors. Cumulative explanation of variance was 59.6%. Multiple correspondence analysis identified categories according to the groupings of variables comprising the questionnaire. Overall and standardized internal consistency coefficient was 0.80. The study indicated an acceptable performance by the SRQ-20 for evaluating common mental disorders, for use in mental health screening in the workplace.

Contexts of HIV vulnerability among Brazilian women

Abstract: This article aims to identify contexts of vulnerability related to HIV among Brazilian women. From November 2003 to December 2004, a cross-sectional study was conducted in 13 municipalities in the five Brazilian regions. The study included 1,777 women with a positive HIV diagnosis and 2,045 women attending public health care services. There were no significant differences between the two groups concerning number of sexual partners. However, HIV-positive women had a history of earlier sexual initiation and lower frequency of condom use. Higher proportions of HIV-positive women had used drugs, had a history of previous STDs, and had been victims of sexual violence some time in their life. The findings suggest the importance of considering strategies for HIV prevention focused on women's empowerment as a whole, and not focused only on their individual behaviors.

Objective and subjective factors related to self-rated oral health among the elderly

Abstract: The aim of this study was to investigate factors associated with negative self-rated oral health Elderly subjects from the Brazilian Ministry of Health's oral health survey (2002-2003) who rated their own oral health as bad or very bad were compared to those who rated their oral health as excellent, good, or fair, using prevalence ratios based on Poisson regression The minority (870; 17%) gave their own oral health a negative rating Negative self-rated oral health was less prevalent among those with 1-9 teeth and the edentulous, and more prevalent among blacks, mixed-race, and indigenous, those who had never used dental service, with soft tissue alterations, who reported little pain or medium to intense pain, rated their own appearance and chewing as fair or bad or very bad, reported that their oral health limited their social interaction a little or considerably, and reported needing dental treatment (PR = 1,47; 95%CI: 120-179) Despite their precarious oral conditions, the majority gave their oral health a positive rating Subjective conditions were more heavily associated with self-rated oral health than were objective conditions The findings suggest unequal oral health conditions and allow orienting public policies aimed at oral health and quality of life

[Research on abortion in Brazil: gaps and challenges for the public health field].

Abstract: This paper provides a review of abortion studies produced in the field of public health in Brazil, highlighting current research gaps and challenges. Most studies focus on women admitted to public hospitals for treatment of incomplete abortion, so their scope is limited to abortions presenting complications. Women's profiles, abortion methods, motives, and immediate consequences for women's physical health are also included. However, there remains a need for studies on the following aspects: measuring abortion incidence; investigating cases of post-abortion complications and death; analyzing the relationship between abortion and contraception; investigating the impact of abortion on women's mental health; and incorporating men's perspectives. There is an urgent need for evaluative research on abortion care in public services. Research results should be disseminated widely, so as to help overcome any ideological bias in the current debate on abortion rights in the country.

Dengue in the Americas: challenges for prevention and control

Abstract: Dengue is the most important vector-borne disease in the Americas and threatens the lifes of millions of people in developing countries. Imprecise morbidity and mortality statistics underestimate the magnitude of dengue as a regional health problem. As a result, it is considered a low priority by the health sector with no timely steps for effective control. Dengue is perceived as a problem of "others" (individually, collectively and institutionally), therefore responsibility for its control is passed on to others (neighbors, the community, municipality, health institutions, or other governmental agencies). With no precise risk indicators available there is little opportunity for timely diagnoses, treatment, health interventions or vector control (poor surveillance). Solutions only targeting the vector reduce the impact of interventions and there is no sustainable control. Without political commitment there are insufficient resources to face the problem. This paper discusses the challenges for prevention and control in the Americas.

Culto ao corpo e uso de anabolizantes entre praticantes de musculação

Abstract: O objetivo do estudo foi investigar as motivacoes para a pratica da musculacao e uso de anabolizantes, assim como as representacoes e usos sociais do corpo entre usuarios de anabolizantes praticantes de musculacao. Foi realizado um estudo etnografico com observacao participante em academias de musculacao de bairros de classe media e classes populares de Salvador, Bahia, Brasil, e realizacao de 43 entrevistas em profundidade com usuarios de anabolizantes. A pratica da musculacao e o uso de anabolizantes, tanto entre usuarios de classe media quanto populares, sao motivados sobretudo por razoes esteticas. A insatisfacao com corpo real em comparacao ao padrao ideal disseminado pela midia, o receio de ser desvalorizado ou excluido do grupo de pares, o capital simbolico associado ao corpo "trabalhado" e o imediatismo na obtencao dos resultados favorecem o uso de anabolizantes. Faz-se necessaria a realizacao de campanhas de prevencao voltadas para os jovens que aliem a visao critica na desconstrucao dos valores associados ao corpo na sociedade de consumo a veiculacao de informacao de qualidade sobre os riscos a saude no consumo de anabolizantes.

The spatial distribution of Aedes aegypti and Aedes albopictus in a transition zone, Rio de Janeiro, Brazil

Abstract: Dengue fever has become the most important vector-borne viral disease in Brazil. Human facilitated transport of desiccation-resistant eggs has led to its two most important vectors, Aedes aegypti and Ae. albopictus, becoming widespread. In this paper, we report seasonal and spatial variation in larval abundances of Ae. aegypti and Ae. albopictus across a small-scale transition zone between an urban area and an urban wooded/forested area within Rio de Janeiro, Brazil. We installed 400 ovitraps across 10 sites with different human population densities and vegetation coverage. Eggs and larvae were collected for three weeks during the wet and dry seasons of 2002 and 2003. Ae. albopictus was predominantly found in the forested areas of the study site whereas in the urbanized area Ae. aegypti was more abundant. Both species peaked during the wet season. This distribution pattern, which may reflect adult flight range, may favor the co-occurrence of larvae of these species in a small-scale urban/urban forest transition zone.

Analysis of the prevalence of and factors associated with urinary incontinence among elderly people in the Municipality of São Paulo, Brazil: SABE Study (Health, Wellbeing and Aging)

Abstract: To investigate the prevalence of urinary incontinence among elderly people living in Sao Paulo, Brazil and their associated risk factors. The Pan-American Health Organization and World Health Organization coordinated a multicenter study named Health, Wellbeing and Aging (SABE Study) in elderly people (over 60 years old) living in seven countries in Latin America and the Caribbean. In Brazil, the study was carried out in Sao Paulo in the year 2000. The total Brazilian sample included 2,143 people. The prevalence of self reported urinary incontinence was 11.8% among men and 26.2% for women. It was verified that among those reporting urinary incontinence, 37% also reported stroke and 34% depression. It was found that the greater the dependence that the elderly people presented, the greater the prevalence of urinary incontinence. The associated factors found were depression (odds ratio = 2.49), female (2.42), advanced age (2.35), important functional limitation (2.01). Urinary incontinence is a highly prevalent symptom among the elderly population of the municipality of Sao Paulo, especially among women. The adoption of preventive measures can reduce the negative effects of urinary incontinence.

Gender and incidence of functional disability in the elderly: a systematic review

Abstract: This systematic review aimed to assess the effect of gender on the incidence of functional disability in the elderly. The search for publications in the MEDLINE, EMBASE, and ProQuest electronic databases from January 1990 to March 2008 identified 879 publications, from which 21 cohort studies were selected that evaluated gender as an independent variable and incidence of functional disability in elderly as the outcome. Review of the studies found that after adjusting for socioeconomic, health, and social relations indicators, incidence of functional disability was similar between genders. The main risk factors for functional disability in the elderly, regardless of gender, were: lack of schooling, living in rental housing, chronic diseases, arthritis, diabetes, visual impairment, body mass index above 25, poor self-perceived health, cognitive impairment, depression, slow gait, sedentary lifestyle, tiredness while performing daily activities, and limited diversity in social relations.

Visita domiciliar no âmbito da Estratégia Saúde da Família: percepções de usuários no Município de Fortaleza, Ceará, Brasil

Abstract: Home visits have become increasingly widespread in Brazil since the emergence of the Family Health Program. The present study deals with users' perceptions of these visits, focusing on comprehensiveness and humanization of care. The study was exploratory and qualitative. Twenty-one interviews were performed with users from the six administrative health districts of Fortaleza, capital of Ceara State, Brazil. Analysis of the interviews revealed the existence of three core themes: (1) health professional-user relationships, i.e. users' perceptions of completeness and humanization of care during visits; (2) characterization of visits, with emphasis on operational aspects; and (3) user-health facility interaction, focusing on integration with other service. This theme was divided into three items: health facility management, equity, and integration of care. In conclusion, the study suggests that home visiting practices can be improved by enhancing the aspects of intersubjectivity, dialogue, and negotiation between health professionals, users, and the community.

Adverse drug events in hospitals: a systematic review

Abstract: The objective of this study was to evaluate studies on the occurrence of adverse drug events (ADEs) in hospitals in order to learn about their frequency and characteristics, comparing the methods for identifying them and the various definitions. A search was conducted on MEDLINE and identified studies published from 2000 to 2009. Inclusion criteria were: studies in populations not selected for specific diseases or drugs and ADEs that occurred during hospitalization. Twenty-nine studies were selected, displaying multiple sources of heterogeneity, including differences in the study populations, surveillance techniques, definitions of ADEs, and indicators. The proportion of patients with ADEs ranged from 1.6% to 41.4% of inpatients and the rates ranged from 1.7 to 51.8 events/100 admissions. A considerable share of these events could have been avoided. The findings show that ADEs in inpatients are a public health problem. However, further studies are needed to monitor these adverse events in order to effectively promote safe drug use.

Interventions to solve overcrowding in hospital emergency services: a systematic review.

Abstract: This review discusses interventions aimed at solving the problem of overcrowding in hospital emergency services (HES), characteristic of low organizational effectiveness. In free-access and restricted-access databases, the target descriptors were "overcrowding; emergency; medicine; first aid". The survey identified 66 citations of interventions, grouped in 47 related interventions. The majority of the studies used observational designs that evaluated the results before and after interventions. Of the 47 related interventions, 34 had results for organizational performance. Four were the most frequently cited: implementation of an observation unit for patients already hospitalized and awaiting diagnosis or clinical stabilization; designation of a dedicated nursing station for the patient's admission, discharge, or transfer; establishment of protocols with indicators of operational saturation and implementation of an emergency care unit. Analyzing 21 interventions that were intended to solve overcrowding in HES and with positive results for length-of-stay, 15 were related to patient stream improvement, interfering actively and positively in patient stream. Interventions that increased access barriers or that merely improved the HES structure were ineffective.

Factors associated with the incidence of urban visceral leishmaniasis: an ecological study in Teresina, Piauí State, Brazil

Abstract: The objective of this study was to identify socioeconomic and environmental factors associated with the incidence of visceral leishmaniasis in the city of Teresina, Piaui State, Brazil. This was an ecological study based on 1,744 cases reported from 1991 to 2000, and the city's neighborhoods served as the unit of analysis. Mean annual incidence rates were related to socioeconomic and demographic indicators and a vegetation index derived from remote sensing images by means of spatial multiple linear regression models. The neighborhoods with the highest incidence rates were mostly located in the city's peripheral areas. Multivariate analysis identified an interaction between population growth and the vegetation index, so that areas with high population growth and abundant vegetation showed the highest incidence rates. The percentage of households with piped water was inversely associated with visceral leishmaniasis incidence. Spatial distribution of visceral leishmaniasis in Teresina during the 1990s was heterogeneous, and incidence of the disease was associated with the peripheral neighborhoods with the heaviest vegetation cover, subject to rapid occupation and lack of adequate sanitation infrastructure.

Factors associated with overweight and abdominal fat in adults in Salvador, Bahia State, Brazil

Abstract: O objetivo foi identificar os fatores associados ao excesso de peso e concentracao de gordura abdominal em adultos de ambos os sexos. Um estudo transversal envolvendo amostra representativa de 570 adultos de Salvador, Bahia, Brasil. A regressao de Poisson foi utilizada na analise, adotando-se o indice de massa corporal (IMC) e a circunferencia da cintura como variaveis dependentes. Para as mulheres, a inadequacao do IMC e da circunferencia da cintura ocorreu com o aumento da idade e entre as que faziam dieta no momento do estudo, a historia familiar de obesidade associou-se apenas com o IMC elevado. Para os homens, o IMC elevou-se na faixa etaria de 30 a 39 e 50 a 59 anos. A circunferencia da cintura elevou-se com a realizacao de tres ou menos refeicoes-dia, com a hipertensao arterial, uso de bebida alcoolica e diminuiu entre mulatos e negros. Tanto IMC quanto circunferencia da cintura elevaram-se com a historia familiar de infarto. Portanto sao distintos os fatores que se associam ao excesso de peso e da gordura abdominal em homens e mulheres. Mas muitos deles podem ser modificados com a adocao do estilo de vida saudavel.

Physical activity in Brazil: a systematic review

Abstract: The purpose of this study, based on a systematic literature review, was to describe the prevalence of physical activity (or inactivity) in the Brazilian population. The databases consulted were: LILACS, SciELO, MEDLINE, Web of Science, and the Google Scholar portal. The terms "physical activity", "physical exercise", "physical inactivity", "sedentary" "Brazil", and "Brazilian" were used in the search. Overall, 47 studies (all cross-sectional) with random samples were found, and in 26 studies physical activity was the main variable. Only two studies were published before the year 2000, as compared to 12 in 2008 alone. The studies were heavily concentrated in the South and Southeast of Brazil, and there were few studies on physical activity in children and adolescents. In all the studies, physical activity was measured subjectively, mainly with questionnaires, and the most widely studied domain was leisure time. The criteria for defining physical activity varied widely, as did prevalence. The study highlighted the need for standardization of instruments, criteria, and nomenclature in epidemiological studies on physical activity.

Cobertura do teste de Papanicolaou e fatores associados à não-realização: um olhar sobre o Programa de Prevenção do Câncer do Colo do Útero em Pernambuco, Brasil

Abstract: This research aimed to assess coverage of Pap smear screening in the State of Pernambuco, Brazil, during the three years prior to the study, among women 18 to 69 years of age, and to identify factors associated with women's lack of participation in screening. This was a cross-sectional, population-based study, using data from a survey in 2005-2006 with 640 women, selected by three-stage cluster sampling. Information on 258 women was analyzed. Pap smear coverage was 58.7% for women 18 to 69 years of age and 66.2% for those 25 to 59. Single marital status, no history of childbirth, and not having consulted a physician in the previous year were associated with lack of Pap smear screening. In the multivariate analysis, low schooling also showed a significant effect. Pap smear coverage in Pernambuco was satisfactory, but insufficient to impact the epidemiological profile of cervical cancer. It is necessary to strengthen and upgrade health promotion activities in order to reduce the inequalities and encourage women's active participation in cervical cancer prevention.

[Prevalence of metabolic syndrome in adolescents: a systematic review].

Abstract: The present study aimed to review the literature on the prevalence of metabolic syndrome and its components in adolescents (10-19 years old). The search was conducted in online databases (MEDLINE and SciELO), references from retrieved articles, and contacts with authors. Only original articles using either the criteria of the World Health Organization (WHO) or the National Cholesterol Education Program's Adult Treatment Panel III (NCEP ATP-III) were considered. Sixteen studies met the inclusion criteria. Eight studies were undertaken in low to medium-income countries, but none of them in Brazil. Prevalence of metabolic syndrome in studies using the NCEP-ATP III criteria ranged from 4.2% to 15.4%. Prevalence in studies using the WHO criteria was slightly higher: 4.5% to 38.7%. High triglyceride level was the most frequent component of the metabolic syndrome, with prevalence ranging from 4.9% to 75.0%, while high blood glucose showed the lowest prevalence. In conclusion, although there are few available studies, metabolic syndrome in adolescents is a highly prevalent health issue. The exact prevalence of metabolic syndrome in Brazilian adolescents is unknown.